Birth control in the digital age

Photo inspired by “La Femme Fetal,” a sculpture created by former UC Berkeley student, Claire Astrow.
Michael Drummond/Senior Staff
Photo inspired by “La Femme Fetal,” a sculpture created by former UC Berkeley student, Claire Astrow.


We have sent robots to Mars, yet many people in the United States still lack the resources to plan their families.

Benefits of family planning are far-reaching, including reducing pregnancy complications and infant mortality, advancing educational attainment and slowing population growth. Efforts to increase birth control accessibility have resulted in innovative models aimed at reducing barriers to access.

The Pill Club, which started distributing out of Redwood City in August, is a pharmacy that only supplies birth control. With the goal of simplifying and personalizing the process of obtaining contraceptives in a cost-effective manner, the Pill Club mails prescriptions directly to its patients’ homes and utilizes text messaging for responsive communication.

CEO Nick Chang said his vision for the company arose through his work in family planning. Seeing how many unplanned pregnancies occur in the United States, the highest of any developed country, spurred his interest in finding a way to help.

Unplanned pregnancies are most common among women ages 18 to 24 in the United States. Low-income, cohabiting and minority women are also disproportionately affected. Statistically, unintended pregnancies adversely impact maternal and child health outcomes, making their reduction a public health goal. The Healthy People 2020 campaign, a U.S. Department of Health and Human Services initiative, aims to increase intended pregnancies by 10 percent between 2010 and 2020.

Chang said college students and young professionals are the Pill Club’s target demographic but that they serve anyone of reproductive age. The Pill Club offers birth control in the form of the pill, patch, ring and injectables, but it does not offer insertions such as the birth control implant or IUD.

To receive their services, users must switch their prescription over to the Pill Club’s pharmacy and provide insurance information if they want their medication covered. The Pill Club then mails their order at no additional cost, and nurse practitioners communicate reminders and answer questions over text message.

Work and school make scheduling doctor’s appointments, refilling prescriptions or consistently taking medication difficult, all of which confound the effectiveness of birth control and burden the user. Nap Hosang, lecturer of maternal and child health in UC Berkeley’s School of Public Health, said other companies such as Pandia also mail birth control and automate refills. The Pill Club, however, is its own pharmacy and is pioneering a texting intermediary in the United States.

With the goal of simplifying and personalizing the process of obtaining contraceptives in a cost-effective manner, the Pill Club mails prescriptions directly to its patients’ homes and utilizes text messaging for responsive communication.

“The thing about the Pill Club that makes it so interesting is not only does it increase access … but it’s convenient,” said Larry Swiader, vice president of digital media at the National Campaign to Prevent Teen and Unplanned Pregnancy. “It’s confidential (and) appealing to people who are digitally fluent.”

Since its recent opening, the Pill Club already has thousands of users, which Chang said is exciting yet unexpected. “(It) goes to show that we are doing something right in that there is a big need here.”

Swiader said his group has found that compelling and well-timed text message reminders have improved consistent birth control usage, considering the surging rate of smartphone adoption for 18- to 24-year-olds.

The Pill Club has automated aspects of the typical pharmacy process in order to reallocate funds to support more thorough and personalized patient care. Low barriers to entry for patients, coupled with profits made on each medication from insurance, makes for an effective business model in which delivery costs are covered, Chang said. He added that automation is used only in instances where patients benefit, such as reducing errors made in repetitive tasks such as packaging medications. Chang hopes the Pill Club will soon be able to make prescriptions with an online survey, which would further improve access for individuals who do not have a doctor.

Students who use SHIP would be reimbursed if they decided to get their prescriptions through the Pill Club, said Kim LaPean, communications manager for the Tang Center. LaPean added that the Tang Center, too, has been working to make contraceptive access easier for students, mainly by streamlining the refill process through an online system since August. By January, LaPean hopes the Tang pharmacy will offer prescription refill services directly.

In April of this year, hormonal contraceptives became available for distribution by pharmacists without going through a doctor. But patients are still required to pass a screening process to obtain the medication, such as having their blood pressure taken and filling out a questionnaire, because hormonal methods are not yet over-the-counter.

Hosang and Professor Malcolm Potts of the School of Public Health are involved with efforts to make oral hormonal contraceptives available over-the-counter.

The Pill Club model, and other companies of its ilk, indicates a push toward telemedicine, or the treatment of patients through telecommunications technology. Telemedicine allows patients to access medical care remotely and without the pressures of a clinic visit. Through apps such as Facetime, medical professionals can inspect eye color, gather medical history and other aspects of a physical exam, Hosang said. He added that a limitation is transferring information, such as the results of an at-home blood pressure test.

“A lot of the barriers to contraceptives are slowly being eroded,” LaPean said, adding that she sees advantages in the Pill Club for students at campuses with fewer resources than UC Berkeley. “I think anything that makes the process easier is good.”

Currently, the Pill Club operates only out of California but mails prescriptions out-of-state. Chang hopes the Pill Club will be licensed to open pharmacies in a majority of states in the next year and eventually wants to bring the model to other countries. Hosang, who has worked with maternal and child health care in developing countries, said parts of the model could be successful internationally, while others may not.

Poverty, along with a lack of infrastructure, is the largest barrier for women to access contraceptives in developing countries, Hosang said. In India, for example, although the birth control pill is over-the-counter, a widespread rural population results in very low prevalence of use. Additionally, where costs are largely upfront due to a lack of insurance coverage, price can be prohibitive, and women would rather buy food for their children, he said.

Hosang said the text messaging aspect could be successful, as “by and large, women do have cell phones even in the poorest places,” and there has been some success with existing texting platforms in eastern Africa. He said, however, that there would be no means of paying the nurse practitioner intermediaries. “I think the system would fail because the behavioral economics don’t work,” he said, adding that a phone reminder in such cases would be counterproductive.

Chang and Hosang emphasized the importance of male participation in improving access. “Largely, I think this is a question for men to do some introspection on, and the results will show,” Hosang said.

Despite President-elect Donald Trump’s stated intent to repeal the Affordable Care Act, LaPean said the Tang Center’s options for birth control access shouldn’t change. She said it had already proactively added birth control coverage at 100 percent before the Affordable Care Act went into effect. “Certainly I think in the national level we are keeping an eye on it,” she said. I think a lot of women are, as well, because we think it’s an important part of the ACA.”

Swiader said, “We are holding our breath to see what will happen.” He added, “I’m hopeful that because access to birth control use is a bipartisan issue, that level heads will prevail, and contraceptive access will be preserved.”

Abortion has been more partisan. Around 6.1 million pregnancies occur each year in the U.S., of which nearly half are unplanned. Of those unplanned pregnancies, just less than half result in abortions. “Mechanisms that improve the ease of access and the affordability will all contribute to the reduction of unintended pregnancies,” Hosang said, which, by extension, reduce abortions. The Pill Club is one of many efforts important to achieving this goal.

Increasing awareness of the benefits of contraceptive access is important, Swiader said, and college students are well-positioned to advocate for a wide range of options and greater accessibility where it may be lacking.

“We should talk about it as part of our lives, and we should be intentional about having a family or adding to our family,” he said. “It’s one of the biggest decisions we make.”

Contact Hannah Lewis at [email protected]