How This Southern University Is Leading on Campus Reproductive Health

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In 2022, following the Supreme Court’s overturn of Roe v. Wade, Tennessee’s “trigger ban” went into effect. It prohibits abortion at all stages of pregnancy with limited medical exceptions, including to prevent death or serious or irreversible physical health consequences, or if the fetus is not viable outside of the womb.

The state also enforced targeted regulation of abortion providers (TRAP) laws, which are designed to create costly and medically unnecessary structural barriers to abortion care, such as requiring providers to have admitting privileges at a nearby hospital. Additionally, a Tennessee “abortion trafficking” law passed in April criminalizes any adult who assists a minor in obtaining or concealing an abortion.

Despite its policies that restrict bodily autonomy, Tennessee schools are not required to teach sex education. If they do, a curriculum is not required to be comprehensive and must “emphatically promote only sexual risk avoidance through abstinence,” according to state code.

Students are not only struggling to navigate a rapidly changing health-care and political landscape, but also face a lack of unbiased, easily accessible information on reproductive health.

And reproductive health care is only a piece of the pie: During the 2015 to 2016 school year, more than 1 in 5 undergraduate students in the United States had children, and nearly 70 percent—or around 2.7 million—of all student-parents were mothers.

At Vanderbilt University, the school has been working creatively to mitigate gaps in students’ reproductive and parenting needs, and their awareness of available resources.

Holistic approach to supporting students

In anticipation of the Dobbs v. Jackson Women’s Health Organization decision, Vanderbilt’s Office of Student Health and Wellness set up a task force to create a system that would support its community around reproductive health and parenting.

The task force was established in early June 2022 by the Office of the Provost in coordination with the chancellor’s office, along with leadership at the Divinity School, Law School, the School of Medicine, the School of Nursing, and their partners at Vanderbilt University Medical Center.

Its initial focus was to hone in on the impact of a statewide abortion ban, particularly on clinical care, student and employee health, and academic instruction. Pam Jones, Vanderbilt’s associate vice chancellor for health and wellness, said the task force was created with a person-centered, programmatic approach to also drive discussion and programming.

“My role was to think innovatively about what we put in place that helps support our community,” Jones said. “We wanted to be sure our students had access to everything they needed.”

In September 2022, Jones brought on Hannah Proctor, a certified nurse-midwife, as the university’s inaugural reproductive health and parenting resource coordinator and set up a support fund that provides up to $2,000 per student to access reproductive and parenting resources, such as funding for unexpected medical expenses, fertility treatment, diapers, and baby formula. Proctor had previously worked for Vanderbilt as a COVID-19 tracer, and Jones said that while being a midwife was not a requirement for the role, she had Proctor in mind while thinking of the health and parenting resource position.

“Midwives are so incredible at having unbiased conversations with people because they are there to support the individual and whatever that individual’s choices are,” Jones said. “So I knew the skill set was perfect for the role.”

Though Vanderbilt has reproductive health services on campus, Proctor’s role is the first formalized position to provide information and financial support outside of a clinical role.

The council took a “multi-pronged approach” to educate students on this new resource, including telling students already using the campus counseling center and asking each individual school to inform its students. But most students discover Proctor by word of mouth.

“That’s been the most effective when it comes to someone feeling comfortable enough to reach out to me,” Proctor said.

Since the role is not clinical, Proctor cannot give students medical advice. This also prevents bias and allows the student to dictate the direction of their conversation and the nature of the resources provided within their comfort level and personal preferences, Proctor said.

Proctor also provides information on how to access basic reproductive health services, like booking your first OB-GYN appointment or preparing for a first Pap smear.

“People can feel pretty overwhelmed being away from home and having their first appointment,” Proctor said. “Right now the current guidelines [are that] you don’t need your first Pap until you’re 21 years old, and that’s usually when people are in college.”

And, while reproductive health is the most sensitive aspect of the role, the vast majority of services Proctor provides are related to education and parenting, according to preliminary data collected by Proctor and Jones.

“The biggest concern I run into is graduate students who want to start building a family,” Proctor said. “They have questions around local resources, or a lot of unexpected out-of-pocket costs.”

With this holistic approach, Vanderbilt hasn’t received any pushback from the state or university.

According to Jones, the recommendations from the task force were “almost immediately” accepted by the provost, and then the chancellor, because they were “consistent with Vanderbilt’s values of supporting our community.”

