The messy middle of equity and inclusion in femtech

Uncomfortable questions about the tension between commercial viability and true equity

Can femtech scale without serving affluent women first?

It’s an uncomfortable question, and one I’ve been thinking about a lot recently, particularly as I write about a lot of emerging technology that is simply out of reach for the average person.

As healthcare waiting lists grow longer, healthcare deserts expand and advanced technologies move faster, the gap between innovation and the women who need it most can start to feel ever more urgent.

And yet, from a founder perspective I also have to be brutally honest about the realities of building a commercially viable and sustainable business.

Which is why I think the sector needs to discuss these questions more honestly.

Who are the products in femtech really being designed, validated and distributed for?

Can innovation eventually scale beyond early adopters and traditional healthcare pathways?

At what stage should companies realistically be expected to operationalise equity and inclusion?

This week, Teal Health, the makers of an at-home cervical cancer screening kit, shared a timely example of how parts of the sector may be starting to navigate this tension.

The company announced a new pilot with Washington University School of Medicine focused on expanding access to at-home cervical cancer screening through trusted community spaces including health fairs, food banks and local wellness initiatives across Illinois and Missouri.

Importantly, the initiative is not simply about distributing Teal’s product more widely. The study is also testing broader questions around how women’s health infrastructure itself can become more accessible: whether community-based outreach, navigators, telehealth follow-up and trusted local partnerships can help reconnect women with preventive care and screening systems.

The findings could ultimately have implications far beyond Teal itself - there could be useful learnings from the research for how health systems, Medicaid programs, academic institutions and public-health organisations think about scaling cervical cancer screening and preventive women’s healthcare more broadly.

In many ways, this feels symbolic of where women’s health now finds itself as a sector. Until recently, much of femtech has been focused on simply proving commercial viability and demonstrating that there is a market at all.

The next phase should start to look very different. The real success stories will likely be the ones that can integrate into public health systems, reimbursement pathways and community-based care infrastructure capable of reaching broader populations at scale.

And so perhaps the playbook at a company-level is to first prove commercial viability within a narrower initial market before expanding into broader questions around accessibility and infrastructure.

What I find interesting, though, is whether an alternative approach was ever realistically possible.

Could this sort of accessibility work and research partnership have happened earlier in a startup’s journey? Could it have happened from day one?

My instinct is probably not.

And that’s where brutal honesty comes in.

This tension also sits at the centre of a recent paper published in Frontiers in Global Women’s Health* which explores how femtech can evolve into a more equitable healthcare ecosystem.