Is it safe to order birth control online?
In this day and age, you can order pretty much anything online and get it delivered to your door—including protection against unplanned pregnancies. A number of companies have sprung up in the last few years that allow women in certain states to request birth control pills and other contraceptive methods via the Internet, sometimes without even seeing a doctor.
These suppliers—with catchy names like Maven, Nurx, Lemonaid, and Pandia Health—offer convenience and confidentiality to women who may be too busy to squeeze in a visit to their gynecologist or nervous about picking up their prescription at a local pharmacy. And according to a recent NPR article, they’re gaining popularity in rural parts of the country sometimes called “contraception deserts” that lack easy access to women’s health services.
But is getting a birth control prescription online really safe? And is it a good option for everyone? Health spoke with Sophia Yen, MD, CEO and co-founder of Pandia Health. (Yes, she's got skin in the game, but she's also got real medical cred: She's a clinical associate professor of pediatrics and adolescent health at Stanford University and a member of the Association of Reproductive Health Professionals.) Here’s why Dr. Yen jumped into the online market, and what experts say about the science and safety behind these services.
Online consultations can do almost everything in-person visits can
Customers can use companies like Pandia Health to fill existing birth-control prescriptions they receive from their doctor—but if they don’t have an Rx, they can usually get one in just a few simple steps.
On Pandia’s website, for example, users answer a series of questions about their health and are asked to submit a blood-pressure reading. “If you’ve been to a doctor’s office in the last year, you can ask them to send it over—or you can go to most pharmacies or grocery stores to have [blood pressure] checked, too” says Dr. Yen.
Some birth control delivery apps require a phone call or video conferencing instead of an online questionnaire. Regardless, the point of these evaluations is for a doctor to make sure that women don’t have existing health issues that could raise the risks associated with birth control pills. If you get certain types of migraine headaches, have a history of blood clots or stroke, or if you smoke, for example, your request could be denied.
Doctors support the idea of fewer barriers to birth control
In 2012 and again in 2016, the American College of Obstetricians and Gynecologists (ACOG) issued position statements advocating that oral contraceptives be sold over the counter, without a prescription. “That’s already the case in China and in many European countries, because they know that the benefits of preventing unplanned pregnancies and making women’s lives easier outweigh the risks,” says Dr. Yen.
In fact, ACOG’s position statements cite research showing that when women use a self-screening checklist—similar to the health questionnaires used by these apps—they are more likely to identify risk factors that could make birth control dangerous than their doctors are.
While a doctor’s prescription is still required in most states, Dr. Yen says ACOG’s statements gave her the confidence to invest in telemedicine and to issue prescriptions over the Internet. And it’s paying off, she says: Already, her company has helped many women get contraception who never had it before.
“We thought we’d get a lot of 18-year-old customers, but we’re also getting 23-year-olds who have never been on birth control,” she says. “When we ask them what they’ve been doing for protection, they say condoms, withdrawal, and prayer. Thank goodness now they have a better option.”
Cost can still be an issue
Thanks to the Affordable Care Act, birth control is free for most women with health insurance. But these apps may still charge a fee for a doctor’s consultation. Pandia Health’s fee, for example, is $39 if you opt for mail delivery of your meds, or $59 if you choose to fill your Rx at a pharmacy.
Uninsured customers, on the other hand, must pay upfront for birth control pills. These companies offer medications at several different price points, but even low-cost, generic options (which run about $15 a month) can be prohibitive for low-income women, says Kyl Myers, PhD, a sociologist and research associate in the University of Utah's department of obstetrics and gynecology.
“These apps can be really great for people with insurance or who can afford out-of-pocket care,” says Myers, who leads a University of Utah and Planned Parenthood initiative to provide free birth control to women in Salt Lake County. “But we need to make sure that all women have access to affordable contraception.”
In-person visits are still a good idea, if they’re doable
Dr. Yen still recommends seeing a doctor in person “if it’s doable for you,” especially if you have questions about which type of birth control is best for you. (Pandia Health offers the pill, the patch, or the ring.) “We’re here to give you access,” she says, “but having a provider talk you through your options is always better if you’re a newbie.”
Seeing a doctor in person is also a good way to make sure you’re up-to-date on important screenings. A face-to-face visit can give you a chance to bring up any health-related questions or concerns you might have as well. But it's those issues that should determine when and how often a woman sees her doctor, says Myers. “If nothing’s changed with your health or your sex life, you shouldn’t have to go every 12 months just to get your prescription renewed,” she says.
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If you want an IUD or implant, you still need to see a doctor
Another drawback of these online subscription services is that they can’t provide implants or intrauterine devices (IUDs), which have been shown to be the most effective forms of birth control on the market. “I always encourage patients to learn about and consider the IUD, but you do need to visit a doctor to have it inserted,” says Dr. Yen.
Myers agrees. “These apps are a step in the right direction, but we need to be making sure people have access to a whole range of effective contraceptive methods,” she says, “not just to user-dependent methods like the pill, the patch, or the ring.”