California requires state universities to provide access to medical abortion on campus
32 public colleges with a combined enrollment of more than 700,000 students must comply with the law by January 2023.
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 that they offer medical abortion resources through an on-campus source.
The universities affected are the 23 campuses of 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 state commitment to fund each university’s health center, the cost of services, and 24-hour medical hotlines.
This was not the first attempt in the state to pass statewide legislation requiring public universities to offer medical abortions 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 an average distance of 5 to 7 miles from campuses, rendering the bill unnecessary.
California State Senator Connie Levya drafted 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 barriers prevent students at California universities from having adequate access to abortion facilities.
Each month, 322 to 519 public university students seek medical abortions. Students typically face barriers related to costs, schedules, and transportation.1
The average cost of a medical abortion is approximately $604.
On all but one University of California campus, student health insurance covers medical abortions. However, if an off-campus abortion center does not accept insurance, students may face higher fees. Up to 64% of students at California’s public universities in the state are more than 30 minutes by public transportation from the nearest abortion facility. Not all have access to personal vehicles. In addition, 2 visits are recommended, which may cause students to miss classes.
Also, not all abortion centers are open on weekends, which makes it difficult for some students to balance their schedules. The average wait
the lead time for the first available appointment is approximately one week. This delay may cause students to exceed the 10-week gestation limit and no longer be eligible for medical abortion.
Those considering the possibility of terminating a pregnancy with medication can easily find information online.2
The diet is a combination of 2 drugs: mifepristone (Mifeprex) and misoprostol (Cytotec). The former blocks the progesterone needed to sustain a pregnancy, and the latter works to soften and dilate the cervix and cause 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 diet is as follows:
- day 1: 200 mg mifepristone orally
- 24 to 48 hours after taking mifepristone: 800 mcg of misoprostol by mouth
- 7-14 days after taking misoprostol: follow up with a health care provider
Efficacy and safety studies have shown it to be an effective and safe regimen up to 63 days of estimated gestational age, with a 95% success rate and serious adverse events occurring in 0.3% of patients. Hospitalizations were rare and the need for suctioning was low.
The approach of terminating a pregnancy using medication has gained tremendous popularity. It first became available in 2000 when the FDA approved mifepristone. In 2004, the medical approach was used in 14% of all abortions, and by 2015 it had risen to almost 25%. The latest data, from 2017, puts this 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 issued an update in 2019 to its official guidelines on the use of the suit, removing the stipulation that use of the suit required “medical supervision”. narrow”.4
To appreciate the impact of this change, it is useful to know the enrollments in these university systems in the most populous state of the country. The fall 2020 enrollment in the Cal State system was 485,550, while the UC enrollment was 285,862.
The pharmacy profession is constantly evolving and shaped by policies that emanate from different parts of the country. Although this is a California law, it is important to be aware of activities elsewhere that could 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, J.D., DSC (Hon), BSPharm, FAPhAis Professor of Pharmaceutical Law and Policy and Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.
1. Upadhyay UD, Cartwright AF, Johns NE. Access to medical abortion among students at public universities in California. J Adolescents Health. 2018;63(2):249-252. doi:10.1016/j.jadohealth.2018.04.009
2. The availability and use of medical abortion. Kaiser Family Foundation. June 16, 2021. Accessed March 9, 2022. https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/
3. Solis M. California just became the first state to require public colleges to offer abortions. Vice. October 11, 2019. Accessed March 9, 2022. https://www.vice.com/en/article/a35y7e/gavin-newsom-california-public-universities-will-offer-abortion-pills-on-campus- in-2023
4. WHO launches new guideline to help health workers ensure safe medical abortions. World Health Organization. January 8, 2019. Accessed March 14, 2022. https://www.who.int/reproductivehealth/guideline-medical-abortion-care/en/