She’s Lost Control
Last spring, Deira Inouye, SEAS ’09, went to the Health Services at Lewis and Clark College in Portland, OR expecting business as usual. Every three months, Inouye went to receive her supply of birth control, as she had done for the past two years. She was shocked to find that there was virtually nothing left in the college’s dispensary. “I was going into them [Health Services] to get birth control,” Inouye recalls. “I was only going in every three months, so nobody warned me about the price increase. When I went in during the middle of spring semester there was barely anything left. I couldn’t get the contraception I needed.” By the time Inouye left Lewis and Clark in May 2007, the college’s Health Services could only offer her enough birth control to last a month.
Inouye was witnessing firsthand the repercussions of the Bush Administration’s Deficit Reduction Act of 2005. The Deficit Reduction Act, designed to reduce federal spending, has caused dramatic price spikes for previously discounted prescription medicines. In January 2006, Bush initiated the Deficit Reduction Act, which is intended to save over $40 billion in the next five years by cutting spending from certain federal programs—including Social Security, Medicare, and programs that had sponsored subsidized birth control to college health clinics, non-profit health organizations, and Medicaid, which offers health insurance to low-income recipients. These medications include birth control in all forms: oral contraception, Depo-Provera shots, and the NuvaRing.
Before the DRA was passed, Congress made it possible for pharmaceutical companies to offer certain health care establishments discounted drugs, allowing those who had no access to private insurance a way to receive necessary medication. A White House press release from last February states, “The bill helps restrain Medicaid spending by reducing federal overpayment for prescription drugs so that taxpayers do not have to pay inflated markups.” As a result, prices of birth control skyrocketed an estimated 900 percent, a government oversight that caught college officials completely off-guard. Under the act, it became too expensive for college campuses and free clinics to purchase birth control for distribution.
Students and health care providers alike have been scrambling to find alternate means or providers, but each path seems to lead to a dead end. Inflation has affected almost all viable means of receiving contraception—including private health insurance, free clinics, campus health services, and Medicare. Even Planned Parenthood, which previously had the ability to give patients a number of different types of birth control either at a discount or for free, has taken a hit—they have been forced to scale back on the amount of options offered, giving students and low-income women even fewer ways to receive a discount.
Inouye had used her private health insurance to pay for birth control before she began to rely on the supply of her school’s Health Services. She made the switch when the private insurance dramatically increased her co-pay. “With my private health insurance at home in Hawaii, I was paying a co-pay of $7. Then, they changed their co-pay to 50 bucks. So I started getting it at school until they ran out.” When Inouye transferred to Columbia, the price at affiliated pharmacies increased from $8 to around $30. She now pays $25 through her primary insurance. “I just have to pay. It’s frustrating—I’ll probably have to switch to a generic brand soon.”
Laura Cole, CC ’08, was surprised by the price increase when she returned to campus in September. “I had been getting birth control pills from Town Drug for $10,” recalls Cole. “When I went back [to Town Drug] to get it, it was $242 for one month.” Cole had previously used a non-generic brand of oral contraception and was forced to use her parents’ insurance to cover the cost. “It’s $25 a month now, which is fine, but I realize what a problem it is for people who don’t have insurance.”
Brenda Slade, the medical director of Barnard Health Services, prides herself on being able to foresee trends in women’s health care. Still, she was caught off guard by the sudden spike in prices. “We were shocked when we found out. The government let feminine health concerns fall completely by the wayside ... We really thought there was nothing we could do.”
Starting in September, universities found themselves running low on their stores of discounted birth control. Many could offer their students only a one-month supply before running out. Some students were encouraged to stock up on cheap contraception while they could, depleting the stockpile at a much faster rate.
Some colleges have been unable to offer birth control at all due to the rising costs. Last month, Bowdoin College in Maine stopped offering oral contraception, following the lead of schools such as Temple University, University of Montana, and the aforementioned Lewis and Clark College.
As a result the difficulty in obtaining certain forms of contraception, some students may have to discontinue use of more effective types of contraception, including the pill and the NuvaRing, a combination contraceptive ring. They’ll be forced to use less reliable methods of birth control—like condoms, or worse, luck.
