Why It’s Nearly Impossible to Get Birth Control on Some College Campuses
Published on Oct 9, 2024 at 2:30 PM
For many college freshmen, the fall semester marks not only their first time being away from home, but also the first time managing their own healthcare, including sexual wellness essentials such as condoms, birth control, and pregnancy tests. Eighty-one percent of sexually active college students report using one or more birth control methods to prevent pregnancy, and for other necessary health reasons like managing PCOS or painful periods, according to the American College Health Association. But actually getting their hands on contraception is challenging for many of them, particularly since the overturn of Roe v. Wade in 2022. According to a study recently published in Frontiers in Public Health, university students expressed fears about being able to access contraception post–Dobbs vs. Jackson, as well as a desire to use long-acting, effective birth control methods. That same research also underscored the necessity of birth control access for college students due to their increased risk of sexual assault.
There are some logistics that influence how difficult it may be to get birth control in a college health center or at an off-campus supermarket or pharmacy. For instance, many religious-affiliated schools are not obligated to cover contraception as part of student or employee healthcare plans, thanks to a 2020 Supreme Court Ruling. These private religious schools often do not let sexual health organizations distribute information or resources on campus without sponsorship from a student-run club, which is rare, says Sophia Yen, MD, MPH, an adolescent medicine specialist and founder of the telehealth and birth control delivery service Pandia Health.
In addition, contraceptive deserts — counties that lack health centers with access to a full range of birth control methods — tend to exist in areas where there are abortion bans. They’re particularly common in areas where Historically Black Colleges and Universities, HBCUs, are located, according to the organization Power to Decide. Some students who spoke with PS report having to drive almost 40 minutes to their nearest pharmacy to pick up over-the-counter contraception or a prescription.
In short, many students are responsible for procuring their own contraception, packing the pill and condoms along with their XL twin sheets and shower caddies. Ahead, more on the challenges these young people face when trying to get their hands on birth control, why it’s so difficult, and what can be done about it.
Why Is It So Hard to Get Birth Control on Campus?
Access to contraception is often more challenging in states and geographic areas where reproductive rights are generally lacking. Kim*, a recent graduate of Northwest Missouri State University, grew up in the Bible Belt of Missouri (where abortion is currently banned) and says that college was the first time she had access to resources about sexual education and reproductive options. Previously, she did not have discussion or enough knowledge around sexual education and reproductive health — and for that reason advocates for the continued availability of over-the-counter contraception in order for students to have as much agency in their reproductive decisions as possible.
But in June 2022, when Roe v. Wade was overturned, those reproductive decisions became limited as the right to access abortion legally was stripped away in many states. The lack of available reproductive health services in abortion ban states has also made birth control access more difficult. Statistics show that there was a 4.1% drop in birth control prescriptions in those restrictive states, and a 65% drop in emergency contraception by mid to late 2023. On top of that, 5% of reproductive health clinics in the U.S., which offered a variety of services beyond just abortion care, shut down between 2022 and 2024, because of legal restrictions on abortions and too much financial strain to stay open.
“This is especially apparent in Tuskegee, located in Macon County, which is considered a contraceptive desert,” Haleigh*, a student at the HBCU Tuskegee University in Alabama (a total abortion ban state), and campus ambassador with Power to Decide, tells PS. “In this region, almost half of women aged 13 to 44 are in need of publicly funded contraceptive services, but have limited access to clinics that provide a full spectrum of birth control methods.”
Students in the area face their own unique challenges. Haleigh explains that the student health center at Tuskegee has limited hours and long wait times, making access to urgent services like emergency contraception difficult. She adds that there’s only one nearby pharmacy. If that pharmacy is out of emergency or over-the-counter contraception, such as Opill, students will have to drive to neighboring cities Opelika, Auburn, or Montgomery, all of which are 25 to 40 minutes away — that is, if they have a car.
Historically Black colleges are even more disadvantaged when it comes to reproductive healthcare. Many HBCUs are located in Southern states such as Mississippi, Alabama, and Louisiana; these areas are both contraceptive deserts and are facing critical shortages of ob-gyns and reproductive care, according to a report from the American Association of Medical Colleges. Many of these abortion ban states don’t mandate comprehensive sexual education, which can negatively impact students’ health and mental well-being, Haleigh points out.
Even at HBCUs located in areas that do protect abortion and other reproductive rights, getting birth control may mean trekking far off-campus. For example, at the University of the Virgin Islands St. Croix campus, there isn’t a CVS or Target within walking distance of the school, notes Kurvonte*, a student at the school. Which brings up another logistical barrier students face when accessing contraception off campus: pharmacies are not always located near college campuses or stocked with enough contraception.
