FemTech is on The Rise

By: Emmanuelle Lipski

Although women make up just over 50% of the world’s population, and despite significant advances in medical practices, we still observe gaps in gender health outcomes, treatment abilities and bias when it comes to healthcare delivery.

The fact that modern medicine is largely built on a “man model” has determined the understanding of physiology for researchers and physicians around the world, leading to significant gaps in research and treatment ability.

While we often hear that women live longer than men, it came out in 2016 that women (in the EU) spend more of their lives in poor health. These findings did gain a lot of attention at the time but failed to spur the momentum needed to address and prioritize women’s health.

Like many, seeing some of the alarming stats surrounding women’s health outcomes led me to spend some time researching and exploring FemTech. As both a beneficiary and recipient of women’s healthcare and an investor in high tech (including health tech!), I wanted to take the time to explore the “why and why now” of FemTech (mostly because better late than never) as well exciting opportunities surrounding it.

The problem

We already mentioned that modern medicine is heavily based on male physiology, which leads to both suboptimal health outcomes as well as experience in healthcare delivery.

• Women are disproportionally under-diagnosed and suffer from more adverse outcomes

1. Women are on average (across 750 diseases) diagnosed 4 years later than men. For example, endometriosis takes 7 years to diagnose, on average (and costs $21k per person per year to the system, on average)
2. Women account for 75% of people with autoimmune diseases
3. Women are twice as likely to experience adverse events from drugs
4. Women are more likely to suffer from persistent pain. A 2017 study indicates that 70% of those affected by chronic pain conditions are women, whereas 80% of pain research is conducted on males

• Women’s health is under-researched and invested in

1. 4% of tech investments and 4% of research is focused on FemTech worldwide
2. The inclusion of women in clinical studies became mandatory only in 1993, which has had a huge implication in researching the differences between male and women’s metabolic and hormonal differences. Similarly, medical practice is still largely built on a “reference man”, while the first advanced “reference woman” was developed only in 2022
3. 1% of healthcare research and innovation is invested in female-specific conditions (beyond oncology)

• Women CEO have a harder time raising

1. 70% of FemTech companies have at least one female founder (vs. 20% on average)
2. Less than 3% VC funding goes into female-led start-ups. Women are indeed massively under-represented among both entrepreneurs and VC investors (<15% of check-writers)

FemTech: The opportunity

Women’s health is increasingly becoming a topic of focus, conversation and of investment too, partly driven by a huge market potential:

• As of 2020, women spent $500B on medical expenses annually
• It is also estimated that women make 80% of the household medical decisions, are responsible for 85% of consumer spending and control 60% of personal wealth
• WHAM (Women’s Health Access Matters, a nonprofit) estimated in 2021 that investing $300M in health research focused on women will generate over $13B in economic returns through improved quality of life, reduced healthcare costs and more productive years added back to our workforce

All in all, it is an issue that can’t be ignored. In that context, we have seen a rise in FemTech solutions to include a wide range of products and solutions and to be valued at $500M-$1B according to a McKinsey research

The term “FemTech” was first coined in 2016 by entrepreneur Ida Tin and includes solutions that aim to improve healthcare for women across a number of female-specific conditions (e.g., maternal health, menstrual health, pelvic and sexual health, fertility, menopause, and contraception), or general health conditions that affect women disproportionately or differently (such as osteoporosis or cardiovascular disease) as well as biases in care delivery (e.g., mental health, pain management).

FemTech includes approx. 1,800 companies that have raised $1.6B to date — in Israel this translates into 130 companies having raised $160M (according to Start-Up Nation Central).

Looking at the different verticals included in FemTech, we are starting to see the emergence of success stories, yet numerous white spaces still remain:

