New changes in the law are creating more counties without full access to birth control. But there are things women can do.
Ordering birth control pills online is one way women can overcome “contraception deserts.” Getty Images
Across the United States, 19 million women live in counties that lack a single clinic with a full range of contraception.
Dr. Saya Nagori, who practices in Washington, D.C., told Healthline that there are a number of policies that have created this situation.
For example, changes to the Title X reproductive healthcare program are making it harder for women to find clinics that offer contraception, creating “contraception deserts.”
“If you consider how large a county can be, even if it does have a clinic offering a range of services, if it’s 45 minutes away, that’s not really easy access,” said Nagori.
Other legal decisions allow employers that offer health insurance to opt out of coverage for birth control on religious or moral grounds.
“So even if you’re fortunate enough to have coverage through your employer, it’s not necessarily true they would also cover birth control. Those policies impact access and affordability,” explained Nagori.
It’s a problem with widespread consequences.
“Career, finances, socially, emotionally. Access to birth control means being able to plan a career. It has a financial impact. If you just think about someone having trouble affording a prescription on a reliable basis, they’re unlikely prepared for a child they hadn’t planned on,” said Nagori.
“Having a child is not about one thing. It’s multifactorial,” she added. “We should be able to plan for it, especially since we have so many ways to do that in 2018.”
Natural family planning
Women’s health clinics that don’t offer contraception are becoming more common.
While they do perform pregnancy tests and screen for diseases, these clinics only offer information on natural family planning methods.
Dr. Thomas Ruiz is OB-GYN Lead at MemorialCare Orange Coast Medical Center in California.
He told Healthline that the “rhythm method” of family planning has a failure rate of 25 percent.
The rhythm method involves carefully tracking the menstrual cycle. The goal is to figure out the most fertile period and avoid intercourse during that time.
Ruiz said that to be effective, a woman would have to have a very regular cycle. But most women do not.
“There are a lot of rhythm method babies walking around today,” said Ruiz.
Deserts aren’t the only problem
Kiley Holmes doesn’t live in a contraception desert.
But she still has a problem with birth control.
“I’m a military wife. So, every single time we move there’s some sort of problem or frustration with my birth control,” she told Healthline.
In a recent move from Maryland to New York, a glitch caused her to lose her insurance for a month. Then her new insurance forced her to switch pharmacies.
In another series of mix-ups, her prescription was lost. Now she’s only allowed a one-month supply at a time. She has to call two weeks in advance to get the next month’s supply on time.
Having just moved, she can’t get in to see a new physician for three months.
“Insurance is just a disaster and it shouldn’t be that big of a deal,” said Holmes.
“You need to get an exam to continue. I have a real problem with that. They use birth control as a carrot to get you to make another appointment, even though I’m perfectly healthy,” she explained.
Holmes is frustrated with policies surrounding women’s reproductive health.
“If politicians really wanted to help women, they would make birth control over the counter. It would be cheaper and more accessible and the risks aren’t that high. They turn it upside down to make it seem like they care, but it sounds like they just want to get elected,” she continued.
Several states, including California, Oregon, and Colorado, now allow pharmacists to dispense oral contraceptives without a prescription. Similar legislation is under consideration in other states.
But according to Nagori, this isn’t well known and only about 10 percent of pharmacists are actually offering that service.
Ruiz noted that one of the major accomplishments of the Affordable Care Act was that most insurance plans, including Medicaid, pay for contraception.
“But exceptions were carved out and it depends on the state you’re in. Some states are making it more difficult for women to get appropriate care. It’s done on purpose,” said Ruiz.
How neighborhood clinics can help
Uninsured patients are falling through the cracks, according to Ruiz.
“For some, the best place is Planned Parenthood. If you don’t have insurance, they have floating price scales based on your income. Other clinics use the same price model,” he explained.
Lizette Caldera is women’s health coordinator at AltaMed Health Services in California.
AltaMed is a group of community health centers in Los Angeles and Orange counties.
“Our women’s health department disseminates information through education and outreach. We talk to them about Family PACT, which is a big part of what we do,” Caldera told Healthline.
Family PACT (Planning, Access, Care, Treatment) is administered by California’s Department of Health Care Services, Office of Family Planning.
“We help enroll females and males into the Family PACT program. If they qualify, they have access to free birth control. They receive a card and they can get services at any AltaMed location or any family planning clinic in the state,” she said.
