美国国家公共电台 NPR Birth Control Apps Find A Big Market In 'Contraception Deserts'

 

DAVID GREENE, HOST:

You know, there seems to be a smartphone app for everything. You need a taxi, you use a ride-sharing app. You want food, you have delivery apps that are a dime¹ a dozen. Well, now access to birth control is a few clicks away. Online services allow patients to avoid waiting rooms, pharmacies², even political controversy³. But is it safe to skip the doctor? We have two reports now - one from California, which is providing the service, and another from Texas, where women are using it. First, Lesley McClurg from member station KQED in San Francisco.

(SOUNDBITE OF FOOTSTEPS)

LESLEY MCCLURG, BYLINE⁴: It's nearly 8 o'clock at night. Rachel Ralph trudges⁵ up the stairs to her apartment.

(SOUNDBITE OF LOCK OPENING)

RACHEL RALPH: I'm very happy it's the end of the day.

MCCLURG: She works long, erratic⁶ hours at an accounting⁷ firm in Oakland, just across the bay from San Francisco. The floor of her artsy apartment is covered in mail. She picks up a package.

RALPH: It's just basic birth control pills. I've been on the same kind forever.

MCCLURG: She ordered a three-month supply of pills from an app called Nurx. It's one of several digital ventures, like Maven and Lemonaid, that provide contraception. Ralph heard about the service about six months ago when she was regularly working 12-hour days. She coordinated⁸ as much of her life as possible through apps.

RALPH: Food was delivered. Dinner was often delivered. Anything I could get sent to my house with little effort, the better.

MCCLURG: Millennial⁹ women like Ralph were some of the first users of Nurx. Hans Gangeskar is one of the founders¹⁰ of the San Francisco startup. He wanted to make it easier for women to access birth control.

HANS GANGESKAR: There's no offering for people who need something quickly from the healthcare system and then sort of just want to go on with their life.

(SOUNDBITE OF MUSIC)

MCCLURG: Lounge music plays in the background at Nurx headquarters, an upscale brick loft¹¹. Most of the company's employees are 20-somethings dressed in skinny jeans and T-shirts. Many consider themselves activists¹² trying to prevent unplanned pregnancies¹³.

GANGESKAR: We naively¹⁴ thought that if you go to a doctor, even if it's in a really red state and in a really small town, and you, like, suffer through the judgment¹⁵ and the questions, that you would walk out with a prescription¹⁶ to birth control. And the fact that that's not true really surprised us.

MCCLURG: That's why patient interactions take place almost exclusively in online chats. Jessica Horwitz is a nurse practitioner¹⁷ for the company who consults with patients.

JESSICA HORWITZ: Maybe they don't feel comfortable saying to their doctor in front of them, you know that birth control I was on before, like, killed my sex drive.

MCCLURG: The whole process is pretty simple. After users log into the app, they fill out a medical questionnaire.

HORWITZ: They tell us about their medical history. They give us a blood pressure check.

MCCLURG: Then a clinician, like Horwitz, reviews the answers and makes a suggestion for a pill, a ring or a patch. The morning-after pill is also available. If the patient has a question about the product, they can send a chat.

HORWITZ: And it doesn't matter what time of day it is, someone responds.

MCCLURG: Then a prescription is sent to a pharmacy¹⁸, and the drugs are mailed out. Jennifer Conti is a gynecologist at Stanford University. She says that process is safe, but something is lost in virtual medical care.

JENNIFER CONTI: The downside with making it too simplistic is that a lot of times in real life, there's follow-up questions.

MCCLURG: Conti says face-to-face interactions allow for more nuanced care, which she says is especially necessary for patients with medical complications.

CONTI: That's the situation in which you want to be seeing an actual gynecologist and talk in person about what might be the right method for you.

MCCLURG: But seeing a gynecologist is difficult for some women. Nurx sells contraception in 18 states. And some of their customers live in areas with no easy access to women's health services. For them, a smartphone is another way to prevent pregnancy¹⁹. For NPR News, I'm Lesley McClurg in San Francisco.

ASHLEY LOPEZ, BYLINE: And I'm Ashley Lopez in Texas, where many women live in these so-called contraception deserts. Claire Hammons is one of them. She lives in a small community in Central Texas about an hour and a half outside of Austin. It's called Llano.

CLAIRE HAMMONS: It's a very small town. There's a population of 3,000 people. But we have a lot going on. We're a huge art town. We have the Llano River. We're surrounded by state parks.

