Leslie Ortiz, 24, has many of the same responsibilities as plenty of other college students: She’s double majoring in molecular cell biology and physiology and minoring in chemistry at California State University Long Beach while juggling part-time jobs as a vet assistant and receptionist. But Ortiz has another major responsibility: She’s the mother of a 4-year-old boy.

Children can be a beautiful addition to life, as Ortiz can attest, but they also unequivocally and irreversibly change the course of your life.

Not everyone feels ready, at 20, to be a parent; women 24 and younger make up almost half of all abortions in the United States. Advocates say it’s imperative that college students have access to abortion care, so California and Massachusetts have supplied their public college and university health centers with abortion pills. Soon, New York will, too.

The catch? No one seems to know the services are available.

Medication abortion comes to college campuses

With Senate Bill 24, introduced in 2019, California became the first state to require its public universities to provide medication abortion on campus. By January 1, 2023, all University of California and California State University schools were required to provide on-site medication abortion services, which brought access to over 700,000 students between the two systems.

But students overwhelmingly aren’t aware they have this access, due to a lack of publicity and awareness efforts on the part of the schools. An LAist investigation published in January found that many schools don’t even list medication abortion as a service at the health center.

And even at the schools that do publicize medication abortion services, it’s often the result of external pressure: At Cal State Fullerton, for instance, the Department of Women and Gender Studies chair had to push the university to include information online, telling LAist that she saw “no preparation for this around campus at all.”

The medication abortion services are being funded by the California Commission on the Status of Women and Girls, whose Reproductive HealthFund allocates funds directly to the UC and CSU systems.

In Massachusetts, which passed a similar law in 2022, an early rollout of medication abortion services at the University of Massachusetts Amherst—the flagship campus for the University of Massachusetts and home to over 20,000 undergraduate students—has seen students experiencing a similar situation as their peers in California. Medication abortion services are there, but people just don’t know about it.

In May, New York Gov. Kathy Hochul signed a similar law for the State University of New York and the City University of New York. Between SUNY and CUNY, there are 89 public university campuses in New York. It’s another important step in providing medication abortion access to college students, but services can only truly be useful when people know they have access to them. California’s rollout, and anecdotes of similar struggles in Massachusetts, may prove to be a cautionary tale for public schools in New York.

California students left in the dark

Phoebe Brous was a junior at UCLA when the California law went into effect in 2023, but she only found out about medication abortion services being available because she was covering gender-related issues for the Daily Bruin, UCLA’s student-run newspaper. In February of 2023, she reported that most students were unaware of these services or how to access them. And a year later, she said little has changed.

“I don’t feel that students have enough of an understanding about the resources available to them on campus, particularly surrounding reproductive health issues,” Brous said. “The only reason I really know about them is because I’m interested in gender-related things, and I’ve covered these stories for the Daily Bruin.”

Knowing she has access to the service puts Brous in the minority among her peers. “There really isn’t an institutional push to publicize or promote these services,” she said.

Arisa Dhiensiri, a graduate student at the UCLA Fielding School of Public Health, similarly noted that she only knew about the service because of her interest in reproductive health and her role as the advocacy chair of the Reproductive Health Interest Group, a graduate student group at UCLA.

“I feel like the service isn’t widely advertised and many peers don’t know that this option is available to them,” she said. “I don’t think that the university has done a good job with outreach.”

Over at Cal State Fullerton—where the information about medication abortion services was only added to the health center website after pressure from faculty—Desiree Moshiri is the president of the university chapter of Planned Parenthood Generation Action, Planned Parenthood’s youth organizing arm.

“When we posted about it in the first place, people were like, ‘What? I had no idea this was even a thing!’ and that was in January 2023,” she said. “People still don’t have any idea. You would think that over a year later, there would be more awareness about it.”

Moshiri said she doesn’t understand why Cal State Fullerton doesn’t want to share the availability of this resource with its students. Neither UCLA nor Cal State Fullerton responded to requests for comment.

“If we have access to such a great resource, they should be advertising it. They should be talking about it more,” Moshiri said.

Her Planned Parenthood Generation Action group has tried to help get the word out by making flyers, and they plan to collaborate with the women and gender studies department.

“I really don’t think the actual school is going to get anything done,” Moshiri said.

Why don’t students know what resources are available?

There’s a lack of education about safe sex on college campuses, Brous said, and when sex, a ubiquitous part of college life, isn’t talked about, it becomes taboo. Through a podcast called Sex Lives of Bruins, Brous explored the culture surrounding sex, dating, relationships, and reproductive health at her school. In talking to her peers, she noticed a lack of education and training about certain services, including medication abortion.

“While UCLA has access to these services, it’s a question of students knowing, understanding, and overcoming barriers and stigma that might prevent them from using those services,” Brous said.

She acknowledged that UCLA provides comprehensive health-care services and resources, but these services and resources don’t do much when they exist in a vacuum, she said.

“There wasn’t any publicity, or awareness efforts, or announcements, besides students trying to make those announcements,” Brous said.

Even if it’s not totally clear why schools don’t want to publicize the availability of medication abortion, it’s important that students know they have access, said Shannon Olivieri Hovis, California Director for Reproductive Freedom for All, a national reproductive rights organization whose California branch co-sponsored Senate Bill 24 in 2019.

“When the bill was passed, none of the student health-care centers at California’s public universities provided medication abortion services, despite how clinically simple the service is to offer,” Hovis said. “At that time, all students had to travel off campus to access abortion care—often with serious logistical and financial barriers.”

This sentiment was echoed by UCLA Professor Jessica Gipson, who is the Fred H. Bixby chair of Population and Reproductive Health Science and the director of the Bixby Center to Advance Sexual and Reproductive Health Equity (formerly known as the Bixby Center on Population and Reproductive Health) at the UCLA Fielding School of Public Health.

