Date of Award

6-2020

Document Type

Dissertation

Degree Name

Doctor of Education in Educational Leadership

Department

Educational Leadership and Curriculum

First Reader/Committee Chair

Martinez, Edna

Abstract

Large, prospective cohort studies such as The Contraceptive Choice Project have been conducted regarding safety, efficacy, satisfaction, and usage of Long-Acting Reversible Contraception (LARC) such as the Contraceptive Implant (Nexplanon) and Intrauterine Contraception (Winner, Peipert, Zhao, Buckel, Madden, Allsworth & Secura (2012). Despite these findings, access and financial barriers remain for many women, and less than 7 percent of women utilize the most effective methods of contraception in the United States (Winner et al., 2012). Barriers to effective LARC methods exist at a higher rate with our young, poor, and non-white marginalized populations (Finer & Zolna, 2016).

Unplanned pregnancies have a significant impact on the retention of college students. In the United States, 1 in 10 dropouts among female students at community colleges is attributed to an unplanned pregnancy and 7 percent of dropouts among community college students overall (Prentice, Storin, & Robinson, 2012). Carr, Raker, Clark, Khan, and Allen (2018) noted that although a large percentage of the 20 million college students in the U.S. obtain their contraception through student health centers, there is a gap in the literature regarding the implementation of LARC services (Carr, Raker, Clark, Khan, & Allen, 2018). Therefore, the purpose of this case study was to explore the factors that influence the implementation of full-spectrum contraceptive care, including the most effective LARC methods, in a comprehensive, public, university student health center. A critical organizational theory lens and a critical feminist theory lens were utilized to better understand barriers to effective contraception including institutional problems such as the role of embedded racism, classism, and gender issues.

The research questions guiding this study were: 1) How does a four-year public university student health center implement full-spectrum contraceptive services for their student population? 2) What are the factors influencing the provision of full-spectrum contraceptive care in a four-year, public, comprehensive university student health-center? 3) In what ways, if any, do student demographics influence the provision of contraception in the student health center?

The four major interrelated themes constructed from the data included: 1) Essentialization of Students and the Influence on Operationalization of Student Health Services in Regard to Full-Spectrum Contraceptive Care, 2) Fear and Discomfort as Drivers of Decisions Regarding Full-Spectrum Contraceptive Care 3) Organizational Structure and Power Dynamics and their impact on Institutional Culture which Influences the Implementation of Full-Spectrum Contraceptive Care and 4) External Drivers of Decision Making in Regard to Full-Spectrum Contraceptive Care in a Student Health Center. These findings are discussed, as are implications for policy, practice, and future research.

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