Contraception Online

The goal of the program was to remove barriers to reliable contraception for any Oregon woman with access to a computer and a credit card — and in just under two years, it has done exactly that. Starting with emergency contraception (EC) and moving on to other birth control pills, patches, and rings, a wide range of contraception options are now available to women in Oregon and, more recently, Washington, through a collaboration with four Planned Parenthood affiliates in that state. As the idea of contraception online catches fire, there is talk of extending the program into other parts of the Pacific Northwest.

The Genesis

The idea behind Contraception Online came to PPCW president/CEO David Greenberg as he was driving back from a Planned Parenthood affiliate three or four hours outside of Portland. The drive was desolate — open space, populated by a single Indian reservation. He thought to himself, "I bet there are women out here who can't get the contraception they need." By the time he reached Portland, the seeds of Contraception Online had been sown.

With growing access to computers — not just at home but in Internet cafes and libraries — the perceived "digital divide" between the wealthy and the impoverished and the urban and the rural has narrowed in the 21st century. Indeed, the minds behind Contraception Online believed that computers had become ubiquitous enough for the project to reach many — though, admittedly, not all — remote areas of the state.

By October 2002, Greenberg's dream had started to become reality. Under the leadership of Women's Health Care Nurse Practitioner and PPCW Director of Medical Services Linda Bryant, EC Online began in November 2002 and Pills Online in April 2004. "We quickly ramped up to add the ring and patch," says Cathryn Wilcox, PPCW vice president of patient services, who along with Bryant has overseen the program from the start.

How it Works

With Contraception Online, a nurse phones potential patients who have requested EC or birth control via the Internet. She reviews a client's health history and alerts her to any warning signs or side effects — just as nurses do in health centers. Clients then receive EC or a two-month supply of the birth control method of their choice — they can pick it up at a nearby Planned Parenthood health center or have it mailed to them, or a prescription can be phoned into a local pharmacy. At the end of two months, the woman must provide a current blood pressure reading to PPCW — which can be done for free at the health center or off site by anyone qualified to take a blood pressure reading, in which case the results can be faxed or mailed in. If a woman's blood pressure is within acceptable limits, she can receive an additional 11 to 15 packets of birth control.

Vickie Pedegana, the online health center clinical manager at PPCW, has been the voice of Contraception Online since the start. (Recently, PPCW enlisted another nurse to help manage the ever-growing number of requests.) Pedegana estimates that 60 percent of the time women choose to come into a Planned Parenthood health center to pick up their birth control and roughly 10 percent request that prescriptions be called into outside pharmacies. All other birth control is mailed out — sometimes with priority overnight mail, especially with EC, which is more effective the sooner a woman takes it.

The process is streamlined, flexible, and client-centered. And the feedback has been overwhelmingly positive. Says Pedegana, "Our most common response is, 'You rock.'"

Who's Online

The demographics of Contraception Online have proven somewhat surprising, given the genesis of the program. "Our initial idea was that it would be suited for women in outlying areas," says Wilcox. By and large, that hasn't been the case. Indeed, busy suburban and urban women juggling a mix of children, home, and/or work have been Contraception Online's major users — more so than rural women.

Convenience, confidentiality, and money all play a role.

"Pretty frequently, we hear women say that they really like being able to order [birth control] online at 10 o'clock at night," says Pedegana. For many women, it may be the only moment they have to deal with this aspect of their reproductive health. Says Wilcox, "It's all about breaking down the barriers to access and breaking into the 24/7 world we all live in now."

For rural women, or women living in small towns, privacy is at stake. "To some, it's a matter of confidentiality — especially in those small towns, where everybody knows everybody, and your uncle is the pharmacist," says Pedegana.

And cost, as always, remains a concern. While Planned Parenthood health centers are committed to providing birth control and health care at the lowest possible cost, birth control can still be prohibitively expensive. Some users choose Contraception Online because they are struggling with insurance — either they don't have it, or their plan does not cover contraceptives or has such a high deductible that it's more affordable to pay out of pocket at Planned Parenthood. In the future, says Pedegana, "I hope we're able to offer some sort of funding program." For now, Wilcox says, "This is still the most affordable contraception around."

Initial Concerns

Putting EC and other birth control methods online posed a number of challenges to a "brick-and-mortar" health care model and to Planned Parenthood's commitment to providing affordable health care to the underserved. Wilcox says there was concern that Contraception Online would be serving a different population — people with money and credit cards. But when PPCW enlisted a business school student to look into the issue — and did some analysis of its own — they found otherwise. "Except for a slightly higher education level and a little bit higher income, there's not that much difference," says Wilcox. "Online patients really mirror our health center patients."

There was also some concern that online access would decrease the number of clients seen in the health centers, but that hasn't been the case. Many women still choose to come to the health centers to pick up birth control in person. "We have been able to connect those patients back to a bricks-and-mortar health center for exams and other services," says Wilcox.

Another worry was teens — particularly younger teens who do not usually have credit cards. Minors can legally access birth control in Oregon and have used the site, but the numbers have been low. Pedegana says she recently spoke with her youngest client, who was 15: "She had been talking with her mother about [getting birth control] and used her mom's credit card." Most women clients, she says, are between 19 and 23.

New Frontiers

In 2005, key staff from PPCW and several Washington state affiliates gathered together to discuss expanding services into Washington. "Everybody just jumped on the idea," says Wilcox.

"It took a lot of calls to standardize [procedures] within five [Planned Parenthood] affiliates, says Wilcox, but soon a system was put in place. The process has proved to Wilcox and others at PPCW what can be achieved through collaboration and consensus. PPCW, on behalf of the five affiliates, was awarded a Planned Parenthood Federation of America Fund for the Future grant of $60,000 in spring 2006, and with that, upgraded the technical infrastructure to support the expansion as well as develop a marketing campaign for the service. By May 2006, the Planned Parenthood affiliates in Washington were on board.

The response was almost immediate. Even with no marketing effort of any kind, 27 Washington women had found and used the site in its first month. "They covered rural and urban — all corners of the state," say Wilcox. Nursing staff at PPCW has indicated that the numbers for June and July were much higher — and growing. A full-fledged marketing campaign is slated to go live this fall, says Wilcox, and PPCW has invested in new, more robust software to meet the expected volume.

© 2006 Planned Parenthood Federation of America, Inc. All rights reserved.