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Research & Policy

Improving access to contraception and care

Our research aims to improve access to contraception while reducing coercion and provider bias through patient-centered approaches to care. Additionally, we investigate financial, educational, and medical barriers that hinder access, especially among underserved populations, including adolescents and young adults. Our studies evaluate approaches to expand access to contraception, including evidence-based counseling, provision of care in varied practice settings, and elimination of unnecessary medical exams and visit requirements.

Featured Research: Public funding improves access to birth control

According to our 2016 study published in the American Journal of Public Health, public funding reduces the high upfront costs of some methods, which is critical to increase access to birth control, especially for low-income and uninsured patients who wish to use these methods. 

Infographic: Women at clinics with a Medicaid family planning program were twice as likely to actually get an IUD or implant, compared to women at clinics without a program.

 
As part of the effort to expand access, we have evaluated the provision of contraception in a range of practice settings, including family planning clinics, pharmacies, primary care, school-based clinics, and abortion providers. We have conducted studies on over-the-counter and direct pharmacy access to emergency contraception, advance provision of emergency contraception, same-day provision of long-acting reversible contraception, and post-abortion access to contraception.

We have studied health care providers’ contraceptive education and counseling practices to assess the extent to which they are evidence-based and to identify the need for training on contraceptive eligibility and indications.

Our research has also focused on streamlining access to reproductive health care and reducing unnecessary medical tests, including removing the pelvic exam requirement for hormonal contraception. The pelvic examination can present an obstacle for patients seeking to prevent pregnancy, especially for adolescents. While the dissemination of new clinical practices can be a lengthy process, our research has helped to move reproductive health care in the direction of greater clinic efficiency and improved patient health outcomes.

Selected Publications

  • Access to contraception during the COVID-19 pandemic
  • Over-the-counter, direct pharmacy, advance and same day access to contraception
  • Post-abortion access to contraception
  • Health education & counseling
  • Streamlining testing and exam requirements in reproductive health care

Access to contraception via telemedicine during the COVID-19 pandemic

  1. Comfort, AB, Alvarez A, Goodman S, Upadhyay U, Mengesha B, Karlin J, Shokat M, Blum M, Harper CC. Provision of DMPA-SC for self-administration in different practice settings during the COVID-19 pandemic: Data from providers across the United States, Contraception, 2023.
  2. Rao L, Comfort AB, Dojiri S, Goodman S, Yarger J, Shah N, Folse C, Blum M, Hankin J, Harper CC. Telehealth for Contraceptive Services During the COVID-19 Pandemic: Provider Perspectives. Women's Health Issues, 2022.
  3. Comfort AB, Rao L, Goodman S, Raine-Bennett T, Barney A, Mengesha B, Harper CC. Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States. Reprod Health 19(1): 99, 2022.

Over-the-counter, direct pharmacy, advance and same day access to contraception

  1. Rafie S, Kelly S, Gray EK, Wong M, Gibbs S, Harper CC. Provider opinions regarding expanding access to hormonal contraception in pharmacies. Contraception 26(2):153-160, 2016.
  2. Biggs A, Harper CC, Brindis C. California Family Planning Health Care Providers' Challenges to Same-Day Long-Acting Reversible Contraception Provision. Obstetrics & Gynecology 126(2):338-45, 2015.
  3. Thompson KMJ, Raine TR, Foster DG, Speidel JJ, Darney PD, Brindis CD, Harper CC. Access to levonorgestrel emergency contraception: Science v. federal politics. Women’s Health 9:139-43, 2013.
  4. Rafie S, Haycock M, Rafie S, Yen S, Harper CC. Direct pharmacy access to hormonal contraception: California physician and advanced practice clinician views. Contraception 86:687-93, 2012.
  5. Harper CC, Weiss DC, Speidel JJ, Raine-Bennett T. Over the counter access to emergency contraception for teens. Contraception 77:230-233, 2008.
  6. Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC, Grimes DA. Advance provision of emergency contraception for pregnancy prevention: a meta analysis. Obstetrics & Gynecology 110:1379-88, 2007.
  7. Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC, Grimes DA. Advance provision of emergency contraception for pregnancy prevention (full review). Cochrane Database of Systematic Reviews, 2007.
  8. El-Ibiary SY, Raine T, McIntosh J, Darney PD, Harper CC. Pharmacy access to emergency contraception: the perspective of pharmacists at a chain pharmacy in San Francisco, California. Journal of the American Pharmacists Association 47:702-710, 2007.
  9. Raine TR, Harper CC, Rocca CH, Fisher R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: A randomized, controlled trial. JAMA 293:54-62, 2005.

