Women’s health has been neglected, poorly studied and underfunded for far too long now. It is now well established that historically, women were excluded from most medical studies. They were conducted on men, and the data collected from them were generalized to women. In fact, many studies conducted on rodents too, excluded female rodents, as they thought it could “hamper research because of the need for increased sample sizes, and increased costs.”

This only started changing in the 1990s. But even then, research which included women were many a times limited to “diseases affecting fertility and reproduction.”

” For these reasons, the prevention, diagnosis, and treatment of chronic diseases in women continue to be based primarily on historical findings in men, and sex-specific clinical guidelines are often lacking. Many illnesses, ranging from cardiovascular disease to cancer to mental health issues, for example, differ by sex in terms of prevalence and adverse effects,” according to this article from just earlier this year, highlighting how it is still a persistent problem.

Even ailments that are more prevalent among women, receive much less funding, compared to the case burden. A study conducted in the US found that “migraine, headaches, endometriosis and anxiety disorders, for example, which disproportionately affect women, all attract much less funding in proportion to the burden they exert on the US population than do other conditions.” It went on to add that “HIV/AIDS and substance misuse, which disproportionately affect men, get more funding than their corresponding burden might suggest.”

Today, in India, some companies are trying to change that. By investing in and creating solutions that address issues faced by women, these organisations are trying to bridge a gap that has been created by years of neglect and apathy.

From ACT Grants that is investing in multiple tech led health solutions, including many that cater to women’s health, to Periwinkle Technologies that is redefining cervical examinations, and from Niramai that is changing the way we think about otherwise invasive breast exams to Wysa that is prioritizing emotional well-being for all women, everywhere, First Check spoke to some of the pioneers in this space this International Day of Action for Women’s Health, to understand why they chose to work on these issues, how their solutions could help millions of women, and the future of healthcare for women.

‘Investment in women’s health increases everything from national prosperity to GDP’

Krisha Mathur, Director, ACT for Health

“According to a study by The Lancet, India ranks 145 among 195 countries in terms of quality and accessibility of healthcare – patients are either never diagnosed or diagnosed too late.”

This is one of the first lines on the website of ACT for Health, the health vertical under the larger ACT Grants, a tech first venture philanthropy platform.

“We want to make sure that tech reaches the last mile—tech reaches those who really need it and at the right time, place and cost. And venture philanthropy really tells you… we want to bring in the rigor and the expertise that our founders and anchors, who are mostly from the VC and startup community, bring, but do it with the heart at the right place,” explained Krisha Mathur, Director, ACT for Health.

“We believe grants have a huge role to unpack and derisk innovation that comes in,” she added.

The platform has funded a wide array of tech driven health solutions from Adagio VR which is a “digital health startup with a preventive well-being and behavioural change solution that leverages Virtual Reality (VR) to create impact” to Evolve, a “digital health startup, focused on improving mental health outcomes for LGBTQIA+ communities, that will accelerate the vernacular version of its solution to support larger underserved communities.”

These also include multiple startups and companies that address women’s health and women’s access to healthcare as well. For instance, Dvara, a “service innovation that enables the transition from the fee-for-service model to a fee-for-value model, facilitated by community health workers and the use of technology,” can be of particular benefit for women. These micro finance packages can “help improve their agency to receive health care products better,” according to Mathur.

Mathur underlined how women’s health was important for everyone, but was also an “underrated and under solved tech area,” pushing them to fund these specific health solutions.

“If the women of the house does well, there’s a lot of research to show that everyone in the house does well. There are studies to show that investment in women’s health increases everything from national prosperity to GDP,” she said, while adding that whether it is screening tools or diagnostic tools, women many a times don’t have access to the tools that are specifically made for them.

“There is really interesting innovation out there (that address women’s health). The fact that it is going to reach 50% of our population is just the icing on the cake,” she explained with a smile.

However, Mathur acknowledges that gaps still exist when it comes to women’s health, as women and their well-being are under-represented in health conversations and innovations.

“Being a woman myself and now the mother of a young daughter, I do not wear rosy glasses. Yes, women are under-represented. I must call that out. Even now there isn’t enough data to even design protocols for solutions for women. Solutions for women are often made using either global data, or data for men. That is a scientific fact. We don’t have enough products out there made for women, by women, really understanding the women and their unique needs and the unique challenges that we face, and we are 50% of the population. We are half the world!,” she said.

However, she also sees things changing, with tech philanthropy capital, innovators and even government coming together to encourage startups and innovations that address the gaps.

“I do feel that the future is bright. and I think the thing we must do is really think about where technology can have that multiplier effect and what can we do to enable that technology… For us the future lies in how many such voices we can bring into the room to support these innovations to do well,” she said.

