1965: The right to contraception
The pink pouches are sealed with stickers, cheerful as gift bags. Inside: no branded merchandise or flavored lip balms. Instead, the quasi-favors are stuffed with pills. The people who pack them — who source the pills, who keep the spreadsheet tracking their disbursal, who organize the confidential handoffs — chose these pouches in part because of their saturation. The wash of pink obscures the contents. It’s no one’s business who’s taking Plan B on campus.
That’s the operating principle of a student-led effort at Loyola University Chicago called EZ EC, which makes the morning-after pill available to whoever wants it, whenever. No explanations, no prescription, no lectures. Volunteers with EZ EC — founded last year — deliver four to five orders of the morning-after pill per week. Last semester, organizers completed 70 handoffs. It might sound improbable that an organization like EZ EC operates on a Jesuit campus. But Andi Beaudouin, who helped launch it, sees its success as a simple matter of fact: “It’s like, if universities aren’t going to do it, we have to. Because students deserve it.”
From Texas to South Carolina to California to Illinois, students on at least a dozen campuses have built ad hoc fulfillment centers like EZ EC to provide Plan B to their peers, circumventing both pharmacies and traditional student health centers. In the process, as access to other reproductive services has been rolled back nationwide, the peer-to-peer distribution networks — part of a loose national federation called EC4EC (Emergency Contraception for Every Campus) — have modeled a radical approach to care in an era in desperate need of new tactics.
Within a matter of hours after the Supreme Court overturned Roe v. Wade in June, the United States — which had long been a patchwork of uneven abortion law — became even more dangerous for pregnant people. The same week that the court announced its decision, sales of morning-after pills like Plan B surged. One company reported that demand for its form of the contraceptive had tripled.
The reasons for the run varied. Some people wanted to secure boxes to ensure a pipeline of pills for their adolescent and college-aged children. Some ordered the pill out of a desire to reassert control over their own reproduction. Some worried that the medication would soon become a legal target after Justice Clarence Thomas wrote in a concurring opinion in Dobbs v. Jackson Women’s Health Organization that perhaps it wasn’t just Roe that needed to be reviewed, but also cases like Griswold v. Connecticut, which sanctioned birth control for married couples and was later used as the basis for its more widespread legalization.
Whatever the precise explanation for the sudden sales, it was about to become much harder to obtain a legal abortion. The morning-after pill — designed for the kind of emergencies the name indicates — was suited to the moment. The all-volunteer staff of EZ EC felt it too: the scramble, the fear. “When the Dobbs decision came out, we all got together and cried,” Beaudouin, now 20 and a junior, tells me. “It was during finals week; it was terrible.” Amid that collective mourning, their Instagram account filled with direct messages from terrified students.
In the three hours after the decision was released, Beaudouin and their friends raged and commiserated, and debated what to write in a statement to post on Instagram. Then the shock settled, and students affiliated with Students for Reproductive Justice — the umbrella organization at Loyola that advocates for access to contraception on campus — considered what people needed to hear from them. “We as SRJ stand with our fellow students and will continue to be a resource for contraceptives and education,” the eventual statement read. It went on to frame its conviction in terms that the university administration could perhaps understand: “An essential Jesuit Value is Cura Personalis, care for the whole person, which must include respect for reproductive freedom.” The work that EZ EC does has been subversive from the start, in defiance of the bigger and more powerful institution whose students it serves. That work would continue. In the wake of Dobbs, and bolstered by their Instagram declaration, Beauduoin recalled, “We felt more concrete in our roles as providers.”
EC4EC was dreamed up more as a tool kit than a movement. It was meant to answer the deluge of questions that Kelly Cleland — who runs the nonprofit American Society for Emergency Contraception, which advocates for access and coordinates collaboration between advocates and providers — started to receive around 2017, when national news outlets began picking up local stories about a wave of college campuses installing vending machines that dispensed Plan B. Cleland is a researcher at heart, having spent over a decade in the Office of Population Research at Princeton University. She has long studied the persistent barriers that can keep people from getting their hands on birth control, and so the trend interested her. She wondered whether she could get more involved.
