Why we need to stop treating women’s health as a “category”

Forbes published an article last week proclaiming 2021 will be the year that women’s health goes from niche to mainstream. As a woman operating a femtech startup, I was excited by this. Or, at least, I was at first. I am an optimist at heart, after all.

But the reality is that femtech has been touted as the next-hot-thing by media for years:

• 2017: Why This Is the Year of “Femtech”
• 2018: Women’s Healthcare Comes Out Of The Shadows: Femtech Shows The Way To Billion-Dollar Opportunities
• 2019: Femtech’s billion dollar year
• 2020: After years of neglect, femtech is getting substantial investment

Which begs the question: Why, in 2021, are we still only considering women’s health an emerging category? Why are we still calling it niche?

The answer, I believe, lies largely in the fact that by defining this space as a single category, we inherently limit its implied opportunity.

Women’s health is a really, really big market.

We’re talking about healthcare for half the global population.

At the risk of this article turning into another market sizing manifesto with unfathomable potential-spend buckets, let’s breeze through a few important data points:

• Women’s health tech is a massive space. Femtech is expected to reach a $50 billion market opportunity by 2025.
• Women are the healthcare decision makers for their families. 80% of all healthcare decisions are made by women.
• Fertility is still a big problem. 1 in 8 couples struggles with infertility, an experience that costs expecting parents tens of thousands of dollars.
• But infertility is not the only high-cost segment. According to our analysis at Pollie, an estimated 25% — 45% of the female population has a complex chronic condition like PCOS, endometriosis, hypothalamic amenorrhea, a thyroid disorder, or an autoimmune condition. And each year they are spending up $1k — $3k on average to manage these symptoms, with some studies suggesting total costs are multiples of this.
• Research remains abysmal. Only 4% of all global medical research is currently dedicated toward women’s health, and until 1993 NIH-funded studies were not required to include women. This means there is a lot of work to do when it comes to understanding how female bodies respond to illness and different treatments.
• Underserved communities are struggling. Native American and Black women see 2x and 3x higher maternal mortality rates respectively compared to white communities. Black women are 3x more likely to develop uterine fibroids and Hispanic populations are 2x more likely to suffer from PCOS. Unfortunately, the list goes on. Targeted solutions are needed to improve this issue, both from a systemic standpoint as well as a patient trust and comfort perspective.

Labeling women’s health as an investment category has undoubtedly raised its profile as an issue, drawing more funding.

In recent years, women’s health startups have received buzz. What started with cycle tracking apps and infertility solutions has expanded into the emergence of more generalized players such as integrative primary care chains and on-demand telehealth platforms.

Much of this expansion is due to the venture community. If it were not for the virtuous cycle of top firms seeing femtech as an untapped space within tech and thus giving this market more PR time, we undoubtedly would not be seeing as many new femtech tools today.

This shines through in the numbers: funding in women’s health startups has been steadily on the rise since 2011. In 2019, Pitchbook data showed that femtech companies received nearly $592M of venture funding, and 2020 numbers capped in at nearly $700M.

But while last year continued to be an exciting time for femtech funding, it is important to remember that all of digital health saw an uptick in 2020. And a 2020 Rock Health report outlines that despite consistent femtech investment interest, only 3% of the nearly 3,000 digital health deals made since 2011 focus on women’s health. And in 1H 2020, that number was a measly 1.5%.

The takeaway? Despite skyrocketing investment in femtech and the broader digital health space in 2020, a smaller proportion of dollars went to women’s health companies.

And data suggests the way investors are thinking about women’s health opportunities is also limited. The same Rock Health report states that 65% of women’s health funding has been focused on fertility solutions. As noted above, infertility is a major problem on a personal and systemic level. But when two-thirds of an entire segment’s dollars are going to roughly 4% of the market’s population (10% of women of reproductive age struggle with infertility x 40% of the female population is of reproductive age) we should all be scratching our heads. Especially when we remember that other very large female populations — like those suffering from a chronic condition or going through menopause — also need specialized care.

Bucketing all of women’s health under a single umbrella is not only limiting, it’s damaging.

Categories are helpful for the overlap between the startup and venture worlds. They provide organization and some form of systemic understanding. Having a conversation without the mutual agreement of a market and its subparts would be pretty confusing.

The interesting thing about a category is that its functionality can become victim to a Goldilocks syndrome of sorts. Too small a market, and it never receives attention from investors. But too big? It’s possible that in defining a mega-space as a category, we are ironically limiting it, particularly if investors lack the deep understanding required to understand how its nuanced pieces fit together.

The majority of this problem lies in perceived competition (hello competition 2x2s, my old friend). By calling women’s health a category, something unintended can happen: every femtech company becomes competitive with one another to those who are not deep in the space, even players who are complementary or entirely unrelated. And then, our minds gravitate to thinking of women’s health as a single-player market.

This appears more frequently with generalist funds, as well as those rushing to femtech as a check-the-box investment. While essentially every venture firm will say they are thesis-driven, it requires an enormous amount of effort to be truly deep in a space, and funds that do this the best usually have a hyper-focused (read: not generalist) investment strategy. This is not to disparage generalist funds, and in that vein, I am not saying that every venture firm who wants to invest in femtech should become SteelSky. But it is difficult to intimately understand a market if you are simultaneously interested in a dozen other spaces, and this is how many firms operate.

Given this is the reality we’re dealing with, it is only human nature to make broad-stroke connections between things that are not really that connected if we bundle them into a single category. At Pollie, we are currently streamlining support for polycystic ovarian syndrome (PCOS), a chronic hormone issue that impacts 1 in 10 women and requires lifelong management. From a threat perspective, in investor meetings we get compared to Tia (integrative primary care), Kindbody (customer-centric fertility clinics), and Maven (on-demand telehealth with focus on employer channel) more frequently than we do to (non-femtech) chronic condition management platforms like Omada or Livongo. In fact, despite pitching ourselves as a Livongo for PCOS, in our first fundraise we did not have a single investor tread far down the path of what-ifs when it comes to other digital programs for chronic conditions.

Here’s a tip: investors should be asking us what we’ll do if more mature chronic condition management platforms enter the hormonal health space, not how we plan to compete with female-focused clinic chains and on-demand care platforms. From a product and distribution perspective, we’re way more concerned about the former.

By assessing women’s health companies with rigid femtech-is-a-category blinders on, we run the risks of (1) missing viable opportunities and (2) misinterpreting what should actually be monitored from a competitive risk standpoint. Both traps should be avoided.

Without said femtech-is-a-category blinders, we are able to re-focus on the core problem: that women have historically been an underserved group in healthcare, and this market, ripe with a laundry list of unmet needs, requires a laundry list of solutions. This attitude shifts our thinking to consider how women’s health solutions relate to the entire healthcare landscape while also allowing us to see its sub-sectors as standalone categories themselves.

Understanding women’s health in this way lets us spend more time thinking about how to integrate femtech upstarts into the entire healthcare system, rather than obsess over how unrelated players are competing with one another under the commonality of focusing on the female population. In other words, Tia is more competitive to One Medical and traditional physician offices than it is to Maven. Maven is more competitive to Teladoc and urgent care clinics than it is to Pollie.

I do think things are moving in the right direction. In the first three months of 2021, we have had several casual discussions with funds who were looking at PCOS as its own category. This is an improvement from 2020, but widespread reframing is still needed to lift femtech into the status quo. If 2021 is really the year that femtech surpasses a “niche” category, we must stop planning for it to go mainstream and instead make it mainstream by expanding our view of how women’s health companies relate not just to one another, but the healthcare ecosystem as a whole.