Serving the Sexual and Reproductive Health Needs of Community College Students: PROMISING PRACTICES TO PROMOTE STUDENT SUCCESS Lindsey Reichlin Cruse, MA Anna Bernstein, MPH 1 ABOUT THIS REPORT BOARD OF DIRECTORS Lorretta Johnson, Chair, American Federation Sexual and reproductive health and well-being plays of Teachers, AFL-CIO a central role in the lives of young adults. Having the Martha Darling, Vice Chair, Boeing (ret) ability to plan whether and when to become pregnant, to protect against sexually transmitted infections, and Nadia Allaudin, Merrill Lynch to receive essential medical care during pregnancy, for Daisy Chin-Lor, Daisy Chin-Lor & Associates example, have important effects on young people’s Hilary Doe, NationBuilder lives—including their ability to earn a postsecondary education. Ensuring community college students have Beth Grupp, Beth Grupp Associates access to the care, information, and resources they Rhiana Gunn-Wright, New Consensus need to take care of their sexual and reproductive Darrick Hamilton, Kirwan Institute, health is an important factor in their ability to achieve The Ohio State University their educational goals. This report shares findings Mary Hansen, American University from an Institute for Women’s Policy Research (IWPR) study of promising practices for providing sexual and Esmeralda O. Lyn, Worldwide Capital Advisory Partners LLC reproductive health services to community college students in the United States. Based on a scan of Joan Marsh, AT&T efforts to provide community college students with Anne Mosle, Aspen Institute sexual and reproductive health services, interviews William Rodgers, Rutgers University with key experts in the fields of higher education and Kristin Rowe-Finkbeiner, MomsRising reproductive health, and a literature review, IWPR identified the major programs, strategies, challenges, Paula Sammons, W.K. Kellogg Foundation and opportunities related to improving access in Elizabeth Shuler, AFL-CIO community college contexts. The report describes Marci B. Sternheim, Sternheim Consulting existing gaps in service provision and highlights a range of practices that can be replicated and scaled up to Damali Taylor, O’Melveny Law Firm expand access for community college students. Marcia Worthing, New York, NY ABOUT THE INSTITUTE FOR WOMEN’S POLICY RESEARCH The Institute for Women’s Policy Research conducts and communicates research to inspire public dialogue, shape policy, and improve the lives and opportunities of women of diverse backgrounds, circumstances, and experiences. We are the leading think tank in the United States applying quantitative and qualitative analysis of public policy through a gendered lens. IWPR advances women’s status through social science research, Institute for Women’s Policy Research policy analysis, and public education. We develop new 1200 18th Street NW, Suite 301 policy ideas, encourage enlightened public debate, Washington, DC 20036 and promote sound policy and program development. www.iwpr.org Our work also helps to change minds and improve the IWPR #B389 practices of institutions. IWPR operates on the principle that knowledge is power and that social science evidence ©Copyright 2020 by the Institute for Women’s Policy Research based on strong data and analysis, compellingly presented and systematically disseminated, makes a difference in moving public policy. 2 ACKNOWLEDGEMENTS The authors wish to thank the experts and researchers, program leaders, and college administrators, staff, faculty, and students, whose perspectives and interviews were integral to the writing of this report (a list of interviewees is included in the appendix). The authors wish to particularly thank Andrea Kane, of Power to Decide, for the guidance and insight she provided to the research team throughout the project and for her review of this report. Dr. Barbara Gault, former Institute for Women’s Policy Research Executive Vice President, helped conceptualize and provided guidance and leadership for the research that informed this report. The authors would also like to thank Christine Clark of the William and Flora Hewlett Foundation for her dedication to improving reproductive health access for community college students. Final thanks go to the IWPR staff who contributed to the preparation and dissemination of this report, including Adiam Tesfaselassie, Research Assistant, Elyse Shaw, Study Director, Tessa Holtzman, Research Assistant, and Lea Woods, Development Associate. 