Publications > Contraceptive research and services

Increasing capacity at school-based health centers to offer adolescents counseling and access to comprehensive contraceptive services

Results show that Beyond the Pill's provider training is an effective approach that can be scaled and replicated across school-based health centers to enable adolescents to have access to the full range of contraceptive methods

  • Comfort AB, Rao L, Goodman S, Barney A, Glymph A, Schroeder R, McCulloch C, Harper C. Journal of Pediatric and Adolescent Gynecology. July 2020.

Women's preferences for contraceptive counseling in Mexico: results from a focus group study

This research investigates women’s preferences in Mexico to inform efforts to improve the quality of family planning services. Several key themes emerged from their focus groups.

  • Holt K, Zavala I, Quintero X, Mendoza D, McCormick MC, Dehlendorf C, Lieberman E, Langer A. Reproductive Health. July 2018.

Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial

The study shows significant changes in providers’ attitudes, knowledge and practices in the group that received a 4-hour continuing education course that shared updated evidence on IUDs and implants and hands-on training on IUD insertion and contraceptive counseling.

  • Thompson KMJ, Rocca CH, Stern L, Morfesis J, Goodman S, Steinauer J, Harper CC. AJOG. June 2018.

The intrauterine device as emergency contraception: how much do young women know?

This research shows that very few young women had heard of using the IUD as a form of emergency contraception.

  • Goodman SR, El Ayadi AM, Rocca CH, Kohn JE, Benedict CE, Dieseldorff JR, Harper CC. Contraception. April 2018. 

"Birth control can easily take a back seat": Challenges providing IUDs in community health care settings 

This paper shows that significant barriers exist to community health centers providing intrauterine devices (IUDs).

  • Biggs MA, Kaller S, Harper CC, Freedman L, Mays AR. Journal of Health Care for the Poor and Underserved. February 2018.

Role of insurance coverage in contraceptive use after abortion

This research shows that even in a state where Medicaid covers abortion and birth control for low-income women, some still face cost-related barriers.

  • Biggs MA, Taylor D, Upadhyay UD. Obstetrics and Gynecology. December 2017.

Providing family planning services at primary care organizations after the exclusion of Planned Parenthood from publicly funded programs in Texas: Early qualitative evidence

This research shows that providing family planning care to patients without the participation of established women’s health organizations presents serious challenges.

  • White K, Hopkins K, Grossman D, Potter JE. Health Services Research. October 2017.

Quality and content of patient-provider communication about contraception: differences by race/ethnicity and socioeconomic status

This study used audio recordings of visits, as well as patient surveys, to analyze both their quality and content. The vast majority satisfied with “how their provider helped them choose a contraceptive method.” At the same time, the analysis also revealed several areas in which providers can improve communication.

  • Dehlendorf C, Anderson N, Vittinghoff E, Grumbach K, Levy K, Steinauer J. Women's Health Issues. September 2017.

Contraception after delivery among publicly insured women in Texas: use compared with preference

The study found that, among 1,700 publicly insured postpartum women in Texas, only about half of those who preferred a long-acting method were actually using one six months after delivery. The “use gap” was roughly the same for women who preferred sterilization.

  • Potter JE, Coleman-Minahan K, White K, Powers DA, Dillaway C, Stevenson AJ, Hopkins K, Grossman D. Obstetrics and Gynecology. August 2017. 

Interest in self-administration of subcutaneous depot medroxyprogesterone acetate in the United States

More than in one in five women reported interest in using a self-administered birth control shot, which could improve contraceptive continuation by removing the difficulty of having to return to a clinic for repeat injections.

  • Upadhyay UD, Zlidar VM, Foster DG. Contraception. June 2016.

Public funding for contraception, provider training, and use of highly effective contraceptives: A cluster randomized trial

Public funding expands young women’s access to birth control, especially for methods with high up-front costs like intrauterine devices and implants.

  • Thompson KM, Rocca CH, Kohn JE, Goodman S, Stern L, Blum M, Speidel JJ, Darney PD, Harper CC. American Journal of Public Health. January 2016.

Association of the quality of interpersonal care during family planning counseling with contraceptive use

Patients who received compassionate care from health care providers were more likely to keep using their chosen birth control method.

  • Dehlendorf C, Henderson JT, Vittinghoff E, Grumbach K, Levy K, Schmittdiel J, Lee J, Schillinger D, Steinauer J. American Journal of Obstetric Gynecology. January 2016.

