Women’s health is more than one issue

What *is* women’s health? Ask 10 strangers, and you’ll get 10 different answers inclusive of heart disease, hypothyroidism and anxiety, to endometriosis, postpartum depression  — and yes, abortion. In other words, things inclusive of but not limited to ovaries, uteri and reproduction.

Four years ago, we started Tia with a vision to create a fundamentally new paradigm for modern women’s healthcare — one that didn’t reduce women to body parts, insurance CPT codes, or narrow reproductive life chapters. We believed then and we believe now that women’s health cannot be reduced to a single issue — any issue — and that to do so is a disservice to women’s whole health and livelihood. To give you a sense of both the depth and breadth of health problems facing women in America:

• Heart disease is the number one killer of women
• Women are diagnosed with anxiety and depression at 2-3X the rate of men
• More women die in childbirth in the U.S. than in any other developed country in the world
• 1 in 3 women have an autoimmune disease, with rates climbing annually

If the (inexhaustive) list of problems above overwhelms you, you’re not alone — it overwhelms us, too, but it also motivates us every single day. When we founded the company, the question of where to start — given all of these problems and shortcomings — was a big one. We were undoubtedly shaped by our own experiences as women and patients first, then founders and entrepreneurs second. We are women who have endured our own trials and tribulations with the U.S. healthcare system and its tendency to treat women as “small men with different parts,” and over-index on managing instead of preventing sickness. We recognize, too, that despite our own pitfalls getting quality care, we are nonetheless privileged white, cisgender women with health insurance. And, our experiences pale in comparison to those faced by BIPOC and LGBTQIA+ communities, who endure systemic discrimination and access barriers that engender disparities in health outcomes.

A business with a mission

We believe that building a big business and positively impacting women’s health and well-being are not mutually exclusive, but rather, inextricably linked. Accordingly, we distilled our many aspirations down to this single mission statement:

You might notice there’s no mention of clinics, services, body parts or even “healthcare” in this statement — that’s intentional. This mission statement is high level by design to afford us the opportunity to invest in many different “what’s” and “how’s” — from clinics to apps for doctors to community education — that all serve our greater northstar “why.” Despite its breadth, each word or phrase has clear intention and purpose:

Every Woman

Every woman = We exist to improve the health of all women and not just some — even if we aren’t there just yet. Committed to continuously investing in diversity, equity and inclusion, we take an intersectional approach that recognizes the multitude of ways that age, sex, gender, race, ethnicity, religion, ability, sexual orientation, and economic status impact us — clinically, psychosocially and experientially.

Optimal Health

Optimal health = The antidote to (just) treating sickness; we invest in healthcare that is physical, mental and emotional and helps you get and stay truly well.

As defined by herself

As defined by herself = Affirming and option-based to enable true choice — for decisions about your reproductive health *and* everything else.

On choice

We believed then and we believe now that choice — a notoriously triggering word in American healthcare and politics — is a critical part of our mission, both in philosophy and in practice. Yes, as applied to reproductive choices — the decision about if, when, how, and with whom a person should choose to get pregnant, stay pregnant or end a pregnancy — but also other choices women face day in and day out about their health, from her contraceptive method to endometriosis treatment, to birth plan.

While choice in healthcare sounds really great, enabling it is actually quite difficult. We believe true choice requires:

• Information — evidence-backed facts; better when personalized to an individual’s health history and lived experience (e.g. culturally-informed care)
• Counseling — objective, non-coercive discussion about all of a woman’s options, with the support of a trusted provider
• Access — the ability to act on that choice, logistically, financially etc. You can have all the information and counseling in the world, but if you don’t have access to those options, it’s a moot point

On abortion

The abortion question — specifically, is it the core issue in women’s health, or one of many core issues in women’s health — has caused division within the healthcare industry and feminist movement for decades. While the abortion rate has been steadily declining for years, due in large part to increased access to contraception, nearly 1 in 4 women in America will have an abortion by age 45. Thus, abortion is not “niche,” or a rare experience, but relatively commonplace, despite the barriers to access and heightening restrictions (e.g. TRAP laws) in certain parts of the country.

