Spotlight 26 November 2018 Femtech: healthcare for 51 per cent of people Health technology for women is a growing market; could “femtech” change women’s lives around the world? SHUTTERSTOCK/David Dea Sign UpGet the New Statesman's Morning Call email. Sign-up Women’s healthcare has long been characterised as underresearched, underfunded, and inadequate. Before smartphones, if a woman wanted to take a fertility test she would have to visit a clinic on the third day of her period. Until just over two years ago, women were often excluded from medical trials, and many products and services have been developed with scarcely any female input. But with the advent of digital healthcare and the “femtech” – female technology – industry, this is rapidly changing. Women make up 51 per cent of the population and working-age women spend 29 per cent more per capita on healthcare than men. Women’s health technology has an estimated market potential of $50bn by 2025. The term “femtech” was coined by the Danish entrepreneur Ida Tin. In her early 30s, Tin was frustrated by the lack of anything other than drugs – namely the contraceptive pill, which has unwanted side effects for many women – to help plan and control her reproductive health. She developed an app called Clue to solve this problem; it helps users track periods, measure fertility and manage reproductive health, and it now claims ten million users in 190 countries. “When it comes to the future, investing in, and building, female-led, female-focused tech isn’t just a step towards gender equality,” says Tin, “it makes business sense. While the femtech industry has grown significantly, menstrual health is still considered to be a niche or even taboo subject by many. The conversation around female health needs to become more open. To do this, femtech companies and reproductive health in general needs its champions: from other startups, through to doctors and researchers.” The interest and investment in Clue has allowed it to become more than a simple tracking app. It now partners with the University of Oxford, Stanford University and the Kinsey Institute in the US, carrying out in-depth research into menstrual cycle health. “The more information we have on women’s cycles, their health and everything else that falls under female healthcare, the more advancements can be made, both in terms of research and the technologies produced,” says Tin. Natural Cycles, a fertility app, was the first to win FDA approval as a method of “digital contraception”, and has proved popular, with more than 125,000 users in the UK. The Ava tracking bracelet, which looks like a fitness tracker and monitors ovulation, offers women more information on fertility and pregnancy, and the Braster offers app-connected breast examinations with data analysis from the company’s medical team. It is in developing countries, however, that femtech could have most impact. Five billion people around the world have little or no access to advanced medical treatments, and health and wellness in the third world are in dire need of solutions that are cost effective and practical. Research conducted by the World Health Organization shows that more than 800 women die of pregnancy-related complications every day, and most deaths occur in low-income countries such as India and Africa, particularly in rural areas where healthcare facilities are in short supply. Apps and portable devices could provide valuable support in these areas. For example, while developing economies may lack large-scale resources to screen for women’s healthcare issues such cervical cancer and breast cancer, the iBreastExam by UE Lifesciences is a low-cost, battery powered and handheld device, currently being used in Africa and south Asia for screening breast health. More than 175,000 women have now received an iBreastExam test and over 120 cancer patients have been diagnosed through a number of public and private healthcare programmes. The Eva System, too, could prove particularly valuable in the developing world, where 80 per cent of cervical cancer cases occur, causing around 190,000 deaths each year. The device is made by MobileODT and captures high-quality images and videos for cervical, vaginal and vulva examinations. The scans can only be accessed by the provider, physician or consultant. Even in rural or remote areas where women might struggle to get a WiFi connection, the patient’s data can still be stored on the Eva device until they have internet access, and the files can be updated and made ready to be reviewed by a consultant. In India, a company called CareMother is helping to detect high-risk pregnancies in early stages through mobile monitoring tools and an algorithm that screens the data collected. The company says it has helped the Indian government, medical colleges and doctors to double their reach and reduce operational expenses by 50 per cent. Bhaumik Sangvhi, co-founder and director of UE Lifesciences, is confident that femtech technologies can “cross social, cultural and economic barriers and create access, which earlier was impossible... Whether it’s monitoring menstrual cycles or tracking and monitoring personal health data, women are now able to achieve it using technology while maintaining their privacy within the comfort of their location. These technologies also help guide women on issues which otherwise are considered taboo in some of these developing countries.” Sanghvi says fentech may also help to overcome cultural issues that impede healthcare in the developing world, by “offering solutions that are minimally invasive and personalised to the needs of the patient. What’s needed in a developing country is a solution that is less intrusive and more practical, and femtech is focused on that.” However, devices and apps are not without their own challenges in developing countries. One of the setbacks, Sanghvi explains, is the lack of visibility and communication of femtech products. “Additional pain points also include social and cultural barriers and overall affordability. So, awareness and education will be the biggest factor [for] fuelling this movement,” he says. As in any area of healthcare in which new solutions are being offered, it’s imperative to ask how reliable they are. Fertility tracking apps have come in for particular criticism regarding their accuracy. Natural Cycles was investigated by Sweden’s Medical Products Agency after a significant number of women seeking abortions at one Swedish hospital were using the app as their only means of birth control. In 2016, researchers at Georgetown University in the US compared 40 apps that predicted a fertility window. Only six apps were able to predict fertile days without any false negatives. Helen Stokes-Lampard, chair of the Royal College of GPs, says that although femtech apps have science behind them – to varying degrees – people who use them “shouldn’t completely rely on them, and should still speak to a healthcare professional”. Paljit Sohal, principal consultant at global growth partnership company Frost & Sullivan, points out that a Facebook advert for Natural Cycles was banned in the UK after the Advertising Standards Agency (ASA) ruled it to be misleading. While Sohal says that “the number of pregnancies was in line with the published typical use effectiveness rate for Natural Cycles (93 per cent), which is based on a study of over 22,000 women,” the team behind Natural Cycles have “distanced themselves from traditional methods” enough that the medication-free technology can be seen as “contraception 2.0”. Illustrating some of challenges the “nascent market” still faces, Shruthi Parakkal, another consultant at Frost & Sullivan, says it’s important to consider the bigger picture. “Anything that can make healthcare more accessible, easier or affordable for women is good. Women in the third world have a pressing need for more accessible care, whether it is due to the demographics or the urban-rural divide, or because there are no screening programmes. Socio-cultural norms often make women’s healthcare issues taboo subjects, especially for infertility, menstrual health, birth control and sexual wellness.” Parakkal thinks femtech could address concerns around access to portable screening equipment, better communication with healthcare professionals, remote consultations, and self-management using wearables. But as long as complications surrounding social and cultural barriers and cost still exist in emerging countries, femtech will have major hurdles to clear. At the same time, women in the developing world are increasingly receiving an education and entering the workforce in ever greater numbers, and their purchasing power is only going to keep increasing. As the products and solutions of femtech become more easily accessible, they could start to contribute towards health and wellness among women the world over. › Ukraine accuses Russian navy of firing on their ships in the Black Sea Subscribe For more great writing from our award-winning journalists subscribe for just £1 per month!