Corinne H Rocca

University of California, San Francisco | UCSF · Department of Obstetrics, Gynecology and Reproductive Sciences

Purpose Significant methodological shortcomings limit the validity of prior research on pregnancy decision-making and the effects of ‘unintended’ pregnancies on people’s health and well-being. The Attitudes and Decisions After Pregnancy Testing (ADAPT) study investigates the consequences for individuals unable to attain their pregnancy and childbea...

Introduction Concerns about safety and side effects from contraceptives are widespread and related to reluctance to use them. Measuring these concerns is an essential component of understanding contraceptive decision-making and guiding contraceptive and interpregnancy clinical care. Methods We used qualitative research and item response theory to...

Background A longstanding gap in the reproductive health field has been the availability of a screening instrument that can reliably predict a person’s likelihood of becoming pregnant. The Desire to Avoid Pregnancy Scale is a new measure; understanding its sensitivity and specificity as a screening tool for pregnancy as well as its predictive abili...

Introduction: Agency in contraceptive decision-making is an essential aspect of reproductive autonomy. We conducted qualitative research to investigate what agency means to patients seeking contraceptive care to inform the development of a validated measure of this construct. Methodology: We held four focus group discussions and seven interviews...

Men’s adherence to constraining male gender norms can lead them to resist contraceptive use. Very few interventions have attempted to transform masculine norms to encourage greater contraceptive acceptance and gender equality. We designed and evaluated a small-scale community-based intervention targeting the masculine norms tied to contraceptive re...

Background Clinicians and women of reproductive age would benefit from a reliable way to identify who is likely to become pregnant in the next year, in order to direct health advice. The 14-item Desire to Avoid Pregnancy (DAP) scale is predictive of pregnancy; this paper compares it with other ways of assessing pregnancy preferences to shortlist op...

Objectives Racism is associated with undesired pregnancy, but no studies examine how experiencing discrimination might shape pregnancy preferences or contraceptive use. Methods We recruited n=1,790 non-pregnant individuals, with the capacity for pregnancy, aged 15–34 from 20 health facilities in West Texas, Nevada, Arizona, New Mexico, and Souther...

Objectives Understanding the relationships between people's pregnancy desires and outcomes is essential to guiding patient-centered reproductive healthcare and measuring attainment of reproductive preferences. Methods We used longitudinal data from participants aged 15–34 recruited in 2019–2022 from 23 healthcare facilities in the Southwestern US...

Background Clinicians and people of reproductive age would benefit from a reliable way to identify who is, or is not, likely to become pregnant in the next year, to direct health advice. The 14-item Desire to Avoid Pregnancy (DAP) Scale is predictive of pregnancy; this paper compares it with other ways of assessing pregnancy preferences to shortlis...

Study question What is the predictive ability of the Desire to Avoid Pregnancy Scale, with regard to pregnancy within one year, and how could it be used as a screening tool? Summary answer The Desire to Avoid Pregnancy (DAP) Scale is highly predictive of pregnancy within one year and could be used as a screening tool with a suitable cut-point sele...

Context: Understanding how pregnancy preferences shape contraceptive use is essential for guiding contraceptive interventions and policies that center individuals' preferences and desires. Lack of rigorous measurement of pregnancy preferences, particularly on the population level, has been a methodologic challenge. Methods: We investigated assoc...

Background Patient agency in contraceptive decision-making is an essential component of reproductive autonomy. Objective We aimed to develop a psychometrically robust measure of patient contraceptive agency in the clinic visit, as a measure does not yet exist. Design For scale development, we generated and field tested 54 questionnaire items, gro...

Importance: Understanding how the COVID-19 pandemic affected people's desire to avoid pregnancy is essential for interpreting the pandemic's associations with access to reproductive health care and reproductive autonomy. Early research is largely cross-sectional and relies on people's own evaluations of how their desires changed. Objective: To i...

