Early Pregnancy Detection
- Any delay in early recognition of a pregnancy may significantly impact a student’s ability to access desired reproductive health services, making early detection and confirmation of pregnancy critical. A recent study found self-testing is feasible and acceptable to individuals when provided with free at-home urine pregnancy tests. Pregnancy testing should be made easily accessible to students.
- Optimize access to pregnancy testing through self-directed testing.
Resources:
Pregnancy Test Instructions | Planned Parenthood
Pregnancy Test Instructions | University of North Carolina School of Medicine
- Increase availability of pregnancy tests at no cost or low cost, including through vending options (see further details in Vending Machine Implementation) and student wellness/health promotion safer sex or self-care supplies. Safer sex supply kits could include pregnancy tests and information on next steps in the case of a positive result.
- External condoms, finger cots, and dental dams can be ordered from the following vendors in a bulk and reduced rate once you establish a non-profit status: World Condoms and Condom Depot. Internal condoms (aka female condoms) can be purchased in bulk at the FC2 website here. Your campus student health services or office of health promotion may have additional vendors they use. Ask them to increase their orders based on the supplies needed for your service.
- Pregnancy tests can be ordered inexpensively from a variety of sources — for example, Amazon, Pregmate, or other sites where your institution purchases health-related materials. Ask your administrators for their list of vendors and procurement resources.
- Utilize nurse protocols for pregnancy testing.
Resources:
Example Protocol: Urine Pregnancy Testing Protocol | University of Michigan Health Service
Perform a CLIA Waived Urinalysis: Perform a Pregnancy Test | Elsevier (video)
How Does a Pregnancy Test Work? | Cleveland Clinic (video)
Resources:
Pregnancy Test FAQs Informational Card | Case Western Reserve University
Pregnancy Options Informational Card | Case Western Reserve University
“I think I’m pregnant…now what?” | University of Maryland
Some examples of procurement companies: HPSRx Enterprises Inc. (specialty distributor for reproductive health care clinical supplies, including rapid tests, procedural devices, contraception/EC, and other medications)
Emergency Contraception
Emergency contraception (EC) is a safe way to prevent pregnancy after unprotected intercourse or failed contraception. Increasing access to EC will optimize its effectiveness. While most of the information in this toolkit refers to medications used for EC, the most effective form of EC is an IUD.
- Assess current state of access and barriers to EC, including cost.
- Optimize access to EC through nursing and/or pharmacy protocols, including prescription EC (ella®); inclusion in safer sex supplies kits, and in vending machines.
- Implement vending machine options on campus.
- EC could also be distributed through offices on campus, such as the student wellness center, LGBTQ+ center, and/or the women’s center. Check with your administration and legal counsel about what might be possible for your campus.
- Optimize use of IUDs for EC by having staff available to perform same-day IUD insertion.
Resources:
Emergency Contraception for Every Campus
ThxEC! The Power of Emergency Contraception Student Distribution Groups | Power to Decide
Where to Buy Plan B | Plan B One-Step®
Eliminating Barriers and Improving Access to Contraception
Improving student access to effective contraception is a critical component of reducing unplanned pregnancy and increasing individual autonomy around family planning and reproductive agency.
- Provide adequate staffing to ensure the ability to provide a wide spectrum of contraceptive options including long-acting reversible contraception (LARC).
- Train providers and staff regarding counseling about available contraceptive options and access.
- Utilize options such as virtual visits/telehealth and e-consultation to optimize access to contraceptive services.
- LARC devices can be ordered individually as a medical or pharmacy benefit option through specialty pharmacies for those student health centers who are not able to maintain stock levels of devices. The pharmacy will file a claim through the individual student’s insurance and mail the device directly to the patient or the student health center for insertion.
Resources:
Training Overview | Beyond the Pill
Contraceptive Care via Telehealth | Reproductive Health Access Project
Upstream’s Guidance on Implementing Telehealth for Contraceptive Care
LARC Statement of Principles (Sister Song and NWHN)
Barrier Contraceptive Options
Ensure widespread low-cost or no-cost access to barrier methods of contraception. In jurisdictions that limit access to other contraceptive options, barrier methods may not be affected due to their use in prevention of disease.
Strategies for delivery of barrier method supplies (penile/external and vaginal/internal):
- Place in vending machines, student health center, wellness center/health promotion, student markets, and in strategic locations on campus like identity-based centers, residence halls, library, recreation center, bathrooms, and student unions.
- Determine if there are local (e.g., local health department) or state programs for free/no cost barrier method supplies for student distribution or for student self-ordering of no-cost/low-cost supplies.
