PRL-IHPS: Focus on Reproductive Health

Reproductive Health Amid COVID-19
Cynthia Harper, PhD and Jennifer Yarger, PhD are conducting a randomized trial among community college students to test a contraceptive access intervention in California as compared to Texas, with their colleagues from the University of Texas at Austin. They have several COVID-19 hotspots as study sites, including the Rio Grande Valley, and are collecting data on the impact of social determinants of health, including food and housing insecurity, on access to health care among these young people ages 18-25. 

Cynthia Harper is also conducting national surveys, with colleagues Alison Comfort, PhD and Lavanya Rao, MPH on challenges faced by reproductive health care providers throughout the country on delivering contraceptive care during the COVID-19 pandemic.
Her team is addressing practice gaps identified in these surveys through the development of new content for the curriculum in their training program for contraceptive providers to increase their capacity to deliver high-quality contraceptive care during the COVID-19 pandemic and beyond. The training program, Beyond the Pill, has delivered their UCSF CME-accredited courses nationally to over 8,000 health care providers serving more than 4 million patients each year. The impact of the COVID-19 pandemic on the mental health of outpatient reproductive health providers was published this month in Reproductive Health. Evaluations of training impact in primary care settings were recently published in Preventive Medicine and in School-based Health Centers in the Journal of Adolescent and Pediatric Gynecology.

Marissa Raymond-Flesch, MD, MPH is also looking at the impact of COVID-19 on reproductive health, focusing on how to provide reproductive health care to teens via telehealth, recently published in the Journal of Adolescent Health.

Valerie Flaherman, MD, MPH, is a principal investigator of UCSF’s PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY), a nationwide study of pregnant or recently pregnant people who are either under investigation for, or have been confirmed to have COVID-19.  Focusing on the needs and experiences of low-income and women of color, Monica McLemore, RN, PhD, FAAN as part of the Reproductive Health Equity and Birth Justice Core of the PRIORITY study, has deployed the Research Priorities of Affected Communities (RPAC) in regions of the U.S. differentially impacted by COVID-19, to determine the healthcare, research, and policy questions and priorities that are important to Black, Indigenous and People of Color (BIPOC) communities that can be examined using PRIORITY data, and possibly launch future studies. Dr. McLemore and her team have partnered with 7 organizations throughout the months of March through to December 2021 to have RPAC sessions to gauge research prioritization questions. 

CA Adolescent Sexual and Reproductive Health Program Evaluations 
Mara Decker, DrPH, evaluates and provides quality technical assistance and training to a wide range of reproductive health programs:

  • Adolescent Sexual Health Education Programs, the California Personal Responsibility Education Program (CA PREP) and the Information and Education Program (I&E) which support local agencies to provide comprehensive sexual health and life skills education to young people.  
  • Adolescent Family Life Program (AFLP), an evidence-informed program model that provides expectant and parenting adolescents with comprehensive, strengths-based case management services to enhance protective factors and promote resilience.   
  • In the Know, an innovative new initiative in Fresno County, which combines existing, in-person, group-based, comprehensive sexual health education with wraparound digital technologies. 
  • Promoting Optimal Health for Rural Youth, guided by a systems-thinking approach, this program combines the replication of an evidence-based sexual health education curriculum (Positive Prevention Plus) in local school districts in rural Fresno County with additional leverage points in the community to ensure the greatest impact on adolescent health.  
  • Aiming to reduce health disparities in contraceptive knowledge, access, unintended pregnancies among sexually active Latina adolescents. Health-E/Salud iTu is an interactive, individually tailored, patient-centered, contraceptive decision support tool available in English and Spanish. It is designed to be used in conjunction with clinical encounter to provide sexual health and contraceptive education, support the contraceptive decision-making process and increase access to patient-centered contraceptive services. Based on user input, the app provides individually tailored contraceptive recommendations asks youth what method(s) they are most interested in. This information is then shared with the provider prior to the face-to-face portion of the visit. In this way, the app prepares youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. This intervention is being evaluated using a cluster randomized control trial (CRCT) in 18 school-based health centers throughout Los Angeles County, California.  

Reproductive Justice

Mara Decker leads a US/Mexico binational qualitative study that aims to capture the voices and perspectives of pregnant and parenting adolescents living in Guanajuato, Mexico and Fresno, California. Through focus groups and interviews with adolescents as well as interviews with adult providers, this project explores experiences with and perspectives of prenatal and postnatal care, access to contraception, and migration. 

Marissa Raymond-Flesch is conducting a study that builds on the Salinas Teen Health Study, a prospective cohort study of 600 Latino adolescents over two years as they transition from early to middle adolescence in a Californian agricultural community (Salinas, CA). Latinas have disparately high rates of pregnancy compared to all other racial and ethnic groups of adolescents, with rates highest in California among rural populations, despite falling rates of teen pregnancy nationally. Factors such as emotional health and immigrant generation likely impact engagement in the high risk sexual and reproductive health behaviors that give rise to high rates of teen pregnancy, sexually transmitted infections, and other poor health outcomes for these youth. In her current study, Dr. Raymond-Flesch uses quantitative and qualitative methods, including questionnaires and interviews with youth and mothers, to prospectively investigate the individual, family, and structural factors that either promote positive youth development or place youth at risk for high risk sexual and reproductive health outcomes such as pregnancy and sexually transmitted infections.

Monica McLemore is the Co-Director of the ACTIONS program. The Abortion Care Training Incubator for Outstanding Nurse Scholars (ACTIONS) program is an innovative fellowship that seeks to connect, mentor, and support scholars looking to pursue a PhD or postdoctoral studies at the School of Nursing (SON), University of California San Francisco (UCSF). The program provides funding for pre- and post-doctoral scholars to design studies that prioritize reproductive justice as the primary approach to reproductive health services provision, including abortion, birth, contraception, healthy sexuality, parenting and pleasure.

Global Reproductive Health
The overarching aim of Jenny Liu, PhD, MPP, MA is to improve the delivery and utilization of reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) services in low-income countries by conducting programmatic and policy-relevant research. 
Currently, Dr. Liu is working on a number of projects based in Africa.  She is the principal investigator of a study that will design and pilot-test an intervention to improve access to contraceptives and HIV self-testing kits for adolescent girls in Tanzania via a loyalty program specially designed for adolescent girls to be delivered by drug shops. The “Queen Club” program was developed using human-centered design methods and incorporate strategies from behavioral economics. The project aims to increase access to contraception and HIV testing among adolescent girls as a means to reduce the dual threats of unintended and early pregnancy (among the highest in Tanzanian adolescent girls) and HIV transmission.  

Dr. Liu is also the principal investigator of a 4-country study (Nigeria, Kenya, Uganda, Malawi) to assess the market introduction and scale-up of subcutaneous DMPA (depot medroxyprogesterone acetate, an injectable form of birth control) and optimize service delivery for informed choice across different channels (e-commerce, drug shops, women’s groups, community health workers).

Increasing access to sexual and reproductive health services among adolescent girls is also the primary aim of Dr. Liu’s SKILLZ intervention and evaluation in Zambia. This project aims to use the innovative appeal of soccer to deliver a life skills-building curriculum linked directly to community-based distribution of sexual and reproductive health commodities (including HIV self-test kits and subcutaneous DMPA) to empower girls’ self-determination and goal attainment.

Mara Decker, DrPH



Valerie Flaherman, MD, MPH





Cynthia Harper, PhD






Jenny Liu, PhD, MPP, MA






Monica McLemore, RN, PhD, FAAN






Marissa Raymond-Flesch, MD, MPH