Access to abortion care, a critical & essential part of healthcare, continues to be dismantled

Abortion care is highly stigmatized despite the fact that it is a common & extremely safe form of healthcare. 

Sources included at end of section. 

Access to abortion care is not only a question of whether you can access the medical care itself. Along with financial support, practical support — for example, appointment coordination, transportation, overnight housing, child care, and translation — has always been a critical aspect of abortion care. It's this practical support that helps people navigate the logistics to get the care they need. 

Via Guttmacher as of Sep 25, 2022

Now, as we see more states restrict access to abortion everyday and more and more patients needing to travel for care, the importance of practical support continues to grow. People living in states with bans and restrictions have a more difficult time accessing information about how and where to travel for abortion care, and getting support to access that care.

More information about Abortion Care in the US:

Abortion care can be expensive and time-consuming:

• In-clinic medical abortion cost ranges from $500-$800+

• Often requires multiple visits

• ‘Cost’ does not factor in hidden costs such as additional time off from work, child care expenses, or cost of travel 

More about practical support: 

People of all walks of life need practical support for abortion care. Non-profit, grassroots practical support organizations have been doing this invaluable work for a long time, and they are working hard to meet the needs of the most vulnerable populations.

However, there is an increased need for practical support post Roe. As more states impose restrictions and pass complete bans on abortion, people living in those states will have a more difficult time accessing information about how and where to travel for abortion care. 

Sources*

• 24% of women and people with uteruses will have an abortion in their lifetime

• Abortion is 14x safer than giving birth

• Abortion medications are safer than Tylenol and Viagra  

Choix* pushes boundaries to expand abortion care access

* Pronounced "choice"

Expanding access and breaking down barriers to abortion care is critical and patients are increasingly turning to telehealth to meet their needs.

Choix has been pushing boundaries to expand abortion care access through the use of telemedicine since 2020.

Choix uses technology and innovation to provide people high-quality, non-judgmental, affordable abortion care via telehealth at home.  

But with restrictions on abortion growing by the day across the country, we understand that telehealth is only part of the solution.

Introducing: Choix Travel
A complement to our Direct Patient Care

Choix Travel is a B2B model expanding abortion access for anyone who needs travel & logistical support

Employers are looking for solutions for how to support their employees seeking abortion care, but may have concerns about privacy and state regulations that pose barriers to accessing care. 

Choix will develop a business to business (B2B) arm that works with employers and employee health plans and beyond to support the travel & care coordination needed for people who must travel for abortion, miscarriage or other reproductive healthcare needs that are restricted by the states they are located in.

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Building long-term solutions

Infrastructure around Choix Travel will be developed with the intent to extend the travel support offering to patients who do not have access to benefits through an employer and lack resources to travel out of state.

The B2B offering will also fund: 

• Expansion of support services for all direct patient care:  24/7 support-line, virtual doula services

• Expansion into additional states

• Financial support to non-profit practical support organizations
  
  

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Direct Patient Care (D2C Offering)

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We believe comprehensive sexual & reproductive healthcare is essential — including abortion care.  Abortion care is a critical aspect of the care we provide at Choix.

By providing abortion care via telehealth, Choix helps alleviate the financial, logistical, and emotional stress that can come with in-person care. We provide private, discrete, non-judgmental care for patients in the comfort of their own homes. And Choix increases access to highly needed abortion care by saving patients both time and money.

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Advance provision of abortion pills

Our newest care offering furthering
expansion of abortion care access

Advance provision is one way Choix is meeting patients’ reproductive healthcare needs today and in the future. “Advance provision” of abortion pills (mifepristone and misoprostol) allows people to access abortion pills before they are pregnant. 

• With advance provision, people who live in or travel to the states we serve can fill out our secure online questionnaire, receive pills in the mail, and have them on hand should they need them in the future.

• For patients who receive abortion pills before becoming pregnant, Choix providers are just a message away. Everyone who uses the Advance Provision service receives access to Choix’s patient portal and can contact Choix whenever they are ready to use their abortion pills.

