Looking at the proliferation of healthcare and wellness solutions targeting women, as an investor I have, admittedly, been slightly overwhelmed. In the past five years in particular, countless companies have emerged in the space looking to tap into the women’s health revolution. What I absolutely love about healthcare — and female-focused healthcare even more so — is that most companies are born from personal struggles, meaning that glissando the majority of companies are highly mission-driven.
But — it also feels like dozens of startups are following the steps of the first successful entrepreneurs in the space who raised capital, perhaps suddenly realising that there was a target market there, and an appetite for investment, for their ideas. From an investor’s perspective, it’s confusing when several companies suddenly pop up in the same space when you know that the success of one is by no means an indicator of the success of the next. It could risk cannibalisation in the target market and, in turn, a price competition with squeezed margins. This is particularly true for consumer products and low barriers to entry services.
In order to be able to make sense of this now massive space ($50bn by 2025), I have spent a lot of time thinking: what are women really looking for in their wellness and fertility journey, and beyond that? There is a leadenly tendency in the market to narrow female health down to female reproductive health. The reality is that there are numerous health conditions that see distinct differences in how they affect men versus women due to a wide range of biological, social and behavioural factors.
HEALTHCARE: IT’S (STILL) A MAN’S WORLD
The global healthcare system has a long history of systematically failing to serve women. To give you a concrete idea of the degree of ignorance against women in healthcare, here’s a few examples for you:
Women make up only 19% of the participants in clinical trials in HIV research despite making up 50% of the affected population.
The overwhelming majority of health research historically has been done using only male animals. The inclusion of female animals would cost healthcare companies more because they’d have to account for differences caused by their menstrual cycle, which could add huge complexity to their research.
Research around heart health concluded that taking a baby aspirin every day decreased the risk of coronary heart disease: but the sample was 80% male. Later research that examined the effects of aspirin in both genders concluded that regular consumption does not decrease the risk of coronary heart disease for women. In fact, it might do them more harm than good as it can make it harder for women’s bodies to stop bleeding in the event of injury
Let’s take the pill as an example. While it has certainly been a means for women to get into higher education and the workplace thanks to a significant drop in unwanted pregnancies, recent studies have also surfaced the impact of hormonal contraception on the non-reproductive system, and how different hormone dosages can intrinsically affect a woman at her core. Side effects go well beyond minor ailments: hormonal imbalance can impact the decision-making process within a female brain! (For more info on this, I highly recommend reading How the Pill Changes Everything: Your Brain on Birth Control by Dr. Sarah Hill). Almost half of the women who go on the pill stop using it within the first year because of intolerable side effects on their physical and mental health. How is this OK??!
It is then fair to assume that most of what we know about health is actually specific to men. Comparably, we know very little about women’s health.
IF SHE CAN’T TRUST THE HEALTH SYSTEM, WHERE DOES A WOMAN TURN AMIDST A HEALTH CONCERN?
Given the above, as a VC I’m trying to understand where innovation will come from based on women’s behaviour in seeking medical guidance for female-specific health issues.
Intuitively, women should turn to their healthcare provider when seeking help for symptoms: especially for reproductive health issues. GPs, however, often do not have enough information on women’s health to be able to give substantiated advice due to the significant knowledge gap that goes way back to the clinical research stage. Will the healthcare system change and serve women more efficiently, accounting for their hormonal — and even molecular differences — to the other gender? To me, this is very unlikely, as firstly, the healthcare system is notoriously slow to change: it takes years for changes in scientific research practices to come into play. Secondly, women’s trust in the healthcare system is low, given that it has consistently and systematically failed to address their needs for decades. In a survey I ran on a sample of 22 women (across relatively different age groups, social backgrounds and countries of residence), GPs and specialists like gynaecologists ranked as the last port of call when analysing what resources women use when they have a health concern. Based on this, it seems unlikely that we’ll see a change in the traditional healthcare system anytime soon.
So, if a woman isn’t immediately turning to the healthcare system for advice, where does she go first? You could assume that most of the time — and especially for fertility related issues — it’s her friends, or a community that she’s part of. But when her friends can’t directly relate to her the issue, or can’t offer advice (or, the topics are too taboo to be shared), who does this woman turn to? Scarily, Google actually ranked as the first port of call for medical advice in my survey. There are no further options unless you really trust search engines (which, in most cases, are the only viable option): resulting in a very lonely, misunderstood and quite frankly scary journey.
