Saturday, July 2, 2022

Axios Pro Rata: 🤰🏼Startups react to Roe's end

Plus: Early testing battleground | Saturday, July 02, 2022
 
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Axios Pro Rata
By Kia Kokalitcheva · Jul 02, 2022

After a jam-packed week of news, I hope you're excited for the long weekend! We'll be back in your inboxes on Tuesday.

Today's newsletter is 1,144 words a 4-minute read.

 
 
1 big thing: Startups undaunted by Roe rollback
Illustration of a scale with colored shapes and images of dollars.

Illustration: Gabriella Turrisi/Axios

 

The U.S. Supreme Court's decision that overturned the constitutional right to obtain an abortion has devastated many Roe vs. Wade supporters. Yet venture capitalists focused on health care are more determined than ever to invest in the sector.

  • Startups addressing women's needs attracted only about 7% of venture dollars that went into U.S. digital health care startups during the first nine months of last year, per Rock Health.

Why it matters: In addition to allowing restrictions and bans on abortion across multiple states, the ruling is likely to add more challenges to accessing reproductive health care.

What they're saying: "It has never been more important to invest and innovate in women's health," says Lux Capital general partner Deena Shakir, echoing other VCs who spoke to Axios about the ruling.

What's happening: At least for now, there's not much clarity about the ruling for investors and entrepreneurs alike — or what potential future decisions could mean for health care companies.

  • "A lot of our companies are going through the exercise of 'what does that look like, how is it going to work,'" OMERS Ventures principal Chrissy Farr tells Axios.
  • But startups are also likely to increase the resources they devote to legal and regulatory issues, as they navigate a more complex and tricky environment, investors believe.

Zoom in: VCs expect to see an uptick in backing companies focused on women's health, reproductive needs, and the like.

Telehealth: A critical tool in providing health services such as birth control prescriptions, this sector is likely to become even more important.

  • "There is an opportunity for startups to double down on closing the gap in care access for underserved markets" like in rural areas, says SteelSky Ventures founding partner Maria Velissaris.
  • However, companies will have to navigate how certain post-Roe state laws may affect virtual care.

Information: Patients' need to access information about their own health and care options will be larger than ever, 7wire Ventures partner Alyssa Jaffee tells Axios.

  • However, some state laws are already raising concerns over how well some apps are protecting patient data, and companies may be restricted in providing abortion-specific information.

Fertility: OMERS' Farr describes this area as "TBD," but she doesn't foresee a waning interest in investing in startups catering to fertility care. Still, there are big questions about how some state abortion bans will impact in-vitro fertilization specifically.

Mental health: VCs expect the stress of abortion bans to heighten mental health care needs, exacerbating an ongoing lack of accessible resources.

  • While a number of startups have tried to tackle psychology and psychiatry, a string of reports over the years about some questionable practices shows that it remains a challenging area for innovation.

Abortions: Since the court's draft decision leaked in early May, startups mailing abortion pills have gotten more attention. Medications can't be mailed or used in a number of states, yet some are likely to seek them out more if alternatives such as clinics close down where they live.

The bottom line: "I really hope that other investors jump into this because we need their dollars and expertise," Rock Health founder and investor Halle Tecco tells Axios.

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2. The early pregnancy testing battleground
Illustration of a hand holding a pregnancy test and a hand holding a vial of blood.

Illustration: Allie Carl/Axios

 

As states across the U.S. pass restrictive abortion laws with tight timelines, early pregnancy detection can give people the most possible time to make the right choice for them, writes Axios' Alex Fitzpatrick.

Yes, but: Early home pregnancy testing tech is limited by human biology.

Why it matters: Taking a home test is typically a first step in confirming a pregnancy, followed up by blood work.

The details: Many home pregnancy testing companies offer "early detection" options, though they're typically less reliable than traditional home tests.

  • Clearblue says its early test can spot 71% of pregnancies five days before an expected period — compared to more than 99% from the day of an expected period.
  • Fertility startup Proov recently unveiled an "Early Check" pregnancy test, though its use is also limited to five days before an expected period.
  • Such tests also rely on a person's knowledge of their cycle, yet it may be getting riskier for some people to track such data. Plus, an individual's cycle can vary widely, and those who aren't planning to get pregnant may not be testing before missing a period.

The challenge? Simple biology.

  • Home pregnancy tests check urine samples for the pregnancy hormone, human chorionic gonadotropin (hCG). But it can take weeks between the time someone has sex, and the point at which the body produces enough hCG to be detected on such tests.
  • And the pace of the early pregnancy process can vary widely between individuals — and even for one individual between different pregnancies, says the Mayo Clinic's Leslie Donato.

Laboratory testing, Donato says, is far more accurate than at-home urine tests.

  • "If you were to send a blood sample to a lab, most laboratory tests would actually detect that pregnancy at the first day of missed menses," Donato says. "But some over-the-counter urine pregnancy testing may actually miss it."
  • But blood testing is often more expensive and harder to access — a problem that may worsen in states where clinics are closing, and some may feel less safe seeking abortion care.
  • "Something as simple as going in for a lab draw can sometimes be a limitation for people, especially if they have to drive a long distance to get there, or if there are capacity issues wherever their laboratory is," says Donato.

The bottom line: There's no perfect early detection home pregnancy test on the horizon, meaning that people seeking to maximize their decision-making window should understand the limits of what's on the market.

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3. Mapping it out
Data: Axios research. Cartogram: Sara Wise and Oriana Gonzalez/Axios
  • For a significant portion of Americans, abortion is now banned completely or severely restricted — though a few states with "trigger" laws haven't yet taken the necessary steps to make the rules official.
  • Nonetheless, some states without preemptive laws already in place moved quickly moved to add new restrictions, such as Florida and Alabama. Some laws are also currently blocked by courts.
Data: Guttmacher and Axios research. Map: Jacque Schrag/Axios
  • Medications that trigger abortions — Mifepristone and Misoprostol — have become the next battleground, with almost half of states already banning them or imposing severe restrictions.
  • In December, the FDA changed its guidance on abortion pills, permanently allowing for access through telemedicine and mail, where permitted by state law.
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A message from PwC

New opportunities for dealmakers
 
 

Key factors influencing transactions this year, but not stifling them, include:

  • Economic contraction.
  • Real wage challenges.
  • Consumer spending variability.

See how your industry may be impacted — and how transformation can help — in PwC's 2022 deals midyear outlook reports.

 
 
📚 Due Diligence
  • Abortion pill startup Hey Jane to seek new VC funds (Axios)
  • A bunch of men are about to make a fortune on Plan B (Quartz)
  • Next post-Roe battlefield: Online abortion information (Axios)
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🧩 Trivia

The Supreme Court's Dobbs decision's main argument is that Roe's legal basis is not sound (a pushback that is itself debated by legal experts).

  • Question: How did the original Roe decision justify the right to abortion? (Answer at the bottom.)
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🧮 Final Numbers
Data: PitchBook. Chart: Simran Parwani/Axios
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A message from PwC

A return to capital discipline
 
 

Low interest rates over the past 15 years have been a leverage luxury.

Okay, but: In the current environment, dealmakers once again need to exercise capital discipline.

Learn how executives can be more deliberate with their capital choices in PwC's 2022 deals midyear outlook.

 

🙏 Thanks for reading! See you on Tuesday for Pro Rata's weekday programming, and please ask your friends, colleagues, and health care VCs to sign up.

Trivia: Roe v. Wade's majority opinion asserted that the Fourteenth Amendment's Due Process Clause provides the right to privacy, and therefore to abortion.

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