Why access abortion pills before pregnancy?

• For some people, the period between finding out they’re pregnant and receiving abortion pills can be extremely stressful, and present a range of legal, logistical and financial hurdles. Advance provision reduces those barriers and provides patients peace of mind by allowing them to keep abortion pills on hand even before they become pregnant.

• Advance provision is legal, safe and just makes sense. Doctors prescribe just-in-case medicine for all sorts of hard-to-predict healthcare scenarios like pain, anxiety, allergies, nausea and infection. 

• Abortion is highly stigmatized and politicized, people accessing abortion care, even in states where it is legal, often come to us with an additional feeling of anxiety about whether or not they will be “allowed” to get an abortion when they want one. Advance provision with Choix helps to alleviate  stress and put the power to decide back into the hands of the person seeking care. With advance provision  people know that they can access  care when they need to, with the clinical support they deserve.

More about Medication Abortion

• Medication abortion is an FDA-approved method of ending a pregnancy and has been used in the United States since the year 2000.

• The World Health Organization affirms abortion with pills as an option to safely and effectively end a pregnancy.

• Research shows that when people have accurate information and access to pills they can end a pregnancy safely and effectively in their own homes.

• The overwhelming majority of people who choose to manage their abortions with medication via telehealth are satisfied with the method and would recommend it to others.

• With telehealth and medication abortion, more of us will have the tools and support to make the best decisions for our own bodies and futures.

• For countless patients in rural areas, communities impacted by clinic closures, or clinics that are overwhelmed from seeing an influx of patients, telehealth provides an additional option for accessing abortion care. Advance provision will make accessing this time-sensitive care easier and less stressful for patients who may need abortion care in the future.

• Telehealth helps make many forms of healthcare more accessible, and abortion should be no different. Everyone should be able to choose the method of abortion care that feels best for them.

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• Emergency contraception

• Hormonal birth control options (Pill, Patch, & Ring)

• Non-hormonal birth control services (Phexxi)

• UTI care

• Oral and genital herpes care

• STI Testing for patients receiving abortion care

Today, Choix is funded & growing

$1M raised to date

• Launched fully remote abortion care offering in October 2020 

• First US abortion provider to allow patients to communicate with healthcare professionals exclusively on their own schedule via text

• Launched in California, expanded to another 5 states: CO, IL,  ME, NM, and VA

• 2023 goal of expansion to all states where abortion care remains legal

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  180+ pieces of coverage in a wide range of publications from Bloomberg, The Wall Street Journal and Inc. to Ms. and People magazines

• Included in two Journal of American Medicine Association articles using Choix de-identified data:

  • Safety and Efficacy of Telehealth Medication Abortions in the US During the COVID-19 Pandemic

  • Outcomes and Safety of History-Based Screening for Medication Abortion

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A deliberate approach to expansion

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• We started in Q4 2020 seeing approximately 100 patients a quarter

• Closed Q2 2022 seeing over 1,000 abortion care patients a quarter. 

• 2023 EOY goal is to be serving over 1,000 patients a month with our D2C offering  

Direct Quotes from Choix Patients

Abortion Seekers in the US.  

Abortion is a normal and essential form of healthcare: 1 in 4 people with periods in the U.S. will have an abortion by the age of 45.

Access to abortion care is critial and lack of access disproportionately impacts low-income communities, communities of color and other underserved communities — heightening broader healthcare inequities. 

Many people seeking abortion are already experiencing economic hardships at the time they seek care. In fact, not having enough money to care for a child or another child is the most common reason for seeking an abortion — and being denied a wanted abortion results in even greater economic insecurity. 

Choix exists to bring patients the accessible, supportive, and non-judgmental abortion care they need — so that individuals, families, and communities can live the lives they want to lead. 

We are committed to addressing systemic inequities and barriers to abortion access, and working to reach patients who need to access care most by:

• Building partnership strategies with local abortion funds & practical support organizations

• Providing care to young people

• Having Spanish-speaking clinicians and offering other translation services

• Prioritizing the creation of a dual English-Spanish website

• Working toward acceptance of Medi-Cal

• Using language that reflects the diverse experiences of those seeking abortion care

• Offering sliding scale payment options that allow people with fewer financial resources to pay less 

• Focusing on reducing potential technological barriers to care by prioritizing mobile over desktop performance and speed

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Current Choix patients 

As of September 25, 2022

Choix minimizes the amount of information we ask from our patients by ensuring that it is medically and legally necessary, or helps us better measure the impact to different communities seeking abortion care.

Direct Quotes from Choix Patients

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Partners & Referral Networks

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• AbortionFinder.org & INeedAnA.com
• Abortion Freedom Fund
• Access CA
• California Abortion Alliance Member
• Chicago Abortion Fund
• National Abortion Federation Member Clinic
• Plan C Pills
• Reprocare
• UCSF CHAT Study

Choix Travel:
A new B2B expansion

The creation of the B2B model will fuel infrastructure and operations to extend travel support to patients who do not have access to benefits through an employer and lack resources to travel out of state. The revenue from this channel will also support general expansion of the current direct to patient care offering.

B2B model overview 

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Choix's current abortion care model

Direct patient care via telemedicine

• Choix is a direct to consumer (DTC) healthcare provider.

• Our abortion care is a bundled service: everything (consultation, prescriptions, shipping, and follow up visits) is included in a flat cost to the patient.

• In order to improve access, we recently began offering all abortion care on a sliding scale. If patients need financial assistance, they can pay less on the scale. When patients choose to pay more on the scale (up to $350), this helps us support people who need care and cannot afford the full cost.

• Our other healthcare services are consultation based ($15-$20 each) and medications are paid for by the patient directly (cash or insurance).

Employee repro-benefits in the US: >$2B

Including travel benefits

Post Roe, many employers have shared their support for abortion access and publicly stated that they are committed to supporting employees who need access to abortion care and other crucial reproductive healthcare.

Over 170 companies, across many industries and representing ~6.5 million employees, have publicly expressed their support for abortion care travel. The average amount of covered travel for companies that have pledged is $4,500 per employee. 

The Rhia Ventures #WhatAreYourReproBenefits guide lists many of the employers who have pledged their support for employees seeking to access abortion care, as does Don’tBanEquality. We know that these employers are looking for solutions for how to support their employees, but may have concerns about privacy and state regulations that pose barriers to accessing care. For many of their employees, the best or only option for affordable travel would be to utilize their employer benefits for care. 

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Broad reproductive healthcare market in US:

$10B+ annually

• Aligns with Choix’s long term vision of providing care from your first period through your last. 

• Includes anyone in the U.S. with a uterus between the ages of 13–54

Uniquely positioned at the intersection of travel & reproductive health

Most healthcare travel agencies in the US are focused on international healthcare travel, so there are no direct competitors that we are aware of in the US. We are aware that many employers have created solutions internally to support their employees, but these solutions are generally not the full-service support for abortion and reproductive health, travel, and medical support that Choix Travel will provide.

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We consider other abortion care
providers colleagues, not competitors

As healthcare providers committed to reproductive freedom, we believe that the more healthcare providers offering abortion care — the better. We consider other abortion providers to be our colleagues and allies. The more medical providers offering abortion care, the stronger our community becomes and the more we dismantle the stigma and barriers to abortion care.  When options for care increase, so does social acceptance and understanding around abortion care. 

There is not one solution to increasing access to abortion and every abortion provider has different strengths to offer. Expanding abortion access requires ensuring that all forms of abortion care remain available and patients can access the method that works best for them — whether that be at a brick-and-mortar clinic or through a telehealth platform. 

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Where Choix shines as a company is in its drive to innovate in abortion care access during a time when restrictions are ever-growing.