For anyone who doesn’t live near a clinic like AltaMed, Caldera recommends searching online, starting with your county’s website.
She also suggests visiting Bedsider.org, a birth control support network. The site provides a database of birth control providers and is searchable by zip code.
Education is key, according to Caldera. And that goes for men, too. Especially young men.
“When we educate boys on birth control, they often feel it doesn’t apply to them. It’s difficult to get a teen’s attention. I honestly think they can play a huge role and we don’t bring them into the conversation enough,” she said.
With or without a steady partner, Caldera believes you should be creating a reproductive life plan to support your goals.
“Decide if and when you want to have kids. Determine the gap between each child. Then find the birth control method that will fit best. It’s key for your plans for what you want to do with your life,” she advised.
“And if you’re not looking to have children in the next 10 years, there are long-term methods. When you have an IUD inserted, you’re protected for 12 to 14 years,” said Caldera.
Telemedicine filling the gaps
There are a growing number of services where you can order birth control online without visiting a healthcare provider or a pharmacy.
But are they a good idea?
“Online clinics are useful and can be a way to give access to people not near an urban center or community clinic,” said Ruiz.
The most important thing is to answer the online questionnaire honestly, he cautioned.
Among those who shouldn’t take hormonal contraception are people with a history of deep vein thrombosis or uncontrolled high blood pressure. People who smoke, especially those over 35, shouldn’t be using birth control pills, said Ruiz.
According to Nagori, there’s a safe level of counseling that occurs in the physician-patient interaction that can be preserved in a telemedicine visit.
“With issues and policies preventing access, telemedicine can get into pockets of the country that don’t have clinics. Even at Planned Parenthood clinics, women are intimated by protesters and that creates another barrier for patients,” said Nagori.
“Our telemedicine company was founded in 2015. We decided birth control is the next issue we want to tackle. At SimpleHealth.com we want to help provide access for something that should be simple and routine,” she explained.
SimpleHealth is up and running in California, Florida, Illinois, New York, Pennsylvania, and Texas. They plan to be active in 20 states soon, eventually serving all 50 states.
Insurance is accepted but not required. There’s no fee if you’re transferring an existing prescription. Otherwise, there’s a $20 fee.
Once you choose a birth control method, shipping is free and refills will be sent before your supply runs out. Cost of contraceptives varies.
But there are still problems with getting birth control online.
“Even if you have insurance, you may be tied to a certain pharmacy. We’re really passionate about trying to change what we can about the health system that’s been broken and use all these wonderful new resources and new technologies to trim costs and get the patients the care they need,” said Nagori.
Visiting a doctor in person can involve time off work and lost pay.
The sheer number of patients per doctor can lead to long waits and shortened appointments.
Nagori believes telemedicine may help ease those problems.
“If we can get some of these patients that really don’t need to be in a doctor’s office out, it will provide more time for physicians to spend with really sick patients. We can start changing how this behemoth system works. I know it’s a very lofty goal, but we’re trying to improve what we can,” she said.
More mail-order services
Regulations for telemedicine vary from state to state.
In some, a questionnaire will suffice. In others, it also takes a phone consultation.
These are some of the services that are available in multiple states:
- Lemonaid has a consultation of $25 out of pocket, but you can use insurance for your prescription. Delivery is free.
- Nurx accepts many health insurance plans. But if you’re uninsured, you can get birth control starting at $15 per pack. You get automatic refills and shipping is always free.
- The Pill Club accepts most insurance plans. Without insurance, birth control starts at $20 for a three-month supply after a $15 consultation fee. Shipping is free.
- Planned Parenthood has an app through which you can order birth control. Prices vary by state and income level. They offer auto refills and free delivery.
- Plushcare accepts many insurance plans. If you have insurance, your consultation will be free or will reflect your co-pay. Without insurance, the consultation is $99.
- PRJKT RUBY doesn’t accept insurance, but you can get birth control for $20 a month with free shipping and automatic refills. For each month you order, 25 cents will be donated to support contraception access in developing countries.
- Virtuwell has a consultation fee of $49, but insurance could lower that cost. Prescriptions are sent to a local pharmacy for pickup.
Telemedicine options for birth control are changing rapidly, so look for frequent updates to these sites, as well as the addition of new ones.