Resources/examples for supplies:
The Condom Collective | Advocates for Youth
Cervical Barrier Advancement Society (provides resources and a list of suppliers/manufacturers)
Local city, county, or state health department
Trojan (offers university bulk pricing)
Lactic Acid, Citric Acid, and Potassium Bitartrate (Phexxi) Vaginal Gel for Contraception | AAFP
Hormonal Methods (non-LARC)
Prevention of unintended pregnancies should be a primary focus for student health centers. Student health centers should employ best practices to ensure quick, easy access to any contraceptive method including quick start method for hormonal contraceptives and long-term prescriptions when appropriate.
- Utilize virtual visits/telehealth with clinicians for contraceptive counseling and prescriptions.
- Develop nursing and pharmacist protocols to provide hormonal contraception (pills, patch, ring, injectable [i.e., Depo-Provera]) where allowed by state regulations.
- Utilize quick start protocols.
- Have OPill®, currently the only non-prescription daily oral contraceptive available in the U.S., available in campus markets, pharmacies, the student health center, and vending machines.
- Provide mail order delivery of contraceptive medications through the student health center or private pharmacy partners.
Resources:
Contraception | Innovating Education in Reproductive Health
Quick Start Algorithm for Hormonal Contraception | Reproductive Health Access Project
Clinic Tools | Beyond the Pill
Long-Acting Reversible Contraception (LARC)
Although LARC options have been shown to have superior continuation rates and the highest efficacy of all contraceptive options, they are underutilized at student health centers.
- Increase provider training for IUDs and implants.
Resource: Contraception | Innovating Education in Reproductive Health
- Maximize access and decrease barriers.
- Offer one visit, same day access.
- Consider ordering devices as a medical or pharmacy benefit.
- Refer to community partners if unable to provide LARC at the student health center.
Resources:
Clinic Tools | Beyond the Pill
LARC Insertion & Removal Series | Innovating Education in Reproductive Health
Customer Support Center for Nexplanon
Progestin Implant Policy and Procedure | Reproductive Health Access Project
Long-Acting Reversible Contraception (LARC) | ACOG
IUD E-Consult Information | University of Michigan Health Services
Depo-Provera Guidelines | University of Michigan Health Services
Example Protocols:
Nurse Protocol for Depo-Provera
Contraceptive Start by UHS Nurses
Student Contraception Eligibility Questionnaire for RN/Pharmacist Example Protocol
Medication Abortion
Provision of abortion services on-campus may not be legally or logistically feasible, but comprehensive support and medical care should be made available for students who are at-risk, considering or intending to undergo medication abortion.
- In jurisdictions where abortion is not restricted, provide medication abortion directly to students, through on-campus providers, student health pharmacies, or, if necessary, through prescriptions at off-campus certified pharmacies.
- Consult with legal counsel regarding care of students from jurisdictions where access is restricted.
- Train clinicians or contract with clinicians capable of providing medication abortion.
- Utilize telehealth options. See State Level Telehealth Policies | Power to Decide
- Review SHIP coverage for abortion and develop financial support pathways for those without insurance or with financial need.
Program Development Considerations
If offering on campus:
- Assemble stakeholders (student groups, administration, security, pharmacy, lab services, health promotion, social services, after hours care network).
- Will there be capital purchases (e.g., ultrasound, lab equipment, medication)?
- What will be the cost to students?
- Determine a workflow:
- How will students access the service (portal, nursing triage protocols, confidentiality issues)?
- Staff training, values training
- Establish a medical protocol
- After hours care
- Contraception services
- Behavioral health support
- Accommodations for academics/work if needed
- Assess legal considerations
- Understand the legal landscape in your state, including any shield laws.
- Consider issues of initiation/completion in the states where legal, as travel can add complexity and potential risk/liability.
Resources:
State and Federal Reproductive Rights and Abortion Litigation Tracker | Kaiser Family Foundation
- Metrics and quality care considerations:
- Student satisfaction survey
- Evaluation of medical outcomes
Tools for implementation:
Abortion in Primary Care | Reproductive Health Access Project
Resources | Reproductive Health Access Project
Quality/Standards | National Abortion Federation
Sample medication abortion patient handout | University of California, Berkeley
Sample large school medication abortion protocol
Sample small school protocol workflow (adapted from Reproductive Health Access Project)
Sample large school protocol for very early abortion
Sample medication abortion patient handout | Columbia Health
Sample medication abortion workflow | Columbia Health
Staff training tools:
Values Clarification Training | Reproductive Health Access Project
TEACH (Training in Early Abortion for Comprehensive Healthcare)
If not offering on campus:
- Clarify and streamline the referral process.
- Understand and relay expectation(s) in accessing referrals.
- Consider legal issues.
- Review SHIP or other insurance coverage.
- Provide contraception services post abortion.
- Provide behavioral health support.
- Explore considerations/accommodations for academic and financial assistance (travel, missed classes and work).
- Set up temporary housing accommodations if needed or requested by the student.
In jurisdictions where abortion is restricted, consider planning for how to care for students before, during, and after self-managed abortion.
Resources:
