Ms. Q&A: Dr. Sophia Yen on the Explosion of Telehealth and the Future of Birth Control

While contraception delivery services are greatly expanding access to birth control, the growing industry is largely dominated by men. Dr. Sophia Yen, co-founder and CEO of Pandia Health, is the exception.

While COVID-19 rages across the U.S., women’s access to sexual and reproductive health has been devalued, ignored or restricted—a fight feminists will continue to wage long after the pandemic is over.

Even prior to the pandemic, accessing contraception was unreasonably difficult, with women being forced to jump through hoops and constantly stay aware of their dwindling supply of pills—a burden that is particularly onerous for poor women. Ninety-seven percent of women in need of publicly-funded birth control live in “contraceptive deserts,” or counties where demand for publicly-funded contraception is higher than the feasible supply, according to Power to Decide, a nonprofit aimed at preventing unplanned pregnancy.

One in three women reported to the Guttmacher Institute that because of the pandemic they had to delay or cancel visiting a health care provider for sexual and reproductive health care, or had trouble getting their birth control—and as is often the case, barriers to timely care were more common among Black, Hispanic, queer and low-income patients. When a monthly trip to a doctor’s office or pharmacy can put women and their families at risk, demand for non-traditional options like telemedicine is higher than ever.

Cue: contraception delivery services, like Pandia Health and others, which make it possible to order prescription birth control methods for home delivery. While these services existed prior to the pandemic, they’ve taken on a new significance in the age of social distancing.

But while contraception delivery services are greatly expanding access to birth control, the growing industry is largely dominated by men. 

Dr. Sophia Yen, co-founder and CEO of Pandia Health, is an exception. A clinical associate professor of pediatrics in the division of adolescent medicine at Stanford Medical School, Yen has decades of experience as a practicing physician. With Pandia, she’s worked hard to create a company that prides itself on informed consent, listening to patients, and putting medical expertise above profit margins.

Dr. Sophia Yen, Birth Control delivery
Dr. Sophia Yen, CEO & co-founder of Pandia Health. (Courtesy)

Ms. writer Katie Fleischer recently spoke with Yen about the explosion of teleheath, and Yen’s experiences as the founder of a women-led, doctor-led birth control delivery service.

Katie Fleischer: Pandia Health is at the forefront of an emerging telehealth industry. What’s your goal with this work? 

Dr. Sophia Yen: Pandia Health is the only women-founded, women-led, doctor-led company in birth control delivery.

I came up with the idea about six years ago, when I was giving a talk to a bunch of doctors, explaining, “Why don’t those pesky women take their birth control?” And one of the top three reasons was because they didn’t have it in their hand. It was a huge pain, having to run to the pharmacy every single month, and having to worry about, what I coined the term for, “pill anxiety.”

As you get to that last week of pills, if you don’t get to the pharmacy by the time you run out, there will be a dire consequence. So those of us with uteruses who are heterosexual and want to prevent pregnancy, or those of us who are using those medications to prevent bleeding or polycystic ovarian syndrome, acne, or other issues, suffer from pill anxiety for about 20 to 40 years of our lives. And so our goal is to make women’s lives easier, and Pandia Health was born as the end-to-end solution for birth control.

Fleischer: What services do you provide, and how does it work for patients?

Yen: As long as you ask a set of 20 questions and you get a self-reported blood pressure within the past 365 days, women are perfectly capable of saying, “Oh my gosh, I have one of these things. No, I’m not going to take the birth control pill.” And so that’s basically what we’ve done. We’ve taken the 20 questions that I would ask you if you came into my office, and we ask them online in a questionnaire, then we ask you for a self-reported blood pressure in the past 365 days, because we want to make sure it’s safe to give you the medications. 

We need a government ID and a selfie to prove that you are who you are. And then you pay us $20 per year to use our expert physicians. It’s cheaper than any copay, cheaper than driving to an office and wasting an hour of your time. And then that allows you 365-day access to our physicians. Our doctor looks at your information; if it looks good, they’ll write the prescription, send it to our partner pharmacy, bill your insurance, ship it to your door.

If you don’t have insurance, it’s roughly $20 for a pack of pills or $15 per pack with a three-pack minimum. We give you the options of the pill, the patch, or the ring, and we also provide emergency contraception, so that you can get it in advance of need. The key thing about emergency contraception is that if your BMI is 26 or greater, Plan B and its generics won’t work. So we provide the prescription one, Ella, which will work.

Dr. Sophia Yen, Birth Control delivery
Pandia Health allows patients to buy birth control online. (Courtesy)

Fleischer: Tell me about the #PeriodsOptional movement. I was always told that the placebo pills are necessary, but experts say that it can actually be safer to skip periods.

Yen: One, it is perfectly fine to skip your period if you’re on medication. That week off is not a period. It’s actually a withdrawal bleed. So the way that the pill, the patch, the ring works is it keeps your hormones up for three weeks. And then if you don’t take that last week, after two or three days off the medication, that’s when you have a withdrawal bleed.

