The problem with mail-order birth control

Thanks to the current administration’s domestic gag rule and religious exemptions to the Affordable Care Act’s requirements around birth control, access to contraceptives is incredibly restricted for women in the U.S. As a result, more and more women are starting to turn to mail-order services as a quick and cheap source for birth control pills. But many of these women may not be aware that they are putting themselves at risk by obtaining their pills this way.

According to a recent Vice report, this is because birth control pills can be exposed to high  temperatures in un-air conditioned mail trucks. Birth control brands such as Sprintec, Yashmin, and Ortho Tri-Cyclen Lo assert that their pills should be kept between 68 and 77 degrees Fahrenheit, or they could potentially lose their potency. A 2017 report, however, showed that roughly 70% of United States Postal Service delivery vehicles did not have air conditioning. Some were even reported to have reached 117 degrees.The USPS also does not have a separate system to deliver medications. Cargo holding facilities typically do not have air conditioning, either, and three big providers of mail-order birth control — Planned Parenthood, Nurx, and Hers — do not use air conditioned cargo storage for their operations. 

This lack of air conditioning helps to keep costs low — but at what cost to the customers’ health?

While not a lot of research has been done on the effect of temperature on birth control pills, toxicologist Scott Dudley told Vice that birth control is “mostly hormones, like estrogen and progestin, and we do know, like all proteins, they are sensitive to heat for a prolonged period of time.” He asserted that temperature changes “can cause a loss of potency and decrease efficacy. The results can be pretty dramatic, especially when you’re talking about somebody who is trying to prevent conception.” 

This potential health risk, and lack of public awareness about that risk, could be detrimental to a large number of women of all ages in the country. According to the Guttmacher Institute, 25% of sexually active women in the U.S. take birth control pills — the highest percentage of use compared to other contraceptive methods — and 35% of sexually active adolescents (women between the ages of 15 and 19) are on the pill as well. This is mostly due to its less than 1% failure rate, if used correctly — and, it’s assumed, if temperature in this instance has no effect on the medication.

Lower-income women are particularly at risk, because the unplanned birth rate for women under the poverty level is already close to seven times that of women above it. Further, in 2014, an estimated 20 million women under the age of 20 sought publicly funded access to birth control due to their lack of finances and insurance. On top of these existing inequities, the administration is also trying to undermine Title X, which helps to fund family planning clinics, and low-income women account for two-thirds of the people utilizing Title X’s services. Thus, as clinics lose funding and raise prices, women with little income or no insurance turn to mail-order services, facing a $30 bill rather than one that is $200. The pills’ potential potency loss only increases their already high risk for unwanted pregnancies.  

The risks these women are facing are largely unknown to them because of the stark lack in research on birth control as a whole. Even after more than 60 years of existence, there has only recently been serious research done on the general effects of birth control on a woman’s mental well-being. All of this reveals a longstanding and largely ignored issue of the systematic exclusion of women from medical research. Women’s issues are scarcely researched, and not taken as serious concerns. The way in which women’s health is dealt with needs to be reformed heavily in order to inform reduce and inform people of risks, and improve access to health care, such as contraceptives, in safe and easily available forms.