Growing Tech Markets, GRL PWR, and Government Pronatalism: Investigating the Intersections of Femtech and Fertility
20 April 2023
What is Femtech?
Advances in wearable health technology, mHealth applications, patient-empowerment movements, and commitments from high-income countries to promote a patient-centered approach in health care delivery have produced an explosion of patient-reported data. A small but rapidly growing section of the digital health market is “Femtech”, or technological software, diagnostics, products, and services focused on women’s health. Initially coined by the female CEO of menstruation tracking app “Clue” to make women’s health technology more palatable to overwhelmingly male investment panels at venture capital firms, Femtech has since ballooned into a formidable slice of the digital health market, with a predicted value of $103 billion globally by 2030. Proponents of Femtech frame it as a women’s empowerment movement seeking to revolutionize digital care; its critics argue industry has used the moniker to popularize tools that surveil women’s reproductive data for profit. My research focuses on a use case within Femtech that illustrates this tension; digital interventions used to manage infertility.
Femtech and Fertility: A Perfect Pairing for Data Sharing
Fertility management products are one of the most popular Femtech apps in terms of downloads, and are pioneering patient-managed app, testing, and device integration with fertility and ovulation tracking wearables such as AVA and Oova. There are several major drivers behind the popularity of fertility digital health interventions; national movements to digitize health systems, attention from individuals and governments on falling fertility rates, and affordable convenience.
Firstly, national eHealth and digital health strategies have been a focal point of the WHO and United Nations for decades for their potential to expand access to care and improve care coordination. The embrace of digital health technologies accelerated during the COVID-19 pandemic, with many countries making a rapid transition to virtual consultations, monitoring, and communication to prevent the spread of infection. This shift was also seen in fertility care; some fertility clinics successfully converted to delivering consultations via telemedicine, but many patients saw their fertility services deemed as “elective” and therefore either significantly delayed or canceled. With few affordable face-to-face services available, digital applications emerged as a cheap and quickly accessible alternative for education and self-management.
Their language medicalizes reproduction and frames women as culturally responsible for conception, placing both the complex burden of reproductive labor on women’s shoulders and offering them reprieve through real-time visually stimulating data tracking and decision support. AVA, for example, offers to help women “take charge of your cycle” through machine learning algorithms, while Oova offers to “demystify your fertility” with “seamless” tracking and guidance on when to have intercourse. This concern over women’s ability to manage their own fertility isn’t limited to industry; governments worldwide are committing to pro-natalist policies aiming to encourage women and families to have more children due to social anxieties over falling birth rates and aging populations. Though it’s understood this is in large part due to women choosing to have children later in life (and therefore when they are naturally less fertile), Femtech marketing frames this phenomenon as a condition that can be prevented, treated, and monetized.
Lastly, digital health platforms for fertility are sought after as convenient and affordable alternatives to clinical services. Cost is a major factor; private fertility services can cost thousands of pounds, and fertility services available through the NHS have age and time criteria patients may not meet. Not meeting criteria is a common experience; a recent survey by Fertility Network UK found 63% of patients with infertility had to pay for at least part of their treatment, and of those who could not access NHS-funded care, over half did not meet the criteria. Many patients also find traditional clinical fertility care to be unwelcoming; marginalized groups including LGBTQ, single people, and lower socioeconomic status face additional stigma and a lack of culturally competent care .
It’s unsurprising then that due to these barriers many patients choose never to seek professional services; of women in the UK who report experiencing infertility, just under half report not seeking clinical care. Using a fertility self-tracker is less invasive and more affordable than in vitro fertilization (IVF), using prescription fertility drugs, or egg freezing, and can be done anonymously and on a patient’s own time. Additionally, most women seeking fertility services do so for advice, rather than drugs or procedures, and overestimate or struggle to estimate their fertility window effectively. This further drives the use of tracking apps, which are mainly used for educational purposes, either around general reproduction or predicting and understanding their cycle, and can be easily downloaded from a mobile phone rather than requiring in-office care.
Surveillance and Privacy Concerns: An Ovary-action?
As a relatively new and quickly growing area within the digital health sphere, my research seeks to understand how digital health fertility platforms are complimenting, and in some cases replacing, traditional care pathways. Digital fertility platforms report millions of users across the globe, and surveys completed in the UK show women have positive attitudes towards fertility tracking apps and would use a prediction app to support conception. If patients are seeking care through alternative digital pathways, we must understand how it influences their decision-making and health behaviours.
Fertility care is a component of reproductive justice; if digital applications are more affordable and accessible to groups of women who experience stigma or are unable to access traditional clinical care, they could be more extensively vetted and advertised to women through the NHS. However, if they provide women with misinformation and erroneous fertile windows, real harm could be done to a woman’s chance at conception. My research seeks to understand how patients and professionals are utilizing these tools through qualitative interviews, observations, and surveys.
Additionally, few studies have assessed how the overturn of Roe v. Wade, which protected the constitutional right to abortion in the United States, has impacted the privacy risks of using fertility trackers, as well as the broader Femtech industry. Following the Supreme Court decision, abortions were quickly banned or seriously limited across about half of US states, with legal precedent already established for using digitally collected data to persecute women for procuring an illegal abortion. Viral social media campaigns spread across the internet urging women to delete their period and ovulation tracking apps, and Femtech companies faced difficult challenges on whether they would comply with law enforcement in abortion cases.
Simultaneously, some women may need their period trackers more now than ever, as keen awareness of the menstruation cycle would be necessary to procure an abortion in time. Many states have implemented abortion bans at six weeks following conception, meaning women may only have one opportunity to take note of a missed period before needing to travel out of state to access full reproductive health services. My research aims to deconstruct the consequences of these changes on Femtech through legislative policy analysis, fertility tracking, privacy and security policy analysis, and qualitative interviews.
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