Over the years, women working in healthcare have been asked why “women’s health” solutions are not just “health solutions.” We’ve been asked if we really need to build separate care paths for women. We’ve been told the market for women’s health is too “niche.”

When Kate Ryder started Maven, now a $1 billion women’s telehealth company, some investors said that employers would never pay for a solution that “only” supported half the population. What they didn’t consider is that pregnancy and delivery is one of the largest costs for employers providing health insurance benefits. When Everlywell was first founded to provide at-home lab tests for women, one potential investor even said “the whole idea sucks.” Most potential investors who were willing to take a meeting had heard about the products from their wives or assistants. Otherwise, they simply didn’t think “there was a real problem to solve or market opportunity.” The company (which Julia founded and Halle backed) was reported in March 2021 to be worth $2.9 billion dollars.

But this is changing as investors are warming up to the vast opportunity to serve the unique healthcare needs of women. In fact, U.S. digital health startups serving women raised $1.4B across 37 deals in 2021—nearly doubling 2020’s $777M funding across 23 deals. And we now have successful businesses that prove this industry is not niche, including KindBody (fertility care), Sema4 (prenatal and carrier testing), Simple Health (accessible birth control), Tia (modern female clinic), and the companies we’ve founded: Everly Health, Everlywell, and Natalist.

What even is women’s health?

There’s no universally-accepted definition of women’s health. According to one source, it’s “the branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a woman's physical and emotional well-being.” However, it’s much deeper than that. At an individual level, studies have shown that women utilize more healthcare services—in fact, we are 76% more likely than men to have visited a doctor within the past year. At the family level, women control 80% of healthcare decisions in the home. Women are more likely to be the primary caretakers of the family, making appointments and healthcare purchasing decisions on behalf of partners, children, and parents. We even pick up 70% of prescriptions at the drugstore. Simply put, we are the Chief Medical Officers of the home.

At an individual level, studies have shown that women utilize more healthcare services—in fact, we are 76% more likely than men to have visited a doctor within the past year.

So when it comes to defining our category, what do we mean by “women’s health”? Is it serving health needs based on gender (one’s identity of being a woman) or sex (different biological and physiological characteristics females face)?

Women’s health through the lens of “sex” and “gender”

For too long, women’s health has been solely focused on gynecological and reproductive health. This is because most females experience reproductive health events that males do not (i.e. menstruation, pregnancy, and menopause). However, this does not work as the foundation of all women’s health can be. For example, women are more likely than men to become disabled during their lifetime, more likely than men to be obese, and face a 20% increased risk of developing heart failure or dying within five years of their first severe heart attack compared with men. That is to say, women’s health is not limited to reproductive health.

Even looking solely at diseases and conditions, as seen above in the NIH definition of women’s health, is too narrow. Women also face the challenge of existing within a system that was designed by and for men. The cost of simply being a woman in our society, and certainly in our healthcare system, is high. Women pay more for the same consumer products and services men also use in what is called the Pink Tax, affecting everything from the price of razors to dry cleaning and more. And we pay more in injuries and deaths in a world designed by and built for men. For example, women are 47% more likely to sustain severe injuries in car crashes, even when using seat belts. This is because car safety testing is done with 50th-percentile male test dummies, optimizing safety for the muscle mass distribution and body shape of men. Women also have a greater risk for adverse side effects from medications. This is because women are underrepresented in clinical trials (it wasn’t even until 1986 that women were allowed to participate in clinical research and trials).

Women also face the challenge of existing within a system that was designed by and for men. The cost of simply being a woman in our society, and certainly in our healthcare system, is high.

Even at work, we are faced with occupational hazards. Buildings are set to temperatures based on a formula that uses the metabolic rates of men. Women are the victims in nearly two-thirds of the workplace injuries resulting from assaults. And female healthcare providers are put at higher risk due to ill-fitting personal protective equipment (PPE), which is manufactured for the “standard” U.S. male face shape.