1. Choix is a majority clinician-founded company with a vision of using telemedicine to expand access for all people who seek safe and affordable abortion care from the privacy of their own homes.

2. Choix was the first healthcare provider to offer asynchronous abortion care in the US (appointment free care via online medical questionnaires and text) and the first healthcare provider in California to offer abortion care via telehealth to people in California.

3. In addition to abortion care, Choix provides an entire suite of sexual and reproductive healthcare. Choix sees abortion as one critical part of healthcare, not a standalone service.

4. Choix is a platform designed with both patients and providers in mind to allow our care to be convenient, efficient, and secure.

5. Choix is one of the first companies in the United States to offer medication abortion through advance provision, allowing patients to request abortion pills they can have on hand even before they’re pregnant. This is a major milestone in the movement for accessible abortion care for everyone who needs it.

6. Choix serves young people 15+ via telehealth while most telehealth providers only serve people 18+.
   
   

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The abortion care landscape

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US-based businesses offering abortion care via telehealth	Non-profit organizations offering abortion care
HeyJane   FPA (California)  Wisp	AidAccess  Planned Parenthood CaraFem  AbortionOnDemand  JustThePill  ForwardMidwifery

Advancing access to safe, affordable abortion care

 Choix innovates to expand access to high-quality, supportive & non-judgmental abortion & sexual & reproductive healthcare.

With abortion access no longer protected by the constitution — and with threats to other reproductive healthcare, like emergency contraception and birth control pills, potentially on the rise — we are working harder than ever to continue expanding access and alleviate barriers to both abortion care and other essential reproductive healthcare services.  

Through our services, we are committed to addressing systemic inequity and expanding access to healthcare for all. 

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Looking towards the future

Goals for 2023 & beyond

• Developing ReproBenefits business model to support patients who need to travel to receive care and the companies that are offering such benefits to their employees.  

• Addition of 24/7 medical and doula support for all patients

• Providing care in every state where abortion care is legal by the end of 2023

• Creation of a Spanish language website, expansion of interpretation and translation services

• Medicaid pilot and acceptance

• Miscarriage management service pilot

• Deepen partnership strategies with local abortion funds, practical support and reproductive justice organizations

• Subscription service for all sexual and reproductive health services: a monthly fee for unlimited access to medical consults with our providers and doulas for any of our reproductive health services.  

• Develop Gender Affirming Care 

• Offering PrEP/PEP (medications to prevent HIV transmission)

• Expansion of sexual and reproductive healthcare services including Vaginitis, STI Testing, and STI Treatment

Innovating abortion care to expand access

Choix is driven by its mission of expanding access for all people who seek safe and affordable abortion care through the method that works best for them. 

We are committed to addressing systemic inequities and barriers to abortion access through:

• Sliding scale of payment options that allow people with fewer financial resources to pay less 

• Building partnership strategies with local abortion funds & organizations

• Spanish-speaking clinicians

• Providing care to young people

• Working toward acceptance of Medi-Cal

• Focus on lessening potential technological barriers to care by prioritizing mobile over desktop & performance / speed
  
  

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Our Values

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One of the first US-based companies to offer advance provision of abortion pills

Advance provision is the ability to access abortion pills before a person is pregnant. This offering in combination with telehealth helps people overcome financial and logistical barriers to abortion care. It especially helps people who:

• Are unable to access an abortion quickly. 

• Know that they will be logistically unable to travel long distances or out of state, or available on multiple days to access either surgical or medication abortion due to childcare, work, school, or other schedule restrictions.

• Live in a part of the United States where abortion bans exist in surrounding states over large geographic areas and need to access care elsewhere. 

• Are unable to easily access abortion care because they may be in unsafe domestic situations. 

• Are seeking privacy and discretion from unsupportive family or community members.

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Public Health & Research Impact

We partnered — and continue to partner — with researchers at UCSF to provide data on our patient outcomes, and we have an ongoing relationship with UCSF via the CHAT Study.

