Femtech’s Limited Role in Tackling Healthcare Inequity
If you walk into the Nurx headquarters in San Francisco, California you will find yourself in an open-office space, colorfully accented with pastel pillows, plants and modern furniture. The trendy office is home to reproductive telehealth startup Nurx. Nurx aims to make reproductive healthcare more accessible through direct-home delivery of sensitive services such as birth control and HPV testing. Focused on accessibility and with a primary audience of women-identifying patients, Nurx is part of a broader movement in Femtech–the startup sector that specializes in healthcare technology for women-to improve women’s healthcare equity.
To some, the trendy set-up of the Nurx office marks a shift from an era in which women’s reproductive health-a field that has been historically underfunded-is growing increasingly popular. Yet to the less optimistic, the fast rise of Femtech raises concerns surrounding accessibility; and the need for such advancements to be coupled with integrative and inclusive efforts to improve healthcare equity.
Femtech emerged in response to systemic gender biases in biomedical research. The biomedical research industry has historically based its understanding of diseases, drugs and biotechnology on men, and under-researched conditions that primarily affect women. Until the early nineties, the U.S. National Institutes of Health was not legally required to include women as a part of clinical trials. In the pharmaceutical industry, this underrepresentation meant that women’s response to prescription drugs was frequently understudied. Dramatically, this led to eight out of ten prescription drugs to be removed from the U.S. market in 2005 due to unexpected adverse side effects that developed widely in women: illuminating the danger of male bias in the biomedical research process.
Furthermore, many health conditions that develop differently in women often go unnoticed, or are diagnosed incorrectly. For instance, in a 2015 study, Urinary Tract Infections and Sexually Transmitted Infections were found to be misdiagnosed in women almost 50 percent of the time at a Cleveland emergency room. Such misdiagnoses lead to expensive outcomes for the health sector: ranging from antibiotic overprescription, unneeded antibiotic resistance, and uncertainty for thousands of American women each year (Tomas, 2015).
To Femtech leaders, the under-representation of women in clinical research and the persistent effect this has on the female experience with the medical system reifies the need for more investments in Femtech. According to Forbes Women contributor Estrella Jaramillo, advocates are encouraging more investment firms to prioritize Femtech, so that more technology can be developed to address problems that disproportionately affect women and to research opportunities for better designed products and services.
Millions of dollars are already invested into Femtech annually, and Frost & Sullivan estimate that the Femtech market may be worth $50 billion by 2025: signaling the lucrative rise of Femtech.
In many ways, Femtech portrays an optimistic portrayal of the future of women’s healthcare in the United States. Similar to other startups, Femtech companies such as Nurx identify a problem, and create a model or product to address it. Tech optimists laud startups for their ability to creatively tackle healthcare issues-such as Nurx, which makes services more accessible outside the traditional clinical setting (spaces that even prior to COVID-19, patients faced long wait-times to see a healthcare provider); as well as women-focused gynecology companies like Tia, which focus on an integrated approach to managing their patients health.
Healthcare startups are challenging the way Americans perceive how healthcare should be delivered, and by whom. By claiming to streamline the healthcare experience through privately-delivered technologies, healthcare startups-including those in the Femtech sector-are making a statement against the American public sector’s historic difficulty in managing healthcare.
Yet, the rise of the health startup industry is also dividing those in the healthcare sector regarding how large of a role the private industry should play in managing healthcare. Such debate raises concerns that private involvement in social issues can cause complicated issues to be simplified as technical issues to be fixed by simple technofixes.
The issue of technofixes–the process in which people take a technological approach to handing a problem–is outlined in-depth by political theorist Timothy Mitchell in his book In Rule of Experts. While based in a discussion of how Egypt grappled with World War II and the malaria epidemic the same year, In Rule of Experts highlights a common tension in the development space: the problems that can arise when large-scale issues are not treated as outcomes of systemic, structural failings, but isolated as individual events to be addressed through technofixes. In his own words, Mitchell argues that that Egypt’s approach to managing the social vulnerability that the epidemic exposed through this framework makes the unjust assumption “technical expertise” was the key to “overcome the obstacles to social improvement.”
Perhaps the same risk exists within the Femtech sector. While Femtech startups can certainly streamline arguably outdated medical delivery pathways by honing in on and responding to individual gaps in the healthcare system-they run the risk of turning inherently political issues, such as what women receive equitable healthcare and why-into technical issues. Such a siloed approach can cause sociopolitical issues to be divorced from the structural factors that caused these inequities to begin with, and for systemic issues-such as the fact that women in the U.S. have the highest rate of maternal mortality because of complications from pregnancy or childbirth (compared to similar high-income countries) to be treated as a technical issues, unrelated to other failings in healthcare in the U.S.
Dr. Rachel Logan (PhD, MPH, CPH)-a public health researcher focused on improving sexual and reproductive health care for historically marginalized communities-is a realist about the net impact and capacity Femtech has to equitably improve women’s healthcare equity.
“When considering Femtech’s role in improving reproductive health, we have to ask who is it being designed for? Who is asked to come to the table to design and create technologies? And whose issues are valid?”
To Dr. Logan, advancements in the Femtech space are insufficient to addressing the root cause of reproductive healthcare inequity: a fragmented American healthcare system that has deep systemic racial inequity. Nearly 30 million Americans are uninsured and millions more receive poor coverage, or even with coverage, have difficulty in accessing culturally sensitive healthcare at all.