LOPEZ: Living in a small town like Llano has its drawbacks. There's only one doctor, and there are no clinics nearby. For Hammons, this means getting health care isn't easy. And Hammons says what she needs the most is birth control pills.

HAMMONS: I've been taking birth control since I was 16 because of endometriosis.

LOPEZ: Without birth control pills, Hammons is in a lot of pain every month. And a while ago, she had a particularly hard time getting a prescription. That's because she lost her health insurance.

HAMMONS: I really did not have - literally²⁰ have the money to go to the doctors, period. And the local doctor - the only doctor, you know - is $140 to get in.

LOPEZ: She would also have to pay out of pocket to pick up the pills every month at a pharmacy. And Hammons says she just couldn't afford it. But about six months ago, Hammons went online and found out about Nurx. The app offers birth control pills at a price she can afford, and she doesn't have to pay to see the doctor. Hammons says finding Nurx has been...

HAMMONS: Really amazing, and awesome²¹ and saved me a lot.

LOPEZ: Texas has become a big user base for the app. Dr. Brook²² Randal is a physician based in Austin working for Nurx. She says patients come from different backgrounds and use the app for different reasons.

BROOK RANDAL: A lot of them are low-income women who may not have a low-cost clinic available to them in the communities where they live.

LOPEZ: In 2013, Texas passed an abortion²³ bill that led half the states' clinics, which performed abortions²⁴, to close. Clinics that often also provided birth control and other medical services.

RANDAL: And so many of those women will tell us that they would've had to drive a really long distance in order to get to a clinic where they could get birth control economically. And so we provide an important service for those women.

LOPEZ: Advocates say the state has long struggled to serve low-income women seeking contraception. And access also got worse when Texas lawmakers cut funding for the state's family planning program. Stacey Pogue with the Center for Public Policy Priorities in Austin says the cuts came at a time the state's population was growing and more women were seeking services.

STACEY POGUE: The ability of our safety net system to meet those needs and deliver health care, to actually get health care to women who are looking for contraceptives and well-woman exams - that has certainly been diminished.

LOPEZ: Pogue says it's a good thing women are finding ways to get birth control pills through technology. But she says this app doesn't give women access to more effective birth control, like IUDs and implants²⁵. It also is not a substitute for clinics that provide lifesaving services like pap smears²⁶, breast exams and cervical cancer screenings. For NPR News, I'm Ashley Lopez in Austin.

(SOUNDBITE OF THE MICROPHONES SONG, “I WANT WIND TO BLOW”)

1 dime   

n.（指美国、加拿大的钱币）一角

参考例句：

• A dime is a tenth of a dollar.一角银币是十分之一美元。
• The liberty torch is on the back of the dime.自由火炬在一角硬币的反面。

2 pharmacies   

药店

参考例句：

• Still, 32 percent of the pharmacies filled the prescriptions. 但仍然有32%的药剂师配发了这两张药方。 来自互联网
• Chinese herbal pharmacies, and traditional massage therapists in the Vancouver telephone book. 中药店，和传统的按摩师在温哥华的电话簿里。 来自互联网

3 controversy   

n.争论，辩论，争吵

参考例句：

• That is a fact beyond controversy.那是一个无可争论的事实。
• We ran the risk of becoming the butt of every controversy.我们要冒使自己在所有的纷争中都成为众矢之的的风险。

4 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

5 trudges   

n.跋涉，长途疲劳的步行( trudge的名词复数 )

参考例句：

• She trudges, schlepps, trains, drags, trascines her load. 她吃力地跋涉，schlepps、trains、drags、trascines重荷。 来自互联网
• Matvey, who has not tasted food or drink all day, trudges up the hill again. 玛特威从一大早起就什么也没吃过，什么也没喝过，这时候却又爬上坡去。 来自互联网

6 erratic   

adj.古怪的，反复无常的，不稳定的

参考例句：

• The old man had always been cranky and erratic.那老头儿性情古怪,反复无常。
• The erratic fluctuation of market prices is in consequence of unstable economy.经济波动致使市场物价忽起忽落。

7 accounting   

n.会计，会计学，借贷对照表

参考例句：

• A job fell vacant in the accounting department.财会部出现了一个空缺。
• There's an accounting error in this entry.这笔账目里有差错。

