For some, contraception holds stigma



She still doesn’t know whether or not the condom broke.

Just after spring break her freshman year, a female student, who declined to give her name, said she was drinking with a friend and “suddenly came to discover” that they were having sex. She does not know exactly how it happened. She does not know if she was date raped or if she cheated on her boyfriend back home. She did nothing about the situation for two days, even though she was falling apart inside. It was not how she had imagined she would lose her virginity.

A friend urged her to go to University Health Services to get emergency contraception, or EC. As it was nearing the 72-hour mark — the traditional cutoff point for EC — the friend accompanied her there, telling her it would be good for her peace of mind.

But the student said the doctor on duty was less than comforting. He called her “young and naive” and said when she was older she would realize how foolish she was for using EC. He told her it was not a form of birth control and that she was “using it irresponsibly.” In a raised voice, he accused her friend of being the “dumb boy to get [her] into this situation.” She left in tears.

“I ended up taking [EC] from him and taking it, but the whole situation left a really bad taste in my mouth,” she said. “Since then, I refuse to go back there.”

UHS Director Paul Genecin said a situation such as the one the student described would be “very unacceptable.”

Peer Health Educators and Yale Women’s Center members alike praise UHS’s liberal policies on sex education and sexual health. Condoms are available for free in a variety of places, and birth control is subsidized to make it affordable for students. But emergency contraception is less widely publicized. And the patients have said their experiences ranged from positive and helpful to negative and judgmental.

The Obstetrics and Gynecology Department and the Student Health Education pages on UHS’s Web site state that EC is available at UHS, but the Yale Health Plan Student Handbook section on gynecology does not mention it.

Genecin said EC is not explicitly mentioned because it falls under the “full range” of obstetric and gynecologic care the handbook says the OB/GYN department provides. The handbook includes “family planning” in a list of services the department provides.

The Reproductive Rights Action League at Yale, or RALY, which operates out of the Women’s Center, published its pamphlet because members were dissatisfied with the low level of publicity for some of the reproductive care available to students. The pamphlet explains available options from birth control pills to prenatal care and details which departments to contact and what YHP pays for with each service.

“[UHS has] a remarkably liberal policy in terms of what they fund,” RALY member Poppy Alexander ’04 said. “It’s unfortunate that Yale students don’t know what they can get.”

YHP began offering coverage of prescription forms of birth control, including EC, in 1998. UHS provides EC to students free of charge, Genecin said. Emergency Contraceptive Pills contain hormones that reduce the risk of pregnancy when taken shortly after unprotected sex. UHS adheres to the 72-hour window, but Planned Parenthood cites more recent studies that say EC is effective for up to 120 hours. EC is 75 to 89 percent effective, according to Planned Parenthood, while “regular” birth control pills are 99 percent effective if taken correctly.

Genecin stressed that UHS makes EC constantly available to students, who can go directly to the OB/GYN department during the day on weekdays, or to Urgent Care during off-hours.

EC is more effective the sooner it is taken. While EC can keep a woman from getting pregnant, it cannot end a pregnancy. The pills can stop ovulation, fertilization, or implantation of a fertilized egg, but once an egg has implanted in the uterus, EC cannot cause an abortion.

But when a Yale Daily News staffer anonymously called Urgent Care after hours, the receptionist suggested she wait to get EC the next morning at OB/GYN, even though it would have meant waiting 36 hours rather than 24. When the staffer asked if she could come in to Urgent Care that night, the receptionist responded that “GYN is the experts.”

People often confuse EC with RU-486, the so-called “abortion pill,” said Susan Yolen, vice president of public affairs and communications at Connecticut Planned Parenthood. EC was at first known as the “morning-after pill,” a term that has gained disapproval from reproductive rights activists because it connotes irresponsibility. There is a movement to change the name again among those who, like Yolen, feel the emphasis on “emergency” is not always accurate.

“The first thing that comes to someone’s mind is, ‘Oh, you weren’t responsible,’” Peer Health Educator Samira Nazem ’04 said.

But sometimes bad things happen to responsible people. The first time another female student had sex with her boyfriend, the condom broke. She was not taking birth control at the time, so she spent her Saturday morning waiting for EC at Urgent Care. She described the clinician’s tone as “not very empathetic” as she received her prescription and said she sensed an air of “here are these pills, take them — Next” condescension.

UHS is “sold as ‘no one will judge you’” with regard to students who must go in when they are intoxicated, she said. But when she went in for EC, the case was different.

But a third student said she had no trouble when she got EC at UHS, even though she was expecting the experience to be harrowing based on rumors she had heard. But with the idea in mind that students have both “good” and “bad” experiences getting EC, some women criticize the inconsistency of the UHS environment.

Opinions about situations in which women should turn to EC vary. Yolen said she considers EC part of an “arsenal” of contraceptive options, and some think EC should be available over-the-counter, or at least in advance.

But UHS will only offer advance prescriptions of EC to students who are travelling to countries where they would have virtually no chance of access to a pharmacy that stocks it, Nazem said. Students going home to rural areas with no guarantee of access to EC should have the same option, she said. A number of pharmacies in the United States, including those at Wal-Mart, refuse to stock pills specifically manufactured for use as emergency contraceptives.

Many RALY members support the notion of advance prescription EC. The group has tried to push EC as a method of responsible backup birth control, Alexander said. Von Gutfeld said when she called while working on the pamphlet to ask about getting an advance prescription, the receptionist sounded “confused.”

“She said, ‘That would be like me telling you to go have unprotected sex,’” von Gutfeld said. “There’s still a stigma attached that if you want it, you’ve been irresponsible — It makes going early a foreign notion.”

One way pro-reproductive rights activists take part in the debate over EC’s place and purpose, they said, is by trying to change the way people perceive it. Alexander said the lack of publicity for EC reinforces the idea that getting it is something to be ashamed of.

“Because it’s kept secret, that sort of keeps the stigma attached as well. It doesn’t mean you’re irresponsible, it just means that an accident happened or you were unprepared,” Alexander said.

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