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Medication Abortion: State of Information on Student Health Center Websites

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Title: Medication Abortion: State of Information on Student Health Center Websites
Language: English
Authors: Sepideh Modrek (ORCID 0000-0003-4557-7156), Mike Wong (ORCID 0000-0002-9013-1041), Anagha Kulkarni (ORCID 0000-0002-1442-9153), Carrie Holschuh (ORCID 0000-0002-5061-7637), Venoo Kakar (ORCID 0000-0001-9881-2004)
Source: Journal of American College Health. 2024 72(9):3131-3135.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 5
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Pregnancy, Web Sites, Information Dissemination, Higher Education, Drug Use, Health Services, College Students
Geographic Terms: California, Indiana, Connecticut, Georgia, Michigan, Minnesota, New Jersey, North Carolina, Virginia, Washington, Tennessee, Louisiana, Wisconsin
DOI: 10.1080/07448481.2022.2155472
ISSN: 0744-8481
1940-3208
Abstract: Objective: To document the information on medication abortion on university Student Health Center (SHC) websites. Study Sample: Four-year bachelors granting public universities' Student Health Center websites. Methods: We conduct thematic content analysis for medication abortion-related information on 547 SHC websites in the United States as of August 2022 using computer-assisted software. We validate the software with human annotation. Results: Medication abortion is mentioned on 23 (4%) university SHC websites, and in 13 (57%) of these websites, it is only mentioned to exclude it from definitions of emergency contraception. Only two websites, 6% of the California public schools included in the sample, advertise medication abortion services through their SHC websites. One hundred fifteen (21%) university websites provide links to Planned Parenthood that gives information on how to navigate abortion access across all 50 states. Conclusion: There is inadequate information on SHC websites regarding medication abortion services and how to access them.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1452165
Database: ERIC
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  Value: <anid>AN0181109485;acl01dec.24;2024Nov28.03:47;v2.2.500</anid> <title id="AN0181109485-1">Medication abortion: State of information on Student Health Center websites </title> <p>Objective: To document the information on medication abortion on university Student Health Center (SHC) websites. Study Sample: Four-year bachelors granting public universities' Student Health Center websites. Methods: We conduct thematic content analysis for medication abortion-related information on 547 SHC websites in the United States as of August 2022 using computer-assisted software. We validate the software with human annotation. Results: Medication abortion is mentioned on 23 (4%) university SHC websites, and in 13 (57%) of these websites, it is only mentioned to exclude it from definitions of emergency contraception. Only two websites, 6% of the California public schools included in the sample, advertise medication abortion services through their SHC websites. One hundred fifteen (21%) university websites provide links to Planned Parenthood that gives information on how to navigate abortion access across all 50 states. Conclusion: There is inadequate information on SHC websites regarding medication abortion services and how to access them.</p> <p>Keywords: Health communication; health education; medication abortion; university student health centers</p> <hd id="AN0181109485-2">Background</hd> <p>The June 2022 reversal of the federal right to an abortion through the Supreme Court ruling in <emph>Dobbs v. Jackson Women's Health Organization</emph> is expected to have a profound impact on educational equity as this decision allows states to ban abortion entirely.[<reflink idref="bib1" id="ref1">1</reflink>],[<reflink idref="bib2" id="ref2">2</reflink>] One in five abortion patients report that attaining education and career goals were the reasons for seeking abortion.[<reflink idref="bib3" id="ref3">3</reflink>] Annually, about 1% of sexually active college students report becoming unintentionally pregnant.