Sexual and Reproductive Health and Rights on Community College Campuses

Approximately 10 million students per year are attending community colleges in the U.S., and many students are balancing multiple responsibilities while they study. Yet, most community colleges do not offer robust health care services, like contraception, STI testing and treatment, and pregnancy testing. Dr. Martinique Free, Director of Connect for Success at the Institute for Women’s Policy Research, talks to us about the state of limited access to sexual and reproductive health services and care on community college campuses and the program that is seeking to change that reality.

The Connect for Success Initiative considers the dramatic shift of the sexual and reproductive health and rights landscape in the U.S. over the past five years. The program gives funding support to nonprofits, health departments and community colleges that are working to provide SRHR care and information to students across the U.S.’ geography and policy environments. Connect for Success also works hand-in-hand with students that attend partnership universities to make sure the programming matches their true needs. 

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hi, rePROs. How's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, last week was a little wild. The weather was like all over the place. It started off the week like in the 70s. By the time I left work on Wednesday, it was 85. And then it snowed on Thursday. Like just all over the place in terms of weather. And then also, like, I've just been, it's been chaotic. I just have had so much on my plate that needed to get done. We're getting so close to releasing this year's 50-state report card, but that also means I have a thousand and one things that I'm trying to get done with the report card plus other things happening. Like, it's just been a lot. And then on top of all of that, my little munchkin Cinder hasn't been feeling great. And I thought one day last week I was gonna have to take her to the emergency vet. She seems to have gotten better, but I'm still keeping an eye on her. So, I don't know if she, like, ate something or- I don't know. I'm hoping she's better. But that just added to the overall stress of the week to have a little kitty who was not feeling well, and then she kept waking me up at night because she wasn't feeling well, and it just was all the things with just one more stress added on top of all of the general stress from what is happening in the world right now. Like, it is just a lot at the moment. So, I hope everybody is taking care of themselves. I feel like I've just been so busy with work that I have not been paying as close of attention to all of the other general terribleness, but it's just been a lot. I'm recording this on Friday, so before this comes out, I was thinking that since it is St. Patrick's Day when this comes out, I was thinking I ran across a recipe for a Guinness cake, a Guinness chocolate cake, and I happen to have Guinness in my refrigerator. I don't really like drinking it, but I do like cooking with it. And I made a Guinness stew a couple weeks ago. So, I have Guinness that I'm not going to drink but need to use. So, I think I'm gonna make a Guinness chocolate cake. So, fingers crossed that it turns out, I am very excited to try it. It's supposed to be really good. So, I will let y'all know next week if I do succeed in making the Guinness chocolate cake. I think maybe I'll leave it there. I am excited to share this week's episode. It is something that I haven't spent a lot of time thinking about, so I was really grateful to have this conversation. We're gonna be talking about access to sexual and reproductive health services on community college campuses and the great work that is being done by the Institute for Women's Policy Research. And we talked to Dr. Martinique Free about their Connect for Success program. And it was good to have a bit of a good news story to hear about work being done to increase access and also in an area that I hadn't spent a lot of time thinking about, which is community college access. So, it was a wonderful conversation, and I'm so grateful to have learned more about this topic. So, with that, let's go to my interview with Dr. Free.

Jennie: Hi, Martinique. Thank you so much for being here today.

Martinique: Thank you so much for having me.

Jennie: I am so excited to talk to you about y'all's program. But before we get started, let's do a quick intro. Would you like to introduce yourself?

Martinique: Sure. I am Dr. Martinique Free. I am Director of Connect for Success at the Institute for Women's Policy Research. For almost two decades, I've worked across public health research and policy to advance sexual and reproductive health and address HIV and STI disparities. My work centers health equity in ensuring that students and communities, especially those that are too often overlooked, have access to the care and resources they need to succeed.

Jennie: I am so excited to talk about this program. It's one of those things that I haven't really thought a lot about. And I'm so great, glad we're gonna talk about it. And that is access to SRHR services at community colleges. Like, that is such an important chunk of people that need access to services, but it just never crossed my mind. So, I am so excited for today's conversation. I guess before we get to Connect for Success, maybe let's talk a little bit about access. What does access look like at community colleges right now?