To outsiders, the vending machines sounded like a gimmick. But Cleland knew better. While Plan B and its ilk have been sold over the counter without age restrictions since 2013, students have continued to report obstacles to acquiring them. The medication costs too much. Or the pharmacies near them have failed to maintain a reliable stock. Some cashiers still don’t know or care to abide by the rules that require them to sell the pills without asking for ID.
Vending machines — which students the world over know how to use — presented a new and appealing point of sale, solving several problems at once. Unlike most bricks-and-mortar businesses or student health centers, vending machines are open 24/7. Most address cost too, stocking generic medications like one called AfterPill for far less than the name-brand equivalent.
On the West Coast, undergraduates at a spate of universities, including Stanford, petitioned for the machines to be installed, and succeeded within months. Others followed suit. Young people had to seek approval from their administration and spearhead the fundraising required both to procure the machine and to bulk-order contraception. Student leaders had to coordinate with the facilities departments that keep vending machines stocked on a given campus to ensure that the medication was available. But once a machine was operational and the matter of who needed to refill it was settled, it could operate without much oversight.
Cleland and Nicola Brogan, a nurse who works as a project manager at the American Society for Emergency Contraception, wanted to be able to advise students interested in landing a vending machine on their campus. It seemed to both like the future of access: birth control, sandwiched between foil packets of Advil and Gatorade.
It was a nice idea until students from Catholic and evangelical schools wrote to Cleland, pointing out that their colleges would never sanction the sale of contraception on campus. “We realized there’s a lot of places where there’s never going to be that vending machine,” she told me.
And so, while Cleland and Brogan continued to champion vending machines at amenable universities, the pair formulated a lower-tech alternative: a peer-to-peer distribution network, built on the hunch that students would trust their peers to provide them with the pills at low or no cost. Cleland reasoned that a human infrastructure could be established and maintained, even though students are transient presences on college campuses. The approach would be resilient, able to withstand changing attitudes in an administration. It was simple, too — faster to get up and running than a vending machine. And it was less sensitive to legal judgments. Vending machines required permits and approvals. No one has to sign off on the creation of an off-campus association.
Cleland and Brogan consulted legal experts, who explained that as long as medication was stored at an appropriate temperature and not given out past its expiration date, students could not be found liable for handing it out. Deans could avert their gaze if it offended them. No law prevented the practice.
In 2020, Cleland and Brogan unveiled EC4EC. The two drew up a list of items to include in starter kits. Brogan consulted with millennial and Gen Z activists. She and Cleland assembled a board of recent graduates from a range of colleges and universities who could advise participants. Cleland waited for calls. Beaudouin was soon on the other end of the line.
When Andi Beaudouin embarked on their first fall semester at Loyola in Chicago, the pandemic was in full swing. It was 2020 and classes were online. Opportunities to meet fellow students were slim. But Beaudouin lived in the area and so heard about a beloved event that Students for Reproductive Justice puts on once a week. Volunteers meet on a corner, just past the boundaries of campus, and hand out condoms to passing students. The vibe is sex-ed-meets-celebration. Intrigued, Beaudouin attended an SRJ meeting and received a more comprehensive sex education presentation than high school had ever attempted. “I was like, ‘Wow, this is so sad that I’ve never had this before,’ ” Beaudouin recalls. They joined on the spot.
In 2021, someone raised the issue of the morning-after pill in a meeting. Previous student leaders had wanted to distribute it, but momentum had stalled, and setting up a structure to do it had proved daunting. Someone needed to lead the effort. Beaudouin looked around and saw no takers. “I was like, ‘I’ll do it.’ ”
Beaudouin reached out to Cleland, who explained what it would take to initiate the program. From there, Beaudouin enlisted a team of committee members who enrolled in language-training courses to be as sensitive as possible about distribution; composed scripts for all communication with recipients so as not to overstep legal boundaries; and developed a protocol for stocking supplies, answering queries and executing deliveries. Cleland sent them a starter kit, complete with several boxes of Plan B to prepare for the launch.
