In 2013, a federal judge struck down the age limits on the morning-after pill, ordering that it be available over the counter for women of all ages, instead of just for those 17 and up. However, access to emergency contraception has remained a large issue and recently, college students have turned to vending machines for an answer.
Grace Cheung ’20, along with members of the Reproductive Justice Action League at Yale, is spearheading an effort to install vending machines on Yale’s campus that will offer a variety of health products, including emergency contraception, condoms, UTI medication, and allergy medication. The goal is to have one vending machine in every residential college.
Emergency contraception, commonly referred to as “the morning after pill,” is a type of birth control that prevents pregnancy after sex. It can be taken up to five days after sex, but its effectiveness decreases each day. Plan B is the most widely recognized form of emergency contraception, but it is also sold in a generic form called My Way.
Given the pervasive hookup culture on college campuses, the demand for emergency contraception has increased among students. According to a study, 59.3 percent of students across the country engage in sexual activity at least once a week and 31.6 percent have many sex partners. A 2016 survey at Harvard College showed that only 59 percent of students are “mostly” or “always” using protection during sex.
Currently, the Yale Health Center Pharmacy offers students My Way for free, as it is covered under Yale Basic Coverage health insurance plan. However, the Pharmacy has limited hours, as it is only open until 6:30 pm on weekdays and until 3:30 pm on Saturdays. Emergency contraception can also be purchased from Amazon, but the shipping delays make this outlet impractical. The last option is for students to look on the shelves of local pharmacies—at least theoretically. However, Kelly Cleland, a public health expert at Princeton University, describes the results of a recent nationwide survey of pharmacies in an interview with The Politic. “In many stores, emergency contraception is not on the shelves because the pharmacy refuses to stock it on the shelves. That can be because they object to it or because they are concerned about theft, since emergency contraception is quite expensive.” The price of emergency contraception can range from $35 to $60, which can be prohibitive for many college students.
According Cleland, another challenge with obtaining emergency contraception from pharmacies is sometimes “the boxes will behind the counter because [the pharmacies] still think that there is an age restriction or ID requirement.”
The vending machine that Cheung and the group is advocating for not only provides a more convenient solution, but also a more private one as well, so students who want to purchase emergency contraception can do so without fear of judgement. In an interview with The Politic, Cheung explained, “I’ve had friends who have gone to local pharmacies where cashiers have said ‘what’s that?’ or ‘are you sure you need this?’”
Cheung also mentioned that the price of the products in the vending machine will be subsidized and provided at a discount for students.
Ultimately, Cheung’s goal is to “provide options for students and making sure that the most comfortable route is available for everyone.”
Yale is not the only university to advocate for the placement of emergency contraception vending machines on campus. Cheung says that she was inspired by similar initiatives taken at other campuses, including an effort by Rachel Samuels, an undergraduate student at Stanford.
Samuels explained the lack of access to emergency contraception that Stanford students faced on campus in an interview with The Politic. “The health center did give Plan B, but it closed after business hours and when someone needs Plan B, it won’t be on a Tuesday morning,” she said. Seeing the challenge and getting advice from her older brother, who had installed a similar vending machine at Pomona University, Samuels sent out a survey to gauge interest in the project. After getting over 300 responses in one week with overwhelming support, she knew that she had to continue with the project. The vending machine was finally placed in a single-stall gender neutral restroom in the Student Union after Samuels had already graduated.
For Samuels, the vending machine is more than just a convenient fix for accidents, it’s also a crucial solution for victims of sexual assault. She recounts the experience of her friend, who, after being sexually assaulted, drove 30 minutes to another city to get emergency contraception because the university health center was closed and because she didn’t want to endure the judgement of the staff at the local pharmacy. “When someone’s just been assaulted, getting emergency contraception is the last thing they want to worry about,” she said. Samuels explained that with the vending machine, a victim can take care of this one concern and then take other actions in response.
While advocating for the installation of the vending machine, Samuels was surprised to uncover all the misconceptions and stigmas that still surround emergency contraception. Some of the confusion was about the law. Even after conversations with the pharmaceutical board, the health center director at Stanford believed that it was illegal to sell Plan-B to 18-year-olds. Others were confused by the science of the pill. Samuels noted articles that called her project an “abortion vending machine.”
Cheung has observed the same mix-up of the two medications. “A lot of people have thought that emergency contraception was an abortion pill, which is a common misconception. Emergency contraception just stops implantation of the embryo, rather than ending the survival of an already existing embryo.”
Another stigma relates to the way that society views users of emergency contraception, as Sarah Croucher, the Executive Director of NARAL Pro-Choice Connecticut, said in an interview with The Politic. “I think there are so many things that are stigmatized around birth control, abortion, and reproductive health in general. But I think that the morning-after pill is especially associated with someone who is sexually loose or sexually promiscuous,” she said.
This viewpoint on the users of emergency contraception is indicative of the wider controversy over the effect of emergency contraception effect on sexual behavior and culture.
In an interview with The Politic, John Jansen, a representative from the Pro-Life Action League, says that the vending machines will “exacerbate the already toxic culture” present on college campuses and lead to higher incidents of risky sexual behavior and sexual assault. He continues, “As a parent, I think it’s frightening when looking at the casual sexual environment on college campuses.”
Jansen referenced the results of a 2013 research paper published in the Journal of Policy Analysis and Management, which found that “increased access to emergency contraception has not had an effect on unintended contraception rates or abortion rates.”
Another 2012 paper published in Economic Inquiry found that changes to county-level access to emergency contraception in Washington State led to a statistically significant increase in STD rates, both overall and for females.
A subsequent study published in the Health Services Research journal corroborated the finding that on a state-level, increased access to emergency contraception led to an increase in STI risks for females. However, it notably also found that this correlation was not present on a national level. In fact, researchers discovered a decrease in the probability of sexual activity and multiple partnerships in response to increased access.
Cheung disputes that the vending machines will encourage increased risky sexual behavior on campus. “Emergency contraception isn’t something seen by everyone as a first option.” She lists several non-minor side effects of the pill, including prolonged menstrual bleeding, hormonal reactions, and minor weight gain. In order to make sure that all users are aware about these side effects of emergency contraception, Cheung says that she will place informational pamphlets next to the vending machine.
Samuels dismisses all of the controversy, as she simply sees the vending machines as a tool to promote student health. “I would love for contraception to be an open topic, where everyone feels comfortable talking about it, but at this point it’s just better for students to have a way to take care of themselves without having to talk to someone else if they aren’t mentally in that space to do so.”