No Student Left Behind: Supporting Access to Sexual and Reproductive Health Resources for LGBTQIA+ Community College Students

This brief was done in partnership with IWPR’s Connect for Success initiative and innovation Research & Training (iRT).

Key Findings

• Many young adult community college students identity as LGBTQIA+.
• LGBTQIA+ community college students need accessible, affirming resources to support their sexual and reproductive health. Like their cisgender, heterosexual peers, many do not consistently engage in sexual and reproductive health-promoting behaviors, highlighting an opportunity for more inclusive support systems. LGBTQIA+ community college students report that their previous school-based sexual health education was not relevant, inclusive, preparative, or empowering, and that they are concerned about a lack of sexual and reproductive health resources at their community college.
• LGBTQIA+ community college students believe their college should be responsible for providing sexual health counseling (e.g., discussing contraception options with a medical provider) and service referrals (e.g., referral to off-campus health centers for STI testing), as well as sexual health education for all incoming students.

Introduction

Sexual and reproductive health are linked to undergraduate students’ overall health and well-being. As defined by the World Health Organization, sexual health requires “a positive and respectful approach to sexuality and sexual relationships” in addition to the absence of health problems (e.g., sexually transmitted infections, or STIs, and unplanned pregnancy).¹ Sexual health is also linked to educational and vocational success.² For example, some young people who leave school prior to graduation cite unplanned pregnancy as a primary reason for dropping out. Thus, providing students with the resources to achieve their sexual and reproductive health goals can also position them to successfully matriculate through higher education. Community college students make up nearly half of the undergraduate student population in the US, yet compared to their peers at four-year universities, they are less likely to have access to comprehensive sexual and reproductive health resources.³

In the US, about one-quarter of people ages 18–29 identify as LGBTQIA+.⁴ LGBTQIA+ youth, including adolescents and young adults, experience unique barriers to positive sexual and reproductive health outcomes. For example, LGBTQIA+ youth often report that the sexual health information they receive from parents and schools is heteronormative, irrelevant, and/or not inclusive of their identities and experiences.⁵ Also, LGBTQIA+ youth are more at risk of facing barriers in the process of seeking sexual health care. This has been demonstrated in research showing a high prevalence of health care discrimination and problems accessing health care among LGBTQIA+ youth.⁶ In addition, research has highlighted a lack of training in the area of LGBTQIA+ health among medical students and residents/fellows, and greater discomfort among this group with addressing the sexual health issues of LGBTQIA+ patients compared to all patients.⁷

Despite these disparities, there is a lack of recent research on this group’s experiences and needs. This brief addresses this gap and illuminates the experiences and needs of LGBTQIA+ students at community colleges by examining the sexual health outcomes, previous sexual health education experiences, and current concerns of this highly understudied group. This brief also reports new findings on the types of related resources that LGBTQIA+ students believe their community college should be responsible for providing. Taken together, community colleges have an opportunity to close gaps in education and care in order to better serve LGBTQIA+ students and strengthen sexual and reproductive health for all students.

Many community college students identify as LGBTQIA+.

A national study was conducted from 2021 to 2024 that enrolled 1,647 18–19-year-old students from 34 community college campuses across the US, called the Community College Health Study (CCHS).⁸ Participants completed surveys multiple times over the course of one year. Among the CCHS sample, 37 percent of students identified as part of a sexual minority and/or gender minority group. With respect to sexual orientation, 16 percent of participants were bisexual, 5 percent were pansexual, and 4 percent were gay/lesbian. With respect to gender identity, 8 percent of participants were transgender. See Figures 1a, 1b, and 1c for additional statistics on the sexual orientation and gender identity of participants in the CCHS.

Sexual and reproductive health of LGBTQIA+ students attending community college.

Analyses from the CCHS show that among 18–19-year-old sexual minority and gender minority students attending community college, 64 percent have had sex (defined as oral, anal, or vaginal sex). This is similar to the percent of students who have had sex in the larger CCHS sample, which includes heterosexual and cisgender youth as well as sexual and gender minority youth.⁹

Given the persistent barriers that LGBTQIA+ youth experience, it is perhaps unsurprising that many sexually active sexual and gender minority community college students are not consistently using protection (e.g., condoms; see Figure 2) and many have not been tested for STIs (Figure 3). Notably, only around 60 percent of sexual and gender minority students used any contraceptive method the last time they had vaginal sex. Just 51 percent of sexual minority students and 58 percent of gender minority students used a condom at last anal sex. And just 10 percent of sexual minority students and 14 percent of gender minority students used protection at last oral sex.

Similar patterns of inconsistent engagement in protective behaviors were noted in analyses of the larger CCHS sample (i.e., including heterosexual and cisgender students).¹⁰ Students who fail to consistently engage in protective sexual health behaviors (e.g., condom/contraception use) are at risk of poor sexual and reproductive health outcomes, including unplanned pregnancy and STIs.

Efforts are needed to promote healthy sexual behaviors and prevent sexual risk-taking for all students at community colleges, including LGBTQIA+ students. High-quality, relevant sexual health education can decrease engagement in sexual behaviors that can lead to unplanned pregnancy and the spread of STIs/HIV—e.g., unprotected sex—and increase engagement in healthy behaviors that promote linkage to health care as well as relationship satisfaction and sexual well-being, e.g., communication, STI testing.¹¹

Prior sexual health education experiences of LGBTQIA+ students attending community college.

Best practices for providing sexual health education highlight the importance of ensuring that programming is relevant to the lives of LGBTQIA+ youth and inclusive of their identities and lived experiences.¹² Sixty-three percent of sexual minority and gender minority students in the CCHS sample reported having received school-based sexual health education since the 9th grade. The extent to which they found this sexual health education to be relevant, inclusive, preparative, and empowering is shown in Figure 4.