Each committee member has designated tasks, such as wrangling spreadsheets or managing social media. Some work is shared: Windows for deliveries are divvied up; the entire committee monitors the inbox where requests come in. After a recipient has verified that she’s read the resource guide and that the medication will be taken within 72 hours of unprotected sex, EZ EC orchestrates a handoff via a Google Voice number. EZ EC — like the other chapters that are part of EC4EC — does not charge for pills, which can retail for $25 to $50. It gets them at a discount and can place bulk orders through a deal with one of the generic makers. Its leaders tell me that most recipients choose to make the suggested donation of $8 to cover the cost that EZ EC incurs for each dose it receives from its wholesale supplier. SRJ organizes an annual fundraiser to cover the rest.
The process is not much more complicated than getting Domino’s delivered. But it is a far more profound experience. This generation of students has been raised in a world of crises so existential that even beginning to address them can feel impossible. When EZ EC organizer Skylar Kanine volunteered to do this work, the scale was part of the appeal. It has made her feel like she can make an actual difference in the lives of people she knows. She mentions the 70 orders from last semester and marvels: 70 people. “It feels so good to feel like I’m doing something,” she says.
The members of EZ EC relish the impact, but the tone and protocols of the organization are borderline prosaic. Beaudouin believes getting basic health care shouldn’t have to be dramatic. To that end, SRJ has a saved Instagram highlight that explains how to place an order with EZ EC. Most users stick to the basics and provide just the required information; they are appreciative without being confessional. “A lot of the girls who order EC from us — it’s like we give them an example in the demo of what to tell us, and people will just have that text copied and pasted,” Beaudouin reports. “We’re like, ‘Cool,’ and we move on. It’s nice that people don’t feel the need to overshare.” (If there’s an exception to that rule, it tends to come from male partners. Beaudouin laughs, recalling their earnest notes: “It’s hilarious and so endearing. I’m just like, ‘Thanks for this very graphic description of your intercourse. Yes, I can give you EC.’ ”)
Once, a student who had been enrolled at Beaudouin’s high school reached out, requesting that Beaudouin be the one to drop off the medication. “We’d never gotten a request for a specific person before,” Beaudouin remembers. “I recognized the name, but I wasn’t sure. I handed it off to her, and she was like, ‘I was just afraid that someone else would judge me for this. You’re the person I felt comfortable with.’ ” The girl was new to college. She hadn’t known whom else to ask.
For Cleland and Brogan and Beaudouin and Kanine, trusted networks are the future of reproductive care, whatever the legal status of abortion and birth control: Whether it’s coalitions of students or doctors or pharmacists or activists, it will fall to grass-roots efforts to shore up access. That means taking risks now before the legal status of birth control is further jeopardized.
In a paper published on its website in June 2022, the National Women’s Law Center outlined threats to birth control. The paper stated that attempts to legislate birth control would increase after the Dobbs decision — and Justice Thomas’s accompanying invitation to reconsider Griswold — but stressed that legal challenges were not new. Antiabortion politicians demonized birth control long before Roe was overturned. Their work relied on a favored bit of misinformation: the claim that some forms of birth control, the morning-after pill notable among them, work to induce abortion and must therefore be restricted.
“It is a prime target,” explains Mara Gandal-Powers, the director of birth control access and senior counsel for reproductive rights and health at the women’s law center. “We see folks conflating birth control with abortion, and EC is on the front lines of that.”
