SB320: Access to
medication abortion

VA N C I N G N E W ASDTAVAN ND CAIRNDGS NI NE WR ESPTAR ON D UA RC TDISV EI NH RE AE PLTRHO D U C T I V E H E A LT H

ISSUE BRIEF #1, DECEMBER 2017

Assessing barriers to medication abortion among California’s public university students
Executive summary
Abortion is a commonly needed health service for
students attending California’s public universities, but
obtaining an abortion is difficult for students. Every
month, up to 519 students at the 34 University of
California (UC) and California State University (CSU)
campuses seek medication abortions at off-site health
care facilities.
Students at California’s public universities face several
barriers to obtaining an abortion. Many college students
have no or limited income. Over half (51%) of students
across the UC and CSU systems are low-income (defined as qualifying for a Pell Grant). Financial limitations
already impact students’ daily needs, with 42% of UC
students and 21% of CSU students experiencing food
insecurity. Additionally, 9% of CSU students suffer housing displacement such as homelessness. Consequently,
paying for the abortion may be a significant financial
stressor as students may go to a provider that does not
accept their student or other private health insurance,
may not want to use their health insurance so they can
keep the abortion private, may not have health insurance
that covers abortion, or may not have insurance coverage at all.
Public transit is key to abortion accessibility off-campus,
as over two-thirds of UC students and one-third of CSU
students do not have a car. 22 UC and CSU campuses,
which account for 62% of the UC and CSU student
body, are more than 30 minutes away from the closest
abortion provider via public transportation. For these
students, the multiple visits for a medication abortion requires a minimum of two hours travel by public
transportation.
Distance and cost barriers are further compounded
by the inherent delays in scheduling an appointment
at an off-campus abortion provider. Since only 15%
of providers closest to university campuses are open

on weekends, students may need to alter classes,
exams, and work schedules to attend appointments.
Even after students identify a provider, they will have
to wait an average of one week for the next available
appointment at the facility closest to their campus.
Ultimately, the cumulative delay from all of these barriers can make a student ineligible for medication abortion which can only be done through the 10th week of
pregnancy.
Finally, access to abortion care is also important to
college participation. Women who have a child while in
college are less likely to graduate than those who do
not, and 89% of students say that having a child while
in school would make it harder to achieve their goals.
Students seeking abortion need convenient access to
services that do not involve unnecessary interruption
in their complex schedules. The necessity of leaving
campus for this service while other healthcare services
can be obtained on campus unnecessarily burdens the
student who needs an abortion.

Research aims
To better understand the barriers that California university students face in accessing abortion, we conducted
background research, data collection, and analysis. The
aims of this research were:
n To

describe and quantify access to abortion for
students at University of California (UC) and California
State University (CSU) campuses

n To

assess how far and for how long these students
currently have to travel to receive the care which would
be covered by SB320

Methodology
Data for this assessment came from several sources
involving different analyses. The sources and methods
for our findings are:

For more information about this research and other ANSIRH work, please visit www.ansirh.org

University of California, San Francisco   UCSF Medical Center   Bixby Center for Global Reproductive Health

 SB320—Access to medication abortion: Issue Brief #1, December 2017, page 2
A D VA N C I N G N E W S TA N D A R D S I N R E P R O D U C T I V E H E A LT H

n Projection

of total medication abortion demand on
campus calculated using age- and state-adjusted
abortion rates and a range of rates for medication
abortion as preferred abortion type (see below for
detailed assumptions and data sources)

n Determination

of existing care providers in California
from an abortion facilities database maintained by
the UCSF Advancing New Standards in Reproductive
Health (ANSIRH) program
n Based on publically available information obtained in
systematic online searches
n Verified with phone calls to facilities

n Distance

calculations using Stata and Google Maps
n Calculated driving distance in miles and travel time
from every campus to every abortion provider
n Minimum distance value was closest facility
n Calculated public transit time for closest facilities

n US

News & World Report for demographic information
about campus populations
n Enrollment, tuition, race, sex, and car ownership
information as of November 2017

n Mystery

calls to all abortion providers in California
to determine types of abortion offered, Medi-Cal
and insurance acceptance, and wait times until first
available appointment

n Review

of the grey and published literature on
students’ financial and mobility barriers

