We recently posted an article titled ‘No Brainer: Recent Data Shows Birth Control Is The Best Method To Prevent Unwanted Pregnancy‘. While we know there are plenty of our readers who already understand the general message about this article, the reason we feel very strongly about this issue is because of the ultra divisive ways reproductive health is discussed, voted on, and talked about here in the United States, especially when it does not take into account the many other health reasons women take birth control aside from family planning.
Over the past couple of decades we have seen incredible innovation and progression in the types of birth control and contraception and sadly there is a lot of information that doesn’t always make it out to the mainstream. The benefits of having birth control more widely available need to be talked about more, and we firmly believe if every legislator and anti-birth control proponent knew about these, it could have a far reaching impact on women in terms of family planning, earning potential, education, health and more.
States like California, Oregon and Washington which have passed laws allowing birth control to be sold over the counter without a prescription is a major step forward in helping women make easier reproductive and family planning decisions, and in the long run prevent many unwanted pregnancies, and the rate of abortions. A couple of experiments conducted in Colorado as well as St. Louis, saw a dramatic result when long-acting, reversible contraceptives were given to low-income women and teen girls.
In Colorado, the pregnancy and abortion rates were reduced by 40%, in St. Louis, the teen pregnancy rate fell by 79%. These are stunning numbers, made all the more apparent when we realize that there are 3 common barriers to accessing birth control in the United States today: lack of accurate information, lack of access to effective birth control and lack of funds to pay for it.
With the slow change in knowledge, scientific data, and legislation reflecting the innovation we are seeing in this issue, we are also seeing a number of healthcare companies emerge in order to become an effective part of getting the right contraception to women more easily. One such company is NURX, a website and app started by two male entrepreneurs based out of San Francisco, who want to ensure that healthcare is more accessible, and not just a service set aside for those in a certain financial bracket.
Hans Gangeskar and A. Edvard Engesaeth (who is an MD) are the co-founders of Nurx, which allows women with insurance to get birth control free, and non-insurance customers to purchase it for $15. The best part is that it is delivered to a customer’s house. They have a team of medical doctors who can answer any questions, including Dr. Alyssa Dweck who we have featured on GTHQ previously, talking about the need-to-know facts about birth control. We had the opportunity to talk to Hans and another team doctor, Jessica Knox, who prescribes birth control as well as the HIV prevention drug PrEP. After all, we don’t want women across the country to have to experience what Amy Schumer did in the sketch below moving forward.
HANS GANGESKAR – CEO
How did you come up with the idea to create NURX?
Getting birth control to the people who need it is a huge public health concern. We kept thinking that there has to be a better way, and we thought given our backgrounds (my cofounder is a medical doctor, and I a lawyer and a programmer), we could help change this for the better.
We wanted to build a service that not only makes healthcare more convenient, but also one that really changes outcomes, and we’ve done that. But it doesn’t stop with birth control access. We also recently launched a service allowing people to get access to the HIV prevention medication, Truvada for PrEP.
The current system fails to get it to the women who really need it, and that’s why there are over 3 million unintended pregnancies in the US every year.
For those who are unfamiliar, how does it work, and can anyone use it?
After visiting Nurx.com, there are three easy steps to using the app:
- User Chooses Brand – The user selects their brand, answers a few questions, enters their insurance and shipping info.
- Doctor Reviews Submission – a Nurx partner physician reviews the request manually and writes a prescription.
- Delivered to Customer – The prescribed medication is delivered right to the user’s door.
In the US access to birth control often differs by state laws, and depends on an individual insurance coverage. How does Nurx fill in the gaps and fit into a woman’s existing regime?
We currently operate in California and New York, but will also be launching in Washington State this month (June). The state laws regarding telehealth are what have slowed down the expansion nationwide, because each state has different laws about this.
When using our app, users are shipped a three month-supply of their prescription, making the process more convenient. Unlike with similar apps, with Nurx, patients can use their insurance to cover their contraceptives, rather than being forced to pay cash. Those who do not have insurance, or just wish to pay with cash, can access brands for as low as $15 a month, and the delivery is still free to the end-user.
