As investors and advocates in women’s health,[1] we view the recent SCOTUS decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, as a significant step back in women’s health and rights. Now is the time to capitalize on the growing momentum in women’s health innovation and investment to meet new and existing gaps in care.

A renaissance in women’s health

As early movers in the women’s health space - Stasia as a co-founder of RH Capital[2], an impact venture capital fund dedicated to women’s health, and Alice as a clinician, patient and consultant researching FemTech and women’s health innovation trends prior to joining Stasia - we have seen how vastly underinvested and underserved women’s health historically has been, as recently described by Halle Tecco and Julia Cheek (both MBA 2011). Merely three or four years ago, women’s health was uniformly viewed as “niche,” with few interested investors, pharma companies looking to divest women’s health portfolios and little public discourse or recognition of women’s unique health needs.

However, the tides are beginning to turn. Women’s health is at an exciting inflection point with increased innovation, public awareness and capital. We are excited to be joined by a growing roster of specialized women’s health investors - including Linda Grueb (MBA 1987), Anula Jayasuriya (MBA 1993) and Maneesha Ghiya (MBA 2005) - as well as generalist investors developing a thesis in the space. Our pipeline of innovative companies has grown quickly over the years and expanded across numerous stigmatized and ignored conditions. We’ve also been excited to see specialized women’s health conferences, accelerators, pitch events and podcasts spring up in the past few years.

The fall-out from the overturning of Roe v. Wade

The recent historic SCOTUS decision has unsurprisingly led to a series of aftershocks, with 26 states now likely to ban abortion despite 1 in 4 women having one by age 45. Tens of millions of women have now lost their right to determine if and when to have children. No matter what one’s personal or religious views are, the impact will be felt by all - health systems and payors bearing costs from pregnancies now forced to continue, employers with more employees taking parental leave or traveling for abortion care, companies in states with restrictive abortion laws having a harder time attracting female employees, communities with more families entrenched in poverty.

From a clinical standpoint, physicians in restrictive states have become limited in their ability to properly treat (and sometimes even counsel) patients, and future generations of medical students will lack skills in abortion care, which is intimately tied to reproductive health overall (e.g. miscarriage and ectopic pregnancy management). Health systems are bracing themselves for restrictive policies and abortion clinics are closing down, leading to the greatest impact on low-income people who rely on these clinics for other reproductive health care. Women are facing difficulties accessing medications for other conditions due to miscarriage potential. Infertility patients and physicians are grappling with what the potential impact could be on treatment options.

The private sector is reacting as well. Business leaders are speaking up on their abortion experiences to destigmatize the topic. An increasing number of corporations are offering travel and other benefits to enable employees in states with restrictive abortion laws to access necessary care, as tracked by our colleagues at Rhia Ventures, who have assembled a host of resources for corporations[3]. The role of health tech is becoming increasingly important - both given rising privacy concerns and to enable greater access to abortion care.

Role of private capital to fill the gaps

In the past few weeks, we have seen numerous guides on where to donate, protest and take political action, as well as appeals for philanthropic capital to continue abortion access. As impact investors, we’re keenly interested in the role that private capital - specifically venture capital - can play. Now is the time to capitalize on the current momentum in women’s health with several investable opportunities in the market.

We see four key areas ripe for investment and innovation to mitigate the impact of the overturning of Roe v. Wade:

1. Doubling down on pregnancy prevention

Over the past several years, we have been excited to see a growing number of start-ups (alongside publicly traded players Evofem and Dare) developing novel non-hormonal contraceptives. Investors can play an important role in helping bring these next-generation products to market, including:

Other startups are looking to increase access to current methods (Cadence Health* bringing hormonal birth control over the counter), improve adherence (Aavia, smart pill case) or enable precision medicine in birth control selection (Adyn). Timely access to emergency contraception has become critical as well; reproductive health telehealth and marketplace companies like Nurx*, Pandia Health and Stix can play a role.

