When a leaked report indicated that the Supreme Court was working on overturning Roe v. Wade, Choix, a San Francisco-based telehealth startup that prescribes and mails medical abortion pills, saw a significant spike in traffic to its website. Emails poured in asking which states it serves. The founders, a coalition of nurse practitioners and healthcare providers, realized they needed to shift into fast-growth mode. Choix formally announced Wednesday it raised a $1 million round from Elevate Capital, a Portland-based venture capital firm that targets investments in underserved entrepreneurs.

Choix's CEO and co-founder Cindy Adam told Inc. the company would use the funding to expand its clinician team and grow operations beyond the three states it currently serves, California, Colorado, and Illinois. Choix, which is French for "choice," was founded in 2020 and the 10-person company also offers patients emergency contraception, birth control, herpes care, and UTI treatment. The co-founders say they will seek an additional $500,000 to $1 million in coming months. 

Choix is one of a small handful of U.S. startups and nonprofits providing the two-pill regimen known as "medical abortions" to Americans older than 16 through online consultations and mailed prescriptions. Federal approval of the procedure and the mail-order prescriptions last year in response to the pandemic enabled these organizations to launch. Demand for the at-home alternative to surgical abortions has only grown in the wake of Texas and Oklahoma enacting stricter abortion bans. Until recently, however, these digital pharmacy startups have faced challenges raising funds: Investors have been reluctant to back a business whose primary product is both polarizing and not legal in every state. Doing so might require standing up to their limited partners, or potentially carving our a special-purpose vehicle. 

Now, founders say, the funding picture is starting to change. Similar to Choix, Hey Jane, which describes itself as a digital abortion clinic, is prepping for a surge in patients. The entirely remote company of 28, which was also founded in 2020 and launched in 2021, has successfully raised $3.6 million, and is also seeking another round of funding. It expects to close in late Spring. Hey Jane serves six states, and expects to serve an influx of patients traveling to those locations to receive the medications by mail. 

"Already, Hey Jane has seen an increase in patients reporting that they're coming to Hey Jane because of longer-than-expected appointment wait times, which suggests to us that bans in places like Texas are already having a ripple effect," Hey Jane founder and CEO Kiki Freedman told Inc. in an email statement. "Losing Roe would only magnify that."

For Choix, fundraising wasn't easy, but became smoother once it found Elevate Capital, whose mission is to fund companies built by women of color. "We were very pleasantly surprised at the business they'd built so far, just living off of scraps! They were highly focused," says Elevate founder and managing partner Nitin Rai. And the hot-button issue didn't scare the fund off: "I'm pro-choice, and pro-women," Rai says.

In early 2021, the U.S. Food and Drug Administration lifted in-person dispensing requirements on mifepristone for the duration of the pandemic, and made that change permanent in December. "Medical abortions" have been available since 2000, when mifepristone was approved as an abortion pill. It's most commonly prescribed as a two-pill procedure, with the first, a mifepristone pill, ending the pregnancy. Within 48 hours, the patient takes the second pill, misoprostol, which causes cramping and bleeding to clear the uterus. By 2020, at-home medical abortions accounted for more than half (54 percent) of all abortions in the United States, according to the Guttmacher Institute, a research organization for advancing sexual and reproductive health and rights.

In 19 states, mostly in the South and the Midwest, telemedicine visits for medical abortions are banned. While both Choix and Hey Jane technically serve limited geographies, in practice they do not require residency proof from patients; they only need a mailing address in a state where the company operates legally and through which the individual can receive the medication. 

"Abortion care is health care, and we don't think patients should have to jump through hoops. Unless it is required in the states where we operate, we are not going to raise the bar in terms of what patients have to do to get care," Adam says.

Adam notes that Americans receive cross-state health-care frequently. "If you have a cold and are visiting California, you can get care. Our goal is to the best of our ability continue to provide abortion care via telehealth the same way we do all other health," she says.