A Tough Pill to Swallow

UC Berkeley’s Adiba Khan has spearheaded a bill that would require California public colleges to provide on-campus access to medical pill abortions, but funding the measure has proved challenging.

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UC Berkeley’s Adiba Khan has spearheaded a bill that would require California public colleges to provide on-campus access to medical pill abortions, but funding the measure has proved challenging.

Adiba Khan, a UC Berkeley student, is working to expand students' reproductive rights (Photography by Saul Urbina-Johansen, Harvard)

In spring 2017, the California Senate Health Committee passed the “College Student Right to Access Act,” or Senate Bill 320, introduced by State Senator Connie Leyva. If implemented, the bill will require all California public university systems, such as University of California and California State University campuses, to provide medical pill abortions in student health centers.

Two organizations, the Women’s Foundation of California and ACCESS Women’s Health Justice, decided to sponsor the bill after being inspired by a similar piece of legislation proposed by Students United for Reproductive Justice (SURJ) at UC Berkeley earlier that year. Co-founder of SURJ and UC Berkeley Public Health and Sociology major Adiba Khan helped to author that bill, and has been advocating for its passage on both the school and state level since.

Laying the Ground Work

Growing up in conservative Norman, Oklahoma, as a Bangladeshi-American woman of color, Khan, now twenty-one, became interested in reproductive justice after realizing how difficult it was in many states to access not only pregnancy termination services, but also contraception and other health services as well.

“Who are the people that are not getting their justice and accessing their rights?” she asks. “Undocumented immigrants, people of color, women of color, black women, South Asian women…are all not able to access what we are able to access. Reproductive justice includes so many other things besides abortion.”

Khan, who is Bangladeshi, was inspired after seeing the medical challenges facing women of color (Photograph by Saul Urbina-Johanson, Harvard)

Recognizing discrepancies in women’s health policies from state to state, as well as the limited access to reproductive health services many poor women of color face as a result of unfair policies, Khan felt the need to do more, and move somewhere she felt more “in-sync” with the people and political climate. As a result, she worked very hard to leave growing up, before eventually applying and getting accepted to UC Berkeley and moving to California.

Once she reached the campus, Khan realized that she had found the perfect environment for her activism. “UC Berkeley is known for being progressive, and historically speaking, radical in a lot of ways,” she says. While participating in anti-sexual assault advocacy at Berkeley, Khan and a fellow student women’s advocate, Meghan Warner, searched for an organization to align with what worked with reproductive justice, but were unable to find one. “Some women’s advocacy groups probably include that in their work,” says Khan, “but there wasn’t an organization that focused solely on that, so we thought, ‘Hey, let’s just make one.’”

In the fall semester of 2015, both Khan and Warner attempted to fill this gap in student activism by founding SURJ as one of the first pro-choice organizations in Berkeley’s history. Now, with an established group, Khan began looking for ways to help students improve their access to reproductive health care on campus by examining the student health insurance plan, as well as the services offered by the student health center.

Khan found that while abortion is covered by the required student health insurance, students are referred out to community health clinics to receive the medical pill abortion, a two-dose medication (not to be confused with the morning-after pill) that is generally prescribed by providers up until ten weeks after a woman’s missed period for termination of a fetus and is much like a very heavy menstrual flow. This method is extremely safe, with only 0.5 percent of women experiencing serious complications as a result of the medication, according to the National Abortion Federation, and is far less invasive than a surgical abortion procedure.

Khan reached out to a fellow student to hear about her experience with accessing a medication abortion on campus through the health center, and was surprised to find out that the student had encountered a number of obstacles in seeking care. Aside from the student citing concern about having to disclose her need to obtain an abortion to not only the health center staff, but to the community clinic staff that she was referred to as well, the student experienced other difficulties that she had not anticipated.

“She had to take public transportation to get there,” says Khan. “She had to miss a decent amount of class for that. Plus the health insurance wasn’t too great for covering abortion; she had a deductible, and she ended up paying about $250, which she felt angry about,” as the student assumed the school’s health insurance would have covered it in full.

Hearing about these roadblocks from someone who experienced them firsthand, Khan began to research the Tang Health Center at Berkeley to find out why they did not provide the service on-campus, when more invasive procedures, such as placement of IUD contraception, were already offered. After speaking with the health educator at Tang, Khan found that they did have the capacity, logistics and means to do so, but just felt that it was easier to be able to refer outside instead of providing it at Tang.

The Making of a Bill

Taking action the next semester, in spring 2016, Khan co-authored a symbolic student bill with support from the undergraduate student government to be presented to the school administration. After writing the bill, Khan and SURJ focused their attention on gaining support through old-school petition signings on the main campus plaza at Berkeley, wrote an op-ed for Berkeley’s school newspaper, “The Daily Californian,” and garnered local media attention to show the school’s medical administration that “we are advocating for this because there is a need, it’s not being met, and students really want it, and you [the administration] all serve students,” says

Khan. “All of these things, that may be small in their own way…presented a solid case for this being looked at in a serious matter for the medical directors, which was very important to us.”

That fall, SURJ gained more support by obtaining signed letters of support from the Berkeley faculty, as well as an endorsement from the City of Berkeley itself. Eventually meeting with the administration again, they were told it would cost at least $15,000 to implement the medical abortion procedures, but were later given a figure of $150,000 to support what the university deemed as a necessary need for a salaried security guard and a public affairs officer during the first year of implementation for increased security support. “They needed to update their health center anyway,” says Khan. “But it was strategic on their part to put the cost on us. So it was like, ‘Okay, we’ll play game.’”

