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Femtech must acknowledge the risk of perpetuating medical racism, say campaigners
Campaigners have warned that health tools could overlook women from marginalised communities
Femtech must address medical racism, campaigners have warned, amid concern that the sector could be perpetuating long-standing racial inequities.
Femtech is already showing promise to help clinicians make better diagnoses and support women with managing their health.
But as excitement grows, campaigners have warned that these powerful tools could overlook women from marginalised communities and perpetuate long-standing racial inequities in how care is delivered.
“Any technology meant to help people track and improve women’s health outcomes must be inclusive and anti-racist,” Dr Regina Davis Moss, president and CEO of In Our Own Voice, told Femtech World.
“Black women have historically been disregarded, overlooked and undermined by the medical technology industry. It is past time for our interests and needs to be prioritised in clinical trials and other forms of scientific research.
“Femtech companies must ensure that their research and clinical trials equitably involve communities of all backgrounds.”
Around 2,000 femtech companies and apps have sprung up in the last decade to address women’s needs, including tracking apps, fertility solutions and menopause platforms.
These new tools are often built using machine learning, a subset of AI where algorithms are trained to find patterns in large data sets like billing information and test results.
The data these algorithms are built on, however, often reflect inequities and bias that have long plagued the healthcare system. Research shows clinicians often provide different care to white patients and patients of colour. Those differences in how patients are treated get immortalised in data, which are then used to train algorithms.
“When our research omits subsets of the population, the accuracy and potential benefits of that research do not extend to those who disproportionately bear the burden of disease,” said Dr Monique Gary, breast surgical oncologist at Grand View Health.
“We are seeing already how AI can harm marginalised communities, where biased algorithms require racial or ethnic minorities to be considerably ‘more ill’ than their white counterparts to receive the same diagnosis, treatment, or resource. This is perilous and avoidable.”
To create responsible and equitable technologies that include BIPOC (Black, Indigenous, and people of colour) women, Gary said companies could start identifying and recruiting experts of colour, via pipeline programmes and incubators.
“We need to start listening to, believing and supporting the voices of Black women,” she said.
“In 2024, women of all ages and races, ethnicities and orientations are telling us out loud what they need to actualise a better version of healthcare which incorporates significant tech utilisation. It’s now up to us to listen.”
Ashley Jones, creative director of Tones of Melanin, said femtech must acknowledge the risk of perpetuating medical racism and prioritise inclusivity.
“Companies in femtech should actively seek out diverse perspectives and experiences, particularly from BIPOC women, in both their datasets and research.
“This includes collaborating with BIPOC brands, stakeholders and organisations to ensure that their products address the specific needs and concerns of BIPOC women.”
Tech developers, Jones said, could address racism by implementing robust diversity and inclusion initiatives within their teams, actively seeking out BIPOC voices in decision-making processes and educating themselves on the unique experiences of BIPOC women in healthcare.
Sylvia Kang, co-founder and CEO at Mira, pointed out that femtech companies should also focus on affordability, as cost can be preventing women from marginalised communities from accessing healthcare.
“Most of the people that can access femtech tools for their health are white mid-to-high income women,” Kang explained.
“Unfortunately, there are some communities, including BIPOC that do not have enough resources to purchase these tools.
“I believe it’s our responsibility to take action and democratise our data and tools in specific ways.”
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Australia’s drug advisory committee has recommended wider funding of triptorelin for women with breast cancer or endometriosis.
The recommendation comes after AstraZeneca announced plans to remove Zoladex from the market, risking leaving more than 7,500 women with breast cancer without an alternative treatment.
Both medicines block the release of oestrogen and testosterone and can be used as part of treatment, or for fertility preservation, in some forms of cancer.
The Pharmaceutical Benefits Advisory Committee met urgently in July and recommended making triptorelin unrestricted under the Pharmaceutical Benefits Scheme (PBS), which would mean it was funded for all uses.
The drug has been listed on the PBS for prostate cancer since 2006.
Triptorelin and Zoladex can also be used to treat endometriosis and to block puberty for either precocious puberty or gender-affirming care.
