As California's efforts to enshrine abortion access continue, the University of California and California State University are working to provide medication abortions on all campuses by Jan. 1. So far, none of the Cal State campuses offer medication abortions, and access within the UC system varies from campus to campus.
Both university systems, however, say they are on track to implement a law passed in 2019 requiring their student health centers to provide access to the pills. As many as 6,228 students could seek medication abortions on UC and Cal State campuses each year, once they are available, according to Advancing New Standards in Reproductive Health, a research program at the University of California San Francisco.
Making medication abortions available on college campuses would likely free up appointments at clinics throughout the state that could then be sought by people living in areas of California where abortion access is limited or in other states where it is now illegal, multiple reproductive health experts and advocates told CalMatters.
"Because there is going to be this increase in people coming to California, all of the clinics are going to have, you know, additional demand and kind of struggle with capacity," said Cathren Cohen, a reproductive rights expert at the UCLA Center on Reproductive Health, Law and Policy. "While it's not necessarily going to help all the people coming from out of state, it's just generally going to increase the number of abortion providers."
State Sen. Connie Leyva, who authored Senate Bill 24, said its significance could not have been anticipated years ago, before the recent Supreme Court ruling that overturned Roe v. Wade and ended the constitutional right to an abortion in the U.S.
"Little did we know how important this bill would be and this law would be based on the Supreme Court's decision," said Leyva, a Chino Democrat. "I think it's even more important than it was when we did it."
Securing abortion access on university campuses
Each month, between 322 and 519 students at Cal State and UC seek medication abortions, according to a 2018 report published by UCSF's Advancing New Standards in Reproductive Health. As many as two-thirds of those students have to travel at least 30 minutes on public transportation to reach the closest non-campus clinic, the report estimated. The average cost of medication at facilities near campus is more than $600, according to the report, and the average wait time is a week.
"If one part of the population is able to get pregnant, has to go through hoops and overcome barriers to terminate a pregnancy, and in trying to do that has to miss class, that's kind of an equity issue," said UCSF OB-GYN and abortion specialist Josie Urbina. "You want everybody to have the same access, to have the same opportunities, to be able to concentrate and focus on their studies and their coursework without having to take time off."
As campuses start providing medication abortions, many students will spend less time on the road and will see out-of-pocket costs decrease. Getting a medication abortion often involves a couple of appointments -- either in person or virtually -- and receiving a prescription.
The University of California Student Health Insurance Plan, which is required for students, covers the costs of medication abortions. However, students in the Cal State system -- and those who waive the insurance requirement at the UC -- will have to pay to receive the medications. Sacramento State University expects the cost of medications would be between $60 and $80.
"There's still a lot of areas where abortion access maybe is less than perfect or varies between different campuses and surrounding communities, or for different students within those communities," said Alex Miles, chairperson of government relations for the UC Student Association. "Reproductive health care access, in general, has to be central and fully accessible."
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To meet the Jan. 1 deadline, Cal State and UC campuses without medication abortion access -- including UC San Diego, UC Davis and UC Riverside -- will have to both train providers and update information on websites so students know the service is available. The COVID-19 pandemic has delayed some of that preparation, said Annie Sumberg, senior director for medication abortion access for Essential Access Health, a reproductive health advocacy and consulting group that is helping campuses gear up.
Essential Access Health is offering Zoom training sessions for UC and Cal State campus providers that give an overview of the new law, how to administer a medication abortion and how to support patients after they end their pregnancies. Several campuses said they are considering offering telehealth appointments for medication abortion and allowing students to pick up pills at a pharmacy closer to home.
The FDA approved having abortion medications sent by mail in 2021, and demand for telehealth has grown during the pandemic. Physical exams and ultrasounds are not necessary to safely end a pregnancy, said Urbina, the OB-GYN at UCSF.
Cal Poly San Luis Obispo's assistant vice president for health and wellbeing, Tina Hadaway-Mellis, also raised the possibility of having prescriptions mailed to students. Increased access to telehealth, she said, has been one of "very few silver linings as a result of the pandemic."
"If (students) prefer to be someplace that offers them a sense of privacy, or if they don't live very close to campus, if they're only coming to campus one or two days a week, but they live an hour away, a telehealth appointment would be much more approachable and convenient," Hadaway-Mellis said.
UC Berkeley has been offering medication abortions at the campus Tang Center since the fall of 2020, according to University Health Services spokesperson Tami Cate. The campus has provided 34 medication abortions since 2020, and students are often able to get an appointment the same day, Cate said. Currently, UC Berkeley only administers medication abortions on site, but it might add telehealth options in the future, she said.
Enabling access for community and out-of-state seekers
Directing students toward campus medical centers is particularly important, abortion rights activists say, because California is expecting a surge of people seeking abortions from states where it is now illegal. UCLA's Center on Reproductive Health, Law, and Policy expects the influx could be as large as 8,000 to 16,100 people each year.
There are also several regions throughout the state where abortions are already difficult to access. These "abortion deserts" are especially concentrated in California's Central Valley, said Larissa Mercado-López, Fresno State University Chair of Women's, Gender & Sexuality Studies.
"We have large swaths of land without abortion providers or even comprehensive reproductive health clinics," Mercado-López said.
Forty percent of California's counties do not currently have an abortion provider, according to the Guttmacher Institute, a research and advocacy organization. There are several Cal State and UC campuses located in these areas, Cohen said, including CSU Bakersfield, CSU Fullerton and CSU Stanislaus.
Raising awareness
Regardless of where individual campuses are in implementing the new law, advocates stress the importance of raising awareness of abortion services at student health centers.
"It's not well advertised," said Esmeralda Quintero-Cubillan, president of the UC Student Association. "Most students, if you were to ask them, would not know we offered medicated abortions or that you could pursue reproductive health care services."
Many anti-abortion groups, including the California Family Council, opposed the requirement for public universities to provide medication abortion before it passed the Legislature, but did not return CalMatters' requests for comment. Pro-abortion activists say they are gearing up to educate campus communities about the availability of medication abortion. URGE, a group that organizes young people to support reproductive rights, is conducting presentations on medication abortion to gender studies classes and students pursuing health-related careers.
The presentations highlight the safety of medication abortions, introduce audiences to the new law and provide an overview of the reproductive justice movement, said Callie Flores, a student at UC Merced who sits on the group's student advisory board. The board also conducts anonymous surveys that ask students for input on what their campuses should be doing to support abortion access, and shares the results with campus health centers.
"We try to push like that, you know, being abortion positive means that there's no shame, no stigma and no apologies connected to getting the abortion," Flores said. "Abortion isn't a bad word. It's not a bad decision. It's a decision that people make for themselves, and it's totally valid."
Reeling after the Supreme Court's ruling overturning Roe v. Wade, Flores said activism has given her a sense of purpose and made her feel like she's making a difference.
"I gotta do something with this anger," she said.
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