Findings
Current and expected abortion rates:

n Given

increasing popularity, and potential higher demand if greater accessibility, assumed high percentage of 50%

n Estimate

of number of medication abortion equations

n Low

estimate (using lower rate of medication abortion) = campus population x % female [proxy for %
with uteri] x 0.023 x 1.34 x 0.31
n High estimate (using higher rate of medication abortion) = campus population x % female [proxy for %
with uteri] x 0.023 x 1.34 x 0.50

Monthly estimates
n Currently,

we estimate that students across UC and
CSU campuses obtain 1,038 abortions each month
n 365

each month at UC campuses
n 674 each month at CSU campuses
n Given

the lower estimate that 31% of abortions
are medication abortions, and the higher estimate
that up to 50% of abortions could be medication
abortions if the service were available on campus, we
estimate there would be between 322-519 medication
abortions occurring across UC and CSU campuses
every month.
n 113-182

medication abortions per month for the
UCs combined
n On average, 10-17 medication abortions per month
per UC campus
n 209-337 medication abortions per month for the
CSUs combined
n On average, 9-15 medication abortions per month
per CSU campus

Methodology for calculations1
n Age-specific

estimates of abortion

rate for ages 18-19 = 1.8%
rate for ages 20-24 = 2.8%
n Given that approximately half of undergraduate students
are 18-19 & half 20-24, the simple average = 2.3%

Key finding: We project that there would be

n Abortion

up to 519 medication abortions each month

n Abortion

across the UC and CSU campuses if student

for higher abortion rate in California
compared to national averages

health centers offered medication abortion.

n Adjusted
n US

overall abortion rate = 1.46%
n California abortion rate = 1.95%
n California has 34% higher abortion rate
n Used

a range of estimates for percent of all abortions
that are medication abortion
n No

California-specific estimates exist
of abortions that are medication abortion in
the US = 31%

n Percent

Student socioeconomic status and abortion access:
Limited financial resources
College students have limited financial resources for
several reasons, including paying the cost of tuition and
room and board, as well as reduced time for employment due to class attendance and homework obligations. These financial constraints may limit students’
ability to cover the costs of an abortion and pay for other

ANSIRH   1330 Broadway, Suite 1100   Oakland, CA 94612   p 510.986.8990   f 510.986.8960   email: ansirh@obgyn.ucsf.edu   www.ansirh.org

 SB320—Access to medication abortion: Issue Brief #1, December 2017, page 3
A D VA N C I N G N E W S TA N D A R D S I N R E P R O D U C T I V E H E A LT H

transportation options such as taxi or rideshare service
to an off-campus provider.
n The

average yearly cost of attending university
(including tuition and room and board) is $30,083 for
UC students and $20,354 for CSU students.2

n Over

the past 20 years, in-state tuition for UCs and
CSUs has tripled.3

The percentage of students qualifying for Pell grants is
the best available indicator of how many low-income students there are on a campus.
n 51%

of students across UC and CSU systems
received Pell Grants—44% at UCs and 53% at CSUs.4

Due to increasing tuition costs and cost of living in California,
many students at UC and CSU campuses are financially
insecure and may lack funds to cover the cost of abortion.
n 42%

of UC students were experiencing low or very
low food security in 2015 and 25% said they had to
choose between paying for food or educational and
housing expenses.5

n According

to a 2015 CSU campus-wide survey, 21%
of CSU students are food insecure and 9% suffer
housing displacement such as homelessness.6

Health insurance limitations
UCs require students to either be enrolled in their
Student Health Insurance Plan (SHIP) or to provide
waiver documentation that they have another source of
health insurance. CSUs do not offer any campus-specific
student health insurance.
n About

10% of CSU students lacked health insurance in
2014, and this was higher on certain campuses (CSU,
Los Angeles reported 19% of students uninsured).7

n Latino

and African American students at CSUs were
more likely to be uninsured than white or Asian
American students.6

n Approximately

23% of CSU students6 and 12% of UC
students8 are enrolled in Medi-Cal.