Objectives To evaluate the psychometric performance, including predictive validity, of a UK version of the Desire to Avoid Pregnancy (DAP) scale. Design Prospective cohort study for psychometric evaluation. Setting UK. Participants Women in the UK aged 15 years to menopause, who were not pregnant at the time of recruitment in October 2018, were...

Objective Although abortion in Nepal is broadly legal and free of charge, many women seek abortion care outside the legal system, including from pharmacies. We evaluated the prevalence of, and factors associated with, prior unsuccessful abortion attempts among women presenting to 14 randomly‐selected government approved abortion health facilities a...

Objectives Understanding the timing of pregnancy suspicion and confirmation, including the role of home pregnancy tests, can facilitate earlier entry into pregnancy-related care and identify individuals likely to be impacted by gestation-based abortion restrictions. Study design We use data from 259 pregnant individuals participating in a cross-se...

Male partner resistance is identified as a key factor that influences women’s contraceptive use. Examination of the masculine norms that shape men’s resistance to contraception—and how to intervene on these norms—is needed. To assess a gender-transformative intervention in Kenya, we developed and evaluated a masculinity-informed instrument to measu...

s These scientific abstracts are scheduled for presentation at the 2021 Society of Family Planning Annual Meeting. This year, 225 abstracts were submitted for consideration, of which 12 were selected for oral presentation and 84 were selected for poster presentation. The scientific abstract review was completed by the scientific reviewers and selec...

Objective: Opioid use disorder (OUD) is increasing among U.S. women. Research indicates higher levels of unintended pregnancy among women with OUD as compared to the general population. Following formative in-depth research documenting the complexity of considerations around pregnancy in this population, we collected information on pregnancy prefer...

CONTEXT Hospital policies and culture affect abortion provision. The prevalence and nature of colleague opposition to abortion and how this opposition limits abortion care in U.S. teaching hospitals have not been investigated. METHODS As part of a mixed‐methods study, a nationwide survey of residency and site directors at 169 accredited obstetrics...

Study Objective Provider misconceptions regarding intrauterine device safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of N gonorrhaeae or C trachomatis diagnoses among young women adopting intrauterine devices. Design Secondary analysis of a cluster-randomized provider educa...

Building capacity for contraceptive services in primary care settings, including for intrauterine devices (IUDs) and implants, can help to broaden contraceptive access across the US. Following a randomized trial in family planning clinics, we brought a provider training intervention to other clinical settings including primary care in all regions....

Background: Concern regarding pelvic examinations may be more common among women experiencing intimate partner violence. Objective: We examined women's attitudes towards pelvic examination with history of intimate partner violence (pressured to have sex, or verbal, or physical abuse). Design: Secondary analysis of data from a cluster randomize...

Objective Abortion is often characterized as an inherently difficult decision, despite research demonstrating high decision certainty among abortion patients. Minimal research has examined decision certainty among people planning to continue a pregnancy. We examined whether women seeking abortion experience lower decision certainty than those plann...

Background The Turnaway Study was the first to follow women denied abortions because of state law or facility policy over five years. The study has found negative effects on women’s socioeconomic status, physical health, and on their children’s wellbeing. However, women did not suffer lasting mental health consequences, prompting questions about th...

Introduction Abortion is often characterized as an inherently difficult decision, despite previous research finding high levels of decision certainty among abortion patients. Minimal research has examined decision certainty among pregnant people not seeking abortions. We examined whether abortion patients experienced higher levels of decision uncer...

Objective: To evaluate the prevalence and features of policies regulating abortion in U.S. teaching hospitals. Methods: In this mixed-methods study, we conducted a national survey of obstetrics and gynecology teaching hospitals (2015-2016) and qualitative interviews (2014 and 2017) with directors at obstetrics and gynecology residency programs....

Context: Measurement of pregnancy intentions typically relies on retrospective reporting, an approach that may misrepresent the extent of unintended pregnancy. However, the degree of possible misreporting is unclear, as little research has compared prospective and retrospective reports of intention for the same pregnancies. Methods: Longitudinal...