THE TWO BIG OPPORTUNITIES IN FEMALE HEALTHCARE
Based on the above, the obvious area for disruption in women’s healthcare lies within the pharmaceutical and clinical trials sector. I’d be curious to see new entrants to the market that tackle the lack of clinical trials on women for commonly based drugs, going back on research already undertaken to reassess drugs dosages for women. The key barrier here, however, is that there are no clear incentives for the pharmaceutical industry to invest in this. Nonetheless — I would love to see companies emerging in this space. (If you have any information on innovators looking at this, I would love to hear about it: you can contact me at email@example.com).
Taking this into account, I hereby see two main opportunities for companies innovating in the women’s health space.
The first is a new, radically different model of healthcare that is built around the female experience. In this, we can forget the results of the majority of clinical trials that have ever happened since most of them were undertaken without factoring in the differences between the male and female bodies. We are starting a healthcare revolution: an entirely new model tailored to women from the very beginning.
Companies like Pexxi are doing just this: starting from scratch by building a dataset with hundreds of datapoints on an individual woman and using this to recommend the right contraceptive for her unique profile. Wild.ai is also collecting data on individual women and is building an algorithm for personalised fitness recommendations that operate in harmony with the menstrual cycle and their nutritional choices. Datasets like this are very hard to build, but are also extremely defensible because of the invaluable proprietary dataset they are in charge of. New clinical models tailored to women have also emerged, such as Maven, Tia and Kindbody, which serve as one-stop shops for women’s health (online and offline).
I chatted with Shardi Nahavandi, founder of Pexxi, which confirmed my thesis:
“There are a lot of myths to be debunked in the contraceptive space, and we want to help re-educate people. Misinformation around contraceptives has led to women taking the wrong products for them for decades. We are working to revolutionise the healthcare industry out of its one-size-fits-all template. The contraception pill, for example, is not simply a pregnancy prevention device — there is a ‘massive therapeutic aspect’, with contraception being prescribed for a range of different conditions unrelated to pregnancy prevention, like acne treatment, for example. And yet every single study done on measuring the effectiveness of contraception is based solely on how effective they are at preventing pregnancy.
At the heart of it all lies education.
“If you decide to take a contraceptive, you should be made aware of the potential impact that different brands and types may have on your health. There are 227 brands of oral contraceptive on the market at the moment: rather than being prescribed the cheapest option by default, you should have the right to choose, based on data that factors in your own hormones and your own body. Pexxi believes that ‘contraception is health; health is contraception’. There should be no division between the two, nor should they be mutually exclusive.”
The second opportunity I see is in communities, where women can find support from other women going through similar experiences. Given women’s reliance on support from their female peers when faced with a medical or personal issue and the weight of the emotional component in issues related to reproductive health, this is a critical area for innovators in the femtech space.
We are human, and humans have an innate desire to ‘belong’. Motherhood, for example, can be a daunting and isolating time if you don’t have peers to share your experience with. Humans naturally thrive off social interaction and being able to compare and share experiences and ideas with people on the same journey can be helpful and comforting. Communities like Peanut, which connects women with other women to share their experiences of motherhood, have been very successful for this reason. It is more difficult to have a successful peer support system with more ‘taboo’ or personal topics like menopause and fertility, but I’m excited to see so many startups beginning to tackle this.
MAPPING THE FEMTECH REVOLUTION
I’ve mapped the femtech ecosystem below. The sector has received more than $1bn worth of investments since 2014, with around $750m of that in 2019 alone. If you’re an entrepreneur building a new healthcare model for female health, don’t hesitate to get in touch with me at firstname.lastname@example.org.
WELLNESS & PREVENTION
Wellness and prevention is by far the largest category and it’s is the area that has received the majority of investments to date. The breadth of the sector is tangible, with solutions spanning from fitness, period trackers, education and media platforms, period-related consumer goods and sexual wellness platforms. We’re even seeing an emergence of corporate benefits pure plays, which play a huge part in preventing absenteeism and presenteeism in the workplace as a direct result of reproductive health or family related issues.