Underfunded, under researched, and under innovated. Since the early days of medicine, women’s health has been plagued by gender bias, resulting in poorer delivery, chronic misdiagnosis and higher risk of fatality.
Women in the UK have clearly decided it’s time for change. In March 2021, 110,000 women responded to a call for evidence – around 10x the average response – leading to the first government-led Women’s Health Strategy to address challenges around the gender health gap.
An area ripe for innovation, impacting over half the population, this is a powerful opportunity for founders to drive forward innovation on understanding women’s health challenges, around how women access healthcare and the quality of care they receive.
There are some glaringly obvious areas that require serious attention and innovation.
First and foremost, efforts around improving access to health services.
For one, women-specific conditions – such as endometriosis and PCOS – are chronically underserved, seeing far longer waiting times, and therefore pose considerable risk. Start-ups like Bloomful offer digital care pathways to help improve access for patients.
It’s also worth considering the ease at which women can access reproductive health products, particularly given certain taboos around this topic.
Founded after one of the founders ran into her boyfriend’s mum while buying a pregnancy test, Stix is a DTC women’s health platform offering a convenient and discreet way to access products from emergency contraception to pregnancy tests.
The gender data gap has also come to the fore in recent years, particularly following the popularity of Caroline Criado Perez’s Invisible Women.
For years, women have been directly underrepresented in research and clinical trials—for example, in psychiatry, where mean participation of women in trials was just 42 per cent, while 60 per cent of patients are women.
Hertility is one start-up looking to close the gap. They’re building the largest data set on gynaecological pathologies, powering their digital diagnostic tool that can screen for 18 reproductive health conditions in just 10 days.
But even among women, there is a huge gap to close. Women experience radically different outcomes depending on their ethnicity and socio-economic background.
Black women in the UK are four times more likely to die in pregnancy and childbirth than white women. The digital health platform Mae, for example, hopes to change this by connecting black expectant mothers to critical resources to drive improved outcomes.
The Women’s Health Strategy has indeed put focus on a number of issues, but there are still challenges that need solving in order to bring women’s health to where it needs to be.
For one, the sector still suffers from a lack of investment. 2021 saw US$1bn invested in women’s health start-ups – a number that needs to grow significantly to see any meaningful change.
Founders need to see the right funding mechanisms in place, with clear aims and assessment criteria to incentivise innovation in that area.
The funding that does exist is largely channelled towards start-ups in the reproductive health space – fertility, menopause, hormone health, and sexual wellness.
This ignores the number of conditions in which women experience vastly different risk factors, or that women can respond differently to certain medications than men.
Take cardiovascular health, which is plagued by misdiagnosis for women, or the fact that despite having a longer average lifespan, women live in poorer health than men.
There’s also the risk of women’s health becoming a ‘women’s issue’. Any start-up innovating in the health space (and beyond) needs to be acutely aware of gender differences, as well as differences across ethnicity and socio-economic background.
It’s also important to note that, to understand health, you need to have a much wider picture of social, economic, and environmental determinants of health. Improving health services is not enough to improve health at a population level.
The job to be done is clear—and it’s a mammoth task. Health providers and governments cannot tackle it alone.
With the right funding mechanisms and a deeper understanding of layers of problems that are steeped in women’s healthcare, progress is promising.
Olivia Brooks is an investor at the London-based venture capital company, Founders Factory.
How the UK’s ‘pharmacy first’ policy will change women’s healthcare
By Katherine Bridges, head of brand and clinical lead at the pharmacy app Charac
On the January 31, the UK government will roll out its long-awaited “pharmacy first” policy, a measure designed to cut the size of the NHS backlog – which currently stands at around 7.6 million patients.
With “pharmacy first”, patients suffering from various lesser ailments – such as sore throats and shingles – will be directed to their local pharmacy as their first port of call.
Pharmacies will also be able to supply certain prescription medicines. It is hoped that this will ease pressure on Britain’s seriously overstretched hospitals and GPs.
