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Research

Supporting reproductive autonomy in contraceptive decision-making

We study the connections between contraceptive access and reproductive autonomy. We ask how and why people make decisions about contraception and whether their preferences are met. Our research in this area informs public policy, counseling practice, and programmatic efforts to promote contraceptive awareness, access, reproductive autonomy, and health equity. 

We employ survey research, psychometric scale development and testing, longitudinal observational studies, randomized trials, focus groups, in-depth interviews, and policy analysis, to identify gaps in knowledge and to better understand patient preferences and the factors that influence contraceptive decision-making, including the role of health care providers, partners, and social support. Understanding these complex issues is essential to the development of effective programs and policies to advance health equity and improve public health outcomes. 

Featured Research: Understanding young people's concern that contraception affects their future fertility

Recent research published in Contraception (2023) showed that among sexually active female community college students, most students feared contraception’s impact on fertility, and this fear was associated with not using contraception. The authors noted that disparities in this concern may be tied to discrimination, reproductive coercion, and limited reproductive health care access. The study highlights the importance of addressing concerns about contraception affecting future fertility to person-centered contraceptive counseling.

Graph showing contraceptive method use by concern that contraception affects future fertility among community college students assigned female at birth in California and Texas

Fig. 1. Contraceptive method use by concern that contraception affects future fertility among community college students assigned female at birth in California and Texas (N = 2060). The horizontal bar graph displays participants’ main contraceptive method (%) by concern that contraception affects future fertility (yes or no). IUD = intrauterine device.

 

The importance of metrics assessing reproductive autonomy and interventions to support and increase contraceptive agency is highlighted in our work below, which has expanded beyond prior research on contraceptive use. In an effort to uphold the principles of reproductive autonomy and acknowledge each person’s right to determine whether or not they use contraception, our research has shifted to measuring contraceptive agency and preferences. 

Selected Publications

  1. Rocca, C. H., Muñoz, I., Rao, L., Levin, S., Tzvieli, O., & Harper, C. C. Measuring a Critical Component of Contraceptive Decision Making: The Contraceptive Concerns and Beliefs Scale. Maternal and Child Health Journal, 28(5): 847–857, 2024.  

  2. Harper, C. C., Hopkins, K., Yarger, J., Hecht, H., Brandi, K., Perez, A. T., Muñoz, I., Rodriguez, M., Wong, I., & Rocca, C. H. Reproductive Autonomy: Supporting Contraceptive Agency for Young People in the Clinic Visit. Journal of Adolescent Health, 74(3), 2024.  

  3. Watson, A., Yarger, J., Sedlander, E., Urbina, J., Hopkins, K., Rodriguez, M. I., Fuentes, L., & Harper, C. C. Concern that contraception affects future fertility: How common is this concern among young people and does it stop them from using contraception? Contraception, 2023. 

  4. Hopkins, K., Yarger, J., Rossetto, I., Sanchez, A., Brown, E., Elmes, S., Mantaro, T., White, K., Harper, C.C., Baig, K. Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage. PLOS ONE, 18(8), 2023 

  5. Harper CC, Rao, L, Muñoz I, Stern L, Kerns JL, Parra M, Chambers BD, Rocca CH. Agency in Contraceptive Decision-Making in Patient Care: a Psychometric Measure. J Gen Intern Med, 2023.
  6. Rao, L., Rocca, C. H., Muñoz, I., Chambers, B. D., Devaskar, S., Asiodu, I. V., Stern, L., Blum, M., Comfort, A. B., & Harper, C. C. “She should support me, she’s my doctor:” Patient perceptions of agency in contraceptive decision‐making in the clinical encounter in Northern California. Perspectives on Sexual and Reproductive Health, 55(2): 94–103, 2023. 
  7. Kaller, S., Mays, A., Freedman, L., Harper, C. C., & Biggs, M. A. Exploring young women’s reasons for adopting intrauterine or oral emergency contraception in the United States: a qualitative study. BMC Women’s Health, 20(1), 2020.
  8. Steinberg JR, Adler NE, Thompson KM, Westhoff C, Harper CC. Current and past depressive symptoms and contraceptive effectiveness level method selected among women seeking reproductive health services. Soc Sci Med; 214:20-25, 2018.
  9. Cabral MA, Schroeder R, Armstrong EM, El Ayadi AM, Gürel AL, Chang J, & Harper CC. Pregnancy intentions, contraceptive knowledge and educational aspirations among community college students. Perspectives on Sexual and Reproductive Health, 2018.
  10. Goodman SR, El Ayadi AM, Rocca CH, Kohn JE, Benedict CE, Dieseldorff JR, Harper CC. The intrauterine device as emergency contraception: how much do young women know? Contraception, 2018.
  11. Jones EA, Schroeder R, Tebb KP, Boyer CB, Harper, CC. Young adult male knowledge of emergency contraception. Journal of Adolescent Health, 62(2), p.S61, 2018. 
  12. Steinberg JR, Tschann JM, Furgerson D, Harper CC. Psychosocial factors and pre-abortion psychological health: The significance of stigma. Social Science & Medicine 150:67-75, 2016.
  13. Raine-Bennett TR, Rocca CH. Development of a brief questionnaire to assess contraceptive intent. Patient Education and Counseling 98(11):1425-30, 2015.
  14. Steinauer J, Upadhyay U, Sokoloff A, Harper CC, Diedrich JT, Drey EA. Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion. Contraception 9(6):553-559, 2015.
  15. Craig A, Dehlendorf C, Borrero S, Harper CC, Rocca CH. Exploring young adults' contraceptive knowledge and attitudes: Disparities by race/ethnicity and age. Women's Health Issues 24(3):281-9, 2014.
  16. Rocca CH, Harper CC, Raine TR. Young women’s perceived benefits of childbearing: association with subsequent contraceptive use and pregnancy. Perspectives on Sexual and Reproductive Health 45:23–32, 2013.
  17. Steinberg JR, Tschann JM, Henderson JT, Drey EA, Steinauer JE, Harper CC. Psychological distress and post-abortion contraceptive method effectiveness level chosen at an urban clinic. Contraception 88(6):717-24, 2013.
  18. Rocca CH, Harper CC. Do racial and ethnic differences in contraceptive attitudes and knowledge explain disparities in method use? Perspectives on Sexual and Reproductive Health 44:150-158, 2012.
  19. Harper CC, Brown BA, Foster-Rosales A, Raine TR. Hormonal contraceptive method choice among young, low-income women: How important is the provider? Patient Education and Counseling 81:349-354, 2010.
  20. Raine TR, Gard J, Boyer CB, Haider S, Brown BA, Hernandez FAH, Harper CC. Contraceptive decision-making in sexual relationships: Young men’s experiences, attitudes and values. Culture, Health and Sexuality 12:373-386, 2010.
  21. Raine, TR, Epstein LB, Harper CC, Brown BA, Boyer CB. Attitudes towards the vaginal ring and transdermal patch among adolescents and young women. Journal of Adolescent Health 45:262-267, 2009.
  22. Stewart FH, Brown BA, Raine TR, Weitz TA, Harper CC. Adolescent and young women’s experience with the vaginal ring and oral contraceptive pills. Journal of Pediatric and Adolescent Gynecology 20:345-351, 2007.
  23. Foster DG, Ralph L, Arons A, Brindis C, Harper CC. Trends in knowledge of emergency contraception among women in California, 1999-2004. Women’s Health Issues 17:22-28, 2007.