👩⚕️ Medication abortion vs. viagra: access, safety and shame.
Telemedicine can help destigmatise abortion.
Hello and welcome to Careviser, the weekly newsletter that cuts through the healthcare noise with a single focus: productization of the latest research and tech breakthroughs.
I live in France where access to abortion services is legal until the 14th week of pregnancy and mostly covered by the statutory health insurance scheme. Access to abortion care isn’t always easy depending on where you live, but it’s a right. I am always surprised when I see how precarious access to abortion is in the US. We are in 2021 and it’s not a done deal. So of course the news from Texas last week was a shock.
Perritt J, Grossman D. The Health Consequences of Restrictive Abortion Laws. JAMA Intern Med. 2021;181(5):713–714. doi:10.1001/jamainternmed.2020.9279
🗝️ Why it matters: A recent bill passed in the state of Texas has banned abortions after 6 weeks of gestation. There’s been a lot of outrage at the news all over the world. Between 2017 and 2020, 37 US states have enacted legislation that restrict access to abortion, as opposed to 13 states that have expanded access. A lot of these restrictions make access to abortion harder for women requiring wait times between appointments, limiting funding for abortion services or additional licensing of facilities or providers.
🔎 The study: The current trend in many US states is to restrict access to abortion. These restrictions have had negative health consequences for women seeking to terminate a pregnancy. This commentary reviews a few of the existing studies on these consequences.
✅ Findings:
After the implementation of a restrictive law in Texas in 2013 that led to the closure of about half of the state’s abortion facilities, the rate of women requiring a second-trimester abortion increased as there were less facilities to serve them.
Later abortion is associated with more complications and health risks for women.
Women who wish to terminate a pregnancy but are unable to face a higher risk of morbidity and mortality at birth.
🚀 Opportunities ahead: Restrictive access to abortion puts women’s health at risk, even for the ones that are unable to terminate their pregnancy. On top of the health risks associated with restrictive abortion laws, The macroeconomics of abortion: A scoping review and analysis of the costs and outcomes shows the financial burden linked to poor access to abortion:
High post-abortion costs for health payers in countries with limited access to legal abortion
Financial hardships on abortion seekers
Higher birth rates among teenagers limiting their access to education and good career prospects
Better outcomes for children born in families where they were wanted, including reduced crime levels in the US after Roe v. Wade.
When I started looking for start-ups around abortion, at first there weren’t any. There are so many startups focused on pregnancy and fertility and yet it seemed as though women seeking help on abortion were left to their own resorts. I didn’t know that the tele-abortion regulation had been through a roller-coaster for the past eighteen months. Tele-abortion only applies to medication abortion which can be done until the tenth week of pregnancy in the US. Surgical abortion is obviously always done in a brick-and-mortar facility.
In the US, until the covid-19, medication abortion could only be given in person. Pharmacies were not allowed to dispense the medication, even with a prescription. This requirement was lifted last year by a district court allowing tele-medecine services focused on abortion to be created. These include: Hey Jane, Choix, Just The Pill and Abortion on Demand.
Then 6 months later, the Supreme Court overruled the ruling, and direct-to-patient abortion services were banned again...until the FDA finally lifted the in-person requirement by itself for the duration of the pandemic. The FDA is now exploring whether to amend the in-person requirement for good. As a comparison, viagra which is many times more dangerous than abortion medication can be dispensed online which has enabled companies such as hims to reach unicorn status.
I read a few weeks ago an article on Hey Jane on TechCrunch and it shocked me. The article was about the launch of Hey Jane, and their US$ 2.2m funding round. At first, it seemed like a typical TechCrunch article. Yet one of the investors declined to give their name. It still is controversial and dangerous to be involved with abortion care to the extent that people will conceal their identity. I could not believe it. It shows how much there is to do to normalize women exerting their right to choose for themselves.
Some women, especially during the pandemic, cannot leave home to visit a provider. Medication abortion is proven and safe. Visiting a provider is also expensive. Some direct-to-patient-abortion services are priced at less than US$250 when medication abortion in a brick-and-mortar practices is twice as expensive. Yet many don’t take insurance which is an issue for some women.
So far teleabortion companies are focused on abortion, but will likely expand to other services such as contraception to ensure recurring revenues from their customer base. Launching a telemedicine service focused on abortion is still risky given how much the regulation on teleabortion varies between states, and is overall unstable. Let’s hope the FDA will make access to abortion medication easier for good in the near future.
That’s a wrap for today! Don’t hesitate to reply to this email with comments, I read and answer all emails :)
Marie