Patriarchy in healthcare is as old as healthcare itself

Then there’s the time, emotional cost, and cognitive load of navigating our healthcare system, one that makes too many people feel unseen or unheard. One in five women report having felt that a healthcare provider has ignored or dismissed their symptoms, and 45% of women said they’d been labeled as chronic complainers. Perhaps that’s why Rock Health’s 2020 Consumer Adoption Survey and the 2020 Kaiser Family Foundation Women Health Survey found that, at the height of the pandemic in 2020, women were more likely to forgo healthcare altogether compared to men. Or maybe it’s because women generally have less favorable opinions about their health insurance compared to men, and we feel less favorable toward healthcare organizations we must deal with.

How come? Well, patriarchy in healthcare is as old as healthcare itself. Think about pregnancy tests, which initially required a doctor’s analysis to prove a positive or negative result; that is, until product designer Margaret Crane saw an opportunity to eliminate the middleman and create a way for women to take a pregnancy test privately, conveniently, and affordably at home. Of course, she met resistance from her male managers, who believed women could not handle this information and would simply become hysterical if they were to discover an unplanned or unwanted pregnancy. When the at-home pregnancy test was eventually greenlit years later, the male executives wanted it to be designed with flowers and frills… you know, just in case.

The effects of bias and patriarchy in our healthcare system are compounded even more for Black women, who have a shorter life expectancy than white women. The difference in average life expectancy in two Baltimore neighborhoods—one where 93.3% of its female population is Black and one where only 6.9% of its female population is—amounts to a staggering 20 years. Furthermore, Black mothers die at a higher rate from pregnancy-related complications than any other racial/ethnic group at 40.8 deaths per 100,000 births.

So, where do we go from here?

Rebuilding the industry

We have to move beyond the biomedical model and begin to acknowledge the social determinants of women’s health and wellbeing in our society. Health is a product of cultural, social, and psychological factors, and the impact of navigating a patriarchal society and healthcare system. One tool we have to do that is the biopsychosocial model, which gives us an expanded lens of health that focuses on social and psychosocial factors as well as biology.

It’s also important we’re inclusive of people who have female reproductive organs, but don’t identify as women, as well as those who may not have female sex organs, but experience oppression due to their gender identity, along with anyone else impacted by the baseline inequities that exist in the healthcare system today. One solution for renaming this category to be more inclusive was suggested in September 2021 by digital health venture fund Rock Health, which now the term “women+ health” to encompass the full spectrum of health needs experienced by cisgender women, as well as transgender individuals, nonbinary individuals, and others whose health needs relate to those of cisgender women.

We must look beyond female anatomy and reproductive health to uncover and rectify the impact of centuries of navigating a healthcare system that wasn’t built for us.

Regardless of what we call it, moving forward, our industry needs to be mindful and inclusive as we continue to rebuild this industry. We must look beyond female anatomy and reproductive health to uncover and rectify the impact of centuries of navigating a healthcare system that wasn’t built for us. By learning from the gaps and inequities that exist in status quo healthcare, we can build a healthcare system that is truly inclusive of different diseases and conditions, and different journeys and experiences, to serve all people with better care for better health.

About the authors:

Halle Tecco (MBA 2011), MPH is the Founder of Natalist and now the EVP of Women's Health Strategy at Everly Health. Previously she was the founder of early-stage digital health venture fund Rock Health and an Adjunct Professor at Columbia Business School. Halle started her career working in finance and business development roles at Intel and Apple. She is currently an advisor to the Harvard Medical School Department of Biomedical Informatics and is a Board Director at the International African American Museum. She received her MBA from Harvard Business School and her MPH from Johns Hopkins University with a concentration in Women's and Reproductive Health.

Julia Cheek (MBA 2011) is the CEO and Founder of Everly Health, the digital health company at the forefront of the virtual diagnostics-driven care industry. Cheek founded Everlywell in 2015 to provide consumers access to at-home lab tests with insightful results. She now serves as CEO of Everly Health and its subsidiaries, including Everlywell, Everly Health Solutions (formerly PWNHealth), EverlyDx, and Natalist. As a solo female founder, she has raised over $300M in venture capital funding and built a company achieving “unicorn” status in 5 years. Julia attended Vanderbilt University and earned her MBA from Harvard Business School where she graduated as a Baker Scholar with high distinction. She serves on the Board of Directors for Headspace Health, the Digital Health Advisory Board for AstraZeneca, and the President’s Innovation Board at The University of Texas at Austin.