While most media coverage of the almost decadelong legal battle against the Affordable Care Act’s (ACA) birth control benefit focuses on the impact it might have on workers, I know from personal experience the impact it might have on college campuses, especially Catholic schools.

Last week, the Little Sisters of the Poor argued before the U.S. Supreme Court in the latest legal salvo against the popular birth control benefit, which guarantees access to contraception approved by the Federal Drug Administration (FDA) at no additional cost or co-pay in most employer-sponsored health plans. Both the nuns at Little Sisters and the Trump administration are looking to blow a hole in the benefit, giving any employer the ability to deny providing contraception coverage.

Conservatives’ fight against the birth control benefit has gone to the Supreme Court multiple times, and there’s a good chance the Court will rule in support of religious institutions once more. 

The impact will be felt by students, professors, graduate students, student employees, and other staffers on Catholic college campuses. Catholic colleges are already given free rein to deny contraception to undergraduate students who may not know other resources to access birth control. Solicitor General Noel Francisco estimated 75,000 and 125,000 people would lose contraception coverage.

Lauren Morrissey, a 2020 graduate of Loyola University Chicago, a Catholic and Jesuit school, told Rewire.News she’s worried about the impact that losing university-sponsored health insurance will have on those already struggling to access contraceptives. Birth control “can cost hundreds of dollars, and as college students, you don’t have hundreds of dollars just to throw around most of the time,” she said. 

I chose a Catholic university for undergraduate studies because it offered the most financial aid. When I got there, I had to find out from other students that the university didn’t offer similar health-care services that other colleges did. We didn’t have access to contraceptives, resident assistants were told not to provide them, and when student activists set up a hotline to provide condoms and emergency contraception, they risked punishment from the university.

Though Catholic colleges doggedly recruit students, including those from non-Catholic backgrounds, many retain restrictive health policies to meet “Catholic values.”

Jamie Kessler, a rising senior at Loyola Chicago, said she had no idea what to expect once she started college, which she chose based on the financial aid package she would receive.

“I was completely ignorant of the extent of Catholicism’s viewpoint on this,” Kessler said. “I’m Jewish, so I had no idea, and I’m from Tennessee and there also aren’t a lot of Catholic people in Tennessee. It was only when I got to Loyola and then started talking to people that I realized that oh, this is actually a really big problem, this lack of access.”

So what do you do if you need contraceptives on a college campus that intentionally makes it hard to access them? There are some workarounds. Most Catholic schools will provide some reproductive care in their health centers, so long as you don’t say you need it for sex. But even that has unintended negative consequences, Morrissey said.

Mauna Dasari, a doctoral candidate at the University of Notre Dame, chose the school because it was the only place she could research her niche area of biology. When she started her doctoral program, she was on the pill, and was able to say she needed it for cramps. When she decided to get an intrauterine device (IUD), she was unable to get it through her graduate student insurance and had to pay paid around $600 out of pocket to circumnavigate Notre Dame. Why? Because unlike the pill, which some use to control their acne or menstrual cramps, IUDs are specifically for contraception.

“It’s a hassle,” Dasari said. “You have these people that you’ll never meet acting super paternalistic to you—even though you’re in your mid-to-late twenties and have worked and been in charge of your own health care for a number of years at that point—telling you that they supposedly know better than you.”

Students pushing for contraceptives on campus are told they should transfer or, according to Loyola New Orleans student Claire Lyons, are given a map of places they can buy contraceptives locally.

“It’s always like, ‘Why can’t you just walk to CVS and buy a pack of condoms?’” Morrissey said of the dismissive attitude of critics, which include both school administrators and, sometimes, anti-choice or economically privileged students.  “And I think that is genuinely a misrepresentation of the people that Catholic universities are serving, and that there are people at our schools that need access to this care and that rely on the university for their health care.”

Christina Frasik, a 2018 Loyola Chicago graduate who’s a medical student in Albany, New York, said a health counselor at a university directing a student to a pharmacy for their health-care needs is not providing health care. She knows this from personal experience early in college, after she was in a situation where a condom broke.

Frasik said if she had attended her partner’s school, she could’ve “easily turned to the student clinic” for emergency contraception. “But because I happened to be at a Catholic university, there were so many barriers in my way to accessing care,” Frasik said. “I think so many people will say, ‘Why couldn’t you just go to CVS and pick up Plan B?’ And just like with so many sexual and reproductive health-care questions, it’s so much more complex than that. I think so many people don’t recognize for emergency contraception that for women and other individuals of a certain weight class, those medications just don’t work, and your only option is really a copper IUD.”

Students across the country have informally organized on Catholic and some Protestant campuses for many years to provide health care that their university denies. In partnership with local unaffiliated clinics, students have set up hotlines to provide condom drops, crowdsourced funds to purchase Plan B for students, and distributed sexual health education.

They do this at risk of disciplinary action from their school administration, including academic probation. While some of the student organizers I spoke with didn’t see their schools’ Catholic identity as an appealing factor, some did, and all the undergrads said Catholic social teaching is part of why they stayed—and part of why they organize there for reproductive rights.

Morrissey, who along with Frasik are cofounders of Students for Reproductive Justice at Loyola Chicago, attended a progressive Catholic high school that inspired her passion for social justice.

“As this movement has grown and the more time I’ve spent in it, I really actually see my Catholic faith intersecting with reproductive justice in a weird way, when you really consider Catholic social teaching and preferential access for the poor,” Morrissey said. “It’s so frustrating to me that you can talk about ‘care for the whole person’ but not talk about sex and not talk about reproductive health.”

These students often work with other groups organizing around other issues seen as “controversial” under Catholic teaching, such as LGBTQ rights. Students pointed out that if the schools recruit from non-Catholic and marginalized backgrounds, they should be prepared for them.

In 2018, after Frasik and Morrissey proposed the idea, students from Loyola Chicago, Notre Dame’s Irish 4 Reproductive Health, an independent coalition of Notre Dame students, and Georgetown University’s H*yas for Choice, created a national Student Coalition for Reproductive Justice (SCRJ)  There are now several campuses nationwide in the coalition, including Seattle University, Loyola New Orleans, Santa Clara College in California, and colleges throughout the Midwest, such as the University of St. Thomas in Minnesota.

In partnership with the National Women’s Law Center, the Center for Reproductive Rights, and other groups, SCRJ member Irish 4 Reproductive Health filed a lawsuit against Notre Dame and the Trump administration for violating the ACA’s birth control requirement. The case will be impacted in some way by the Supreme Court’s decision on Little Sisters of the Poor v. Pennsylvania.

An estimated 870,000 students were enrolled in Catholic colleges and universities in the 2017-2018 school year. “That’s a massive number of people to then have their reproductive health care accessibility really cut down and limited even further than it already is,” Frasik said. “I think it’s going to make so many of these student chapters and organizations so much more influential and necessary on campus because there really isn’t going to be anyone else.”