[<reflink idref="bib4" id="ref4">4</reflink>] Though easy access to abortion has long varied by geography, the disparity in access to abortion for college students has now substantially changed as state abortion policies are diverging. Some states now have banned access to abortion altogether, even for instances of rape or incest, or have placed prohibitive restrictions on the gestational age for abortion that limit the procedure to a window of time that ends before many pregnancies would normally be diagnosed. Meanwhile, other states are increasing access to abortion through legislative initiatives to expand abortion services,[<reflink idref="bib5" id="ref5">5</reflink>] including medication abortion provisions on college campuses.</p> <p>In this changing landscape, Student Health Centers (SHCs) have an opportunity to provide their college communities with timely and accurate information on medication abortion and its local accessibility. Previous studies have found that college students faced cost, scheduling, and travel barriers to obtaining medication abortion services.[[<reflink idref="bib6" id="ref6">6</reflink>], [<reflink idref="bib8" id="ref7">8</reflink>]] In California, these barriers persuaded the California legislature to pass the nation's first law that required public university health centers to offer medication abortion in 2019. Massachusetts has followed suit and passed similar legislations in 2022.[<reflink idref="bib7" id="ref8">7</reflink>] Meanwhile, Washington has mandated that any student insurance covering maternity care must also cover abortion.[<reflink idref="bib9" id="ref9">9</reflink>] Thus, some state legislatures are asking the SHCs to take an active role in abortion care. At the same time, other states are adding restrictions to abortion access, such as Texas, where abortion is now banned except to save the life of the pregnant person, and any citizen may sue an individual for aiding and abetting abortion provision. Since SHCs at public schools are funded by the state and thus must follow state laws, they may be deeply constrained in their ability to serve pregnant students.</p> <p>Regardless of state laws, SHCs can serve as a hub for trusted and accurate health information, including information on abortion and medication abortion. More than ever, having rapid access to accurate information on how to obtain an abortion, particularly medication abortion is vital. Medication abortions are now the most common type of abortion and can in some states be provided with out-of-state telemedicine services.[<reflink idref="bib10" id="ref10">10</reflink>] Since medication abortion must be completed within the first ten weeks of pregnancy, providing information to navigate access, even if the SHC itself does not have the capacity or legal ability to provide abortion services, is increasingly important. In addition, the online availability of the drugs needed for medication abortion without a prescription from overseas vendors has made it possible for students who feel they do not have other options to attempt "self-managed" medication abortions. Providing complete and accurate information on medication abortion and links to qualified providers could increase support and safety for students seeking abortions.[<reflink idref="bib11" id="ref11">11</reflink>]</p> <p>We document the state of information on medication abortion on university SHC websites across four-year public institutions as of August 15, 2022—just after the <emph>Dobbs</emph> decision. We explore the information on the SHCs and whether they provide links to outsourced information on abortion options nationally. Furthermore, we comment on California public universities because they are required by law to provide medication abortion services or referrals starting January 2023, and previous research suggests that major investments would be needed to implement this law fully.[<reflink idref="bib12" id="ref12">12</reflink>]</p> <hd id="AN0181109485-3">Materials and methods</hd> <p>We conduct a computer-assisted content analysis on the SHC websites. We used Quantitative Measures of Online Health Information (QMOHI), a newly developed open-source software tool that gathers relevant information about keywords from SHC websites. This tool first finds SHC websites for a pre-specified list of universities and searches the entire SHC website for the given keywords.[<reflink idref="bib13" id="ref13">13</reflink>],[<reflink idref="bib14" id="ref14">14</reflink>] Because there are no standards for SHC naming, hosting structure or website changes, the tool uses a dynamic algorithmic approach to find SHC websites using a commercial search engine (e.g. Google Custom Search API). Of the 591 four-year bachelors granting public universities in the United States, the tool could find 547 SHC websites. Those that could not be found either did not have a SHC website (<emph>n</emph> = 33), had a separate health system outside the university (<emph>n</emph> = 9; Native American and Veteran serving institutions have separate health systems for their students), or were not found because the custom search timed out before the SHC website could be found (<emph>n</emph> = 2). These 547 university SHC websites were searched for the following words: "abortion pill," "nonsurgical abortion," "medication abortion," "mifepristone," "misoprostol," "Mifeprex," and "RU-486" and small variations on these words.