• Our data was utilized in JAMA as part of the first published study in the US on fully remote care and submitted to the FDA as part of its review of the Risk Evaluation and Mitigation Strategy (REMS) on Mifepristone. 

• We are asking patients to share their reasons for accessing Advance Provision to better understand motivations and develop a knowledge base around  expanding access to this care. 

$1M raised to date

• We bootstrapped the company and launched in three major states (California, Illinois, Colorado) during the pandemic, before having access to any outside capital.  

• In May of 2022 we secured Elevate Capital as our lead investor ($1M)

• We have raised additional funding with 5 angel investors

• We are continuing to fundraise, all while those of us in the reproductive care space face arguably one of the most critical healthcare and social justice issues of our time.

Founded & led by practicing medical professionals

Choix was founded by practicing clinicians who recognized the critical need for expanded access to abortion care and were frustrated by the lack of abortion care offered via telemedicine despite its safety and efficacy. 

And now we are more committed than ever to do our part to ensure that people have equitable access to the care they want and need.

Aisha Wagner, MD
Co-Chief Medical Officer & Founder

Dr. Wagner graduated from the UCSF-SFGH Family Medicine residency, and completed the Reproductive Health Access Project fellowship in NYC and the Leadership Training Academy through Physicians for Reproductive Health — both focusing on advocacy for equity and access within the abortion world. She currently works at an FQHC in Los Angeles and contracts for Planned Parenthood Los Angeles. As a Black physician she draws pride in serving communities of color, and strives to bring a reproductive justice framework into her learning, teaching, and patient care.

Dr. Wagner did her undergraduate studies at University of Puget Sound, attended medical school at University of Southern California and completed residency at the University of California San Francisco Family and Community Medicine Residency Program.

Cindy Adam, FNP
CEO & Founder

Cindy completed her Master’s Degree in Nursing at the University of California in San Francisco. She started her nursing career practicing full scope primary care with the Santa Rosa & Santa Cruz Community Clinics. She specialized in sexual & reproductive heathcare through her work with the SF Department of Public Health, in private practice with a local obgyn, and was one of first nurse practitioners with an early stage contraceptive care telehealth provider. Cindy also had the pleasure of working with UCSF’s Advancing Standards in Reproductive Health Turnaway Study on the experiences of people seeking abortions.

Cindy & Lauren Dubey, Chief Nursing Officer for Choix, won the National Abortion Federation 2022 Clinicians in Abortion Care Leadership Award for their work advancing the scope of NP practice through their work at Choix.  

Lauren Dubey, FNP-C
Chief Nursing Officer & Co-Founder

Lauren completed her Master’s Degree in Nursing at the University of California in San Francisco in Family Nursing. She started her nursing career at Planned Parenthood, where she quickly become the official staff trainer for advanced clinical services in prenatal care, abortion care, and ultrasound.

Before co-founding Choix — during her time with PPLA, Femme, Bailey Health/You Health, Hims & Hers & Maven Clinic — she gained extensive experience providing both urgent and ongoing gynecologic healthcare services to women across the lifespan in person and via telehealth. Lauren and Cindy Adam, CEO of Choix, won the National Abortion Federation 2022 Clinicians in Abortion Care Leadership Award for their work advancing the scope of NP practice through their work at Choix.

Mark Adam
President, CTO, and Co-Founder 

Mark received his Bachelor of Science in Computer Engineering from The George Washington University, and his Masters of Science from George Mason University. He has been involved in all aspects of creating and building online experiences throughout his work history. Most recently, before he transitioned to Choix full-time, he was an Enterprise Architect Director for Akamai Technologies. In that role he was responsible for the consulting teams that worked with the largest and most technologically complex companies online to improve their customers' online experience, and has brought that experience to building and operating Choix. 

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The Team

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We are an experienced team of nurse practitioners, physicians, and professionals — combined we have decades of experience in reproductive healthcare that contributes  to our expertise and approach. We all have a story that shaped our commitment to reproductive and abortion care — for us, it’s personal and a calling.