The policy is set to transform healthcare provision in the UK, which is important for women’s health across the country. If the policy can be carried through successfully, women’s access to NHS will improve in a number of ways. The success of “pharmacy first” will, however, rely on a big technological upgrade to Britain’s 11,500 high-street pharmacies.
Improving women’s access
This shift of several key medical functions to Britain’s pharmacies will give women easier access to important medicines and treatments. For instance, under “pharmacy first” patients will be able to pick up prescription medicine for urinary tract infections (UTIs) from pharmacies; previously this required a GP appointment beforehand.
This change will be especially valuable for women, given that this ailment disproportionately affects women, with roughly 50 per cent experiencing one over the course of their lives.
Crucially, under the new policy, women will also be able to purchase contraceptive pills at their pharmacies without seeing a GP. It is vitally important, but easily prescribed and administered medications such as this that will see “pharmacy first” freeing up countless of hours of GP and hospital time.
Further, the reduction of pressure on GPs and hospitals will improve women’s access to critical medical procedures and treatments. For instance, the policy will put a dent in the NHS’s mastectomies backlog, which is currently putting thousands of women in the UK at a greater risk of breast cancer.
Femtech critical to making a success of “pharmacy first”
Of course, “pharmacy first” represents a very large administrative and operational task for Britain’s high-street pharmacies.
It is uncertain whether these pharmacies, in their current state, will be able to meet the challenge. Community pharmacies are often small and family run. As such, they find it difficult to afford key labour-saving technologies that cut costs and free up time.
These pharmacies’ internal systems are often ramshackle and antiquated. Many still run on paper, making everything from prescriptions to payroll arduous and time-consuming.
It is clear that these pharmacies will need to undergo a big technological upgrade as the policy is rolled out this year. Femtech will play a key role in this effort.
Femtech technologies could help pharmacists manage the transition to a greater scope of provision. For instance, femtech companies, such as Vivoo’s at-home women’s UTI test, could help pharmacists manage the task of treating this common women’s ailment.
Another would be the online self-assessment system Tuune, which matches women to the contraceptive treatment appropriate to their particular hormonal profile.
Innovations like these will be an essential part of women’s healthcare in the age of “pharmacy first”, driving efficiencies in high-street pharmacies and expanding women’s access to treatment.
The future of health tech will empower women
Other health technologies will help amplify the impact of femtech. Apps, such as Charac, offer a dashboard for both pharmacists and their customers, allowing customers to book pharmacy appointments and get their prescriptions delivered to their door.
These kinds of accessible, integrated health tech systems that will prove so valuable in the age of “pharmacy first” will also help improve patient outcomes for women. One of the primary hindrances to better healthcare for women is a lack of information and access.
Research by the Department of Health and Social Care revealed that around 85 per cent of British women did not feel comfortable talking to their GPs about their physical health, and a similar percentage can remember an occasion where they did not feel listened to by medical professionals.
Similarly, knowledge of women’s health issues is often low: less than one in five UK women felt that they had enough information on menstrual health, and less than one in 10 felt they knew enough about gynaecological conditions.
What’s clear is that a lack of information and access is leading to worse health outcomes for women than men, but health tech can make a valuable contribution – streamlining appointments and prescriptions, raising public awareness of health conditions and the treatment services that women can access and making patient outcomes and healthcare more equal.
As “pharmacy first” becomes policy, we have a chance to use the latest developments in femtech and health tech to both make a dent in the NHS backlog, and to put women’s healthcare on a surer foundation.
Katherine Bridges is head of brand and clinical lead at the pharmacy app Charac.
Transforming women’s health: a bold roadmap to a more equitable future
By Kavelle Christie, director of the gender equity and health justice program at Community Catalyst
Equity lies at the heart of progress, demanding a healthcare system that not only provides affordability and accessibility but also centres the distinctive needs of women.
The deliberate inequities affecting Black, Indigenous, and Latinx women, transgender women, those in rural communities, women with disabilities and those with low incomes underscore the urgent need for transformative change.
From alarming maternal mortality rates among Black and Indigenous women to abortion bans, limited healthcare access in rural areas, discriminatory practices against women with disabilities and stigmatisation faced by Black, immigrant, and transgender women, these inequities demand a comprehensive reimagining of our healthcare system.
