Investment in what is typically called “FemTech” – defined as diagnostic tools, products, and services related to women’s health — has exploded over the past decade. Some of the most promising ventures have been focused on reproductive care. Then came the U.S. Supreme Court’s decision to overturn Roe v. Wade. The legal and policy restrictions on reproductive health care that result from this decision will not only have swift impact on people who can get pregnant and their families, it will also undermine critical areas of research, innovation, and progress toward more equitable health care outcomes. Among the areas of concern: fertility treatments like IVF; personal data collection and the ability to drive research; a limiting of new investment and curbing of health care innovation more broadly; and the introduction of new obstacles for women founders.
Growth in what is typically called “FemTech” — defined as diagnostic tools, products, and services related to women’s health — has exploded over the past decade. As recently as 2013, less than $200 million was being invested in the field, but funding reached $2.5 billion in 2021, with projections predicting a continued ascent.Forward-thinking founders have been developing groundbreaking new products and care models for women and families. Some of the most promising ventures in FemTech are focused on reproductive care: fertility clinic Kindbody reached unicorn status in early 2022, and menstruation and pregnancy app Flo is valued at more than $800 million. Maven Clinic, a telehealth clinic whose services include reproductive care, became the first U.S. unicorn dedicated to women’s health in 2021 when it closed a $110 million series D round.Then came the Supreme Court’s recent decision to overturn Roe v. Wade. Legal and policy restrictions on reproductive health care will not only have swift impact on people who can get pregnant and their families, especially those who are hourly workers or low-income, it will also undermine critical areas of research, innovation, and progress toward more equitable health care outcomes. In the words of Alice Zheng, principal at RH Capital and former clinician: “The overturning of Roe v. Wade has vast implications for our society and economy — not just patients and clinicians who can no longer appropriately receive or provide care, respectively, but health systems and payers bearing additional costs, employers with a workforce traveling for abortion care, and society at large as we grapple with this new world.”While we acknowledge that some may be reluctant to take a position, we believe that business leaders and policy makers should care about the issue of abortion access because it deeply impacts the rights, health, and life prospects of individuals and communities. They should also understand the related implications for the kinds of scientific advancements that drive economic growth. As academics who study gender, innovative startups, and health care, we see several key areas of science and business at risk as we consider the impact of the Dobbs decision on this space. The damage the ruling does may not be fully revealed for some time, but the immediate effects are likely to be chilling.A first area of concern surrounds IVF. With the loss of federal privacy protection for reproductive health care decisions, states are now free to grant legal personhood to fertilized eggs, a longstanding goal of many anti-abortion advocates. Such laws would upend — or altogether end — the use of standard fertility treatments such as IVF for large swaths of U.S. residents in part because it could make it illegal to discard unused embryos. One analysis estimates that 18% of IVF cycles nationwide could be impacted if the states which have moved to ban abortion enact fetal personhood laws. (Thus far, seven state legislatures have introduced such laws.)This threat comes just as startups like Maven and Kindbody have been innovating to make such treatments more widely available, including by making insurance coverage options more accessible. Companies that provide IVF services may need to scramble to move fertilized embryos to different states or engage in costly litigation. In addition to generally dampening innovation in this area of fertility care, people who need IVF to conceive may face even fewer options.Next are troubling implications for personal data and the companies that leverage it to improve consumers’ health. The privacy of health data collected by apps used for reproductive care was a topic of concern before Dobbs, and the stakes have now become much higher. State laws that incentivize or require citizens and law enforcement officials to report and penalize people suspected of obtaining or providing abortions threaten a whole host of fertility-related care options. Prenatal diagnostics could become fodder for retaliatory “investigations,” as could digital tools for managing menstrual health.This would compromise the ability of companies like NextGen Jane and Frame Fertility, which focus on data-driven approaches to health, to serve their customers. NextGen Jane collects menstrual blood from tampons, using genomic data to discover early signs of disease that may affect fertility and quality of life. Frame Fertility helps users discover risk factors, such as endometriosis, that were previously undiagnosed and could impact their pregnancy outcomes. Forcing these and other ventures to operate in riskier, more ambiguous conditions, isn’t good for their investors, founders, employees, or the people they serve.Data collection and data sharing are enabling better care delivery and driving research in countless other ways, such as making medical diagnoses more reliable and accurate, creating safer and more comprehensive treatments, and reducing costs in virtually all areas of care delivery. For example, GIFT-Cloud, a data-sharing platform for fetal imaging research, has virtually limitless potential uses in other areas, including identifying cancer risks. An innovation like this is unlikely to survive long enough to reach such broad-scale implementation if a shortage of prenatal data hinders it today. An unraveling or stalling of responsible data accrual and sharing will have deleterious effects on care, on science, and on the business outcomes of health systems.Third, there may be a spillover effect into other forms of health care innovation. Even FemTech companies that don’t work directly in reproductive care could be constrained by extreme abortion restrictions. They may feel forced to divert resources away from their core business to managing legal risk — and potentially lose out on investment from funds that now view women’s health as too uncertain a prospect. These include ventures working to address health issues that affect tens of millions of people, such as Renovia, a Boston-based company with a digital therapeutic to treat pelvic floor disorders (weakening of muscles or connective tissue of the pelvic area). This condition is sometimes but not always related to pregnancy and affects one in three women. Sowing confusion about the boundary between legally restricted and legally permissible medical care not only makes it harder for existing companies to operate, it’s likely to discourage new entrants from taking the plunge.And what might the investment outlook be in a post-Roe era? According to Pitchbook, venture capital funding for FemTech has tripled since 2015. There are likely investors who believe strongly enough in the moral imperative to resource innovation in women’s health that they won’t be scared away from including such companies in their portfolios. But on the whole, the patchwork nature of abortion restrictions will contribute to an environment in which we may see this capital shrink instead of grow, as potential returns become less clear, especially for ventures suddenly viable only in certain states. Some investors may understandably shy away from wading into the now-murky territory of women’s health for a whole host of reasons, a development which will slow the flow of dollars to companies trying to solve problems with massive implications for both individual and community health.Beyond the potential to choke off investment in women’s health, the post-Roe era could also curtail female founders and limit women’s careers. Women are 40% more likely to invent for women than men, and with a potential pullback in funding to turn these ideas into businesses, the gender gap in entrepreneurship could well widen. Better access to reproductive health care increases women’s propensity to become entrepreneurs no matter the industry they work in, increases women’s ability to secure VC funding, and improves the performance of female-run ventures. Consider that the introduction of oral contraceptives in the mid-20th century closed or narrowed gendered wage and career gaps, enabling firms to retain more and better female talent. The Dobbs decision may well roll back these gains.It’s true that constraints can spur innovation as well as impede it, and there are organizations well-positioned to mitigate the pernicious implications of Dobbs. As women’s health investor and entrepreneur Halle Tecco, speaking to the Securities podcast noted, “Constraints can compel creativity, but this is a real challenge facing every human — not just every woman — and one that leaders in this space need to address.” Ventures like Contraline and YourChoice Therapeutics, which are focused on developing male contraceptive — a long-underfunded field — may see increased interest and investment in the coming years. Existing companies are finding ways to protect their users from prosecution. Aid Access, Hey Jane, and Plan C, are pushing to improve access to medication abortion and provide consumers with resources about how to access abortion pills.But operating in the narrow, fraught confines of a post-Roe America is unlikely to yield the kind of innovation that patients deserve, that investors and founders want, and that drives significant economic growth. It’s far more likely that reproductive care will languish compared to other health tech fields where the legal landscape is reasonable to navigate. Such an outcome is bad for health and bad for business.