“Having timely access to comprehensive reproductive health care on campus, including medication abortion, is critical to ensuring that college students can continue and complete their college education,” Gipson said.

She noted that college-age students face unique barriers to abortion care, citing a 2017 study by Advancing New Standards in Reproductive Health (ANSIRH) that assessed the barriers to medication abortion among California’s public university students.

It “highlighted the specific difficulties students face, including having to pay for an abortion at an off-campus provider, especially when students may already be facing financial difficulties,” Gipson said. “On average, students have to travel over two hours on public transit to obtain an abortion off-campus, taking time away from work and studies.”

The funding and oversight of the California program will end January 1, 2027, but the goal is that colleges will continue to offer these services beyond then.

“We are learning that there’s a need for more consistent communication and education on the ground about the offerings, so that all students know about it and have access to it,” said Holly Martinez, executive director of the organization funding the program. Martinez added that they’re asking: “What efforts can be made to really evaluate the services being rendered? And are there areas where improvements can be made?”

Mifepristone access soon to be challenged

There’s also uncertainty over whether this service will even continue to be offered in its current form, due to the upcoming Supreme Court challenge on mifepristone. The medication abortion available in college health centers uses a combination of two drugs called misoprostol and mifepristone. If mifepristone is banned, medication abortions using misoprostol alone would become less effective, leading to more procedural abortions. The Supreme Court will hear oral arguments for the case on Tuesday.

This comes amid news that CVS and Walgreens will begin selling mifepristone this month starting in a select number of states that includes California, Massachusetts, and New York and ultimately expand to all other states where abortion is legal and pharmacies are legally allowed to dispense abortion pills.

Lawmakers in some states have taken precautionary measures against the brewing case, like Massachusetts Gov. Maura Healey, who worked with UMass Amherst to purchase 15,000 doses of mifepristone in April 2023 after a lower court judge ruled in favor of challenging mifepristone, which has held FDA approval since 2000. These doses ensured coverage for the state for over a year, and Healey also pledged another $1 million to support providers contracted with the Department of Public Health to pay for additional doses of mifepristone.

“Our administration will always remain committed to protecting access to reproductive care, but DPH will re-evaluate the guidance following the [Supreme Court] ruling if necessary,” said Karissa Hand, Healey’s press secretary.

Similarly, in New York, Hochul has made a $35 million investment for supporting abortion providers and purchased a five-year supply of misoprostol.

Healey and Hochul, along with California Gov. Gavin Newsom, are members of the Reproductive Freedom Alliance, a nonpartisan coalition of governors seeking to protect and expand reproductive freedom. The group of 22 governors filed an amicus brief in January calling on the Supreme Court to protect abortion medication access.

And in California, organizations like the California Commission on the Status of Women and Girls and Reproductive Freedom for All California are pushing for protected access. In its 2023 annual report, the commission noted that should the Supreme Court rule against mifepristone, the University of California and Cal State campuses would need to change protocols to prepare for offering misoprostol-only medication abortion.

“No matter what comes down the pipeline, we’re going to work to ensure that women have access to this in whatever form we are legally able to offer it and ensure that our school systems are prepared and trained for those changes in protocols,” Martinez said.

Student parents face limitless challenges

To understand the gravity of a Supreme Court ruling against mifepristone and the impact it would have on students is to understand the plight of student parents.

Ortiz is far from the only student parent at Cal State Long Beach, and nationally, student parents make up almost a quarter of all undergraduate students, according to the Urban Institute. It can be extremely hard to balance parenting and studying, said Naomi Rosales, who has 9- and 14-year-old daughters and is majoring in creative writing and pursuing a writing certificate at Cal State Long Beach.

“I wish people knew the reality of it,” Rosales said. “We juggle a lot that is not seen. I don’t get started on my homework until after I’ve finished work, my girls are fed, they’ve done their homework, and the house is clean.”

At 29, she’s “started and stopped school so many times, it’s too many to count.”

“A lot of it has been because of my children, lack of child care, the scheduling of classes, because I also work; I’ve been employed the whole time,” Rosales said.

Similarly, after starting community college at 18, Krystal Giron had to take a break from school to raise her daughter, who’s now 9 years old. She has gone back to school, at Cal State Long Beach with Ortiz and Rosales, where she studies accounting. Giron echoed the challenges of being a student parent and “feeling invisible.”

“It’s just not even considered whatsoever—in the scheduling of classes, in the prioritization given to students,” Giron said. “It’s a taboo thing to talk about … as a group of people I don’t think we’re really seen or understood.”

She reported difficulties with professors, like during finals week of her first semester. Her daughter was already out of school for the holidays, and when her babysitter called Giron to tell her she was sick, she had no choice but to take her daughter to her exam.

“My professor pulled me aside after class and said to never do that again, to never put him in that kind of situation again,” she said.

Ortiz, Rosales, and Giron are all part of a Cal State Long Beach student group called Students With Dependents, which was relaunched at the beginning of the school year to raise awareness about their presence at the university, hold family events, and, they say most importantly, to increase community among students who are also parents or caregivers. Giron emphasized how hard it is to balance it all when it feels like no one is in your corner.

“Statistics show that out of all student parents that try to get an education, only about 50 percent of them are earning it, and I don’t think it’s because they gave up,” Giron said. “I think it’s because there have been so many hurdles.”

Giron has also faced similar inflexibility from professors over other reproductive health issues; in the last three years, she’s had difficult pregnancies and has had to receive medication abortions because of her inability to carry to term. She’s tried to self-advocate, but has had little luck.

Giron did not receive her medication abortion through the university health center; she did not know they were available there.