Cross-Border Impact Ventures has spent the past five years looking at more than 2,000 healthtech investment opportunities.
What it is seeing now looks quite different from what was landing in its inbox when it raised its first fund, which had its first close back in 2021.
The Toronto-based impact VC firm announced earlier this month that it has secured a $58 million first close for its second Women’s and Children’s Health Technology Fund, towards a target of $125 million.
Returning institutional investors include KfW, on behalf of Germany’s Federal Ministry for Economic Cooperation and Development, the Skoll Foundation, Ceniarth and Equality Fund, while CBIV says a number of existing investors have increased their commitments.
But the five years between its first and second funds also provide an interesting window into how the women’s health investment market is developing - both in the companies coming through and the capital available to support them.
When managing partner Annie Thériault first began developing the idea for CBIV in 2018, women’s health was only just beginning to be talked about as an investment opportunity.
“There were fewer allocators or funds focused on as not as much in women’s health,” she tells FutureFemHealth.
“There were a lot of efforts around climate, but healthcare was sort of funded by that diverse founder initiative because a lot of women, a lot of diverse people, are creating companies that address these gaps.”
CBIV eventually closed its first $90.3 million fund in 20231, targeting companies that were commercially ready or approaching commercialisation.
At the time, that meant much of the investable pipeline sat in diagnostics, medical devices, software and healthcare delivery.
Five years later, the pipeline has become considerably deeper within these sectors and across new types of technologies as well.
From femtech to deep tech
“A lot of that pipeline that was early in the first fund is now ready for investment,” says Annie.
“What we’re seeing is a lot more deeper technology opportunities for Fund II.”
Drug discovery is one obvious difference.
“In Fund I we weren’t seeing drug discovery platforms focused on gender as one of the criteria, or racial equity, and really focused on healthcare areas that are disproportionately relevant to women and children, whereas now we’re seeing a lot more of that.”
That is taking CBIV into areas that might not once have appeared in a conventional definition of femtech.
Annie points to autoimmune disease, central nervous system disorders, mental health and cardiovascular disease as areas where the firm is now seeing more companies considering sex and gender differences within the science itself.
And the pitch decks look different too.
“If I look at the pitch decks I was receiving five, six years ago, often you would still see the image of the man holding his chest,” she says of cardiovascular companies.
“We know that women don’t suffer heart disease in the same way, and now we’re seeing more and more pitch decks that will show areas of cardiovascular health that are still relevant to men... but when you start digging deeper into the technology, there’s been more effort to ensure that the problem that’s addressed often is disproportionately the type of heart disease that women suffer from, and the clinical studies were developed with women’s needs in mind as well.”
Microbiome is another area where CBIV is seeing more activity, spanning the vaginal and gut microbiomes and their potential applications in areas including fertility.
“We’re seeing a lot more teams come to market with strong clinical backgrounds and interest to use these types of science to address the healthcare of women and children,” says Annie.
It is a picture of a women’s health market extending well beyond the categories that defined much of the first femtech wave.
The companies may be maturing faster than the capital
The funding environment, however, presents a more complicated picture. Annie says it is easier today to make the investment case for women’s health than it was when she started building CBIV.
“Six, seven years ago when I started to work on this, I had to really work hard to pull data together to prove our point,” she says.
“You had to do all your original research by yourself to find this data to show, ‘Hey, this disease is prevalent and women should want a better treatment.’”
Research from organisations including the World Economic Forum, McKinsey and Women’s Health Access Matters, alongside a growing body of market data, has changed those conversations.
“There’s a lot more rich data showing that you can make a lot of money in this sector,” says Annie.
CBIV is also seeing evidence in M&A.
“We continually see M&A transactions that are relevant to the types of things that we do at high multiples of invested capital.”
Yet capital has not necessarily followed at the same pace.
“There are still very few funds out there like Cross-Border that are deeply ingrained in the sector,” she says.
Traditional institutional investors can remain difficult to bring into specialist women’s health funds.
“Some of the more traditional institutions are still kind of younger in the process.”
There are signs of movement. Annie points to wealth managers and investment advisers beginning to pay closer attention to the category, helped in part by the transfer of wealth to women and younger generations.
“We see groups like UBS or Morgan Stanley holding sessions about women’s health to their women asset owners,” she says.
“These are some of the more credible managers of wealth in the world, some of the larger ones, and they’re showing up more and more.”
The funding gap doesn’t stop at Series A
Much has been written about the difficulty women’s health companies face moving from seed funding into a Series A.
Annie thinks the problem is broader.
“I think the drop-off is a little bit longer than seed to Series A,” she says.
Seed-stage companies can often find investors, even if they don’t always raise the amount of capital they would ideally want.
The lack of investors able and willing to lead larger healthcare rounds becomes more apparent as companies progress.
