If a University of Michigan student walks into the school's Ann Arbor health center and learns they're pregnant, the health worker's response is never exactly the same.
"It's easy to list: 'Well, you can continue a pregnancy, or you can consider a medication abortion or ... a surgical procedure,'" says Dr. Susan Dwyer Ernst, chief of gynecology at the University Health Service. "But we take those conversations in the context of the human being who's sitting in front of us."
In the wake of the U.S. Supreme Court's overturning of Roe v. Wade, Ernst has been thinking a lot about how those conversations with students will change. Michigan is one of several states with long-standing abortion laws that weren't enforced while Roe guaranteed the constitutional right to abortion. Now, as abortion-banning state laws take effect, university health centers across the U.S. are trying to figure out their rights and responsibilities when counseling students.
And another thing is adding to the confusion: In some states, it's unclear whether individuals could be prosecuted for helping pregnant students get the resources they need to obtain an abortion, including transportation or funding.
"While some states have laws that specifically make aiding and abetting an abortion illegal, it may still be illegal to do so in other states even if they don't have that language in their abortion statute," says Kimberley Harris, who teaches constitutional law and reproductive rights at Texas Tech University School of Law.
States typically have laws that make it illegal to aid someone in committing a crime, like robbing a bank. "If abortion is a crime, it would be illegal to aid and abet someone in procuring an illegal abortion," Harris says.
Dr. Jessica Higgs, president of the American College Health Association, which represents over 700 institutions of higher education, says larger universities are likely better equipped to navigate this confusing legal landscape. "Really concerning [will] be smaller universities in more rural settings" with fewer resources, she says.
Many small rural schools don't have health centers
Most colleges don't provide abortions on campus — rather, they connect students to reproductive health services that are available in the surrounding community. That's especially true at small rural colleges that can't afford their own health centers.
Prescott College, in central Arizona, is one of those schools. Because it doesn't have its own student health center, organizations like Planned Parenthood come to campus a few times a year to offer counseling as well as testing for sexually transmitted diseases and pregnancy, says Kristine Preziosi, the college's dean of student affairs. Most students at Prescott College attend remotely, and the 200-some students who live on campus primarily seek health care in the surrounding community.
"We train our resident assistants, our student mentors, our advisers ... to help individuals sort of figure out what is available in the community and what is available outside of the community," Preziosi explains.
She says some students who need reproductive health care, including an abortion, wind up driving nearly two hours to reach a Planned Parenthood facility in one of the closest large cities: Flagstaff or Phoenix.
Those options may not be available much longer. With Roe overturned, Arizona's attorney general has said that a pre-statehood law banning abortions is enforceable. He's working to remove an injunction that has blocked the law for nearly 50 years.
Given the law's possible revival, Preziosi says there's talk among Prescott administrators about changing the school's academic accommodations policy to give students and employees more time to travel for health care — even out of state if they need to.
In the meantime, Preziosi says students have a lot of questions. If they need time off to travel for an abortion, will the school report them to the state? "And how will their personal freedom to travel actually be in jeopardy? And will the college be asked any questions about them traveling for reproductive health care?"
She says she and fellow administrators don't have all the answers yet but are "trying to figure out the best way forward."
A large university can prepare for all scenarios
Like in Arizona, the fate of abortion in Michigan remains highly uncertain. The state has an abortion ban still on the books from 1931. The law makes providing an abortion a felony unless termination is necessary to save the woman's life. The law offers no exception for rape or incest. Currently, the state has an injunction in place that keeps abortions legal, but the Republican-led state legislature has asked a state court to overturn it.
At the University of Michigan, Ernst has been preparing for all possible scenarios, from a complete statewide ban on abortion to less extreme changes. In May, following the leak of the Supreme Court's draft ruling, the university launched a task force to identify what reproductive care would look like on campus if Roe were overturned.
As the head of gynecology, Ernst says she's most worried about whether her staff can do their jobs effectively. Will their conversations with patients after a positive pregnancy test have to change? For now, the answer is no.
The University of Michigan can currently counsel students on all options, but in case the 1931 abortion law does go into effect, the school is looking at how to legally refer students to out-of-state abortion providers.
"We're currently working with our legal team to actually lay out all sorts of scripts ... for health care providers, for nurses, for anyone who would get these questions from a patient ... so that we do stay within the law," Ernst says.
There's concern over students taking matters into their own hands
Schools in Michigan and Arizona are adapting to laws that were created decades before Roe made abortion legal. In 13 other states, schools are navigating trigger bans that were designed to criminalize abortion if Roe were reversed.
In a statement after Roe was overturned, the American College Health Association raised concerns that the decision will "directly endanger college health professionals' ability to provide evidence-based, patient-centered care, and may place them in legal jeopardy."
That's because there is still confusion over what the consequences might be for aiding and abetting, or offering counseling or other services, to someone seeking to terminate their pregnancy.
While health care workers learn to navigate their new legal landscapes, Ernst worries that some things will slip through the cracks. She's particularly worried about self-managed medication abortions.
The two-drug regimen is approved by the Food and Drug Administration and is widely recognized as safe. More than half of U.S. abortions were medication abortions in 2020, according to the Guttmacher Institute, a research organization that supports abortion rights.
But Ernst worries that in places where medication abortion becomes illegal, as may happen in Michigan, students will take matters into their own hands by obtaining the medications through an online source instead of a medical provider.
"We need to be ready to help manage any complications that occur," both physical and emotional, she says.
Texas gives a glimpse of what the future could look like
Texas is a case study in what a post-Roe future could look like on some college campuses. The state has long been pushing to limit abortions. Last year, for example, the state passed a law that incentivizes private citizens to file suit against anyone who "aids or abets" an abortion after cardiac activity is detected, about six weeks into pregnancy. The state awards a minimum of $10,000 for successful lawsuits.
At Texas A&M University, the student health center doesn't manage pregnancies, but it can diagnose them and refer students for prenatal care. "We are guided by state law," said Dr. Martha Dannenbaum, director of student health services, in an email to NPR.
Nimisha Srikanth, a rising senior at Texas A&M, says even if pregnancy care were available on campus, a student seeking an abortion may not search for that care for fear of being reported.
Srikanth helps run Feminists for Reproductive Equity and Education, or FREE Aggies, a student group that provides free sexual health resources, including contraception and pregnancy tests, to students and the local community.
"Some people are uncomfortable with the idea of going to the student health center and talking to school workers," she says. "Our service is free, and we do it inconspicuously." Srikanth and her team provide students with pregnancy tests and contraceptives, which they discreetly deliver in brown paper bags.
She says the student health center does offer Plan B, a form of emergency contraception, selling it at a lower price than the local pharmacy.
But the future availability of Plan B is also in question.
"There are some people who say Plan B ... might actually prevent implantation of a fertilized egg," says Harris, the law professor at Texas Tech. And under Texas' trigger law, expected to go into effect in the coming weeks, life begins at the point of fertilization.
If states do move to limit access to Plan B, it will create yet another legal obstacle for colleges to navigate.
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