We Asked College Health Centers How They’ll Deal With Abortion Restrictions. They Aren’t Saying.

Ask a college health center how it’s planning to support students’ reproductive health this fall, and at most you’ll get a generic statement like this one, from the University of Oklahoma:

“Our top focus is supporting the needs, aspirations and well-being of our students. While the university must and will comply with all applicable laws, we remain unwavering in our commitment to serve our students to the fullest extent possible.”

Six weeks after the U.S. Supreme Court overturned Roe v. Wade, opening the door for states to ban abortion, and days before the start of the fall semester, most colleges in states with restrictive abortion laws aren’t making their plans public.

From mid- to late July, The Chronicle called and emailed 50 campus health centers in states with strict limits on abortion to ask whether the ruling is reshaping their policies on contraception, abortion, leaves of absence, and prenatal care. Just over a dozen institutions responded, most with vague statements from the public-relations office. One referred a reporter to a list of services on the campus website; another said the health center was awaiting direction from legal counsel and senior administration. Only three agreed to interviews.

Professional associations, which typically speak on behalf of their members, are treading carefully, too. A spokeswoman for the American College Health Association answered some questions by email but said the group’s president wasn’t available for an interview. The president of the National Association of College and University Attorneys, Ona Alston Dosunmu, said she’d “struck out” in her efforts to get general counsels to go on the record.

“Generally, folks don’t want to get out ahead of their presidents and administrations,” Alston Dosunmu said. “Most of them were like, ‘I’m not touching this with a 10-foot pole.’”

Colleges have reason to be cautious, according to Kimberley Harris, a visiting assistant professor at Texas Tech University School of Law. The legal landscape around abortion is still shifting, with some state bans on hold, and other states threatening to punish people who “aid and abet” an abortion, even if they don’t provide it themselves. This leaves college leaders unsure what they’ll be legally allowed to say and do come fall.

Publicizing their plans now would carry political risks, too, Harris said. Given how divisive the issue of abortion is, any change in an institution’s policy is sure to please some students and alumni and alienate others. An announcement could also anger state lawmakers, whom public colleges depend on for funding.

Still, some say the secrecy surrounding colleges’ plans to respond to the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which ended the constitutional protection for abortion, is adding to the uncertainty and anxiety that many students are feeling right now.

“Not talking about it creates shame, it creates stigma, and it makes students feel unsafe to access these services,” said Cindy Cruz, western-states program director for URGE: Unite for Reproductive & Gender Equity, a youth-led nonprofit.

A Shrinking List of Options

Women between the ages of 20 and 29 account for about 57 percent of all abortions, according to the Centers for Disease Control and Prevention. But even before the fall of Roe, few colleges provided abortion on campus. In 2020, less than 3 percent offered medications to end a pregnancy, according to a survey by the American College Health Association.

The vast majority — 87 percent — of surveyed colleges said they referred students to off-campus clinics instead.

“We give them a handout of resources and let them make their own choices,” said Pinkey Carter, a nurse administrator at South Carolina State University.

Under such laws, college employees in states with abortion bans could conceivably be sued for providing students with information about how to obtain abortion pills through the mail or offering them advice on traveling out of state. Colleges that offer emergency funds to students who need to travel for medical care could also be in legal jeopardy.

Though it’s unclear if such a lawsuit would be successful — particularly if the abortion occurred in a state that allows it — the threat of litigation has the potential to muzzle campus clinicians, Harris, of Texas Tech, said. In Texas, campus providers already have to wonder whether the “student” sitting across from them is a plant, out for the $10,000 citizen’s bounty they’ll get if their lawsuit succeeds, she said.

“This is going to shut down a lot of communication between people and their health-care providers,” she said. “If you have providers who are afraid to speak, it’s going to lead to worse health outcomes.”

And it’s not just the health-center staff that college administrators are worried about, said Natasha J. Baker, a managing attorney at Novus Law Firm, who spoke on a panel on the Dobbs decision at the annual conference of the National Association of College and University Attorneys.

“I can envision a scenario where a well-meaning student-affairs staffer, or resident adviser, or coach is trying to help someone and engaging in what state law would consider aiding and abetting,” Baker said.

There’s also a risk to health-care providers, both on campus and off, who treat patients who arrive in the midst of an incomplete miscarriage or abortion. If they wait to extract the remaining embryo or fetus, the patient could go into septic shock. But if they act with urgency, they could be accused of violating state laws that allow abortion only in cases where the woman’s life is in danger.

As more students turn to medication abortions, this dilemma is going to come up more often, said Lucinda M. Finley, a professor at the University at Buffalo School of Law.

“The exceptions to save the lives of women are very vaguely written,” Finley said. “It puts doctors in the situation of not knowing how imminent the risk to life has to be.”

Closed-Door Conversations

When the Supreme Court struck down Roe in late June, weeks after Politico published a leaked draft opinion, a few college presidents issued statements decrying — or in some cases supporting — the decision.

But the vast majority of presidents stayed silent, unwilling to stick their necks out on such a controversial issue. Several told The Chronicle they were still weighing whether to comment.

In a statement issued the day of the ruling, the American College Health Association called the decision “deeply distressing,” warning that it would “directly endanger college health professionals’ ability to provide evidence-based, patient-centered care, and may place them in legal jeopardy.”