8 coordinated   

adj.协调的

参考例句：

• The sound has to be coordinated with the picture. 声音必须和画面协调一致。
• The numerous existing statutes are complicated and poorly coordinated. 目前繁多的法令既十分复杂又缺乏快调。 来自英汉非文学 - 环境法 - 环境法

9 millennial   

一千年的，千福年的

参考例句：

• Both Russia and America looked to the future to fulfill their millennial expectations. 俄国和美国都把实现他们黄金时代的希望寄托于未来。
• The millennial generation is celebrating the global commons every day, apparently unmindful of Hardin's warning. 千禧一代显然对哈丁的警告不以为然，每天都在颂扬全球“公地”。

10 founders   

n.创始人( founder的名词复数 )

参考例句：

• He was one of the founders of the university's medical faculty. 他是该大学医学院的创建人之一。 来自辞典例句
• The founders of our religion made this a cornerstone of morality. 我们宗教的创始人把这看作是道德的基石。 来自辞典例句

11 loft   

n.阁楼，顶楼

参考例句：

• We could see up into the loft from bottom of the stairs.我们能从楼梯脚边望到阁楼的内部。
• By converting the loft,they were able to have two extra bedrooms.把阁楼改造一下，他们就可以多出两间卧室。

12 activists   

n.（政治活动的）积极分子，活动家( activist的名词复数 )

参考例句：

• His research work was attacked by animal rights activists . 他的研究受到了动物权益维护者的抨击。
• Party activists with lower middle class pedigrees are numerous. 党的激进分子中有很多出身于中产阶级下层。 来自《简明英汉词典》

13 pregnancies   

怀孕，妊娠( pregnancy的名词复数 )

参考例句：

• Since the wartime population needed replenishment, pregnancies were a good sign. 最后一桩倒不失为好现象，战时人口正该补充。
• She's had three pregnancies in four years. 她在四年中怀孕叁次。

14 naively   

adv. 天真地

参考例句：

• They naively assume things can only get better. 他们天真地以为情况只会变好。
• In short, Knox's proposal was ill conceived and naively made. 总而言之，诺克斯的建议考虑不周，显示幼稚。

15 judgment   

n.审判；判断力，识别力，看法，意见

参考例句：

• The chairman flatters himself on his judgment of people.主席自认为他审视人比别人高明。
• He's a man of excellent judgment.他眼力过人。

16 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

17 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

18 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

19 pregnancy   

n.怀孕，怀孕期

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
• Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。

20 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

21 awesome   

adj.令人惊叹的，难得吓人的，很好的

参考例句：

• The church in Ireland has always exercised an awesome power.爱尔兰的教堂一直掌握着令人敬畏的权力。
• That new white convertible is totally awesome.那辆新的白色折篷汽车简直棒极了.

22 brook   

n.小河，溪；v.忍受，容让

参考例句：

• In our room we could hear the murmur of a distant brook.在我们房间能听到远处小溪汩汩的流水声。
• The brook trickled through the valley.小溪涓涓流过峡谷。

23 abortion   

n.流产，堕胎

参考例句：

• She had an abortion at the women's health clinic.她在妇女保健医院做了流产手术。
• A number of considerations have led her to have a wilful abortion.多种考虑使她执意堕胎。

24 abortions   

n.小产( abortion的名词复数 )；小产胎儿；（计划）等中止或夭折；败育

参考例句：

• The Venerable Master: By not having abortions, by not killing living beings. 上人：不堕胎、不杀生。 来自互联网
• Conclusion Chromosome abnormality is one of the causes of spontaneous abortions. 结论：染色体异常是导致反复自然流产的原因之一。 来自互联网

25 implants   

n.（植入身体中的）移植物( implant的名词复数 )

参考例句：

• Hormone implants are used as growth boosters. 激素植入物被用作生长辅助剂。 来自《简明英汉词典》
• Perhaps the most far-reaching project is an initiative called Living Implants From Engineering (LIFE). 也许最具深远意义的项目，是刚刚启动的建造活体移植工程 (LIFE)。 来自英汉非文学 - 生命科学 - 医学的第四次革命

26 smears   

污迹( smear的名词复数 )； 污斑； （显微镜的）涂片； 诽谤

参考例句：

• His evidence was a blend of smears, half truths and downright lies. 他的证词里掺杂着诽谤、部份的事实和彻头彻尾的谎言。
• Anything written with a soft pencil smears easily. 用软铅笔写成的东西容易污成一片。