By Nancy Li
After sitting down with 50 founders, investors, researchers, and activists, we identified three major patterns as we connect the dots:
1. Founders dilemma in data, digital, taboo
- Data data data! Founders generally face a lack of consumer data and research data. Though more and more legacy organizations such as FemTech Insider, FemTech Analytics and rising star such as Ultra Violet Agency tabbing into this gap of information, the FemTech data landscape is still very much fragmented and there is a need for consolidation of reliable data. One example has been the global FemTech market size data, throughout our summer tour, we came across three drastically different figures from $50 billion by 2025 (Frost&Sullivan), to $100 billion already (interview with investor), to $1.19 trillion by 2027 (FemTech Landscape Report 2021), which can be driven by classification or growing bullish perceptions.
- Product first or digital first? With the booming digital health wave, one common question faced by many early stage founders is whether to jump on the digital wagon or go with a tangible product or device. Given the significant knowledge and awareness gap of various women’s health issues such as PCOS and peri-menopause, it has been hard for founders to prove willingness to pay to investors without spending time and effort on educating patients. Often times, founders get stuck by what the investors want v. what works for the customers at this stage.
- Am I too taboo to win? Following Maven Clinic‘s $1 billion valuation and Elvie‘s $97 million Series C funding, more products that were previously stigmatized surfaced and more FemTech entrepreneurs are encouraged to look into other taboo topics such as period health, sexual wellness and menopause. However, we have observed a consistent struggle across the board among early stage founders on getting traction from investors, some of which are limited by vice clauses. Most recently, many FemTech companies are banned from social media for using words and images for the female anatomy. For the future success of FemTech industry as a whole, there needs to be more resources addressing the bottle neck between early stage and later stage start-ups.
2. Burning gap between research v. industry
Despite more attention going into FemTech in the market, a mere 4% of total healthcare R&D funding is going into women’s health issues. This could result from the fact that women globally tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. Only until 2016 did the US National Institute of Health (NIH) introduce a policy that requires sex to be included as a biological variable in pre‐clinical research. All these factors go into a significantly underdeveloped women’s health research landscape and in turn contribute to the viscous cycle of lack of research data, lack of knowledge, and lack of solid proof to demonstrate willingness to pay for investments. After interviewing the researchers, we were able to zoom into the career dilemma faced by many researchers and majority of the paths further delineates researchers from market
3. Incubators/Accelerators playing pivotal roles in fostering FemTech innovation
- FemTech incubators are still very much concentrated in Europe and US
- Asia-based and Latin-America-based incubators (e.g. B2Mamy) struggling to get attention from investors despite start-ups getting tractions in this field
- Big corporations getting involved via open innovation (e.g. Tech4Eva) and membership-based networks (e.g. FemTech Collective).
Let’s hear voices from…
Driven by the payor structure and innovation hubs, the US has been a fast leader in hosting a number of FemTech start-ups. However, there has been a trend among founders to bring innovations to European markets and a growing number of European FemTech founders.
“I think that the US is moving faster in terms of acceptance of digital therapeutics. But in the long run we may see an acceleration through Europe, because of the cultural focus on holistic health and non pharmaceutical interventions, whereas culturally in the United States, there tends to be the desire to take a pill.”– Elizabeth Gazda, CEO of Embr Lab
Europe is more prone to adopting medical innovations earlier than others. As such, it is critical to understand the dynamics of the different healthcare systems, find physicians that are early adopters to champion your innovation and validate the product fit in these markets. Generally, some of these markets are the UK, Germany, Switzerland, Austria, the Netherlands and the Nordics.
🇨🇭ASPIVIX, an early stage women’s healthcare company based in Switzerland, got off the ground by tapping into a rich local startup ecosystem built to drive innovation. To fund activities related to product development and First-in-Women Clinical Trial, Aspivix raised capital from private investors, local government incentives and grants as well as the Horizon 2020, a European grant. Their clinical trial is currently ongoing at the CHUV and HUG and is expected to be completed in early Q4 2021. Carevix TM , Aspivix’s flagship product, is disrupting the traditional cervical tenaculum, developed over 100 years ago, that causes women pain and bleeding in common procedures.
“Women are conditioned to accept pain in gynecology as ‘just part of life’ leading to many years of neglect thus lack of better solutions”– Andrea Albornoz, Head of Marketing & Sales at Aspivix
Annemieke Jordans and Jo-Ann Dietz started Cycle Care to create a community with reliable information and high quality products on all aspects of the female body, from menstruation to menopause, for women to take control of their health and wellbeing. They confirmed that as advanced as the Dutch medical system and as tolerant as the Dutch culture, there is still so much to be done in women’s health and wellbeing. Specifically, they found that more than 2/3s of women in the Netherlands🇳🇱 don’t know their body & mind enough to take care of themselves. While helping her stepson with biology homework on sexual reproduction, Annemieke was disappointed to see outdated information being taught in school.