Perspectives among a diverse sample of women on the possibility of obtaining oral contraceptives over the counter: A qualitative study

In focus group discussions with African-American women, Asian-American women and young women, researchers found that a broad range of women support over-the-counter access to the pill. Benefits of particular interest were the convenience and privacy of getting the pill OTC. Concerns included cost and the worry that first-time and young users may not have enough information to use the pill properly.

  • Baum S, Burns B, Davis L, Yeung M, Scott C, Grindlay K, Grossman D. Women's Health Issues. October 2015.

Reduced pregnancy in the US from long-acting reversible contraception: a cluster randomized trial

The rate of unintended pregnancy can be reduced by training providers to routinely include long-acting reversible methods in their contraceptive counseling.

  • Harper CC, Rocca CH, Thompson KM, Morfesis J, Darney PD, Westhoff CL, Speidel JJ. The Lancet. August 2015.

Population and climate change: who will the grand convergence leave behind?

On the basis of the model of the Lancet Commission, we suggest that a group of experts from the Sahel and research institutions elsewhere in the world should be convened to explore and document the cross-sectoral, scalable initiatives needed to avoid the Sahel (and other least developed regions) being totally excluded from the promise of improved health and welfare foreseen in the Lancet Commission.

  • Campbell M, Casterline J, Castillo F, Graves A, Hall T, May JF, Periman D, Speidel JJ, Walsh J, Wehner MF, Msiyaphazi Zulu E. The Lancet Global Health. May 2014.

Interpregnancy intervals: impact of postpartum contraceptive effectiveness and coverage

To achieve optimal birth spacing and ultimately to improve birth outcomes, attention should be given to contraceptive counseling and access to contraceptive methods in the postpartum period.

  • de Bocanegra HT, Chang R, Howell M, Darney P. American Journal of Obstetrics & Gynecology. April 2014.

Counseling and provision of long-acting reversible contraception in the US: National survey of nurse practitioners

Nurse practitioners have an increasingly important position in addressing high unintended pregnancy in the US, but require specific training in long-acting reversible contraceptives.

  • Harper CC, Stratton L, Raine TR, Thompson K, Henderson JT, Blum M, Postlethwaite D, Speidel JJ. Preventive Medicine. December 2013.

Routine bimanual pelvic examinations: Practices and beliefs of US obstetrician-gynecologists

Obstetrician-gynecologists perform bimanual pelvic examinations in the vast majority of asymptomatic women, but the importance placed on the examinations and reasons for conducting them vary.

  • Henderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya G. American Journal of Obstetrics & Gynecology. November 2013.

A nationally-representative survey of health care provider counseling and provision of the female condom in South Africa and Zimbabwe

Female condoms were integrated into provider counseling and care, although providers reported a need for new female-initiated multipurpose prevention technologies, suggesting female condoms do not meet all patient/provider needs or are not adequately well known or accessible.

  • Holt K, Blanchard K, Chipato T, Nhemachena T, Blum M, Stratton L, Morar N, Ramjee G, Harper CC. BMJ Open. March 2013.

Long-acting reversible contraception method use among Title X providers and non-Title X providers in California

On-site utilization of LARC is a potential quality indicator for family planning programs. Title X resources are associated with increased use of LARC.

  • Park HY, Rodriguez MI, Hulett D, Darney PD, Thiel de Bocanegra H. Contraception. November 2012.

Direct pharmacy access to hormonal contraception: California physician and advanced practice clinician views

Overall, providers viewed increased access to hormonal contraception as an important public health service and supported pharmacy access. They thought that pharmacy access can be accomplished through pharmacist education and training.

  • Rafie S, Haycock M, Rafie S, Yen S, Harper CC. Contraception. June 2012.

Contraceptive features preferred by women at high risk of unintended pregnancy

The contraceptive features women want are largely absent from currently available methods. Developing and promoting methods that are more aligned with women’s preferences presumably could help increase satisfaction and thereby encourage consistent and effective use.

  • Lessard LN, Karasek D, Ma S, Darney P, Deardorff J, Lahiff M, Grossman D, Foster DG. Perspectives on Sexual and Reproductive Health. September 2012.

