At least getting protected isn’t the hard part.
While college is a time when many students choose to explore their sexual freedom, universities such as Michigan have been on the frontline of advancing sexual health and contraception education.
Prescription contraception was first introduced in the United States in the early ’60s. While certain progressive states allowed unmarried women under the age of 21 to seek prescriptions, others did not. University alum Brad Hershbein, an economist at the W.E. Upjohn Institute, co-authored an academic paper titled “The Opt-In Revolution? Contraception and the Gender Gap in Wages” and found that women who had access to contraception when it was first introduced often had a different life path than those who did not.
“They were more likely to enroll in college, more likely to get a degree, more likely to get job training when they actually did enter the workforce,” Hershbein said.
Women at the University of Michigan use contraception at a higher rate than average when compared to U.S. universities, according to the National College Health Assessment survey administered at the University in 2010. Through his research, Hershbein concluded that contraception usage increases with education. Approximately 50 percent of college women nationally are on birth control at any given time, and consume contraception at twice the rate of those not in college before their 40s, he said.
Gwendolyn Chivers, director of University Health Service’s ancillary services, said it is generally a student’s personal preference where they chose to purchase their prescription contraception. While the UHS pharmacy offers some forms of contraception at lower prices than other pharmacies, merchandise stores — such as pharmacies inside grocery stores — offer certain brands at a less expensive price.
“We make the effort to make sure that we are in line with as many prescription insurance (plans) as we can be with so that we can service our students,” Chivers said, adding that approximately 80 percent of women on campus who purchased birth control had prescriptions covered by health insurance even prior to the Affordable Care Act.
“Today a lot of birth control is purchased with health insurance so you don’t have to be concerned of the cost that you used to have to be worried about,” she noted. “Some prescription insurance carries birth control at zero copay, and that is all because of the Affordable Care Act.”
A place on campus
Located on the third floor of the UHS building, the Women’s Clinic works with enrolled students to provide contraceptive counseling and prescriptions. Many of their services are covered by the mandatory health service fee that all students are required to pay.
The physicians at the Women’s Clinic administer “comprehensive contraceptive counseling” to students who wish to start a birth control prescription but are not sure of what type of contraception they are interested in, said Susan Ernst, chief of UHS Gynecology Services.
As of spring 2013, the American College Health Association found that 60.4 percent of college students prefer the birth control pill as their primary form of contraception, while 6.5 percent prefer to use an intrauterine device. Recently, national organizations such as the American College of Obstetricians and Gynecologists have pushed the University to recognize Long Acting Reversible Contraception methods, according to Ernst.
“More recently, we are trying to talk about the most effective methods first,” Ernst said. “In the past we would often talk about the most used methods — such as birth control pill, the ring, or the patch — and then go on to talk about things like the Long Acting Reversible Contraception — such as the implant or the IUD.”
Ernst added that the possibility of human error when periodically replacing birth control pills, patches and rings increases the chance of unintended pregnancy when compared to LRAC methods. Though barrier methods of contraception — such as condoms, female condoms, diaphragms and cervical caps have the least efficacy, Ernst said the Women’s Clinic still offers them to students as an option.
For University alum Sydney Gallup, former president of student organization Students for Choice, reproductive health is more than just a personal concern. As a part of her role in Students for Choice, Gallup sat through the waiting rooms at UHS, evaluated informational materials and scrutinized the location and quality of their available condoms to evaluate ways to recommend improvements to the same.
“At the time I was paying $1,000 a year for pills that for most of the time had horrible side effects, and I was working a shitty job downtown to help pay for it,” Gallup said. “I was paying $45 dollars a week, while being a full-time student, to pay for birth control — which was pretty silly.”
Gallup said she found many of the pamphlets were outdated and didn’t include comprehensive information on IUDs. Furthermore, she said the pamphlets did not help women learn about the questions they should be asking about their reproductive health.
“If (UHS) is not going to redirect students to a place like Planned Parenthood and they want them to overcome these barriers, they need to cover all their bases,” she said. “Otherwise they’re really cheating students from knowing about reproductive health.”
Gallup added that because she believes contraceptives are often stigmatized on college campuses, many students she spoke to found it difficult or embarrassing to take condoms from UHS. Though the condoms are offered for free, she said the fact that they are not placed in a discrete location and are not from a major brand dissuades students from using them.
Located a floor above the Women’s Clinic, sexual health educators at Wolverine Wellness also work with students and advise on contraceptive options. While the Women’s Clinic looks at a patient’s medical history to determine their optimal contraceptive method, Wolverine Wellness connects students with public health professionals to provide general health advice.
Laura McAndrew, a sexual health educator at Wolverine Wellness, said students are often concerned about whether their insurance providers would cover contraception and if their parents would find out about their contraception usage. While Wolverine Wellness can’t answer many of those questions directly, it helps point students in the right direction.
A risky affair
As the number of contraceptive options increase and the Affordable Care Act improves accessibility, weighing the associated risks and side effects of contraception becomes a daunting task for many.
Gallup said she believed the primary problem with contraception awareness on campus was misinformation. Anti-Planned Parenthood protests organized by the Planned Parenthood Project, and clinics — such as Arbor Vitae — frequently give out what she said is false information to women about their contraceptive options.
“That is a big problem because their advertisements are really present on campus,” Gallup stressed. “It doesn’t help with the stigma that women on campus face, because if they do go there thinking they can go discuss contraceptive options, they are essentially shamed out of it.”
While contraception options that include estrogen and progesterone hormones have inherent risks, including heart attacks and strokes, Ernst said this was not a major concern for most healthy women. Common side effects such as nausea and breast tenderness are typically not dangerous and diminish over time, she added.
“We always outline those risks but when you look at the chance of risk for a young, healthy woman who doesn’t have blood pressure, or cholesterol, or high blood pressure, or smokes, or obesity, then those risks are even slightly lower than you would see even in pregnancy,” Ernst said. “When you talk about the risks in context of their other health (concerns), I think most people are reassured by the fact that why there are risks from using hormonal contraception, the risks are actually fairly low.”
Mood changes tend to be a common side effect of hormonal contraception in the first few months after starting a prescription, Ernst said. The Women’s Clinic advises students to discontinue medication if severe mood fluctuates persist after an extended period of time. If mood changes are accompanied by other psychiatric issues, Ernst said she advised those students to seek help from Counseling and Psychological Services.
“Patients more often think that weight gain is caused by their pill and we have to counsel them that it’s probably not the pill, and maybe there’s some other cause for the gain,” she added, referring to the misinformation that students might have in regards to side effects.
While the purpose of different University programs might vary, McAndrew said the scientific information provided at each was comparable and the purpose was to provide women with all the information they might need so that they could make informed decisions.
“Many students are using birth control, and we’re happy about that, but at the same time we’re happy to be here to address their concerns,” she said.