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‘The capacity for harm is real’- experts raise concerns over use of AI in reproductive health
Without prioritising equity, AI algorithms may end up providing “flawed” evaluations, experts have warned
Experts have raised concerns over the use of AI in sexual and reproductive health after the World Health Organisation stepped in to address the risks and opportunities of the rapidly advancing technology.
The World Health Organisation and the UN Special Programme on Human Reproduction unveiled a new technical brief that would explore the application of AI in sexual and reproductive health and rights.
The brief, developed by researchers through consultation with specialists in the field, aims to assess trends and challenges ahead and mitigate potential harms and risks.
While experts have acknowledged that AI has the potential to improve sexual and reproductive health, they have warned that without prioritising equity, algorithms may end up providing “flawed” evaluations and neglecting certain groups of people.
“AI tools are only as good as their inputs,” Dr Regina Davis Moss, president and CEO of In Our Own Voice, told Femtech World.
“Without deliberately building equity into the process, algorithms may rely on racially biased data to provide flawed evaluations and recommendations for healthcare providers.”
Assuming one type of body to be the default in medicine, she said, has already had serious consequences historically, particularly for people of colour and those from ethnic minorities.
“AI tools aren’t perfect yet. When we use this technology to address our sexual and reproductive health needs, we’re putting our trust in tools that lack the precision, nuanced understanding, and reliability that good care requires.
“We’re also putting our medical information at risk, which then can be used to perpetuate medical racism. That’s why we need policy regulations for AI that address biases, risks and potential disinformation.”
Robert Ranisch, researcher in medical ethics and digitalisation at the University of Potsdam, Germany, said: “It’s crucial to recognise that AI-driven tools are vehicles for information delivery, inherently embedded with certain values – they are not inherently neutral.
“Think about digital tools for sexual education, for example, in a society with strong patriarchal views. It makes you wonder who’s behind these systems and what kind of ideology they’re pushing. It is crucial to have reliable and trustworthy institutions in place.”
Inherent challenges of some AI systems, such as biases, Ranisch added, underscore the fact that a flawless system is an illusion.
“Systems effective in one context or for one population may not perform as well in others,” he explained.
“This highlights the importance of contextual and cultural sensitivity in AI deployment. Engaging local communities in the design, development, and testing of these applications is crucial for their acceptability, trustworthiness and effectiveness.”
Dawn Laguens, vice president and chief of global strategy and innovation at Planned Parenthood Federation of America, said the possibilities of AI in sexual and reproductive healthcare and information are promising, but the capacity for harm is real.
“As innovators, our charge is to responsibly apply tools like AI to health care in ways that positively transform patients’ lives, without compounding existing harms or disparities to the detriment of communities that already face the most barriers to care,” Laguens said.
Multiple studies have found that AI models built to predict conditions, such as liver disease, are more likely to miss disease in women than in men.
Additionally, machine learning algorithms designed to diagnose common infections in women have been shown to present diagnostic biases among ethnic groups.
Dr Kala Wilson, content and community manager at Health in Her HUE, said to effectively address the “systemic” biases in AI, we need to see the technology as a tool rather than a solution.
“This approach can help make health resources accessible to everyone, ensuring fair and equitable progress in healthcare delivery,” she told Femtech World.
Dr Saralyn Mark, women’s health innovation lead at the American Medical Women’s Association, added: “As recommended by UNESCO, it is essential for civil society to develop gender-inclusive AI principles and guidelines to overcome the built-in gender biases found in AI devices, data sets and algorithms.
“This will not only provide a remedy for our existing technologies, but also for the new ones that are being pioneered now and in the future.”
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Small bowel microbiome differences between women and men may help explain why some conditions are more common in women, a study suggests.
The small bowel microbiome is the community of microorganisms living in this part of the digestive tract, where they play vital roles in immune function, metabolism and hormonal regulation.
Researchers found differences between women and men in the composition and organisation of these microbial communities. One bacterial community containing Granulicatella was found only in women.
The study was conducted by investigators at Cedars-Sinai Health Sciences University.
Ruchi Mathur, director of clinical research and clinical operations for the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai and corresponding author of the study, said: “One intriguing finding was a bacterial community containing Granulicatella, which we found only in women.
“Bacteria in this community appear at increased levels in women with polyendocrine metabolic ovarian syndrome, formerly known as polycystic ovary syndrome.”
The researchers also identified differences between women and men in how microbes in the small bowel produce fructans, complex carbohydrates known to trigger digestive symptoms in irritable bowel syndrome (IBS).
