While many Republican male politicians and pundits have treated insurance coverage for contraception as some kind of indulgent luxury, Dr. Sophia Yen says it’s more of a basic human rights issue. “The number one cause of missed school and work” for girls and women is period-related symptoms, she explains.
“If you want women in the workforce and full participation, we can’t do that if we’re rolling on the ground from menstrual cramps and bleeding out,” she says, adding:
“If dudes were being blood-let one week out of four, they would have covered birth control years ago.”
This idea of reproductive medical care-as being central to empowerment is at the core of Dr. Yen’s work and the company she co-founded, Pandia Health, which she describes as the only doctor-led and woman-led birth control telehealth company. Pandia Health just launched its telemedicine service in Pennsylvania, making it one of 13 states in which they can do online doctor’s visits. They can deliver birth control to all 50 states, however.
“We only prescribe what we can deliver,” she says, “If you ask me what the best birth control is out there, I’d say IUDs and implants, but we can’t deliver those. Maybe someday we’ll have a drone and drop a robot and we’ll be like ‘ding dong, spread em’ and we’ll throw in an IUD.” But in the meantime, they send out hormonal pills, patches and vaginal rings.
In the future, it could be conceivable that doctors could even train patients to put in their own contraceptive implants, she says. “My 11-year-old could put in an implant if we trained her,” says Dr. Yen. “It’s not that hard, it’s not rocket science.” What is critical is having a doctor who is knowledgeable about the variety of hormonal options and which ones are best for which patients.
A joke in medicine is that most of the research on side effects and effectiveness of a medication is based on the “70-kilo white male,” according to Dr. Yen. But not all pills work equally well for every body size, age or ethnicity, a fact of which she says many physicians are unaware. “Norgestimate is what we were all taught in med school, and what we’ve seen is if you’re a person of color and it’s not working for you, maybe consider trying Desogestrel.”
Dr. Yen also mentions that she would recommend different dosages of estrogen for people under 30 years old, and issues a warning that for folks with a BMI over 26, Plan B and its generics won’t work but there are other options for morning after pills, like Ella. This is the kind of personalized care that every patient should expect to receive while discussing contraceptives, she says.
If you’ve ever been on hormonal birth control, you may know the fear of realizing you are low on pills and short on time to get a refill. Not being able to get a new pill pack on time is arguably a bigger deal than having a dwindling supply of toilet paper, and we saw in the last year what that kind of chaos that threat can cause. Dr. Yen refers to this stress as #PillAnxiety.
“If you don’t get to the pharmacy, there will be a dire consequence. You will either have a baby you don’t want to have, be pregnant, or you’ll bleed when you don’t want to bleed.”
This is why she says it’s important to provide the option of what she calls “set it and forget it” contraceptive delivery and to remove barriers to access.
“To cover birth control is fiscally smart and morally right,” Dr. Yen says. “Birth control pills are so inexpensive. Abortion is $800, a vaginal delivery is $10,000 and a C-Section is $40,000 and that’s not including the pre and postnatal care, the ultrasound, the doctors’ visits, and the impact of an unplanned pregnancy on a family who might have lost their job and insurance during COVID.”
Additionally, Dr. Yen also cites that 70 percent of hormonal birth control users are taking these medications for additional reasons besides preventing pregnancy. These meds can be used to control heavy periods and treat conditions like anemia, acne, and menopause side effects. The steady level of hormones can be beneficial for asthma, depression, seizure disorders and diabetes and even reduce the risk of certain types of cancer.
Further evangelizing the liberating powers of birth control, she has an entire TED talk about the upsides of rescheduling periods or eradicating them entirely. Preventing periods has not only a huge impact on the lives and performance of patients, but preventative health benefits, she says. “And not to mention the landfill. We use 10,000 to 13,000 menstrual products in our lives,” she says. Skipping periods means reduction of waste products and lots of savings in time and money.
“If you’re economically smart and you want to do good in this world, you absolutely should cover birth control,” she says, adding, “and it is a public health good that nobody is pregnant that doesn’t want to be pregnant.”
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