Statistics released by the Allen Guttmacher Institute reveal that unplanned pregnancies among the 18-24 age group are on the rise. The trends suggest that students aren’t cutting back on sex, even if they’re no longer able to afford adequate protection. Inouye isn’t surprised. “People are going to have sex, I’m sorry. We’re at the most sexually active age and not making it safe is going to make other things happen,” she says.
Elizabeth Harris, a student at the University of Illinois at Chicago, proves Inouye’s assertion. In September 2007, the Chicago Sun Times reported that Harris decided to stop purchasing birth control after her clinic raised the price by $20. The decision to rely on less effective methods of contraception contributed to her unplanned pregnancy. At the time, Harris was a pre-med student planning to travel to Costa Rica for a semester abroad. Her plans no longer include this excursion.
Slade explains that the effects of the DRA are more than just an inconvenience. “It’s a policy that could jeopardize a woman’s academic future.” Women have to find extra money to support contraceptive needs, and face a more severe threat of pregnancy at a crucial time in their lives.
At Barnard, students who rely on Health Services for birth control have been surprisingly fortunate. “I wasn’t even aware of the severity of the crisis,” says Rika Tanaka, BC ’08. Her nurse suggested she buy a few extra months worth of birth control, but other than that, she remained untouched by the crisis that faced women nationwide.
“We try to stay ahead of the curve,” remarks Slade. “We knew it would be a problem.” Slade has acted as medical director of Barnard Health Services for the past four years after a four-year stint at Columbia. She realized that Health Services needed to take action right away. Barnard had already offered generic birth control in addition to the name-brand options, so when news of the price hike reached Barnard’s campus, Slade scrambled to make connections with distributors to purchase enough oral contraception to last. “What we tried to do was find companies that would sell us generics identical to corporate products in terms of chemical composition and effectiveness, but which would be cheaper,” she says.
Oral contraception comes in two forms—one is a combination of estrogen and progestin, and the other is solely progestin. Generic brands mimic the chemical composition of their brand name counterparts. In fact, FDA regulations dictate that the generic versions must act just as the brand names do. The generic versions are often half the price of more popular brand names—while Yasmin, a popular brand, is $50, its generic counterpart is only $25.
Barnard Health services laid down a significant sum of money—the exact amount of which Slade won’t divulge—to ensure that students can still receive discounted oral contraception. Students are even allowed to obtain a supply to last for up to a year after graduation. Still, the least expensive brands are generic, a fact that may discourage some people. “Estrogen is estrogen, but some women do better on different brands,” says Slade. Though generic brands are equivalent, women may react differently to slight hormone variations and suffer side effects. Also, some contraceptive methods and brands of oral contraception do not have generic counterparts.
Slade recognizes the advantages for students of having multiple choices of contraception, so they can find a method that works best for their unique body chemistry. Still, even Barnard’s Health Services have had to cut back on the number of contraception methods they offer students. While oral contraception is still discounted at Barnard, other methods are not: the price of the popular NuvaRing recently tripled. Slade is attempting to remedy the price increase as quickly as possible. “That has always been our greatest concern: the best quality health care for the lowest price. We need to take into consideration that not all students can pay the same prices and make the same quality health care available for every student.”
For other campuses, the matter is not as easily resolved. Columbia, which has not had its own dispensary for more than 10 years, has no way to distribute its own medication. Instead, Health Services offers students prescriptions for birth control that rely heavily on local pharmacies, such as Town Drug. After Town Drug ran out of discounted birth control in March 2007, just three months after the DRA went into effect, prices went from the arranged $5 rate for Columbia students to about $50, depending on the brand.
Students like Inouye feel betrayed by the University’s inability to provide them with birth control. “Your college is like your home, it’s your whole community, and you get everything that you need from it really,” Inouye says. “This is one of the few medical issues we have, and now we can’t be taken care of.”
