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  • Hannane Ferdjani — Côte d'Ivoire

Can femtech erase gender bias in medical care?

Technology-based products are helping more women access healthcare in sub-Saharan Africa. Along the way, they also shine a light on the systemic challenges women face in seeking and receiving medical care.

“It was a horrible pregnancy from the very beginning. I was constantly in pain. The drugs I was prescribed weren’t making any difference. I had no choice but to stop working. I was alone, pregnant, jobless, and depressed,” says Michelle Gonto.

Gonto’s road to becoming one of Côte d'Ivoire’s most famous midwives began with her own agonising nine months. Seven months in, on a June 2013 night, she was admitted to the emergency room.

“I was in excruciating pain and tired of not understanding what was going on with me. I wanted it to end. I even asked if they could terminate the pregnancy,” Gonto recounts.

A few moments after she arrived at the hospital, a midwife came to her and held her hand. The older woman immediately started explaining Gonto’s symptoms, as well as listened to her concerns.

“She told me the pain had to do with the many fibroids in my uterus. Hearing this explanation didn’t stop the pain, but it felt like a weight was finally lifted,” Gonto says.

The founder of La Case Maternelle, an educational social media platform for pregnant women in Côte d'Ivoire, found her calling after her encounter with the midwife she refers to as her “guardian angel”.

Understanding medical conditions and their impact on the different stages of life is as crucial as it is challenging, especially for women. For years now, studies have shown the stark gender discrepancies within healthcare globally.

In 2016, the World Health Organization (WHO) found that although women in the European Union live longer than men, they spend more of their lives in poor health. Despite significant progress in other spheres, the gender health gap remains unaddressed across the world.

In recent years, however, there has been growing interest in ‘femtech’—namely tech-enabled women’s health solutions and products. From tracking menstrual cycles and pregnancy to providing personalised contraception, femtech addresses a range of health needs for women.

While femtech companies have mostly tapped markets in Europe and North America, the products have potential to change lives elsewhere, too, including low- and middle-income countries (LMICs).

Tackling information shortage and the taboo epidemic

Entrepreneurs like Michelle Ijomah, co-founder at Agnes Health in Nigeria, have stepped up to meet this need.

The tech start-up [Agnes Health] says it has lowered the risk of maternal death by four times and reduced newborn deaths by a whopping 22 times.

“As co-founders, we realised we hadn’t met and didn’t know women who felt they were heard during their pregnancy. What that does over time is build timidity. Women don’t feel comfortable asking questions or seeking advice from healthcare providers,” Ijomah says.

Agnes Health wants to change that. The platform provides 24/7 teleconsultation with board-certified midwives and programmatically delivers health education in Nigerian local languages during pregnancy.

Ijomah and her partners are confident that empowering women to seek information and providing reliable counselling in a consistent manner can reduce maternal and infant mortality. The tech start-up says it has lowered the risk of maternal death by four times and reduced newborn deaths by a whopping 22 times.

This is striking in a region that still suffers from staggering maternal and infant mortality rates. It is estimated that in sub-Saharan Africa, 390 women will die in childbirth for every 100,000 live births by 2030, according to the World Health Organization’s Atlas of African Health Statistics 2022 report. This is much higher than the average of 13 deaths per 100,000 live births witnessed in Europe in 2017.

Literacy about women’s reproductive health is scarce, which means that many women of different ages go through painful experiences with little to no understanding of their condition.

It is a challenge that spans African regions, as the Rwandese founder of Umubyeyi Elevate, Marie Chantal Umunyana, discovered.

“I conducted a local survey to assess the need for improving education on female reproductive health. It turns out that 92% of people get information from their friends and the internet. We all know there’s a lot of misleading information out there,” Umunyana says.

Her own experience with motherhood also led this medical doctor and mother of one to create Umubyeyi Elevate.

“Even though I was a medical student, I realised that I didn’t have all the information I needed to guide me through a smart and empowered journey. I was always scared. I didn’t know if what I was doing was wrong or right. It became evident that there was a need to link science with reality, to create a bridge between what science says a woman should do and what it actually is like to go through a pregnancy,” she says.

Umunyana prioritises fostering a safe environment for women who join the Umubyeyi community, whether online or offline. Through sessions with healthcare professionals and regular roundtables, participants are encouraged to speak up, ask questions about their health, and inquire.

“It’s a step in the right direction and a good place to start,” says Dr Deddeh Supuwood about the availability of femtech solutions that address taboos. The first female oncologist in Liberia, who trained in Egypt before returning home, she has concluded that an educational shift is needed.

“The fact that women feel they cannot speak freely about their health issues has real-life consequences: it translates into them not being treated early for their conditions,” Supuwood says.