To be clear: The morning-after pill works as a contraceptive because it releases a flood of hormones that staves off ovulation. Without ovulation, fertilization cannot occur. Plan B almost certainly does not — counter to some outdated label information that advocates have begged the Food and Drug Administration to correct — prevent the attachment of a fertilized egg to the uterus. Legal experts like Gandal-Powers believe it should be permissible even in states that have enacted the most extreme “fetal personhood” laws, although she points out too that no one requires the law to bow to science.
For now, birth control is legal. Gandal-Powers isn’t sure if that will remain true. Skeptics can claim fearmongering, but those who wish to see contraception banned have gotten to work. In Idaho, the general counsel for the state’s public university issued guidance that suggested its campuses should stop offering birth control for students and warned staff that speaking in support of abortion could invite prosecution. The guidance identified the “unclear and untested” nature of the antiabortion trigger law that took effect in Idaho in August to explain its “conservative approach.” Later, officials revised the memo and said that birth control would continue to be offered on campus, but the flip-flop did not inspire confidence.
Cleland keeps tabs on state laws that could affect her contacts. The Idaho guidance seized her attention. She wanted to know how the rule would be applied to students. Could they hand out contraception even if staff were barred from doing so? The walked-back guidance doesn’t spell it out. “We don’t know,” Cleland admits. “The last thing we want to do is put students at risk, but I think a lot of them are willing to put themselves out there.” She and Brogan serve as sounding boards for the people who lead EC4EC chapters, but in the end, it is up to the students to set their own boundaries — and to take their own chances. So it was in the pre-Roe era, when college students helped found the underground abortion service that would come to be known as Jane. So it will be now, if access to birth control is further curtailed.
In the meantime, women consider their options. After Donald Trump was elected in 2016, interest in intrauterine devices — better known as IUDs — spiked. A journal article later published in JAMA found that in the month after that race was called, insurance claims for IUDs — which can be implanted for up to a decade as a semi-permanent contraceptive — rose more than 21 percent among women with commercial insurance. Doctors have reported a similar swell now. Over the summer, Democrats introduced legislation that would have protected access to contraception at the federal level. A handful of Republicans voted with House Democrats, but more backed a GOP countermeasure that would have allowed people over 18 to access FDA-approved birth control without a prescription, while excluding drugs like Plan B. Democrats swatted it down, and the debate in Washington continues. Yet the truth is apparent not just to people like Beaudouin, but in the market: Undergraduates will continue to need access, no matter how the law shakes out.
In September, a new morning-after pill hit the shelves in all 4,500 Walmart stores nationwide. (It’s also available online.) Julie — which was designed to appeal to Gen Z users and shrug off the stigma of traditional morning-after pills — isn’t a steal at $42. But for each box sold, one is donated to brand partners, including college-campus organizations.
The EC4EC network continues to grow. Brogan estimates that she and Cleland have been in touch with students on over 60 campuses. At least a dozen are working with her consistently. Student leaders have grand plans for what comes next. Kanine wants SRJ to start offering free testing for sexually transmitted infections on campus. And, though she concedes it would be a logistical nightmare, she would like to see EZ EC explore whether it can make medication abortion available to students too.
Beaudouin is thinking ahead — to their graduation in December 2023 and past that. “It makes me sad,” Beaudouin says. “I don’t want to let go of it, but I’m going to have to.” The next micro-generation of leaders will have to put their own stamp on the project. “It’s bittersweet,” Beaudouin continues. “It’s just like, ‘Oh, I don’t want to lose this.’ ”
Kanine will graduate six months later. She plans to continue working in the reproductive-justice space. It’s inconceivable that, after all this, she would do something else. But she is determined to train the new EZ EC organizers before she goes: “We want to build a strong foundation because campus officials and admin keep thinking we’ll disappear. And we haven’t because we keep bringing people up and lining them up to succeed us. That’s the strongest thing we do. We’re still here.”
Mattie Kahn is a writer in New York and the author of the forthcoming book “Young and Restless: The Girls Who Sparked America’s Revolutions.”