With the overturning of Roe v. Wade earlier this year, digital health and reproductive care startups bolstered their efforts to make abortion pills and emergency contraceptives more accessible. Now, as state laws shift and abortion bans go into effect across the United States, companies are still trying to find ways to provide care while reimagining what healthcare should include.
Following the decision by the U.S. Supreme Court that overturned Roe, many leading organizations focused on reproductive medicine have spoken out against the ruling. “Decisions about healthcare, particularly reproductive healthcare, should be made by patients and physicians, not by interest groups, religious organizations, politicians, pundits, or Supreme Court justices,” said Marcelle Cedars, president of the American Society for Reproductive Medicine.
Nationally, the situation is proving tricky to navigate as each state can begin implementing individualized abortion laws. By November, 26 states are expected to face near-total abortion bans.
For that reason, TechCrunch checked in with digital health startups to learn how they intend to continue to offer reproductive care despite an increasingly hostile legal environment.
What do demand and restrictions look like?
In wake of the decision, there has been a national surge in demand for emergency contraception like Plan B, also known as the “morning after pill.”
In Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Kansas, Maine, Mississippi, South Dakota and Tennessee, a pharmacist can refuse to dispense an emergency contraceptive if it conflicts with their religious beliefs. In some states, the medication is also excluded from what is considered mandatory contraceptive coverage, according to the Guttmacher Institute.
But digital health companies, which provide care virtually, claim they are better able to avoid these limitations.
DiRx, an online pharmaceutical provider, claims it’s already seen as much as a 38% increase in demand for oral and emergency contraceptives following the Supreme Court’s decision.
“Since the whole Roe v. Wade conversation recently came up, we continue to see several inquiries and active conversations around [oral contraception], and in whatever legal and compliant manner, we can, you know, service our customers, we always strive to do that,” said Satish Srinivasan, CEO and founder of DiRx.
But Texas and five other states have laws prohibiting abortion pills (aka medical abortions) from being sent via the mail.
The effects of Roe’s reversal are rippling beyond reproductive care. Srinivasan explained that misoprostol — one of the two medications used in medical abortions — can also be used to treat ulcers and other issues in the gut. He said DiRx relies on the “prescriber’s conformance to local regulations and will ship the product to the state it needs to be shipped to.”
“However, if the drug is primarily indicated for abortion, the pharmacy team would check on the basis of diagnosis and state-specific regulation to ensure compliance prior to shipping,” he said.
Despite the limitations on sending abortion pills via the mail, companies say it’s still a viable way to distribute emergency contraceptives. Nationally, some large drug store chains and Amazon have limited how much Plan B an individual can purchase.
In order to make the product more accessible, TBD Health, a women’s sexual healthcare company, and Stix, a women’s health product company, launched emergency contraceptive lines. For TBD Health co-founders Stephanie Estey and Daphne Chen, the decision to accelerate the launch of their emergency contraceptive line in response to the Supreme Court’s decision was necessary.
“The overturning of Roe was just a really big signal and a big wake-up call to all of us that healthcare is no longer a guarantee for women and birthing people,” Chen said. “And so for us, it was really important to meet this moment and to see if we can provide resources to support birthing people with the medications that are necessary for health care, which includes emergency contraception.”
Although TBD Health can currently send its products across all 50 states, D.C. and Puerto Rico, the varying state regulations are keeping the founders on their toes.
“We are absolutely watching the regulatory landscape on a day-by-day basis and working with our regulatory law firm as well as our pharmacy partner to make sure that we can still send medication to certain states,” Estey said. “But who knows if that will be the case in two hours or three hours or tomorrow.”
Stix’s co-founder agreed, emphasizing the need to destigmatize access to emergency contraceptives.
“Being really loud and outspoken and clear about those elements is really important so that people across the country know that they can have access to this pill that will prevent a pregnancy before it starts,” said Stix co-founder Jamie Norwood.
