India's Femtech journey has many hurdles on the way

Gurgaon-based IT professional Anuja Mohul’s smartphone beeped in the morning as she was getting ready for work. On checking, Mohul realised it was her period tracker app giving her a heads-up to expect her cycle in the next few days. A cautious Mohul stocked up on her cycle requirements – menstrual cup, pain relief patches – along with the usual hygiene products she carried to work, including a disposable contraption that allowed her to use public toilets standing up and the toilet seat sanitiser spray for emergency use.

As Mohul checked her bag again to make sure that everything she needed was in place, she looked up at her maid, Rekha. Unlike Mohul, Rekha did not have access to any of these accessories of women’s health. For that matter, nor did some of Mohul’s cousins who lived in Saharanpur in Uttar Pradesh. “My urban lifestyle allows me to take for granted femtech that many of my peers are unable to access,” she admits.

According to Global Market Insights, a US-based market research and management consulting company, the femtech industry is expected to grow at a CAGR of 16.2 per cent from 2021 to 2027. India, though still at a nascent stage regarding femtech, is home to five per cent of the world’s total femtech companies. As per a consumer report by Indian femtech startup Savage, the year 2021 saw the highest number of funding deals in the last seven years, 40 in total amounting to $98 million. Altogether, the femtech market is poised to grow at a healthy rate of 17 per cent from 2020 to 2026.

What is femtech?

In 2009, Danish author and entrepreneur Ida Tin was busy trying to track her fertility days. With no help at hand, Tin sat herself down with a cellphone and a thermometer, manually noting down her temperature on a spreadsheet. She hoped that somehow she would be able to arrive at a solution that would make it easy for women to track their monthly cycles, ovulation phase and more. It was no surprise that in 2013 her efforts led her to co-found the menstrual and ovulation tracking app, Clue. Tin went on to coin the term ‘femtech’ or female technology in 2016.

The overall digitisation of the femtech industry has been catalysed by the pandemic. Women, who were traditionally not online, have started coming online. – Swathi Kulkarni, co-founder and CEO of Elda Health

Today, femtech is a flourishing industry worldwide. With innovative technologies, the industry aims to target menstruation issues, fertility and birth control, menopause, pregnancy, pelvic health, chronic conditions, sexual wellness, and generic women’s health issues such as cardiovascular disease or osteoporosis. Femtech counters misconceptions and inequities in women’s health and wellness. It also aims to change the paradigm that clinical trials are generally male-dominated, with hardly any data on women’s healthcare. In simple terms, it addresses the gender gap in the healthcare industry.

Co-founder and CEO of Elda Health, a holistic, digital wellness platform offering mid-life and wellness solutions for women, Swathi Kulkarni, says, “The overall digitisation of the femtech industry has been catalysed by the pandemic. Women, who were traditionally not online, have started coming online. This has accelerated the growth of the reach of femtech in India. Femtech is giving women the ability to have uncomfortable conversations discreetly.”

Beyond the basics

Femtech is no longer just about the basic sanitary napkins. Startups in the field are throwing up innovative technologies that promise to make women’s day-to-day living a tad easier. “My peer group uses various apps that assist with many women-related issues.

From managing period pain to having access to a platform that addresses sexual harassment or deals with cardiovascular health and mammogram accessibility and need, femtech is finally putting woman in the forefront,” says Mohul.

For example, Sirona pioneered India’s first female urination device, PeeBuddy. It allows women to stand and pee. It has also forayed into the female safety segment with Impower, a leading provider of pepper sprays. OoWomaniya.com by Impetus Wellness is a networking platform that spreads awareness on issues such as women’s intimate hygiene, menstrual health, polycystic ovary syndrome management, parenting, nutrition, stress and anxiety management, prevention of sexual harassment, and more. Niramai offers a software-based solution for the early detection of breast cancer with a portable cancer screening tool. Proactive For Her is a women-focused healthcare startup that offers tele-consultation as well as offline services for problems related to skin and haircare, among others. Healofy helps Indian women across key life stages, starting from preconception to early motherhood.

Hurdles in India

Recently in the wake of the controversial Roe vs Wade ruling in the US, many in India celebrated the fact that we are better at giving our women agency over their bodies. This is only theoretically and superficially true at best. A resident of Pune, who wishes to remain anonymous, remembers how when she had to seek an abortion, the gynaecologist insisted that she visit the clinic with her husband, only then would the process be carried out.

India accounts for 17.7 per cent of the total world population according to some estimates, of which nearly half are women. But only a fraction of the women in India have direct access to technology that can boost their health. Needless to say, rural/urban disparities, education and decision-making, and gender equality are massive roadblocks to femtech growth in India. Moreover, even taken at face value, the internet reach in India is far from complete. The country currently has 61 per cent of its population using the internet. It still leaves 39 per cent population out of the equation.

“Women in India traditionally have been underserved. Our needs have always been overlooked. Most women have no access to basic healthcare and hygiene. A number of women’s health issues are still considered taboo,” says Kulkarni.

In India, approximately 70 per cent of all reproductive diseases are caused by poor menstrual hygiene. Women in Tier 3 cities and rural and semi-rural areas are still ostracised at the time of their monthly cycle. There is hardly any awareness. This lack of dignity instils a feeling of hesitancy among young girls and women when it comes to discussing their health. Also, the fact that many doctors practising in small towns and villages are men discourages women from openly discussing their health issues. It also has an underlying social sanction, where the woman is considered the giver, never the receiver.

“Overall the efforts of femtech companies in the country have had a good reception. But it is sadly limited to urban women, generally professionals. Many of my patients who belong to the upper classes have access to femtech and use it to help themselves. But women who belong to the middle class and lower-middle-class even in urban areas, are still at sea when it comes to access to femtech. They seek medical help only when they are pregnant and need advice to care for the baby. The concept of femtech is foreign to most,” says Dr Sudha Agrawal, Consulting Gynaecologist, Apollo Hospital, Delhi.

Way ahead

India’s one million all-women ASHA volunteers, or Accredited Social Health Activists, were recently honoured by the World Health Organisation for their “crucial role” in providing direct access to healthcare facilities in rural areas and their indefatigable efforts to rein in the coronavirus pandemic in the country. ASHA volunteers are Indian government’s affiliated healthcare workers who are the first point of contact in rural India. By educating ASHA workers on femtech and the need for the same, one can increase the reach of femtech. It can then empower women at the grassroots and will no longer be an elitist tool of access.

Overall the efforts of femtech companies in the country have had a good reception. But it is sadly limited to urban women, generally professionals. Many of my patients who belong to the upper classes have access to femtech and use it to help themselves. – Dr Sudha Agrawal, Consulting Gynaecologist, Apollo Hospital, Delhi

Then there are initiatives led by women’s groups that can be a changemaker. Khud Se Pooche, led by Sakhi, Gaurav Gramin Mahila Vikas Manch, is a women-led collective movement that aims to encourage the women in Patna, Bihar, to give voice to their experiences around dignified healthcare. The project invited women aged 18-30 to apply to be ambassadors for the campaign and lead this movement for change by initiating a conversation around accessing healthcare services.

“Though the reach of femtech is increasing by the day, there is still a lot of scope. In my opinion, decision-making, awareness and agency of women over their own bodies are of utmost need to fuel the growth of the femtech industry,” says Agrawal.