A robust, truly transformative healthcare system is the cornerstone of a thriving society and it is time for the nation to prioritise women’s health.
Additionally, improving Black maternal health outcomes and the preservation and enhancement of reproductive rights, which encompasses unfettered access to abortion care, comprehensive family planning services and contraceptives, form other vital pillars.
Improving Black maternal health outcomes
Maternal health remains a significant concern, particularly among Black women. Passing the federal Black Maternal Health Momnibus, introduced by Rep. Underwood and Sen. Booker, can help address inequities and promote access to quality maternal care.
In addition to passing the Momnibus, it’s time for the US to invest in an ethical supply chain to ensure the improvement of necessary pre- and postpartum drug delivery. By guaranteeing the consistent availability of essential medications, we can enhance the overall quality of care.
Power and control over women’s bodies
Every woman should have the autonomy to make informed decisions about her body and reproductive health.
Policies that fail to centre marginalised communities perpetuate existing power imbalances and exacerbate health disparities. Not only is it time to pass the federal Women’s Health Protection Act to re-establish a national right to abortion to create a just healthcare system for women, but it is likewise vital to implement policies that monitor and account for the funding and actions of crisis pregnancy centres and anti-abortion maternity homes.
These often-unregulated places disseminate misleading information about abortion care, manipulate women and can come with deeply conservative ideologies, such as mandatory church service attendance in exchange for shelter and additional restrictions on reproductive choice.
Building a better healthcare system means we closely monitor and regulate crisis pregnancy centres and maternity homes, ensuring they provide comprehensive, unbiased, and evidence-based information and care to women without imposing ideological beliefs.
It is also essential to note that anti-abortionists are swiftly rolling out policies that would even prevent women from travelling on highways to access abortion services.
These predatory webs of restrictions to deprive us of our freedom are not merely about abortion rights; this is about who has power over you, who has the authority to make decisions for you and who is going to control how your future is going to be.
Therefore, to build a better healthcare system for women, we must fiercely defend abortion rights and dismantle any barriers that may obstruct women’s ability to make choices about their bodies and reproductive health.
We must give women back the power to control their own bodies, especially for those most impacted who have the least resources, who can’t afford to lose a job, who don’t have access to childcare, who have no access to healthcare and who face many more systemic barriers.
Transparency in healthcare decision-making processes is also vital. This extends to hospital ethics committees, which often make critical decisions about abortion access, but whose membership is often shrouded in secrecy.
For a more just healthcare system, we must eradicate this wall of secrecy and ensure transparency in these committees’ composition and decision-making process.
Women deserve to know that their healthcare decisions are made with impartiality and respect for their rights.
Protecting gender-affirming care
Gender-affirming care for transwomen is a critical component of comprehensive healthcare.
This specialised care involves a range of medical, psychological, and social interventions to align an individual’s physical characteristics with their gender identity. Key elements may include hormone therapy, gender confirmation surgery, mental health support, and ongoing medical monitoring.
Gender-affirming care is not only a matter of medical necessity for transwomen but is also closely tied to mental health, overall wellbeing, and a sense of self.
Creating a healthcare environment that offers inclusive, affordable, and accessible services for transwomen is essential to a holistic approach that acknowledges and validates their gender identity, ultimately contributing to better health outcomes and improved quality of life.
Kavelle Christie is the director of the gender equity and health justice program at Community Catalyst, a national health advocacy organisation that works alongside organisational partners across 45 states and territories to build people power and create a health system rooted in race equity and health justice.
The impact of menopause and ageing on urinary incontinence in women
By Lydia Zeller, CEO at Pelvital USA
The natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.
One of the most rewarding aspects of my role as CEO of Pelvital is amplifying the conversation around women’s health, especially on historically stigmatised topics like urinary incontinence (UI) and menopause.
If you suffer from bladder leaks, you’re not alone. Research from 2022 shows more than 60 per cent of US women suffer some form of bladder leaks. It is unacceptable that an issue impacting over half of women has historically been kept quiet and stigmatised.