Most providers closest to UC and CSU campuses accept Medi-Cal.
n 1

provider did not accept Medi-Cal, but the next
closest provider is only 0.05 miles further away

As students currently have to obtain abortion services offcampus, it is possible that that a provider will not accept
their student or other private health insurance to cover
the cost of the abortion. Further, some students covered
by their parent’s health insurance may want to keep the

abortion private from their parents and not charge their
insurance for the abortion. Other students may not have
health insurance that covers abortion or may not have insurance coverage at all. For numerous reasons, students
may have to pay out-of-pocket for an abortion.
The average out-of-pocket cost of medication abortion
at the providers closest to campuses was $604. Costs
at an off-campus provider include coverage of facility
overhead that student health centers would not need to
charge. Student health centers have the potential to offer
medication abortion at a lower cost than what is currently
charged out-of-pocket at off-campus providers.

Key finding: Paying for an abortion out
of pocket at an off-campus provider may
be difficult for already financially stressed
students.

Distance and time to closest providers:
Limited mobility
Though variable by campus, students at public universities in California are unlikely to own a car and have it on
campus.
n Weighted

by campus enrollment, 28% of UC students
have a car on campus9

n Weighted

by campus enrollment, 63% of CSU
students have a car on campus

Distance and public transit
Students without a car are likely to rely on public transit
to access healthcare which cannot be obtained on campus. Traveling more than 30 minutes for primary health
care is considered inaccessible according to California
Code of Regulations; that translates to roughly 5 miles
without a car.10
n 15

campuses (44%) are further than 5 miles from
the nearest provider—6 UC campuses and 9 CSU
campuses

n Among

all campuses, median time by public transit to
closest provider is 34 minutes one-way
n UCs:

Median 29 minutes, max 55 minutes
Median 34 minutes, max 1 hour 32 minutes

n CSUs:
n 22

campuses (65%) are more than 30 minutes from
the nearest provider via public transit

ANSIRH   1330 Broadway, Suite 1100   Oakland, CA 94612   p 510.986.8990   f 510.986.8960   email: ansirh@obgyn.ucsf.edu   www.ansirh.org

 SB320—Access to medication abortion: Issue Brief #1, December 2017, page 4
A D VA N C I N G N E W S TA N D A R D S I N R E P R O D U C T I V E H E A LT H

n Given

two round-trip visits for medication abortion,
this equates to over 2 hours of travel time

access medication abortion, and any delays limit opportunities for receiving care.
n People

Key finding: As medication abortion requires
2 visits to an off-campus provider, each with
travel to and from the facility, the average
time students must travel to obtain an
abortion using public transit is over 2 hours.

n Using

a population-weighted average analysis based
on the number of students at each campus, the
average distance is 5 miles one-way, and average
public transit time is 38 minutes one-way
n UCs:

7 miles, 37 minutes one-way
n CSUs: 5 miles, 38 minutes one-way
n Travel

time for five campuses is more than 1 hour
each way
State University, Stanislaus is the furthest
campus from an abortion provider, at an hour and
a half by public transit one-way, or 6 hours in travel
time for two round-trip visits
n UC Davis is the furthest UC campus from a
­provider, at 55 minutes by public transit one-way,
resulting in nearly 4 hours in travel time for two
round-trip visits

recognize that they are pregnant at 41 days
(6 weeks) on average.11

n Women

with unplanned pregnancies and younger
women are significantly less likely to recognize a
pregnancy within the first 6 weeks.12

The average wait time until first available appointment at
the facilities closest to campus was 7 days (range 1-20
days).
n UCs:

average 5 days

n CSUs:

average 7 days

Key finding: With limited weekend options
and appointment wait times of one week,
having to seek care off-campus may lead to
delays in care and interruption to coursework.

n California

On-campus referral and travel distance
n Some

campuses may refer students to a campusaffiliated provider (e.g. a UC hospital-based provider) or
to a clinic which they have an established relationship
rather than the closest public abortion provider.

n This

provider may not be the closest, but may have
other accessibility benefits, such as free on-campus
shuttles or streamlined insurance processes.