But a period is when you build up that uterine lining and wait for an embryo. Let’s imagine that’s building up to a level of 10. But when you’re on contraception, it’s only building up to a level of two or three. A lot of people say, well, it’s unnatural not to bleed every month. Actually, the natural state of a female animal is pregnant or breastfeeding. How many periods do you have when you’re pregnant or exclusively breastfeeding? None. 

The pill was developed with this one week withdrawal. .. But that withdrawal bleed could be every three months, every six months. It could be never. 

You can ask your physician to give you the okay to skip the placebo, and have them dispense 17 packs of pills for the year. And doctors don’t know that, that is a huge education point that you as a person with a uterus can educate your provider on. 

More from Yen on why it’s safe to skip your period:

Fleischer: How has the COVID-19 pandemic affected Pandia Health and telehealth in general?

Yen: COVID-19 has actually been a huge promoter of adoption [for telehealth]. One, people are realizing, “If I go to the pharmacy, I risk standing in a line, somebody coughing on me, and infecting me.” And we actually calculated that women spend 10 weeks of their lives going to the pharmacy, waiting for the medication, and coming back home. We have #BetterThingsToDo! I’m giving you back 10 weeks of your lives by making sure you don’t have to run to the pharmacy.

And then the other thing is, we always had to explain to people what “asynchronous telemedicine” is. But now with asynchronous education, everybody understands it. And the medical field used to be really anti-telemedicine, but because of COVID, everybody is getting more comfortable with telemedicine. 

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Fleischer: Pandia Health stands out as the only telemedicine birth control company that’s women-founded, women-led and doctor-led. How does that affect the work you do?

Yen: The value of being the only doctor-led company is that I’ve taken a Hippocratic oath: Do no harm. Compare that to somebody who’s an MBA or J.D, who’s just trying to make as much money as possible. I will make money for my investors, but I won’t do it by pushing stuff you don’t need.

And I believe in specialists because I’m a specialist: I’m an adolescent medicine and young adult specialist, somebody who’s written 2,000 birth control prescriptions in the past two years, personally looked at all the side effects, noticed that there were ethnic differences in the side effects. And now we’re trying to study that to make sure that each woman has a tailored experience

And the other factor is, being female-founded, female-led, we have certain core values built into our company. Like the importance of informed consent. Some companies have been like, “Well, we’re losing money. So we’re not going to tell you about your three options. We’re only going to give you the pill or the ring,” and they totally omit the patch. But at Pandia Health we really look for people who care, and we’re here to use our dedication and expertise to make women’s lives better.

Fleischer: What barriers have you faced in creating this company, as a woman and a doctor?

Yen:  The example I give is, the two major birth control companies ahead of me were just like six months ahead of me, and they were both 21- to 23-year-old men. And they presented their idea and people were like, “Oh, amazing!” and they threw down money.

And then I came along with three times as many customers, and I’m just begging for money, and people are like, “Oh, no, there’s these two other companies already.” And I was like, “And you don’t think there’s room for the only women-founded, doctor-led company?” And so that was quite frustrating.

I think it speaks to the startup world, where only 3 percent of women-founded, women-led companies are funded. And part of that is the networking situation. I don’t drink. I don’t do sports. I don’t play basketball. I can’t go to your poker whiskey game. I mean, I’ve seen it at so many levels, places that you just can’t get in. And I’ve also seen it in terms of like, I’m not part of a fraternity. There’s no possible way I could join your fraternity!

And then, it’s also that they don’t understand the problem. For the longest time, the major investors were like seventy year-old dudes, and their wives or significant others were perfectly happy going to the pharmacy. But for those of us who have jobs and children and busy lives, we’d rather #SkipTheTrip to the pharmacy. 

Fleischer: How can consumers support women-led, doctor-led organizations?

Yen: We need consumers to be more savvy. When you’re choosing between two equal companies, choose the one that’s run by a woman, choose the one that’s run by a physician who’s taken the Hippocratic oath. And people can check out our nonprofit campaign that we’re launching, #FFFL, to support female-founded, female-led companies.

Those of us with uteruses, we just been sucking it up with all this crap, things that could be fixed if we were in power. But we are not a niche. We are the majority and that’s part of Pandia Health, we are building the brand that women trust.

Fleischer: In an ideal world, what policy changes would you like to see in order to help everyone access contraception? 

Yen: I think that contraception should be free. It should be covered by the government or your insurance. It’s fiscally smart and morally right to cover birth control. And the reason why is, for every $1 you spend as a private insurance, you save $4-5 in expenses. And as a public insurance, they’ve shown it’s like $7 in public expenses, because you’re avoiding an abortion or pregnancy. An abortion is $800, a vaginal delivery $10,000, a C-section $40,000, and that’s not including the pre- and post-natal care. Plus the consequences to society, and that person with the uterus and their family, to have an unplanned pregnancy. So it’s fiscally smart and then morally right to let people decide when and how many children to have. 

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Katie Fleischer (she/they) is a Ms. editorial assistant working on the Front and Center series and Keeping Score.