In recent years, a growing number of companies have been offering prescriptions for birth control through web-based services and smartphone apps. Now a "secret shopper" study suggests it's a safe and reliable source for women.
So-called "telecontraception" services have emerged as an alternative to trips to the doctor or local family planning clinic. They allow women to get prescriptions for birth control pills (or contraceptive patches or rings) after completing an online questionnaire, and sometimes having a follow-up call with a health care provider.
Family planning clinics close
The prescription can be picked up at a local pharmacy or delivered by mail.
Many women get contraceptives through their doctor, but the issue of access to birth control has become more pressing as family planning clinics close across the United States.
Advocates argue that these online companies fill a gap, making at least some birth control methods more accessible – particularly to women who live in "contraception deserts" lacking reproductive health clinics. And the American College of Obstetricians and Gynecologists just recommended in a new statement that all hormonal contraceptives, including rings, shots and patches, be available without a prescription, to help meet that need.
On the other hand, the idea of online health care makes some people uncomfortable, said senior study author Dr Ateev Mehrotra.
"It's common for people to say, 'Really? This couldn't be high-quality care,'" said Mehrotra, an associate professor at Harvard Medical School.
So his team decided to gauge the quality of online contraception services using a secret shopper approach: They had seven "patients" seek prescriptions for "the Pill" from nine companies that provided the service in the United States as of March 2018.
Better than in-person care
The patients made a total of 63 visits to the sites, filling out the standard questionnaires. Two companies provided video calls during the visit, and in about one-third of visits there was some kind of follow-up, either a call or text message from a health care provider with the service.
Overall, Mehrotra said, the companies did a good job of screening.
There were 45 visits in which secret shoppers reported contraindications to using the Pill such as a history of blood clots or migraine with aura. In those cases, the companies followed medical guidelines 93% of the time.
How does that compare with traditional office visits? It's a bit tricky to judge, according to Mehrotra.
"A limitation of this study is that we didn't directly compare this with the care these same patients would've received at an office visit," he said.
But, he added, based on past research, that 93% figure may actually be better than in-person care.
Online has shortcomings
If that's the case, there's some sense to it, according to Mehrotra: A busy doctor may not always ask all the right questions, while a standardised online questionnaire would be consistent.
Still, the online approach has its shortcomings, Mehrotra added.
One concern is that women who use the services may not be aware of all the contraception options out there. Only two companies in this study offered information about long-acting contraceptives. Those include intrauterine devices (IUDs) and small implants placed under the skin of the arm; they have to be inserted by a doctor or nurse, but they are also the most effective forms of reversible birth control.
Susan Wysocki is a women's health nurse practitioner and serves as a medical advisor to the American Sexual Health Association.
"One thing these companies could improve upon is information on long-acting reversible contraceptives," Wysocki said.
She suggested that women who are interested in getting birth control online first do some research on all of their options, for example, through a trustworthy website like Planned Parenthood.
Most accept health insurance
In general, though, women can feel comfortable getting their birth control through these services, according to Wysocki.
"Birth control pills are safe and effective when taken correctly," she said. "But accessibility is an issue. These [companies] make reliable contraception available from the comfort of your home, and that's a good thing."
As for price, the study found that sites ranged widely. Most accepted health insurance, but uninsured customers would pay anywhere from $67 (±R1 007) to $519 (±R7 800) for a one-year prescription (including the cost of the visit). The average price tag was $313 (±R4 700).
It's not clear, Mehrotra added, whether any one company is better than others in quality.
The findings were published in the New England Journal of Medicine.
Contraceptives are not the only prescription available online. Consumers can get medications for a number of conditions, from acne to erectile dysfunction. There's a need for research into the quality of those services, too, Mehrotra said.
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