Martinique: Yeah, so I think that's a great question to start with. I think it's even more important to kind of describe the typical community college student. And so, when we talk about higher education, I think people default to thinking about four-year institutions, 18 to 19-year-olds. That's not necessarily the case at community colleges. And so, when we talk about students at community colleges, we often forget that nearly 40%, about 10 million students per year attend these schools. And many of those students are balancing work, family obligations, and real adult responsibilities while trying to finish school. These campuses are one of the most important entry points into higher education and into economic mobility. And so, to further build out that profile, I just want to share some demographic data to kind of just paint the bigger picture of community colleges and the people that they serve. So, the average community college student is about 27 years old. About two-thirds of community college students attend part-time, and a large share are working full-time while enrolled. Community colleges also serve a diverse population of students who are often navigating significant economic pressures. Around one-third are first-generation college students, and many come from low-income households. I also think it's worth mentioning it's not uncommon for community college students to be parents themselves. So, they're juggling caregiving responsibilities alongside coursework and employment. So, when we talk about the needs of community college students, we're talking about people who are managing, again, like real adult responsibilities, trying to build better futures through education. And yet, unlike many four-year institutions, most community colleges do not have robust health care centers, which means students often lack easy access to basic services like contraception, STI testing, pregnancy care, and accurate sexual health organization. And so, that gap really does matter, because when students don't have access to sexual and reproductive health care that they need, it can affect not just their health, but their ability to stay enrolled, finish their degree program, and achieve the economic mobility they came to college for in the first place. So, in many cases, these students have to depend on community resources to fill that gap.

Jennie: That's so great to get a better idea of not only who we're talking about, but what access looks like. Can you tell us a little bit about the Connect for Success initiative?

Martinique: Sure. So, I want to give a little bit of background, right? Because a lot has changed in the reproductive [landscape]. There's been a lot of shifts. And so, the context for this initiative really starts with how dramatically the reproductive landscape in the United States has changed just within the last five years. So, as we all know, in 2022, the Supreme Court's decision in the Dobbs v. Jackson World Health Organization overturned Roe v. Wade, ending federal constitutional rights to abortion, and shifting authority to the states. Since then, the country's become incredibly patchwork. Some states have enacted near total abortion bans, some have imposed strict gestational limits, and many have moved into the opposite direction by passing policies designed to protect providers and those seeking resources. So, patience. And so, what does that look like in practice? What does that mean? It means that where you live now largely determines whether you can access reproductive health care at all. And if you can, the quality and type of care available to you. In some states, people have to travel hundreds of miles across state lines to obtain care, which adds costs, time off of work, and other barriers that disproportionately would affect young adults and people with limited resources. And so, the rapidly changing environment was really the backdrop for why we launched Connect for Success at the Institute for Women's Policy Research. And when access to reproductive health services becomes more restricted or complicated, those barriers can directly affect whether students can stay enrolled and complete their education. So, through Connect for Success, we fund nonprofits, health departments, and community colleges that are working to expand access to sexual and repro health for students. We currently support 15 partners across every region of the United States and across different geopolitical contexts. And that was very intentional. It's really important to me that we include organizations in both protected as well as restricted states because the policy environment where students live dramatically shapes the options available to them. We also engage a group comprised of 23 community college students that reside and attend the colleges where our partners are. So, it's just as important to include the student voice and their experiences in this initiative because the work is really about them. They're the ones navigating these systems every single day. And their lived experience helps us better understand the real barriers to accessing care in their states and what solutions will actually work on their campuses. And so, I also want to highlight that this initiative has several pillars that reflect the real barriers students face when trying to access sexual and repro care. And so, there's menstrual care access, which focuses on: how are these institutions addressing period poverty? There's contraceptive access, queer inclusive care access, abortion care, just general repro care access. And so, when I say that, I mean your women's wellness visits and your STI testing. What we've done with Connect for Success is create a learning community where individuals and students can learn from each other with the intention of strengthening campus community partnerships so colleges can connect students to local providers and expand direct access to the services they need. Also, just thinking about how we can make students more aware of the services that are offered in those community resources. What does it look like to navigate that support? And we also generate research and practical tools that help campuses understand how repro health access limits are linked to student persistence and success. And so ultimately, Connect for Success is about recognizing the sexual and repro health care, that sexual and repro health care is not separate from education, right? It's part of what allows students to plan their lives and stay in school. And that's really important.

Jennie: Yeah, there is so much in what you were just saying that I found really interesting. I love that you're in all different contexts across the country because I think a lot of people think immediately of states where there are bands who have problems accessing care, and absolutely they do. But just because a state has abortion access does not mean access to care is easy or that it's accessible to get reproductive health care. So, it is important to have both contacts. And I also really loved the working with the students to hear what their needs and concerns were, because if you're not meeting them where they are and where the gaps they see are, you might not be meeting what needs they actually have.

