Sending contraceptives through the mail seems like a remnant of the early 20th century when methods of preventing pregnancy and sexually transmitted diseases were largely relegated to legally-murky backchannels. But 86 years after Margaret Sanger’s shipment of diaphragms to a New York City doctor was confiscated, students at Catholic universities are using anonymous texting services and covertly mailed packages to circumvent their schools’ restrictions on sexual health products.

Colleges and universities provide health care and insurance to millions of young American students, but these health plans often do not adequately cover sexual health resources or services such as condoms and birth control. In addition to preventing pregnancy and disease, contraception has other, equally important applications. Women who suffer from endometriosis use hormonal birth control to control painful periods and prevent infertility. Hormonal birth control is also used to treat polycystic ovary Syndrome, primary ovarian insufficiency and acne.

With over 19 million students enrolled in higher education institutions, campus health centers and insurance plans are essential to the conversation surrounding their health care. By denying students access to contraceptives, Catholic universities make it difficult for students with medical conditions to receive care while also withholding the resources and tools that would encourage students to be safe during sexual activity.  

Health care payers in academia and the private sector refused to cover contraceptive care on religious grounds. Hobby Lobby Stores, Inc., for example, successfully challenged the requirement that it cover contraception for employees under the Affordable Care Act before the Supreme Court on the grounds of its management’s religious objections. The larger tension evident in Burwell v. Hobby Lobby Stores, Inc. — between the religious freedom of institutions and the right of Americans to have reproductive care covered by their insurance — also manifests itself in certain religious-affiliated college health care systems, particularly at Catholic universities.  

While not all students use their school’s health insurance, many, if not most, students use university health centers. At public universities, contraceptives are generally available at these university-run clinics. At colleges and universities with religious affiliations, this is often not the case. Some schools’ health centers, such as those at Fordham University and Georgetown University, only prescribe hormonal birth control for non-contraceptive uses. While controversial, providing contraceptives at Catholic universities isn’t entirely without precedent. The University of Notre Dame, for example, recently began allowing its health center to prescribe hormonal contraceptives for the purpose of preventing pregnancy despite a federal court ruling allowing it to be exempt from a U.S. Department of Health and Human Services mandate to supply contraception.

What happens when university health systems refuse to provide contraceptives or sexual health information — services that college students both want and need? At Boston College — a Jesuit institution in the leafy Boston suburb of Chestnut Hill, Mass. — friction has been growing between students and administrators over sexual health resources. This protracted enmity illustrates the tension between what providers want to offer and what Americans need — reflecting a bitter division that exists across the United States.  

Boston College’s University Health Services does not provide contraceptives since premarital sex is against the institution’s rules. Boston College’s Code of Student Conduct states that “incidents of sexual intercourse outside the bonds of matrimony may be referred to the Student Conduct System.” While this policy is not strictly enforced, its presence in the Code of Conduct is symbolic, demonstrating just how deeply Catholic beliefs about sexuality are embedded in the established principles of Boston College.

It seems unlikely that all students follow this policy, an assumption supported in a study conducted by Boston College alum Connor Kratz. He found that in 2018, 79.9 percent of students reported being sexually active during their tenure at the school.

Boston College Students for Sexual Health was founded in 2009 by Boston College students. After 89 percent of voting students approved a referendum asking for improved access to contraceptives and sexual health information, SSH was established to construct a peer-to-peer network countering the administration’s refusal to take action. Notably, the group changed their name to Students for Sexual Health, excising their explicit affiliation with Boston College when the college’s administration threatened them with disciplinary action.  

SSH has faced significant opposition in their quest to provide condoms and other contraceptive devices to students, despite a 2018 non-binding referendum which found 94 percent of students in favor of accessible contraception. Furthermore, SSH initially ran so-called “safe sites” — places where students could obtain condoms and information — out of their dorm rooms until Boston College threatened disciplinary action. Now, SSH is turning to the postal service to distribute condoms.

Boston College junior Esteban Coellar, SSH acting president, said the group’s practice of mailing condoms to students is federally protected.

The Comstock Law, under which Margaret Sanger’s package was confiscated in 1932, prohibited the distribution of “obscene” materials such as condoms and sexual health information. A series of Supreme Court cases eventually found the law and others like it unconstitutional. This loophole is grudgingly accepted by the Boston College administration, though SSH hopes that one day these secretive and mecumbersome methods will not be necessary.

“Ultimately, our goal is to get to a place where University Health Services offers sexual health resources,” Coellar said. This year, they’re starting small and specific. “We’re trying to get UHS to provide Plan B to sexual assault victims.”   

Students at Vincentian-founded DePaul University — a Catholic institution in Chicago — are using similar methods.

DePaul University senior Jenni Holtz is the co-founder of Students for Reproductive Justice, a student-run organization promoting sexual health at DePaul and in the Chicago community. They said grassroots efforts are important when students are asking for changes in the administration.

SRJ recently began running TxtJane, a confidential delivery service that began at Loyola University Chicago. Students can text a designated number and a member of SRJ will personally deliver contraceptives or pregnancy tests to a specified location. TxtJane was inspired by the Jane Collective, a clandestine network of women who provided abortions in Chicago during the four years prior to the Roe v. Wade decision.

“What’s important to us is to get resources to students even when the administration refuses to protect their students,” Holtz said. “Our efforts are also showing students what the university is not providing to them, so they can share in our anger and get involved in calling out the administration for their lack of care for students. We have been able to get resources to students without help from the university and we will continue to do so until DePaul does it.”

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