Earlier this year, California began allowing pharmacists to write a prescription for contraception. However, this law has not really changed much, and most pharmacies are unwilling to provide birth control under the new law. Jessi Phillips wrote a really good article about this in April for Vice’s Broadly. Phillips details how she called over a dozen pharmacies in Los Angeles, San Diego, and the Bay Area, yet none of them would provide her with birth control. According to her article, several of the pharmacists were aware of the law, but had not received the necessary training, allowing them to implement it. So, even though this law is a step in the right direction, it’s still a lot easier for women in California to use Nurx.
It’s not just birth control, but also emergency contraceptives and access to communication with a doctor. Tell us about these features of the app.
As far as communication with a doctor, users are able to send and receive messages through the app. Though most users prefer communication through the app, one of our doctors can speak to a user over the phone as well.
Regarding emergency contraception, users are able to request Plan B and Ella through the app. Those who have insurance can get one of these options covered by their provider. We’ve seen that many users request these to have in case of an emergency in the future. If a user does in fact need Plan B or Ella fast, we can deliver to a user’s door in under a couple hours or less using Uber Rush if they live in the Bay Area or in New York City. Another option is that we call it into a pharmacy where they can pick it up. Soon, we will also be expanding our two hour delivery service to other markets we serve as well.
Birth control has become quite a major topic across America with two major US Supreme Court cases involving the way patients have access to it through their employers (Burwell v Hobby Lobby, 2014, and Zubik v Burwell, 2016). What are your thoughts on how the politicized discussions over birth control affect a woman’s daily access to it?
We stand firmly against any move that restricts a woman’s rights over her own body. It’s hard to reason with those who oppose increased access to birth control. It just doesn’t make sense. One would think that conservative leaders would embrace increasing access to birth control with open arms- it reduces the teen birth rate, decreases abortions, and saves the taxpayers billions of dollars.
Nurx is part of a growing number of services aiming to help women directly with their reproductive healthcare needs. Why do you think we are seeing this movement?
Technology is a big reason for this. With technology such as Nurx, women are able to remove unnecessary barriers they often face today, and take more control over their own bodies.
One reason is that young people today have more liberal views on reproductive health care than older generations-even among self-described conservatives. According to a survey by the National Campaign to Prevent Teen and Unplanned Pregnancy, about two thirds of young conservatives think contraception should be affordable and accessible to women.
What are the benefits of someone using Nurx, as opposed to going to their local GP?
Users often tell us that it saves them time and stress. Instead of taking off work to go to a physical location, then waiting in line at the pharmacy, women can conveniently do this over their computer and save time and money. Another reason we often hear is because of privacy. Users tell us that they feel more comfortable asking questions they otherwise would not if they were interacting with a doctor in person. Thirdly, some of our users are under 18 years old and do not want their parents to know. We prescribe and deliver it to them in a discreet package, without advertising what they are receiving.
JESSICA KNOX, MD:
What are the birth control and contraception options available through Nurx?
Nurx offers a wide selection of combined hormone birth control pills, progestin-only pills, and the contraceptive skin patch and vaginal ring. Nurx also offers two emergency contraceptive pills, Plan B One-Step and Ella.
What is PrEP and why does Nurx offer this in addition to birth control?
Truvada for PrEP is a daily pill for HIV-negative people to prevent HIV infection. You can think of PrEP kind of like birth control, except for HIV – consistently taking one PrEP pill per day reduces the risk for getting HIV by more than 90%. PrEP does not protect against other STIs or pregnancy, and people using PrEP should still practice safe sex and use condoms consistently.
Nurx has set out to improve access to preventive medications, especially those we believe are underused due to unnecessary barriers to access. Both birth control and Truvada for PrEP fit this description. Surprising as it may (or may not) seem, many women who want birth control still have trouble getting it – this could be for a number of reasons, some as simple as it’s challenging to get into the doctor for a prescription, but some more complicated relating to personal reasons that may make it uncomfortable for a woman to go through the traditional channels to get birth control. Meanwhile, it is widely accepted that only a small fraction of the people who could benefit from PrEP are actually using it.