‘Women need to prioritize their health as much as their family members’ health’

Geetha Manjunath, CEO, NIRAMAI

For Geetha Manjunath, an engineer by training, life took a turn when two close relatives were diagnosed with breast cancer at very young ages of 38 and 42. While still working at a large corporate, heading their AI research, she started her research into the disease which is the most common cancer among Indian women.

However, that project needed to be shelved after about a year, as it did not align with her then company’s strategic direction.

She then quit her job, and that started her journey with NIRAMAI, which has “developed a new method of detecting breast cancer which is accessible, privacy conscious as well as portable and it works for women of all age groups.” It uses AI over thermal scans to enable a universal cancer screening method which “can be used in any part of the world with the same accuracy or better accuracy than existing methods,” she explained.

“I’m so glad that I got this opportunity to sort of work on this problem if you will because it’s helping so many women. Every few days I get a call saying I mean I wouldn’t have detected if it were not the NIRAMAI test. So it’s extremely fulfilling,” she said, while adding that close to 3 lakh women have benefited from the tests.

Breast cancer has the highest incidence among all female cancers and accounts for 28.2% of all female cancers, with an estimated 216,108 cases in 2022. In fact, Manjunath said that is was the top cancer killer not only in India, but in 152 countries in the world, when you look at female cancers. “For the rest it is second,” she added.

“In fact, the world average in some senses, one in 12 women are likely to have breast cancer in their lifetime. This number is one in seven for US. It’s just that other places we are not screening and detecting enough. Many people don’t even know they’re dying of breast cancer in some of the countries,” she said, while adding that what makes this statistic even more devastating is that “every alternate lady detected with breast cancer is dying within two to five years.”

The reason, according to Manjunath, is clear—it is late detection. “Women wait till there is a big lump before they even go to a hospital, show it to somebody or do a mammogram or any of these tests also,” she said.

Manjunath explained that for many, the preventive screening mammograms can prove to be too expensive and unaffordable and there is also limited access to these tests. The lack of privacy during a breast exam, and the experience of getting a mammogram done can also be a deterrent for some. And even if you overcome these challenges, Manjunath said that mammograms may not always work for younger women, and people from Asia, including India, as the test has low accuracy for women with dense breast tissues.

NIRAMAI addresses all these challenges according to her, as it is cheaper, accessible because of portability and low cost, and works for women of all ages and all breast densities. It also affords the patient a lot more privacy as no one sees or touches the patients during the test.

“It’s like a changing room. They may enter into a room, close all doors and curtains. No one, not even a technician is inside. They just sit in front of a device which is placed 3 ft from the person and five minutes of cool air is blown and then she just rotates on the rotating stool for 2 minutes. That’s about it. She comes out, and her report will be ready for review by the doctor,” Manjunath explained. The solution has been revolutionising and even made it to the World Economic Forums list of Technology Pioneers in 2024.

On the International Day of Action for Women’s Health, Manjunath urges women to prioritise their health and get regular breast exams to keep themselves healthy.

“Prioritise your health as much as your family members’ health… It’s important because you are the centre of the family,” she said.

“Second, I would like to mention breast health; please go for a screening test be it, Thermalytix which is available in 300-400 locations in India and 22 countries, or of course a nearby mammogram or an ultrasound based on your age. Take this test at least once a year and once a month please do a self breast examination. Observe the changes in your breast yourself with hand. You can just Google and figure out how to do this. But monthly self breast examination and annual screening test is mandatory for every lady above 18 years. So please take care of your breast health for the best health,” she said.

‘Cervical cancer can be avoidable with screening and early detection’

Veena Moktali, CEO, Periwinkle Technologies

When Veena Moktali and Koustubh Naik, both from engineering and technology backgrounds, moved back to India after spending almost a decade in the West, they realised that healthcare was vastly different in India. Initially they worked on a solution that would help ailing seniors, like their own parents, access healthcare even if they are in the rural parts of the country.

“People like our parents who in those days were in their late 60s or early 70s had to travel to city areas to meet their experts for issues such as diabetes or hypertension or whatever it is that they were diagnosed with. So this was becoming very cumbersome because traveling to the city area itself, they have to carve out a time for that, and then there will be a wait time when they go to the expert. And this would be a repeated procedure especially for people with chronic ailments,” she said.

“So we were thinking that using technologies such as mobile phones which were becoming very popular in the 2012-13 era we could develop a solution where clinicians could look after their patients by exchanging clinical data and that’s how we developed our software platform first, which is called the Net4Medix,” Moktali added.

However, they soon pivoted after they spoke to healthcare experts and realised in India, cervical cancer was a largely unaddressed problem in the country, that could be avoided altogether.