“The fallacy of the trickle-down belief [of healthcare startups] is that it assumes if we keep tinkering with science and technology, and fail fast, but design quickly, we will eventually produce a successful product or platform that will trickle down across populations, and eventually to the most disadvantaged communities,” Dr. Logan commented.
Notoriously, history has proven the opposite trend to be true. As Charlton McIlwain of the MIT Technology Review stated in his 2020 article , “We often call on technology to help solve problems. But when society defines, frames, and represents people of color as “the problem,” those solutions often do more harm than good.”
Furthermore, historically, medical practices do not change as quickly as technological advancements. Due to strict patient safety and provider satisfaction guidelines in the healthcare sector, technological innovations can take longer to be implemented in the healthcare sector compared to other industries. This data suggests that large-scale investments in Femtech are not enough to dramatically catalyze improvements in women’s healthcare equity: signaling a need for policy change beyond the startup sector.
As technology companies grapple with improving access for disadvantaged communities, they must doubly work to ensure the inclusivity of their products and delivery models. The lucrative rise of Femtech companies raises the questions: who are these companies’ target audience, and how accessible are their services to underrepresented communities? While many Femtech companies like Nurx have the potential to improve the health outcomes of underrepresented communities, studies have found that technological innovations often first lead to and cause the most health differences for individuals of higher socioeconomic status: “creating social inequalities in health where they were once very low or nonexistent”. Additionally, one-size-fit all health models and products that do not take into account cultural factors can risk misrepresenting why underserved groups have difficulty accessing their services to begin with.
Such a concern is especially pertinent for Black women whose healthcare concerns are particularly placed at-risk by both structural inequities and clinical providers: Black American mothers face disproportionately high rates of maternal mortality, and beyond but connected to reproductive health, Black women receive less medical intervention for pain management and cardiovascular care.
To Dr. Logan, the answer to addressing reproductive health inequity cannot be found in Femtech alone, but in a holistic healthcare approach that prioritizes individual autonomy, and a whole-person health framework that sees reproductive health as just one interconnected element of people’s health.
Inequities in reproductive healthcare-such as the high rates of maternal mortality in the U.S, particularly for Black mothers-can be magnified when they are isolated as individual health risks, rather than outcomes that become more likely when other healthcare safety nets are not in place.
Health issues in the U.S. are often siloed off as individual issues. Notoriously, the U.S. is famous for its high volume of specialist physicians, and simultaneously, for its delivery of fragmented healthcare. As Dr. Kurt Stange MD noted in 2009, “it is the poor generalist health professional who considers only the disease and not the whole person. It is the poor policy maker that designs health care systems that deal only with discrete diseases and fails to create environments that support creative interaction between different parts of the system.”
As Dr. Logan similarly expressed, a fragmented healthcare system cannot allow for comprehensive whole-person health that attacks negative health outcomes such as high maternal mortality rates within particular populations at its systemic root, in tandem with other societal, and individual patient factors.
One of the most important elements in making reproductive health more accessible beyond integrative/comprehensive healthcare coverage?
“Improving services care delivery and system healthcare coverage so that people can exercise autonomy over their reproductive decisions. Public health funding can sometimes be at odds with individual autonomy,” Dr. Logan stated.
In the reproductive health space, people’s wants and needs are often assumed by both the healthcare industry and clinical providers. To combat this, Dr. Logan believes that there must be “resources, services, for everyone across the spectrum to get access to information, tools, and resources that can help them make choices that align with their needs” and for such information to be delivered in a way that does not stigmatize certain behaviors or people. Femtech startups must be intentional to avoid perpetuating the same paternalistic pattern.
With Femtech’s fast-rise to being one of the top startup sectors, innovators in the Femtech space and institutions across the private and public sector alike must be intentional about how they deliver and maintain inclusivity with their products. To Femtech enthusiasts, startling rates of unequal healthcare outcome amongst American women compared to women in similar high-income countries–and disparities faced by Black and Indigenous Women of Color–exemplify the need for large-scale investments in Femtech. Indeed, many Femtech industries intend to target these exact inequities. The growth of venture capital certainly marks a shift in healthcare delivery, signaling that “advancements in medicine are no longer exclusively born from providers within the delivery system and increasingly from innovators outside of it” (Health Affairs, 2019)
However, Femtech innovations cannot be seen as the sole route to making women’s healthcare more equitable. Femtech must be complemented by robust health policy and structural safety nets to support women’s health. Women’s health does not exist in a vacuum of reproductive health, but is influenced by a web of social and biological factors beyond the reproductive system: a nuanced web that should be reflected in women’s healthcare. Yes, Femtech aims to expand into how health issues in general affect women differently–but innovative healthcare technology is not enough to address systemic inequities in American healthcare that cause disproportionate sexual health outcomes, particularly for BIPOC and low-income women.
Femtech offers exciting technologies and telehealth platforms to women who have the privilege to access them–but raises concerns of inclusivity and accessibility for underrepresented women who may not be considered the main target for these technologies. Yes, companies like Nurx have already provided hundreds of thousands of women with more accessible sexual health options-but we can celebrate these wins in women’s reproductive healthcare while still not presenting them as the sole answer. To make holistic steps towards addressing women’s reproductive healthcare equity, women should have a safety net outside of Femtech startups alone to support their sexual reproductive health, and more largely, their general health.