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Online birth control services, which have grown in popularity in recent years, do a good job of screening women for health conditions that may become dangerous when taking birth control pills, according to a new study that sent "secret" shoppers to test the safety of these companies.
The study, published last month in the New England Journal of Medicine, aimed to address concerns over online birth control sites and apps, which make access to birth control as simple as downloading an app or filling out a form online.
“Given all the concerns regarding the quality of these companies, they actually appear to be very safe for women to use,” said lead study author Tara Jain, a candidate for a joint medical degree and an MBA at Harvard University.
Complications from hormonal birth control are rare, but can be serious or life-threatening for women who have certain health conditions including lupus, migraines with aura, uncontrolled blood pressure or diabetes, or a history of blood clots.
To determine whether women were being properly screened before receiving birth control prescriptions, researchers from Harvard and the University of California, Davis, conducted a secret shopper study, sending seven shoppers “undercover” to buy birth control from nine different online providers, for a total of 63 virtual visits.
Five of the seven secret shoppers claimed to have medical conditions that would make taking certain oral contraceptives risky. Of the remaining two shoppers, one didn’t claim to have any medical conditions, and one said she may not be able to commit to taking a pill at the same time every day. (Taking the pill at different times could decrease its effectiveness.)
Birth control prescriptions were written three times for the five secret shoppers with medical conditions that would put them at risk. In other words, only three out of 45 virtual visits led to inappropriate prescriptions. In one of these instances, birth control was prescribed to a woman for whom taking the medication would pose a serious health risk.
Different companies took different approaches to prescribing, the study found.
“Generally, all patients fill out a questionnaire, a doctor reviews it and then writes the prescription when appropriate,” Jain said. All of the providers closely followed prescribing guidelines from the Centers for Disease Control and Prevention, and asked the same questions that doctors ask during in-person screenings. But in less than one-third of the visits, the doctor interacted with the patient directly, either through messaging, video or a phone call.
What’s more, none of the companies asked about a woman’s ability to stick to taking a pill every day, or discuss other options that may be a better fit, such as long-acting methods including intrauterine devices or IUDs, which are 99 percent effective in preventing pregnancy, compared with the pill’s 91 percent effectiveness. Contraceptive patches, rings and shots are also options a woman may consider.
Still, “the study shows that there are ways to build in screening questions to make sure women aren’t prescribed these contraceptives inappropriately,” said Dr. Jennifer Robinson, an assistant professor in the Division of Family Planning at the Johns Hopkins School of Medicine who wasn’t involved with the new research. Robinson added that for women with medical conditions that could make taking birth control unsafe, pregnancy would pose a much greater health risk than oral contraceptives.
The study also looked at other aspects of online prescribing services. Costs ranged from as little as $67 for a year’s supply to as much as $519. Some, but not all, accepted insurance.
How the medicine was delivered also varied: Some companies mailed the prescription directly to the patient, while others sent it to a pharmacy. In both cases, the pharmacist would act as an additional medical professional who can screen women for any possible health concerns.
Overall, where safety and access was of concern, online providers performed well and filled in some of the gaps that prevent women from accessing birth control.
Online prescribing services help any women who struggle to access both a doctor’s office and a pharmacy, who do not have health insurance or simply don’t have the time to go to a clinic, said Dr. Lauren Thaxton, an assistant professor of women’s health at the University of Texas at Austin’s Dell Medical School.
These services can be particularly beneficial for women in rural areas, where it’s difficult to get to a doctor, Thaxton added.
The American College of Obstetricians and Gynecologists announced last month its support for over-the-counter access to all forms of hormonal birth control, including pills, patches, shots and rings. Still, the new recommendations do not mean the prescribing policy will change.
“We recommend that women be allowed to self-screen for over-the-counter pills,” Jain said. “But right now that isn’t an option, so these businesses are safely filling a very important need for women.”