The Supreme Court’s ruling striking down legal protections for abortion is transforming the delivery of reproductive health care in the US, as telehealth startups fill treatment gaps caused by restrictions and bans.
Hey Jane and Choix, which dispense abortion pills to women after online inquiries, have raised millions of dollars in venture capital funding to expand their services, as demand rises after abortion clinics closed in several states controlled by Republicans.
At least a dozen nonprofit telehealth providers, including Just The Pill and Aid Access, are also ramping up operations. In some cases, the groups provide access to emergency contraceptive pills and other reproductive and sexual health care services through online platforms.
Providers say the Supreme Court ruling overturning Roe vs. Wade has increased public awareness of the abortion pill, a safe method of terminating pregnancy that was developed in the 1980s. Most commercial operators do not post pills directly in states that prohibit abortion, but women can use friends’ addresses in states where abortion is legal or travel to receive the drugs.
The boom in telehealth has been welcomed by the Biden administration and women’s rights advocates. They argue that it can help maintain access to abortion and ease the financial and emotional stress faced by women with unwanted pregnancies.
But it is raising complex questions about the legality of services provided to women in states where abortion is banned, and whether this new generation of abortion providers can offer equitable access to their technology platforms and appropriate standards of care. while protecting user privacy.
“Everyone must learn to use new technologies and what their limitations are. Patients and doctors can be overwhelmed by new responsibilities and new ways of doing things,” said Bonnie Kaplan, an expert in medical informatics and bioethics at Yale University.
She said the ethical issues had become more relevant now that telehealth is one of the few remaining ways to access abortion services in some US states. Better data protection and privacy rules are needed along with updated ethical guidelines, Kaplan said.
Demand for medication abortion, which involves taking two drugs, mifepristone and misoprostol, to terminate a pregnancy in the first 10 weeks, was growing before the Supreme Court ruling and now accounts for more than half of all terminations in the US .
But the lawsuit has been overshadowed by the Roe vs. Wade ruling last month and a decision by federal regulators to allow telehealth providers to dispense pills to women’s homes without the need to visit a doctor or pharmacist in person at due to Covid-19.
“On the day of the ruling we saw a 600% increase in visits to our website and since then we’ve seen a 50% increase in the number of patients we serve,” said Cindy Adam, co-founder. and the CEO of Choix, a San Francisco-based telehealth provider.
Just The Pill, a not-for-profit provider, said it had 437 appointment requests in the four weeks before the Supreme Court ruling and 801 requests in the four weeks after, an 83% increase of the demand.
Choix charges women $289 for an online consultation and to mail abortion pills to addresses in California, Colorado, Illinois and New Mexico, all states where abortion and telehealth services are legal.
Hey Jane, co-founded by ex-Uber exec Kiki Freedman, raises $3.6 million and offers telehealth abortion in six states © Hey Jane
Adam predicts demand will continue to grow as more Republican-controlled states ban abortions and walk-in clinic appointments in states where the procedure is legal become harder to secure due to high demand, as more women are forced to travel to receive treatment.
The changing political climate against abortion was one of the main reasons why Adam, a former nurse, and several other health professionals founded Choix in 2020.
Choix last month raised $1 million in seed funding from Elevate Capital, a U.S. venture capital fund, to accelerate its rollout, and is seeking to raise an additional $2 million. It wants to expand its telehealth services, which include abortion, emergency contraception and treatments for genital herpes and other conditions, to 10 states where abortion is legal by the end of 2022.
Choix has no plans to release pills in states that ban telehealth abortions, but is considering launching a service to help women, along with other aid groups, who need to travel from those states to receive abortion pills in neighboring jurisdictions where abortion is legal.
“These [state] The laws are designed to make abortionists or health care providers afraid, but we believe we have a very good right to provide care coordination for our patients,” said Adam, who hopes Congress will pass laws that provide legal protection to telehealth providers.
The legal threat is real, as 19 states ultimately require a doctor who prescribes abortion pills to be present when they are taken, effectively banning telehealth services. Some states enforce abortion laws through “bounty hunter” clauses, which allow private citizens to sue anyone who “aids or encourages” an abortion, including pharmacists or doctors.
President Joe Biden signed an executive order this month to protect access to abortion, but the lack of clarity about conflicting federal and state laws remains a concern for providers. The American Pharmacists Association warned Monday that the confusion is “compromising patient care.”
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Kiki Freedman, a former Uber executive and co-founder of Hey Jane, which has raised $3.6 million and offers telehealth abortions in six states, said the company would comply with state laws to reduce legal risk for patients and providers.
“Working at Uber, I definitely had a lot of exposure to navigating the regulatory complexity within a hypergrowth business,” said Freedman, who came up with the idea for Hey Jane in 2019 when the last abortion clinic of Missouri faced closure.
But as an example of the complexities of operating in such a sensitive industry, Hey Jane was recently forced to remove some material from its website to protect user privacy. This was followed by a research from The Markup, a news organization, which raised concerns about the potential disclosure of personal information contained in user reviews on its website and the use of software that tracks visitors’ online movement and facilitates advertising on social media platforms.
“We’ve found that the best way to reach people seeking safe abortion care is through the channels they’re already in,” Freedman said. “That said, as the regulatory environment has become increasingly hostile, we’ve chosen to remove the Meta Pixel (the tracking software that allows you to advertise on Facebook and Instagram).”
Health experts say the incident shows why data protection and privacy must be strengthened, given that women seeking abortions or doctors providing services could face prosecution in some states.
Yale’s Kaplan said: “We’ve already seen people looking for abortion services as tracking and data about them being sold by various websites. This is happening with social media, and it’s happening with telehealth services themselves for abortions”.
“This certainly puts people at risk,” he said.
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