Nurx: Disrupting the Contraception Industry with Digital Health Innovation

As consumption upgrades, women are increasingly investing in health areas beyond physical appearance. With their social and economic status continually rising, women are assuming greater leadership roles in society. To enhance women’s quality of life and meet their consumer demands, the upgrading and development of contraceptive products are essential.

First, there has been an opening up of social attitudes and mindsets, with people no longer regarding ignorance as a virtue or procreation as the sole purpose. According to the “2015 Report on Chinese People’s Marital and Relationship Status” published by the Social Survey Research Center of Peking University, the average age at first sexual intercourse among individuals born after 1995 was 17.71 years, which is 4.46 years earlier than that of individuals born in the 1980s.

Despite a more open societal mindset, many women still lack proper contraceptive knowledge due to information asymmetry and lagging sex education. According to the 2017 White Paper on Chinese Women’s Physiological Health by CBNData, over half of women do not use contraception. Although women under the age of 24 have higher contraceptive usage rates than other age groups, nearly half still do not employ any contraceptive measures.

The primary reason for the persistently high number of abortions is that many women either do not use contraception or employ unscientific contraceptive methods. Data provided by the National Health and Family Planning Commission show that China records over 10 million induced abortions annually, with more than half of young women under the age of 25 experiencing recurrent abortions.

From Japan to China, an increasing number of women are choosing not to have children. According to the latest "White Paper on Declining Birthrate" released in Japan on June 19, only 46.6% of respondents believed that Japan offers a favorable environment for child-rearing, whereas in Sweden, the satisfaction rate among citizens regarding their country’s child-rearing environment reached 97.9%. This indicates that the growing reluctance among women to bear children is not a trend that emerges with social progress. A supportive social environment plays a crucial role in ensuring women have positive health and childbirth experiences.

Of course, national circumstances vary. In China and Japan, there is a saying that “high housing prices are the best contraceptive,” whereas in the United States, the challenge lies in the fact that emergency contraceptives are classified as prescription drugs.

Fortunately, there are always more solutions than problems. In overseas markets, the female physiological health products sector has become highly segmented, with products increasingly incorporating advanced technologies. Examples include patch-based devices that use sensors to track ovulation, blood tests that predict preterm birth and monitor pregnancy complications, and menstrual discs that serve as alternatives to tampons.

San Francisco-based Nurx is a company that aims to transform the existing healthcare system by making it easier for women to access contraceptives and HIV post-exposure prophylaxis (PEP).

In the United States, emergency contraception is a prescription medication. To obtain it, individuals must present identification at pharmacies, which effectively discloses their sexual activity to others. Furthermore, some low-income and disadvantaged women may be unable to access these medications because they lack passports, driver’s licenses, or other forms of age verification. Nurx aims to make the experience as close to over-the-counter access as possible by eliminating the need for in-person doctor visits. Launched in December 2015, Nurx has been dubbed the “Uber of birth control” by the media. Because it disrupts the existing system for obtaining contraceptive pills, Nurx garnered immediate attention from media outlets such as CNN upon its launch.

On Nurx, users can download the app or visit the official website to select their preferred brand of birth control pills and answer a series of health-related questions. Based on the user’s symptoms and data, Nurx will recommend a physician to provide a contraceptive diagnosis and prescription. The prescribed medication is then shipped directly to the user at no additional shipping cost. For users with health insurance, both the prescription and shipping are provided free of charge by Nurx.

Nurx maintains that birth control pills have a well-established safety profile after decades of use. Oral contraceptives have been available for over 40 years and are among the most extensively studied, thoroughly understood, and safest medications to date for long-term use in healthy young women.

In response to the U.S. Department of Health and Human Services’ classification of contraceptive pills as such due to ethical and cultural considerations, the American College of Obstetricians and Gynecologists (ACOG) has strongly recommended following international conventions by reclassifying emergency contraceptives as over-the-counter medications. However, transitioning contraceptive pills to over-the-counter status has proven even more challenging than obtaining FDA approval for medical devices.

Interestingly, in 2016, Nurx also launched a free contraceptive product named “Donald Trump,” offering new users a $45 credit toward contraception. The company’s CEO stated that President Trump had repeatedly expressed his desire to repeal the Affordable Care Act passed under President Obama, which would result in millions of American women losing access to free contraceptive services.

After three rounds of financing, Nurx has raised a total of $41.4 million. Investors include Y Combinator, the well-known Silicon Valley venture capital firm Union Square Ventures, and Kleiner Perkins Caufield & Byers, the investment firm that early on recognized Google’s potential.

Andy Weissman, a partner at Union Square Ventures, said in a statement: “The lack of affordable healthcare is an issue many people face today. Nurx is developing revolutionary technology that transforms how people interact with healthcare, leveraging messaging platforms, mobile apps, bots, and embedded systems to lower costs and streamline the patient experience through telemedicine.”

