As the first stop for students looking for cold medicine, condoms and counseling, the Counseling and Wellness Center (CWC) is an essential resource on campus. But for some students looking for a birth control prescription, the CWC’s services are either too costly or invasive.
Second-year Julia Scully received a contraceptive prescription at the CWC in her first year relatively simply.
“She wrote me the prescription, no tests, no invasive procedures, no cost, no nothing,” Scully said. However, when she came back to campus after summer vacation and attempted to renew her prescription, Scully was told she needed to have an additional procedure which would cost $150. Scully was told this exam was required for her health and safety.
The Well Woman Exam, consisting of a yearly pap smear, gonorrhea, and chlamydia screening, is required for anyone wishing to obtain a prescription for a method of birth control from the CWC. A pap smear is the procedure used to screen for cervical cancer and involves the collection and testing of material swabbed from the upper cervix.
“Unfortunately [our birth control services are] pretty limited,” CWC Program Director Dr. Anne Fisher said. “The clinic we have is really meant to be a basic health clinic, like a walk-in clinic.” Fisher added that with more resources and money, the CWC would be able to focus on expanding and cheapening their reproductive health services. “Our health fee was not able to be raised for a while and we actually had to cut our hours,” Fisher said.
“I think it is great that the CWC offers this service for students who want it, but to require it for a birth control prescription is unnecessary and restrictive for students who cannot afford it, or do not need it.” third-year Annie Rosenblum said. Rosenblum is a member of Generation Action and InterACT and was the Health Center Advocacy intern at Planned Parenthood. Rosenblum continues to volunteer as a patient escort.
According to Fisher, the equivalent exam at Planned Parenthood costs around $218 and may reach $300 at a private practice. For students without insurance, the CWC rate is the most inexpensive option. While the CWC undoubtedly offers the procedure at a low cost to students, the question remains whether it is necessary for most of those seeking contraceptive care.
“In order to make sure there is no medical problem, we need to basically perform the pelvic exam,” CWC Dr. Ahmad Sahebzamani said. “We need to know the status of any kind of inflammation or reason not to prescribe. I’m going to do the pap exam no matter what.”
“It places a financial barrier to people seeking contraception, and requires people to go through unnecessarily invasive exams that have no reasonable benefit when providing appropriate contraception,” alum Cassandra “Cassie” Corrado ‘11 said. While at New College, Corrado was very involved with VOX (Voices for Planned Parenthood), founded the Sexual Health & Relationship Education (SHARE) Resource Center and regularly organized sexual health and education events on campus.
“I can understand that people might not want to get a pap, that it feels kind of invasive, if I had a daughter and she were sexually active, I would want her to get a pelvic exam just for her health,” Fisher said. “You may not choose to do that but I would want to.”
“Unless someone has known or potential health risk factors, they should be able to receive birth control by simply having a conversation with their chosen healthcare provider,” Rosenblum said.
The American College of Obstetricians and Gynecologists (ACOG) reported in 2012 that birth control pills may be safely prescribed to those without unusual risk without a full pelvic exam and pap smear. However, many doctors have continued to administer these tests. Nearly half of doctors in 2010 reported regularly requiring a pelvic exam for contraceptive prescriptions.
“The [Centers for Disease Control and Prevention] (CDC) has come out with new guidelines, or advice, that says that people under the age of 21 do not need to have a pap,” Fisher said. “However CDC guidelines are completely based on what the CDC research has said, and medical practitioners always have their own practice.”
According to a joint report on cervical cancer screening guidelines from the ACS, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology, “Screening adolescents leads to unnecessary evaluation and potentially to treatment of preinvasive cervical lesions that have a high probability of regressing spontaneously and that are on average many years from having significant potential for becoming invasive cancer.”
In other words, screening young adults for cervical cancer before age 21 may result in a false positive result and lead to unnecessary procedures for precancerous cells that will likely be handled naturally in a person with a healthy immune system.
“You can get diagnosed with cancer when you don’t have it,” Scully said. “That’s not for my safety. What is the CWC for if we can’t have access to care as students?”
The report concludes, “This overtreatment, and subsequent increased risk of reproductive problems, represents a net harm.” The same report offers that, for those over the age of 21 with no more than average risk factors, pap smears should never be administered more frequently than every three years.
These recommended guidelines have also been supported by the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists (ACOG). ACOG qualifies that those with HIV or weakened immune systems should receive pap screenings as soon as possible. Moreover, for those with healthy immune systems, pelvic examinations may detect HPV, the virus that leads to cervical cancer, although 90 percent of these infections are resolved by the immune system.
“There are different debates about birth control, but the debate is about punishing women and people with vaginas,” Scully said.
Planned Parenthood offers a birth control option without a pelvic exam for those who qualify. This is only possible for hormonal contraception and is not an option for those with higher than average risk factors. Planned Parenthood still recommends regular health screenings for sexually transmitted infections and cervical cancer starting at age 21 or “three years after your first vaginal intercourse,” according to their website.
The CWC is not the only resource on campus for contraception. “Outside of the contraception that the CWC offers, students like me who are involved in Generation Action and InterACT do our absolute best to make sure that the student body has constant access to a variety of contraception/sexual health resources: condoms, dental dams, lube, etc. all located in the SHARE center,” Rosenblum said in an email. “It is up to us to find all of these resources ourselves, for free, which can sometimes be challenging. Whenever the SHARE room is not stocked with enough of something, it is usually because we are having a hard time finding the resources, our shipment is late, or something along those lines. We fully believe that students need and deserve every resource possible to have a safe, healthy, and consensual sex life, and if the SHARE center is ever lacking something, it is not because we don’t care, but because we are working really hard behind the scenes to restock whatever is needed.”
In addition to the resources listed above, the NCSA and the CWC have emergency contraception, or Plan B, available at no cost. Fisher noted that no questions are asked of students who pick up Plan B, although they do need to make an appointment.
Information for this article was taken from cdc.gov, acog.org, cancer.org, plannedparenthood.org.