About half of pregnancies in the U.S. are not planned, and non-use or inconsistent use of birth control is a leading cause. Both of these issues can be tied, in part, to a lack of accessibility.
How women access contraception has been a topic of debate in recent years, particularly whether to make more forms of birth control available over the counter and whether telecontraception – prescribing birth control through a website or an app – is safe.
A September 2019 research letter published in the New England Journal of Medicine outlined the results of a small study that examined the safety and efficiency of telecontraception. Patients completed an online questionnaire – and in some cases participated in a follow-up phone call – about their health and, if approved, received a prescription at a local pharmacy or through the mail.
"All women deserve safe, effective birth control if they want it."
researchers found that while such services improve access to contraception,
there are some concerns regarding potential gaps in the process of determining
a patient's best options based on her health needs and goals.
Telecontraception and over-the-counter birth control would certainly increase access for women, but only to a few types of contraception. Also, while some patients could avoid having to visit a doctor’s office to renew their prescription, there are many benefits to annual in-person exams.
We are not currently offering telecontraception – more research must be done. However, it's important for women to think about what they want out of a birth control option and whether a short- or long-term option is best for you.
Match your goals to your birth control choice
When a woman expresses interest in a contraceptive method, one of the first questions I ask is, “What are your goals for wanting to be on birth control?” Preventing pregnancy isn’t always the main reason. A woman may want to regulate her periods – or avoid them altogether – help manage pain due to menstruation or endometriosis or prevent a sexually transmitted infection.
Not every birth control method can do all of these things, so we want to make sure we are choosing the best option to meet your goals. Each comes with potential side effects. This is why we ask about your medical history so we can determine if you have any conditions that would increase the risk of complications.
Only after your goals have been determined, your medical history has been considered, and the risks and benefits of each option have been weighed, can we come to an informed decision on the best contraceptive method for you.
There are many types to choose from:
- Barrier methods: Condoms, diaphragms, and contraceptive sponges are single use and prevent sperm from reaching the uterus. Barrier methods can help prevent the spread of sexually transmitted infections. However, their failure rate is 18%, meaning 18 of every 100 women using this method will get pregnant. Often, this is due to improper use.
- Hormonal methods: Birth control pills, the vaginal ring, the patch, and contraceptive implants or shots use hormones to reduce the risk of pregnancy. Their failure rate is 6% to 12%, often due to missing a dose, improper use, or interactions from other medications. However, these methods can cause hormone-related side effects such as low mood, blood pressure changes, and weight gain.
- Intrauterine devices (IUDs): Inserted in the uterus, IUDs are the most effective long-acting reversible contraception (LARC) method. The failure rate is less than 0.2%, meaning less than 1 per 100 women will get pregnant when using an IUD.
- Sterilization: Getting your tubes tied (tubal ligation) is also highly effective, with a failure rate of less than 0.2%. It is considered an irreversible form of birth control. A woman should not choose this option thinking they may reverse it in the future.
- Natural family planning: This method relies on estimating ovulation dates and avoiding sperm-to-uterus contact during fertile days. The failure rate is high at 24%.
- Withdrawal method: This method relies on the male partner "pulling out" before ejaculation. However, sperm can be released prior to ejaculation, and the failure rate for this method is 22%.
Your annual exam should be about more than birth control
A physical exam is not always necessary to be prescribed birth control. But that shouldn’t be the only reason to visit your doctor every year.
Annual well-woman exams are an opportunity to discuss ongoing health concerns and focus on disease prevention. We'll discuss routine measurements such as height, weight, and blood pressure; perform a pelvic exam, breast exam, and a Pap test if you're due; determine whether you’re due for any vaccinations; and discuss concerns about tobacco and alcohol, intimate partner violence, and depression.
Discussing birth control will be related to these conversations. For example, while the risk of hormonal birth control causing a blood clot is low, it increases with risk factors such as smoking and high blood pressure. If you begin smoking or develop high blood pressure after being prescribed a birth control, we want to know so we can talk about quitting smoking, controlling the condition, or changing to a new contraceptive method that may be safer.
Concerns with over-the-counter and telecontraception
Over-the-counter medications are safe for most patients, but two main concerns are potential side effects and accessibility to all types of birth control.
Potential side effects
The recent study found a high rate of adherence to the recommended use of birth control in patients who used telecontraception services. However, there were a few gaps in the information requested in telecontraception online questionnaires and follow-up calls. For example, few organizations asked whether the patient could take a pill daily or whether they have other health issues that might cause unexpected side effects.
Barrier methods such as condoms already are available over the counter. Today, telecontraceptive services apply only to a few hormonal forms of birth control such as the pill, patch, and ring. An over-the-counter option wouldn’t be possible for methods like an IUD, arm implant, or birth control shot. These options must be placed by a medical professional.
Related reading: Would an IUD or birth control implant work for me?
Increasing access to birth control
So, how can we increase access while ensuring safe and effective contraceptive use?
One way is to avoid making women visit a clinic or doctor’s office multiple times a year to renew a prescription. We know the more often a woman has to make a trip to a doctor, the more likely she is to discontinue use or to use it sporadically.
There are few reasons I can think of why a woman couldn’t receive a year-long prescription. We could review the effectiveness of the method during her annual exam, and she'd be good to go for another year. Once-a-year visits are less time consuming and financially burdensome than having to stop in multiple times, particularly for underserved populations, those who live far away from their provider's office, and those with limited transportation options.
We want to empower women to take control of their bodies and their health. This includes assisting them to make the best choice for their contraception and overall health.