2. Protect against worsening maternal health outcomes

It is well known that maternal mortality and morbidity in the US has worsened over time and is worse than other high-income countries. Yet, states with the most restrictive abortion laws also have worse maternal mortality rates, creating even more impetus to invest in maternal health.

Greater investment is needed in novel technologies addressing drivers of poor maternal outcomes such as pre-eclampsia, preterm labor and postpartum hemorrhage. Additionally, existing racial and ethnic disparities in maternal health outcomes are compounded by the disproportionate impact of the SCOTUS decision on vulnerable populations. This makes solutions to reduce systemic biases, such as Medicaid and minority-focused companies Cayaba Care*, Mae* and Wolomi, more important than ever.

3. Directly investing in medication abortion

Medication abortion, which can be administered up to 10 weeks in pregnancy (by which 80% of abortions in the US occur), is a highly safe and growing method that now accounts for over half of US abortions. As an alternative to in-person clinic visits, tele-abortion providers such as Hey Jane (founded by Kiki Freedman, MBA 2020) and Choix vastly expand access to medication abortions. Medications are delivered through mail-order pharmacies such as Honeybee Health and manufactured by Danco Labs and GenBioPro. Capital to grow and expand operations for these companies is critical to mitigate the impact of the overturning of Roe v. Wade.

4. Spurring innovations not yet seen (or scaled)

As ramifications of the SCOTUS decision fully play out in the coming month and years, investors can spur innovation in newly created white spaces to further support women needing abortion care. These might include:

  • Benefits management solutions to support corporations and payers to execute on new policies to provide travel and other support for women seeking out-of-state abortions, particularly in the states that fully ban abortions after conception. Also solutions for women to identify out-of-state and telehealth abortion options.
  • Diagnostic tools to confirm pregnancies and fetal complications earlier, particularly as states move to ban abortion at earlier time points.
  • Mobile abortion clinics to provide surgical options around state borders of restrictive states to reduce travel burden, as nonprofit Just the Pill is piloting.
  • Solutions to protect providers from litigation and support individual privacy to protect women themselves, given the introduction of legislation that criminalizes abortion for women and providers.


The roadmap ahead: Now is the time to invest in women’s health

In an era with increased discourse on gender equity and health equity, the overturning of Roe v. Wade seemed unthinkable until recently. Coupled with the recent renaissance in women’s health innovation, investors have an opportunity to help mitigate the impact in a post-Roe v. Wade world. By doubling down on women’s health, both reproductive health and beyond, investors can support more innovations to reach the market and move the needle in women’s health.

Footnotes:

1 We use the term “women’s health” to encompass needs of people with uteruses and other people assigned female at birth. We acknowledge that not all people assigned female at birth identify as women and vice versa.

2 RH Capital portfolio companies mentioned in this article are denoted with an asterisk (*).

3 Rhia Ventures’ Corporate Engagement program has a host of resources including the re-released Hidden Value: Business Case for Reproductive Health, a one-pager on How Companies Can Strengthen Reproductive Health Care, and their latest offering, Post-Roe Resources for Employers.

About the authors:

Alice Zheng (MBA 2014), MD, MPH has been a women’s health enthusiast throughout her career spanning global public health, clinical medicine, consulting and now venture capital. She is currently a Principal at RH Capital, a women's health-focused venture capital fund, and was previously a women’s health practice leader and consultant at McKinsey. She holds an MBA from Harvard and MD/MPH from the University of Michigan. Alice is a frequent speaker on FemTech and women's health innovation and holds advising and mentoring roles with multiple women’s health accelerators and forums.

Stasia Obremskey (MBA 1987) is the co-founder and Managing Director of RH Capital, a women’s health-focused venture capital fund. As a passionate philanthropist and impact investor, she has been investing in global solutions for women’s health throughout her career. Prior to co-founding RH Capital in 2018, she was a CFO to several startup companies, primarily in the healthcare field. Her goal is to develop the next generation of non-hormonal contraceptive products so her twenty-something year-old kids don’t have to rely on their grandmother’s hormonal products.