Abstract
BACKGROUND: College-aged young adults in the US have low utilization and high need for reproductive healthcare. Multiple barriers to reproductive care exist. University Student Health Centers (SHCs) provide varying degrees of reproductive products and services. Recently, California legislated that public university SHCs add medication abortion to their care. METHODS: To examine existing attitudes and barriers to reproductive healthcare for public university students, we conducted an anonymous online survey at a large, diverse, urban coastal California State University. Students were asked about numerous barriers accessing reproductive services in general and at the SHC, which we categorized into three groups: stigma, access and system. Respondents were also asked about knowledge and preferences for accessing and recommending various services. To understand the extent to which inequities exist, we compared differences across racialized/ethnic identity, gender identity, anticipated degree, and living distance from campus using chi-squared tests. RESULTS: The majority of survey (n = 273) respondents experienced stigma and access barriers in general healthcare settings which made obtaining reproductive healthcare for themselves or their partners difficult (stigma barriers 55%; 95% CI 49%-61%; access barriers 68%; 95% CI 62-73%). Notably, students reported statistically significant lower rates of access barriers at the SHC, 50%, than in general reproductive healthcare settings, 68%. There were limited differences by student demographics. Students also reported a high willingness to use or recommend the SHC for pregnancy tests (73%; 95% CI 67-78%), emergency contraception pills (72%; 95% CI 66-78%) and medication abortion (60%; 95% CI 54-66%). Students were less likely to know where to access medication abortion compared to other services, suggesting unmet need. CONCLUSIONS: Our study provides evidence that students face barriers accessing reproductive healthcare and that SHCs are a trusted and accessible source of this care. SHCs have a key role in increasing health, academic and gender equity in the post-Roe era. Attention and financial support must be paid to SHCs to ensure success as state legislatures mandate them to expand reproductive and abortion care access.