Availability of emergency contraception through student health centers is growing, but gaps remain. (Digests).

Obtaining emergency contraception on college and university campuses may be getting easier, but the method is still not universally available on campus, according to results of a 1999 survey of student health centers. (1) Half of participating centers offered emergency contraceptive pills, and more than half of these had done so for five years or less. Centers that did not offer emergency contraception typically said that they faced administrative or clinical objections, the school's religious affiliation prohibited it or the clinic was run by a nurse and could not provide medications. Most centers that did not offer the method referred students to other health care providers for it.

The sample consisted of 358 student health centers that responded to a survey mailed to institutional members of the American College Health Association. One-third were at colleges or universities in the Northeast, one-quarter each in the Midwest and South, and the rest in the West; half were at public institutions. Fifty-three percent reported that the student population at their school was fewer than 5,000, 38% were at schools with 5,000-24,999 students and 8% served larger populations. While 45% said that most students lived in university housing, 27% reported that the majority commuted and 27% said that equal numbers lived on campus and commuted.

Fifty-two percent of responding health centers offered emergency contraception. Of these, 54% had initiated the service within the previous five years, including 16% that had begun offering it only within the last year. Three-quarters of clinics that offered emergency contraceptive pills dispensed them directly to students, and half gave students prescriptions for the drug; two-thirds included information about the method in their routine contraceptive counseling.

Most centers that offered emergency contraception (60%) publicized its availability--predominantly through peer educators (57%) and brochures (56%), but also through posters or the campus Web site or newspaper. The main reason for not publicizing this service was concern about generating controversy on campus (53%); others were the desire to avoid promoting use of the method (17%) and insufficient funding (11%). Fewer than one-quarter of centers were listed with Princeton University's emergency contraception hot line.

Facilities that offered emergency contraception identified several benefits of doing so: Virtually all (97%) cited the prevention of unintended pregnancy, and sizable proportions mentioned students' appreciation of the service (71%) and the opportunity to link students with regular contraceptive methods (59%).

Restrictions on the provision of emergency contraceptive pills were common. Large majorities of centers reported that students could obtain the method only after having unprotected intercourse (73%) and in the absence of health conditions that contraindicate use (68%). In some cases, provision was restricted to students who had had another episode of unprotected intercourse during the same menstrual cycle (27%) or who had missed one or two doses of regular oral contraceptives (21%). Nine percent of facilities provided emergency contraceptive pills only if a woman had been sexually assaulted, and 8% limited provision to one time per student.

Of the 48% of health centers that did not offer emergency contraceptive pills, three-quarters referred students elsewhere for the method; one in six, however, did not refer for this service. Only 7% of these facilities were considering offering the method, and another 1% planned to begin offering it within the next year. Most (67%) either had not considered making emergency contraception available or had ruled it out; 2% had offered the method in the past but no longer did so.

One-quarter of health centers that did not offer emergency contraception reported that administrative objections prevented them from doing so, close to one in five cited clinical objections or liability concerns, and about one in eight said that they thought the practice would undermine regular contraceptive use; a negligible proportion denied the need. Seventy percent gave a variety of other reasons for not offering emergency contraception; one-third of these reported that their school's religious affiliation prevented it, one-fifth said that the clinic was run by a nurse and could not provide drug prescriptions.

Results of a logistic regression analysis revealed that schools in the Midwest and the South were less likely than those in the Northeast to offer emergency contraception (odds ratio, 0.4 for each). The odds were also reduced for private institutions (0.3). Compared with schools that had equal numbers of residential and commuting students, those whose students mainly commuted were less likely to provide this service (0.2), and those whose students were mostly residential were more likely to do so (2.9). Size of the student body also influenced the provision of emergency contraception: Schools with enrollments of 10,000 or more had higher odds of offering the method than those with fewer than 5,000 students (odds ratios, 3.2-5.1).

The researcher notes that the survey findings are not generalizable to all college and university health centers in the United States. Nevertheless, she concludes that the results highlight a need to expand the availability of emergency contraception through student health centers. Contending that many barriers to provision of this method may owe more to a lack of education than to outright opposition, she encourages researchers to "determine the underpinnings of these barriers in order to develop appropriate interventions for change."

REFERENCE

(1.) McCarthy SK, Availability of emergency contraceptive pills at university and college student health centers, Journal of American College Health, 2002, 51(1): 15-22.