No Contraception on Campus

Abortion laws and outsourcing are changing college health

My Facebook feed this week is full of friends dropping their kids off at college and setting up dorm rooms with comforters, fairy lights, and pillows that look like the family dog. While accessories have gotten so much cooler since I was in college (how much fun could I have had with peel-and-stick wallpaper alone), one thing we did have in college that today’s students might not get is birth control.

It’s actually how I got my start in sexuality education. At UMass-Amherst, if you wanted a prescription for the pill or a diaphragm (yes, those were still a thing), you had to go to a workshop at the health center where a peer-educator (me) would take you through all of your options and show you a reel-to-reel movie that we dubbed “Marcia Brady Gets a Pelvic” because it was a relic even then. Participants were mostly pissed off about having to attend but they went into their provider appointment with a stamped attendance form and a lot more knowledge and left with the contraceptive method of their choice.

We could also get emergency contraception if needed, even though EC hadn’t been FDA approved. Providers at the health center would give you a prescription for a package of birth control pills and instructions on how to take them for “morning after” purposes. We even had a nun who counseled patients considering an abortion, and she didn’t try to talk them out of it.

We didn’t realize how lucky we were, and it certainly never occurred to us that our daughters would have trouble getting these services but that might be happening. Between restrictive state laws against abortion and the outsourcing of health services, some college campuses will be very different this year. 

Oberlin College in Ohio is not known as a conservative institution—it was the first college to allow women and among the first to allow Black students—nor is it a religiously affiliated. In an effort to save costs, however, the college abruptly fired all of the health center staff and outsourced those services to Harness Health Partners, which is a subsidiary of Bon Secours Mercy, a Catholic health system.

How this partnership will affect students is not yet clear. Oberlin President Carmen Twillie Ambar assured students in her welcome back letter that the campus health center would continue to offer birth control, emergency contraception, STI testing, and even referrals to abortion. A spokesperson for Bon Secours Mercy, however, said that they only offer contraception when “medically indicated” and only give EC prescriptions to those who have been sexually assaulted. It also appears that any prescriptions that are given for contraception would have to be filled off campus.

This is not what students at Oberlin are used to. A former health center staff person told the Chronicle Telegram that 40% of health center visits in past years were related to reproductive health and that the onsite pharmacy stocked many methods of contraception because students often lacked the transportation needed to get off campus. The staff person also questioned whether trans and non-binary students would still be able to get the gender affirming care that had been offered in previous years.

If it is true that birth control is not available on campus, President Ambar will have a lot of explaining to do. Over the summer she participated in a roundtable with Vice President Kamala Harris and other university leaders about the current state of reproductive rights. Ambar said: “I believe that being free to make decisions about one’s own reproductive healthcare and being enabled to access that care reflects the values of this institution.”  

I’m a couple of years from sending anyone to college, but the list-making has already started. In addition to distance from home, choice of majors, and size of campus, I suppose parents these days have to add availability of reproductive health services to our criteria list.

Texas Orthodontist Wants to Take Away Free Birth Control and PrEP, and He Might Succeed

People were being mean to John Kelley. He was a victim of cyberbullying and his business—he’s an orthodontist—suffered as a result. That’s what his lawyer said to the judge in a motion to change the name of the lawsuit he brought —Kelley v. Xavier Becerra et. al. While both the judge and Xavier Becerra (who is the Secretary of Health, by the way) were fine with the name change, I think we should have made Kelley stick it out. He got himself into this mess when he decided that as a small business owner who didn’t use birth control and isn’t at risk of HIV, he should not be forced to pay for insurance policies that cover these services and as a result, the rest of us shouldn’t get them for free.

Under the guidance of Jonathan Mitchell—a prominent Texas attorney who began his career clerking for Justice Antonin Scalia and is said to be a key strategist behind the Texas abortion law that wants to turn citizens into reproductive snitches—Kelley and a colleague sued the federal government. Their goal is to overturn much of the Affordable Care Act’s (ACA) preventative care mandate.

The ACA (affectionately known as Obamacare) requires most private insurance plans to cover a wide range of preventative care services without charging a co-pay. Some covered services include those that could be subject to judgement like contraceptive care, Pre-Exposure Prophylaxis (medication that can prevent HIV transmission), alcohol abuse counseling, and nutritional counseling to those at high risk of disease. Also included, however, are completely non-controversial services like colon cancer screenings and mammograms. (No matter how disgusting the preparation is, I have yet to hear of anyone who is morally opposed to colonoscopies.)

As we all remember, the contraception part of this mandate has been debated before both by nuns and the owners of a national chain of craft stores (all people who are clearly qualified to decide whether I get free birth control pills). Both plaintiffs argued that their religion opposed contraception and, therefore, they shouldn’t have to pay for insurance policies that cover it. Both won their cases forcing the government to find work arounds.

