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Research

Promoting access to contraception, safe abortion, and new technologies globally

Our research contributes to science, clinical practices, and policy globally in low-resource settings where maternal mortality is high. Our global work focuses on access to contraception, safe abortion, and the integration of new prevention technologies into clinical practice.

We have worked closely with the Center for Research on Environment Health and Population Activities (CREHPA), a leading research organization in Nepal, to document improvements to women’s health over the past decade in Nepal. Our research showed a decline in the severity of abortion complications at hospitals following abortion legalization in 2004. Other studies have demonstrated ongoing barriers to safe abortion and contraceptive care, including widespread use of unsafe medications and attitudinal and structural barriers.

Featured Research: Effects of Abortion Legalization in Nepal, 2001–2010

Our 2013 research, published in PLOS ONE, showed that the liberalization of abortion policy in Nepal benefited women’s health overall and likely contributed to falling maternal mortality in the country, especially after the expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion.

Chart showing the effects of abortion legalization on the number of abortion cases with serious complications in Nepal 2001-2010

Figure 1. Trend in the percentage of abortion cases with serious complications presenting at four tertiary care hospitals in Nepal, 2001–2010.

2002 - Passage of legal abortion legislation

2004 - First trimester services and trainings begin

2007 - Second trimester services and trainings begin

2008 - Midlevel providers trained and legally provide first trimester abortion

2009 - Medication abortion added to safe abortion program.

 

Our research in Mexico has focused on providers' and potential users’ knowledge, perceptions, and experiences with abortion and contraceptive services.

In sub-Saharan Africa, we conducted an NIH-funded R01 to assess the integration of new contraceptive and HIV prevention technologies into clinical practices. Our results guide efforts to integrate novel prevention methods, including microbicides, male circumcision, and long-acting reversible contraceptives, into patient education, counseling, and service delivery.

Selected Publications

  1. Diamond-Smith N, Gopalakrishnan L, Leslie H, Katz E, Harper CC, Weiser S, Patil S. Life skills and reproductive health empowerment intervention for newly married women and their families to reduce unintended pregnancy in India: Protocol for the TARANG cluster randomized controlled trial. BMJ Open.14(4):e086778, 2024.

  2. El Ayadi AM, Nalubwama H, Painter C, Kakaire O, Miller S, Barageine J, Byamugisha J, Obare S, Korn A, Harper CC. Contraceptive Preferences and Adoption Following Female Genital Fistula Surgery in Uganda: A Mixed-Methods Study. Reproductive Health 20(1):121, 2023.

  3. Comfort AB, El Ayadi A, Tsai A, Comfort, Nalubwama H, Byamugisha J, Walker D, Moody J, Roberts T, Usenoga, Krezanoski P, Harper CC. The role of informational support from women’s social networks on antenatal care initiation: qualitative evidence from pregnant women in Uganda. BMC Pregnancy and Childbirth 22(1):708, 2023.

  4. Comfort AB, Harper CC, Tsai A, Moody J, Perkins JM, Ranjalahy Rasolofomana J, Alperin C, Noeliarivelo Ranjalahy A, Heriniaina R, Paul J. Krezanoski. Social and provider networks and women’s contraceptive use: Evidence from Madagascar. Contraception 104(2):147-154, 2021.

  5. Comfort AB, Harper CC, Tsai AC, Moody J, Perkins JM, Rasolofomana JR, Alperin C, Schultz M, Ranjalahy AN, Heriniania R, Krezanoski PJ. The association between men’s family planning networks and contraceptive use among their female partners: an egocentric network study in Madagascar. BMC Public Health 21(1):209, 2021.

  6. Diamond-Smith N, Plaza N, Puri M, Dahal M, Weiser S, Harper CC. Perceived conflicting desires to delay the first birth: a household-level exploration in Nepal. International Perspectives on Sexual and Reproductive Health, 46:125-133, 2020.

  7. Gitome SW, Kwena ZA, Harper CC, Cohen CR, Bukusi EA. Educating men about vaginal microbicides: considerations from Kenya. Culture, Health & Sexuality 22(6): 660-674, 2020.

