Sophie Gray (2020) is completing a DPhil in Interdisciplinary Bioscience. This academic year, she founded the Oxford FemTech Society with a group of DPhil students. Their aim is to promote understanding of the health gap within student and staff populations across a wide range of disciplines, and to encourage engagement with technology-based solutions for women’s health and wellness through regular panel discussions with industry experts and collaborations with other societies and groups across Oxford. In this article, Sophie explores why there is a health gap and how the Femtech Society hopes to provide solutions.
Historically, women’s health has been stigmatised, under researched and underfunded. Throughout the history of medical research, women have been neglected, leading to a lack of data and of understanding concerning women’s health and the construction of healthcare systems which cater predominantly for men.
Why is there a health gap and how can FemTech provide solutions?
Patriarchal systems of power have a persisting impact on women and non-binary individual’s health outcomes. From Aristotle describing “The female [as] a mutilated male” to Christian scholars teaching that “God made a woman from the rib he had taken out of the man” (Genesis 2:2, Bible), female bodies have historically been seen as an inferior deviant of the male form (1,2) . Unfortunately, these archaic schools of thought propagated through the ages and have culminated in the construction of healthcare systems built by and for men (3).
Before being approved a treatment is tested for its safety and efficacy in preclinical trials in animal models then in clinical trials in humans. In the UK, women were excluded from clinical trials and research up until 1993, either completely or during certain phases of the menstrual cycle to avoid the effects their ‘complex’ biology would have on trial outcomes, and consequently, one can imagine, big pharma’s profit margins (4). Despite our knowledge today that human beings are very heterogenous and that sex has an impact on our biology and our clinical outcomes, as recently as 2021 – only male mice were used in the majority (80%) of preclinical trials and only a fifth (22%) of Phase I clinical trial participants were female (5,6). Even when women are included, it is the minority of trials that complete any form of sex or gender disaggregation to investigate the influence that these factors have on clinical outcomes.
Therefore, majority of surgical methods, drugs, treatments and medical advances approved in the UK are assessed in their competency to treat men who are considered to be “a ‘normal’ study population” (7). Thus, in the eyes of the research community, women are seen as different enough to be excluded from scientific investigation, but similar enough to be expected to rely on a healthcare system built on data disproportionally derived from male animal models and from men. Compounding this paradox and consequent insufficiency of knowledge on women’s bodies, we have a shortfall in patient advocacy – with a governmental survey (2022) of 200,000 women, revealing over 5 out of 6 (84%) had experiences where they were not listened to by healthcare professionals. These trust and research disparities have galvanised a dangerous, and life-threatening health gap with real world consequences.
Let’s take a look at this in the context of cardiovascular health. Only a third of participants in clinical trials on heart disease and stroke are women, this means that data on symptoms and treatment outcomes are biased. Women have a 50% higher likelihood of being misdiagnosed or undertreated for cardiovascular disease and only half of women experiencing a heart attack will be correctly diagnosed (8). Contributing to this are both personal bias, with women’s pain and symptoms more likely to be dismissed by health care professionals, and systemic inequity – with the threshold for diagnostic blood tests measuring a protein called cardiac troponin being calibrated to men, who have higher levels of the protein, meaning many women who have had a heart attack are below the diagnostic threshold (9). Patients who are misdiagnosed have a 70% increased risk of mortality contributing to women being twice as likely to die of coronary artery disease or heart attack than men (10). Interestingly, one study showed that these biases only happened when the doctor was male (11).
This inequity ripples throughout the depth and breadth of our healthcare system leading to a bias in outcomes in both general health, and in sex or gender specific health issues. So whilst women may live longer, they spend a greater proportion of their life in ill health than men (14).
FemTech and Innovation
FemTech is a term coined in 2016 by Ida Tin which has grown to encompass all technology-based services, software, diagnostics, and products offering innovative solutions to conditions or diseases that predominantly or differently impact women (15). The FemTech ecosystem is populated by a diverse range of companies and institutions who are developing digital health solutions, producing educational content, redesigning medical instruments and generating novel treatments. The FemTech industry is tackling both health issues that disproportionately or differently effect women and non-binary individuals – for example mental health, patient advocacy, and work-place wellness as well as devising solutions for challenges that can arise from having a female reproductive system such as endometriosis and polycystic ovarian disease.
Despite the rapid growth of FemTech, unconscious bias, limited knowledge of female health and discrimination are still contributing to a lack of engagement from investors in women’s health ventures and in female entrepreneurs. Currently women represent only 12% of decision makers in VC firms and only 4% of healthcare R&D funding is channelled into women’s health (16). Furthermore, this funding is disproportionally allocated towards fertility and reproductive health, which accounts for 65% of woman’s health R&D funding. Others areas of women’s health, for example menstruation and menopause, are markedly more difficult to successfully pitch to a room full of men, meaning there remains much white space for innovation (17). Therefore, in this nascent industry, a key role of FemTech pioneers is to increase awareness of the unmet needs in women’s health and to combat and dissolve the stigma surrounding them.
