Supporting contraceptive access and equity in adolescents and young adults

Young people across the United States face critical barriers to contraceptive care. We conduct research among youth populations to better understand these barriers, as well as youth preferences, beliefs, and awareness of different methods. We test educational interventions that improve youth access to sexual health information and support greater reproductive autonomy for young people. We directly counteract scientific misinformation on contraception with youth-friendly visual resources that describe available methods and how to access them. Additionally, as young people face a worsening mental health crisis, we investigate the relationship between sexual and reproductive health and mental health.

Featured Research: Young people don’t know about their emergency contraception options, but that can change

Our 2023 study, published in the Journal of Adolescent Health, found that timely educational interventions can improve young people's knowledge of their emergency contraceptive (EC) options.

Researchers held a low-cost, 10-minute education session using youth-friendly visuals (Fig. 1) explaining the different EC options.

Chart displaying information about different emergency contraception options

Fig 1. Chart presenting the different EC methods, with access information for each method, the time limit for use, effectiveness, and other factors. The chart was developed with Bedsider and piloted among youth and health educators.

The young people in the study showed significant increases in knowledge of different EC methods, and of critically important facts like how time sensitive it is, effectiveness, and need for a prescription (Fig. 2).

Chart showing Increased knowledge of emergency contraception from educational intervention

Fig 2. Increased knowledge of emergency contraception from educational intervention.

Our ongoing REACH Youth Study studies reproductive health and gender equity among community college students in Texas and California. 

We consult and collaborate with youth and youth advocates to improve our research through our Youth and Community Advisory Boards. 

Our research informs clinical practice and policy and supports increased access to quality contraceptive care for young people, especially in restricted environments.  

Recent publications

  1. Harper, C. C., Yarger, J., Mangurian, C., Hopkins, K., Rossetto, I., Elmes, S., Hecht, H. K., Sanchez, A., Hernandez, R., Shokat, M., & Steinberg, J. R. Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults. Journal of Women’s Health, 2024.
  2. Rocca CH, Muñoz I, Rao L, Levin S, Tzvieli O, Harper CC. 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. Yarger, J., Gutmann-Gonzalez, A., Borgen, N., Romero, J., & Decker, M. J. In the Know: A Cluster Randomized Trial of an In-person Sexual Health Education Program Integrating Digital Technologies for Adolescents. Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine., 74(5), 1019–1025, 2024.
  5. Yarger, J., Hopkins, K., Elmes, S., Rossetto, I., Van Liefde, D., De La Melena, S., & Harper, C. C. Use of telemedicine to obtain contraception among young adults: Inequities by health insurance. Contraception, 134, 2024.
  6. Harper, C. C., Jones, E., Brindis, C. D., Watson, A., Schroeder, R., Boyer, C. B., Edelman, A., Trieu, S., & Yarger, J. Educational Intervention Among Adolescents and Young Adults on Emergency Contraception Options. Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine., 72(6), 993–996, 2023.
  7. 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.
  8. Yarger, J., Hopkins, K., Rossetto, I., Trieu, S., & Harper, C. Awareness and use of state family planning programs among community college students: missed opportunities to support contraceptive access. Contraception, 127, 2023.
  9. Yarger, J., Van Liefde, D., Quirarte, A., Elmes, S., Dojiri, S. S., Jackson, A. V., & Harper, C. C. “I Didn’t Know Before that You Can Get Birth Control this Way”: Developing a Tool to Teach Young People About Telehealth for Contraception.Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine., 70(4), S47–S48, 2022.
  10. Yarger, J., Elmes, S., Rossetto, I., Hopkins, K., Van Liefde, D., Marquez, L., & Harper, C. Use of direct-to-consumer telemedicine companies for contraception among young adults. Contraception, 116, 2022.
  11. Harper, C., Elmes, S., Yarger, J., Brandi, K., Hopkins, K., Rossetto, I., White, K., Van Liefde, D., Marquez, L., & Upadhyay, U. Medication abortion via telemedicine: Interest among young people in Texas and California. Contraception, 116, 2022.
  12. Yarger, J., Hopkins, K., Elmes, S., Rossetto, I., De La Melena, S., McCulloch, C. E., White, K., & Harper, C. C. Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity. Journal of General Internal Medicine, 38(2), 302–308, 2023.
  13. Yarger, J., Schroeder, R., Blum, M., Cabral, M. A., Brindis, C. D., Perelli, B., & Harper, C. C. Concerns About the Cost of Contraception Among Young Women Attending Community College. Women’s Health Issues, 31(5), 420–425, 2021.
  14. Comfort, A. B., Rao, L., Goodman, S., Barney, A., Glymph, A., Schroeder, R., McCulloch, C., & Harper, C. C. Improving Capacity at School-based Health Centers to Offer Adolescents Counseling and Access to Comprehensive Contraceptive Services.Journal of Pediatric and Adolescent Gynecology, 34(1), 26–32, 2021.
  15. 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.

Earlier publications

  1. Cabral, M. A., Schroeder, R., Armstrong, E. M., El Ayadi, A. M., Gürel, A. L., Chang, J., & Harper, C. C. Pregnancy Intentions, Contraceptive Knowledge And Educational Aspirations Among Community College Students. Perspectives on Sexual and Reproductive Health, 50(4), 181–188, 2018.
  2. Goodman, S. R., El Ayadi, A. M., Rocca, C. H., Kohn, J. E., Benedict, C. E., Dieseldorff, J. R., & Harper, C. C. The intrauterine device as emergency contraception: how much do young women know?Contraception, 98(2), 115–119, 2018.
  3. 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. 
  4. 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.
  5. 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. 
  6. 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. 
  7. 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.
  8. 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. 
  9. 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. 
  10. 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. 
  11. Harper CC, Weiss DC, Speidel JJ, Raine-Bennett T. Over the counter access to emergency contraception for teens.Contraception 77:230-233, 2008.
  12. Sambol N, Harper CC, Kim L, Liu CY, Darney P, Raine TR. Pharmacokinetics of single-dose levonorgestrel in adolescents.Contraception 74:104-109, 2006.
  13. 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.
  14. 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.
  15. 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.