“And because we all care about the safety of the health staff and students, it was something I couldn’t argue against.”

Khan and her organization eventually found a way to apply for funding to be granted by the Wellness Referendum Fee, a collection of student fees used to support wellness programs for the students at Berkeley. After they received the $150,000, the administration requested to consider implementation of the medical pill abortions at Tang, Khan and SURJ were told in one of the last meetings with the school, in spring 2017, that the entire effort would then require $5 million to account for any unknown security issues and to meet their needs in upgrading the facility and staff itself. “The $5 million was a strategic way to totally cross us out, on the basis of uncertainty that nobody can give a concrete answer to,” says Khan. “And because we all care about the safety of the health staff and students, it was something I couldn’t argue against.”

After that last meeting with administration, Khan says the Women’s Foundation of California contacted her after they saw the bill that she had authored had passed, and were inspired to create a state bill, introduced as SB 320, that would spread this idea of increased access to medical pill abortions to all public universities in California. Khan then joined the policy project, working with Senator Leyva and the sponsoring organizations to provide student input, helping to change some policies addressing the student health insurance plan, as well as requiring that all counseling received by women seeking an abortion be scientific counseling and nothing that could be coercing someone out of an abortion.

After passing the Senate Health Committee in April, SB 320 will move onto the Senate Education Committee, where it will remain to be worked on and amended until it is reintroduced for a vote in January 2018. “SB 320 will ensure that pregnant college students—if they choose to do so—are able to end their pregnancy within the first few weeks without needing to travel off campus to a distant clinic, pay out of pocket and even miss class or work obligations in order to access these constitutionally protected services,” said Senator Leyva in a press release following the passage of the bill.

Since the symbolic student bill has more or less transformed into a piece of state legislation, direct interactions with the university have lessened somewhat. “University Health Services at UC Berkeley fully support a woman’s right to choose and have long provided contraceptives, including the ‘morning after pill’ (which is not to be confused with the ‘medication abortion pills’ indicated in the proposed bill) as well as referrals to nearby facilities for abortion services,” said UC Berkeley in a statement made to “Study Breaks.” “We are aware of students’ interest in this issue and have been in meetings with them to discuss their concerns. Those meetings and conversations continue. Student leaders we are working with have shifted their current efforts to SB 320.”

What Happens Now

As the bill hangs in legislative limbo, Khan has continued her reproductive justice work over the summer by interning across the country in Cambridge, Massachusetts, as a research assistant for Ibis Reproductive Health. Working on projects such as “Free the Pill,” an effort to increase access to oral contraception by providing it over the counter and covered by health insurance, Khan works with the non-profit to study the effects that this increased access would have in order to present to the Food and Drug Administration for approval.

Increased access for all women, regardless of societal status or demographic, is important to Khan, and she sees reproductive rights encompassing many factors that affect women’s choices, which is why much of her work spans outside of advocating for the medical abortion bill. “My work is envisioning where we can all live somewhere where people can exercise their right to not have a kid, to have a kid,” and the “ability to access those said choices and also be able to make choices and speak about them clearly and openly without any shame attached,” says Khan.

After completing her summer internship, Khan will return to her position as a case worker for Berkeley’s Student Advocate Office, where she assists students who want to formally report their assailants, or go through the formal university reporting process in situations such as harassment or sexual assault. Providing students with support at the university is just another way that proves activism, in many forms, touches every part of Khan’s life.

Khan knows that the upcoming fall semester will also require her to refocus her attention on preparing for the bill to be reintroduced. As a result of the bill requiring student health insurance to cover medical abortion pills, reconciliations between the UC and CSU school health systems will have to be made, as UC requires health insurance and CSU does not. Collaborating with campaign directors, communicating with other schools and creating a structured communication base from which they can begin to lobby for the bill, are all goals for SURJ and the upcoming semester, says Khan.

Recruiting additional members to assist with the undoubtedly heavy workload that organizing between different school systems and lobbying for the success of a state bill will also be pursued by the organization this semester. “It’s not only about activism, but also hopefully changing the way we all look at abortion, hopefully inspiring other places to make similar efforts,” says Khan. “Seeing abortion in a regular health center with everything else changes the way that we look at it.”

Khan, who will be graduating this year, hopes to continue working for women’s reproductive rights (Photograph by Saul Urbina-Johanson, Harvard)

No formal opposition has been posed against the bill by lawmakers as of yet, but religious groups, such as the anti-gay, anti-abortion Christian advocacy non-profit and affiliate of the California Family Council, the California Family Alliance, have been vocal against it. “To my knowledge, no other state has gone so far as to try to require chemical abortion coverage on campus,” said Jonathan Keller, CEO of the California Family Council, to “The Mercury News.” “Unfortunately, I think this is really an overreach by Sen. Leyva.”

If the current timeline is any indication, the complete passage of the bill through the general assembly will likely take place after Khan graduates next spring. Passing on the position of director of SURJ will inevitably happen when her time comes to an end at Berkeley, but she has confidence that the younger members will continue the work that she, and her co-founders, have laid out for them. As she doesn’t plan to leave California anytime soon, she will be as involved as ever in monitoring the condition of the bill and working for its passage. “I kind of joke that this abortion project is my baby,” says Khan. “I really want to be there with it until it’s a law.”

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