“I was really surprised. It’s 2021 now. I had explain to him that the correct answer for passing the exam is just wrong in reality.”– Annemieke Jordans, Co-Founder of Cycle Care
On the positive side, Jo-Ann, Co-Founder of Cycle Care, was surprised to find out 20% of their visitors are male. A recent market research shows that men are willing to involve in and invest in their partners’ sexual health, often even more than women themselves. This is also driven by the fact that most women simply don’t know what they like, plus a huge layer of shame on what turns them on.
Just riding south towards Amstel, we met with Robert Stal, who was working on an idea seemingly too simple to be true: by pushing the sperms closer to the cervix and keeping it up there, 3x more sperms swims to the cervix and the chance of conception increases by 48% according to a recent clinical study. The birth of FERTI·LILY conception cup, a 🇳🇱 Dutch-designed, 🇨🇭Swiss-manufactured cup made from medical implantable silicone, is inspired by the personal story of Founder Robert and his wife’s. While succeeding after going through intrauterine artificial insemination, Robert wished there could be a less stressful and more intimate way to help conceiving.
“Having a baby together is supposed to be very important and special to couples. However, when couples start seeing the specialists in the clinics, the intimacy disappears very quickly, which is why FERTI·LILY aims to design a product giving the couples ‘a little help to make a little miracle’.”Robert Stal, Founder of FERTI·LILY
Robert admitted that his #1 challenge at the moment has been PR and to get people to try it. Putting the cost aside, it also comes down to being a male founder developing a product that he cannot test himself, even though his wife has been fully involved in the product development.
FemTech in Asia remains a taboo topic in most areas despite a long history of women’s health being part of the traditional medicine. Positive side is that many founders are making bold moves in areas such as sexual health (e.g. Ferne Health and ZaZaZu) and supplements (e.g. Moom Health). Although there are many supplement companies in the market, there isn’t much discussion around holistic health when it comes to women’s health. In Asia, people are used to combining both natural health supplements and western drugs to heal diseases.
Shifting gear to Latin America, Stephanie von Staa Toledo, Founder of Oya Care, is working on empowering women with access to the information and resources they need to make the right decisions for their bodies. Before Oya Care, there was limited innovation on female fertility in the region. Stephanie believes that it is critical to engage doctors early on and build a solution that’s oriented around the pains of not only women but doctors as well. Marina Ratton, Founder of Feel, spotted an overlooked market of lubricants for post-pregnancy and menopause as intimal moisturizer to prevent dryness. Despite women being the main end-user, most lubricant brands still target men. Thought regulatory process in Brazil can usually take up to 2 years, Marine was surprised to find out that many volunteers are willing to be part of its initial trial even without official approval. The active participation already shows that the local community has been waiting for this product for too long.
Dr. Deana Mohr-Haralampieva is CEO and Co-Founder of MUVON Therapeutics, a life science spin-off from the University of Zurich focusing on a personalized cell therapy for the regeneration of skeletal muscle tissue. She was surprised to find that there is a huge unmet need related to stress urinary incontinence (SUI) and only 8% of the affected women actively seek treatment today, meaning that 92% suffer in silence for years. However, she found it challenging to convince the male investors.
“One of the challenges is that 99% of the VCs we met are men. It’s difficult to convince them how much the suffering (of SUI) is, although it can be their wives, their daughter, their grandmother. It’s not that easy to explain, of course, the disease affects also male population, But it’s the later stage rather after 65.”– Dr. Deana Mohr-Haralampieva, CEO and Co-Founder of MUVON Therapeutics
Nienke Helder started Sexual Healing to find a new approach for overcoming ‘sexual dysfunctions’ that women can experience after a traumatic experience. Having been working closely with researchers in sexual health, Nienke shared that the limited information and research data made it incredibly difficult to get sexual health related scientific researches approved by medical board and funded. Even when the paper gets published in a scientific journal, it is not guaranteed that the society would necessarily benefit from it.
Dr. Simona Roggero, Founder of Fidelio and Entrepreneur in Residence at CV Lab – Cardiovascular Laboratory, is excited about a growing FemTech sector in Italy 🇮🇹, even in comparison to innovations in pediatrics and other medical areas. As a researcher-entrepreneur, she pointed out a burning gap between research and industry in Italy today. Often time, researchers are not aware of their career paths outside publications and it is common to be distant from the market products. Specifically, Simona advocated for changes in knowledge and network.