</p> <p>We manually examined 50 randomly selected universities. Human annotators with detailed annotation instructions validated the search results. We detail the themes in the content related to medication abortion found on the SHC websites. We also used the tool to examine whether the SHC website linked to any Planned Parenthood website, either a local Planned Parenthood Affiliate or a national website. Links to Planned Parenthood websites are of interest because Planned Parenthood is a nationally recognized organization that supports access to abortion with presence in all 50 states until very recently. Even after the <emph>Dobbs</emph> decision, the national Planned Parenthood website offers a navigation tool to help find clinics where abortions are provided by the type of abortion.</p> <p>Gathering information posted on SHC websites does not require interactions with human subjects and our research design was found to be exempt from human subject oversight.</p> <hd id="AN0181109485-4">Results</hd> <p>Five hundred forty-seven SHC websites were searched. Only 23 (4%) of these SHC websites had any mention of medication abortion-related keywords as of August 15, 2022. The information on websites varied substantially. Two California universities provided detailed information on how to access medication abortion on campus.</p> <p>"On-Campus Family Planning Service - Medication Abortion</p> <p>Medication abortion services are available at the X Center for pregnancies up to 70 days (10 weeks). If your pregnancy is < = 70 days (10 weeks) and there are no contraindications after screening, you will be eligible to make an appointment with a X Center nurse and clinician who will discuss the medication abortion process and what to expect <emph>...</emph>"</p> <p>One California school detailed information about medication abortion safety, the legal right to abortion in the state, and contact information to access the service.</p> <p> <bold>"</bold>Abortion</p> <p>Abortion is an option that is available to you if you find that you are pregnant and do not want to continue the pregnancy. It is a very safe procedure if performed by a trained health professional fewer than.5% of people experience complications. California is one of the most liberal states when it comes to abortion laws. If you are a student that is under the age of 18 and are in California, there is no parental involvement or consent required to receive an abortion. .... Abortions are not performed at the Y Student Health and Wellness Center, but if you are considering an abortion, you may want to meet with a provider here at SHCS so they can refer you to Z Hospital"</p> <p>One Indiana school detailed information on local restrictions on access to abortion in general and the process to get an abortion (medication or otherwise) in the state at the time.</p> <p>"In the state of Indiana, only first trimester abortions are permitted in outpatient clinics. If a person is under the age of 18, parental consent or judicial bypass is required.</p> <p>What procedures are available for first trimester abortion in Indiana? A person may choose from two types of first trimester abortion procedures.... medical abortion and involves taking two oral medications, mifepristone and misoprostol. ...Pregnancy tests can be done ten days past conception at the Student Health Center. This will allow you to make an appointment within the proper amount of time at a clinic that provides abortion services. (The Student Health Center does not provide surgical or medical abortions.) ...Some clinics also require that you bring evidence of pregnancy, such as a note from your health care provider or lab test results. The Student Health Center can provide all paper work that most clinics require, although we do not perform abortions at the Student Health Center..."</p> <p>Three universities across the US (Tennessee, Louisiana, and Wisconsin) provided contact information to local organizations that provide abortions but with no other details. Two California universities mention medication abortion as a new service that will be added shortly. One Georgia university only states that the SHC does not offer medication abortion.