3 CONTENTS INTRODUCTION • 1 COMMUNITY COLLEGE STUDENTS’ NEED FOR IMPROVED SEXUAL AND REPRODUCTIVE HEALTH SUPPORTS • 2 THE KNOWLEDGE GAP AMONG COMMUNITY COLLEGE STUDENTS • 2 A LACK OF SERVICES AND CAPACITY ON CAMPUSES AND IN COMMUNITIES • 3 The Absence of Health Services on Community College Campuses • 3 Scarcity of On-Campus Sexual and Reproductive Health Services • 3 Gaps in Community-Based Contraceptive and Abortion Care • 4 ATTITUDES ON COMMUNITY COLLEGES’ ROLE IN ADDRESSING STUDENTS’ SEXUAL AND REPRODUCTIVE HEALTH NEEDS • 5 PROMISING PRACTICES FOR SERVING COMMUNITY COLLEGE STUDENTS • 6 EDUCATING AND EMPOWERING COLLEGE STAFF AND FACULTY • 6 LEVERAGING COMMUNITY PARTNERSHIPS • 9 Building Referral Networks between Colleges and Community Service Providers • 9 Partnering with Health Care Providers to Increase Services for Students • 10 PROVIDING SEXUAL AND REPRODUCTIVE HEALTH EDUCATION AND RESOURCES • 11 Incorporating Sexual and Reproductive Health Education into Campus Activities • 11 Making Use of Technology • 12 Emergency Contraception Vending Machines • 13 OPPORTUNITIES TO EXPAND ACCESS • 14 INTEGRATING SEXUAL AND REPRODUCTIVE HEALTH INTO HOLISTIC SUPPORT INITIATIVES • 14 ENGAGING WOMEN’S FUNDS IN MEETING STUDENTS’ NEEDS • 14 IMPROVING STUDENT ACCESS THROUGH STATE AND FEDERAL POLICY • 16 Medication Abortion Provision on Campus • 16 Legislation to Prevent Unintended Pregnancy in Mississippi and Arkansas • 16 Policy to Improve Contraceptive and Abortion Access • 17 BUILDING EVIDENCE ON WHAT WORKS • 18 INCREASING MOMENTUM FOR CHANGE • 19 APPENDIX. LIST OF EXPERT INTERVIEWS • 20 REFERENCES • 23 4 INTRODUCTION Improving community college students’ success is increasingly recognized as essential to meeting U.S. economic and workforce demands. Yet, community college completion rates remain lower than rates at public bachelor’s degree-granting institutions—just 41 percent of community college students earn a credential within six years, compared with 67 percent of students at public four-year institutions (National Student Clearinghouse Research Center 2019). Growing awareness of the diversity today’s community college students’ experiences has increased attention to the effect of life circumstances and needs on educational attainment. Increasingly, community colleges are acknowledging the challenges posed by factors such as poverty, structural racism, and caregiving responsibilities to academic outcomes, recognizing the imperative to holistically support students of color, students with low incomes, and students who are parents, among other historically marginalized populations. These students are also likely to need accessible, comprehensive sexual and reproductive health services, which research shows can affect students’ ability to persist in and complete educational programs.1 As the U.S. community college system places growing emphasis on holistic approaches to improving student outcomes, institutions, communities, and policymakers must consider how to better support students’ access to sexual and reproductive health services and information. More than one third of all U.S. undergraduates are enrolled at public community colleges (U.S. Department of Education, National Center for Education Statistics 2018). These students have high need for sexual and reproductive health services and low levels of sexual and reproductive health knowledge (Cabral et al. 2018; Eisenberg, Lust, and Garcia 2014). Little is known, however, about the state of reproductive health access on community college campuses. Community colleges often do not offer health care to their students, due in part to the fact that they are unlikely to have on-campus health centers. They also face increasingly restricted budgets, leaving them with limited resources to support the needs of their student body (Kahlenberg 2015). Through a scan of existing community college reproductive health programs and services, over 40 expert interviews, and a review of the literature, the Institute for Women’s Policy Research (IWPR) assessed the state of community college students’ need for and access to sexual and reproductive health services and information (a list of experts interviewed for this project can be found in this report’s Appendix). This research was complemented by a convening in July 2019 of community college staff, faculty, and administrators, higher education experts, sexual and reproductive health researchers, advocates, and students who shed vital insight into the range of students’ reproductive health needs and the opportunities for building a stronger network of reproductive health supports at the community college level. This report summarizes IWPR’s findings around promising programs and practices for meeting community college students’ sexual and reproductive health needs. It discusses the importance of expanding sexual and reproductive health care access for community college student success, shares the challenges and opportunities to doing so, and describes strategies that have been successful or hold promise for advancing reproductive health services for community college students. The report concludes by offering recommendations for future action to increase community college students’ access to sexual and reproductive health support as a part of holistic student support efforts. 