“It’s important to have an entrepreneur soul to speak to researchers and show them different futures of their ideas besides publications. We desperately need a link between women researchers and entrepreneurs who have international and diverse experience to learn from, especially on how to lead people with a vision.”– Dr. Simona Roggero, Founder of Fidelio
Dr. Joanna Szaub-Newton, Founder of Feminive, echoes the limited future proofing career paths after finishing her Biotechnology PhD in the UK. It almost seemed like a dichotomy of either stay in research or go into regulatory. It took her some courage to step out of academia and dive into the start-up world.
As a medical student at ETH Zürich, Oriana Kraft was shocked that women of reproductive age are often still excluded from clinical trials because hormonal fluctuations are considered ‘unnecessary’ variables. She was equally disturbed to learn that gynaecological conditions affecting 10% of the female population such as Endometriosis or Polycystic Ovarian Syndrome or 90% in the case of PMS not only lacked effective therapy but also remain poorly understood with unsatisfactory forms of diagnosis.
“It’s also worth mentioning that there are sex differences in every single cell in the human body. The logical conclusion to this fact is that there are differences in every organ and disease manifestation in the human body as well. This should have repercussions on how we diagnose and treat diseases differently between women and men. And yet, for the most part, there is no difference in terms of diagnosis and treatment. This is due to the fact there is not nearly enough research being done in this field as there should be as investors, companies, governments and universities have not understood either the market potential or the need. This has got to change.”– Oriana Kraft, medical student at ETH Zurich
The No.1 challenge in FemTech is to correct the misconception that “the market is too small”, according to Dr. Chandra P. Leo, Partner at HBM Partners AG, who was involved in financing Alydia Health prior to its acquisition by Organon in June 2021. While he has observed changing perceptions from more investors since Progyny, Inc.‘s successful IPO and more pharma companies (e.g. Organon, Bayer) showing appetite, there is still so much to be done with a large gap in growth stage start-ups. Early-stage founders are advised to think strategically on their revenue approach: low-price-point (e.g. educational/awareness building) v. high-price point (e.g. wearables) v. complex therapeutics (e.g. breast cancer).
Shiraz Mahfoudhi, investor at Speedinvest, sees “a boulevard of opportunities ahead” in women’s health in Europe and there’s no better time to start a FemTech start-up than now. VC investors usually think of market sizing in two fronts: pathology and user behavior. From an investor point of view, the key challenge is monitization.
Ankita Vashistha, founding partner of StrongHer Capital, recommends the company to scale up with global similarities and local nuances. As most women’s issues are common worldwide, the solution could be different depending on the region and stage of women’s life.
Hana Besbes from Heal Capital recommends founders to focus on one thing and target an end-to-end approach. Education and awareness are simply not enough, and the solution should be fully integrated, serving the women end-to-end. This is because the main pain points today are not the lack of access only, rather the lack of holistic women-focused experience from awareness to detection to diagnostic to treatment. Vertical integration does NOT necessary mean building the full journey from scratch as a parallel option to the establish healthcare system pathways, but rather integration with existing digital health solutions, while having the core of the solution owned by the startup, as well as owning the patient end-to-end – one face to the women. She also believes that a successful FemTech start-up tend to have a minimum of three founders with medical, tech, and commercial background.
A Final Thought – Role of Male in FemTech
I started the tour with an ambitious vision to break a viscous cycle, assuming it is driven by underrepresentation of female players in the FemTech Ecosystem across research, start-up, investing. Approaching the end of this fruitful startup tour, I couldn’t help but to reflect on the role of the other 50% of the population. One of the interesting highlights for me during the tour was meeting the welcoming male players in FemTech such as Dr. Chandra P. Leo, Nicolas Loeillot, Robert Stal, and Antoine Bachmann.
“We need to involve guys as well! The message is stronger when it comes from guys simply because it’s not intuitive for men to understand the fluctuations of women’s body. Communications and awareness are so instrumental to the success of FemTech.”– Nicolas Loeillot, Co-Founder of Tech4Eva
At one point, I started to question my original assumption of the vicious cycle and even the term “FemTech”. Does it somehow marginalize male FemTech founders and create a new taboo within FemTech?
Thanks to Kathrin‘s recommendation, I had a refreshing revisit to Amanda Menking, Ph.D.’s 2019 Femtech Insider blog. I cannot find a better end to this blog than the following.
“…we now have this polarizing word that does work for some people (e.g., generating capital, creating an ROI, providing a community) and does harm to others (e.g., excluding them from conversations, design decisions, access). Choosing a new word isn’t going to resolve all of these issues. The unintended consequence of femtech is that it draws our attention to these issues, which are timely and important and need to be discussed…”– Amanda Menking, Ph.D.
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