Columbia students who use birth control are faced with two options. They can switch to a generic to help cut the price. Alternatively, they can opt to pay full price for contraception, generic or otherwise. Inouye considered switching to a different method—her chosen method does not have a generic option—to help with the cost, but she ultimately decided to pay the full price. “I know I can’t use that method—it’s for people who can take it every single day at the same hour, which doesn’t work for me.”
Other students acknowledge the difficulty of finding flexibility in a very tight budget. “A lot of people can’t afford price hikes. It’s a big thing to factor into your college budget if the price increases that much,” Sarah Leonard, CC ’10, says. “To go from $5 to $50 is absurd—we’re students; we’re not exactly earning a lot of money.” Inouye says of the price difference, “That is a couple days’ worth of food if you do groceries, or it’s a book, or subway rides—it’s a lot of things.”
Dr. Marcy Ferdschneider, the associate medical director of Primary Care Medical Services at Columbia, says in a statement to The Eye, “Health Services at Columbia has not been directly affected by the Deficit Reduction Act.” That doesn’t mean they cannot help female University students seeking Health Services’ assistance. Columbia cannot control the pricing at local pharmacies, but Health Services does offer comprehensive women’s health services—prescriptions, exams, counseling and follow-up care. Still, most students wish there was more they could do to alleviate the price strain. “It’s outrageous that it’s fallen through the cracks. Columbia needs to have the students’ health as a priority. We need to see that something is being done,” Leonard says.
The federal government is acting to remedy the issue in response to student demands. On Nov. 1, 2007, State Representative Joseph Crowley, D-N.Y., introduced the Prevention Through Affordable Access Act or the HR4054. The new bill will reverse the DRA’s effect on birth control without any cost to taxpayers. It will restore and protect the right to dispense discounted birth control to all entities that were previously eligible.
Realistically, the process will take time—time a lot of college students don’t have in matters regarding sexual health. The bill is still in the early stages, and it could be years before anyone sees an effect from this legislation. Again, it is up to students and campus health services to find a way to make a difference. Campuses nationwide are mobilizing, attempting to get both the problem and its solution into the public conscience. NYU hosted a rally in Washington Square Park two weeks ago in collaboration with Planned Parenthood NYC. Other campuses are asking students to send e-mails and letters to local representatives to get the bill pushed through as quickly as possible.
Cole is on the board of Students For Choice, an organization that discusses women’s reproductive issues, organizes abortion clinic escort services, and plans events to raise awareness about sexual health. She realizes that the price increase alone isn’t enough to incite change for the University. “It [the price] may deter people from birth control, but it’s not going to pressure the University in a mass way,” Cole says.
In collaboration with the Student Activist Board, a sub-committee of the Columbia Democrats headed by Cassie Spodak, BC ’09, and Leonard, SFC is planning a campus event on Thursday, Dec. 6 to raise awareness of the problem and bolster support. “We’re trying to make people more aware of why this is happening, who caused it to happen, and what they can do to get elected officials to address this issue, or to get the University to address it until the government does something about it,” Cole says.
The event, which includes signature drives and letter-writing to expedite the Prevention Through Affordable Access Act, will be held at Low Plaza today from 11 a.m.-3:30 p.m. There will be a public petition to Columbia University to ask them to take action as well. “There is an issue on the national level, it’s reflected on the college level. We think Columbia really needs to put a premium and a priority on students being able to afford birth control—it’s necessary to our lives.” Leonard says. Cole, Leonard, and Spodak are counting on students to rally behind an issue that affects so many aspects of sexual freedom, regardless of gender.
“Barnard is all women, so reproductive health applies to the entire student body. But at Columbia, it applies to more than half of the community. It affects the male half as well—they may not know it, but it’s a big issue for everyone,” Spodak says.
As the 300 million college women who are presently using birth control have the greatest ability to organize and the greatest amount of resources, the strength of a resolution rests in the student body. Among the many issues that have ignited the spirit of protest and advocacy at Columbia this year, rectifying the carelessness of the Bush Administration regarding women’s sexual health has joined the ranks, or highest priority.
Slade, for one, is glad to hear of the rejuvenated sense of activism on campus. “For an old hippie like me, that is wonderful to hear.”