Objective: To facilitate assessment of patients' pregnancy preferences, we compared responses to One Key Question® with the validated Desire to Avoid Pregnancy (DAP) scale and assessed their relationships to patient-reported reproductive health behaviors. Methods: In this after-visit survey in primary care and obstetrics-gynecology practices, wo...

Background: Despite weak theoretical grounding and ample research indicating women feel high levels of decision rightness and relief post-abortion, claims that abortion is inherently stressful and causes emergent negative emotions and regret undergirds state-level laws regulating abortion in the United States. Nonetheless, scholarship does identif...

Objectives: An understanding of the relationship between individuals' pregnancy preferences and contraceptive use is essential for appropriate patient-centered counseling and care. We examined the relationship between women's pregnancy preferences and contraceptive use using a new prospective measure, the Desire to Avoid Pregnancy (DAP) scale. Stu...

Objectives Retrospective assessment of pregnancy intention may be unreliable as women’s perceptions of a past conception can change over time. We compared the stability of retrospective pregnancy intention reporting over 5 years among women who sought and either received, or were denied, an abortion. Methods We recruited women from 30 abortion faci...

Background Existing approaches to measuring women’s pregnancy intentions suffer important limitations, including retrospective assessment, overly simple categories, and a presumption that all women plan pregnancies. No psychometrically valid scales exist to prospectively measure the ranges of women’s pregnancy preferences. Materials and Methods Us...

Objective: To examine how receiving or being denied a wanted abortion affects the subsequent development, health, caregiving, and socioeconomics of women's existing children at time of seeking abortion. Study design: The Turnaway Study is a 5-year longitudinal study with a quasi-experimental design. Women were recruited from January 2008 to Dece...

Importance Evidence indicates that there are potential health, development, and maternal bonding consequences for children born from unwanted pregnancies. Objective To examine the association of women receiving or being denied a wanted abortion with their children’s health and well-being. Design, Setting, and Participants A 5-year longitudinal ob...

Objectives: To understand how having or being denied an abortion affects the likelihood of trying to become pregnant, overall pregnancy rates, and the rate and timing of an intended pregnancy in the future. Study design: The Turnaway Study is a prospective cohort study of women who received or were denied a wanted abortion. Women were recruited...

Context: Medication abortion has the potential to transform the provision of safe abortion care in low- and middle-income countries, and can be provided with minimal clinical skills and equipment. In Nepal, first-trimester abortion using mifepristone and misoprostol is legally available at government-certified health facilities, but little is know...

Objective: To examine whether auxiliary nurse-midwife provision of medical abortion in pharmacies is associated with reduced post-abortion contraceptive use in Nepal. Methods: The present prospective observational study compared contraceptive use among women aged 16-45 years and up to 63 days of pregnancy, who presented at one of six privately-o...

Objective: To evaluate whether conducting a bimanual examination prior to medication abortion (MAB) provision results in meaningful changes in gestational age (GA) assessment after patient-reported last menstrual period (LMP) in Nepal. Study design: Women ages 16-45 (n=660) seeking MAB at twelve participating pharmacies and government health fac...

Background: Unprotected intercourse is common, especially among teens and young women. Access to intrauterine device (IUD) as emergency contraception (EC) can help interested patients more effectively prevent unintended pregnancy and can also offer ongoing contraception. This study evaluated young women's awareness of IUD as EC and interest in cas...

Background: U.S. unintended pregnancy rates remain high, and contraceptive providers are not universally trained to offer IUDs and implants to women who wish to use these methods. Objective: To measure the impact of a provider training intervention on integration of intrauterine devices (IUDs) and implants into contraceptive care. Methods: We...

Background Expanding access to medication abortion through pharmacies is a promising avenue to reach women with safe and convenient care, yet no pharmacy provision interventions have been evaluated. This observational non-inferiority study investigated the effectiveness and safety of mifepristone-misoprostol medication abortion provided at pharmaci...