1 For a review of the literature on the on the association between childbearing and educational outcomes, see Bernstein and Reichlin Cruse (2020). 1 COMMUNITY COLLEGE STUDENTS’ NEED FOR IMPROVED SEXUAL AND REPRODUCTIVE HEALTH SUPPORTS THE KNOWLEDGE GAP AMONG COMMUNITY COLLEGE STUDENTS Adolescents and young adults often lack access to comprehensive and accurate information about sexual and reproductive health. Although most young people want to avoid or delay pregnancy, research has demonstrated that a substantial portion are not using contraception to do so—likely due in part to misconceptions and a lack of knowledge of effective contraceptive methods (Kaye, Sullentrop, and Sloup 2009). The quality and content of sexual education also varies widely across the country—including within “…our students are not given enough secondary school settings—which can contribute to information or education about community college students’ knowledge gap, despite having safe sex, about how to the fact that they tend to be older than students avoid getting pregnant if they do at bachelor’s degree-granting institutions (Landry not intend to, or about sexually et al. 2003). IWPR’s interviews with college staff transmitted infections. So our first and program administrators reinforced the need for goal is to educate.” greater awareness of sexual and reproductive health among community college students, citing a lack of Kimberly Rush comprehensive sex education in high school as one Academic Advisor, Plan2Postpone, reason for students’ need for sexual and reproductive East Mississippi Community College health information at the community college level. Gaps in sexual health education in high school have consequences for students’ lives in community college. For example, one 2015 study of community college students in California found that participants expressed both strong desires to avoid pregnancy in the next year and high aspirations for educational attainment. Yet their awareness of pregnancy risk and contraceptive knowledge were low, with many holding fears and negative beliefs about contraception (Cabral et al. 2018). A separate study of the Make It Personal: College Completion project from 2010-2012, conducted by Power to Decide, (formerly the National Campaign to Prevent Teen and Unplanned Pregnancy) and the American Association of Community Colleges, identified similar knowledge gaps among participating community college students. Three quarters of students reported that avoiding pregnancy was very important to them, with 8 in 10 respondents saying that having a child while in school would make it harder to accomplish their goals. Yet respondents reported low levels of knowledge about many contraceptive methods (Prentice, Storin, and Robinson 2012). These findings demonstrate a discrepancy between young people’s desire to avoid pregnancy and the knowledge and ability to successfully do so. 2 “Students need more help and opportunities to learn how to communicate honestly with one another. They need to be supported in understanding their needs and wants, and how to communicate that [to their partners]. They need to be conscious of the fact that it is their body and that they have the right to make choices about it. They need to know what a healthy relationship looks like.” Mona Scott Residential Faculty, Mesa Community College A LACK OF SERVICES AND CAPACITY ON CAMPUSES AND IN COMMUNITIES The Absence of Health Services on Community College Campuses In recent decades, public community colleges have faced progressive cuts in state higher education investments, leaving them with fewer resources to provide services and supports for their students (Kahlenberg 2015; Mitchell, Leachman, and Saenz 2019). Partly a consequence of this declining funding, “Community college administrators the availability of sexual and reproductive health seem to be so pulled in so many services on college campuses varies widely (Eisenberg et al. 2012). directions and have so many expectations [for what they should Community colleges are less likely than bachelor’s prioritize]. They just don’t have the degree-granting institutions to have health centers on bandwidth.” campus. They are under-represented in the American College Health Association (ACHA), a membership Kristine Hopkins, Research Scientist network for higher education institutions’ health Texas Policy Evaluation Project professionals. Of the 137 institutions included in the The University of Texas at Austin 2016 ACHA National