As student advocates across the country increasingly call for easily accessible morning-after pills on their campuses, some have turned to a new source: vending machines.
At least 39 colleges and universities across 17 states have implemented emergency contraception vending machines on their campuses, including in some places that have largely banned or restricted abortion access. This move is gaining steam in schools located in or near contraceptive deserts – areas that lack reasonable access to health centers.
The rise of vending machines – which often sell Plan B, condoms, and other health products like ibuprofen and pregnancy tests – comes as advocates and federal officials across the country push for broader access to contraception.
The vending machines are effective because they allow 24/7 access to emergency contraception and let universities offset the cost, said Nicola Brogan, a nurse and project manager for Emergency Contraception 4 Every Campus. The nonprofit has worked with schools to implement the vending machines.
For Meghan Eagen-Torkko, an associate professor and director of nursing at the University of Washington in Bothell, access is of paramount importance after the overturning of Roe v. Wade in June 2022 led to the ban or restriction of abortion access for more than 22 million women of reproductive age, according to the Guttmacher Institute.
“When we deny people access to over-the-counter contraception, what we’re doing is we’re placing them in a position where they are being placed at higher risk because of our discomfort as a society with people having control over their fertility,” Eagen-Torkko said.
Difficulties in access
Emergency contraception pills can prevent pregnancy if taken shortly after sex.
There are two types of morning-after pills: levonorgestrel pills and the ulipristal acetate-based Ella pill. Only levonorgestrel pills – including Plan B – are available over the counter and without a prescription. The pill typically has a time-limited use of less than 120 hours and the likelihood of efficacy drops the further out a person is from unprotected sex. Because of this, Eagen-Torkko stressed the importance of easy access to emergency contraception pills.
Student advocates attributed the cost of the morning-after pill as a barrier to access. Mackenzie Pike, co-president of Students for Reproductive Freedom at Boston University – a Planned Parenthood-affiliated club — said access to low-cost morning-after pills on campus is vital.
Over-the-counter emergency contraception typically costs around $40 to $50, Eagen-Torkko said. Boston University’s vending machine sells it for around $10. The University of Washington sells it for $12.70.
“We’ve really made an effort to think about accessibility and affordability and equitable access to emergency contraception on campuses, and that it’s affordable,” Riley said.
Although Eagen-Torkko applauded the rise in emergency contraception access on college campuses, she expressed concern this will disincentivize young people from meeting with health providers and having important conversations about their options.
She worries marginalized people who don’t have access to quality care will rely on emergency contraception pills “because that’s what they can get” and be “essentially shunted into what is less effective and potentially not their method of choice.”
“What I worry about is if this is offloading the obligations that we have as providers to, essentially, a vending machine,” Eagen-Torkko said.
What are contraceptive deserts?
Experts noted emergency contraception vending machines are valuable in schools located in rural or more conservative-leaning areas, as well as other locations that don’t have easy access to health centers – often considered “contraceptive deserts.”
Roughly 19 million women live in contraceptive deserts and 1.2 million women live in counties with no health centers that offer the full range of contraceptive methods, according to Power to Decide, a nonprofit that aims to advance sexual and reproductive well-being.
Those who live in contraceptive deserts “are more likely to be people of color and those living in rural communities, all of whom face systemic inequities in access to health care,” said JeNeen Anderson, senior director of health equity at Power to Decide. “They have to travel farther, arrange more childcare, and take more time off work to get the birth control they need.”
“Reasonable access” is considered to be one health center for every 1,000 women in need of publicly funded contraception, based on the ratios developed for the Hospital-Specific Physician Requirements Model in 2012. To track contraceptive deserts, Power to Decide created an interactive map that depicts the availability of health centers in each county across the country.
“There’s a lot of overlap between abortion-banned states and states with high numbers of contraceptive deserts, so having access to emergency contraception in colleges is critical,” said Amy Moy, co-CEO of Essential Access Health, an California-based organization that works to advance sexual and reproductive health.
In January, Power to Decide announced a student-led initiative that targets historically black colleges and universities, many of which are located in the South, according to Anderson. The organization partnered with five HBCUs located in contraceptive deserts to address the sexual and reproductive health needs at each school.
Cumberland County, for example, is home to Fayetteville State and has four health centers for the nearly 29,000 women aged 13 to 44 in need of publicly funded contraception services that reside in the area.
Demand felt across the country
This need for contraception and abortion access increased immensely since June 2022, when the Supreme Court issued its decision on Dobbs v. Jackson Women’s Health Organization and ended federally legalized abortion, according to Anderson.
“Post Dobbs, especially in states with abortion bans, we have seen clinics close. Some hospital labor and delivery units have closed as well. These changes are contributing to increasing disparities in sexual and reproductive health care,” JeNeen wrote. “Chipping away at abortion care and birth control access makes all other forms of health care vulnerable.”
Taylor Riley, a doctoral candidate in epidemiology at the University of Washington, was part of a broad student coalition that secured a $200,000 budget from the state beginning in 2024. This budget – the first of its kind in the country – will be available to community colleges, universities and technical schools across the state to implement their own emergency contraception vending machines.
The University of Washington installed its vending machine in November 2022 following months of student-led efforts. It sold more than 600 emergency contraceptives in the first three months, Riley said. However, she noted that although the university’s Seattle campus has access to the machine, “this need is not being met for students across the state.”
Eagen-Torkko expressed concern that emergency contraception vending machines “are not being deployed equitably.”
UW’s Bothell campus, for example, does not have a vending machine despite being the only University of Washington site without a health center on campus. Bothell is also located near Snohomish County, which has nine health centers for nearly 39,000 women who qualify for publicly funding contraception.
“We are trying to organize with folks across the state because this is a big need across campuses across the state, particularly those campuses in more rural areas where access to health care of pharmacies is harder,” Riley said.
Boston University unveiled its emergency contraception vending machine in March 2022. With over 1000 morning after pills sold since, the student response was widely positive and some have noted that access to the machine saved them in time of need, Pike said.
“We have people messaging us, asking us where it is and then thanking us for having it there because it’s very helpful,” Pike said.