More Support Needed for Contraceptive Healthcare at Student Health Centers
College students are less sexually experienced now than they were 20 years ago, and they may not know how to obtain reproductive healthcare and contraceptives.
States, universities, and the sexual and reproductive health community need to help students obtain optimal contraceptive and reproductive healthcare through the most convenient place for students — the college health center, according to recent research.1
“As more and more women have gone to college — since the 1960s and 1970s, when colleges were predominantly male — the student health center’s role has changed and they do more with sexual and reproductive health and sexually transmitted infections [STIs],” says Sepideh Modrek, PhD, study co-author and an associate professor of economics at the Health Equity Institute in the Lam Family College of Business at San Francisco State University. In California and Massachusetts, state laws require public universities to offer medication abortion on campus. New York may soon pass a similar law, she says.
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In the post-Roe era, some states are expanding women’s access to contraception and abortion, while other states are passing bills to ban or restrict access to abortion. Contraception also may be more difficult to obtain in abortion-ban states as well. For young adults in college, the best way to help them with their sexual and reproductive health needs is through the student health center. But colleges and reproductive health websites must do a better job of marketing these services, Modrek says.
“If we look at 549 public, four-year universities and look online for medication abortion, information shows up in 4% to 6% of schools, mainly to say that emergency contraception is not medication abortion,” she explains. “Few university health centers advertise this care — even in liberal states like California. This is changing.”
Some question why resources should be put into reproductive health services at universities. “My response is students are still unfamiliar with the general healthcare environment,” Modrek asserts. “They’re new to this. [They] just moved out of their parents’ house and may have different values from their parents.”
In California, where public colleges provide abortion medication, it is important for this service to be listed on their websites. “Some public universities in California list the service on their websites, but some universities that may be located in more conservative districts do not list it,” Modrek explains.
Fear and stigma also play a role to students’ access to reproductive care. “In our study, we saw undergraduate students report high levels of stigma in accessing reproductive healthcare, and students say that they have better access at the student health center,” Modrek says. “Students are new to this and need extra support, and they experience stigma. This is where we should be offering care.”
For instance, students say they experience embarrassment, privacy, and confidentiality issues. They fear running into someone they know at a reproductive health clinic.
Not only are today’s college students less experienced sexually than students in the past, they also are more diverse ethnically, Modrek says. “We know empirically that the mix of college students in California is changing,” she explains. “It’s more ethnically diverse than 20 years ago, with a lot more Latino students coming into college and a lot more first-generation coming to college. Women are the majority of college students.”
These are young people who are transitioning into adulthood. They may not be able to talk with their parents about these issues, even if they have a great relationship with them, she adds.
Provide Neutral Information
Universities in states that ban or severely restrict abortion care can still provide neutral information on their student health centers’ websites. For example, Indiana University Bloomington, which is in a state that bans most abortions, provides information about STI testing, family planning, contraception, pregnancy, gender identity and roles, sexual function and dysfunction, sexual pleasure, and sexuality across cultures. The student health center website also offers students an opportunity to speak with a certified sex educator on topics ranging from abstinence to orgasm.2
College student health center websites can at least do that much in states that are hostile to women’s reproductive healthcare. They also can provide links to services in places where abortion is legal if their state laws do not prohibit such speech. “There are ways to do this without going against your state laws,” Modrek says. They have to be aware of state funding and the politics of that, but they can provide neutral information, she adds.
The differences in how student health centers educate and provide reproductive health services to students is one example of how states are diverging in the era immediately following the U.S. Supreme Court overturning Roe v. Wade.
“This is the problem of not having Roe anymore,” Modrek says. “What was once in my generation a right and so it didn’t matter where you lived or went to school, is [no longer a fundamental right].”
Where a person lives has always been a barrier, but now it is double and triple the barrier. “In some states, it’s even easier to obtain [abortion care], and in other states, it’s much harder,” Modrek says. “It was critical before, but now it’s even worse.”
Modrek and colleagues concluded that a solution for college students in every state is for universities to provide more attention and funding to student health centers. The reproductive health community also can help provide students with information and resources.
Students need easier access to reproductive health services, and college health centers are being asked to meet that need. “They need to be supported in doing what they’re asked to do,” Modrek says.
REFERENCES
- Rohrer CD, Modrek S. Decreasing reproductive and abortion care barriers: Findings on the student health center’s role from a student survey. BMC Womens Health 2023;23:84.
- Indiana University Bloomington Student Health Center. It’s a fact of life. 2023.
States, universities, and the sexual and reproductive health community need to help students obtain optimal contraceptive and reproductive healthcare through the most convenient place for students — the college health center, according to recent research.
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