Lack of awareness of PrEP is a big barrier to accessing it – many people and even some doctors have still never heard of PrEP. And sadly, there is still a lot of stigma surrounding HIV and habits that may increase risk for HIV infection, even in the medical community. Many people who do know about PrEP often have trouble finding a doctor who is willing to prescribe it for them. Still other people have trouble accessing PrEP because getting a prescription for it requires talking to your doctor about some really personal information – this can sometimes be hard to do face to face!
What are some important questions every Nurx user should ask of their doctor if they aren’t sure about which medication to use?
Just like in a regular doctor’s visit, doctors at Nurx rely on our users to provide us with complete information about their health history, so don’t hold back or hide anything from us when you answer our medication surveys. If you’re not sure whether some information is important or relevant, just let us know anyway, and we will determine whether it should affect what we do or don’t prescribe for you.
We also want our users to share any and all of their questions and concerns regarding the medication they are considering. If you need help selecting a birth control pill, let us know what you’re concerned about – whether it’s acne, or the risk for blood clots with the pill, or anything in between.
You can also ask us about how to use the pill, patch, or ring correctly, and what to do if you miss a pill or are late applying your patch or ring. If you are curious about Truvada for PrEP, just complete a Truvada request and our doctors can talk with you about your risk for HIV and whether PrEP is an appropriate medication for you. Whether you’re requesting birth control or PrEP, we might ask you some pretty personal questions along the way, but it’s just because we want to provide you with awesome care and the best medication for you.
There is a lot of stigma around women’s reproductive healthcare in the US today, how do you think a service like Nurx will cut through all that and give women the resources they need?
Reproductive health is a very personal topic, and one that should be handled at a personal level. Nurx enables women to not only get on birth control during a busy day at work or from the comfort of their own couch (or wherever!), but also to keep a personal choice – personal!
No more sitting in the clinic waiting room, undergoing an annual PAP that is unnecessary for a birth control prescription, or having to talk to the receptionist, and the nurse, and the doctor, then standing in line at the pharmacy to talk even more to the pharmacy tech, and then the pharmacist just to get your birth control. Nurx gives you the space to talk directly to the doctor for as long or as little as needed to get a birth control or emergency contraceptive that is right for you, and then your medication is delivered directly to you.
PrEP through Nurx, while a little more involved because it does require a visit to a lab for testing prior to a prescription, also keeps the sensitive parts of the prescription process private.
Instead of rhetoric around birth control “encouraging sexual behavior” as certain types of legislators claim, making sex a shameful thing, how do we as a society stick to the information about birth control and not politicize sexuality?
Birth control is not a women’s issue. It is a human issue. Of course, current birth control pills are for use by women only (though happily, there are some male birth control medications in development). One unfortunate side effect of this fact is that women have long and solely endured the full weight of birth control – both the shame that some people would heap on birth control users, as well as the economic costs of obtaining birth control.
Yet birth control protects not only women, but also their male partners who are not yet ready to have children either, and also society at large, which ultimately bears at least some of the burden of many unintended pregnancies. We need to reframe the birth control conversation from a women’s issue to an issue of proactive family planning, one in which men have just as much stake and responsibility as women do.
What do you want every young woman reading this to know about their bodies when it comes to birth control and reproductive issues?
You know your body and mind better than anyone else does, and it is your duty and responsibility to take care of them both. There will be many people in your lifetime who have opinions about your body and mind and what you should do with them; some of those people may be sinister or selfish and have negative opinions and input for you, while others will have good intentions and offer positive feedback and guidance.
But ultimately, you have to feel good about who you are and the life you live. So when making choices about your birth control and reproductive health, put yourself and your health first. Ask all the questions you need – of your doctor, of your partner, and of yourself – and do not rest or settle until you have all the information to make the best decisions for your health and wellbeing. They are the most valuable assets you have. Do not leave them to chance or another person’s care – your health and wellbeing are yours to nurture and protect.
Want more info on NURX? Visit the website, and watch the video with founders Hans and Edvard answering the FAQ below: