Rebecca Simmons, M.P.H., Ph.D., brings a broad perspective to reproductive health. On November 6, 2023, she brought that perspective to a national roundtable to help policymakers understand the barriers to contraception access.
The roundtable was hosted by U.S. Department of Health and Human Services Secretary Xavier Becerra to understand the research behind barriers to reproductive health. The roundtable brought together experts on a diversity of topics related to contraceptive access, from permanent contraception to pharmacy prescribing. Simmons, a research assistant professor of obstetrics and gynecology at University of Utah Health, provided a scientific voice grounded in Utah-based initiatives.
Understanding a broad range of experiences is central to improving contraception access, Simmons says, because no single solution will be one-size-fits-all. “In sexual and reproductive health, there aren’t really any right answers,” she says.
“The answer that’s right for you in this minute might change tomorrow… Pregnancy can be either the best thing or the worst thing, and it can be that for the exact same person depending on their circumstances.”
Simmons is an expert on programs that improve access to contraception, having evaluated multiple initiatives that provided no-cost contraceptive options to Utahns. The first, HER Salt Lake, was a countywide initiative that partnered with Planned Parenthood to provide free contraception to more than 7,000 people, more than 4,000 of whom enrolled in a study to help understand how that contraception impacted their lives. Building off the lessons learned from HER Salt Lake, Simmons went on to direct the evaluation of a statewide initiative called Family Planning Elevated (FPE) that similarly provided free contraception to more than 18,000 Utahns.
Throughout both initiatives, Simmons and her colleagues gathered crucial information on how Utah residents accessed family planning services. In HER Salt Lake, they focused on individual outcomes, like whether people became pregnant and which contraceptive methods they used; in FPE, they looked at clinic-level outcomes, like the number of family planning services each clinic offered over time.
Both initiatives identified barriers to access that were previously unknown and sometimes unintuitive. Over the course of the FPE initiative, for instance, Simmons noticed that when birth control became covered by the 2019 Medicaid expansion rather than through a separate waiver, use of contraceptive services actually decreased. “Our monitoring data were really the first indicators that nobody was signing up for this,” she says. The waiver has since been separated from the main Medicaid application.
All methods to all people at all times
What makes Simmons’ research unique is her emphasis on the big picture—an effort to include the widest possible spectrum of experiences and needs. While previous interventions related to contraceptive access focused on specific methods, like IUDs and implants, Simmons’ interventions expanded the scope to methods ranging from fertility awareness and diaphragms to vasectomies. “Our initiative was really putting a focus on all methods to all people at all times,” she says.
Similarly, Simmons has endeavored to zoom out her data analysis from a narrow focus on unintended pregnancies to a bigger picture that captures peoples’ experiences. Exit surveys for patients included questions on pregnancy outcomes, clinic quality, and interactions with clinic providers and staff. Simmons made a point of measuring the experience of all contraceptive clients, regardless of age, gender, or specific needs.
By bringing a wider perspective to the roundtable, Simmons hopes that studies like hers can help introduce empathy to a topic that can be polarizing. “In environments where people are really committed to a particular side, data can help people understand that there is more nuance… I think we do our best work when we can expand the notion of the range of what’s the reality for folks.”