Given our strong and explicit pro-choice beliefs, why then does Tia not provide abortion services ourselves?

Put simply, Tia is not equipped to provide abortion services in a manner that supports quality and choice in full, inclusive of surgical options and backup. Tia is a female primary care provider — not a surgical practice — focused on outpatient or “clinic-based” care. We put an extra emphasis on prevention through our core offerings like the Tia Well-Woman Exam, which goes far beyond the you’re-in-and-you’re-out cervical cancer screenings that most of us think about as “preventive health.” Given the massive female primary gaps plaguing the U.S. healthcare system, and the delays in preventive care that result when women lack a primary care provider, we explicitly chose to invest here by creating a new type of medical home model that recognizes the importance of sex-specific difference in the diagnosis and treatment of people assigned female at birth. By becoming the go-to sex-specific primary care provider for the modern healthcare system, Tia can change the trajectory of health outcomes and cost of care across a woman’s lifespan — a notable feat unto itself.

While Tia provides many services that a typical primary care practice does not — from acupuncture to mental health to ultrasound and IUD insertions — we are not a surgical practice. There are many, many services we are not equipped to provide ourselves, clinically or operationally, and thus refer out to high-quality providers who can.

For example, if a Tia patient needs fertility treatments (IVF or egg freezing), we refer her to a reproductive endocrinologist. After the first trimester, we refer our patients to an obstetrician. If a patient has appendicitis, a surgeon at an affiliated hospital will operate.

Referring a patient to a safe, trusted abortion provider who is better equipped than we are to enable access to “all options” — both medication and surgical abortion — is no different than referring a patient for other care Tia does not provide within our four walls. First and foremost, our role as a primary care provider is to be the go-to front door to healthcare for women — the first place a woman turns to for information, counseling, and yes, routing, to enable access. And, that is exactly what we do.

Today in New York City and Los Angeles — and soon, Phoenix — Tia adheres to a four-part abortion care model that upholds our definition of true choice: one that encompasses information, counseling and access. Tia provides the exact same services to women across these markets, which includes:

#1: All-options counseling — a private, judgement-free discussion between a patient and provider about her pregnancy, health factors and “all-options” in the context of her legal rights in a given state (parenting, adoption, termination), and without coercion or limitation.

#2: Mental health support — Tia provides 1:1 talk therapy to support patients throughout their care journey for both episodic and ongoing mental health needs. We also offer “Support Circles” for patients who may want to connect with other women going through similar health journeys.

#3: Referrals to safe, high-quality abortion providers who can offer both medication and surgical options — Pregnancy termination is a highly local issue, which necessitates local considerations and partners. If and when termination is chosen by a patient, referrals are made with the support of Tia Care Coordinators, just like any other referral.

#4: Follow-up preventive care — To prevent repeated unintended pregnancies, we provide post-termination contraceptive counseling unique to a patient’s needs and circumstances as well as postpartum care.

Tia’s abortion care model was developed by our NYC Medical Director, Dr. Jacque Moritz, a renowned OB/GYN with extensive experience providing abortion care himself when he worked in a hospital setting — a very different environment from Tia’s outpatient, “retail-style” clinics. Tia’s model prioritizes quality and safety above all else, while upholding our commitment to patient choice in Tia’s comprehensive definition of this word.

We are (just) four years into Tia’s journey and mission: to enable every woman to achieve optimal health, as defined by herself. While we have not achieved this mission in full yet and recognize the extensive mountains we still have to climb to get there, the essence of choice shine brights in everything we make and do — from enabling our patients to choose the gender of their provider (and soon race) when booking appointments, to the multiple tools in the toolkit discussion of both pharmacological and nonpharmacological interventions in patient’s Care Plans, to the unhindered, objective support and counseling we provide every patient with respect to her reproductive health decisions, both proactively and reactively.

Every day that we expand access to Tia’s whole person healthcare, and elevate women’s health beyond a single issue, we are one step closer towards seeing and treating women for who we really are: whole people.