Efficacy, safety, and tolerability of a monophasic oral contraceptive containing nomegestrol acetate and 17β-estradiol: a randomized controlled trial

Nomegestrol acetate and 17[beta]-E2 were well tolerated and provided excellent contraceptive efficacy and acceptable cycle control.

  • Westhoff C, Kaunitz AM, Korver T, Sommer W, Bahamondes L, Darney P, Verhoeven C. Obstetrics & Gynecology. May 2012.

Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers

Recommendation of the copper intrauterine device (IUD) for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method.

  • Harper C, Speidel J, Drey E, Trussel J, Blum M, Darney P. Obstetrics & Gynecology. February 2012.

Race, ethnicity and differences in contraception among low-income women: methods received by Family PACT clients, California, 2001-2007

The reduction in racial and ethnic disparities following introduction of the patch suggests that methods with novel characteristics may increase acceptability of contraceptives among minority women.

  • Dehlendorf C, Foster DG, de Bocanegra HT, Brindis C, Bradsberry M, Darney P. Perspectives on Sexual and Reproductive Health. September 2011.

Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies

Making oral contraceptives more accessible may reduce the incidence of unintended pregnancy and abortion. Health insurance programs and public health programs may avert costly unintended pregnancies by increasing dispensing limits on oral contraceptives to a 1-year supply.

  • Foster DG, Hulett D, Bradsberry M, Darney P, Policar M. Obstetrics & Gynecology. March 2011.

Vaginal ring contraception

Combined hormonal contraception is a popular and effective method of preventing pregnancy. The EE/ENG ring offers improvements over OCs with respect to compliance, cycle control and systemic side effects without compromising contraceptive efficacy.

  • Kerns J, Darney PD. Contraception. February 2011.

One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives

The patch and the ring may not be better options than the pill or depot medroxyprogesterone acetate for women at high risk for unintended pregnancy. This study highlights the need for counseling interventions to improve contraceptive continuation, education about longer-acting methods, and developing new contraceptives that women may be more likely to continue.

  • Raine TR, Foster-Rosales A, Upadhyay UD, Boyer CB, Brown BA, Sokoloff A, Harper CC. Obstetrics & Gynecology. February 2011.

Pelvic examinations and access to oral hormonal contraception: Results from a national survey

One third of clinicians we surveyed require pelvic examinations before provision of oral contraceptives, despite guidelines indicating they are unnecessary and research suggesting they can pose a barrier to contraceptive access.

  • Henderson JT, Sawaya GF, Blum M, Stratton L, Harper CC. Obstetrics & Gynecology. December 2010.

Cost savings from the provision of specific methods of contraception in a publicly funded program

All contraceptive methods were cost-effective – they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods.

  • Foster DG, Rostovtseva DP, Brindis CD, Biggs MA, Hulett D, Darney PD. American Journal of Public Health. March 2009.

The levonorgestrel intrauterine system in nulliparous women

The levonorgestrel intrauterine system (LNG-IUS) is both safe and extremely efficacious for use in nulliparous women.

  • Prager S, Darney PD. Contraception. June 2007.

Number of oral contraceptive pill packages dispensed, method continuation, and costs

Dispensing a year's supply of oral contraceptive pill cycles to women is associated with higher method continuation and lower costs than dispensing fewer cycles per visit.

  • Foster DG, Parvataneni R, Thiel de Bocanegra H, Lewis C, Bradsberry M, Darney P. Obstetrics & Gynecology. November 2006.

Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial

While removing the requirement to go through pharmacists or clinics to obtain EC increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to EC to clinics.

  • Raine TR, Harper CC, Rocca, CH, Fischer R, Padian N, Klausner JD, Darney PD. JAMA. January 2005.

Expanded state-funded family planning services: estimating pregnancies averted by the Family PACT program in California, 1997-1998

Providing contraceptives to low income, medically indigent women significantly reduced the number of unintended pregnancies in California.

  • Foster, DG, Klaisle, CM, Blum, M, Bradsberry, M, Brindis, CD, Stewart, F. Research and Practice. August 2004.

Provision of hormonal contraceptives without a mandatory pelvic examination: the First Stop Demonstration Project

Programs that provide hormonal contraceptives without requiring a pelvic examination can expand low-income women’s access to these methods and improve the chances that they will obtain other reproductive health services.

  • Harper C, Balestreri L, Boggess J, Leon K, Darney PD. Family Planning Perspectives. January 2001.