IBS is far more common in women than men.
Mathur, who is also a professor of medicine, said: “Our findings show that biological sex is a critical variable in the small bowel microbiome.
“We must consider it as we move toward more personalised approaches to understanding and treating disease.”
An experimental cancer drug reduced bone loss and body fat in mice modelling post-menopausal changes, early research suggests.
The compound, CADD522, appeared to strengthen bones and help the animals stay leaner after surgery designed to mimic hormonal changes seen after menopause.
The treatment remains at an early experimental stage and has so far only been tested in animals.
The study, led by the University of East Anglia, investigated CADD522, which was originally developed to block a protein involved in the growth and spread of several cancers.
Mice treated with the compound for eight weeks showed significant improvements in bone health. Scans found increased bone volume and better preservation of the honeycomb-like structures inside bones that are crucial for strength and resilience.
Blood tests suggested the treatment stimulated new bone growth without interfering with the body’s normal process of breaking down and rebuilding bone.
Dr Darrell Green, lead researcher from UEA’s Norwich Medical School, said: “Osteoporosis affects around one in three women over the age of 50, leaving sufferers vulnerable to painful fractures that can seriously impact quality of life.
“Current treatments exist, but many are plagued by side effects, safety concerns or inconvenient dosing schedules that make long-term use difficult.”
The researchers also found that mice receiving CADD522 weighed less than untreated mice despite eating the same amount of food.
They had less body fat and fewer fat deposits in their bone marrow, a process commonly seen after menopause and linked to declining bone health.
The team also examined brain tissue and found that the drug appeared to reverse several menopause-related changes in fatty acids.
Levels of omega-3 fats including DHA remained largely intact, while several other lipid abnormalities shifted back towards healthier patterns.
Green said: “We didn’t directly test for memory or thinking ability, but our work raises questions about whether this drug could one day help address wider menopause-related health problems.”
Safety experiments in mice, rats and dogs found that CADD522 could be taken orally and was well tolerated.
The compound also appeared to be metabolised more slowly in human tissue than in rodents, potentially improving its performance in people.
“This is still in the early stages and has so far only been tested in animals but we hope that the benefits will translate to humans to ultimately reduce fracture rates,” added Green.
The research was led by UEA in collaboration with the University of Maryland, the Scintillon Research Institute in San Diego and the University of Stirling.
Safety testing was funded by The Sir William Coxen Trust as part of the development of CADD522 as a childhood cancer treatment.
Weight loss surgery was linked to more regular periods and fewer polyendocrine metabolic ovarian syndrome (PMOS) symptoms in women aged 18 to 45 living with obesity in a recent study.
The researchers recommend that women undergoing the procedure have access to preconception care and reproductive counselling to support their reproductive health.
Researchers at the University of Surrey analysed data over 24 months from 84 women who underwent bariatric surgery and 18 women living with obesity who did not have surgery.
Of those who underwent surgery, 49 had gastric bypass procedures and 35 had gastric sleeve surgery.
Women who underwent metabolic bariatric surgery lost more than 30kg on average at 12 and 24 months after the procedure.
Among women with polycystic ovaries, the condition persisted in only 10 per cent after 24 months.
Women also reported a resolution of clinical hirsutism, or excess body hair, by 12 months.
Women who had previously experienced irregular periods reported more regular menstrual cycles after surgery.
Professor Martin Whyte, co-author of the study and professor of metabolic medicine at the University of Surrey, said: “A large proportion of those undergoing bariatric surgery are women of reproductive age, who may be planning a pregnancy in the coming years.
“So much remains unknown about the impact of this type of surgery on women who are planning to have children.
“This raises the question of when the ideal time after surgery is to conceive.”
Women have a higher prevalence of obesity than men, with 57 per cent of women in the UK classified as overweight and 27 per cent living with obesity, which can affect fertility and the health of an unborn baby.
The researchers said 17 women had healthy pregnancies following surgery.
Although this was not specifically examined in the study, no difference in birth weight was observed between babies conceived within or after the first year.
Dr Kathryn Hart, co-author of the study and associate professor in nutrition and dietetics at the University of Surrey, said: “What we have found is that bariatric surgery positively affects the reproductive health of women living with obesity and can improve the likelihood of them having a healthy pregnancy after surgery.
“Dysregulated hormone levels, irregular periods and conditions such as polycystic ovaries are affected by obesity.
“By reducing this, what we have seen is that it can lead to improvements without the need for medication.
“We would suggest that clinicians consider medical intervention for obesity to treat irregularities in the menstrual cycle and issues with fertility.”
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