University students' access and use of sexual and reproductive health services in Australia.

The majority of Australian university students surveyed had never spoken to a health professional about sexual and reproductive health (SRH) issues.

• 59% (2934 of 4291 students) had never spoken to a health professional about SRH issues.
• Only 41% (1357 students) had accessed SRH services or spoken to a health professional about SRH.
• The sample was a convenience sample drawn from five universities across Australia.
• Data were collected via an online survey.

Female and non-binary/gender diverse students were significantly more likely to have spoken to a health professional about SRH than male students.

• Descriptive statistics were used to analyse variations by gender, sexuality, and enrolment status.
• Female students were significantly more likely than male-identifying students to have accessed SRH services.
• Non-binary/gender diverse students were also significantly more likely to have spoken to a health professional about SRH compared to male students.
• Statistical significance was noted in comparisons by gender category.

Australian-born students were significantly more likely to have accessed SRH services than international students or overseas-born domestic students.

• International students faced specific access barriers to SRH services.
• Overseas-born domestic students also faced specific access barriers distinct from Australian-born students.
• Enrolment status (domestic vs. international) was one of the key variables examined in the analysis.
• These disparities were identified through descriptive statistics analysing variations by enrolment status.

Heterosexual students were significantly more likely to have spoken to a health professional about SRH compared to students identifying as LGBTQIA+.

• LGBTQIA+ students faced specific access barriers to SRH services.
• Sexuality was one of the key demographic variables analysed using descriptive statistics.
• The finding indicates that sexual minority students experience greater barriers to SRH service access.
• LGBTQIA+ students were identified as a group requiring targeted support in recommendations.

The most frequently reported barriers to accessing SRH services were feeling embarrassed, fear of being judged, and not knowing where to go.

• These barriers were identified through content analyses of responses to two open-ended questions.
• Three primary barriers were: 'feeling embarrassed', 'being judged', and 'not knowing where to go'.
• These barriers were reported across the broader student sample, not limited to specific subgroups.
• The findings informed recommendations for universities to provide 'supportive, non-judgemental, and inclusive SRH promotion and health services'.

University attendance is associated with changes in sexual behaviour that increase risk of negative sexual and reproductive health experiences.

• This contextual finding was noted as motivation for the study.
• Relatively few studies had previously explored access to and use of SRH services by university students in Australia.
• The study involved students from five universities completing an online survey (N = 4291).
• This finding frames the public health relevance of university-based SRH service access.

The authors recommend that universities provide supportive, non-judgemental, and inclusive SRH promotion and health services to address identified barriers.

• Recommendations were directed at targeting 'student-identified barriers to access'.
• Services should cater to the needs of 'diverse student cohorts', specifically including LGBTQIA+ students and international/overseas-born students.
• Universities were called upon to support student wellbeing through inclusive SRH service design.
• The recommendations were derived from both quantitative findings and qualitative content analysis of open-ended responses.