For students who don’t have a car, getting from the University of Massachusetts Amherst to the nearest Planned Parenthood in Springfield can take nearly five hours round trip.
“And then you show up and there are protesters lined up all around the sidewalk,” said State Representative Lindsay Sabadosa, who joined UMass students for a bus trip last fall to show how distant abortion care can be for college students who rely on public transportation.
The Northampton Democrat has sponsored a bill that would close this gap by requiring that abortion pills be dispensed at student health centers across the state’s public university system. As in California, where similar legislation was enacted in 2019, colleges have not leapt to support the potentially controversial measure, which is still in committee. But the effort secured a major victory last week when UMass Amherst announced it would begin offering medication abortion at its health center next fall.
“The campus has heard from students that they want access to the medically prescribed drug,” university officials said in response to a Globe inquiry. “Because of the notable distance to providers from the Amherst campus, and because the campus already offers extensive gynecological and reproductive care to students, UMass Amherst plans to offer the medical abortion pill to students on site at our University Health Services clinic.”
The campaign to make medication abortions available on campuses is viewed as a way of destigmatizing abortion care, and as a Blue state response to restrictions anticipated in the South and Midwest. The Supreme Court is expected to rule this spring on an abortion case that could overturn 49 years of precedent and allow more than half the states in the country to ban the procedure.
Reproductive rights advocates are trying to expand availability in states that remain amenable to abortion and they see a particular opening where young, liberal-leaning people are clustered: in college towns that are often far from abortion clinics.
In 2020, more than a quarter of those who had abortions in Massachusetts were between 20 and 24 years old, state data show.
“You want to make sure you’re expanding access to all the places that make sense,” Sabadosa said.
Her bill, initially filed in 2019, has drawn sharp resistance from activists who are trying to block abortion on campuses nationally. Students for Life Action, which has groups on more than 1,250 campuses in all 50 states, is championing a congressional bill that would prohibit universities that offer medication abortions from receiving federal funds. Opponents contend that medication abortions are riskier than advertised.
“We think it compromises women’s safety,” said Kate Scott, a 21-year-old biochemistry and molecular biology major who started a Students for Life group at UMass Amherst two years ago. “And we also think it’s out of the scope of what a public university should be doing. Especially with taxpayer funding.”
The bill would require the state’s 13 public university campuses to provide abortion pills and would create a state fund to help campus health centers pay for training, facility or security upgrades, and any telehealth or equipment necessary. Sabadosa hopes that private colleges and community colleges with health centers would follow suit.
But the university presidents have concerns about a legislative mandate, particularly because some of their campuses lack “robust medical facilities,” said Vincent Pedone, executive officer of the State Universities Council of Presidents. He also questioned the difficulty of accessing abortion in Massachusetts, where rights are protected under state law and medication abortion is newly available by mail.
Medication abortion involves a two-step protocol of pills that can be taken to end a pregnancy up to 10 weeks. The first, called mifepristone, blocks the hormone progesterone, which is needed to continue pregnancy. A second, called misoprostol, is taken 24 to 48 hours later and effectively induces a miscarriage.
The method has been available for 20 years but until recently was tightly regulated by the US Food and Drug Administration, which required it to be dispensed at clinics. After suspending that requirement during the pandemic, the agency decided in December to allow the medication to be available by mail and telemedicine, prompting new efforts by opponents to bar the practice.
“This is the new frontier of abortion,” said Kristi Hamrick, chief media and policy strategist for Students for Life Action, pointing to Planned Parenthood’s efforts during the pandemic to ramp up abortions overseen through telehealth. “It is the growth model that they clearly are advancing.”
A recently published study by Smith College gender studies professor Carrie N. Baker estimated that between 600 and 1,380 state college students have medication abortions each year. In total, there were 16,452 abortions in Massachusetts in 2020, and 47 percent were medication abortions, according to the state Registry of Vital Records and Statistics.
Marandah Field-Elliot began pushing for campus abortion access as a student at the University of California Berkeley. After a state legislator took up the cause, a bill was passed, vetoed, passed again, and finally enacted in 2019 under a different governor. Higher-education officials were initially not enthused by the idea, she said.
“We felt some apprehension primarily just due to the politicization of the issue,” said Field-Elliot, now the state campaign manager for abortion access for Advocates for Youth, a nonprofit focused on sexual health and rights.
College officials also raised concerns about security, liability, and cost, said Ushma Upadhyay, director of research of the University of California Global Health Institute’s Center of Expertise in Women’s Health, Gender, and Empowerment.
“It is just another thing that they don’t want to have to deal with,” she said.
But activists prevailed after focusing their campaign on the distance many would need to travel to obtain the medication; now, they’re advising Massachusetts proponents on the approach.
In Massachusetts, trips from campuses to abortion facilities would take an average of 103 minutes on public transportation, Baker’s research found.
At UMass Amherst, the study noted, only 21 percent of students have cars, leaving them to rely on public transportation to reach the nearest Planned Parenthood, more than two hours each way.
But abortion opponents use that same argument of distance to argue against campus abortions, worrying the students could face complications in a dorm bathroom that couldn’t be resolved in a campus health center.
“I think the driving distance is a lot more significant when your life’s at risk, if you’re hemorrhaging,” said Scott, the Students for Life activist. “The distance it takes you to get to a hospital is more important for a life-saving procedure than for an optional procedure.”
In California, Hamrick said her group warned against medical abortions, saying campus health centers would be ill-equipped to handle potential complications.
“They didn’t have transfusions and blood products around, should somebody be bleeding out,” Hamrick said. “Then there’s the liability of students dying on campus.”
But both those prospects are extremely rare, according to new FDA data.
While 26 women have died after having medication abortions since 2000, that total includes homicides and other deaths unrelated to the procedure. In that time, an estimated 4.9 million medical abortions were completed. The FDA records the number of transfusions provided over a shorter span — the past nine years — as 187. The American College of Obstetricians and Gynecologists, whose lawsuit pushed the FDA to make abortion pills more accessible during the pandemic, calls the medication safe and effective.
“Medication abortion has a side effect rate of .023 percent. That is lower than Claritin,” Sabadosa said. “That is safer than eating shellfish.”