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From Plan B to Plan A: Health Center’s evolving guidance on contraception

April 14, 2017

The Health Center has seen an increased demand for longer-term contraceptives among students concerned about insurance coverage of birth control, according to Director of Health Services Jeffrey Maher. This increase in demand for long-acting reversible birth control coincides with the Health Center’s current emphasis on education about more proactive, effective forms of preventing pregnancy

Under the Affordable Care Act, private health insurance plans have begun reducing or eliminating co-pays and deductibles on contraceptives. Due to potential new government mandates, Maher said that more students are considering taking advantage of current health insurance coverage as well as the Health Center’s guidance.

“I think what we have our antenna up for are women who are looking for contraception help because of the political climate,” said Maher. “There is a real political discussion about women’s health—and will contraception, for example, be covered by insurance the way it is now?”

Even before this recent increase in demand, the Health Center has helped students to obtain long-acting reversible contraceptives, such as intrauterine devices (IUDs) or contraceptive implants. Because these devices require a specialized procedure to insert, the Health Center helps connect students requesting them to Planned Parenthood in Topsham, where they can get the procedure.

In recent years, the Health Center has generally shifted its focus away from unrestricted access to emergency contraceptives, such as Plan B One-Step, and toward education about other, more effective forms of birth control, including IUDs and implants.

The Health Center still offers Plan B for free to any student of any gender who asks but requests that the student meet with a staff member before being given the medication to discuss other options for longer-term contraception. If students need Plan B when the Health Center is closed and buy it over the weekend, the Health Center reimburses them.

They have dispensed Plan B in this way since the Health Center stopped sponsoring “Plan B Days,” on which any student could pick up the medication from the Health Center without a consultation.

Health Services Physician Assistant Julie Gray said that rather than having students rely on Plan B, the goal of the Health Center is to emphasize “Plan A,” or more proactive and effective forms of contraception that offer a long-term reliable solution, instead of a situational one.

“We can do better than this,” she said. “There are much more effective means of contraception, and maybe we need to be spending as much time talking about those as we are about Plan B.”

The Health Center attempts to align its practices with evidence from up-to-date medical studies, which have largely shown that, globally, the availability of Plan B has not reduced the rate of unintended pregnancies, according to Gray. Of fifteen studies testing the effect of Plan B, one showed a decrease in the unintended pregnancies rate. Gray attended a Contraceptive Technology conference at the end of March, which addressed these findings and others.

Gray and Maher agreed that the best way to provide birth control is to inform students of their options and the effectiveness of each and to then personalize a plan to suit a student’s needs and desires.

“To sort of couple medical counseling with medications … at this point seems to be better medicine and better nursing, and so our Health Center here has sort of adopted that approach,” said Maher.

“Plan B is and probably will always be something that we provide, because it’s a necessary tool,” Gray said. “It’s just recognizing that there’s so much more that we can do to empower women who don’t want to become pregnant, to take charge of that. And so I think that the goal is always going to be education.”

Gray noted that many colleges and universities do not offer Plan B free of charge, as Bowdoin does.

“I think our Bowdoin students have great access, without financial restriction, to every form of contraception there is, and I was really reminded that we do a great job in removing financial barriers,” said Gray.

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