Millions live in ‘contraception deserts’ – can telehealth help?

According to researchers, more than 19 million women of reproductive age are living in “contraceptive deserts,” defined as areas with fewer than one health center for every 1,000 women in need of publicly funded contraception.

Addressing these gaps requires a multipronged approach, say experts – including facilitating access to birth control via telehealth. Dr. Nancy Shannon, chief medical officer for Nurx, a specialty prescription app focusing on contraception and other services that recently announced a merger with Thirty Madison, says the company was seeing steady growth in demand even before COVID-19.

“But once COVID hit, people were concerned about going to their regular doctors,” said Shannon. The reluctance to seek in-person care compounded complications around pharmacy availability, she explained. “Pharmacists have been getting sick; their families are getting sick.” 

Meanwhile, pharmacies have often been the first points of contact for services such as COVID-19 tests and vaccines. “People are asked to do more, and it has just put a huge demand on our pharmacy system,” she said.  

The end result, she says, is that when people need birth control, it’s sometimes hard to find. That’s where telehealth can come in.   

“From the privacy and comfort of their own home, patients can let us know about their health history and any concerns they might have, and our providers will, if it’s appropriate, write a prescription for birth control,” said Shannon.

She explained that Nurx’s model allows for overnight delivery of medication – which, in some circumstances, can be highly necessary.  

The efficacy of emergency contraception, for instance, depends on having quick access to it. Pharmacists in some states can refuse to carry it, although some brands are available over the counter. Other options that are more effective for patients who weigh more than 165 pounds are still prescription-only.   

“Nurx can be contacted anytime, day or night,” said Shannon. “If you have a phone – or you could go to the library – you can request this, and it will be shipped to you overnight in a very plain, unbranded envelope.”  

She notes that this method could potentially provide access to contraception for patients who may face hurdles beyond transit.

“There are people who don’t feel safe letting those they live with know about this, or feel that they could comfortably raise a child in those circumstances,” she said.  

Of course, telehealth itself has its own access issues.  

For instance, Nurx is currently only available in 37 states, although Shannon says there are plans to expand.  

“Regulatory hurdles have kept us out and we’ve progressed more slowly,” she said. “Telehealth is regulated by state laws.”  

State policies also vary with regard to how old patients must be to receive services, with some allowing providing sexual healthcare without parental consent to patients as young as 12. Nurx doctors prescribe acne medications to teens with a parent or guardian’s permission. Other service lines are for patients 18 and up.

Though Nurx’s reproductive care also includes treatment for sexually transmitted infections and PrEP, Shannon says there aren’t currently concrete aims to expand into abortion care, which is also only available in a patchwork capacity throughout the United States.  

“There have been internal discussions about it, but we’re a young scrappy startup still,” she said.   

Details about Nurx’s expansion plan under the Thirty Madison merger will also not be available until the deal is finalized in about a month.  

Overall, though, Shannon says the Nurx model allows patients to take control of services that are still often stigmatized.  

“There’s a lot of people who love the privacy and ask us confidential questions that they wouldn’t feel comfortable talking about face-to-face,” she said. “We want birth control to be the same as getting some antihistamines, but unfortunately I don’t think people feel that way yet.”  

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.