A typical vending machine on a university campus might offer students the usual range of sodas, Sunchips, and Skittles. But a vending machine installed earlier this year at SUNY Upstate Medical University in Syracuse, New York, has a unique offering: Plan B pills.
The vending machine, located in the campus library, is an effort to ensure that emergency contraceptives are affordable and accessible to the student body, with the Plan B pill costing as little as $10, compared to typical costs of $40-$50. Students have 24-hour access to the machine and can purchase other over-the-counter pharmacy items they may need, like pregnancy tests and Tylenol. Proceeds from the machine go back to re-stocking and maintaining products.
“Given the existing stigma around purchasing Plan B, we decided to put other over-the-counter things people could purchase such as Tylenol or Motrin,” said Serena Schmitt, a medical student at the university who, along with medical student Olivia Preston, led the initiative. “The vending machine shouldn’t be something people are afraid to access.”
This is just one example of the range of interventions that reproductive health experts say are needed to help increase access to birth control. Approximately 19 million American women of reproductive age live in a contraceptive desert. Contraceptive deserts are counties that lack at least one health center for every 1,000 women in need of publicly funded contraception.
Many other people live in areas like Syracuse that aren’t classified as contraceptive deserts, but nonetheless face frequent logistical challenges in obtaining the birth control they need. The problem disproportionately affects communities of color and low-income communities, putting patients in the difficult position of either going without contraception or using a substitute that may be less effective or doesn’t otherwise suit their needs and preferences.
That means people run a greater risk of unwanted pregnancies — a particularly urgent concern not only in states that strengthened abortion restrictions after the Supreme Court reversed Roe v. Wade, but in states with longer wait times for abortions because of an influx of demand from patients traveling from places where the procedure is illegal.
Researchers have also found that the Dobbs decision overturning Roe v. Wade has broadly eroded people’s reproductive autonomy. A recent study conducted across four states found that post-Dobbs, there were greater barriers accessing contraception, decreased high-quality contraceptive care, and increased condom usage. In the pre-Dobbs landscape, 62% of people surveyed reported they were using their preferred method of contraception, compared to 45% of people surveyed post-Dobbs. Additionally, people living at less than 200% of the federal poverty level reported greater trouble and delays getting their preferred contraceptive method post-Dobbs.
In New York State, an estimated 1.2 million women live in contraceptive deserts, lacking reasonable access to the full range of contraception methods. STAT spoke with reproductive health advocates and researchers about the access disparities in New York, a state where gaps remain in accessing birth control despite liberal policies on reproductive health care.
When clinics close
In upstate and western New York, contraceptive deserts include Orleans County, Herkimer County, Rensselaer County, Washington County, Madison County, per data from Power to Decide, a reproductive justice nonprofit organization. Many other counties in New York also have a fairly low ratio of contraception prescribers to the female population of reproductive age, according to data from George Washington University’s U.S. Prescription Contraception Workforce Tracker, including Orange, Sullivan, Westchester, Suffolk, Nassau, Queens, and Kings.
The issue is further compounded in areas that lack easy access to publicly funded health centers that provide the full range of contraception approved by the Food and Drug Administration. Many rely on clinics like Planned Parenthood because of lower costs, convenience, and the ability to receive multiple services from the same center. So when Planned Parenthood centers close, the impact is far-reaching.
That’s been the case for the people in Sullivan County, New York, who sought contraceptives and reproductive health care at their local Planned Parenthood in Monticello. That Planned Parenthood center closed in 2020 due to staffing and funding shortages fueled by the pandemic. Residents had to drive about 30 miles to the nearest Planned Parenthood in Goshen, New York.
Then, earlier this month, Planned Parenthood of Greater New York (PPGNY) announced that it would close three of their centers upstate, including the one in Goshen, as well as the center in Staten Island. That means the nearest Planned Parenthood center for Monticello residents is now in Newburgh, more than 50 miles away.
“Systemic failures in the U.S. health care system have yielded unprecedented challenges that are forcing many health care providers, including PPGNY, to take serious and immediate cost-saving measures and pursue long-term structural shifts,” PPGNY said in a statement following its recent closures. “These challenges include growing operating expenses, unreliable insurer reimbursements, ongoing pandemic recovery, a hostile political landscape, and […] a state budget that fell short of responding to the needs of sexual and reproductive health care providers.”
Given the lack of public transit systems in this area, PPGNY is coordinating volunteers to drive patients to the center in Newburgh, as well as recommending that people visit their virtual health center. But virtual care cannot help people access a depo shot, an injection that acts as a contraceptive, or get an intrauterine device, or IUD, as these require a patient to be physically present.
“The recent closure of the Goshen Planned Parenthood adds to the impact of the previous closing of the Monticello clinic; and further limits access to care for women and girls in our rural community,” said Denise Frangipane, a resident of Sullivan County and the chief executive officer of Sullivan 180, a nonprofit focused on improving social determinants of health.
The importance of reproductive autonomy
Contraception access is seen as the cornerstone to reproductive autonomy. Greater availability of safe and effective contraceptive methods has led to improved educational achievements, higher workforce engagement, and increased earnings for women. When women can better manage family planning and childbearing choices, they are better positioned to advance in their education and career aspirations.
