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Research & Policy

Translating Evidence to Practice & Policy

We conduct translational research to bring evidence to the forefront of clinical practice and policy change. Our research, which has ranged from large randomized trials and pharmacokinetic evaluation to in-depth interviews and policy analysis, has helped to transform contraceptive practice and policy in the US and globally, especially for long-acting reversible contraception and emergency contraception.

Our research on IUDs and implants has focused on enhanced service delivery for patients seeking for contraceptive care. We conducted a series of studies, including in-depth interviews and national probability surveys with contraceptive providers, to identify gaps in evidence-based care and to inform the development of a clinic-based intervention to improve contraceptive education and counseling. We developed an intervention increase clinics' capacity to offer the full range of contraceptive methods. We tested our intervention with Planned Parenthood Federation of America in a cluster randomized trial at 40 community clinics, where we recruited and followed 1,500 women for one year to measure contraceptive and pregnancy outcomes. Results from the trial were a breakthrough, as it was the first successful intervention in a randomized trial to reduce unintended pregnancy among family planning patients. After study completion, we commenced an implementation and dissemination phase with our replicable intervention, and continued to deliver our training to clinics throughout the US to help improve provider skills and contraceptive care nationwide. Learn more about our research and training on contraceptive care and access.

Our research on emergency contraception includes pharmacokinetics, a large randomized controlled trial of increased access for adolescents and young adults, and an actual use study with young adolescents. Data from several of our studies were reviewed by the FDA over many years, concurrent with scientific and policy debates over the impact of direct access through pharmacies to the time-sensitive medication. Results showed improved access to emergency contraception and increased use when needed, but did not increase risk behaviors or STIs among teens, as feared by many decision-makers. Evidence from our studies informed significant changes at the policy level, with levonorgestrel emergency contraception ultimately becoming available over-the-counter, with no age restrictions. The research has led to clinical practice and policy changes globally, with emergency contraception now available in pharmacies in most countries.

Selected Publications

  • Long-acting reversible contraception
  • Emergency contraception
  • Policy analysis

Long-acting reversible contraception

  1. Thompson KM, Rocca CH, Stern L. Morfesis J, Goodman S, Steinauer J, Harper, CC. Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial. American Journal of Obstetrics and Gynecology, 218(6), 2018.
  2. Biggs MA, Kaller, S, Harper CC, Freedman L, Mays AR. "Birth control can easily take a back seat": Challenges providing IUDs in community health care settings. Journal of health care for the poor and underserved, 29(1), 228-244, 2018.
  3. El Ayadi AM, Rocca CH, Kohn JE, Velazquez D, Blum M, Newmann SJ, Harper CC. The impact of an IUD and implant intervention on dual method use among young women: Results from a cluster randomized trial. Preventive Medicine 94:1-6, 2017.
  4. Thompson KM, Rocca CH, Kohn JE, Goodman S, Stern L, Blum M, Speidel JJ, Darney, PD, Harper CC. Public funding for contraception, provider training, and use of highly effective contraceptives: A cluster randomized trial. American Journal of Public Health 106(3):541-546, 2016.
  5. Rocca CH, Thompson KM, Goodman S, Westhoff CL, Harper CC. Funding policies and post-abortion long-acting reversible contraception: Results from a cluster randomized trial. American Journal of Obstetrics & Gynecology, 2016.
  6. Harper CC, Rocca CH, Thompson KM, Morfesis J, Darney PD, Westhoff CL, Speidel JJ. Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial. Lancet 386: 562–568, 2015.
  7. Biggs A, Malvin J, Harper CC, Brindis C. Factors influencing the provision of long-acting reversible contraception in California. Obstetrics & Gynecology 123:593-601, 2014.
  8. 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. 
  9. Harper CC, Henderson JT, Raine TR, Goodman S, Darney PD, Thompson KM, Dehlendorf C , Speidel JJ. Evidence-based IUD practice: family physicians and obstetrician-gynecologists. Family Medicine 44:637-45, 2012.
  10. Speidel JJ, Harper CC, Shields W. The potential of long-acting reversible contraception to decrease unintended pregnancy. (Editorial) Contraception 78:197-200, 2008.
  11. Harper CC, Blum M, Thiel de Bocanegra H, Darney PD, Speidel JJ, Policar M, Drey E. Challenges in translating evidence to practice: the provision of intrauterine contraception. Obstetrics & Gynecology 111:1359-1369, 2008.
  12. 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. 
  13. 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.

Emergency contraception

  1. Harper CC, Speidel JJ, Drey EA, Trussell J, Blum M, Darney PD. Copper intrauterine device for emergency contraception: Clinical practice among contraceptive providers. Obstetrics & Gynecology 119:220-6, 2012.
  2. Belden P, Harper CC, Speidel JJ. The copper IUD for emergency contraception, a neglected option. Contraception 85:338-339, 2012.
  3. Raine TR, Ricciotti N, Sokoloff A, Brown BA, Hummel A, Harper CC. An over-the-counter simulation study of a single tablet emergency contraceptive in young females. Obstetrics & Gynecology 119:1-8, 2012
  4. Harper CC, Weiss DC, Speidel JJ, Raine-Bennett T. Over the counter access to emergency contraception for teens. Contraception 77:230-233, 2008.
  5. Sambol N, Harper CC, Kim L, Liu CY, Darney P, Raine TR. Pharmacokinetics of single-dose levonorgestrel in adolescents. Contraception 74:104-109, 2006.
  6. Harper CC, Cheong M, Rocca CH, Darney PD, Raine TR. The effect of increased access to emergency contraception among young adolescents. Obstetrics & Gynecology 106:483-491, 2005.
  7. Harper CC, Rocca CH, Darney PD, von Hertzen H, Raine TR. The tolerability of levonorgestrel emergency contraception in adolescents. American Journal of Obstetrics and Gynecology 191:1158-63, 2004.

Policy analysis

  1. Speidel JJ, Rocca CH, Thompson KM, Harper CC. Pregnancy: Not a disease, but still a health risk. Contraception 88(4):481-4, 2013.
  2. Speidel JJ, Thompson KMJ, Harper CC. Family planning: Much progress but still far to go. Solutions 4:54-61, 2013.
  3. 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.