Areas without access to nearby pharmacies that can adequately serve residents are known as “pharmacy deserts” and people in marginalized and Black communities are the most affected, according to 2022 research.
Ayah*, a student at the University of Colorado Boulder, shares her experience: “Students at my school often face significant delays in obtaining their birth control prescriptions, typically waiting several hours due to Boulder’s overpopulation and the resulting long lines at pharmacies,” she tells PS. “Consequently, the morning-after pill is frequently used, especially since many young people don’t utilize other options. However, the high demand often leads to pharmacies running out of emergency contraception,” she adds.
Online and Over-the-Counter Contraceptives Help — But Not Enough
A 2024 survey by telehealth company Hers found that 71 percent of college students turn to telehealth, often for birth control and other sexual health services.
Telehealth is essential at schools like Bucknell University in Lewisburg, Pennsylvania, where the closest retail stores are 20 minutes away by car and not walkable from campus. Not only are pharmacies tricky to get to, but students may also not have an ob-gyn nearby — especially in the aforementioned Southern states — further limiting students’ ability to, say, get a prescription for birth control pills or get an IUD inserted, says Dr. Yen.
Many students rely on online delivery services for prescriptions, adds Ayah from University of Colorado Boulder. However, telehealth restrictions pose yet another roadblock. Pandia Health, which can ship up to a year’s supply of birth control, for instance, can deliver birth control prescription refills to all 50 states, but can only prescribe new birth control in 15 states (including Colorado), Dr. Yen explains. For a list of other online birth control providers and the states they serve, check out Freethepill.org.
Students who live in low-access areas may be increasingly turning to Opill, the newly FDA-approved over-the-counter birth control that can be purchased in the family planning aisle of pharmacies or ordered online from retailers, including Amazon. But Opill comes with some downsides. The progestin-only pill only works if you take it within three hours of your birth control alarm going off, Dr. Yen points out. Take it outside that window just one time and you’re at risk of getting pregnant, and must use a backup contraceptive method, she says. What’s more, 14% of people—that’s 1.5 million birth control users—take hormonal contraception like birth control pills for reasons other than pregnancy prevention, and Opill may not help certain symptoms associated with menstrual cramps, irregular periods, or acne.
Some Schools Over-Rely On Emergency Contraception
Rather than being proactive and making sure students have regular access to contraception, some universities tend to focus on the “emergency” aspect of conversation. Jenna*, a student at Montana State University, says her school is more focused on morning-after care. When a sexual assault on campus has been reported, the university sends out campus-wide emails to share resources with students so that they can access aftercare including support and emergency contraception. Access to a consultation for non-emergency contraception on campus and daily birth control requires paying a few hundred dollars in student health fees, Jenna says.
Other universities, such as Bucknell, have a policy that requires students to get a consultation in order to access emergency contraception, which could just as easily be dispensed in a vending machine. “This heavily dissuades students from using this resource,” says Annie*, a Bucknell student and impact and innovation intern at the emergency contraception brand Julie. Prerequisite consultations may also give students the impression that anonymity isn’t protected, and/or dissuade them from reporting sexual assault.
Students who want to avoid the consultation may buy emergency contraception elsewhere, but are often stymied by the cost, Annie adds. She notes that Bucknell’s administration has started listening to students demanding that the mandatory consultation be eliminated, and is increasing availability to emergency contraception on campus.
How Can Colleges and Universities Improve Access to Birth Control?
Simply put: instead of making only emergency contraception available, over-the-counter birth control should be easily accessible on campus in health centers or via student groups, Jenna from Montana State University says. If colleges support these types of organizations with adequate funding and publicity, they’ll be able to reach even more students.
Increasing incoming and current students’ awareness of telehealth and mail-order options for birth control could also help young adults going to school in contraceptive or pharmacy deserts.
Finally, campuses also need to further invest in and underscore the importance of general reproductive health education. Just like colleges and universities often require students to complete an alcohol.edu curriculum before starting school, online or in-person sexual and reproductive health education courses should also be a prerequisite, Dr. Yen suggests.
How Can Students Stay Prepared and Protected?
Until things change, it may be helpful to research what birth control options are available to you outside of campus. This includes looking into the OTC Opill, picking up several months’-worth of your usual prescription option before heading back to school after Fall or winter break, or considering a more long-term option, such as an IUD or birth control implant.
Once on campus, it may benefit you to familiarize yourself with the student health center, their offerings, and capability to fulfill prescriptions, as well as how and when you can pick up emergency contraception. (FYI, these are also good questions to ask when touring a college.) It’s also worth scouting out any nearby pharmacies and how easy they are to get to, or if they deliver. This way, you’ll know where and how to access birth control and understand all of your options, before you need them.