“They also tend to think that whatever symptom they have is natural; whether it’s a lump in their breast or an abnormal discharge. They resort to natural medicine because of a lack of education. Culture plays a role in that, but it’s more a lack of education.”

Umubyeyi Elevate founder Marie Chantal Umunyana fosters a safe online and offline environment for women to access healthcare professionals in Rwanda. Photo: Marie Chantal Umunyana

Solutions designed to meet local realities

Femtech as a means to bring meaningful changes in the lives of women in LMICs is still in its infancy. Crucially, most start-ups that have ventured into this sector in Africa have understood the need for localised solutions.

Creating femtech products that cater to both online and offline communities is indeed essential to scaling impact in sub-Saharan Africa.

In Côte d'Ivoire, La Case Maternelle has become a leading social media platform on maternal health, reaching over 177,000 followers on Facebook.

“When I started out, it was obvious that Facebook was the social network where most of my target group was active. It has been a powerful tool for growth. A few years ago, we started using this social media leverage to do more grassroots work and reach offline communities,” Gonto says.

“In my village, for instance, there is no network. So, we go to women’s centres and schools, and we raise awareness and distribute medical supplies wherever health centres are scarce.”

Creating femtech products that cater to both online and offline communities is indeed essential to scaling impact in sub-Saharan Africa. In practice, this means providing a solution that offers the same advantages to women of different social and economic backgrounds.

“When we designed our offline solution, we thought of something that could not be seen on an app but needed to be felt. We’ve been able to provide stage-specific information to pregnant women in different local languages like Yoruba, Igbo, and Hausa. All they need to have is a phone that can receive and make calls to access our services,” says Agnes Health’s Ijomah.

"Technology is really important. But there are building blocks we need to achieve before we make good use of the technology. We need better trained healthcare professionals."

Tackling policy and investment barriers

Femtech entrepreneurs agree that building with users in mind is the best way to effect change where it is most needed. But they all point to the systemic challenges at play in the healthcare ecosystem they operate in.

One key issue is the low professional-to-population ratio in sub-Saharan Africa. If all workers are factored in, excluding health administrators and support staff, the average density of health workers in Africa is 29 per 10,000 inhabitants in 2018, as against the United Nations Sustainable Development Goals (SDGs) target of 134 by 2030. According to the WHO recommendations, there should be 44.5 doctors, nurses, and midwives per 10,000 inhabitants.

“At my hospital, we see 30 to 40 women a day with an average of 15 to 25 minutes per consultation. This does not allow the midwives to be the counsellor that they need to be to their patients. There’s only so much I can do with La Case Maternelle. We need more trained healthcare professionals to achieve more progress,” Gonto says.

Other experts highlight a shortage of trained and certified human resources on the ground. “I’ve been in situations in Ghana where I’ve seen trainees who were part of a programme doing scans on women they hadn’t even spoken to,” says UK-trained gynaecologist and antenatal specialist Dr Theodora Pepera.

Having provided insights on cancers that affect women’s reproductive organs, along with ultrasound training, to healthcare professionals in Ghana, Malawi, and Rwanda, Pepera believes that femtech can bridge some of the existing healthcare gaps.

But she also posits that there are limitations to what it can do.Technology is really important. But there are building blocks we need to achieve before we make good use of the technology. We need better trained healthcare professionals with the right attitude towards patients in general and women in particular as they tend to be more vulnerable,” she says.

This is where proactive policymaking can make a substantial difference to health outcomes. “It would be great if we had more policies that pushed people towards health-seeking activities. If the government also participates in creating awareness, it makes the job easier,” says Ijomah, who has been persuading femtech start-ups to seek partnerships with governments to be able to scale up and become more sustainable.

Though more and more African entrepreneurs have taken the lead in introducing femtech to lower-resource areas, governments and investors alike must engage more to close the gender gap. Fundraising for femtech in Africa still has a long way to go as entrepreneurs struggle to compete with the fintech boom—technology that is disrupting traditional financial services. McKinsey analysis estimates that Africa’s financial services market could grow at about 10% per annum, reaching about US$230 billion in revenues by 2025.

In comparison, the global femtech market was valued at US$51 billion in 2021 and is projected to be worth US$103 billion by 2030. North America is the largest market and Asia Pacific the fastest growing region, with the Middle East and Africa (MEA) the smallest market by geography. Yet even in the US, just 2% of venture capital funding goes to women-led start-ups.

“I’m not sure if the issue is that investors don’t trust women to build big and sustainable things. But I believe a lot of women entrepreneurs are proving that they’re capable of effecting real change in the healthcare space. We’re going to raise funds eventually but, in the meantime, we do the work and take it one day at a time,” Umunyana concludes.


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