Martinique: Mm-hmm. And that's real important too—this alignment between programming and student needs. And often, it's not uncommon for people to just push programs out without doing community needs assessments and really, really meeting people where they are with what they need. And so, that's just as important when working with the community college population.

Jennie: So, what are you hoping to achieve with the Connect for Success program?

Martinique: At its core, Connect for Success is about demonstrating that sexual and reproductive health access is an important part of student success at community colleges. One of our primary goals is to build, to develop a national toolkit of effective services, programs, and resources that campuses can use to start new initiatives or expand the work they're already doing to support students. So, the toolkit itself is being designed for both practitioners and decision makers, for the sexual and reproductive health program staff who are delivering services to students on the ground, and for higher education leaders who ultimately make decisions about resources, policies, and institutional priorities. So, what makes this effort unique is that the toolkit is being built by learning directly from the work of our 15 partners and students that they serve. We were very intentional about selecting organizations that are at different stages of providing care regarding their programs and services and located across very geopolitical environments. That diversity allows us to really understand what it takes to support students in a very different policy and institutional context. So, through those lessons, we're identifying practical strategies that community colleges can realistically implement, particularly around strengthening partnerships between colleges and local sexual health care providers, since many campuses don't have comprehensive health centers. Another key goal is to build broader will and understanding around the issue. We want policymakers, advocates, community college faculty, staff, and administrators, and also community health stakeholders to see sexual and reproductive health access as part of the larger ecosystem for student supports that helps students persist and complete their education. Ultimately, we hope this work will encourage new interests and investment from community college leaders, philanthropists, and policymakers and show that improving access to sexual and repro healthcare can be a powerful lever for improving student well-being, educational attainment, and long-term economic outcomes.

Jennie: This is one of those areas that it seems so obvious and intrinsic to like- that we just take it for granted. Everybody sees the connection between why sexual and reproductive health is important to people's ability to obtain education. Do you maybe want to drill down on that part for me? Just for people who maybe don't see that connection right away.

Martinique: Yeah, I think that I just find it interesting that when we talk about student support services, basic needs for those in higher education, we often leave out sexual and repro health support. And so, I really believe that when you talk about basic needs in the same vein that you're talking about housing insecurity and lack of access to food and mental health services, you should also be including sexual and reproductive health services. It just makes sense. And I don't understand why that doesn't come to the forefront of people's minds. And so, this is a big conversation among the partners too, and how we frame our messages when we when they're out there advocating, when they're out there talking to stakeholders and decision makers to bring more programming to their campus. I think it's really important to frame it as a basic need.

Jennie: Yeah, this feels like one of those continual conversations you have around sexual and reproductive health of making connections of how it is important to education or any number of other given areas. I feel like one of the areas, since I work in the global space as well, is talking about why it's such an important part of humanitarian assistance, right? Because people don't stop being pregnant or getting pregnant when there's a disaster. Same for, like, all of these ways that sexual and reproductive health is so important to these other areas. And yet it still gets so siloed from them.

Martinique: Yeah, and I'm pretty sure everybody can think of examples or know someone, even if loosely, how potentially not having access to these resources has impacted their life. It's not unplanned pregnancies that can completely derail your experience in college. Like some people, because then you have other responsibilities, you have to figure that out. And so, I think again, like it's a basic need like anything else when we talk about what basic needs are for these students.

Jennie: Do we want to talk about a little bit of the work that some of your partners have done and some of the successes that you have seen?