College Health Assessment, just 11 were community colleges—10 of which were from one state (American College Health Association 2016). Community college students are also less likely to have health insurance, potentially in part because fewer community colleges offer school health insurance plans—an issue that was raised by several interview respondents (Hopkins et al. 2018). Scarcity of On-Campus Sexual and Reproductive Health Services A survey completed in 2014-2015 found that community colleges were less likely than four-year campuses to offer screening and testing for sexually transmitted infections (STIs; Habel et al. 2018). This disparity is particularly important given that community college students may be at greater risk for sexual risk behaviors and sexually transmitted infections (Habel et al. 2017; Trieu, Bratton, and Hopp Marshak 2011). Without adequate testing and treatment, community college students are at risk for a number of adverse sexual and reproductive 3 health outcomes, such as infertility, cervical cancer, pelvic inflammatory disease, and pregnancy complications (Deal et al. 2004). Research suggests that community college students may also be considerably more likely to experience sexual assault and intimate partner violence (Scull et al. 2019). While IWPR’s study did not examine the presence of sexual assault services provided by community colleges, this research underlines the need for services tailored to survivors of sexual and partner violence, using principles of trauma-informed care (Reproductive Health Access Project 2017). It also highlights a need for educational programming related to topics such as gender roles and stereotypes, establishing equitable relationships, and recognizing and preventing unhealthy relationships. In addition, even when sexual health education programming or services are available at community colleges, it often does not reflect the diversity of the student population it aims to serve. Programming that is heteronormative may not address the needs and concerns of all students; sexual health programs should be respectful and inclusive of young people who vary in their sexual orientation and gender identity (Scull et al. 2018). Research demonstrates that students of all sexual orientations express contraception as a salient concern, and many young people use contraception for benefits unrelated to pregnancy prevention (Cabral et al. 2018). Gaps in Community-Based Contraceptive and Abortion Care Compounding a lack of sexual and reproductive health care on campus, community college students may not be able to access affordable contraception in the areas where they live or study. Over 19 million women in the United States live in contraceptive deserts—meaning they lack reasonable access to a health center offering the full range of contraceptive methods (Power to Decide 2019a). Students attending rural community colleges face particular difficulty in locating nearby clinics where they can receive care. Even when affordable services are available, students may not be aware of them or know how to access them. In addition, availability of affordable contraception is being further limited by changes to the Title X program, which provides low-income women with affordable family planning services. Although Title X funding is already prohibited from covering abortion services, rules implemented in 2019 and 2020 further limit the activity of Title X providers. These regulations prohibit grantees from providing referrals 4 to abortion providers and block funds to grantees who provide abortion services with separate funding, among other restrictions (Sobel, Salganicoff, and Frederiksen 2019). These regulations have resulted in a number of grantees withdrawing from the program (Kaiser Family Foundation 2019). These changes to Title X threaten to expand contraceptive deserts, which would effect access for community college students who rely on publicly funded contraception (Power to Decide 2019b). Abortion, a key component of reproductive health care, may also be inaccessible for many community college students. Funding for abortion is highly restricted: federal funds are prohibited from paying for the procedure (with exceptions for rape, incest, and life endangerment), as are Medicaid funds in most states (Guttmacher Institute 2020). Lack of funding for abortion care may be particularly burdensome for community college students, since they are more likely to have low incomes compared with students at four-year institutions (Ma and Baum 2016). Beyond funding, abortion services may not be located near community colleges. In 2014, nearly one- fifth of abortion patients traveled over 50 miles to receive care—and the most common reason reported for clinic choice was that