Kelley and his co-plaintiff are taking on the contraceptive mandate again but also extending the argument to other preventative services. The lawsuit explains that he “ …has no desire to purchase health insurance that includes contraceptive coverage because his wife is past her child-bearing years.” Similarly, “he does not want or need health insurance that covers Truvada or PrEP drugs because neither he nor any of his family members is engaged in behavior that transmits HIV." Moreover, and this is the part the Court may actually go for, he’s a Christian and is unwilling to purchase a plan “that encourages homosexual behavior and intravenous drug use.”

Oh, John, maybe you should stick to putting tiny rubber bands in the mouths of middle schoolers because clearly you don’t get it. Preventive services don’t make people sluttier, nor can you stop people from having sex by denying them protection. Blocking coverage for these services will just make it more likely that people get pregnant or sick.

While I really don’t care what John wants to pay for, he might like to know that when people get pregnant and sick, we all pay. According to a Surgeon General’s report, for example, every case of HIV prevented is thought to save $355,000 in lifetime treatment costs. Similarly, a Brookings Institute analysis of contraception found that a $235 million dollar Medicaid investment in contraception would save $1.32 billion dollars in future costs to taxpayers by preventing unintended pregnancies.

It’s not just about sex. Numerous leading medical agencies signed on to a statement against the suit saying: “Rolling back this access would reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable.”

The statement noted that the ACA opened up free preventative care for 150 million Americans and has led to an increase in colon cancer screening, vaccinations, and other chronic disease screenings as well as a reduction in racial and ethnic disparities in preventive care.

But, hey, who cares about those 150 million people if none of them are John Kelley or his post-menopausal wife.

A decision in the case—which is now Braidwood Management, Inc. v. Xavier Becerra et al.—is expected in the coming weeks and some legal experts believe the outlook is not good. The case is being decided by Judge Reed O’Connor of the U.S. District Court, Northern District of Texas who ruled in 2018 that the Affordable Care Act itself was unconstitutional.

Katie Keith, director of the Health Policy and the Law Initiative at the O'Neill Institute at Georgetown University, told NPR she is expecting a sweeping decision that “is likely to invalidate all the preventive care requirements” and that the decision will be immediately appealed to the Fifth Circuit. Keith actually expects that this case will go all the way to the U.S. Supreme Court.

The rest of us may be screwed, but at least John’s name won’t be on it in the history books.

Jerking off to Japanese Porn is Not Academic Research

The journal Qualitative Research has officially retracted a paper it published in April citing “a lack of clarity and hence ethics.” The article, by University of Manchester PhD-candidate Karl Andersson, was entitled “Using masturbation as an ethnographic method in research on shota subculture in Japan.” It drew criticism after it was published in part because it was based largely on the author’s own masturbatory experiences.

Shota is a genre of Japanese anime and manga that features young boys (typically around age 12). In the paper, Andersson describes it as comics or illustrations that “feature young boy characters in a cute or, most often, sexually explicit way.” (My in-house anime expert explained that it’s short for “shotacon”—the male equivalent of “lolicon” which is Japanese slang for a Lolita Complex.) Andersson said he was going to get into the minds of those who enjoy shota by interviewing them and by masturbating to their preferred material and recording his thoughts/feelings in detail. For the sake of “research” Andersson gave up all partnered sex as well as masturbation with any other types of pornography. (Oh, the sacrifices we’ll make for science.)

The paper got past two peer-reviewers but sparked controversy as soon as it hit the web both for the research methods and the material which many believe to be nothing more than child pornography. A spokesperson for the National Society for the Prevention of Cruelty to Children (UK) said: “That this research was published in a peer-reviewed journal is highly concerning…research publications, should be subject to proportionate but rigorous ethical review, including robust safeguarding checks.” Other academics questioned how a researcher’s own masturbation could be seen as a legitimate scientific method.

The University of Manchester said that Andersson did not conduct this research as part of his PhD studies, nor did he run it by the school’s research ethics committees. The school has suspended Andersson while it continues to investigate.

In a statement accompanying the official retraction of the study, the editors of the journal said they had to weigh the constant threat of censorship of academic research based on “arguments of moral offense” with the potential of sanctioning child pornography. Ultimately, they decided, the paper could cause significant harm because it “… legitimizes sexual activity involving sexually graphic illustrated images of children and young people, both as an activity in itself and as a research method.” They apologized to anyone who was harmed by the study.

This should serve as an important lesson for all you undergraduate, graduate, and post-doc students planning this semester’s papers: jerking off to porn is not considered academic research (just procrastination from the real work).