Martinique: Yeah, I'm so glad you asked this question because I love to brag on the work of these phenomenal people doing work in this area. And so, I want to mention states where our grantees are located. We have partners in Texas, California, South Carolina, Washington State, Maryland, Illinois, Mississippi, Alabama, and Florida, Panhandle, Minnesota, Oklahoma, Colorado, and one of our partners has national impact across the United States. Um, and so to talk about some of the successes of Connect for Success and working with our partners since they've been engaged in this initiative, we have the Solano Reproductive Health Club. This is the only partner that is a student organization, and they've done something really phenomenal. They opened a student-led, fully furnished reproductive health center on campus, and I conduct site visits with our partners, and it's phenomenal. It's just like a little market space, and it's a place where students can kind of hang out and ask questions. Then there's Frederick Community College; they created and supported 300 students last year through a program they created called Menstral. And this is their approach to addressing period poverty. And so, their program is a discrete menstrual product delivery program. And what they've done is they've used their food and security lockers on campus as lockers where students can pick up menstrual care products a couple of times out of the week. And so, I thought that was a pretty phenomenal idea to come up with. There is Bellevue College. They've established a student-curated resource library featuring sexual, reproductive, and gender-affirming resources. And I love that they've found a creative way to engage students. It kind of shows where the needs are on that campus and how they're really open to meeting those needs. Another partner of ours is the Yellowhammer Fund. They completed, last year, a 30-bus stop tour. The bus is called the Repro Raven. And the tour was across rural Alabama, where they stopped in areas where there's a rural supply deserts throughout the state, including business to college, passing out menstrual care products as well as Repro Health Supplies. And then we have, we are advocates for reproductive education. And what they did was they created free STI drop boxes, which are available in bathrooms across some of the local community colleges in the town. And so, these boxes allow for self-testing for chlamydia and gonorrhea and the convenience of being available after hours and on weekends when typically, clinics are closed during that time. And so other partners have presented and published research around their work. They've worked together to create these presentations and publications. We also partner with the UCSF Bixby Beyond the Pill and Innovation Research and Training to create publications on repro and sexual health access for community college students. So, our partners are busy.

Jennie: I love this wide range of ideas and different things that the students have done and come up with or the communities have come up and done with.

Martinique: Yeah, you know what I really appreciate about this particular partner is that the university, the college, like, trusted these students to do this. And they've done a phenomenal job. Students access it, ask questions, and it's just really beautiful to listen to students' needs and then the students taking the initiative to create the space that they felt was missing from the campus. I really appreciate it. Because we always think young adults and teenagers don't know anything, but they do. And it's important to elevate their voice in this work as well.

Jennie: I also really loved hearing all of the stuff around menstrual care and in and places that had period products. Like, that is so wonderful and something that definitely wasn't around when I was in college in the same way. And there's still so much... I guess stigma is still the right word. Like, periods [often] just aren't talked about. We had an episode a couple months ago talking about how we don't talk about period pain and that like that is like this hidden conversation that never happens. So, it's really great to see periods and access to period products being put on display and being taken seriously on campus.

Martinique: Yeah, and that's one thing we don't think about, right? There are situations where students just have enough money to get to campus.

Jennie: Yeah.

Martinique: They don't have the money for menstrual products on a monthly basis. They really don't. And so, they have to resort to things that can help them get by. But no, this is an issue we should- [many] individuals who identify as female, they have to menstruate, right? And so, we need to really think about how we can address this issue. The last thing you want to do while you're in college is worry about where you're gonna get a maxi pad from.

Jennie: Absolutely. And we talked about this, touched on this earlier, but there has been this huge attack on SRHR the last, I mean, forever. It feels like forever. It's been just unending. So, what are some of the challenges you're running into trying to get this program going?

Martinique: That's a good question. One of the biggest challenges we're navigating right now, and it's not unique to just us, is that the policy landscape around sexual and repro health has become much more restrictive and politically sensitive in many parts of the country. And it's also moving a lot. Like, there's a lot of the policy that can change month to month. And it’s changing so quickly sometimes, the practitioners in this work, they can't keep up, right? And so, that's in some ways a drawback because, more often than not, if you don't have the knowledge base about something, you kind of pull back from it. And so, what happens when they pull back from this lack of access increases for this population. And so, our partners, they're working in very different state contexts. This type of services, partnerships, and even conversations they can have publicly about reproductive health can vary significantly, which is why I share just some of our grantees' work, although all of them are doing really phenomenal jobs. For example, and so I just want to talk a little bit about states that have these strict abortion bans or limitations, organizations often have to operate within very specific legal, institutional, and communication constraints. And so, that can affect what information can be shared on campus, what services can be directly provided, and even how programs are framed when working with colleges or public partners. There's some instances where programs are offered but cannot be promoted on campus to students. They kind of just have to know that the service is there, which doesn't really work, right? So, they have to rely heavily on word of mouth for students to kind of talk to each other and let them know where to access service on campus. And I think it's really important to point this out because this is something that we didn't account for, but it kind of came up, right, as we started doing these site visits. I don't want people to assume that constraints are only happening in states with repro restrictions because they're not. There are instances where partners may be located in protected states but are located in counties within the state that lean more conservative, which can heavily influence campus politics. It's not uncommon for us to see that. Another challenge is that some of our partners, particularly those connected to public institutions like your community colleges or health departments, have to be careful about how they talk about certain aspects of reproductive health, even as they're engaging students in direct services, especially around abortion care access. In some cases, they may not be able to publicly comment on or directly engage in certain areas of this work because of state policies, funding restrictions, or institutional guidance. So, what that means for Connect for Success is our approach has to be flexible and responsive to those realities. We work closely with each partner to ensure they can pursue strategies that make sense in their local context while still expanding student access to critical sexual and reproductive health information services and resources. And in many ways, that diversity of contexts is actually one of the strengths of this initiative. Because our grantees are operating across very different policy environments, we're learning a lot about how organizations can creatively support students, even in restrictive settings, as well as how programs can grow in places where the policy environment is more supportive. Ultimately, those lessons will help us build a toolkit that reflects the real-world complexity, right, of this work and provides practical strategies for campuses and partners across the country.