“We became a very facile university during COVID [lockdowns],” Jones said. “We had a huge COVID response and brought people back to campus much earlier than most people did. So, we already have this culture of taking a very team-based approach to developing these types of programs.”

She added that similar programs had already been put in place for LGBTQ+ issues on campus as well.

Legal counsel was also involved in the development of the program, and the task force spent “a lot of time trying to understand the law” before Proctor was able to speak with students.

“As we developed her scripts, we were really careful about what we could and couldn’t do,” Jones said. “The legal landscape was rapidly changing, so this was an ongoing process. We put it out there, we started learning, and we can continue to develop and grow it.”

Can Vanderbilt’s model be replicated?

Students at other universities face similar barriers over accessing reproductive health, but they see potential challenges with implementing a similar role on their campus.

Nikita Kakkad and Frances Cates are leaders of the University of Texas at Austin’s chapter of Emergency Contraception for Every Campus, which aims to expand reproductive health resources and facilitate conversations on campus.

According to Kakkad, anxiety around reproductive health has only heightened since the overturning of Roe v. Wade. Texas had already enacted various laws, including SB 8, that restrict the flow of information between providers and patients, limit reproductive health-care options, and prohibit “aiding and abetting” an abortion by providing transportation, distributing information on how to self-administer abortion care, or assisting with funding for an abortion.

Cates says Texan reproductive health-care providers have had their practices “turned upside down” due to the state’s evolving policies. Not only are potential patients in the dark, but providers are also unsure of when and how to disclose reproductive health information.

For a task force like Vanderbilt’s to be viable at UT Austin, Cates said it would need to be marketed more as a maternal health role with reproductive health as a “subcategory” to circumvent controversy surrounding reproductive health care.

“There’s kind of this dichotomy between how the university operates, and then how the Texas government operates,” Cates said. “A lot of the faculty at the university do lean towards a more pro-reproductive health agenda, but then because we’re so intimately connected to the state, there’s a lot of pressure on the higher-ups at the university to really not be making statements about supporting reproductive health.”

Ariel Young, a master’s student at the Ohio State University College of Nursing, echoes Cates and Kakkad’s sentiments.

“If providers have a certain perspective [on reproductive health], they won’t give full information about options,” Young said. “College campuses absolutely do need people that have adequate, up-to-date information about reproductive health care, because everybody in college is sexually active for the most part, and not everybody has good sex education.”

But while Cates is confident that a reproductive health and parenting role on campus would be “useful to so many students,” she cautions that public schools in Tennessee, her home state, may face additional barriers in implementing a similar program, such as funding and campus stigma toward reproductive and sexual health.

Dr. Gretchen Ely, a professor and the PhD program director at the University of Tennessee, Knoxville (UTK) College of Social Work, and a faculty affiliate in the UTK Women, Gender, and Sexuality Studies Program, said that despite her belief that “student needs are not being met by the university,” Proctor’s role would be hard to replicate at UTK.

“We can’t refer people to abortion services, and I doubt we can give them specific information on how to go out of state,” she said. “We don’t even have a building to refer people to; our Planned Parenthood was set on fire. Even if they wanted to help people, there’s nowhere to send them in Knoxville.”

UTK’s “land grant” designation suggests that the work they do at the university is on behalf of the betterment of the state as a whole, according to Ely. So, the university could argue that creating a reproductive health task force fulfills that mission.

But, other reproductive health initiatives at UTK have been shut down or had funding pulled by Tennessee lawmakers. “Sex Week,” for example, is a yearly event hosted by the UTK student organization Sexual Empowerment and Awareness at Tennessee, which provides sex education to students and highlights conversations around sexual health and safety.

In 2013, the event was condemned by then-state Sen. Stacey Campfield, Fox News, and online blogs, which led to the university’s chancellor pulling all state funding. This past spring, Sex Week was produced entirely on donations, outside support, and campus spaces.

This kind of history leads Ely to doubt the success of a council that touched on reproductive health, but she still believes a maternal health initiative could be sustainable.

“Because reproductive health access doesn’t align with the conservative worldview, eventually [state legislatures] would come and say we can’t do that, or at least pieces of it,” Ely said.

But Kakkad is hopeful that UT Austin could develop a similar initiative, even if it gets pushed forward as a general women’s health and wellness program.

“What Vanderbilt did is great, and more schools that are in restrictive states could use it,” Kakkad said. “Schools that are in permissive states could probably still use it. I hope they set a precedent.”

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