Post-abortion access to contraception

  1. Rocca CH, Goodman S, Grossman DJ, Cadwallader K, Thompson KM, Talmont E, Speidel JJ, Harper CC. Contraception after medication abortion in the United States: results from a cluster randomized trial. American Journal of Obstetrics and Gynecology 218(1):107e.1-8, 2018.
  2. Rocca CH, Thompson KM, Goodman S, Westhoff CL, Harper CC. Funding policies and postabortion long-acting reversible contraception: results from a cluster randomized trial. American Journal of Obstetrics and Gynecology 214(6):716.e1-8, 2016.
  3. Morse J, Freedman L, Speidel JJ, Thompson KMJ, Stratton L, Harper CC. Post-abortion contraception: Qualitative interviews on counseling and provision of long-acting reversible contraceptive methods. Perspectives on Sexual and Reproductive Health 44:100-106, 2012.
  4. Thompson KMJ, Speidel JJ, Saporta V, Waxman NJ, Harper CC. Contraceptive policies affect post-abortion provision of long-acting reversible contraception. Contraception 83:41-47, 2011.
  5. Goodman S, Hendlish SK, Benedict C, Reeves MF, Pera-Floyd M, Foster-Rosales A. Increasing intrauterine contraception use by reducing barriers to post-abortal and interval insertion. Contraception 78(2):136-42, 2008.
  6. Goodman S, Hednlish SK, Reeves, MF, Foster-Rosales, A. Impact of immediate postabortal insertion of intrauterine contraception on repeat abortion. Contraception 78(2):143-8, 2008.

Health education & counseling

  1. Gibbs SE, Rocca CH, Bednarek P, Thompson KM, Darney PD, Harper CC. Long-acting reversible contraception counseling and use for older adolescents and nulliparous women. Journal of Adolescent Health 59(6):703-709, 2016.
  2. Thompson KMJ, Stern L, Gelt M, Speidel JJ, Harper CC. Counseling for IUDs & implants: Are health educators & clinicians on the same page? Perspectives on Sexual and Reproductive Health 45:191-195, 2013.
  3. Harper CC, Stratton L, Raine TR, Thompson K, Henderson JT, Blum M, Postlethwaite D, Speidel JJ. Counseling and provision of long-acting reversible contraception in the US: National survey of nurse practitioners. Preventive Medicine 57:883-8, 2013. 
  4. Harper CC, Henderson JT, Schalet A, Becker D, Stratton L, Raine TR. Abstinence and teens: Prevention counseling practices of health care providers serving high-risk patients in the United States. Perspectives on Sexual and Reproductive Health 42:125-132, 2010. 
  5. Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B. Preventing excessive weight gain in pregnancy: How do prenatal care providers approach counseling? Journal of Women's Health 19:807-814, 2010.
  6. Raine T, Marcel AV, Rocca CH, Harper CC. The other half of the equation: Serving young males within a young women’s reproductive health clinic. Perspectives on Sexual and Reproductive Health 35(5):208-214, 2003.

Streamlining testing and exam requirements in reproductive health care

  1. Hsu A, Henderson JT, Harper CC, Sawaya GF. Obstetrician–gynecologist practices and beliefs regarding external genitalia inspection and speculum examinations in healthy older asymptomatic women. Journal of the American Geriatrics Society 64(2): 293-8, 2016.
  2. Schneider A, Henderson JT, Harper CC, Hsu A, Saraiya M, Sawaya GF. Obstetrician-gynecologists' beliefs about performing less cervical cancer screening: the pendulum swings. American Journal of Obstetrics & Gynecology pii: S0002-9378(15)00719-X, 2015.
  3. Henderson, JT, Yu JM, Harper CC, Sawaya GF. U.S. clinicians' perspectives on less frequent routine gynecologic examinations. Preventive Medicine 62;49-53, 2014.
  4. Yu JM, Henderson JT, Harper CC, Sawaya GF. Obstetrician-gynecologists' beliefs on the importance of pelvic examinations in assessing hormonal contraception eligibility. Contraception 90(6):612-4, 2014.
  5. Henderson JT, Saraiya M, Martinez G, Harper CC, Sawaya G. Changes to cervical cancer prevention guidelines: Effects on screening among U.S. women ages 15-29. Preventive Medicine 56:25-9, 2013.
  6. Henderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya G. Routine bimanual pelvic examinations: Practices and beliefs of US obstetrician-gynecologists. American Journal of Obstetrics & Gynecology 208:709e1-7, 2013.
  7. Henderson JT, Sawaya GF, Blum M, Stratton L, Harper CC. Pelvic examinations and access to oral hormonal contraception: Results from a national survey. Obstetrics & Gynecology 116:1257-64, 2010.
  8. Stewart FH, Harper CC, Ellertson CE, Grimes DA, Sawaya GF, Trussell J. Clinical Breast and Pelvic Examination Requirements for Hormonal Contraception: Current Practice vs Evidence . JAMA 285(17):2232-2239, 2001.
  9. Harper C, Balistreri E, Boggess J, Leon K, Darney P. Provision of hormonal contraception without a mandatory pelvic exam: “First Stop,” a California demonstration project. Family Planning Perspectives 33(1):13-18, 2001.
  10. Sawaya GF, Harper C, Balistreri E, Boggess J, Darney P. Cervical neoplasia risk in women provided hormonal contraception without a Pap smear. Contraception 63(2):57-60, 2001.