Vicki Durston, director of policy and advocacy at Breast Cancer Network Australia, described the recommendation as “a significant step forward” and said access to the medicine could mean the difference between life and death for some patients.
She said some women had already chosen to have their ovaries removed because of uncertainty over Zoladex supplies.
Marilla Druitt, Victorian state chair of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said it remained unclear whether triptorelin would work exactly the same way as Zoladex, but the recommendation was likely to be positive for patients with endometriosis and pelvic pain.
She said: “I’m glad we’ve got an alternative.”
“That’s fantastic, and it remains to be seen whether or not it will be as good, but pain is so complex, pain is a really hard thing to study because it’s got so many contributors.”
Druitt said further research would be needed after the medicine was introduced.
If accepted by the federal government, the recommendation would also allow PBS funding of triptorelin for puberty suppression in precocious puberty and gender-affirming care.
This would make gender-affirming care federally funded through the PBS for the first time and would remove a financial barrier for transgender children in Queensland and the Northern Territory.
Stuart Aitken, medical director of Gender Health Australia, said the recommendation had sparked “absolute joy” among his patients.
He said: “It takes away a huge barrier to accessing evidence-based care.”
“It means that the ban has a very limited effect.”
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Sahar Abid is a Science Associate at Ema EQ, where she works on cultural sensitivity and bias in AI.
A woman asks an AI health assistant about postpartum depression.
She mentions that her in-laws are telling her to “push through” and skip medical help, even as her symptoms get harder to manage. She never says where she is from or names her background.
The assistant describes the condition and gives her a hotline number. It sounds correct, but it misses what she needs.
That gap is more common than the industry admits, and it points to a blind spot in how we test health AI for bias.
Most bias testing looks at what people explicitly say.
The typical way to check an AI for bias is to label a prompt with someone’s demographic details and see if the answer changes. That catches some problems but misses a bigger one.
Most people do not lead with their identity. They lead with their situation. The woman above told the assistant everything it needed to help her, just not in the form of a label.
Her real question was not only “what is postpartum depression?” It was “how do I get care when the people around me don’t want me to?
When family members hold sway over health decisions, and in many communities they do, advice that asks someone to overrule their family is not something they can act on.
The AI didn’t say anything factually wrong. It answered a different question than the one she was living.
We call this culturally implicit bias, meaning the AI misses the cultural context a situation implies rather than the context a person spells out.
When systems are trained to notice only the explicit cues, they fall back on a default answer built for the majority. For everyone else, the response can feel generic, off-target, or discouraging enough that they stop looking for help.
In health, that is not small. The people most likely to be missed are often the ones the system already underserves.
What we set out to test.
At Ema, we wanted to know how well AI picks up on cultural context that is implied but never stated. So we built our own way to test for it, across a range of communities and real situations like postpartum depression and fertility, using questions that carried cultural meaning without announcing it.
The patterns were consistent. Models often missed the meaning underneath the question. They dropped the specific details a person did share and smoothed them into something generic.
And even when they pointed toward real care, they tended to offer one option instead of choices that might actually fit a person’s life. Any one of those can be the difference between someone following the advice and walking away from care.
Why this matters for anyone building health AI.
Getting this right is the right thing to do, and it also works better.
When an answer reflects a person’s real context, people trust and act on the recommendations more, so they get the help and support they need.
Testing for it is harder than the shortcut most teams use. Swapping a name or a demographic label in and out is easy. Checking whether a model actually understands the human context around a question takes more care.
The shortcut teaches models to perform cultural competence instead of practicing it. No matter how much or how little someone chooses to share, they deserve an answer that is warm, complete, and usable.
A better question.
The bar for equitable health AI should be “does it serve someone who never told you who they are?” It is the harder test, but it determines whether real people get help.
The work of getting there is far from finished, and it is exactly what we are building toward at Ema.
Sources: Naidoo, V., & Chadha, K. K. (2025), Culturally responsive AI chatbots: from framework to field evidence, Computers in Human Behavior: Artificial Humans. Souligne, N., & Subbian, V. (2026), FairLogue: A toolkit for intersectional fairness analysis in clinical machine learning models.
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