</p> <p>In the remaining thirteen universities, which account for 57% of SHC websites with any reference to medication abortion, medication abortion is only mentioned to contrast it with emergency contraception (EC). The statements aim to ensure that the reader knows that drugs for EC are not the same drug as is used in medication abortion, but there was no other information on medication abortion on these websites. Table 1 presents the exact text. It is important to note that on websites that contrast medication abortion to EC, the keywords RU-486 and abortion pill were often the only words identified.</p> <p>Table 1. Exact text on student health center websites that contrast medication abortion with emergency contraception.</p> <p> <ephtml> <table><thead><tr><td>State where university is located</td><td>Exact text on website</td></tr></thead><tbody valign="top"><tr><td>California</td><td>ECP [the emergency contraceptive pill] is for emergencies only. Using ECP is less effective at preventing pregnancy than using birth control that is used before or during sex (e.g. birth control pills, condoms, etc.). ECP is not the <bold>abortion pill.</bold> If you are already pregnant, ECP will not cause an abortion.</td></tr><tr><td>Connecticut</td><td>Plan B does not protect against sexually transmitted infections. Plan B won't cause an abortion. Plan B is NOT the same as <bold>RU-486 (the abortion pill).</bold> Plan B is not effective after pregnancy has occurred and cannot interrupt it.</td></tr><tr><td>Georgia</td><td>Emergency contraception is not the same as <bold>RU-486 (abortion pill).</bold></td></tr><tr><td>Georgia</td><td>Plan B is Levonorgestrel 0.75 mg. It prevents fertilization and implantation. It will not work once implantation has begun. Plan B is not <bold>the abortion pill</bold>. It will not work if a woman is already pregnant.</td></tr><tr><td>Michigan</td><td>EC [emergency contraception] does not cause an abortion. The "morning-after pill" (ella or Levonorgestrel) is NOT the "<bold>abortion pill" RU-486</bold>. If you are already pregnant, emergency contraception will not end your pregnancy. If you think you may be pregnant, talk to your health care provider.</td></tr><tr><td>Minnesota</td><td>How does Emergency Contraception work? Emergency contraceptive pills prevent pregnancy primarily by delaying or inhibiting ovulation. The Copper-T IUD does not affect ovulation, but it can prevent sperm from fertilizing an egg. It may also prevent implantation of a fertilized egg. EC will not cause an abortion. EC is not the same as the <bold>abortion pill.</bold></td></tr><tr><td>New Jersey</td><td>EC is an FDA approved method used in an attempt to prevent an unplanned pregnancy. It is used after having sex without birth control or with a failed method (i.e. condom broke or slipped off). It is not an <bold>abortion pill.</bold> It works by preventing or delaying the egg from leaving the ovary, being fertilized by the sperm, or attaching to the uterus.</td></tr><tr><td>New Jersey</td><td>EC does not protect against sexually transmitted infections (STIs). Most women tolerate EC relatively well but side effects may include nausea, vomiting, and a delayed or early menstrual period. EC will not cause an abortion or miscarriage (it is not the same thing as <bold>RU-486,</bold> which is known as the <bold>abortion pill</bold>). If you are already pregnant, there is no increased risk to the fetus.</td></tr><tr><td>North Carolina</td><td>What is the difference between emergency contraception and the <bold>abortion pill</bold>? Emergency contraception methods do not cause abortions. All EC methods work to prevent ovulation, fertilization, or implantation. If a woman is already pregnant, meaning that a fertilized egg has implanted in the uterus, emergency contraception will not work. Emergency contraception is not the same as <bold>mifepristone (RU-486</bold>), a pill used for <bold>medical abortion</bold>.</td></tr><tr><td>Virginia</td><td>Emergency contraception can be used when a condom breaks, after a sexual assault, or when unprotected sexual intercourse occurs. Emergency contraception is not the same as the <bold>RU486 (abortion pill).</bold> It will not interfere with an existing pregnancy.</td></tr><tr><td>Virginia</td><td>EC can be used when a condom breaks or another BC [birth control] method does not work successfully, after a sexual assault, or when unprotected intercourse occurs. This method is not 100% effective, and pregnancy can still occur. EC is not an <bold>abortion pill</bold> and will not interfere with an existing pregnancy.