It’s an issue that Jenna Bimbi, the founder and co-executive director of the New York Birth Control Access Project, has long been passionate about. She never wanted to be on the birth control pill. But when she came in for an appointment that she originally booked to get an IUD about 10 years ago, she learned that her New York City-based reproductive clinic had run out of them. Instead, the clinic offered her an oral contraceptive pill to use in the short term, until more IUDs became available.
“The [pill] wasn’t great for me. I wanted the long acting reversible contraception device, because it is easier for me to do a ‘set and forget’ sort of birth control,” said Bimbi.
In an effort to expand birth control access for people who don’t live near health centers, Bimbi and her team advocated for the Birth Control Access Act, which was passed by the state last year. This legislation expands access to hormonal methods of contraception — such as the pill, patch, and ring — by making them available to people after they’ve consulted with a pharmacist, who provides the prescription. As of now, a total of 29 states and the District of Columbia have passed laws allowing pharmacists to prescribe or provide contraception without a doctor’s prescription.
But pharmacy deserts are a problem, too. Bimbi and her team are working to pass another bill in New York State that would mandate contraceptive vending machines, that would sell emergency contraception as well as condoms, across public college and university campuses.
“We realized that private schools [in the state] were carrying emergency contraception and vending machines on their campuses. And we wanted to give public school students that opportunity as well,” said Rochelle Rodney, co-executive director of New York Birth Control Access Project.
Many colleges and universities already offer free condoms, but advocates say these aren’t enough — particularly because condoms are effective 87% of the time due to tears and slips, compared to birth control pills (93%) and IUDs (99%).
Emergency contraceptive vending machines like the one at SUNY Upstate Medical University are steadily spreading across New York State. Another SUNY campus — Binghamton University — has also installed an emergency contraceptive vending machine that is available 24/7 for students in their campus library.
“Given the lack of reliable public transportation in Broome County, this vending machine is especially helpful for students who don’t have cars to visit off-campus pharmacies for purchasing Plan B,” said Mansi Sinha, a junior and president of the Binghamton Planned Parenthood Generation club.
SUNY Upstate medical students and other students working with the New York Birth Control Access Project are pushing for more short-term contraceptive options to be added to campus vending machines, such as Opill — the first over-the-counter birth control pill in the U.S., which was approved by the FDA in March of this year and is now available in major pharmacies and retailers like CVS, Walgreens, and Walmart.
Sinha and her team at Binghamton also provide free condoms on campus and act as peer educators in spreading awareness of where students can visit to get prescribed contraceptives.
“Education is very important among our student body population within the community due to our local reproductive health care landscape. Oftentimes, students may accidentally visit nearby crisis pregnancy centers, which pose as clinics that offer abortions and reproductive health care,” said Sinha.
According to nonprofit ProTruth, there are over 120 fake abortion clinics throughout New York, which outnumber the number of clinics that provide abortions and legitimate reproductive health care. These clinics are often associated with organizations that oppose contraception and evidence-based reproductive health care.
Increasing access to long-acting reversible contraceptives
Among the policies and initiatives aimed at making it easier for people to get ahold of contraception, there is a missing piece of the puzzle: Access to long-acting reversible contraceptives, such as IUDs and the implant Nexplanon, which can be inserted into the upper arm. LARCs are the most effective forms of reversible birth control, but they do require a medical provider to insert and remove them.
In 2014, the American Academy of Pediatrics recommended that pediatricians consider LARCs as “first-line contraceptive choices for sexually-active adolescents.” This was due to the ease of use, safety, and efficacy as some types can last up to 10 years.
“Historically, LARCs have decreased unintended teen pregnancies across the country,” said Sandra D. Lane, a research professor in the department of obstetrics and gynecology at Upstate Medical University.
When clinics close, there’s no easy way to help people get affordable access to LARCs, according to Susan Coots, the former director of Family Planning Services, a clinic in Onondaga County that served nearly 30,000 patients a year in the county and Syracuse area before it closed in 2022 due to lack of funding.
Such closures hit younger patients especially hard, Coot said, since they can’t afford LARCs’ high out-of-pocket costs.
“The cost of a LARC device is a couple hundred, and a medical provider who is not receiving state or federal funding to offset that cost is going to pass that cost on to their patients, and that’s just for the device. You also have to pay for an office visit. Somebody who’s having an IUD inserted is probably going to have screening for transmitted infections before having the device implanted. So you’re looking at a visit that costs upward of $1,000,” said Coots.
Since the clinic’s closure, the local Planned Parenthood of Central and Western New York, which now serves the entire city of Syracuse, is overburdened by high patient volume.
“After calling for an appointment, patients end up waiting four weeks or six weeks before they can be seen,” said Coots.
Because of these disparities in access, communities of color and low-income communities have a higher risk of sexually-transmitted diseases, Lane said.
“We have had among the highest rates of HIV transmission in Syracuse for women of color from mostly heterosexual transmission,” she said.
Despite these challenges, students and advocates are fueled by the hope that they can change the reproductive health landscape in their state.
”The goal is really to make contraception closer by putting it closer to a patient,” said Bimbi. “It can’t be overstated how useful that is when you’re trying to get to birth control.”
This article was supported by the Journalism and Women Symposium Health Journalism Fellowship, with the support of The Commonwealth Fund.