  8. Puri MC, Harper CC, Maharjan D, Maya B, Rocca CH. Pharmacy access to medical abortion from trained providers and post-abortion contraception in Nepal. Int J Gynaecol Obstet, 2018.
  9. Averbach S, Puri M, Blum M, & Rocca C. Gestational dating using last menstrual period and bimanual exam for medication abortion in pharmacies and health centers in Nepal. Contraception, 2018. 
  10. Rocca CH, Puri M, Shrestha P, Blum M, Maharjan D, Grossman D, Regmi K, Darney PD, Harper CC. Effectiveness and safety of early medication abortion provided in pharmacies by auxiliary nurse-midwives: A non-inferiority study in Nepal. PloS One,13(1), 2018.
  11. Keesara S, Juma PA, Harper CC, Newmann SJ. Barriers to postpartum contraception: differences among women based on parity and future fertility desires. Culture, Health & Sexuality 14:1-5, 2017.
  12. Wang LF, Puri M, Rocca CH, Blum M, Henderson JT. Service provider perspectives on post-abortion contraception in Nepal. Culture, Health, & Sexuality 15:1-13, 2015. 
  13. Puri M, Henderson JT, Harper CC, Blum M, Joshi D, Rocca CH. Contraceptive discontinuation and pregnancy post-abortion in Nepal: a longitudinal cohort study. Contraception 91(4):301-7, 2015.
  14. Keesara S, Juma P, Harper CC. Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya. BMC Health Services Research 15:335, 2015.
  15. Blanchard K, Chipato T, Ramjee G, Nhemachena T, McCulloch C, Grossman D, Morar N, Padian NS, Newmann S, Harper CC. Clinicians' perceptions and provision of hormonal contraceptives for HIV positive and at-risk women in Southern Africa: an original research article. Contraception 90(4):391-8, 2014.
  16. Rocca CH, Puri M, Harper CC, Blum M, Dulal B, Henderson JT. Postabortion contraception a decade after abortion legalization. International Journal of Gynaecology and Obstetrics 126(2):170-4, 2014.
  17. Henderson J, Puri M, Blum M, Harper CC, Rana A, Gurung G, Pradhan N, Regmi K, Malla K, Sharma S, Grossman D, Bajracharya L, Satyal I, Acharya S, Lamichhane P, Darney P. Effects of abortion legalization in Nepal, 2001-2010. PLoS One 8(5), 2013.
  18. Rocca CH, Puri M, Dulal B, Bajracharya L, Harper CC, Blum M, Henderson JT. Unsafe abortion after legalization in Nepal: a cross-sectional study of women presenting to hospitals. BJOG: An International Journal of Obstetrics and Gynaecology 120:1075–1084, 2013.
  19. Becker D, Diaz-Olavarrieta C, Garcia SG, Harper CC. Women’s reports on postabortion family planning services provided by the public-sector in Mexico City. International Journal of Gynecology and Obstetrics 121:149-53, 2013.
  20. Morse J, Chipato T, Blanchard K, Nhemachena T, Ramjee G, McCulloch C, Blum M, Saleeby E, Harper CC. Provision of long-acting reversible contraception in HIV prevalent countries: Results from nationally representative surveys in Southern Africa. BJOG: An International Journal of Obstetrics and Gynaecology 120:1386-94, 2013.
  21. Holt K, Blanchard K, Chipato T, Nhemachena T, Blum M, Stratton L, Morar N, Ramjee G, Harper CC. A nationally-representative survey of health care provider counseling and provision of the female condom in South Africa and Zimbabwe. BMJ Open 3:3, 2013.
  22. Sheldon WR, Nhemachena T, Blanchard K, Chipato T, Ramjee G, Trussell J, McCulloch CE, Blum M, Harper CC. Male circumcision for HIV prevention: Clinical practices and attitudes among healthcare providers in South Africa and Zimbabwe. Sexually Transmitted Diseases 39:567-575, 2012.
  23. Harper CC, Holt K, Nhemachena T, Chipato T, Ramjee G, Stratton L, Blum M, McCulloch CE, Mgweba S, Blanchard K. Willingness of clinicians to integrate microbicides into HIV prevention practices in Southern Africa. AIDS and Behavior 16:1821-9, 2012.
  24. Puri M, Lamichhane P, Harken T, Blum M, Harper CC, Darney PD, Henderson JT. “Sometimes they used to whisper in our ears”: Health care workers’ perceptions of the effects of abortion legalization in Nepal. BMC Public Health 12:297, 2012.
  25. Lamichhane P, Harken T, Puri M, Darney PD, Blum M, Harper CC, Henderson JT. Sex-selective abortion in Nepal: A qualitative study of health workers’ perspectives. Women’s Health Issues 21:S37-41, 2011.
  26. Henderson JT, Raine T, Schalet A, Blum M, Harper CC. “I wouldn’t be this firm if I didn’t care”: Preventive clinical counseling for reproductive health. Patient Education Counseling 82:254-9, 2011.
  27. Becker D, Diaz-Olavarrieta C, Juarez C, Garcia SG, Sanhueza P, Harper CC. Clients’ perceptions of the quality of care in Mexico City’s public sector legal abortion program. International Perspectives on Sexual and Reproductive Health 37:191-201, 2011.
  28. Becker D, Diaz-Olavarrieta C, Juarez C, Garcia SG, Sanhueza P, Harper CC. Socio-demographic factors associated with obstacles to abortion care: Findings from a survey with abortion patients in Mexico City. Women’s Health Issues 21:S16-20, 2011.
  29. Callegari L, Harper CC, van der Straten A, Kamba M, Chipato T, Padian N. Consistent condom use in married Zimbabwean women after a condom intervention. Sexually Transmitted Diseases 35:624-630, 2008.
  30. Harper CC, Blanchard K, Grossman D, Henderson J, Darney PD. Reducing maternal mortality due to elective abortion: Potential impact of misoprostol in low-resource settings. International Journal of Gynecology and Obstetrics 98:66-69, 2007.
  31. Langer A, Harper C, Garcia-Barrios C, Schiavon R, Heimburger A, Elul B, Reynoso Delgado S, Ellertson C. Emergency contraception in Mexico City: What do health care providers and potential users know and think about it? Contraception 60:233-241,1999.