Data from the CCHS show that upon reflecting on the school-based sexual health education they have received since the 9th grade, many LGBTQIA+ community college students do not find their previous sexual health education to have been very relevant, inclusive, preparative, and empowering. This aligns with previous research¹³ showing how LGBTQIA+ students are at a disadvantage when it comes to the relevance and utility of their sexual health education. Many of these students will begin community college and engage in sexual activity without the proper knowledge and skills for healthy sexual decision making.

LGBTQIA+ students are concerned about the lack of sexual and reproductive health resources at their community college.

• Among sexual minority students, 84 percent are concerned about a lack of resources for pregnancy prevention at their school, 86 percent are concerned about a lack of resources for preventing STIs, and 86 percent are concerned about a lack of testing for STIs at their school.
• Among gender minority students, 88 percent are concerned about a lack of resources for pregnancy prevention at their school, 88 percent are concerned about a lack of resources for preventing STIs, and 85 percent are concerned about a lack of testing for STIs at their school.

Taken together, LGBTQIA+ students at community colleges need sexual and reproductive health resources. However, many LGBTQIA+ students are not receiving adequate education to prevent sexual and reproductive health problems, and they have concerns with the lack of sexual and reproductive health care and resources at their college. Community college students make up nearly half of the undergraduate population, and many identify as part of a sexual or gender minority group. Thus, community colleges have an opportunity to close this resource gap and provide LGBTQIA+ students with the education and care they need and deserve.

Resources at community colleges: The perspective of LGBTQIA+ students.

Data from the CCHS show that the vast majority of sexual and gender minority students attending community college believe their college should be responsible for providing sexual health counseling and service referrals as well as sexual health education for incoming students (Figure 5). While sexual health education may include general in-person (e.g., classroom-based) or online instruction on a range of sexual, reproductive, and relationship health topics, sexual health counseling often refers to one-on-one sessions with a counselor or clinician in which the topic is tailored to a specific student’s needs. If this counseling is provided by a medical health care professional, they may also be able to conduct additional sexual health services, if needed (e.g., STI testing, provision of contraception). Relatedly, if comprehensive sexual health services are not available on campus, a college may provide sexual health service referrals where students can seek the care they need off campus.

Policy Recommendations

• Establish policies that increase public investment in promoting the sexual and reproductive health of community college students. Federal and state policymakers should establish policies that encourage colleges to implement sexual and reproductive health education and provide smooth linkage to sexual and reproductive health care—either through on-campus clinics or referrals to vetted, accessible off-campus resources. Relatedly, staff that are providing counseling and referrals should be trained to provide care that is inclusive and affirming of LGBTQIA+ students so as not to perpetuate the lack of inclusivity and relevance that characterizes many LGBTQIA+ students’ previous sexual health resources.
• Mandate inclusive and affirming instruction on sexual health topics. Federal and state policymakers should implement policies that require and fund sexual health education in college that meets evidence-informed standards for best practices in the provision of sexual health education, including the standard that this education be inclusive and affirming of LGBTQIA+ youth. Unfortunately, only eight states and Washington, DC, require inclusive instruction in high school on sexual orientation and gender.¹⁴ Community colleges have an opportunity to close this gap for students who have not yet received high-quality sexual health education and provide continuing education that is developmentally appropriate for young adults, regardless of whether students received adequate sex education in high school. However, advocates on community college campuses highlight that securing internal funding for this education is a very common barrier;¹⁵ thus, wide-reaching policies that provide dedicated funding for high-quality sexual health education are likely to have a tremendous impact.

Conclusion

All young people deserve access to high-quality sexual and reproductive health resources. As a critical component of students’ well-being, sexual and reproductive health is linked to students’ educational and vocational success.¹⁶ Unfortunately, many LGBTQIA+ community college students experience barriers to accessing critical sexual and reproductive health resources, including relevant and inclusive sexual health education, resources for pregnancy and STI prevention, and STI testing. LGBTQIA+ community college students believe their colleges should be responsible for providing sexual health education, counseling, and service referrals. Thus, community college leadership and system-level administrators have an opportunity to address LGBTQIA+ students’ concerns as well as promote their educational and vocational success by taking steps to meet their sexual and reproductive health resource needs.

A note about terminology.

This brief is about the experiences and needs of community college students identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual, aromantic, and/or as a part of another sexual and/or gender minority (LGBTQIA+) group.

• We use the term sexual minority to refer to individuals who identify their sexual orientation as lesbian, gay, bisexual, queer, asexual, and/or another sexual orientation other than heterosexual.
• We use the term gender minority to refer to individuals who identify as transgender, nonbinary, and/or another gender identity that is not cisgender.
• LGBTQIA+ is an acronym inclusive of sexual and gender minority individuals.

Survey questions completed by students in this study used the terminology “LGBTQ.” For the sake of clarity, the term LGBTQIA+ is used throughout this brief.

This brief was prepared by Dr. Martinique Free (IWPR) and Dr. Reina Evans-Paulson, Dr. Christina V. Dodson, and Dr. Tracy M. Scull (innovation Research & Training, Durham, NC). It was made possible with support from the William and Flora Hewlett Foundation. Funding for the Community College Health Study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH) under award number R01HD099134 and award number R56HD113725-01A1 to Dr. Tracy M. Scull. Research reported in this brief is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors would also like to thank Jesseca Boyer for her feedback on previous drafts and Miranda Peterson for fact-checking.