In 2016, the number of goods and services available on demand is stunning. With just a few swipes and taps, I can summon a ride, dinner, pot, or even a parrot. One product, though, that has remained difficult to obtain for most women is birth control: it still usually involves a doctor's examination, questions about your sex life, a prescription and then a visit to a pharmacy. But a new contingency of start-ups wants to change that.
For decades, advocates have argued that birth control should be available over the counter, as easy to purchase as aspirin or Nyquil. Recently, legislation in California and Oregon almost got there, making birth control available "under the counter," through a pharmacist. Elsewhere, though, efforts have been stalled amidst partisan debate.
But by taking advantage of telemedicine laws that allow doctors to see patients digitally, start-ups like the newly-launched Nurx offer a work-around to make birth control far more accessible.
Last month, Nurx launched a website that allows women to obtain a birth control prescription almost instantly and get a three-month supply of the pills delivered overnight. Patients simply fill out a series of yes-or-no and multiple-choice questions about things like blood pressure and allergies. A doctor reviews them, following up with more questions if needed or simply filling the prescription. If the patient has insurance, it's free (as mandated by the Affordable Care Act) and Nurx picks up the tab on shipping. Otherwise, a three-month supply starts at about $15. The company launched in California, and is expanding to New York this week.
"It's absolutely ridiculous the way the system works," said Nurx co-founder and attorney Hans Gangeskar. "We absolutely believe oral contraceptives should be available over the counter. This is one step on the way."
Beyond simple convenience, cheap birth control that doesn't involve a doctor's visit could help eliminate the socioeconomic and geographic boundaries that make it hard for some women to access contraceptives. But making birth control available on demand through an app doesn’t necessarily make it more accessible to everyone.
Ultimately, the best way to improve access to birth control for women will be to make it available over the counter—and there's no Silicon Valley solution for that. Birth control on demand may sound like a feminist utopian dream, but requiring that someone have access to a smartphone or computer to order a prescription comes with its own barriers to entry, even if it does skirt obstacles such as having the time or money to visit a doctor.
Regardless, creating more ways for women to obtain the pill helps set the stage for state legislators or the FDA to eventually make birth control available over the counter or through a pharmacist everywhere in the United States. And that is ultimately a very good thing.
Research suggests that the easier and more affordable it is to obtain the pill, the more women who need it will take it. When France made emergency contraceptive Plan B available over the counter in 1999, it led to a 72 percent increase in use over just five years. (The FDA didn't make Plan B available over the counter in the U.S. until 2013.) Research from the CDC in 2013 found that women were much more likely to keep taking birth control pills when they already had it on hand—in other words, not when it necessitated a trip to the doctor or pharmacist.
Besides all that, requiring women to make annual visits to the doctor for the pill is outright sexist—it is essentially a toll women alone are forced to pay in order to enjoy sex free from the burden of potential unwanted pregnancy. While some argue that without requiring a visit to the doctor for the pill, women will miss necessary preventative annual care, the benefits of annual pap exams are currently being debated due to high rates of false positive tests. The American College of Physicians recently changed its recommendations, suggesting that for most women a visit to the Ob-Gyn once every three years is enough.
More over, studies have shown that women can typically self-assess risk factors associated with the pill just as well as a doctor or nurse. Big medical societies like the American College of Obstetricians and Gynecologists and the American Medical Association have issued endorsements of making birth control available over the counter, finding that women can usually self-assess risk factors just as well as a nurse. In more than 100 other countries, it already is.
"It is debatable as to how many unwanted pregnancies would be prevented by making birth control pills available over the counter," Cato Institute scholar Dr. Jeffrey A. Singer wrote last week in Time. "What is not debatable is that there will be a lot less spending on unwanted—and unnecessary—visits to the doctor’s office in order to get a prescription. Not to mention much evidence has suggested there's no significant benefit to having a doctor issue a prescription."
Other start-ups like Maven, and Lemonaid also allow women to easily obtain a prescription through an app and order pills to be delivered either to their home or a nearby pharmacy. Nurx eventually hopes to make birth control available truly on demand, with delivery via Postmates in just a few hours. It also plans to offer emergency contraception, like Plan B, on demand, too.
Silicon Valley start-ups can't win the war against women. But they can help to normalize easy access to contraceptives, just like Uber normalized the expectation to be able to call a cab anywhere at any time. And in the meantime, next time you suddenly find yourself running low on the pill, there's an alternative to waiting three weeks for an appointment with your doctor.