Everyone knows our college years are filled with slip-ups. You’re out, you’re dancing, your bodies are close together, your bodies go upstairs and now it’s hot, it’s steamy, it’s your voice saying, “Don’t worry, it’ll be fine!” I’m talking about unprotected sex. It happens. Best-case scenario it doesn’t. Second-best-case scenario you’re on birth control. But what if you aren’t?
Brand-name Plan B One-Step costs $50 at the drugstore and between $35 and $40 as a generic brand. Still, it’s cheaper than an abortion. It’s cheaper still (and less life-altering) than a baby. But $50 is $50 and sometimes, especially for a college student, this feels like too much. Or, you don’t want to walk to Walgreens at two in the morning in your sequined miniskirt and crop top. You don’t want to stumble through the aisles, sheepishly approach whichever graveyard-shift employee is smacking his gum by the register, and ask him to please show you where the emergency contraceptive is. Don’t want to wait for him to pat his shirt pocket, then his front pants pockets, then finally his back pockets for the lockbox key so he can unlock the pill for you. Why not just risk it?
Childbirth and abortion can each utterly transform the course of a life; no one should be forced into either of these options as a consequence of one lapse in judgement. Yale recognizes this and offers free emergency contraceptive available 24 hours a day, seven days a week, whether you have Hospitalization/Specialty Care or Basic Coverage. Every Yale student is automatically covered with Yale Basic insurance. You can obtain an emergency contraceptive (EC) from the Yale Health Pharmacy up to three times in one academic year with no questions asked. Upon the fourth time, you will receive an automatic email to schedule an appointment with a Yale Health gynecologist to talk about safe sex and birth control options.
This is great! Fantastic! But do students know about it? The answer is that currently not even the administration or Yale Health employees themselves know much about these policies. Last fall, Grace Cheung ’21 brought this issue to the attention of the Reproductive Justice Action League at Yale (RALY). At the time, she had a vague impression that all forms of contraceptive were free at Yale Health but could not find any information on the topic when she searched online. When she talked to other students about this, she received varying accounts. Some said they’d visited Yale Health and been told EC would cost around $60 and that the bill would be viewable by their parents. Neither of these are true.
When you Google “Yale Health emergency contraception,” the first result links you to a simple, user-friendly and informative blurb relaying the efficacy of different emergency contraceptives: the “morning-after pill” is effective up to 72 hours after unprotected intercourse and may work after up to 120 hours. It is available over the counter at the Yale Health Pharmacy. Another contraceptive, Ella, is effective up to 120 hours after and may work as far out as three to five days post unprotected sex. No prices are listed for either. The price is not included in Yale Health’s “Summary of Benefits and Coverage” nor in their “Glossary of Health Care Coverage.” The Yale Health Student Handbook specifies free emergency contraception from the Yale Health Pharmacy for Hospitalization/Specialty Coverage students but does not mention an EC coverage policy for those on the Basic plan. The information is included in the “Schedule of Benefits” document in a table of prescription costs which labels emergency contraceptives as $0 under the heading “network” with no details included on where one might find an EC which is covered under “network” as opposed to out-of-network, which costs 20% of the drug’s original price.
I decided to go to Yale Health and ask about the options in person. This past Sunday, on my trek back to Pauli Murray from main campus, I stopped in — uncertain. After all, I was approaching the counter on the basis of rumor. So when I reached the window, my question came out sheepish. I asked if I could get Plan B at the pharmacy and how much it would cost. The pharmacist told me to wait a moment while she went to ask her manager. She confirmed it would be free. I asked about Yale Basic Coverage. Again, she left to ask her manager. Eventually, she came back to ring it up so she could check the price. “Six dollars,” she reported to me, definitively. I felt certain I had found the truth.
However, according to the director of Yale Health, Dr. Paul Genecin: “[Emergency contraception] is free to students on either health insurance plan.” This has been the case since the enactment of the Affordable Care Act in 2010, he told Yale College Council representatives in October. There’s an issue here of proper communication which Genecin attributes to a high employee turnover rate. What’s the use, though, of subsidized, accessible emergency contraceptives if nobody properly knows about them, not even the pharmacists whose job it is to dispense the product?
