With the recent news that the Undergraduate Council of Students will supply tampons and pads in all non-residential on-campus bathrooms, the health of women and female-sexed students has come center stage on college campuses statewide. Collegiate health centers are oftentimes the first stop for undergraduate women and female-sexed students seeking sexual and reproductive medical care.
Health services at Providence College, Roger Williams University and Brown serve as the starting point — but not necessarily the endpoint — for undergraduates at their respective universities. “A college health center should provide a portal to health care — they will not be able to provide all services, but should be able to diagnose and refer a wide variety of conditions,” wrote Sarah Fox, adjunct assistant professor of gender studies at Brown, in an email to The Herald. That includes “the full range of reproductive health services, mental health, addiction services and basic primary care,” she added.
Most Rhode Island colleges’ health centers are primary-care facilities, meaning that they are not staffed with specialty physicians. “Health Services is really responsible for the health needs of all students,” said Unab Khan, director of Health Services at Brown, adding that the health center provides primary and emergency care for all students.
As certain forms of contraception and needs around sexual assault and rape become more widely acknowledged, some health providers on college campuses are growing to meet those needs.
It is also important to note the way in which health services approach the specific healthcare needs of trans* women who seek medical care, Khan said, adding that many providers at Brown Health Services attended a workshop on trans*-specific health last semester.
For trans* women taking hormones, the experience can be psychologically as well as physically challenging, said Anne Mitchell, director of Health Services at RWU. “There’s certainly a lot of anxiety; there’s a lot of stress; there’s a lot of fear.” RWU Health Services tries to collaborate with psychological services to remedy this, she added.
For cisgender women and female-sexed students, Brown, RWU and Providence College all currently lack gynecologists on staff in their health centers. “There’s not really a reason to support having a gynecologist on staff,” Mitchell said, adding that RWU students can still get pap smears and pelvic exams from nurse practitioners on-site.
“We don’t have specialty care at Health Services, and we don’t have gynecologists for specialty care in the same way that we don’t have urologists for specialty male health,” Khan wrote.
Contraception is also a central part of health care on college campuses. Students at Brown and RWU have access to condoms and birth control pills through their health services.
This contrasts with the policy at Providence College, where students do not have access to contraception of any kind: The school principally opposes the use of contraception, seeing it as contradictory to its Catholic mission, wrote Steven Maurano, associate vice president of public affairs, community and government relations at PC, in an email to The Herald.
But colleges often do not provide all types of birth control. “All college health services should provide a full range of contraceptive options, including, but not limited to, the intrauterine device and contraceptive implants,” Fox wrote. But among universities that do offer contraception, access to IUDs is rare — neither Brown nor RWU health services is able to provide IUD insertion services.
Providing IUDs is expensive, Mitchell said, adding that it is unclear whether RWU will incorporate IUDs into Health Services’s range of offerings in the future.
“It is certainly something that we really look forward to doing” at Brown Health Services, Khan said. But “each IUD costs about $700. That is just the cost of an IUD, without the administrative cost, which would include the time of a trained provider. There are logistics not only about funding but billing that we are trying to figure out,” she wrote in a follow-up email to The Herald. The University must provide IUDs in a “sustainable and responsible way,” she added.
Currently, a student wishing to get an IUD at Brown is referred off-campus to a gynecologist, Khan said, adding that this is standard practice for all specialty medical care that is outside the scope of Health Services.
Emergency contraception is also a key aspect of providing comprehensive contraception for students. Brown Health Services and RWU Health Services both offer emergency contraception at a reduced rate, and students at both universities can access emergency contraception for any reason.
“College health centers should provide immediate access to emergency contraceptives for a small charge or free of charge,” Fox wrote. “Emergency contraception is very effective but can be expensive.”
Emergency contraception is also a key aspect of responding to incidences of rape and sexual assault, Fox wrote.
While, as Khan said, Brown Health Services provides emergency care for all students, including emergency contraception, it does not administer rape kits to victims of sexual assault, said Amanda Walsh, Title IX program officer at Brown. Brown Health Services also does not have a sexual assault nurse examiner — a particular type of nurse who is trained to treat victims of sexual assault in the hours and days following an instance of sexual violence — on staff.
RWU also does not have rape kits or a SANE, Mitchell said.
But offering rape kits and adequately trained medical personnel is “part of the response to a sexual assault allegation,” said Shan Wu, a Washington, D.C.-based attorney who represents college students in legal and campus disputes. The issue of sexual assault can “very much be viewed as a health problem,” Wu added. Therefore, one could argue that a lack of health resources around sexual assault “would violate Title IX,” he said. Failing to train medical staff properly could be a health and safety issue, he added.
But it does not make sense to have a SANE at RWU Health Services, Mitchell wrote in a follow-up email to The Herald. “A SANE exam would not be performed in Health Services due to lack of resources, the length of time it would take to conduct the exam and concerns for maintaining chain of custody with the evidence collected,” she wrote.
While Khan did not elaborate on Brown’s lack of a SANE, the University offers a sexual assault response line that students can call after an incident of assault occurs. This line will refer students to medical and police assistance that may be relevant to their situation, according to BWell, Brown’s health promotion website.