Additional barriers to access:
Weekend services

College continuation:
An unplanned pregnancy during college can involve a
substantial amount of disruption to course work and
pose a risk to college continuation and completion.
n In

surveys, 89% of all students say that preventing
unplanned pregnancy is very important to them and
89% also say that having a child while in school would
make it harder to achieve their goals.13

n 61%

of community college students who have children
after enrolling do not finish their education, which is
65% higher than women who do not have children in
college.14

n In

some studies, adolescents and young adults are
more likely to report that they would have preferred
to get pregnant at a later time or not at all and are
unhappy about their pregnancy when compared to
adult women.15

Students attend classes during the week. In order to
access weekday off-site services, students may need to
miss class.

Key finding: Young adults who want

n Only

to obtain an abortion for an unplanned

5 of the abortion facilities closest to UC and CSU
campuses (15%) are ever open on weekends.

Wait times for appointments
Medication abortion can only be used in the first 70 days
(10 weeks) of pregnancy. There is a limited time frame to

pregnancy need timely access to care to
ensure continuation and completion of their
college education.

ANSIRH   1330 Broadway, Suite 1100   Oakland, CA 94612   p 510.986.8990   f 510.986.8960   email: ansirh@obgyn.ucsf.edu   www.ansirh.org

 SB320—Access to medication abortion: Issue Brief #1, December 2017, page 5
A D VA N C I N G N E W S TA N D A R D S I N R E P R O D U C T I V E H E A LT H

References
1 Jones, R. K., & Jerman, J. (2017). “Abortion incidence and service availability in
the United States, 2014.” Perspectives on Sexual and Reproductive Health, 49(1),
17-27.
2 U.S. News and World Report, 2017-2018 in-state tuition and room and board.
3 Public Policy Institute of California, 2014, “Higher Education in California:
Institutional Costs.”: www.ppic.org/publication/higher-education-in-californiainstitutional-costs/
4 U.S. News and World Report, 2017, “Economic Diversity: National Universities”:
https://premium.usnews.com/best-colleges/rankings/national-universities/
economic-diversity; California State Universities “Measuring the Value of the
CSU”: www.calstate.edu/value/public-good/
5 University of California Global Food Initiative, 2016, “Student Food Access and
Security Study”: regents.universityofcalifornia.edu/regmeet/july16/e1attach.pdf
6 California State University, 2015, “Serving Displaced and Food
Insecure Students in the CSU”: www.calstate.edu/AcadAff/documents/
ServingDisplacedandFoodInsecureStudetnsintheCSUJanuary20163.8.16.pdf
7 CSU Health Insurance Education Project: Project Poll & Analysis, 2014:
www.calstatela.edu/sites/default/files/users/u10891/press_conference_slides_
june_2014_es.pdf

8 UC SHIP Enrollment Waivers Fall 2016 for 6 UC Campuses
9 U.S. News and World Report, 2017, percent of students with car on campus
10 California Code of Regulations, Title 22, Section 53885, “Travel Distance
Standards”
11 Ayoola AB, Stommel M, Nettleman, MD. 2009, “Late recognition of pregnancy
as a predictor of adverse birth outcomes”, Am J Obstet Gynecol, 201:156.e1-6:
www.sciencedirect.com/science/article/pii/S0002937809005055
12 Kost K, Landry DJ, Darroch JE, 1998, “Predicting Maternal Behaviors during
Pregnancy: Does Intention Status Matter?” Family Planning Perspectives, 30 (2):
79-88: www.guttmacher.org/sites/default/files/article_files/3007998.pdf
13 American Association of Community Colleges, 2012, “Make It Personal: How
Pregnancy Planning and Prevention Help Students Complete College”: powertodecide.org/sites/default/files/resources/primary-download/make-it-personal.pdf
14  U.S. Department of Education, 2002, “Short-term Enrollment in Postsecondary
Education”: nces.ed.gov/pubs2003/2003153.pdf
15 Kingston D, Heaman M, Fell D, Chalmers B, 2012, “Comparison of Adolescent,
Young Adult, and Adult Women’s Maternity Experiences and Practices,”
Pediatrics, 129 (5)