There are numerous resources on campus to help educate and guide students during their time at Yale, such as Community Health Educators (CHEs), Community Consent Educators (CCEs), first-year counselors (FroCos) and peer liaisons (PLs). I spoke with numerous students in each of these positions, and one person, a Pierson FroCo, said they knew about the policy. One CHE recalled: “As a CHE we tell people that Plan B costs money at Yale, every single year.” Another corroborated this sentiment: “As a CHE, we say that [EC] are available 24/7 at Yale Health but we say ‘subsided price.’ We don’t say that it’s free.” The CHE program is run through the Yale College Dean’s Office rather than as a program through Yale Health, which could account for this misinformation. The pamphlet handed out by CHEs, “A Guide to Health and Sexuality at Yale,” instructs that to obtain an EC students can “go to the Yale Pharmacy, or to Acute Care after hours (both males and females can purchase).”
On Oct. 24, the YCC sent out a survey to Yale College students. Between 1,850 and 2,000 students responded to each of the given questions. To the question “Were you aware that Yale Health offers emergency contraception 24/7?” 77 percent of respondents said “no.” The same percentage responded “no” to “Were you aware that emergency contraception at Yale Health is free to students?”
When Cheung brought her concerns to the RALY board back in fall 2017, she proposed bringing an emergency contraceptives vending machine to campus. Pomona College; University of California, Davis; and Stanford all operate such machines on their campuses. Such a machine would bring emergency contraceptives closer to students and remove the barrier of needing to interact with someone, which is potentially intimidating, to obtain an EC. Initially, the concept was to work with Yale Health to stock a machine with subsidized emergency contraceptives so they would be free as they are at the Yale Health Pharmacy, but this coordination would require layers of bureaucratic approval. At the end of summer 2018, RALY president Veena Muraleetharan ’20 relayed the idea to the YCC. Since then, YCC Senate member Ileana Valdez ’21 has spearheaded the project working with University Services Director Ryley Constable ‘21. With RALY’s project idea basis and research, the handoff to the YCC has produced rapid progress. This is part of a greater effort by this year’s YCC to work for actionable change.
“We want there to be things students can point to around campus and say, ‘The YCC did that for me,’” current YCC President Saloni Rao ’20 said.
In the spirit of timely progress, the YCC decided to work with Yale College administration rather than Yale Health on the vending machine. Consequently, the products will not be subsidized as they are at Yale Health. Prompt action was the priority. The Yale administration, on its part, was very supportive of this project. Valdez — along with Constable, Rao and YCC Vice President Heidi Dong ’20 — met with Yale College Dean Marvin Chun days before Thanksgiving break, and the machine is now expected to arrive on campus as soon as next week, pending final approval by vending machine contractor Vengo. Vengo is not charging for the machine, so the YCC does not need to spend any funds on its acquisition, stocking or maintenance.
“We discovered anew that asking Yale Health to subsidize these health products would cost another three months in meetings. We can work on subsidizing these products in the future, but at this point we want to get the machine to campus,” Rao said, commenting on the decision to bring the machine to campus before coordinating subsidization.
Rao is optimistic about future subsidization, saying the YCC plans to continue these conversations with Yale Health and work through logistical and liability concerns, such as how to identify Yale students and make sure students can’t extract excessive amounts of product from the machine, especially at once. At the same time, anonymity is in consideration. Potentially, the machine could be equipped with an encrypted software which logs the number of times a given student gets an EC without storing the student’s identity. A system analogous to the current one would be in place, including a meeting with an OB-GYN after three withdrawals of the pill.
This “wellness machine” will be located in Silliman College’s Good Life Center with 24/7 accessibility. The machine will be stocked with other “wellness” supplies as well, such as Advil, condoms and cold medicine. It will be a credit-only machine. The News reported that prices will be comparable to Walgreens’ and other drugstores’ prices. The machine brings emergency contraceptives to a central location for convenience and eliminates the potentially intimidating step of needing to ask for an emergency contraceptive. This eliminates barriers that might otherwise prevent a student from buying an emergency contraceptive.
The machine is a strong first step, but it is only the beginning. Constable is heading a complimentary project to increase awareness of emergency contraceptive access through Yale Health. Though the form this project will take is still in the works, depending on which organizations are most receptive to collaboration, he is expecting to have the details finalized by the start of spring semester. Regardless, emergency contraceptives are here. Soon, they’ll be as close as a stumble into the Silliman courtyard and the press of a button. In health education reform and in safe sex, it’s better late than never.
Julia Leatham | firstname.lastname@example.org .