</td></tr><tr><td>Virginia</td><td>Emergency contraception is not the same as the <bold>RU486 (abortion pill).</bold> It will not interfere with an existing pregnancy. It is meant for emergencies only and should not be used as an ongoing method of contraception.</td></tr><tr><td>Washington</td><td>Emergency contraception is NOT the same as the <bold>abortion pill</bold> NOT capable of preventing an established pregnancy</td></tr></tbody></table> </ephtml> </p> <p>Furthermore, about 21% of the 547 SHC websites provide links to resources on Planned Parenthood where a variety of contraception and abortion services are discussed including medication abortion. The proportion of SHC websites that provided links to Planned Parenthood varied considerably by state. In sixteen states, no public university provided links to local or national Planned Parenthood websites. California had the highest number of public universities that provided links to Planned Parenthood (Appendix Table 1). Manual annotation of the 50 randomly selected universities reveals high specificity with a false negative rate of 0% and false positive rate of 2% for the computer-assisted searches.</p> <hd id="AN0181109485-5">Conclusion</hd> <p>As states diverge in their policies toward abortion in the aftermath of the <emph>Dobbs</emph> decision, the SHCs can serve as a hub for trusted and accurate information, especially for medication abortion. We document the limited information on SHC websites on medication abortion in general with only 4% of SHC websites mentioning the phrase. Our results are in line with previous provider surveys documenting that only 2.5% of SHCs provide medication abortion on campus.[<reflink idref="bib15" id="ref15">15</reflink>]</p> <p>Examining SHC website information on medication abortion shows whether and how SHCs advise students in states with varying laws governing abortion. For example, we find that in Indiana, where access to outpatient abortion services is restricted and laws were in flux at the time of data collection, an SHC posted the details of the state restrictions and still provided neutral information on the procedures and how to access them. Other university SHCs can follow suit and support students' health and autonomy without breaking state laws. A limitation to our approach is that our analysis included information on SHC websites at a point in time and did not examine external link or related brochures. SHC may be disseminating this information through other outlets.</p> <p>We further document that more than half of the references to medication abortion are to highlight that EC is not medication abortion. While stating the differences between EC and medication abortion is important, mentioning medication abortion only to distinguish it from a provided service could stigmatize the use of medication abortion. The lack of information on medication abortion on these websites could send a message that medication abortion is not safe or sanctioned. Websites that state the difference between EC and medication abortion could have detailed information on both medications while still mentioning state restrictions.</p> <p>State regulations are diverging rapidly; some state legislatures are turning to SHCs explicitly to increase access to medication abortion. In these states, universities must change their presentation of medication abortion on their webpages to support the access goals of state legislatures and the safety of their students. Even in states without such legislation, where SHCs are bound by state funding and laws, universities SHC websites can still provide detailed, medically accurate, and neutral information on medication abortion and its accessibility locally and elsewhere, including through telemedicine.</p> <hd id="AN0181109485-6">Acknowledgment</hd> <p>The authors thank Miho Shimizu for software support.</p> <hd id="AN0181109485-7">Authors' contributions</hd> <p>Conceptualization: SM, VK, CH, AK; Methods: SM; Software: MW, AK; Validation: SM, MW; Data Curation: SM; Project Administration: SM, VK; Writing Original Draft: SM; Writing Review & Editing: SM, VK, CH, AK.</p> <hd id="AN0181109485-8">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States of America and received approval from the Institutional Review Board of San Francisco State University (Protocol 2022-259).</p> <hd id="AN0181109485-9">Appendix A</hd> <p>See Table A1.