A simulated patient study to assess referrals to abortion care by student health centers in Pennsylvania

Objective: To determine college health centers' referral patterns for students seeking induced abortion. Study design: We conducted a cross-sectional simulated patient study at 4-year colleges in Pennsylvania between June 2017 and May 2018. A researcher posing as a student seeking abortion referral contacted student health centers twice during the course of the study using a structured script, once as a minor (under 18 years), and once as an adult. The primary outcome was "direct referral", defined as a referral to an abortion provider. We measured proportions of student health centers who provided no referral, "indirect referral" (referral to a non-specific provider), and "inappropriate referral" (referral to a non-abortion provider). We analyzed the relationship between the proportion of direct referrals and minor status of the caller as well as college characteristics (religious affiliation, location, student body mean income, and size). We included variables found to be significant as covariates in a generalized linear model that accounted for the cluster of multiple calls to each institution. Results: We attempted contact with 115 institutions, once as a minor and once as an adult, resulting in 202 successful contacts. Direct referral was the most common outcome (49.5%), followed by inappropriate referral (33.7%) and no referral (21.8%). The proportion of direct referrals given to minors was similar when compared to adults (48.0% vs 52.0%, OR 0.82, 95% CI 0.47-1.42). Religiously affiliated institutions were less likely to provide a direct referral than non-religiously affiliated schools (aOR 0.47, 95% CI 0.30-0.75). With each increase in students' household income tertile, health centers were more likely to provide a direct referral (aOR 1.22, 95% CI 1.05-1.42). Conclusions: Half of college student health centers in Pennsylvania do not provide direct abortion referrals, and many provide inappropriate referrals. Student health centers at religiously affiliated institutions and those with poorer students are less likely to provide direct abortion referrals. (C) 2020 Elsevier Inc. All rights reserved.