Referrals to Abortion Care by Student Health Centers in Pennsylvania: A “Secret Caller” Study [1F

Abstract

INTRODUCTION: One in ten women between 20 and 24 years has an unintended pregnancy. For college students, student health centers play a vital role in providing reproductive health services, but their role in abortion referrals is unknown. METHODS: We conducted a “secret caller” study at 4-year colleges in Pennsylvania between June 2017 and April 2018. A female researcher posing as a student seeking abortion referral contacted student health centers using a structured script, once as a minor (under 18 years), and once as an adult (over 18). Calls were transcribed in real time. The primary outcome was “direct referral,” defined as a referral to an abortion provider; secondary outcomes were “no referral,” “indirect referral” (non-specific provider), and “inappropriate referral” (non-abortion provider). The study was approved by the University of Pennsylvania IRB. RESULTS: One hundred and fifteen institutions were contacted, resulting in 202 successful contacts. One hundred contacts (49.5%) resulted in a direct referral, which did not differ by caller age (P=0.48). Religious institutions were less likely than non-religious institutions to provide a direct referral to both minors (26.3% vs 59.4% P=0.001) and adults (36.6% vs 62.7% P=0.01). For adult callers, larger institutions (1,000+ students) as compared to smaller institutions were more likely to offer direct referral (63.0% vs. 20.0% P=0.003). Inappropriate referrals was the next most common outcome, in 68 (33.7%) contacts. CONCLUSION: Half of college health centers in Pennsylvania do not provide direct abortion referrals, and many provide inappropriate referrals. Religious institutions are less likely to provide direct abortion referrals, particularly for minors.