</p> <p>Table A1. Number of universities in sample and percentage of universities with any referral to planned parenthood by state.</p> <p> <ephtml> <table><thead><tr><td>State</td><td>Universities in sample</td><td>Percent refer out to Planned Parenthood<xref ref-type="table-fn" rid="tfn1">a</xref></td></tr></thead><tbody valign="top"><tr><td>Iowa</td><td char=".">3</td><td char=".">67%</td></tr><tr><td>California</td><td char=".">32</td><td char=".">63%</td></tr><tr><td>Wisconsin</td><td char=".">13</td><td char=".">54%</td></tr><tr><td>Delaware</td><td char=".">2</td><td char=".">50%</td></tr><tr><td>Oregon</td><td char=".">7</td><td char=".">43%</td></tr><tr><td>Washington</td><td char=".">7</td><td char=".">43%</td></tr><tr><td>Maryland</td><td char=".">12</td><td char=".">42%</td></tr><tr><td>Arizona</td><td char=".">5</td><td char=".">40%</td></tr><tr><td>Connecticut</td><td char=".">5</td><td char=".">40%</td></tr><tr><td>Utah</td><td char=".">5</td><td char=".">40%</td></tr><tr><td>New York</td><td char=".">39</td><td char=".">38%</td></tr><tr><td>Florida</td><td char=".">16</td><td char=".">38%</td></tr><tr><td>Virginia</td><td char=".">14</td><td char=".">36%</td></tr><tr><td>Hawaii</td><td char=".">3</td><td char=".">33%</td></tr><tr><td>New Jersey</td><td char=".">12</td><td char=".">33%</td></tr><tr><td>North Carolina</td><td char=".">15</td><td char=".">33%</td></tr><tr><td>Kansas</td><td char=".">7</td><td char=".">29%</td></tr><tr><td>Michigan</td><td char=".">14</td><td char=".">29%</td></tr><tr><td>Minnesota</td><td char=".">11</td><td char=".">27%</td></tr><tr><td>Illinois</td><td char=".">12</td><td char=".">25%</td></tr><tr><td>Kentucky</td><td char=".">8</td><td char=".">25%</td></tr><tr><td>New Hampshire</td><td char=".">4</td><td char=".">25%</td></tr><tr><td>South Carolina</td><td char=".">10</td><td char=".">20%</td></tr><tr><td>Colorado</td><td char=".">11</td><td char=".">18%</td></tr><tr><td>Montana</td><td char=".">6</td><td char=".">17%</td></tr><tr><td>North Dakota</td><td char=".">6</td><td char=".">17%</td></tr><tr><td>Alabama</td><td char=".">13</td><td char=".">15%</td></tr><tr><td>New Mexico</td><td char=".">7</td><td char=".">14%</td></tr><tr><td>Tennessee</td><td char=".">9</td><td char=".">11%</td></tr><tr><td>Massachusetts</td><td char=".">12</td><td char=".">8%</td></tr><tr><td>Pennsylvania</td><td char=".">37</td><td char=".">8%</td></tr><tr><td>Indiana</td><td char=".">15</td><td char=".">7%</td></tr><tr><td>Ohio</td><td char=".">16</td><td char=".">6%</td></tr><tr><td>Georgia</td><td char=".">23</td><td char=".">4%</td></tr><tr><td>Texas</td><td char=".">32</td><td char=".">3%</td></tr><tr><td>Alaska</td><td char=".">3</td><td char=".">0%</td></tr><tr><td>Arkansas</td><td char=".">10</td><td char=".">0%</td></tr><tr><td>District of Columbia</td><td char=".">1</td><td char=".">0%</td></tr><tr><td>Idaho</td><td char=".">4</td><td char=".">0%</td></tr><tr><td>Louisiana</td><td char=".">14</td><td char=".">0%</td></tr><tr><td>Maine</td><td char=".">7</td><td char=".">0%</td></tr><tr><td>Mississippi</td><td char=".">8</td><td char=".">0%</td></tr><tr><td>Missouri</td><td char=".">14</td><td char=".">0%</td></tr><tr><td>Nebraska</td><td char=".">6</td><td char=".">0%</td></tr><tr><td>Nevada</td><td char=".">2</td><td char=".">0%</td></tr><tr><td>Oklahoma</td><td char=".">13</td><td char=".">0%</td></tr><tr><td>Rhode Island</td><td char=".">2</td><td char=".">0%</td></tr><tr><td>South Dakota</td><td char=".">5</td><td char=".">0%</td></tr><tr><td>Vermont</td><td char=".">4</td><td char=".">0%</td></tr><tr><td>West Virginia</td><td char=".">10</td><td char=".">0%</td></tr><tr><td>Wyoming</td><td char=".">1</td><td char=".">0%</td></tr></tbody></table> </ephtml> </p> <p>1 Planned Parenthood had a presence in all 50 states until recently.</p> <ref id="AN0181109485-10"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Startz D, Lundberg S. The end of Roe creates new challenges in higher education [Internet]. Brookings. 2022. Available at: https://<ulink href="http://www.brookings.edu/blog/brown-center-chalkboard/2022/08/09/the-end-of-roe-creates-new-challenges-in-higher-education/">www.brookings.edu/blog/brown-center-chalkboard/2022/08/09/the-end-of-roe-creates-new-challenges-in-higher-education/</ulink>. Accessed Aug 23, 2022.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Jones K, Pineda-Torres MPT. TRAP'd Teens: impacts of abortion provider regulations on fertility & education [Internet]. 