Editor’s note: This is the first installment of Rewire News Group’s Campus Dispatch series, exploring how Gen Z is uniquely impacted by confusing and ever-changing policies on reproductive, voting, and LGBTQ+ rights. On the last Monday of every month, we’ll be publishing a story by a young writer that tackles the issues most affecting their generation.
Medication abortion is simple. It’s not a procedure; it just requires taking two drugs called mifepristone and misoprostol. It has a more than 90 percent success rate up to ten weeks. It can be done in your home, on your own time. And in Massachusetts, thanks to a 2022 law, it’s going to be a free, accessible option for all students at public colleges and universities in the state.
The bill was first filed in January 2022 by Massachusetts Rep. Lindsay Sabadosa and state Sen. Jason Lewis, with the backing of Planned Parenthood, the ACLU, and grassroots reproductive justice organization Reproductive Equity Now. The overturning of Roe v. Wade six months later only added fuel to the fire, and former Gov. Charlie Baker signed the bill into law in July 2022. The law gave public Massachusetts colleges and universities until the end of November 2023 to submit a plan outlining how they will provide medication abortion, and the Department of Public Health (DPH) has until January 31 to review those plans.
“We knew that students face some of the largest barriers to accessing abortion care in Massachusetts, whether that’s long distances to reach clinics, time spent away from classes or work, scheduling conflicts, or a lack of reliable transportation in many regions of our state,” said Taylor St. Germain, communications director for Reproductive Equity Now.
The ability for students to access medication abortion on their campuses will be a game changer, Sabadosa said. But implementation of this service is happening right as the Supreme Court is poised to potentially roll back access to mifepristone nationwide.
“When you don’t have access, procedures end up being later,” Sabadosa told Rewire News Group. “Massachusetts is proving that the more access you have, the earlier the procedures happen. That makes an impact.”
According to a state estimate, anywhere between 600 and 1,380 public college students in Massachusetts need abortion care every year. Accessing care can be a challenge for many reasons, especially for students attending colleges and universities that are not in major cities with reliable public transportation systems. Eight major institutions of higher education in Massachusetts are located more than 15 miles away from the nearest abortion clinic.
The DPH, in collaboration with Reproductive Equity Now, created a toolkit to help colleges construct their plans. It addresses everything from support tools for health center teams to liability and confidentiality concerns, with a step-by-step overview of how to create a plan that works with their college’s unique set of circumstances. DPH is able to provide funding for schools that need it; Sabadosa emphasized that colleges and universities also need support, and financial barriers should not prevent them from being able to provide their students the care they deserve.
Implementation will begin after DPH completes its review.
Many colleges and universities will provide medication abortion to students in their campus health centers directly. If the schools don’t have the space or resources for that, their plan can outline how they will help students access medication abortions off campus, taking into account factors like referrals, transportation, and cost.
The college campus medication abortion guinea pig
The University of Massachusetts Amherst—the flagship campus for the University of Massachusetts with over 20,000 undergraduate students—was interested in providing students with access to medication abortions on campus even before the law was passed.
“We provide a full spectrum of primary care, including at a sexual and reproductive health clinic where we offer contraception,” said Dr. Leora Cohen-McKeon, a service provider in UMass Amherst’s Sexual and Reproductive Health Clinic. “We decided we should offer medication abortion too.”
Medication abortion, it was decided, “falls well within our scope of practice,” Cohen-McKeon said, and the school started offering it in August 2022, just after the state law was signed.
“I don’t see that there should be barriers at other schools who provide general reproductive health care to be able to do this as well,” Cohen-McKeon said.
UMass Amherst has been a sort of guinea pig for the rollout of the law across universities. And so far, it’s been working.
“We’ve had a large number of people come through, and it’s been a really smooth process,” Cohen-McKeon said. “Sometimes students call knowing they want a medication abortion. Sometimes they call and say they just realized they’re pregnant. They don’t know what to do. It’s awesome to be able to offer this service here, to be able to say to them, ‘It’s OK, I can see you tomorrow. We’re going to figure this out.’”
Charlotte Gilson, a UMass Amherst junior, has felt the impact of having medication abortion so readily available.
“It provides a lot of security for me, as a student and as a woman with the capacity to become pregnant but not being in a place where I feel like I can raise a child,” Gilson said. “It’s really powerful that [University Health Services] has taken this initiative.”