Many barriers still exist in accessing contraceptive pills in the United States:

1. In the United States, emergency contraceptive pills are prescription-only medications; women must present a doctor’s prescription to obtain them from a pharmacy. Accessing emergency contraception requires a consultation with a physician. Furthermore, in certain remote areas, pharmacies may not stock emergency contraceptive pills at all. Consequently, women face significant time costs in obtaining emergency contraception.

2. In addition to the complexity of the prescription process, insurance procedures are equally intricate and cumbersome. Some employer-sponsored health insurance plans in the United States explicitly exclude contraceptive coverage; for example, Hobby Lobby, one of the largest arts-and-crafts retailers in the U.S. On Nurx, users with insurance can obtain medications at no cost, while those without insurance pay only around $15.

Although many women may consider these measures unnecessary, data clearly indicate that a significant number of women are not receiving adequate protection.

Survey data published on the World Contraception Day website.

58.1% of women believe that the rhythm method and withdrawal carry little to no risk of contraceptive failure.

In China, 45% of pregnant women choose induced abortion to terminate unintended pregnancies, with approximately 13 million unintended pregnancies ending in induced abortion each year.

40.1% of women actually overestimate the effectiveness of emergency contraception.

30.4% of women had never heard of combined oral contraceptives before. More people hold misconceptions about them, such as the belief that daily intake leads to drug accumulation causing diseases, impairing fertility, or affecting the health of future fetuses.

For different users, Nurx believes that its products can bring unprecedented safety to specific groups. First, minors who are hesitant to have prescriptions issued by their parents’ doctors. Also, women living in remote areas who cannot meet with doctors regularly.

For many people, safe and timely access to contraception is their most critical healthcare need. We are dedicated to empowering women to take full control of their sexual health. Nurx aims to transform the existing healthcare system and drive positive change within communities. Nurx believes that controlling your sexual health is a fundamental right that everyone deserves, free from judgment.

If users do not have insurance, Nurx intelligently selects brands; if they are insured, the service may be free or covered by their insurance. This provides women with an affordable and convenient contraceptive experience.

For the average woman, Nurx’s primary appeal lies in its ability to save significant time. By simply completing a questionnaire and uploading identity verification documents via the app, users can obtain a three-month prescription for contraception. Emergency contraceptive pills are most effective when taken as soon as possible after unprotected intercourse. As stated on Nurx’s official website: “We understand that you don’t have time to visit a doctor’s office or pharmacy again—especially during busy work periods or before final exams.”

Nurx is HIPAA-compliant and encrypts every transaction and conversation to prevent data breaches.

Nurx boasts a diverse team, much like the pioneers who brought oral contraceptives to market, which included two women and one man. Hans Gangeskar, a Nurx co-founder who graduated from the University of Cambridge, is also male.

Nurx was co-founded on their shared belief that access to contraception and PrEP should be as easy as obtaining any other preventive medication. By driving change, Nurx has brought this goal one step closer. Founder Hans Gangeskar once stated that anyone who wishes to take control of their health should be able to do so without incurring excessive costs or lacking access to knowledgeable healthcare providers.

Beyond the professionalism of its executive team, Nurx takes even greater pride in its behind-the-scenes physician team.The team includes Dr. Jessica Knox, a physician who graduated from Harvard University.

Dr. Chung is a seasoned family physician who believes that prevention is empowering and that all patients should have easy access to contraception and preventive care, regardless of where they live or what health insurance they hold. She therefore chose to join Nurx.

Abroad, contraceptive technologies and methods have seen a diverse array of innovative approaches. Innovations span from wearable devices to the development of new pharmaceuticals. As noted above, the key challenge in contraception lies not in the absence of effective drugs, but in overcoming the “last mile” barrier to access.

Microchips Biotech is a chip company headquartered in Massachusetts, dedicated to extending human lifespan by revolutionizing the way drugs are administered. The company’s flagship product involves implanting a microchip into the human body to enable controlled, timed release of medications, thereby addressing the challenges faced by patients who require long-term medication or injections. Microchips Biotech is currently applying this microchip-based technology to the treatment of multiple sclerosis, diabetes, osteoporosis, and female contraception. The company has raised a total of $57.8 million across three rounds of financing.

According to test reports issued by MIT, the contraceptive implant developed by MicroCHIPS measures approximately 20×20×7 micrometers and can be inserted subcutaneously into the arm or buttocks, or into the peritoneal cavity. Its mechanism of action is fundamentally similar to that of subdermal contraceptive implants such as Implanon or Nexplanon, achieving contraception by releasing trace amounts of levonorgestrel (a contraceptive hormone) into the bloodstream on a daily basis. Users can control hormone release via a smartphone to achieve contraception. If a user wishes to become pregnant, they can simply remotely deactivate the chip, much like adjusting the volume on a television with a remote control, thereby reducing the risk of unintended pregnancy due to human error.