This year myself and a group of DPhil students founded the Oxford FemTech Society. It is our aim to promote understanding of the health gap within student and staff populations across a wide range of disciplines, and to encourage engagement with technology-based solutions for women’s health and wellness through regular panel discussions with industry experts and collaborations with other societies and groups across Oxford.
If you want to be involved sign up to our newsletter here and follow us on Facebook and Instagram where we share details of our upcoming events.
Inclusivity Message
Terminology used in this article is a reflection of those used in its sources. Unfortunately as a result, in places the categories relating to sex and gender are binary or used interchangeably – this is due to available data on the health gap or related statistics being categorised in this way. If you have any comments or suggestions please reach out to sophie.gray@linacre.ox.ac.uk or the CR Welfare Officer (cr.welfare@linacre.ox.ac.uk
Want to learn more?
The health gap is an exceedingly complex issue – of which this article only scratches the surface. So I’ve included a list of some resources below for anyone wanting to dig a little deeper into the issue, some I’ve read and some have been gathered from recommended reading lists:
- Rebel Bodies: A guide to the gender health gap revolution by Sarah Graham
- Doing Harm by Maya Dusenbery
- Period Power: Harness Your Hormones and Get Your Cycle Working For You by Maisie Hill
- Ask Me About My Uterus: A Quest to Make Doctors Believe in Women’s Pain by Abby Norman
- Legally FemTech Podcast by Nixon Gwilt Law with Bethany Corbin
- Vagina Obscura by Rachel E. Gross
- Everything You Need to Know About the Menopause (but were too afraid to ask) by Kate Muir
- How the Pill Changes Everything: Your Brain on Birth Control by Sarah E Hill
The Health Gap
This article has focused on sex- and gender-based inequities; however, the healthcare system reflects the full range of discrimination found in the societies that built it. Once we begin to investigate, we quickly find that the sexism, racism, LGBTQ+-related bias, fatphobia, ableism, socioeconomic-based barriers and other forms of prejudice are all interconnected. The most effective solutions for closing the health gap are those that are intersectional and inclusive.
- The Health Gap: The Challenge of an Unequal World by Michael Marmot
- Medical Bondage: Race, Gender, and the Origins of American Gynecology by Deirdre Cooper Owens
- Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna Bowen Matthew
- Bodies and Barriers: Queer Activists on Health by Adrian Shanker
- Disability Visibility: First-Person Stories from the Twenty-First Century by Alice Wong
Structural Sexism
The health gap is part of a wider phenomenon of systemic prejudice towards women within the majority of our institutions – in order to successfully eliminate them we must understand why they exist and what we can do to fix them.
- Fix the System, Not the Women by Laura Bates
- Invisible Women by Caroline Criado Perez
References
1. Adam’s rib. in Adam and Eve in Seventeenth-Century Thought (ed. Almond, P. C.) 143–172 (Cambridge University Press, 1999). doi:10.1017/CBO9780511585104.006.
2. Gilbert, S. F. Sex determination. Developmental Biology. 6th edition (2000).
3. Women’s Health Strategy for England. GOV.UK https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england.
4. Ogletree, K. Women were left out of clinical trials until the ’90s. Well+Good https://www.wellandgood.com/women-clinical-trials/ (2020).
5. Chuck, Y. Drug Safety: Most Drugs Withdrawn in Recent Years Had Greater Health Risks for Women | U.S. GAO. https://www.gao.gov/products/gao-01-286r (2001).
6. Yoon, D. Y. et al. Sex bias exists in basic science and translational surgical research. Surgery 156, 508–516 (2014).
7. Liu, K. A. & Mager, N. A. D. Women’s involvement in clinical trials: historical perspective and future implications. Pharm Pract (Granada) 14, 708 (2016).
8. BHF Press Office. Women are 50% more likely than men to be given incorrect diagnosis following a heart attack. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2016/august/women-are-50-per-cent-more-likely-than-men-to-be-given-incorrect-diagnosis-following-a-heart-attack (2016).
9. Sinden, S. Half the population, half the data: Why women-specific research matters. CHÉOS: Centre for Health Evaluation & Outcome Sciences https://www.cheos.ubc.ca/research-in-action/half-the-population-half-the-data-why-women-specific-research-matters/ (2020).
10. Bias and Biology. British Heart Foundation https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women-and-heart-disease/download-bias-and-biology-briefing.
11. Harding, S. Why gender is at the heart of the matter for cardiac illness. The Observer (2022).
12. Cardiovascular diseases statistics. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Cardiovascular_diseases_statistics (2018).
13. CDC. Women and Heart Disease. Centers for Disease Control and Prevention https://www.cdc.gov/heartdisease/women.htm (2023).
14. Health state life expectancies, UK – Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2018to2020.
