“Femtech” is booming—but does it really make healthcare more equal?

Menstrual apps and other women’s health technology can help close the gender health gap. But much more needs to be done to truly democratise healthcare

September 05, 2021
Piotr Swat / Alamy Stock Photo
Piotr Swat / Alamy Stock Photo

Female technology, or “femtech”—one of the Guardian’s top 10 words for 2019—is booming. The market for it is expected to reach $3.9bn by 2026, as research and funding into women’s health increases. One of the first femtech startups was Glow, a period- and ovulation-tracking app created in 2013 by Paypal co-founder Max Levchin. The app Clue was launched initially the year before, at a time when only 14 per cent of people were using apps to track their health.

There is a long history of women’s health being ignored or undermined. Women are five times more likely to feel ignored when seeking advice for their reproductive health: a Public Health England survey reports that “31 per cent of women experience severe reproductive health problems, but under half seek help.” Femtech apps and digital technologies aim to give control back to women by enabling them to get more intimate knowledge of their own bodies, and map their own cycles without relying solely on medical professionals. By giving women the autonomy to make decisions about their own bodies, these technologies democratise the health landscape. For instance, many women with irregular cycles due to PCOS (Polycystic Ovary Syndrome) use apps to check for patterns. Maria*, who frequently uses of the Flo app to track her PMS and irregular cycle, says it has given her “peace of mind.” However, as well as democratising the healthcare domain, these technologies risk reinforcing some of the societal biases.

Many of the apps claim scientific accuracy. Flo, for instance, claims that it has more than 80 “health and medical experts” and that “users receive evidence-based medical information.” Clue asserts that “all of our predictions are based on the most up-to-date science”. And yet, a 2016 study by Columbia University found that more than 95 per cent of the 108 free smartphone menstrual cycle tracking apps researched were inaccurate, with most having little or no scientific grounding or consultation with medical experts in their design and development process. As most of the apps are not registered as medical devices, they are also wholly unregulated; only Natural Cycles is registered with the Medicine and Healthcare Products Regulatory Agency (MHRA) in England and by the FDA. This particular app works by pairing morning body temperature with an algorithm to learn the pattern of your unique cycle and predict your fertile window. The company’s website claims that the app has been 93-98 per cent accurate but, when investigated by the UK’s Advertising Standards Agency, this language was ruled “misleading.”

In 2016, It was estimated that menstrual apps were downloaded 200 million times. But because these apps mainly tell women the day they ovulate, they are increasingly marketed and promoted as healthcare assistants that can support women who wish to become pregnant or avoid pregnancy. Around 54 per cent of these apps only tracked menstrual cycle dates, a calendar method which simplistically assumes that every menstruating person has 28-day cycles and that the day of ovulation is 14 days before the start of the next menstrual cycle. This method is typically inaccurate, ignoring the huge variability between the lengths of menstrual cycles around the world. Research has shown that only 13 per cent of period cycles last 28 days. Apps giving fertility predictions based solely on this outdated understanding could completely miss the fertile window.

There is also the issue of data privacy. Between 2017 and 2019, the Flo app allegedly shared millions of users’ data concerning menstruation, fertility and pregnancy with companies such as Google and Facebook, even though their privacy statements explicitly stated the contrary. In December 2018, Privacy International reported that several popular menstruation apps were regularly sharing user data with Facebook; of the 36 apps tested, 61 per cent were found to automatically transfer data to Facebook the moment a user opened the app. A 2019 review of 24 health-related apps found that 67 per cent of apps shared user data with a third party for advertisement services.

Femtech is currently dominated by apps that help users track fertility, which account for an estimated 56.13 per cent of the overall market. As of 2019, reproductive health is the largest area of application for the femtech market and saw funding worth $24m in the first quarter of 2019. Technology such as pregnancy and fertility tracking apps form the major component of the femtech market, currently accounting for an estimated 62.28 per cent of the entire industry. These have been traditionally easier to fund, as women’s fertility is big industry. The global fertility market size is predicted to hit around US$ 47.9bn by 2030.

But in order to truly democratise healthcare, we need to expand this narrow focus, and fund scientific research and technological development in broader areas of women’s health such as sexual dysfunction, pelvic floor weakness, sexual health education for LGBTQi and trans community, menopause, dementia, and cervical cancer: all topics that are still considered awkward and uncomfortable by investors. The Femtech market comprises over 200 start-ups worldwide, 92 percent of which are founded and led by women. However, 88 per cent of Venture Capital decision-makers in the US are men. And so even as femtech is getting more traction and investment, stigma against some of the conditions that are not considered as profitable or “sexy” is still rife.

The intersectional ramifications of these technologies are still relatively understudied and not well understood. With the focus on “female” and the reproductive biology, femtech can exclude trans men and women, and non-binary people.  The term in itself has been considered problematic due to its focus on “female” health, on periods and ovulation, with many of the websites using images, design themes and language that excludes people not born biologically female. Now, apps such as Clue are purposefully creating content on their websites to show their commitment to trans inclusion. There are also a few rising start-ups that are exclusively dedicated to LGBTQ and trans community such as Queerly Health that allows you to book LGBTQ+ friendly health and wellness practitioners from anywhere, and Plume, a Denver-based startup that provides gender-affirming hormone replacement therapies and medical consultations tailored to the trans community. But these are few and far between.

Advancements in women’s health are long overdue, but if we want to truly close the gender health gap, we need to increase representation in boardrooms, and the technology sector—both in design and development, and in founders and entrepreneurs—not just from cis women, but also from women of colour, non-binary people, and trans men and women. We need more inclusivity in design of these technologies, taking into account the variability and diversity of people who are using them.