“We, in fact, met a few patients. We saw how they had to travel from rural areas to the Tata Memorial Centre. They used to sleep on the foot paths. I mean this happens to all cancer patients, of course; but women especially undergo a huge amount of trauma once they are diagnosed with cancer,” she said.

“Because not only do they have to suffer the pain of the disease and the subsequent treatment and everything, but they are also subjected to a lot of financial loss because sometimes the family doesn’t support them. Sometimes they also face abandonment issues… We thought this is completely avoidable. If it’s just a simple thing as an early detection test we could do something about it and that’s when we decided to completely focus on this,” Moktali elaborated.

Periwinkle Technologies and the Smart Scope were soon born— a handheld device which is usable in low resource settings such as rural areas and remote areas, that helps in screening for cervical cancer within minutes. The company has since won many awards, including the Zayed Sustainability Prize earlier this year.

“Cervical cancer kills almost 350,000 women every year across the globe. And that’s almost one woman dying every 1.7 minutes which is really disheartening because this is a very preventable disease if it is detected in the early stages,” explained Moktali, who added that it is primarily caused by the human papilloma virus or HPV, which if detected early, can be treated at a low cost.

“But unfortunately because the symptoms are developed over a period of almost five to seven years women don’t understand in the early days that they may be having symptoms because of HPV. And that’s why generally women come to the healthcare providers only in the very late stages when the cancer has metastasized and therefore the death rate is very very high for this particular cancer,” according to Moktali.

India bears the major burden of cervical cancer; official data shows that about 1 in every 5 women globally suffering from cervical cancer is from India, and we also account for about 25% of global cervical cancer deaths. Late diagnosis has been flagged as a major reason behind these numbers, underlining the need for better preventive screening strategies.

Moktali explained that their compact and portable device “is a very easy to use device which is enabled by AI to perform the image analysis and provide a result with 92% accuracy in just 30 seconds.” The probe leverages AI to identify precancerous lesions, so that early detection can help prevent disease incidence and mortalities.

“Periwinkle is a company which is dedicated to making cervical cancer screening accessible to women from all walks of life,” she said.

Mental health integral to women’s health

Ramakant Vempati, Founder, Wysa

Ramakant Vempati, and his partner and co-founder Jo Aggarwal, decided to come up with solutions for mental health issues, after people close to them struggled with mental health conditions like depression and suicide. Vempati shares that his own father was in fact diagnosed with bipolar disorder.

“After doing a variety of things across the world we came back to India and we had the intent of starting something up and had these experiences that’s when we realized that once you see mental health you can’t unsee it, And also, we realized that with all the will in the world, with all the access, and with all the intent in the world, it’s extremely hard for people to reach out and take help. For example, if you have depression and it’s hard to get out of bed, how will you get into a car and go and drive to a therapist? It’s really hard,” explained Vempati.

This realization is what led them to co-founding Wysa, an AI powered conversational platform where you’re delivering mental health interventions through an AI chatbot. While it started in 2017, as “an experiment,” as Vempati calls it, he realised its true potential only about 5 months later.

“We got this email from a 13-year-old girl from the US who wrote in and said I have depression and I tried to commit suicide and you’re the only thing which is helping me hold on, so thank you. When that happened I think that was the moment when the penny dropped and that was the moment when I suddenly started really believing, saying ‘my god! this is actually real and this can have an impact to that extent and be there as that safe space for people to come in and have conversations where there’s nothing else’,” he recollected.

Wysa has grown from strength to strength since then, having helped 7 million users across about a 100 countries, enabled about 750 million conversations on the platform. Having partnered with the National Health Service in the UK, the government of Singapore, UNICEF, and others, it is expected to reach even more people in the near future.

Vempati also understands that mental health is an integral part of women’s health. Women are more likely to experience depression, PTSD, and anxiety, according to research. “One data point which struck me especially given the work we’re doing with younger adults is anxiety amongst teenage girls. So the incidence of anxiety is nearly twice as high as boys and I’m sure there are lots of physiological, psychological reasons as well,” he said, while adding that this was the reason why they are looking at specific solutions to help this demographic.

This year’s theme for the International Day of Action for Women’s Health is ‘Sexual and Reproductive Health and Rights,’ and this also an area that Wysa is looking into now.

“We’re also doing some work for sexual and reproductive health for adolescent girls as well, especially in Hindi and in non-English languages. Because you will have girls who are now very active on social media, who are in relationships, who may or may not be sexually active… but they have absolutely zero your knowledge and support, because they’re not allowed to talk about it. So how do you then bridge that gap? So we think something like Wysa can help even there,” he said.

Also read: Beyond Valentines: The health costs of intimate partner violence

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