Why don't colleges offer the abortion pill?

Imagine you’re a student at the University of California at Berkeley, one of the most prestigious public universities in the country. You are academically driven and career focused. Now imagine you find yourself pregnant and for whatever reason you wish to no longer remain so. The timing isn’t right. You worry about the implications an unplanned pregnancy would have on your education. You have health concerns.

Since the pregnancy is still early, you know that it can be terminated with a pill—a very safe, FDA-regulated oral medication that can end pregnancies up to ten weeks. So you take a deep breath and visit the campus student health center to receive a medication abortion.

There’s only one catch: Your campus health center doesn’t provide abortions. In fact, despite the fact that 42 percent of all abortions are obtained by women between the ages of 18 and 24, no university health centers appear to provide abortions.

If you were this student, you would instead be referred to the nearest Planned Parenthood, in El Cerrito, California, just under four miles away. Without access to a car, this would mean you would need to walk 10 minutes to the closest BART station—the public transportation that runs throughout the Bay area—before riding the train for 23 minutes, and then walking another five minutes to the clinic. That’s more than an hour of transportation time—away from classes, study groups, internships—to obtain two pills for a constitutionally guaranteed service.

This frustrating reality has sparked a groundswell of student activism at Berkeley to bring medication abortion to campus, spurring everything from student government bills to petitions to op-eds signaling how much this student body would like to see the issue addressed. But it’s also prompting a much larger national question: Why isn’t medication abortion available at college student health centers?

Because that’s the thing: Everyone I spoke to in reporting this story, from physicians to activists, said the same thing—as far as they know, every college student seeking a medication abortion in this country must travel off-campus to receive one.

Before exploring how this situation could possibly be, some facts. Medication abortion is really, really safe. Since 2000, more than 1.5 million women in the U.S. have used it to terminate early pregnancies. While the pill can cause side effects such as nausea, fever, and cramping, it has an adverse effect rate of only 0.2 percent. That’s way less than the adverse effect rate for the asthma inhaler Advair (27 percent), the antidepressant Wellbutrin (22.3 percent), the anti-anxiety drug Xanax (13.9 percent), and the cholesterol medication Lipitor (12.9 percent).

And just two months ago, the FDA revised its label of the abortion pill mifepristone to match the evidence-based protocols already being utilized by physicians nationwide—protocols that allow for the drug to be given up to 70 days into a pregnancy, instead of 49 days, and states that a smaller dose can be given to efficiently terminate a pregnancy.

To begin to get some insight into why campus health centers might not prescribe the pills, I reached out to Dr. Jennifer Conti, an OBGYN and clinical instructor at Stanford University and a fellow with Physicians for Reproductive Health, who has written about the benefits of the abortion pill for Fusion before. “There is no clear medical reason why a university clinic or any clinic should be unable to provide medication abortion,” Conti told me.

“It’s laughable,” she added. “Abortion care is just like any other component of women’s reproductive healthcare. The fact that you would isolate it and say that this particular part of women’s healthcare isn’t actually healthcare is ridiculous. It’s dumfounding. It’s almost hard to come up with a response to someone that would think that.”

This past semester, however, Berkeley’s student activists tried to force their administration to do just that—provide a compelling reason why this health care service shouldn’t be administered through the same campus service provider that offers birth control and well-woman’s care. Leading the charge was Aanchal Chugh, who just graduated from the school with a double major in political science and women’s studies. When she ran for student government in the spring of 2015, her platform was women’s empowerment on campus. For her, at the time, that meant looking at how best to end sexual violence at the school. Once elected as a student senator, she helped organize a conference to tackle that issue—and one of the concerns that came up from attendees was the lack of campus access to medication abortion for survivors of sexual assault.

When Chugh started to investigate, she learned that the campus student health center is staffed by state-licensed physicians who were, legally, more than capable of providing medication abortion. She then presented a bill to the student government calling for support for the abortion pill to be administered through the student health center. The measure passed unanimously.

“A lot of sources have misquoted the bill and said we want to start a new abortion clinic on campus. We don’t want to start a new clinic—we just want to get physicians at our student health center trained to administer medication abortion,” Chugh told me earlier in the semester. Notably, the training she is talking about isn’t medical in nature, but rather cultural. She would like the university to provide sensitivity training to its student health center staff to help them best treat those patients wishing to receive abortion care.

Chugh isn’t the only student activist fighting for increased access to healthcare for Berkeley women. Meghan Warner, who also just graduated from the university with a degree in sociology, founded Students United for Reproductive Justice at Berkeley when she learned that the school had an anti-abortion club that received student government funding, as most school clubs do, but that no pro-choice club existed. The first thing the group did was work with the student health center to secure emergency funding to increase access to emergency contraception, or Plan B, on campus.

But when the organization started to look into how to make medication abortion accessible on campus, they hit a wall. The student health center told Warner that they would be unable to provide this service anytime in the foreseeable future. Not only that, but the deductible for services provided off-campus for students enrolled in the university’s health insurance plan had just gone up, making medication abortion prohibitively expensive for many students—with the new deductible and co-pay costs, students could expect to pay close to $400 for a medication abortion that, seemingly, could be provided on-campus at minimal cost. (As Warner explained, most services provided through the student health insurance plan cost under thirty dollars.)

