by Allison Stevens

When Emory University incoming senior Nora Kleinman discovered last winter that the cost of NuvaRing, her preferred method of birth control, had nearly doubled at her campus health center- going from $27 to $44 a month-she was forced to make a quick decision: find a way to come up with an extra $204 a year or switch to her parents' insurance plan, and thus give up the privacy she had enjoyed at the student health clinic. "Everybody's fairly irritated about it," says Kleinman.

"Myself and so many other women I know were depending on health services at universities for cheap and affordable contraception."Millions of women who purchase contraceptives at student and community health clinics across the country have seen prices go from about $10 a month to anywhere between $30 and $50. Such out-of-reach prices are putting intense financial stress on women who can't afford to pay retail for birth control. And the pressure goes beyond the individual level: Some family planning clinics serving low-income women may be forced to shut down if prices aren't soon reduced, leaving poor women with even fewer resources to determine the number and spacing of their children.

Among college undergraduate women, some 3 million of them (39 percent) use oral contraceptives, while others use NuvaRing, the contraceptive patch and other forms of birth control, according to the American College Health Association. Those who cannot find a way to come up with more cash are being forced to switch to an alternative make or method of birth control, says Mary Hoban, a director of the association's National College Assessment Program. Some university health centers and clinics have now even stopped carrying devices such as NuvaRing-a popular method which delivers contraceptive hormones through a vaginal insert-because of their increased price.

For many women, changing birth control methods or makes is not easy. NuvaRing and the patch have no generic alternatives, and women are often reluctant to switch brands of oral contraceptives after finding a good fit without undesirable side effects.

The soaring costs are the result of an obscure provision in the Deficit Reduction Act of 2005 that stripped away a long standing incentive encouraging drug companies to provide steeply discounted birth control to certain low-cost health-care providers. The law took effect in January, forcing many health clinics across the country to ratchet up their prices. Some temporarily defrayed costs by stockpiling drugs before the law took effect, but those reserves are rapidly depleting.

Pro-choice advocates see the change as part of a broader attack on contraception access. "It's a horror," says Rep. Carolyn Maloney (D-N.Y.), who has led the fight in Congress to preserve access to birth control. She points to U.S. pharmacists refusing for personal or religious reasons to fill birth control prescriptions, and four states- Arkansas, Georgia, South Dakota and Mississippi-enacting laws allowing them to do so. She also cites a crackdown on birth control by anti-choice Republicans in Congress and the White House. In 2002, the Department of Defense approved a plan to make emergency contraception (EC) available at all military treatment facilities, but political appointees later reversed the decision. And in 2004, the Department of Justice did not include EC in its recommendations for treating sexual-assault victims-an omission Maloney calls intentional.

In every year he has held office, Bush has sought to freeze Title X funding, which pays basic operating costs at more than 4,500 family planning clinics serving millions of low-income women. Congress nonetheless approved slight increases in Bush's first five years, but those were not enough to keep up with inflation. In fact, taking inflation into account, Title X funding is now 61 percent lower than it was in 1980, according to the National Family Planning and Reproductive Health Association. Had funding levels merely kept up with inflation, clinics would now receive more than $725 million a year; instead, Bush wants to freeze Title X funds at last year's $283 million level.

Meanwhile, anti-choice Republicans have found pots of money to pour into abstinence-only programs, which gag educators from discussing contraception outside the context of its failure rate. Critics have long questioned the efficacy of these programs, and they got a clear answer in an April report conducted on behalf of the Department of Health and Human Services: It showed that abstinence- only education does not prevent young people from having sex, nor does it influence the number of sexual partners they have or the age they first engage in intercourse. Still, federal funding for abstinenceonly has exploded from $80 million in fiscal 2001 to $176 million, according to NARAL Pro-Choice America.

What has shocked reproductiverights advocates is that Democrats in a House Appropriations subcommittee voted to approve $28 million in additional funding for communitybased abstinence-only education. In turn, the subcommittee also approved a $28 million hike in Title X family-planning funding. But the advocates thought the compromise both unnecessary and wrong: "There is no other way to describe this concession but as shameful," reads a statement from William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States.

Other Democrats continue to push a pro-family-planning agenda, however. House Speaker Nancy Pelosi wants to change the language in the Deficit Reduction Act to bring down the price of birth control at health clinics, while other rank-and-file Democrats are promoting bills to require that the Justice Department mention EC in sexual-assault treatment recommendations and the Defense Department make EC available at all military treatment facilities.

And they're counting on support from Senate Majority Leader Harry Reid (D-Nev.) and House Rules Chair Louise Slaughter (D-N.Y.) to push through the Prevention First Act, which would ease access to contraception, require insurers to cover birth control, increase funding for comprehensive sex education and ensure that women can get their birth control prescriptions filled. The prevention push is also playing out in the states: Between January and June 1, state legislators introduced 151 measures aimed at preventing unintended pregnancy, and eight states passed pregnancy-prevention laws.

Still, with a majority of federal lawmakers opposed to access to full reproductive health care, and a president who bends to the will of antichoice leaders, progress is slowgoing, says Mary Jane Gallagher, president of the National Family Planning and Reproductive Health Association. She notes the huge disconnect between a vast majority of voters who support unfettered access to birth control, and their government representatives who are unduly influenced by a small but powerful faction of conservatives.

"We're not there yet," Gallagher says. "Clearly, the conservative right made some serious inroads into policymakers and so it's not going to happen overnight."

Allison Stevens
© 2007 Ms. Magazine