2021. Available at: https://<ulink href="http://www.iza.org/publications/dp/14837/trapd-teens-impacts-of-abortion-provider-regulations-on-fertility-education">www.iza.org/publications/dp/14837/trapd-teens-impacts-of-abortion-provider-regulations-on-fertility-education</ulink>. Accessed Aug 23, 2022.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref3" type="bt">3</bibl> <bibtext> Upadhyay UD, Biggs MA, Foster DG. The effect of abortion on having and achieving aspirational one-year plans. BMC Womens Health. 2015; 15 (1): 102.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref4" type="bt">4</bibl> <bibtext> American College Health Association. American College Health Association-National College Health Assessment III: Undergraduate Student Executive Summary Fall 2021. Silver Spring, MD : American College Health Association; 2022.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref5" type="bt">5</bibl> <bibtext> Senate Leader Atkins' Bill to Expand Abortion Services, Health Care Passes First Assembly Committee [Internet]. Senator Toni G. Atkins. 2022. Available at: https://sd39.senate.ca.gov/news/20220621-senate-leader-atkins%E2%80%99-bill-expand-abortion-services-health-care-passes-first-assembly. Accessed Aug 23, 2022.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref6" type="bt">6</bibl> <bibtext> Upadhyay UD, Cartwright AF, Johns NE. Access to medication abortion among California's public university students. J Adolesc Health. 2018; 63 (2): 249 – 252. doi: 10.1016/j.jadohealth.2018.04.009.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref8" type="bt">7</bibl> <bibtext> Baker CN, Mathis J. Barriers to medication abortion among Massachusetts public university students. Contraception. 2022; 109 : 32 – 36. doi: 10.1016/j.contraception.2021.12.010.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref7" type="bt">8</bibl> <bibtext> Behonick D. Assessing the need for on-campus medication abortion at California Community Colleges. J Am Coll Health. 2021 : 1 – 8. doi: 10.1080/07448481.2021.1908308.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref9" type="bt">9</bibl> <bibtext> RCW 48.43.073. Required abortion coverage—Limitations [Internet]. 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Contraception 2018; 98 (4): 306 – 311. doi: 10.1016/j.contraception.2018.05.014.</bibtext> </blist> <blist> <bibtext> Kulkarni A, Wong M, Belsare T, et al. Quantifying the quality of web-based health information on student health center websites using a software tool: design and development study. JMIR Form Res. 2022; 6 (2): e32360. doi: 10.2196/32360.</bibtext> </blist> <blist> <bibtext> Kakar V, Kulkarni A, Holschuh C, Smirnova A, Modrek S. Contraception information on the websites of student health centers in the United States. Contraception 2022; 112 : 68 – 73. doi: 10.1016/j.contraception.2022.01.007.</bibtext> </blist> <blist> <bibtext> American College Health Association. American College Health Association 2020 Sexual Health Services Survey. Silver Spring, MD : American College Health Association; 2021.</bibtext> </blist> </ref> <aug> <p>By Sepideh Modrek; Mike Wong; Anagha Kulkarni; Carrie Holschuh and Venoo Kakar</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref10"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref11"></nolink> <nolink nlid="nl3" bibid="bib12" firstref="ref12"></nolink> <nolink nlid="nl4" bibid="bib13" firstref="ref13"></nolink> <nolink nlid="nl5" bibid="bib14" firstref="ref14"></nolink> <nolink nlid="nl6" bibid="bib15" firstref="ref15"></nolink>
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  Label: Title
  Group: Ti
  Data: Medication Abortion: State of Information on Student Health Center Websites
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Sepideh+Modrek%22">Sepideh Modrek</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4557-7156">0000-0003-4557-7156</externalLink>)<br /><searchLink fieldCode="AR" term="%22Mike+Wong%22">Mike Wong</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9013-1041">0000-0002-9013-1041</externalLink>)<br /><searchLink fieldCode="AR" term="%22Anagha+Kulkarni%22">Anagha Kulkarni</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1442-9153">0000-0002-1442-9153</externalLink>)<br /><searchLink fieldCode="AR" term="%22Carrie+Holschuh%22">Carrie Holschuh</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5061-7637">0000-0002-5061-7637</externalLink>)<br /><searchLink fieldCode="AR" term="%22Venoo+Kakar%22">Venoo Kakar</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9881-2004">0000-0001-9881-2004</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(9):3131-3135.
