Women’s Health: On The Cusp Of A Revolution?

Considered as a mere subset of healthcare, women’s health has often been overlooked and underserved. Studies inform that modern medicine was developed with male physiology in mind and as a result, women have been underrepresented in clinical trials too. Social and cultural taboos that limit and hinder conversations on sexual and reproductive health have also acted as barriers to women’s health.

However, in the recent past, we have been witnessing a gradual shift, leading to the creation of an ecosystem which is more conducive to women and geared towards their better health outcomes. Novel products with superior routes of administration are being designed and launched specially for the female physiology.

Reenita Das, Partner, Senior VP, Healthcare and Life Sciences, Frost & Sullivan informs, “The market for female health products has received a wave of publicity recently. There is strong momentum in the larger market toward the ‘Sheconomy’ and the impact of women as consumers and commercial entities. Because of this wave of social trends, the focus on women’s health is center stage today.”

Expressing similar views in an earlier article covered in Express Pharma, titled, ‘Is Women’s Health Gaining Momentum, Suchi Ray, Partner, Deloitte says, “In today’s times, pharma companies in the women’s healthcare space are expanding their R&D base and increasing the efforts to expand beyond reproductive health into key women’s health areas.”

The industry seems to agree with these views. Yash Singh, Founder & CEO of Frimline, a company which recently launched a toothpaste specially designed to address oral issues of women, explains, “Addressing the unique healthcare needs of women has been gaining traction. The industry too is more conscious of the trend now.”

Winds of change
There are strong tailwinds spurring progress in this segment. A report from Fortune Business Insights informs that the India women’s health therapeutics market is projected to grow from $2.22 billion in 2022 to $5.98 billion in 2029, at a CAGR of 15.2 per cent in forecast period. While there are several factors contributing to the evolution of this segment, some of key drivers of this transformation are:

◆ Growing health awareness among women: A changing mindset led by education is helping women break taboos surrounding their health and enabling them to seek diagnosis and subsequent treatment for their illnesses at the right time. Women are now learning to prioritise their health and create a demand for healthcare products and services that are better suited for their well-being.

Singh outlines, “There is a growing awareness on health and well-being among the Indian women resulting in a rise in the demand for products that can help address their health issues. Even in the daily lives of women, there is significant opportunity to introduce self-care products that positively impact their well-being. For example, we recently launched Dente91 She, India’s very first toothpaste designed exclusively to address oral issues of women. The correlation between various hormonal changes women go through their lives, and its impact on women’s oral health is not widely known. This prompted the inception of product.”

◆ Advancements in R&D: A report from McKinsey on ‘Unlocking Opportunities in Women’s Healthcare’, states, “A suite of scientific advances can now be harnessed in women’s health. Recent advances in genomics, tissue engineering, and cell and gene therapy are ushering in a new wave of healthcare innovations that can be applied to underserved female-specific conditions. For example, researchers are studying transcriptomics (the study of all RNA molecules in a cell) for treating otherwise elusive conditions such as preeclampsia or preterm birth. Others are now using tissue engineering to create uterine organoids in order to push the knowledge frontier on endometriosis. The potential is vast to redefine a host of conditions, including endometriosis, preeclampsia, and unexplained infertility, and to achieve advances to the degree that researchers are already achieving with oncology and immunology. Investors, researchers, and companies alike have an opportunity to participate in this rising wave of innovation and to deliver a new era in women’s health.”

◆ Rise in FemTech: FemTech, a word to describe tech-enabled solutions addressing women’s health, has a gained a lot of prominence in the recent times. A report from McKinsey called, ‘The dawn of FemTech revolution, reveals, “FemTech’s current market size range from $500 million to $1 billion. Forecasts suggest opportunities for double-digit revenue growth. On the digital health front, FemTech companies currently receive three per cent of all digital health funding. In our scan of hundreds of FemTech companies, we found concentration in maternal health patient support, consumer menstrual products, gynecological devices, and solutions in fertility. Funding reached $2.5 billion by early December 2021.”

Express Pharma’s article on ‘Is Women’s Health Gaining Momentum’, also quotes Arvind Sharma, Partner, Shardul Amarchand Mangaldas and Co, who says, “With 50 per cent of the population as target customers, and with the women’s healthcare market expected to reach $50 billion by 2025, FemTech is the key focus area in the women’s health market, and this is the right time for pharma companies to increase presence in this sector. In this tech-dominated scenario, connected devices and mobile applications will provide key and timely solutions to women. New business models such as telemedicine and remote monitoring platforms will emerge and are expected to play a key role in the women’s health segment. There is a lot of potential in the women’s healthcare segment in India, and this will attract top global investors.”