Context: Nonuse and inconsistent use of contraceptives contribute to a high incidence of unintended pregnancy and abortion among U.S. women. Little is known, however, about how these outcomes shape women's subsequent contraceptive use and unintended pregnancy risk. Methods: Contraceptive use was examined among 880 participants in the Turnaway St...

Background: Understanding how contraceptive choices and access differ for women having medication abortions compared to aspiration procedures can help to identify priorities for improved patient-centered post-abortion contraceptive care. Objective: To investigate differences in contraceptive counseling, method choices, and use between medication...

Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy but do not protect against sexually transmitted infection (STI). Recent efforts to improve access to intrauterine devices (IUDs) and implants have raised concerns about STI prevention and reduced condom use, particularly among teenagers and young women. We ev...

This study investigated whether integrating family planning (FP) services into HIV care was associated with gender equitable attitudes among HIV-positive adults in western Kenya. Surveys were conducted with 480 women and 480 men obtaining HIV services from 18 clinics 1 year after the sites were randomized to integrated FP/HIV services (N = 12) or s...

Purpose The majority of pregnancies during adolescence are unintended, and few adolescents use long-acting reversible contraception (LARC) due in part to health care providers' misconceptions about nulliparous women's eligibility for the intrauterine device. We examined differences in LARC counseling, selection, and initiation by age and parity in...

Objectives: We determined whether public funding for contraception was associated with long-acting reversible contraceptive (LARC) use when providers received training on these methods. Methods: We evaluated the impact of a clinic training intervention and public funding on LARC use in a cluster randomized trial at 40 randomly assigned clinics a...

The government of Nepal has articulated a commitment to the provision of post-abortion contraception since the implementation of a legal safe abortion policy in 2004. Despite this, gaps in services remain. This study examined the perspectives of abortion service providers and administrators regarding strengths and shortcomings of post-abortion cont...

Arguments that abortion causes women emotional harm are used to regulate abortion, particularly later procedures, in the United States. However, existing research is inconclusive. We examined women's emotions and reports of whether the abortion decision was the right one for them over the three years after having an induced abortion. We recruited a...

Unintended pregnancy remains a serious public health challenge in the USA. We assessed the effects of an intervention to increase patients' access to long-acting reversible contraceptives (LARCs) on pregnancy rates. We did a cluster randomised trial in 40 reproductive health clinics across the USA in 2011-13. 20 clinics were randomly assigned to re...

We sought to develop and validate an instrument that can enable providers to identify young women who may be at risk of contraceptive non-adherence. Item response theory based methods were used to evaluate the psychometric properties of the Contraceptive Intent Questionnaire, a 15-item self-administered questionnaire, based on theory and prior qual...

The pelvic examination is under scrutiny given revised cervical cancer screening guidelines. Recent studies have examined physician attitudes and practices, but data are scarce on women's preferences. General mistrust of medical care is higher among Hispanics and blacks, but we know little about attitudes toward the pelvic examination by race and e...

To examine post-abortion contraceptive discontinuation and pregnancy in Nepal, where abortion was decriminalized in 2002. We conducted an observational cohort study of 654 women obtaining abortions from four public and non-governmental facilities in 2011. Patients completed questionnaires at their abortion visit and six months and twelve months lat...

Unintended pregnancy is high - and use of long-acting reversible contraception (LARC) is low - among nulliparous and young women in the US. Healthcare providers have misconceptions about nulliparous women’s eligibility for LARC, particularly intrauterine devices (IUDs). We used data from the UCSF Bixby cluster-randomized trial of a provider LARC tr...

Background Intimate partner violence is common among women having abortions, with between 6% and 22% reporting recent violence from an intimate partner. Concern about violence is a reason some pregnant women decide to terminate their pregnancies. Whether risk of violence decreases after having an abortion, remains unknown.Methods Data are from the...