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  Label: Availability
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  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 5
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Web+Sites%22">Web Sites</searchLink><br /><searchLink fieldCode="DE" term="%22Information+Dissemination%22">Information Dissemination</searchLink><br /><searchLink fieldCode="DE" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Use%22">Drug Use</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22California%22">California</searchLink><br /><searchLink fieldCode="DE" term="%22Indiana%22">Indiana</searchLink><br /><searchLink fieldCode="DE" term="%22Connecticut%22">Connecticut</searchLink><br /><searchLink fieldCode="DE" term="%22Georgia%22">Georgia</searchLink><br /><searchLink fieldCode="DE" term="%22Michigan%22">Michigan</searchLink><br /><searchLink fieldCode="DE" term="%22Minnesota%22">Minnesota</searchLink><br /><searchLink fieldCode="DE" term="%22New+Jersey%22">New Jersey</searchLink><br /><searchLink fieldCode="DE" term="%22North+Carolina%22">North Carolina</searchLink><br /><searchLink fieldCode="DE" term="%22Virginia%22">Virginia</searchLink><br /><searchLink fieldCode="DE" term="%22Washington%22">Washington</searchLink><br /><searchLink fieldCode="DE" term="%22Tennessee%22">Tennessee</searchLink><br /><searchLink fieldCode="DE" term="%22Louisiana%22">Louisiana</searchLink><br /><searchLink fieldCode="DE" term="%22Wisconsin%22">Wisconsin</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2022.2155472
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To document the information on medication abortion on university Student Health Center (SHC) websites. Study Sample: Four-year bachelors granting public universities' Student Health Center websites. Methods: We conduct thematic content analysis for medication abortion-related information on 547 SHC websites in the United States as of August 2022 using computer-assisted software. We validate the software with human annotation. Results: Medication abortion is mentioned on 23 (4%) university SHC websites, and in 13 (57%) of these websites, it is only mentioned to exclude it from definitions of emergency contraception. Only two websites, 6% of the California public schools included in the sample, advertise medication abortion services through their SHC websites. One hundred fifteen (21%) university websites provide links to Planned Parenthood that gives information on how to navigate abortion access across all 50 states. Conclusion: There is inadequate information on SHC websites regarding medication abortion services and how to access them.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1452165
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      – Type: doi
        Value: 10.1080/07448481.2022.2155472
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 5
        StartPage: 3131
    Subjects:
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Web Sites
        Type: general
      – SubjectFull: Information Dissemination
        Type: general
      – SubjectFull: Higher Education
        Type: general
      – SubjectFull: Drug Use
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      – SubjectFull: Health Services
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      – SubjectFull: College Students
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      – SubjectFull: California
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        Type: general
      – SubjectFull: Georgia
        Type: general
      – SubjectFull: Michigan
        Type: general
      – SubjectFull: Minnesota
        Type: general
      – SubjectFull: New Jersey
        Type: general
      – SubjectFull: North Carolina
        Type: general
      – SubjectFull: Virginia
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      – SubjectFull: Washington
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      – SubjectFull: Louisiana
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      – SubjectFull: Wisconsin
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    Titles:
      – TitleFull: Medication Abortion: State of Information on Student Health Center Websites
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            NameFull: Carrie Holschuh
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            NameFull: Venoo Kakar
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