• Maternal health: maternal health has arguably been the fastest growing area of innovation under the FemTech umbrella, it includes technologies ranging from patient support / virtual care (leveraging the remote care technologies and reimbursement trends) to diagnostics all the way to devices, trackers and wearables. One of the advantages of this area is that maternal solutions target a specific population segment (women pre- during- and post-pregnancy), which typically has a pretty well defined patent workflow, with existing (and relatively frequent) clinical touchpoints — this makes them usually simpler to both identify and engage with. Maven Clinic is one of the most successful companies in the space, which offers a wide breadth of support services (ranging from pre-conception to post-pregnancy or family care) and raised ~$300M to date
• Menstrual health is an interesting area too, especially in the context of its broader impact on general health as well as social and economic inequalities. While we have seen some innovation emerge in the space: data collecting companies (one example is Clue, a period tracking app, that has raised over $70M to date and entered into a partnership with L’Oreal to deepen our knowledge on the relationship between skin health and the menstrual cycle), period-proof underwear, new designs of menstrual cups, it has mostly been around consumer products and devices (with some investment in delivery services too)
• Similarly, we have seen pelvic and sexual health-related consumer products and devices come to market (e.g., Elvie which provides pelvic floor training and breastfeeding solutions and has raised >$150M), as well as some patient support / virtual care offering (e.g., Hinge Health, a telemedicine clinic for structural and functional disorders, known for its musculoskeletal offering, recently launched a women’s pelvic health program)
• Fertility: the increasing availability of fertility solutions (mostly IVF and artificial insemination) has been one of the fastest growing segments of FemTech in recent years, and life changing to some 15% of reproductive-age couples affected by infertility as estimated by the WHO. As such the global Assisted Reproductive Technology is expected to reach >$55B by 2028. Innovations in fertility include ML for embryo selection, sperm count, (home) diagnostics tech, IVF and quality management systems as well as new-generation (virtual) service providers (e.g., Kindbody has raised >$300M to expand fertility care in the US) as well as financing and benefits (e.g., Progyny,which provides fertility benefits to employers went public in 2019 and has a ~$4B market cap)
• Contraception is one area that has seen limited innovation in the past few years, beyond delivery services (e.g., Twentyeight health offers access to birth control and other treatments through online prescription and delivery services). According to the Bill and Melinda Gates Foundation, ~40% of pregnancies are unintended, which makes it clear that current contraception options (which haven’t really evolved in the past decades) aren’t working for many women, who want safe, reliable, discreet, easily accessible and longer-acting options, with fewer side effects vs existing hormonal options. The innovations in this space are all pre-clinical and mostly hormone-based (6-month injectables, once-a-month pill, micro-array patch), which means they’ll reach market at best in 8–10 years time, while research in non-hormonal alternatives has been limited
• Similarly, oncology research has been lagging behind for women (who comprise 42.9% participants in oncology clinical trials between 2000–2020 but experienced 46.5% o the burden according to a Nature study) although we see overall cancer mortality dropping significantly (1.8% yearly drop for men vs 1.4% for women and children), driven by earlier detection (e.g., at-home consumer BRCA testing, AI-driven diagnostics such as Vara), better prevention and improved treatments (incl. genetics). Areas of innovation incl. genomics research, precision medicine (e.g, identifying HER2-positive breast cancers that respond to a specific drug — in the pipeline of Bolt Bio), immunotherapy, and have so far lacked behind in funding for women’s health. Given the tech advances and and disease prevalence (and associated cost burden), this is one of the most promising areas of innovation — provided the technologies also address barriers to access in real-world settings
• Menopause, endometriosis, gynecological infections still present lots of white space for innovation — we see the emergence of some (few) patient support/virtual care solutions (e.g., Elektra Health is a platform that supports women through their menopause journey), diagnostics solutions (e.g, Dotlab developing a diagnostics for active endometriosis) and early research in new treatments (e.g., Gedea Biotech developing an antibiotic-free treatment for vaginal infections)

Closing thoughts

• The sense of urgency: There is a clear growth in awareness of both the challenges and opportunities associated with women’s health — from all stakeholders involved
• The enablers: Numerous technological and medical advancements have been made, continuously pushing the boundaries of “what is possible” and market trends have supported the adoption of some FemTech products, e.g., work from home and digitization driving remote care adoption as well as care delivery services, consumerism and women playing a more active role in their own wellbeing journey drove the adoption of several consumer products, an increased focus on tailored-content and services drove the availability of solutions focused on sub-populations (Black women through Health in Her HUE, LGBTQ+ population through FOLX Health). As the possibilities expand, we see solution spaces evolve, overlap and grow altogether
• The role of new players vs incumbents: While there are lots of opportunities for early movers to create a technology that addresses outstanding unmet needs, or to expand existing solutions/products to underserved communities and populations, existing and legacy players have opportunities to create partnerships and collaborations to solidify their position in a given market and/or enter a new one. This is not a market where the winner takes it all but where multiple solutions and products are needed to address different aspects of women’s health
• The limitations: while our understanding of disease burden and health interventions (dictating investment decisions too) are based on facts and data, notable gaps remain in women’s health, along the entire value chain (from pre/diagnosis, to treatment and monitoring to high-level population epidemiological studies), creating blind spots and undermining the advancements of R&D. Addressing this gap will require changes at several levels: from the regulatory agencies to the academics, clinicians/providers, health systems and governments — to ensure this data is properly defined, measured, tracked and utilized
• Our role as investors: I firstly believe that investors may have to adjust their assessment method to invest in FemTech (which typically involves different business models, a higher share of consumer and hardware products, leading to customer acquisition and engagement questions — and all in all requiring a new method of evaluation). Then we also have a role to play as to increasing awareness and PR, and championing the shift towards recognizing FemTech as an essential category in healthcare (and as such in health tech funding)

To conclude, I believe we are at a tipping point in FemTech innovation where there is now enough shared understanding of both the gender health gap and the importance of closing it, as well as innovators and investors entering the space that we are well positioned to unlock significant growth and opportunities.