During the past year, students at the University of California, Berkeley, organized and advocated for adding medication abortion services to their student health center and for extending this service to health centers across the University of California and California State University systems. The actions of students quickly developed into a larger collaboration with reproductive health advocates, which led to drafting a bill introduced to the California Senate. While the bill currently is on hold for future reintroduction, it raises the issue of access to abortion care for college students.

According to the Guttmacher Institute, in 2014 women ages 18-19 received 8.2% of all abortion services, and women ages 20-24 received 33.6% of all abortion services provided in that year.1 Many women in this age range are pursuing undergraduate and graduate school education, and for those women, student health centers are essential for providing access to medical care for a wide range of health needs.

College health centers may be a student’s only access to healthcare, especially on campuses in rural areas. In fact, the American College Health Association (ACHA) reports that rural students are about 50% more likely than urban students to utilize college health services. Beyond serving students, college health centers often serve faculty as well as partners and dependents of students and faculty members.2

Access Is Limited

A 2010 ACHA survey found that 88% of college centers reported gynecology services as the most frequently offered service, second only to primary care and health promotion services.2 While college health centers offer gynecologic exams, provide contraceptives, and offer pregnancy testing and options counseling, abortion services are not provided onsite, with students referred to off-campus sources. In areas like Berkeley, where this movement began, abortion care may be nearby and easily accessible, but this is not the case for many universities.

In general, abortion access is extremely limited and on the decline in most of the United States. In 2014, 90% of U.S. counties lacked an abortion provider, and 39% of women of reproductive age lived in those counties.3 For this reason, students may have to travel long distances from their town or city, or even out of state, to access abortion care.

Aside from the challenges of finding a provider, students may face burdensome out-of-pocket costs when seeking off-campus care if they rely on student health insurance programs or college health fees to cover medical expenses. The need to find or save money to cover the cost of care and potential travel costs can cause delays in care, which increases costs and medical risks related to later abortion procedures.

What Would It Take?

Opponents to on-campus abortion services have raised concerns over the safety of abortion care. However, medication abortion is extremely safe; a recent review found complications occur in less than 1% of medication abortion cases. The most common complication reported was ongoing pregnancy, which occurred in 0.5% of cases. More serious adverse events requiring emergency department treatment or hospital admission occurred in less than 0.1% of cases.4

Adding any new service to a health center comes with implementation challenges, and one issue to consider is clinical capacity of on-campus medical providers. Proponents of improving abortion access point out that California is unique, since state law explicitly allows advanced practice clinicians, such as nurse practitioners, physician assistants, and nurse midwives, to provide both medication and early surgical abortion services. Along with the many physicians who staff college health centers, there are a variety of highly skilled healthcare providers with the potential to offer medication abortion to the students, faculty members, and their dependents who are in need of the service.

Beyond staffing, provider training would remain a challenge. Furthermore, malpractice insurance for medication abortion providers can be prohibitively expensive depending on the state, and increased insurance costs would be a strain for student health centers to absorb.5

Administrative challenges also would exist, such as the unique process of acquiring mifepristone. Medical providers must sign agreements directly with the manufacturer and purchase the medication to have on hand, rather than the common process of writing prescriptions used with other drugs. Some providers of medication abortion choose to utilize ultrasound technology for pregnancy dating, and this may be a financial barrier for college health centers that do not already have the necessary machines.

On-campus abortion care may be much more difficult to offer in states that are hostile to abortion, where highly restrictive laws are in place that affect the types of clinicians who can provide abortion and limit the settings where abortion care can take place.

Students United for Reproductive Justice continues to work on raising awareness about the challenges students face when seeking abortion care, and a wide range of organizations, including California ACLU Affiliates, the American Association of University Women, National Women’s Health Network, and Black Women’s Health Imperative, among others, continue to collaborate in hopes of reintroducing the bill.

REFERENCES

  1. Jerman J, Jones RK, Onda T. Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008. New York: Guttmacher Institute; 2016.
  2. McBride DR, Van Orman S, Leino V; American College Health Association Benchmarking Committee. 2010 Survey on the Utilization of Student Health Services. Hanover, MD: American College Health Association; 2010.
  3. Jones RK, Jerman J. Abortion incidence and service availability in the United States, 2014. Perspect Sex Reprod Health 2017;49:17-27.
  4. Cleland K, Creinin MD, Nucatola D, et al. Significant adverse events and outcomes after medical abortion.Obstet Gynecol 2013;121:166-171.
  5. Dehlendorf CE, Grumbach K. Medical liability insurance as a barrier to the provision of abortion services in family medicine. Am J Public Health 2008;98:1770-1774.