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Who Accesses Birth Control Online? An Analysis of Requests for Contraception Submitted to an Online Prescribing Platform in the United States

Published:September 28, 2022DOI:https://doi.org/10.1016/j.whi.2022.08.001

      Abstract

      Introduction

      Telehealth has the potential to increase contraceptive access. Little is known about the characteristics of people using online prescribing platforms or whether these services help fill access gaps.

      Methods

      We analyzed requests for contraception submitted between July 2015 and September 2017 to an online prescribing platform that offers sexual and reproductive care in the United States. We analyzed the characteristics of people seeking contraceptives, prevalence of contraindications to hormonal contraception among contraceptive seekers, and extent to which online prescribing may close contraceptive access gaps.

      Results

      A total of 38,439 requests for prescription hormonal birth control were received during the study period, with requests increasing dramatically over this timeframe as the platform expanded operations to an increasing number of states. Methods were dispensed in response to 63% of requests. In this population seeking contraception, an estimated 1.2% had a contraindication to progestin-only pills, and an estimated 12.0% of patients who reported their blood pressure had a contraindication to combined hormonal methods. Few requests came from patients younger than 18 (1.2%). In multivariable negative binomial models, urban counties had a larger concentration of requests, whereas counties with higher rates of uninsured and poverty had lower rates of requests.

      Conclusions

      Results suggest that the population seeking contraception from one online prescribing platform has similar levels of contraindications to hormonal contraceptives as found in prior research. Future research should seek to understand why utilization of this online prescribing platform was lower among young people, how to expand outreach to rural populations, and what underlies individuals’ decisions about using these services.
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      Biography

      Alexandra Wollum, MPH, is a Senior Associate Research Scientist at Ibis Reproductive Health. Her research examines barriers and access to reproductive health services including contraception and abortion and the impact of social, economic, and contextual factors on reproductive health.

      Biography

      Carmela Zuniga, MA, is a Senior Research Manager at Ibis Reproductive Health. Her research focuses on documenting the contraceptive and abortion experiences of understudied populations.

      Biography

      Kate Grindlay, MSPH, is a research consultant with Ibis Reproductive Health. Her research focuses on novel forms of reproductive health access in the United States.

      Biography

      Daniel Grossman, MD, is the Director of Advancing New Standards in Reproductive Health at the University of California, San Francisco. His research focuses on improving access to contraception and safe abortion and evaluating the impact of integrating reproductive health and HIV services.