Jennie: It is so complicated. And like you said, everything is so fluid at the moment. States are trying to pass laws around access to information, and that presents a really challenging landscape to try and ensure that people are getting the care they need.

Martinique: Yeah, and this is something that we heavily monitor in Connect for Success. We're always checking in with our partners a couple of times throughout every quarter just to see what's going on, what are the conversations around policy shifts and institutional priorities because that can play a huge role in services that are offered to people who really care about this topic. And in some ways, their hands can be tied on what they can do when they know they see more of a need for the students that they're supposed to be serving.

Jennie: Yeah. And sometimes in cases like that, right, it doesn't even need to be the actual policy changing, but then the school getting skittish about conversations that are happening and deciding to make changes proactively.

Martinique: Exactly. Exactly. And so, we try to encourage our partners to identify their partners on campus who are in support of this work, who have a seat at a decision-making table to say, hey, you need to add this to your institutional priorities. There needs to be a focus on this.

Jennie: This is such a great conversation. I really enjoyed learning so much about access on community college campuses. I always like to end not just talking about challenges or what is wrong, but thinking through ways the audience can get involved. So, what are some of the ways our audience can get engaged in this topic?

Martinique: Hmm. One of the most important things audiences can do is recognize that sexual and reproductive health access is directly connected to student success, right? Especially for community college students. Too often these conversations kind of happen in silos, in policy circles or health spaces, but they don't always include higher education leaders, funders, or community partners that have the power to make change on these campuses. So, the first step is to kind of pay attention and start the conversation where you are, whether that's on a campus, in a community organization, in philanthropy, or in policy making spaces. Ask what services students actually have access to and where the gaps are. In many cases, the issue isn't necessarily a lack of commitment, it's a lack of awareness or coordination. The second thing audiences can do is support partnerships. That's a big part of the work in Connect for Success, like understanding these partnerships and: what does it take to sustain these partnerships? Some of the most successful models we're seeing connect community colleges with nonprofits and other public health entities to serve their students. And so, those partnerships make it possible to bring services directly to the students or at least create a trusted uh referral network when campuses don't have health centers. And finally, I would say invest in the work, right? Invest in the time, the resources, the leadership. If you are a college leader, this might mean integrating sexual and reproductive health into a broader student support strategy outline. If you are a policymaker or a funder, it means recognizing that supporting reproductive health access is also an investment in educational attainment and economic mobility. Because at the end of the day, community college students shouldn't have to choose between taking care of health and completing their education. When we make sure students have access to care and the information they need, we’re not just improving health outcomes. We're helping students stay in school, graduate, and build the futures that they deserve. And that's really what Connect for Success is about turning awareness into action so that every student, no matter where they live or work, can go to school. They can have the support that they need to thrive.

Jennie: That is such a perfect ending. There's nothing to add to that. So, Martinique, thank you so much for being here. I really enjoyed our conversation.

Martinique: Again, thank you for having me.

Jennie: Okay, y'all. I hope you enjoyed my conversation with Dr. Free. I had such a wonderful time talking to her and learning more again about an issue I said, like I said, that I hadn't spent a lot of time thinking about. It was really great to hear about the challenges and the ways that their partners are working to expand access. And I love that there are so many varieties of things being done to expand access to contraceptives and basic sexual and reproductive health care, whether that's menstrual care or many other types of sexual and reproductive health care on campus. It was really great to learn about the number of things being done. And with that, I will see y'all next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com, or you can find us on social media. We're at rePROs Fight Back on Facebook and Twitter, or @reprosfb on Instagram. If you love our podcast and want to make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you want to make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all.