What the Health?: Tackling Tele-contraception
Updated: Oct 5, 2020
With the advent of telehealth, Instacart, and FaceTime, social distancing doesn’t seem so impossible after all. I still really miss aimlessly walking around Target though...
As a number of us are currently displaced and relocated in light of the pandemic, it goes without saying that our typical day-to-day is looking more odd than the last. While shelter-in-place guidelines have limited our mobility, there's luckily so many apps and courier services that allow us to still have access to groceries and prescriptions without actually having to leave the house.
Recently, tele-contraception has been gaining traction and current circumstances have only seemed to accelerate its utilization. In fact, it’s so new that Microsoft actually still flags the term as a typo as I’m writing this article. Like many of these other online services, tele-contraception has been widely advertised for its timeliness and convenience.  Patients can now receive birth control remotely via a mobile app or website, without ever having to go to a doctor’s appointment for a prescription.  The types of contraceptives that are currently
available through these platforms are the pill, the patch, or the shot.
So, is telecontraception safe or sketchy?
And the answer to that is: Yes, they are relatively safe - but it’s important to be aware of your own health history and how that impacts your risk for complications.
In 2019, a study on the quality, efficiency and safety of tele-contraception was published. The study used “secret-shoppers” to undergo the overall process of obtaining contraceptives, but with a twist.  These participants had absolute contraindications - otherwise known as a wide range of health characteristics or conditions that may cause harmful or adverse events to the combination pill, a common oral contraceptive that consists of estrogen and progestin. [1-4] In women with pre-existing conditions, such as hypertension or diabetes, estrogen in the combination pills may lead to or exacerbate cardiovascular complications. [2-5] However, of the 45 total visits where contraindication was noted for patients in this study, 3 were still prescribed the combined pill despite their elevated risk of complications. 
Although there have not been many published studies that directly examine the benefits versus the risks of tele-contraception, there has been some research done on prescribed contraceptive use versus non-prescribed use. In a study that analyzed the number of contraindications between patients prescribed with the combined pill versus over-the-counter (OTC) users, it was found that OTC users had more frequent contraindications in comparison to prescribed users.  A recommendation that was made at the conclusion of this study was to first offer progestin-only pills to reduce the number of contraindications.  All that said, keep in mind that a very small proportion of the overall number of women taking birth control have contraindications that put them at risk for adverse events. 
We’ve come a long way in terms of reproductive rights, and tele-contraception is the newest addition to this movement. Second wave feminism in the 1960s expanded on prior women’s suffrage efforts to improve education, fair wages, and professional opportunities. During this time, women fought for equal representation in the workforce, and the concurrent advent and approval of the birth control pill in the 1960s by the FDA allowed women to balance career-planning with reproductive rights . In 1965, The U.S Supreme Court ruling in Griswold v Connecticut legalized the use of birth control for married couples, and eventually to unmarried women in Eisenstadt v Baird.  Today, access to birth control via online platforms offers increased accessibility to reproductive freedoms. And with COVID-19, reimbursement to services provided through telehealth platforms has been rapidly expanding, so who knows where this may lead in the near future? 
But if you have any concerns or questions on what type of birth control you should choose and if tele-contraception makes sense for you, reaching out to your physician for a consultation and discussing your health history would be your best bet in figuring out what the safest options for you are.
What are some of the benefits of
Tele-contraception has the potential to address a myriad of barriers to access for birth control such as lack of time, transportation obstacles, and stigmatization.  The average tele-contraception appointment takes 7.5 minutes to complete.  Adding to the list of benefits of these services, it was found that adherence to daily oral contraceptives via tele-contraception was higher with those that received their birth control prescriptions through a clinic or through their physician.  Additionally, tele-contraception may offer a safer alternative to in-person visits by providing remote access during the COVID-19 pandemic.
Is tele-contraception covered by my insurance?
Under the Affordable Care Act (ACA), most private insurance companies are required to cover the costs of prescribed, FDA-approved birth control. The key word here though, is prescribed. OTC birth control would technically not be covered. California, Oregon, and Washington are the rare few that provide pharmacy access to prescription birth control, but even this is still not quite truly OTC since it needs to be issued by a pharmacist.  The federal contraceptive coverage applies to 18 methods of contraception, and while your specific health plan may not favor one method over another, they may favor specific types within categories. For instance, while your health plan may not favor an IUD over the pill, they may favor one type of IUD over another type of IUD. This could be something to keep in mind if you’re in the process of switching health plans!
Where and how can I access tele-contraception?
Depending on state law, you can access tele-contraception by the age of 13 or 18.  Some of these platforms include Alpha Medical, Blink Health, Hers, HeyDoctor, Lemonaid, Maven, Nurx, Pandia Health, Planned Parenthood Direct, PlushCare, PRJKT RUBY, The Pill Club, Simple Health, Twentyeight Health, and Virtuwell in the United States; it’s important to note that not every platform is available in each state.  These services are generally accessible via online through a web browser and or through a Smartphone app.
1. Jain T, Schwarz EB, Mehrotra A. A study of telecontraception. N Engl J Med. 2019. doi:10.1056/NEJMc1907545
2. Lima ACS, Martins LCG, Lopes MV de O, et al. Influence of hormonal contraceptives and the occurrence of stroke: integrative review. Rev Bras Enferm. 2017. doi:10.1590/0034-7167-2016-0056
3. De Leo V, Musacchio MC, Cappelli V, Piomboni P, Morgante G. Hormonal contraceptives: Pharmacology tailored to women’s health. Hum Reprod Update. 2016. doi:10.1093/humupd/dmw016
4. Plu-Bureau G, Sabbagh E, Hugon-Rodin J. Hormonal contraception and vascular risk: CNGOF Contraception Guidelines. Gynecol Obstet Fertil Senol. 2018;46(12):823-833. doi:10.1016/j.gofs.2018.10.007
5. Lauring JR, Lehman EB, Deimling TA, Legro RS, Chuang CH. Combined hormonal contraception use in reproductive-age women with contraindications to estrogen use. Am J Obstet Gynecol. 2016. doi:10.1016/j.ajog.2016.03.047
6. Grossman D, White K, Hopkins K, Amastae J, Shedlin M, Potter JE. Contraindications to combined oral contraceptives among over-the-counter compared with prescription users. Obstet Gynecol. 2011. doi:10.1097/AOG.0b013e31820b0244
7. The Vote & the Right to Access Contraception | Power to Decide. https://powertodecide.org/news/vote-right-access-contraception. Accessed May 17, 2020.
8. The Supreme Court . Expanding Civil Rights . Landmark Cases . Griswold v. Connecticut (1965) | PBS. https://www.thirteen.org/wnet/supremecourt/rights/landmark_griswold.html. Accessed May 17, 2020.
9. COVID-19 TELEHEALTH COVERAGE POLICIES | CCHP Website. https://www.cchpca.org/resources/covid-19-telehealth-coverage-policies. Accessed May 17, 2020.
10. Six decades of struggle over the pill. Nature. 2017;546(7657):185. doi:10.1038/546185a
11. Insurance Coverage of Contraception | Guttmacher Institute. https://www.guttmacher.org/evidence-you-can-use/insurance-coverage-contraception. Accessed May 17, 2020.
12. Who prescribes the pill online? | Free the Pill. https://freethepill.org/online-pill-prescribing-resources/. Accessed May 20, 2020.
MPH Candidate | Dartmouth College
B.S. Biochemistry & Cellular Biology | UC San Diego
Shruthi Patchava, Arushi Krishnan, Minda Liu, Divya Chawla
MPH Candidates | Dartmouth College