Moving Beyond Unintended Pregnancy

Principal Investigator: Dr. Anu Manchikanti Gomez

Funding by: Society for Family Planning Research Fund

Summary and findings: There is longstanding recognition of the limitations of current approaches to conceptualizing and measuring pregnancy intentions. Foundationally, the concept of planning a pregnancy may not be relevant to many women, including women of color, poor women, and young women – the groups considered at greatest risk of unintended pregnancy. Our qualitative research has revealed that a significant proportion of young women who do not desire pregnancy currently or in the next year would find a pregnancy acceptable in that timeframe. These results indicate solely focusing on pregnancy wantedness and timing may neglect women’s expectations about how a pregnancy would impact their lives. Together, the concepts of pregnancy desire and acceptability foreground nuance and complexity overlooked in current pregnancy intention measurement approaches. 

     This study aims to advance the measurement of unintended pregnancy by using a nationally representative survey to investigate prospective pregnancy desires and acceptability. Specifically, we will: (1) establish the national prevalence of pregnancy desire, pregnancy acceptability, and the intersection of the two constructs; (2) estimate the prevalence of pregnancy desires and acceptability for Black, Latina and white women; and (3) investigate the role of structural factors in explaining racial and ethnic differences in pregnancy desires and acceptability. 

Reframing LARCs

Principal Investigators and Research Partners: Liza Fuentes, DrPH (Guttmacher Institute), Anu Manchikanti Gomez, PhD (University of California, Berkeley), and Lisa Stern, MA, MSN (Planned Parenthood Northern California)

Funding by: Society for Family Planning Research Fund

Summary and findings: Removing barriers to use of long-active reversible contraception (LARC) has been lauded as an important strategy for reducing unintended pregnancy, yet there has been little attention to women’s experiences of LARC’s “reversibility,” a perceived advantage of LARC over sterilization and a key feature of the life cycle of LARC use. The scant research examining LARC removal indicates that women may face multilevel barriers to removal of IUDs and implants and that the perception that removal may be difficult is enough to dissuade some women from considering LARC. This study aims to fill an important gap in the literature on LARC removal as a foundation to inform clinical recommendations that enhance reproductive autonomy.

     Using mixed methods and a patient-centered approach, this project will describe LARC users’ experiences and perceptions regarding device removal; elucidate facility-, payor-, and provider-related factors that facilitate or hinder a desired LARC removal; and identify LARC removal preferences. The study employs the transtheoretical model stages of behavior change to highlight dynamic decision-making processes and identify salient barriers and facilitators at various stages of the LARC removal process. Survey and qualitative interviews will be conducted in four states with a purposive sample of current and former LARC users (ages 15-44) who are in distinct stages of behavior change with regard to LARC removal. 

Program Evaluation of San Francisco’s Community Doula Initiative for Black and Pacific Islander Women


Collaborators: Cassondra Marshall, DrPH, UCB; Andrea Jackson, MD, UCSF; Alli Cuentos, SisterWeb; Marna Armstead, SisterWeb 
Funding: UCSF Preterm Birth Initiative

Summary: Doula care, or the support of a trained professional during, before, and/or after birth, consistently shows positive impacts for women not only in terms of their birthing experience but also in birth outcomes. The study evaluates the impact of the San Francisco Department of Public Health’s initiative to provide community doula care to pregnant Black and Pacific Islander women through SisterWeb Community Doula Network. The program provides doula care before, during, and after birth, including prenatal visits, labor and delivery support, and postpartum visits, to eligible women delivering at San Francisco hospitals.


Through process and outcome evaluations of this initiative, we aim to determine the impact of community doula care on a range of clinical outcomes and patient-reported outcomes, including engagement with prenatal and postpartum care, satisfaction with childbirth, and experience of respectful care. We use mixed methods and a range of data sources—program data, surveys, and in-depth interviews—to achieve this aim. The process evaluation began in April 2019 and is ongoing.

Collaborators: Cassondra Marshall, DrPH, UCB (PI); Marna Armstead, SisterWeb; Starr Britt, Roots of Labor Birth Collective; Monica McLemore, PhD, UCSF; Sayidah Peprah, Frontline Doulas
Funding: Patient-Centered Research Outcomes Institute

Summary: Research on the impact of community doulas is limited; community doulas provide comprehensive services at low or no cost to underserved communities, are often members of the communities they serve, and share cultures and languages with their clients. The project team will create a collaborative of stakeholders in California that will facilitate equitable, ethical, and patient-centered outcomes research (PCOR) on community doula care. Our objective is to establish a collaborative of California stakeholders to develop a research agenda for community doula care as an intervention to advance maternal and infant health equity. The long-term objective is to inform patient-centered, equity-focused, community-informed research on the impact of community doula care.


Harnessing the Potential of Pharmacists as Family Planning Providers in Rural California

Collaborators: Sally Rafie, PharmD, UCSD; Erin Garner-Ford, MA, ACT for Women & Girls

Funding by: Robert Wood Johnson Foundation

Summary: Rural communities in the Central Valley of California experience sexual and reproductive health inequities, with higher adolescent birth rates than urban and suburban areas, declines in access to formal sex education, and inadequate access to healthcare, including contraceptive care. Pharmacies are an important source of healthcare in rural America, particularly as pharmacists’ scope of practice is expanded to prescribing medication, chronic disease management, and preventive health services. In California, trained pharmacists can now prescribe hormonal contraception directly to patients of any age. Our 2017 research found that only 11% of California pharmacies offered this service, with similarly low levels of availability in chain and independent pharmacies. While research indicates that pharmacist-prescribed contraception is acceptable and of interest to potential contraceptive users and pharmacists, pharmacy students, and other healthcare providers, media reports suggest that perceptions of low demand for this service undergird lack of implementation.


This mixed-methods study aims to examine: (1) the implementation of pharmacist-prescribed contraception; (2) community members' knowledge and interest in this service; (3) pharmacists’ views on facilitators, barriers to implementing this service and decision-making processes regarding implementation; and (4) key stakeholders’ perspectives on implementation. In summer 2019, we held a community researcher summer program in Visalia, where ACT for Women & Girls is located. Through this training, community members from Tulare County learned about and participated in the research process to develop a survey of community members’ interest in pharmacist-prescribed contraception.