ANSIRH   1330 Broadway, Suite 1100   Oakland, CA 94612   p 510.986.8990   f 510.986.8960   email: ansirh@obgyn.ucsf.edu   www.ansirh.org

 SB320—Access to medication abortion: Issue Brief #1, December 2017, page 6
A D VA N C I N G N E W S TA N D A R D S I N R E P R O D U C T I V E H E A LT H

Campus- and system-level data
Campus type
and name

Medication
abortion per month

Travel to
closest provider

Campus enrollment

Low
estimate

High
estimate

Driving
(miles)

Public transit
(minutes)

Total

Annual tuition +
room/board

% undergrads
on Pell grants

Cal Poly San Luis Obispo

8

13

1.7

23

20944

47

Cal Poly Pomona

8

14

4.9

36

23717

45

35

$22,547

20

88

$21,811

CSU Bakersfield

4

6

7.1

63

8002

49

60

$21,780

CSU Channel Islands

3

5

10.0

64

68

6167

64

$22,693

CSU Dominguez Hills

7

12

4.4

55

38

14731

63

90

$19,326

CSU East Bay

7

12

66

2.4

24

14823

61

95

$21,018

CSU Fresno

11

55

18

1.9

30

24403

58

60

$16,287

CSU Fullerton

63

18

29

5.3

82

40235

56

94

$22,492

52

CSU Long Beach

17

27

4.6

25

37446

56

$19,168

56

CSU Los Angeles

13

21

2.9

23

27681

58

$19,969

72

CSU Maritime Academy

<1

<1

3.7

72

1120

17

$18,478

35

4

6

5.1

27

7600

62

$18,309

57

CSU Northridge

17

28

3.6

31

40689

54

$16,841

57

CSU Sacramento

14

22

2.6

31

30284

56

$19,060

60

CSU San Bernardino

10

16

11.2

47

20767

60

$19,567

67

CSU San Marcos

7

11

4.1

46

14179

61

$20,604

52

CSU Stanislaus

5

8

15.8

92

9282

65

50

$15,708

69

Chico State

7

12

2.2

33

17287

53

10

$21,440

50

Humboldt State

4

6

9.9

46

8116

56

25

$20,548

59

San Diego State

15

23

1.4

18

33778

54

$23,426

38

San Francisco State

13

22

6.2

34

30256

56

$20,502

48

San Jose State

13

20

4.5

33

32773

48

36

$25,294

44

Sonoma State

4

7

8.2

40

8668

63

98

$21,278

37

UC Berkeley

17

27

4.4

24

40173

52

$31,372

33

UC Davis

17

27

11.8

55

35186

59

$30,518

40

UC Hastings

<1

1

1.4

20

930

56

UC Irvine

14

23

8.0

48

33467

53

30

$30,345

46

UC Los Angeles

20

33

3.9

37

44947

57

17

$28,697

37

UC Merced

3

5

5.6

28

7336

51

$29,521

62

UC Riverside

9

15

6.2

41

21539

54

40

$29,417

58

UC San Diego

54

$29,437

36

CSU campuses

CSU Monterey Bay

%
female

% with cars
on campus

20

UC campuses

14

22

5.8

29

35821

48

UC San Francisco

2

3

2.6

28

3300

64

UC Santa Barbara

10

17

10.6

46

24346

53

6

$30,627

40

7

11

3.3

12

17335

51

19

$30,083

46

Combined results—
total or populationweighted average

Total

Total

CSU campuses

209

337

UC campuses

113

182

All campuses

322

519

UC Santa Cruz

Average

Average

Total

Average

Average

Average

Average

4.7

38

472,948

55

63

$30,026

53

6.6

37

264,380

54

28

$20,514

41

5.4

38

737,328

55

48

$23,889

49

Advancing New Standards in Reproductive Health (ANSIRH) is a collaborative research program in the Bixby Center for Global
Reproductive Health in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of California, San
Francisco (UCSF).
This study was conducted and the report prepared by Ushma Upadhyay, PhD, MPH; Nicole Johns, MPH; Alice Cartwright, MPH;
Athena Edwards, BA candidate, UCLA; and Aderayo Soyemi, BA candidate, UC Merced.