The mission of the Contraception and Abortion Research and Education in the Social Sciences (CARE) Lab is to advance quality and equity in sexual and reproductive health care, with a primary focus on the US context.
We achieve our mission by conducting bold, rigorous, and inclusive research designed for practical real-world impact.
Elizabeth Janiak, ScD
Assistant Professor, Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School
Assistant Professor, Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
Director of Social Science Research, Planned Parenthood League of Massachusetts
Elizabeth Janiak is an interdisciplinary public health researcher and Assistant Professor at Harvard Medical School and the Harvard TH Chan School of Public Health. Her research explores how government and institutional policies create inequities in access to and quality of sexual and reproductive health (SRH) care, including contraceptive, abortion, and obstetric services. Current projects include several studies of mifepristone use for abortion and early pregnancy loss, social factors shaping postpartum contraceptive use, and the impacts of abortion-related travel following the Dobbs decision. Dr. Janiak completed her undergraduate and graduate training at Harvard. Her research is funded by the National Institutes of Health, the Society of Family Planning, and multiple institutional and foundation grants. Dr. Janiak's work has been cited by the National Academies of Sciences, Engineering and Medicine, and covered in dozens of media outlets including The Boston Globe, Salon, and National Public Radio. A full list of Dr. Janiak's publications can be found via Harvard Catalyst.
Emma Forbes, MPH
Program Manager, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital
Emma Forbes (she/her) is a public health researcher and the Program Manager for the CARE Lab. Her research interests span abortion, contraception, pediatric health, maternal morbidity and mortality, and chronic gynecological conditions including uterine fibroids, PCOS, MRKH, and endometriosis. Prior to this position, she led patient-centered research on fibroid treatment equity as the Program Manager for Boston Medical Center’s Fibroid Center, and developed accessible educational content on infant safe sleep and breast/chestfeeding with the Boston University Slone Epidemiology Center. Emma found her passion for abortion justice in 2018, when volunteering as a patient storytelling liaison for the Planned Parenthood Health Center Advocacy Program. She is committed to a public health practice rooted in racial justice, gender and sexuality liberation, economic accessibility, and patient shared decision-making. Emma received an MPH in Health Policy and Law with a concentration in Maternal and Child Health from the Boston University School of Public Health in 2023.
Emily Newton-Hoe, MPH, MPA
PhD Student, Harvard T.H. Chan School of Public Health Research Trainee, Department of Obstetrics and Gynecology, Brigham and Women's Hospital
Emily Newton-Hoe (she/her) is a Population Health Sciences doctoral student in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health and graduate affiliate of the CARE Lab. Her research explores the social and structural determinants of reproductive and perinatal health inequities using a social epidemiologic lens. She is particularly interested in the ways in which public policies engender inequities in the context of gender and health. Before starting the PhD program, Emily worked at Mathematica for eight years conducting social policy research and evaluations in the areas of social determinants of health, reproductive and maternal health, quality measurement, and Medicaid policy. She holds an MPH from the Harvard T.H. Chan School of Public Health and MPA and BA from Clark University.
ExPAND Mifepristone is a didactic and technical assistance program for primary care and community-based healthcare providers. The program helps facilitate integration of medication abortion into primary care, a critical strategy for stabilizing and growing the abortion provider pool. With abortion care in the United States facing unprecedented challenges, primary care and community health centers play a critical role in abortion access. Serving as first point of care and rooted in longitudinal relationships, primary care providers can expand abortion access by providing accurate information and referrals to their patients seeking abortion, and by providing abortion care when the necessary supports are in place.
ExPAND focuses on capacity-building among the safety net providers that serve the most vulnerable patients, including federally qualified health centers (FQHCs) and look-alike clinics that follow a similar model of care delivery.
Learn more about the ExPAND Mifepristone project
The goal of QuEAST is to describe the burdens of interstate travel for abortion including health, psychosocial, and financial outcomes in the wake of the 2022 Supreme Court decision in Dobbs v Jackson Women’s Health Organization and subsequent state actions taken to curtail access to abortion. This mixed-methods study uses quantitative surveys and qualitative interviews to quantify these burdens and describe inequities in who is experiencing them and their relative impact across groups. We focus on understanding the experiences of those most marginalized in the health care system.
This project is supported by grants from Harvard University’s Milton Fund, the Society of Family Planning Research Fund, and the Robert Wood Johnson Foundation’s Research in Transforming Health and Health Care Systems (RTHS) program, which supports policy-relevant, community-engaged research on current or potential policies to transform health and health care systems. The research team, housed within the ASPIRE Center for Sexual and Reproductive Health at the Planned Parenthood League of Massachusetts, Inc., conducts data collection and convenes a community advisory board to contribute to the project design, conduct, and dissemination of findings and recommendations. Preliminary data from QuEAST were presented at the FIGO Conference in Paris in October 2023, and data collection is ongoing.
Because most people return to sexual activity shortly after giving birth, consistent use of effective contraception is critical to supporting people in spacing births according to their personal preferences and goals. However, data are lacking regarding what knowledge and attitudinal factors drive pregnant people’s intention to use contraception after birth. Additionally, not all individuals who form an intention to use contraception postpartum end up being able to act on that intention after birth. It is unknown what specific environmental barriers prevent patients from receiving desired contraception postpartum. This study will fill the evidence gap around drivers of postpartum contraceptive use by clarifying the role of contraceptive knowledge, attitudes, norms, and self-efficacy in driving intention to initiate contraception postpartum and identifying barriers to enacting intended contraceptive use.
Access to sexual and reproductive health (SRH) services is integral to the wellbeing of individuals and communities. However, stigma and concerns about confidentiality when using health insurance can create barriers to SRH care. These concerns especially interrupt access for younger people, Black, Indigenous, and people of color (BIPOC individuals), those with disabilities and chronic disease, individuals who are transgender or gender-nonconforming (TGNC), and people of lower socioeconomic status. Policies that protect confidential use of health insurance for sensitive services have the potential to improve access to care overall, and for these groups in particular. Massachusetts is one of only seven states that has enacted legislation (the PATCH law) to protect confidential use of health insurance coverage, and one of only five that extends such protections to commercially insured people of all ages, providing a rare opportunity to understand individuals’ utilization of, knowledge of, and attitudes toward such policy protections.
EnPIRHE is a novel mixed-methods study that directly queries SRH service users on their knowledge of, attitudes towards, and intention to use the protections of the PATCH law. This novel study is grounded in an intersectional framework, engages a diverse statewide patient population, and uses a mixed-methods approach to understand barriers to insurance utilization, with the goal of improving future health policy interventions.
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