Rohrer Cynthia D, Modrek Sepideh
Public Health Department, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA.
Health Equity Institute and Department of Economics, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA.
BMC Womens Health. 2023 Feb 24;23(1):84. doi: 10.1186/s12905-023-02230-5.
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.
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.
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.
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.
美国大学适龄青年对生殖健康护理的利用率较低，但需求较高。生殖护理存在多重障碍。大学学生健康中心（SHCs）提供不同程度的生殖产品和服务。最近，加利福尼亚州立法规定公立大学的学生健康中心在其护理服务中增加药物流产项目。
为了调查公立大学学生对生殖健康护理的现有态度和障碍，我们在加利福尼亚州一所大型、多元化的城市沿海州立大学进行了一项匿名在线调查。学生们被问及在一般情况下以及在学生健康中心获取生殖服务时遇到的众多障碍，我们将这些障碍分为三类：耻辱感、可及性和系统问题。受访者还被问及获取和推荐各种服务的知识及偏好。为了解不平等的存在程度，我们使用卡方检验比较了不同种族/族裔身份、性别认同、预期学位以及与校园居住距离之间的差异。
大多数调查对象（n = 273）在一般医疗环境中都经历过耻辱感和可及性障碍，这使得他们自己或其伴侣难以获得生殖健康护理（耻辱感障碍占55%；95%置信区间49% - 61%；可及性障碍占68%；95%置信区间62% - 73%）。值得注意的是，学生报告称在学生健康中心遇到可及性障碍的比例为50%，低于一般生殖健康护理环境中的比例（68%）。学生人口统计学特征方面的差异有限。学生们还表示非常愿意使用学生健康中心或推荐其进行妊娠测试（73%；95%置信区间67% - 78%）、紧急避孕药（72%；95%置信区间66% - 78%）和药物流产（60%；95%置信区间54% - 66%）。与其他服务相比，学生不太清楚在哪里可以获得药物流产服务，这表明存在未满足的需求。
我们的研究表明，学生在获取生殖健康护理方面面临障碍，而学生健康中心是这种护理的可信赖且可及的来源。在罗诉韦德案后的时代，学生健康中心在促进健康公平、学术公平和性别平等方面发挥着关键作用。随着州立法机构要求学生健康中心扩大生殖和堕胎护理服务的可及性，必须给予它们关注和财政支持以确保其成功。
