Online birth control providers are booming amid restrictive care laws

“When you don’t have the option of abortion, you better get your birth control under control,” said Dr. Sophia Yen, chief medical officer and co-founder of Pandia.

Despite many legislative changes beginning a few years ago, some providers say that the boom hasn’t slowed down. Women are increasingly looking to access reproductive care outside the traditional health care system amid threats from anti-choice proposals. An April 2023 survey from Kaiser Family Foundation found that one in four women wanted to use telemedicine to get birth control because it’s delivered to their home. Four in 10 don’t have a regular doctor, and one in five never had an in-person birth control visit.

Yen attributes the increases to women becoming more aware of the concerns around reproduce health care — and wanting some privacy in their health care choices. Pandia, which issues prescriptions based on a questionnaire, estimates about half its customers live in southern states. A month after the Dobbs decision, subscriber rates went up by 44% in Florida, 66% in Georgia and 77% in Texas.

“People are more honest on a questionnaire than video or a telephone,” Yen said. “It’s better without a voice, without that sense of judgment.”

The services are learning that every time there’s a ban or limit made to abortion, customer enrollment in that state usually spikes. In April 2023, Florida Gov. Ron DeSantis signed a six-week abortion ban bill into law that further restricts access to reproductive care except for limited health-related exceptions. After this move, Pandia saw a 10% increase in the number of new Florida-based customers signing up the next month. Similarly, the company saw a 27% lift in March 2023 compared to the month before in Georgia when the state’s so-called “heartbeat bill” was the subject of ongoing court hearings in the Georgia Supreme Court.

The concerns are ongoing as the November election draws near and reproductive health care becomes even more of a hot topic. A Nurx survey of more than 1,000 women published in July 2024 found that 54% of women are anxious about reproductive and sexual freedoms. More than one in four said they do not believe their right to contraception is secure. And about 71% of women have made at least one change to their health care because of the climate around reproductive care laws — whether that’s delaying preventative care or seeking emergency contraception to keep on hand.

Caroline Hofmann, chief business officer at Nurx, said birth control is a growing segment of the business, which also provides sexual health care like STI tests, mental health medications and skin care. Interest in birth control, however, has ballooned since Dobbs, especially among younger women and those located in the South. “We are in places where your next doctor might be 50 miles away,” she said. “We are in places where you can have your privacy. Not everyone will feel comfortable going to their local nurse or physicians because of the fear of being judged.”

In response to the current climate and its survey findings, Hofmann also said the company has decided to bring more awareness to protecting access to birth control. Part of that is a push to show how birth control can be more than just a tool to prevent pregnancy, helping with acne care or painful periods. Recent Nurx Instagram posts say things like “Your location should not limit access to birth control” or “Birth control is basic healthcare.”

“We are picking our moment to focus on these topics because we know that women’s attention is there and that we can grab people’s attention by educating on these topics in an election year,” she said.

Yet certain advertising limitations mean marketers in the space have to tread lightly. Meta, for example, won’t allow contraceptive or family planning companies to market to anyone under 18, and ads “must not focus on sexual pleasure,” per the policy. Hofmann said the goal is to put out messages that resonate with women who may be hearing misinformation on other social platforms. “We want to educate,” she said. “We are explicitly not partisan, but we want women to have all the information they need because everyone’s making a different choice for themselves.”

Beyond getting the word out, the growth of telehealth contraceptive care may be hampered by state laws. Pandia doesn’t operate in Louisiana and Tennessee because of state licensing laws that require video visits. Yen said this would drive up operational costs for its asynchronous prescription services.

“Having a video or phone doesn’t improve care, doesn’t change care, and only increases the cost and causes a barrier to access,” she said. “We need to fix that because there are [approximately] 10 states that we cannot go into because they have those laws.”

Barring any changes, though, Yen still sees a bigger future for the services — even in states that haven’t passed laws banning abortion access. Pandia saw month-over-month customer increases in New York, for example, as high as 20% following the Dobbs decision.

Yen attributes this to the ease of the service and the ability to keep another errand off the to-do list. Pandia estimated that a woman who has to wait 20 minutes at a pharmacy to pick up her birth control every month would spend 10 weeks of her life doing so.

“Even if there’s a pharmacy on every corner, you have better things to do,” she said. “People are stressed out, busy all the time. You have no time for that. None of us do. We have better things to do.”