Women’s health startups are still trying to crack Silicon Valley’s glass ceiling

Just 3% of digital health venture capital investments in the United States between 2011 and mid-2020 focused on women’s health, according to the venture fund Rock Health.

Last year, PitchBook reports, women’s health startups raised more than $1 billion, which may seem like a lot, but in Silicon Valley terms, it’s not.

Marketplace’s Lily Jamali spoke with Brittany Hawkins, co-founder and CEO of Elanza Wellness, who has been navigating these waters. Her platform focuses on women trying to manage the often painful and sometimes debilitating symptoms of endometriosis, which affects 1 in 10 women. It’s a condition in which tissue similar to the lining of the uterus grows outside the uterus.

Hawkins said Elanza aids women with endometriosis, in part, “by making specialist care more accessible virtually. And we use data and insights to recommend more tailored and personalized treatment plans.”

The following is an edited transcript of their conversation.

Brittany Hawkins: Endometriosis patients have often experienced a long road of what I would describe as medical gaslighting. Their pain has not been acknowledged, they haven’t been supported throughout their journey, and therefore, they’re just really frustrated. You go in and a doctor usually has only 15 minutes to provide care for someone, and that’s really not enough time to deliver what is needed. So, these patients are moved into the chronic pain category. It’s not something that’s easy to prescribe in a 15-minute conversation.

Lily Jamali: Why do you think it’s hard for people to talk about women’s health?

Hawkins: I feel like we need to unravel years and years of societal conditioning to answer that, but I think it’s just uncomfortable. And I think it’s even more so since things have shifted in the reproductive health space. One of the pain modulators for endometriosis is contraceptive hormones that you can use to kind of help moderate your menstrual cycle so that it doesn’t perpetuate your endometriosis. This alone is becoming a contentious conversation. The second it hits the reproductive tract, it becomes politicized, it becomes personal, some people might find it gross. You have to really read the room and realize that actually, no one wants to hear your story. They want to know that it’s a problem that people are willing to pay enough money to solve.

Jamali: Part of your task as you’re seeking funding is to show the potential size of the market that you’re trying to reach. Why is that so much harder when there’s been so little funding in the past?

Hawkins: I think one thing begets the other. If you look at research around this, specifically for endometriosis, in 2019, the National Institutes of Health invested $1.70 into every patient with endometriosis and $30 per patient with diabetes. These are both chronic conditions that are not necessarily fatal, but the amount of funding is just abysmal in conditions like endometriosis. So, it starts there. Then, if there’s not enough research, it’s more challenging to understand the market and the market opportunities and you see the lack of funding in the overall market, which means that the market size looks small. Then you have the fact that half of the population is women, and 1 out of 10 of those women is dealing with endometriosis. So, you kind of have to look at the disparity between the funding and the population. It’s hard to show the market size if the spending already is not even close to what the need or the actual size of the population is.

Jamali: How have things changed on the funding front since you got started?

Hawkins: This is my third company, so I definitely feel like things have gotten better, but I think it’s a matter of starting from absolutely nothing and getting to something. But I think what you’re also seeing right now in the market is there’s a lot of factors that are making people not want to jump at new opportunities. Something I’ve heard in the market — and this is not necessarily my perspective — is that female investors tend to be more reticent to invest in times of uncertainty, which tends to mean that the companies they would otherwise invest in are the most impacted. Women’s health is seen already as a higher-risk industry. So, you’re seeing some potential reticence to invest in companies that are outside of the typical, heavy-hitting big names.

Jamali: Is Silicon Valley getting better at funding women and women’s health startups in particular? What are your thoughts there?

Hawkins: We need to see a really concerted effort on the more systemic scale to showcase that this is not risky. It’s just that a lot of investors don’t understand endometriosis and women’s health. It’s complex. Like many areas of women’s health, it’s just not a straightforward thing. So, it requires them to do more thinking, more due diligence. It’s a harder thing to invest in. I don’t see that going away overnight, but I do see this larger momentum. I think a lot of this has to do with the fact that women are becoming a lot more vocal and they’re becoming a lot clearer about what their needs are and hopefully losing some of those social stigmas that have really held this back. I think a lot of this has just been normalized for so long. Realizing that your pain isn’t normal and advocating for yourself in that process will do a lot to articulate the needs of women as we progress into the different phases of funding. We’re definitely on the, on the slow track, but I definitely have hope.

More on this

The chronic underfunding of women’s health startups is especially stunning given that women make more than 80% of health care buying decisions. Investor and former journalist Chrissy Farr points this out in her blog post, “Why we’re betting big on women’s health.” (It’s subtitled “Half the population is no niche.”)

Farr also describes how, despite women generally living longer than men, they suffer higher rates of illness and disability and often see their pain and conditions ignored or dismissed.

Rock Health says women’s health is a “white space.” That’s venture-speak for unmet needs or market opportunities. Those opportunities include combating the maternal mortality crisis for Black women and providing inclusive care for the queer and transgender communities.

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