“If I had a dollar for every email I get from a great founder with something interesting saying, ‘I’ve got all these followers ready to jump in, but I don’t have a lead’…”
CBIV can underwrite deals across medical devices, diagnostics, AI and machine learning and other deeper technologies, but its funds can only make a limited number of investments.
“We’re one of the few firms that can underwrite deals in women’s health across the spectrum,” says Annie. “Yet many, many companies have a hard time finding an investor that’s able to do this.”
The problem can continue into Series B and beyond.
“One of the factors that we’re seeing from A to B is the B investors seem to be moving the bar a little - to want more progress before they step in than they did even five, six years ago.”
What Annie does emphasise here though, is that this isn’t necessarily unique to women’s health. Venture investors across healthcare have become more demanding about the milestones companies reach before their next round. It’s simply more painful in women’s health because there are fewer doors one can knock on.
But in a sector that still receives a small proportion of overall venture funding, Annie’s point is that the consequences can be more pronounced.
What actually makes something a women’s health investment?
As the pipeline expands into cardiovascular disease, autoimmune disease and other conditions affecting both sexes, defining what counts as women’s health becomes more complicated.
CBIV for example, looks beyond whether a product is exclusively designed for women, and we discuss cardiovascular disease as an example.
“At CBIV we look at specifically what they’re working on and is there a difference in prevalence for women and men,” says Annie.
“If it’s more prevalent for women, that would be a checkbox. Or maybe it’s more deadly for women. Sometimes it’s the same prevalence, or maybe women have the disease less, but they have more severe outcomes because the current technology wasn’t developed for women.”
The firm’s diligence then goes into the product itself and the evidence supporting it.
“Was this tested on a sufficient enough number of women that we feel confident that the tech works equally for men and women?”
Annie recalls investing in Cardiosense, which has developed a non-invasive cardiac monitoring technology worn on the chest.
“One of the questions we asked the founders is - do the breasts have an impact on your device?” she says.
“I bet you anything that any of our male industry colleagues wouldn’t have thought to ask whether the boobs mattered.”
And in autoimmune disease, for example, women account for a substantial proportion of patients, yet Annie points out that historically even preclinical research could favour male animals because female hormonal cycles introduced additional variables.
If those differences aren’t considered in preclinical research and clinical trials, the question becomes a fairly fundamental one.
“Does it actually work on females? Does it work on menopausal females? Does it work at all points of the cycle?”
For CBIV, prevalence and disease severity therefore sit alongside clinical trial and product design when determining whether an opportunity belongs within its investment thesis.
Who buys the next generation of women’s health companies?
There has also been movement at the other end of the funding cycle.
CBIV has already had one significant exit from Fund I. AI-powered fetal ultrasound company Sonio was acquired by Samsung Medison in 2024, just four years after it was founded.
Annie thinks the next stage of the market could involve more consolidation before companies reach acquirers of Samsung’s scale.
“It’s still the truth that it’s hard to scale up single-device companies,” she says. “They belong better in a larger portfolio.”
A Medtronic-sized company already has the sales infrastructure, regulatory expertise and customer relationships needed to take a technology into many more markets.
But there remain relatively few sizeable acquirers specifically focused on women’s or children’s health.
“I do think we need to see a few smaller, medium-sized acquisition platforms come to market to create entities that are large enough to be more attractive to some of the main suspects.”
That could mean existing women’s health platforms beginning to acquire smaller companies, or device businesses combining to create companies with sufficient scale to become acquirers themselves.
“The time appears to be now,” says Annie.
Five years on
Fund I ultimately backed 11 companies across maternal and fetal health, neonatal care, cardiovascular disease, oncology, respiratory health, reproductive health and gut health.
CBIV estimates those companies have now reached more than 379,000 women and children across 32 countries.
Sonio is perhaps the neatest demonstration of what CBIV set out to prove. During CBIV’s investment, the company expanded beyond Europe into the US and had a presence in countries including Brazil, Nigeria and India. Under Samsung’s ownership, its AI technology is now being integrated into the company’s ultrasound systems.
“We were making a great investment in a great deep-tech company addressing big challenges for women and children and able to achieve a very strong return for investors in a short period of time,” says Annie.
At the same time, the technology has the potential to reach considerably more patients through its new owner.
“We want to see Samsung be hugely successful with these new machines because we know the health impact of this software on people, especially when you have predicted staffing shortages over the coming years.”
Five years after CBIV closed its first fund, the investment case for women’s health no longer needs quite as much explaining.
The companies coming through its pipeline are tackling a wider range of conditions with deeper science behind them. Large healthcare companies are providing evidence that women’s health assets can deliver valuable exits. Institutional investors that once paid little attention to the category are beginning to appear in the room.
The question for the next five years is whether enough capital follows these companies as they grow.
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