Additionally, Stix started a fund to provide access for individuals who can’t afford emergency contraception. Norwood saw it as a way of “addressing some of the inequities in reproductive access.”
To date, Stix has distributed over 8,000 doses of emergency contraception using money collected via a direct donation link. Donors can contribute between $20 and $200, while individuals in need of the product receive a discount code that gets them the medication for free. However, there is a one-per-person limit to help meet national demand.
The companies report rising demand, especially in what they consider conservative-leaning states (or states likely to ban abortion). But surprises continue to pop up: Voters in deep-red Kansas — which was expected to ban abortion — recently rejected a proposal that would have eliminated a person’s right to an abortion.
Is the solution digital?
The founders who spoke with TechCrunch said yes, though it can be circumstantial.
Digital health founders say demand for their products and services boomed amid the COVID-19 pandemic and hasn’t let up, and providing digital access is empowering to patients. According to data from the Pew Research Center, close to half of abortions performed in a clinical setting were medical abortions, and as of 2017, there were only 1,587 facilities that provide abortion services nationally.
Tia, a comprehensive women’s healthcare provider, wants there to be a redefinition of what it can mean to provide reproductive care. For individuals seeking abortion care, finding a clinic or hospital might not be necessary.
Telehealth enables “women to drive across the border and have a virtual visit from their car or from a safe location and get access to medication abortion in a way that they’re not going to be able to in their home state,” Carolyn Witte, CEO and founder of Tia, said.
Although Tia operates primarily out of Arizona, California and New York, it provides online services to expand access.
“While it’s easy to be mad and bitter, and try to save Roe or feel paralyzed, I want to do something,” Witte said. “I think it’s important that we recognize we can and must shift our focus from the courts to the exam rooms, and see primary care providers and those on the frontlines, [and] empower them with the tools.”
Abortion restrictions disproportionately affect certain populations, and before Roe was overturned, BIPOC communities already faced increased barriers to reproductive care. Since the ruling, many fear they will face some of the harshest repercussions.
Black and Latinx women, compared to their white counterparts, experience higher rates of unintended pregnancy. Additionally, women of color are more likely to live in states with the most restrictive abortion laws.
“Those who were already made most vulnerable will suffer most from lack of access — particularly Black women in the South who already face the highest rates of maternal mortality, who live in reproductive healthcare ‘deserts’ and endure well-documented racism,” said Deena Shakir, a partner at Lux Capital who focuses on health.
Joia Crear-Perry, a physician and founder of the National Birth Equity Collaborative, an organization dedicated to addressing Black maternal well-being, said it is important for these digital health startups to begin hiring diverse people to better care for underserved and undertreated populations.
“People are the solution and the tech is just a tool like a speculum or blood pressure machine,” Crear-Perry told TechCrunch. “Without people, they are worthless. Hire people who are the most impacted.”
Crear-Perry said investing in and promoting BIPOC-founded companies is critical because those founders have a better understanding of the inequities facing their communities in reproductive healthcare. She said it is a way to ensure power isn’t hoarded by just a few.
“Black, brown and Indigenous people with the capacity of pregnancy should be funded to create the technology from designs to implementation, otherwise it won’t work and will fail,” Crear-Perry said.
To best ensure equity and the ability to continue providing these services, Shakir said that digital health startups should invest in “strong legal counsel.”
“The legal situation is dynamic and fluid. As always when it comes to healthcare services and care delivery, investing in a strong legal counsel and keeping a close eye on the changing situation is critical,” Shakir told TechCrunch.
She also recommended startups follow best practices from organizations like the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine.
More broadly, there has also been a push to reframe the topic of reproductive health to be more inclusive of all issues women and birthing people face. That’s an idea that Christina Farr, a health tech investor at OMERS Ventures, said needs to be invested in more.
“Women are not just reproductive organs. There’s much more to us,” she said. “We often go underdiagnosed; our pain is treated differently than men. There’s so many issues here that have been addressed. Even this category of reproductive and maternal health is not broad enough for what we need to do to serve women or women+.”