Women are led to believe that bladder leaks are a natural part of being a mum or growing older. That is not true. Although bladder leaks are common, they are not normal, and women should not accept them as such.
Fortunately, there are effective options for treating leaks and education is the first step in self-advocacy – one of the reasons why I love talking about this topic.
First, let’s talk about the different types of UI. Stress urinary incontinence presents as accidental leakage associated with activities like sneezing, laughing, coughing, or jumping.
Urge incontinence (including overactive bladder) involves the sudden urge to urinate followed by involuntary loss of urine. Mixed incontinence is the combination of stress and urge incontinence. Stress urinary incontinence (SUI) is the most common form and is often caused by weakened pelvic floor muscles.
While one in three mothers report SUI within three months of childbirth, UI prevalence indisputably increases with age: 62 per cent of women in their 40s have UI compared to 68 per cent of women in their 50’s, 72 per cent in their 60s and 83 per cent in their 70s.
But does menopause cause incontinence? Yes and no.
Menopause is defined as the natural event of a woman’s final menstrual cycle. It is associated with reduced functioning of the ovaries due to ageing, resulting in lower levels of oestrogen, progesterone, and testosterone.
While these steep hormonal drops don’t directly cause incontinence, they cause thinning of the tissues in the pelvic floor muscles during perimenopause (the time around menopause when your ovaries gradually stop working).
Combine this thinning with common unresolved pelvic floor weakness or injury (e.g. caused by pregnancy, childbirth, pelvic surgery, falls) and/or with common changes associated with ageing (e.g. lowered fluid intake, lowered activity, constipation) – and urinary incontinence can result.
Stress urinary incontinence is most often caused by weak pelvic floor muscles – and menopause-related changes exacerbate that weakness.
Pelvital on-staff pelvic health doctors of physical therapy Shravya Kovela and Leah Fulker describe how this works in a blog on the menopause / incontinence connection: Weak pelvic floor muscles are unable to contract properly to close the urethral sphincter where urine escapes the body.
When paired with hormonal changes of menopause and the resulting changes in tissue flexibility or elasticity of the vulva, vagina, and urethral sphincter, urinary incontinence will appear or worsen.
Furthermore, discomfort in the vulva and vagina associated with menopause-related vaginal dryness or pain may lead pelvic floor muscles to compensate, worsening urinary incontinence.
Interestingly, menopause and ageing do not equally impact incontinence. Menopause transition has been found to correlate with stress urinary incontinence, whereas increasing age and risk factors such as anxiety, BMI, and new onset diabetes correlate with both stress and urge incontinence. And new onset of SUI is highest in perimenopause as opposed to postmenopause.
But the natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.
Tragically, according to the Study of Women’s Health Across the Nation (SWAN) – a historic study to define menopause transition and “characterise its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women” – fewer than 40 per cent of incontinent women even seek treatment from their healthcare provider.
Women are uncomfortable bringing this topic up with their providers and when they do, too often are dismissed without options.
Menopause gaslighting is occurring to women because historically there has been a significant lack of clinically proven conservative options for women who do not wish to have surgery.
Pelvic floor physical therapy has been the shining light here, but a mere one per cent of physical therapists specialise in the pelvic floor, resulting in significant access gaps.
The continued uptick in virtual pelvic health physical therapy options is a big positive, increasing access and enabling women to fit treatment into their lives. Similarly, evidence-based in-home treatment options allow women flexibility and clinicians the ability to extend their clinic walls and deliver conservative care at scale, with outcomes very similar to surgery.
This conversation is incomplete without mention of economics and gender equity. Not only has research into women’s health been historically massively underfunded, but women bear disproportionate out-of-pocket costs.
Specific to UI, 70 per cent of costs are borne by the woman. And that is also completely unacceptable. I am proud to be part of the growing cohort of femtech companies creating change and step by step moving towards broad access and insurance coverage. Women deserve no less.
Lydia Zeller is CEO at Pelvital USA, Inc., a Minnesota based femtech company providing products to restore pelvic floor health. Flyte by Pevital is an FDA-cleared novel in-home treatment for female urinary incontinence.
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