Online abortion pill startups boom—even as they face new legal and privacy challenges

Over the past few months, abortion pill startups have been trying to keep up with a huge spikes in demand while navigating a tangled web of new regulations and privacy concerns. Since the Supreme Court’s decision to overturn Roe v. Wade first leaked in May, Hey Jane, an online startup that provides abortion pills in seven states, reported a ten-fold increase in traffic to its website. And demand doubled for its mail-order abortion drugs, a combination of misoprostol and mifepristone that can safely induce an abortion during the first 10 weeks of pregnancy in the privacy of one’s home. 

Along with Hey Jane, other telehealth abortion-pill focused service providers like Choix, Just the Pill, Abortion on Demand saw site traffic and interest explode anywhere from 600% to 2,000% after the fall of Roe in late June, according to Axios. Prior to the Supreme Court ruling, more than half of abortions were being conducted via medication abortion, reports the Guttmacher Institute, which specializes in reproductive health policy. Now many states are attempting to outlaw the telehealth services and even the pills themselves.  

Last month, the Biden administration took regulatory action to try to prevent states from banning access to the mail-order abortion pill, stating its beyond the scope of states’ rights given the Food and Drug Administration (FDA) position that it is safe, effective, and does not need to dispensed in-person at a pharmacy.

But the murkiness of federal law presents challenges. For instance, a telehealth provider such as Abortion on Demand uses software which must confirm a patient’s physical location before allowing them to schedule a telehealth appointment to be prescribed a mail-order abortion pill. If they live in a state where access to the telehealth service itself has been restricted, as 19 states had already done prior to the Dobbs ruling, they would have to find a way to travel to a state where such services are still permitted in order to use the digital platforms given the location-verification requirement.

That barrier gets even more fraught given the relatively short window of receiving abortion medication, which are only authorized for the first 10 weeks of pregnancy, just weeks after many women may even be aware that they are pregnant. A period of just a few weeks to get to a site where access to telehealth abortion services is even legal is a complication in its own right, which is why Hey Jane co-founder and CEO Kiki Freedman has said one strategy may be to build demand in blue states where in-person abortion remains relatively accessible in order to free up in-person appointments for women who may have to travel across state lines for an appointment.

“While we do have geographic expansion plans in the works (we recently expanded to New Jersey and will soon expand to Connecticut), our top priority has been accommodating the significant increase in demand in the states in which we’re currently located,” Freedman tells Fast Company in an emailed statement. 

That could be an increasingly important effort given that even more states are trying to ban access to abortion-inducing medications and telehealth appointments for such services, or make it possible for family members of the drugs’ recipients to sue the medication providers. Those legislative efforts are being in part fueled by anti-abortion groups such as the National Right to Life Committee and Life of America who have crafted template legislation to curtail access, the Washington Post reports. And red state legislatures are heeding these activist groups’ call–South Carolina lawmakers, for instance, have already introduced the “model law” concocted by National Right to Life following the Dobbs ruling. 

“Hey Jane is currently in states where telemedicine abortion will continue to be legal, and we’re strategically positioned in these 7 states that are accounting for the majority of abortion volume nationwide post-Roe and receiving an influx of patients who need to travel to get care now that Roe is overturned,” says Freedman, adding that helping over-burdened in-person clinics by homing in on those who would benefit from medication-induced abortion is a top priority for the startup. 

These efforts will undeniably become critical to a growing number of women as anti-abortion state laws are set in motion in the coming months and years. But the nascent women’s health firms in the space may need to build more trust with those they serve given privacy concerns about such sensitive and personal information. For instance, The Markup reported last month that Hey Jane advertises its services on Google and Facebook and was found using pixel trackers and visitor data which was then sent to analytics firms, payments processors, and major search engines, and social media platforms—potentially putting women’s privacy at risk. The company reportedly addressed the issue shortly after the report, including by discontinuing use of Facebook parent Meta’s Pixel tracker, citing an “increasingly hostile” regulatory environment.  

“Having supported our 10,000th patient this month, I’m proud of the work that Hey Jane has—and will continue—to do,” says Freedman. That number is almost certain to grow–as will the hostility of anti-abortion state laws and regulations.

Sy Mukherjee has reported on the healthcare industry for a decade. He is a consultant and communications architect at IDEA Pharma.