Interestingly, the birth of this technology can be attributed to Bill Gates. In 2012, during a visit to the Massachusetts Institute of Technology (MIT), Bill Gates asked Robert S. Langer, a leading expert in microchip technology at the time, whether it would be possible to develop a new method of female contraception. Robert S. Langer, who had already developed drug-releasing microchips with controlled release capabilities in the 1990s, believed it was worth attempting. Bill Gates subsequently provided support for this technology.

Digital contraception has long been established practice abroad. One company that uses data algorithms to help women prevent pregnancy has obtained EU certification. It is Natural Cycles, founded by a European startup team. Since its establishment in 2013, Natural Cycles has completed three rounds of financing, raising a total of $37.5 million.

Natural Cycles, a subscription-based product, currently has over 500,000 users in approximately 160 countries. This menstrual tracking app leverages the rise in body temperature that occurs during ovulation. It employs algorithms to process user-inputted data, including daily basal body temperature measurements (a thermometer is included with the annual subscription). The algorithm analyzes which days of a woman’s menstrual cycle are associated with higher fertility. Users can view a contraception calendar within the app interface, where colors indicate days with higher likelihood of conception.

Dr. Berglund co-founded the company with her husband, Dr. Raoul Scherwitzl. A nuclear physicist, Dr. Berglund previously worked with the CERN team that was awarded the Nobel Prize in 2013 for the discovery of the Higgs boson. She has also stated that her experience in the discovery of the Higgs boson significantly benefited the development of the Natural Cycles algorithm.

Berglund stated that she hopes to leverage the data already collected by the app to detect and alert users to early signs of polycystic ovary syndrome (PCOS), endometriosis, and even infertility. Currently, a limitation of Natural Cycles is that users must manually collect their basal body temperature data; Natural Cycles aims to develop a device capable of automatic data collection.

However, the safety of Natural Cycles has recently come under question. According to a report by The Guardian, Stockholm’s largest hospital found that 37 women who underwent abortion procedures there had been using Natural Cycles for contraception out of a total of 668 cases. The hospital has reported this situation to Swedish authorities.

Monitoring female physiological cycles through body temperature is a common approach in overseas markets. What Natural Cycles aims to achieve has already been realized by other companies. Ava, for instance, is a company that uses wearable wristbands for women to monitor physiological parameters, including pulse, respiratory rate, sleep quality, and temperature. It then calculates the probability of pregnancy using algorithmic models. Ava’s wearable device has received FDA clearance as a Class I medical device. Although Ava’s current products primarily assist women in preconception planning, the company plans to expand its coverage to encompass the entire female life cycle, including pregnancy, childbirth, menopause, and contraception. Earlier this year, Ava announced that its wearable wristband could monitor pregnancy. Having completed four rounds of financing, Ava has raised a total of $45.3 million.

Evofem Biosciences, a biotechnology company founded in 2009 and headquartered in San Diego, California, is currently led by CEO Saundra Pelletier. The company is dedicated to developing female healthcare products for reproductive health and contraception, such as the Nestorone contraceptive vaginal ring.

Evofem Biosciences is developing innovative therapeutic solutions focused on women’s reproductive health, including contraception and the prevention of sexually transmitted infections. The company is creating products that are easy to use and affordable, with its patented vaginal gel forming a key part of this strategy. To date, the company has raised a total of $130 million in financing.

Amphora®, a contraceptive gel under Evofem Biosciences, is designed for female contraception. It is hormone-free and does not require daily use or prior insertion; it can be applied as late as one hour before sexual intercourse.

Kindara, founded in 2010, has raised a total of $8.4 million in funding. Headquartered in Boulder, Colorado, Kindara is a women’s health company that launched the Kindara app. Leveraging established technology, the app enables users to track their menstrual cycles and, depending on individual needs, helps women conceive quickly or practice natural contraception.

Kindara’s specific features also include: connecting with female friends to share fertility plans and offer mutual encouragement; receiving feedback and support from community members and FAM enthusiasts; accessing information on basal body temperature changes, ovulation timing, and the peak day of cervical fluid; and continuing education through an extensive knowledge base and blog.

Data indicates that male contraceptive methods account for only 13.1% of chosen contraception options, with fewer than 10% of individuals willing to adopt male contraceptive technologies, leaving women to bear 80–90% of the responsibility for contraception. As women become increasingly independent, the technological advancement of the female contraception market is inevitable. Looking around, what products we use today were invented 60 years ago? Which of our understandings remain stuck in the last century? This holds true for both contraceptive methods and mindsets. Therefore, in the female contraception market, whether through technological innovation or disruptive service models, there lies a vast blue ocean of opportunity.