California Requires State Universities to Offer Access to Medication Abortion on Campus

On October 11, 2019, California Governor Gavin Newsom signed Senate Bill 24, also known as the College Student Right to Access Act, making California the first state to require state universities to offer medication abortion resources through an on-campus source.

The universities affected are the 23 campuses of the California State University and the 9 campuses of the University of California, which have until January 2023 to come into compliance with the bill.

The law also contains a commitment by the state to fund each university’s health center, the cost of services, and 24-hour medical support hotlines.

This was not the first attempt in the state to pass legislation in the state requiring public universities to provide medication abortion on campus.

In 2018, then-Governor Jerry Brown vetoed California Senate Bill 320.

His reasoning was based on critics’ argument that off-campus abortion services were “widely available” and within an average of 5 to 7 miles from campuses, making the bill unnecessary.

California State Senator Connie Levya authored the bill in 2018 and reintroduced it in 2019, when it passed.

The results of a 2018 study published in the Journal of Adolescent Health showed that many obstacles prevented California university students from having adequate access to abortion facilities.

Every month, 322 to 519 public university students seek medical abortions. Students usually face the barriers of cost, scheduling, and transportation.¹

The average out-of-pocket cost of a medication abortion is about $604.

On all but 1 University of California campus, student health insurance covers medication abortions. However, if an off-campus abortion facility does not accept insurance, students may face higher out-of-pocket costs. Up to 64% of California public university students in the state are more than 30 minutes away via public transportation from the closest abortion facility. Not all have access to personal vehicles. Moreover, 2 visits are recommended, which can cause students to miss coursework.

Additionally, not all abortion facilities are open on weekends, making it difficult for some students to balance their schedules. The average waiting
time for the first available appointment is about a week. This delay can cause students to exceed the 10-week gestation limit and no longer be eligible for medication abortion.

Those considering the possibility of terminating a pregnancy with medication can readily find information online.²

The regimen is a combination of 2 medications: mifepristone (Mifeprex) and misoprostol (Cytotec). The former blocks the progesterone needed for a pregnancy to continue, and the latter works to soften and dilate the cervix and causes uterine contractions. This is different from the “morning after” pill, which contains a high dose of the synthetic hormone found in oral contraceptives that delays or stops the release of an egg.

The FDA-approved regimen is as follows:

• day 1: 200 mg of mifepristone taken orally
• 24 to 48 hours after taking mifepristone: 800 mcg of misoprostol taken buccally
• 7 to 14 days after taking misoprostol: follow-up with a health care provider

Efficacy and safety studies showed that this is an effective and safe regimen through 63 days estimated gestational age, with a success rate of 95% and serious adverse events occurring in 0.3% of patients. Hospitalization was rare and the need for aspiration was low.

The approach to terminating a pregnancy by using medication has grown significantly in popularity. It first became available in 2000 when the FDA approved mifepristone. By 2004, the medication approach was used in 14% of all abortions, and by 2015 it had increased to almost 25%. The latest data, from 2017, puts that figure at 39% of the total approaches used.³

The combination of mifepristone and misoprostol as an abortifacient was first approved in China and France in the late 1980s.

The World Health Organization has recommended the approach since 2013, and it published an update in 2019 to its official guidance on use of the combination, deleting the stipulation that use of the combo required “close medical supervision.”⁴

To appreciate the impact of this change, it is helpful to know the enrollments at these university systems in the country’s most populous state. Fall 2020 enrollment in the Cal State system was 485,550, while UC’s enrollment was 285,862.

The pharmacy profession is constantly changing and being shaped by policies that originate in different parts of the country. Although this is a California law, it is important to be aware of activity elsewhere that may portend changes in other states.

Alvin Tseng is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington.

Joseph L. Fink III, JD, DSC (Hon), BSPharm, FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.

References

1. Upadhyay UD, Cartwright AF, Johns NE. Acce ss 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

2. The availability and use of medication abortion. Kaiser Family Foundation. June 16, 2021. Accessed March 9, 2022. https:// www.kff.org/womens-health-policy/fact-sheet/the-availabili- ty-and-use-of-medication-abortion/

3. Solis M. California just became the first state to require public colleges to provide abortions. Vice. October 11, 2019. Accessed March 9, 2022. https://www.vice.com/en/article/a35y7e/ gavin-newsom-california-public-universities-will-offer-abor- tion-pills-on-campus-in-2023

4. WHO launches new guideline to help health-care workers ensure safe medical abortion care. World Health Organization. January 8, 2019. Accessed March 14, 2022. https://www.who.int/ reproductivehealth/guideline-medical-abortion-care/en/