When Warner asked university administrators whether the school might support the student health center in offering medication abortion, she was given a range of explanations for why that wouldn’t be possible—from the notion that the student health center would need to be open 24/7 (something that’s certainly untrue among other abortion providing-facilities) to the idea that the school would have to provide surgical abortion as well and this would be cost prohibitive (which makes little practical sense). She was also told by the university that the training its physicians would need to provide medication would be too costly. She was starting to see a pattern.

“Well-woman visits and birth control are the number one service our student health center provides,” Warner told me. “You would think they would want to make that comprehensive and provide abortion, too. But no one wants to be first. No one wants to be the first campus to do this. And I don’t think anyone is really against it at the health center, they just don’t want to deal with the opposition.”

When I reached out to Berkeley to learn more about their stance, the university sent me a written statement, in which it confirmed that the school’s student health service “fully supports women’s access to the full spectrum of contraception, emergency contraception, abortion and other pregnancy alternatives”—just not on campus, when it comes to abortion.

“Fortunately,” the statement continued, “the Berkeley campus is surrounded by a high-quality, well-established network of health providers who are expert in this area. No University of California student health center provides this service in-house, and only a handful of colleges in the United States provide this service on campus. This includes campuses with poor access to those services, unlike the broad access available to Berkeley students.”

When asked to clarify which other colleges have student health centers that provide medication abortion on campus—this revelation was, frankly, a surprise to me—a spokesperson for Berkeley said that he can only speak for the University of California system and did not know what other higher education institutions do or do not provide through their respective on-campus health service facilities.

Chugh says that she has been told by multiple sources that Berkeley is the only university that has ever even attempted to bring medication abortion to campus.

This passive distancing from abortion care—whether intentional or not—by universities is an issue that Conti speculates might be a trickle-down from the notion that abortion care is only meant to be part of the realm of OBGYNs and not the work of primary care physicians—the kind of doctor who typically staffs student health centers.

Autumn Katz, a senior staff attorney at the Center for Reproductive Rights, notes that when medication abortion first received FDA approval in 2000, “there was the hope that many, many more providers—including general practitioners and not just OBGYNs and abortion providers—would incorporate it into their practice. And that hasn’t really happened. It probably has a lot to do with abortion being so severely over-regulated and stigmatized. Physicians are very fearful of harassment and the stigma of being a doctor who provides abortions and dealing with all the red tape and restrictions imposed.”

As an example, Katz points to the case of Texas’s HB2 law currently being heard before the Supreme Court. One of the provisions of the law in question requires that the medical facilities that provide abortion—including medication abortion—operate out of a facility that meets ambulatory surgery center requirements, which dictates specified hallway widths and room sizes, measures that in no way impact patient care.

“You take the pills and you go home,” says Katz. “There is no reason for a doctor to have to work in an ambulatory surgical center if only prescribing these pills.”

Conti also points to the continued stigma around abortion care—including the legislative attacks placed on such care throughout the U.S. right now—as a reason why perhaps no university makes such care available on campus.

“I can’t speak for Berkeley in particular,” she said. “I’m at Stanford. They also don’t give medication abortion through the student health center here. They refer students to us at the university hospital. And I think that it’s because the pill used for medication abortion is only for abortion. Birth control is not controversial—you can always say it is being prescribed for other health reasons [besides contraception].”

For this reason, Kaylie Hanson, Communications Director for NARAL Pro-Choice America, applauds Chugh and Warner. “These students are taking an important step toward recognizing that medication abortion is an important part of the full range of reproductive health services,” she said in an email, “and when women have access to it, they’re better able to take control of their own health care.”

Which is why it’s encouraging that Chugh says she has been in touch with student leaders at other University of California schools who want to pass bills similar to the one she passed in her own student government. She is helping these leaders draft their own measures—and prepare for the uphill battle they face.

“The work doesn’t stop after graduation,” Chugh told me last week. She’ll continue to push the university on the issue as an alum. She adds that “if the administration really wants to focus on student health and support women on campus, this is a necessary step. The students are clearly demanding it, and it is the administration’s responsibility to respond to student needs.”

Warner says Students United for Reproductive Justice will continue its efforts, too, working with graduate students to advocate for the cause this fall. In the meantime, in what sounds like the most promising news on the issue yet, Warner told me last week that Berkeley’s student health service says they are currently researching the feasibility of providing the service.

“In the articles I’ve seen about what I’m trying to do, they always use the word ‘radical,’” Chugh told me. “And you can use that word if you want. But my stance is that this is not radical at all … There’s nothing radical about wanting students to have accessibility to health care on campus.”

Jen Gerson Uffalussy is a regular contributor to Fusion. She also writes about reproductive and sexual health/policy for Glamour, and television for The Guardian. She lives in Atlanta.