Asked a month later if the association’s members were making any changes in their policies around contraception, abortion, and medical leave as a result of the ruling, a spokeswoman said in an email that data doesn’t yet exist to answer that question. But she said the group had convened a task force to study the issue.

A handful of colleges, including Vanderbilt University and the University of Michigan at Ann Arbor, have also announced the formation of task forces. Peter Lake, a professor at Stetson University College of Law, said he expects such panels to proliferate in the coming weeks, at both the campus and association level.

For now, though, most of these committees are keeping their work private. An exception is the University of Michigan, where a 50-member cross-campus task force has created scripts that nurses and clerical staff can use when students call to inquire about abortion access and is currently crafting multimodal methods of communicating with students about their options under current law. The task force includes a student representative and has held forums to solicit students’ views.

“I think what students really want is to be kept up to date,” said Susan Dwyer Ernst, chief of gynecology at the University Health Service.

That’s not easy in Michigan, one of several states with longstanding abortion prohibitions on the books that weren’t enforced during Roe’s reign. Though Republicans who control the state legislature say the nearly century-old law should now take effect, the state’s Democratic governor has sued to block it and was granted a preliminary injunction in May. Lawsuits arguing for both sides are wending their way through the courts, as Republicans work to unseat Gov. Gretchen Whitmer in November.

The university’s task force is preparing for all possible outcomes of the litigation, Ernst said. Anticipating an increase in medication abortions if the 1931 law is enforced, the university has already held a lecture for campus providers on the potential complications. If abortion remains legal, the university may prescribe the pills itself, to ensure students can continue to access services amid an influx of patients from neighboring states with abortion bans.

With bans in place in Ohio; Wisconsin; and, in September, Indiana, the university hospital in Michigan and a local Planned Parenthood clinic are seeing a surge in out-of-state patients, Ernst said.

“We’re looking into all our options and trying to decide what is right for our campus and our student population,” she said.

Though few colleges provide medication abortion now, it will become much more common next year, when a California state law requiring all public colleges to offer the pills takes effect. The Massachusetts legislature passed similar legislation last month, ensuring that all public-college students can obtain medication abortion through the college’s health services or outside resources.

Medication abortion consists of a two-drug regimen that can be safely taken in the first 70 days of pregnancy. The pills can be obtained through the mail or off-campus clinics, but the cost is often prohibitive, with studies in California and Massachusetts putting the average at more than $600.

In California, student insurance or student fees will cover most or all of the cost of the pills. In Massachusetts, students who aren’t on a college insurance plan or a private state plan (both of which cover abortion) can tap into a fund created by the law, the bill’s chief sponsor said.

Cruz, who is leading efforts to educate California students about the new law, said providing the pills on campus will remove the logistical barriers many students face in accessing medication abortion, and will free up space in local clinics for out-of-state patients.

A 2018 study found that close to two-thirds of California students have to travel at least 30 minutes on public transportation to reach the closest noncampus clinic. In Massachusetts, public-college students have to travel an average of 19 miles each way and spend close to three and a half hours on public transit, a 2021 study found.

Students in other states are pushing their colleges to follow California’s lead but so far, have seen little success.

More Discrimination Predicted

While college leaders wrestle with how to respond to the recent Supreme Court decision, students are making their wishes clear, through petitions calling on colleges to provide medication abortion, where it remains legal, and to stock vending machines with Plan B, which prevents pregnancy by delaying ovulation, stopping fertilization, or disrupting implantation of a fertilized egg (close to three-quarters of colleges already offer Plan B in the health center, according to the 2020 survey, but few make it so readily accessible).

“They’re moving from fear into action,” said Tali Ramo, manager of youth organizing for the Planned Parenthood Federation of America.

Students are also advocating for clearer and more standardized medical-leave policies. Under Title IX, the gender-equity law, colleges have long been required to provide accommodations to both pregnant students and students who have an abortion or miscarriage. This can include additional time to complete assignments, or an opportunity to make up a missed test. But implementation of the law has been inconsistent, with much discretion left to individual professors, according to Jessica Lee, director of the Pregnant Scholar Initiative.

“I’ve had students fail because they missed exams when they were at the hospital having a miscarriage,” Lee said.

On the other hand, she’s also represented pregnant students whose professors have asked them why they didn’t have an abortion. The question comes up so often that she included it in her training materials for colleges as an example of something faculty shouldn’t say to a pregnant student.

As more students are forced to travel out of state for an abortion, or forgo one altogether, both types of pregnancy-related discrimination will become more common, Lee predicted.

Complicating matters, many students don’t want to disclose to their professors that they got an abortion, said Gretchen Ely, a professor of social work at the University of Tennessee at Knoxville who focuses on access to reproductive care. She said colleges should have accommodation policies in place that don’t force students to “spill their entire story.”

So far, the response from college administrations to students’ demands has been noncommittal, along the lines of ‘we hear you, thank you for your passion,” said Ramo, adding that activists won’t be dismissed.

Asked what students want most from their colleges, Ramo said clarity.

“There is a lot colleges can do to help students navigate the confusing array of abortion laws,” she said. “Students want clear, decisive action and commitment to their care.”

The question is, how many colleges are willing to give them that?