New websites and mobile applications provide a new way for women to obtain contraception amid conservative opposition to legislative efforts to facilitate contraceptive access, the New York Times reports.
According to the Times, experts hope increasing access to contraception through online options will help reduce the number of unintended pregnancies, which account for about 40 percent of all pregnancies in the United States.
Online contraceptive services
According to the Times, there are at least six digital operations that allow women to receive contraception through an online questionnaire or virtual video.
The specifics of the service vary from venture to venture, but all of the services offer birth control pills. Some also provide contraceptive patches, contraceptive rings and emergency contraception. Depending on the service, a woman may receive her contraceptive method directly or pick up a prescription at a nearby pharmacy. The ventures set their own policies for the age at which a woman may use the services. Some of the ventures take insurance, while others require out-of-pocket payment.
According to the Times, the apps and websites rely on clinicians for the contraception prescriptions, which means they do not require legislative approval. However, the ventures are subject to applicable state telemedicine regulations.
One app, Lemonaid, has a doctor review a woman's medical information and then order a prescription to a pharmacy where she can pick it up. The service charges $15, and it is available in seven states. Nurx, another app, currently provides contraceptive prescriptions, picks them up from pharmacies and delivers them to users in California and New York. Two other ventures -- Prjkt Ruby and Maven -- donate some proceeds either to cover the cost of providing care to low-income women or to fund not-for-profits in developing countries that work to facilitate contraceptive access.
Planned Parenthood offers multiple online contraceptive services. Through the Planned Parenthood Care app, a woman can consult with a doctor or nurse practitioner about contraceptive options via video conference. The app is available for use in Alaska, Hawaii, Idaho, Minnesota and Washington. According to Jill Balderson, the app has about 19,000 users, of whom about two-thirds are new to Planned Parenthood.
Through the Planned Parenthood Direct app, which operates in California, a woman can have contraception sent to a nearby pharmacy. The Planned Parenthood Direct app does not involve video conference.
Potential to boost women's access
The Times reports that the privately run online services have been able to grow largely without the anti-reproductive-rights political sentiment that accompanies legislative efforts to increase contraceptive access.
For instance, conservative groups have opposed the Obama administration's effort to facilitate birth control access through the Affordable Care Act, which requires insurers to cover contraception at no out-of-pocket cost. Similarly, while many health experts find it safe to provide hormonal contraceptives over the counter, some conservatives have opposed efforts that would allow a woman to obtain contraception without a prescription. Moreover, regulatory changes can be time-consuming.
In addition, the online services can break down access barriers that women face when seeking contraception through a traditional doctor's office visit, according to the Times. For example, a woman or teenager might find it easier to access contraception via one of the apps or websites if she finds that arranging a physician visit is costly, inconvenient or potentially embarrassing.
Jill Atilano, a California mother who uses Lemonaid, said she uses the online service to make the process of obtaining contraception less costly and less time consuming. Separately, Kristina Campbell, another Lemonaid user, noted that the online service helped her access contraception upon moving to "a conservative area where to find a doctor that [she] even agree[s] with about using birth control was a little bit tough."
According to the Times, the new websites and apps also could facilitate contraceptive access for more women than a legislative endeavor, such as contraceptive access laws enacted in California and Oregon, might.
Overcoming obstacles
The Times reports that while the apps and websites are sidestepping some of the obstacles facing legislative efforts to facilitate contraceptive access, they still face some controversy from opponents.
For example, Peter Ax, CEO of Prjkt Ruby, noted that some opponents have tried to target the organization by posing as underage costumers or providing inaccurate information to deceive the company into making an error. According to Ax, the company has also received "inflammatory" letters.
According to the Times, some of the apps and websites hope to avoid controversy by enforcing more stringent restrictions than required by law. For example, depending on states' ages of consent, Prjkt Ruby requires that consumers be 16 to 18 years old -- higher than medically necessary.
Similarly, another venture, Virtuwell, which provides prescriptions in 12 states, only offers services for women ages 18 to 34, as those who are older might need a more comprehensive medical assessment to pick out the right contraception. Lemonaid prescribes only progestin oral contraception to women older than 35, as pills with estrogen could increase certain health risks for women in that age group. Lemonaid also has a minimum age of 18.
Citing the company's age requirement, Lemonaid CMO Jason Hwang said, "We are being especially conservative by choice," noting that the decision was "not based on clinical grounds; it was a political decision."
Comments
Nancy Stanwood, chair of the board of Physicians for Reproductive Health, praised the online initiatives. "This kind of access is certainly an improvement for some women who have access to the web and a smartphone," she said.
Separately, Mark DeFrancesco, former president of the American Congress of Obstetricians and Gynecologists, voiced concern that app users might opt not to visit a doctor regularly if they are accessing contraception via online sources. DeFrancesco also voiced concern that a woman might have to pay fees through the app that she could avoid if she visited a physician, as some of the online services do not accept insurance (Belluck, New York Times, 6/19).
