A Smarter Way to Compare Birth Control Methods
Katie M. Palmer
It's easy to find sites listing efficacy rates and side effects, but you rarely get a sense of what it's like to live with a given method of birth control every day.
It's happened at the last two parties I've gone to in the Bay Area: At a certain point in the evening, a group of women ends up sitting together, forming a slightly closed-off circle. Maybe a single dude is hanging around, standing at the periphery. He'll interject once in a while, but there's not much he can add here: It's time to talk birth control. Those NuvaRing commercials where a gaggle of girl pals trades info about insertion and ease of use come off cloying and cliche, but … man. They're not totally off the mark.
These conversations happen everywhere, and they reflect a big gap in information available about birth control methods. Ninety-eight percent of women in the United States will use some form of birth control during their lives, and with a rapidly expanding field of methods---IUDs and condoms and implants and pills and rings and dear God what is that spongy thing—the pros and cons are becoming much more complicated to parse. But it doesn't have to be that way. Good data and good design, from outside companies and health care providers, can help women deal with the tyranny of choice.
Right now, though, there's a serious dearth of tools available to weigh the options.
Information on this stuff has always been out there. It's just hard to parse. Google "birth control" and your first four results will be ads. Then comes Planned Parenthood's general information page about birth control methods---it's unwieldy and text-heavy, putting the burden on the reader to click through every page from top to bottom, or to know exactly what they're looking for. Then you get to someone squatting on the domain birthcontrol.com. It's easy to find sites listing efficacy rates and side effects, but you rarely get a sense of what it's like to live with a given method of birth control every day. "There's a lack of curation and quality and accuracy of information that women can find about birth control options online," says Christine Dehlendorf, director of the Program in Woman-Centered Contraception at UC San Francisco. "I think we need a better way to capture lived experience, but I don't know if there's a good way to quantify it."
One company that's making an attempt is Iodine, which surveys patients' experiences with all sorts of medications and tries to turn them into useful information. (Disclosure: Iodine's co-founder Thomas Goetz is a former executive editor of WIRED.) To an extent, you could get that kind of information from Reddit and similar forum-based sites---like one of those party powwows, but at home in your PJs!---though they're not especially curated, and you're likely to find more horror stories than considered reviews. Iodine attempts to get the best of both worlds by quantifying certain elements of the overall experience of a drug: It asks users to rate whether it worked and whether it was hassle, as well as (in what seems like it ought to be an Elaine-from-Seinfeld reference) whether the drug was "worth it."
"The goal of our website has always been we want to gather everyone's experiences," says Katie Mui, healthcare economist at Iodine. So I was surprised when, back in January, I looked at the startup's newly-redesigned site and found no information about the pill or other methods of birth control. (The pill in several forms shows up in the 100 best-selling pharmaceuticals in the United States.) Iodine had the data, it turned out---they just hadn't been able to turn it into anything useful.
The problem was that the data was pretty messy. Iodine asks users questions with Google Consumer Surveys, which function kind of like ad veils on online content. To reveal an article on a website, readers would have to answer a few simple questions about whether they thought their birth control (or other pharmaceutical product) was worth it. After just a few weeks of data collection, though, Google shut the birth control questions down. Even though the data was anonymized, readers didn't like a form probing for information about their reproductive choices.
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Eventually, though, Iodine decided it had enough data to build something. Today, the company has released their findings, along with an interface that attempts to help women and their partners understand the pros and cons of different birth control methods. In addition to Iodine's subjective "worth it" rating, you can also look at cost, failure rate (not efficacy rate, as it's often framed), frequency of use, whether hormones are involved, whether a method allows for spontaneity, whether it regulates your menstrual cycle, and whether it has side effects. The comparison tool---based on one from Cars.com---lets you pick the parameters most relevant to you and then ranks the choices. Then you can dive into the deep information on the top-ranked methods, analyzing data like specific side effects reported to the FDA, or even parsing user reviews by age group.
Of course, the method comes with limitations. Though the original source of data was relatively randomized---the survey came to the users, not the other way around---Iodine will continue to solicit reviews on its site, where users are likely to over-represent negative experiences. Dehlendorf calls this the "silence of the satisfied user." If you're happy with your current birth control method, you're less likely to stumble across a site like Iodine and leave a positive review.
Other groups are attempting to work around those challenges. Dehlendorf is working with Bedsider.org (a great comparative resource, and the number three Google result for "birth control") to develop a contraception choice website that patients can use while they're in the doctor's waiting room. Like Iodine's tool, it's intended to be a starting point for conversation, giving women the right information to ask smart questions when they choose a birth control method with their doctor. Hijacking party conversations is one way to get information out there. Maybe technology can be too.
Katie M. Palmer is a senior editor covering science and health.
Topicsbig datahealth