Background - In Ivory Coast, little is known about health needs and health access barriers among young people. The aim of this study was to describe health provision, health needs and barriers when seeking medical care, with an emphasis on sexual and reproductive health, and the acceptability of a medical examination for students attending their first year at the Houphouët-Boigny University, Abidjan, Ivory Coast. Methods - We conducted a representative cross-sectional study among second year students who were selected by two-stage equiprobable random sampling. In-depth interviews were conducted among students and the university health center staff. Results - Five hundred and forty three students (322 men and 221 women) answered a questionnaire (participation rate 98.4%). Among women who ever had sex, 38.4% (95%CI [30.5%-47.0%]) had unmet contraception needs and 31.2% [23.7%-40.0%] had experienced an unwanted pregnancy. Fear about impaired fertility was the leading reason for non-use of hormonal contraception, the method of choice among most students. The main health problems among students, by order of frequency were malaria (54.3%), respiratory infection (44.6%), constipation (28.0%) and psychological problems (25.9%). High cost perception of services offered, despite their gratuity, were the main barriers against access to the university health center, indicating a lack of communication about this structure and its services. The majority of students favored the establishment of a medical examination during the first year at the university. Conclusion - Establishing a medical examination would improve health center visibility. The following services could be offered: (i) HIV, chlamydia and gonorrhea screening, (ii) hepatitis B virus screening and vaccination, (iii) provision and information about contraceptive methods, (iv) presentation of the university health center services. Dedicated spaces where students could have access to information about health-related topics (e.g. sexuality, nutrition, depression) could complete the university's healthcare offer.