Das from Frost & Sullivan enlightens, “Trends toward using digital technologies for monitoring, prevention and personalisation through apps or digital devices are becoming commonplace. Patients are getting empowered about their health and starting to use online forums and chats to get information. There is the emergence of a new woman who is highly influenced by social media. In fact, 80 per cent of all decisions that women make today are driven by social influencers.” FemTech is definitely bringing about a revolution in women’s health.

Rapid growth
Existing and emerging companies have begun expanding their offerings to cover a wide range of women’s health issues like menstruation, skin and hair care, PCOS, mental health, sexual health, reproductive issues, fertility and pregnancy.

Let’s take a look at some of the subsets where we are seeing phenomenal growth:

◆ Feminine hygiene and menstrual health: A report by Mordor Intelligence predicts that India’s feminine hygiene market witness a CAGR of 14.7 per cent over the next five years. As per market analyses, rising awareness about intimate hygiene and innovations in menstrual products like sanitary pads, tampons and panty liners, are contributing towards the growth of feminine hygiene market in India. Government initiatives to promote menstrual awareness among women and adolescent girls have also helped.

As a result, a lot of newer entrants in this segment such as Avni, Milder Cares, Nua, Padcare, The Woman’s Company etc. Leading brands are also entering and expanding their offerings in this space. For instance, Cipla unveiled ‘Evexpert’, its range of feminine hygiene products in March last year, while FMCG major Dabur forayed into this space with its new brand ‘Fem’ inZ December 2022. Piramal Pharma also forayed into the feminine intimate care category in 2021. Existing products like J&J’s Stayfree and P&G’s Whisper have also introduced product variations and innovations to deal with growing competition.

Sujata Pawar, Co-founder & CEO at Avni, a feminine hygiene and menstrual healthcare startup, shares more details about the growth drivers in this space. She points out, “Over the last decade, the feminine hygiene market has experienced consistent growth. The key growth drivers are increasing female literacy, rising disposable income among women, growing awareness of intimate health issues, and better access to menstrual products. The acceptance and prominence of new-age sanitary products have also contributed to the elimination of many menstrual taboos.”

“The availability of safe and affordable menstrual and reproductive products reduces their risk of infection. This has the potential to have a cascading effect on overall sexual and reproductive health, such as lowering teen pregnancy as well as aiding in maternal decisions, and reproductive success,” she adds.

“The market for feminine hygiene is now characterised by continuous expansion. Menstrual cups, sanitary pads, toilet hygiene, tampons, and other feminine products are the most often used products that fall under the disposable category. A highly dynamic market has resulted from customers’ recent shift in behaviour towards environmentally friendly options. The market for feminine hygiene is characterised by a variety of novel goods, including tampons and menstruation cups made of organic or biodegradable materials,” reiterates Sandeep Vyas, Founder of Mild Cares and GynoCup.

◆ Female contraceptives: As Indian women get empowered to own certain choices about their health and body, there is a growing demand for safe, sustainable contraceptive tools as well. So, we are seeing the emergence of several options in this space such as female condoms, intrauterine contraceptive devices (IUDs), wider range of birth control pills, injectable contraceptives, hormone-releasing contraceptive devices like implants and vaginal rings, patches that can prevent pregnancies etc. Some of the players in this space include Bayer, Pfizer, Merck & Co, CooperSurgical, Reckitt Benckiser, AbbVie, Johnson & Johnson, Lupin Pharmaceuticals, Viatris (Mylan Laboratories), Church & Dwight, The Female Health Company, Mayer Laboratories, Durex, Mankind etc.

A study published in The Lancet on worldwide contraceptive use last year reveals, that women of reproductive age (15-49) in India who need to prevent pregnancies but have no access to contraceptives have come down by over 13 percentage points between 1970 and 2019. The study also informs that over 160 million adolescents (15-19 years) and women (20-49 years) “remain with unmet need for contraception worldwide”, however ‘demand satisfied’ category has increased from 55 percent in 1970 to 79 per cent in 2019.

◆ Infertility treatments:
The demand for fertility treatments and services is growing in India.

Das reiterates, “Infertility is becoming a big issue globally, including in emerging markets, where the rates are increasing drastically. Because of this, access to infertility treatments and monitoring is going to become very important, with lots of focus on wellness, diet and nutrition.”

According to a report published by Allied Market Research on India’s in vitro fertilisation market, “Women comprise the largest market share of nearly two-thirds of the total market revenue in 2020, and are expected to exhibit prominent growth during the forecast period, 2021-2030.”

Growing incidence of male and female infertility, late pregnancies, technological advancements in ART procedures, increasing rates of success in IVF, and rise in disposable income in India etc are contributing to advancements and growth of this market. While reports inform that while the paradigm of fertility drugs haven’t witnessed drastic change, the market today definitely has better versions of the original fertility drugs. Moreover, rising number of fertility clinics and opportunities in emerging markets are expected to help market expansion in future.