If students come in hoping to use the service but are too far along for a medication abortion, the school helps them through the referral process to get an abortion at Planned Parenthood or a local provider.
Nationwide concerns over mifepristone access
Providing access to medication abortion on campuses, though, does not come without difficulties of its own. Last month, the Supreme Court announced it would take up a challenge to mifepristone this term, even while physicians assert its safety and the importance of its accessibility. Reproductive Equity Now called it a “baseless case.”
“Mifepristone is a safe and effective drug that has been used millions of times across our country since the FDA approved it more than 20 years ago,” Rebecca Hart Holder, president of Reproductive Equity Now, said. “This case is a feeble attempt by far-right, anti-abortion extremists to reach across borders and restrict access to abortion in all 50 states, including Massachusetts.”
The state is taking steps to ensure its providers continue to have access to mifepristone. In April 2023, after a lower court’s judge ruled in favor of overturning the FDA’s 2000 approval of mifepristone, Massachusetts Gov. Maura Healey worked with the UMass Amherst to purchase 15,000 doses of mifepristone, ensuring sufficient coverage for the state for over a year. The Healey administration has also dedicated an additional $1 million to support providers who are contracted with the DPH in paying for additional doses of mifepristone as needed.
This comes on the heels of Massachusetts passing shield protections from out-of-state litigation in 2022, and in an April 2023 executive order, Healey doubled down on confirming that the state’s shield law should be interpreted as protecting patients’ access to, and providers’ ability to offer, mifepristone.
Improving the medication abortion experience at UMass
As colleges and universities around the state implement these plans in the coming months, UMass Amherst is onto the next step: finding ways to make the process of a medication abortion on campus even better for students.
Nisha Sabnis, a UMass Amherst senior studying public health, became a certified abortion doula at the beginning of December through an online training with the Colorado Doula Project, inspired by her work with the Abortion Rights Fund of Western Massachusetts.
Now, she’s leading a charge to get a group of students certified as abortion doulas.
“Whenever a student decides to go and get a medication abortion, they would have the option to opt into working with an abortion doula—one of us—and we would be there with them while they’re doing paperwork, bloodwork,” Sabnis said. “After the procedure, they would have our phone number to be able to ask questions if anything comes up, if they have concerns, if they’re unsure about something.”
Abortion doulas are similar to birthing doulas in that they’re there for pregnant people before, during, and after either procedural or medication abortion. Having a doula would be impactful, especially if your doula is a peer.
“People that are getting medication abortions are often living in dorms, or even if they’re living off campus, they’re probably sharing a bathroom,” Sabnis said. “It can be traumatizing to go through this in the first place, and even more so if you don’t have your own space.”
Cohen-McKeon said she doesn’t think enough students are aware that UMass Amherst offers medication abortion services, and even more importantly, some students who come in to access those services are really anxious about getting medication abortions. Sabnis’ doulas could make a huge difference for those students.
“Giving access is only half of the puzzle,” Sabnis said.
Doulas could have a two-fold impact: beyond providing support for students using the service, they could bring awareness to students who don’t know about it.
“I hadn’t really heard that much about it … I haven’t really witnessed any advertising for it or anything like that,” said Gilson, echoing Cohen-McKeon’s concerns that not all students know it’s available. “I think it’s something that with more awareness might gain more use.”
Gilson, who is also involved in Sabnis’ work through UMass Amherst’s Community Scholars Program, suggested the presence of doulas on campus could help destigmatize abortion, which in turn would encourage more students to utilize the service.
“It can be especially difficult for students to feel comfortable using abortion services on their college campus,” Gilson said. “But I think having someone who is there for them, who is an activist and passionate about this program, and who is close in age and able to relate to the student on a more personal level, could really help.”
Looking to the future
The impact medication abortion access has had on UMass Amherst students, and soon will on other public colleges and universities in the state, begs the question: Will private schools follow suit?
UMass Amherst is part of the Five College Consortium, which includes Amherst College and Hampshire College, plus historically all-female Smith College and Mount Holyoke College. While they’re all private, Sabnis hopes UMass’ influence could spread to these schools too. (Smith, Mount Holyoke, and Amherst share referrals for abortions, but offering them on campus could make a huge difference to students—especially when the closest abortion clinic to Mount Holyoke is 13 miles away, rather far when you don’t have a car.)
Public or private, “students deserve access to the health care they need when and where they need it,” St. Germain said.