it was the closest available (Fuentes and Jerman 2019). In addition to the transportation challenges faced by all abortion patients—obstacles that are greater in states that require multiple visits to a clinic—students who do not have easy access to a clinic must navigate complex class, work, and often caregiving schedules to arrange a visit. ATTITUDES ON COMMUNITY COLLEGES’ ROLE IN ADDRESSING STUDENTS’ SEXUAL AND REPRODUCTIVE HEALTH NEEDS Community colleges—whether rural, urban, or suburban—have an opportunity to fill gaps in access to sexual and reproductive health services and information. Although this lack of access can affect their students’ ability to persist, there are varying attitudes around the role of community colleges in students’ personal lives. Interviewees noted that many community colleges do not see it as their responsibility to meet students’ sexual and reproductive health needs. Several interviewees suggested that this may be due in part to the perception that, because community college students tend to be older than four-year college students and are more likely to have life experience—including having families of their own—that they are able to address their health needs without additional support. Findings from a 2010 qualitative study of 78 two- and four-year students in Minnesota suggests that the perspective that providing sexual and reproductive “I think the fact that most are health services is not the role of community colleges can commuter students makes it be shared by community college students themselves tough just finding a time they can (Eisenberg et al. 2012). The authors suggest, though, commit to coming in and doing a that this perspective is likely reflective of students session, out of class time.” expectations based on existing services at community colleges: because most do not offer health services, Ginger Mullaney students are less likely to expect them from their schools. BAE-B-SAFE Program Director Healthy Futures of Texas Depending on the environment of a school and its surrounding community, taboos around sexual and reproductive health may also influence whether colleges 5 are willing to take on these issues. For example, one interviewee studying the effectiveness of reproductive health education for community college students described resistance from colleges who were concerned that dually enrolled high school students who visit community college campuses would be exposed to information deemed inappropriate for minors. Another expressed the low likelihood that community colleges would be willing to engage with the issue of sexual and reproductive health since it can be seen as controversial or polarizing. Hesitancy around engaging with this topic, which can be seen as intensely personal for students, compounds the lack of existing support on campuses to help students understand how and where to access information and services that can meet their needs. Despite this hesitancy, research suggests that students welcome this information and find it valuable when it is offered (Prentice, Storin, and Robinson 2012). PROMISING PRACTICES FOR SERVING COMMUNITY COLLEGE STUDENTS Facilitating the provision of services that can help community college students’ “The people who interact with students on a meet their sexual and reproductive daily basis see how big of a problem [unintended health needs requires information and pregnancy] is with students dropping out, guidance on the range of options that student retention, and other things that come have shown promise, and which can be along. They are the ones reaching out and taking adjusted to fit individual community it upon themselves to solve the problem. There college contexts. The following section is a need for more resources to help students describes practice examples from IWPR’s address their reproductive health needs.” research that can guide how community colleges approach providing support for Latisha Latiker, Director of Grants Programming students’ reproductive health needs. Women’s Foundation of Mississippi The practice and program examples below, identified through IWPR’s program scan and expert interviews, represent opportunities to connect students with the resources and information they need to manage their reproductive lives in a way that aligns with their educational and career aspirations. EDUCATING AND EMPOWERING COLLEGE STAFF AND FACULTY Community college staff and faculty who regularly interact with students have a unique opportunity to not just share information about available sexual and reproductive health services, but to set the tone on their campus and in the classroom that sexual and reproductive health is an essential component of student success more broadly. Educating community college 6