In a comprehensive study of college health centers across the United States, federal investigators found that while basic sexual and reproductive health services are
The Government Accountability Office (GAO) report, released last month, examined 15 colleges nationwide and analyzed data from 184 four-year institutions, revealing a complex landscape of healthcare delivery that varies significantly based on institution size, location, and religious affiliation.
While most campus health centers offered common services like STI testing and basic contraception, more complex reproductive healthcare remained limited. Only one surveyed college provided medication abortion services, and just two institutions offered IUD insertions. The report found that larger institutions with over 10,000 students were more likely to offer comprehensive services compared to smaller colleges.
Privacy emerged as a major concern, with students at 10 of the 15 examined colleges expressing worries about their parents learning about their care through insurance statements. This led some students to pay out-of-pocket rather than use their family's health insurance. Some health centers responded by implementing privacy-enhancing measures, such as installing acoustic panels and using text messages instead of calling out names in waiting rooms.
Cost posed another significant barrier, with seven colleges reporting that some students struggled to afford care, particularly laboratory fees for STI testing. To address this challenge, many institutions developed creative solutions, including partnerships with local health providers, grant funding for specific services, and sliding-scale payment options based on students' ability to pay.
"Unfamiliarity with sexual and reproductive health care was a challenge for some students," the report noted, with officials at 14 of 15 colleges citing this as an issue. Many attributed this to limited sex education before college. Health educators at several institutions reported success with innovative outreach methods, including using games and novelty items to spark conversations about sexual health.
The study also revealed that religiously affiliated institutions typically offered fewer services, with three such colleges reporting that their religious affiliation influenced available care. However, the report found that 25 religiously affiliated colleges did offer some form of contraception, suggesting a range of approaches even among faith-based institutions.
The landscape of reproductive health services has shifted significantly since the Supreme Court's 2022 Dobbs decision. Six colleges reported increased student uncertainty about accessing abortion services, while officials at three institutions said they began sharing less information about abortion services due to state law changes. One college discontinued providing abortion referrals entirely due to their state's political environment.
Some positive trends emerged from the study. Officials at nine colleges reported expanding contraception and emergency contraception options since the 2021-2022 academic year, largely in response to increased student demand. Eleven institutions noted higher overall demand for sexual health services, though some attributed this to the return to in-person learning following the COVID-19 pandemic.
The GAO's investigation comes at a critical time, with approximately 19 million students enrolled in nearly 3,900 degree-granting colleges across the country. For many students, campus health centers serve as their primary source of healthcare, making access to comprehensive services particularly important for their academic success and overall wellbeing.
The report highlighted successful strategies some institutions employed to improve access, including offering free menstrual products across campus, providing emergency contraception through vending machines, and establishing partnerships with local health departments and nonprofit clinics to expand available services.
The findings suggest that while progress has been made in providing basic sexual and reproductive healthcare on college campuses, significant work remains to ensure comprehensive, accessible care for all students, particularly at smaller institutions and in states with restrictive healthcare laws.