Women’s nutrition
The women’s nutrition market in India is also seeing a boom. Alongwith major players such as Abbott, GNC Holdings, Amway India, Bayer, Danone, Unilever, Nestlé, GSK, etc., this field also has seen a lot of new entrants such as Kapiva, Sudeep Nutrition, Chicnutrix, Oorah Nua and others offer products that serve women’s needs ranging from PCOS to pregnancy, menopause and motherhood. Swelling demand for healthy lifestyle choices and growing vitamin deficiencies in women are also driving robust growth in the women nutrition market.

In Express Pharma’s earlier article titled, ‘Evolving landscape of Women’s Nutrition’, Shanil Bhayani, ED, Sudeep Nutrition informs, “Women are growing aware of the importance of consuming essential nutrients in the right quantity. As it stands, many women have incorporated nutraceuticals in their daily lives to treat menstrual disorders as it has anti-inflammatory and smooth muscle relaxing properties. We are witnessing a growing trend for cranberry and bearberry-based nutraceuticals that are preferred by young adults to treat urinary tract infections, a common bacterial infection in women. We have seen many women who have turned to nutraceuticals to stimulate milk production in pregnancy. A lot of women are opting for nutraceuticals such as melatonin, vitamin E, chasteberry, flaxseed, etc. to manage life-altering symptoms of menopause.”

Also quoted in the article is Ameve Sharma, Co-founder, Kapiva, who states, “To say that the women’s nutrition market is ever-evolving would be an understatement. Every year, we see a new selection of ingredients and trends rise to prominence in this industry. With each passing day, women are becoming more and more conscious towards their lifestyle choices.”

White spaces in women’s health
Though women’s health segment is clearly poised to grow and evolve, challenges continue to exist. But, the challenges faced by the women’s health as a segment can also present opportunities to create value and serve women’s healthcare needs through innovative solutions.

Frost and Sullivan recently forecasted the growth opportunities in this field. (See the top 10 in Figure 1) The McKinsey report on ‘Unlocking Opportunities in Women’s Healthcare’, also highlights, “The current global innovation pipeline reveals mismatches between health investments and health needs. The gap highlights some remarkable opportunities for improving women’s health within female-specific conditions (See Figure 2)” So, industry stakeholders outline some measures to optimise the growth potential in this segment.

◆ Ramping up awareness and education: Recommending awareness and education as the tools to deal with the issues and challenges women face today, Das says, “Many women suffer for almost two decades from menopause, and they are not even aware of or prepared for these debilitating symptoms. It is important to provide systematic education. Second, governments and the private sector need to provide tools that women can access easily. Regular screening is also important, along with monitoring. Infertility insurance needs to be updated, and employers need to include it in plans so that employees can access infertility treatments easily.”

◆ Increase in clinical research on women-centric diseases: “Traditionally, women’s health has been viewed as being synonymous with gynaecology and motherhood. However, the healthcare needs of women go much beyond. For example, heart diseases, joint health, oral health etc. have very different implications for women as compared to men. An increase in clinical research on women-centric diseases and introduction of appropriate treatment options and products that fill the whitespaces will help drive growth in this segment. It also requires replacing the gender-agnostic approach with a gender-specific lens,” says Singh.

He adds, “Women are most affected by non-communicable diseases (NCDs) such as heart diseases and cancer besides gynaecological and fertility-related issues. Anemia is also a major concern for women across all age groups while osteoporosis and osteoarthritis are more prevalent among older women. While there are numerous products available in the market, there is still an immense scope to introduce more products to address these issues.”

◆ Investments and policies to promote women’s health: There is a clear uptake in investments in women’s health and many start-ups have sprung to cater to this segment. Many leading pharma companies have also expanded their offerings in this segment.

To cite a few examples:
◆ Bharat Serums and Vaccines (BSV) acquired Tidilan (Isoxsuprine hydrochloride), a brand in women’s health, from Jagdale Industries in 2022

◆ Dr Reddy’s and Mayne Pharma have signed an agreement in February 2023 to buy the latter’s generic products portfolio which includes about 45 commercial products, including a number of generic products focused on women’s health.

However, despite a few measures in the right direction, we need a lot more investment both at the public and private stakeholder level. There are significant white
spaces that need to be filled to expand access and availability of women’s health. Adequate ‘gender budgeting’ is also an imperative to enable sustainable progress in women’s health.

As a report from Emcure released in 2021 finds, “There is a need for women, organisations and the society at large, to become proactive when it comes to managing their health and nor maliase conversations around critical aspect of women’s health. For every being, physical, mental and sexual health is inter-related. Greater investment is required in women’s health including more research to unlock new insights that could lead to new and innovative solutions for women.”

Protecting the future
Since the link between women’s health and economic growth of communities and countries is undeniable, it is time to prioritise women’s health and wellness through
investment, and research.

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