Contraception & Reproductive Autonomy

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.

The importance of metrics assessing reproductive autonomy and interventions supporting 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.

A woman sitting in a doctor's office having a conversation with her healthcare provider

Featured Research

Contraceptive Agency Scale (CAS), a new psychometric scale to measure agency in contraceptive care

Contraceptive agency means the ability to decide about birth control without undue influence, judgment or coercion from healthcare providers. Our research, published in the Journal of General Internal Medicine, demonstrates a new psychometrically robust scale measure of patient contraceptive agency during a clinic visit, the Contraceptive Agency Scale (CAS).

We asked participants recruited from nine clinic sites how they would rate how they would rate their agreement with statements like “My provider helped me choose a birth control method that could work for me” and “My provider wanted to make my birth control decisions for me.” This scale can be used to evaluate patient agency in both clinical care and research to ensure autonomy is preserved. This is the first rigorously tested scale to assess coercion in contraceptive care, as well as patient agency.

Contraceptive care delivery needs to better meet the needs and preferences of all patients. These findings indicate that it’s important to prioritize each patient’s voice and preferences in their care plan. Reproductive autonomy and agency over birth control have been frequently neglected, especially among patients of color. The Contraceptive Agency Scale adds an important dimension by focusing on whether a patient feels pressure about using birth control in general, or a specific method, and whether they are making their own decisions.

If you would like to use the CAS scale in your research or practice, or if you have any questions, please send us an email.

Read the research

Selected Publications

  1. Zia Y, Somerson E, Folse C, Alvarez A, Albergate Davis K, Comfort AB, Brown K, Brandi K, Moayedi G, Harper CC. “I am putting my fear on them subconsciously”: a qualitative study of contraceptive care in the context of abortion bans in the U.S. Reprod Health, 21(1):171, 2024.
  2. 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.  
  3. 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.  
  4. 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. 
  5. 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 
  6. 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.
  7. 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. 
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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. 
  13. 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.
  14. Raine-Bennett TR, Rocca CH. Development of a brief questionnaire to assess contraceptive intent. Patient Education and Counseling 98(11):1425-30, 2015.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.

Subscribe to our newsletter

Stay up to date on upcoming trainings, clinic tools, educational materials, research publications, and more from Beyond the Pill. Choose the updates you'd like to receive and unsubscribe at any time.

Subscribe

Start typing and press enter to search

Scroll to Top