"Women's Health, Inc"

The fertility industry is changing, in part due to private equity. I highlight some key observations made in a recent paper.

More than once I have been scolded by a doctor for using the word "industry" to describe the collection of services that make money out of infertility. There's nothing inherently wrong with an industry, of course. No one blinks when I write about "the steel industry" or "the tourism industry" or even "the beauty industry." But for whatever reason, medicine feels different — and "the fertility industry" feels threatening — even to those who profit excessively from its provision.

There is most certainly an industry here. More importantly, though, that industry has been changing quite dramatically in recent years, in part due to private equity.

This is an area I have not yet dug into, even though I'm extremely interested and several readers have been urging me on. I promise I will.

But for now, I want to share some key points raised in an article recently published in The Lancet by Joseph Dov Bruch, at the University of Chicago, and Sarah Richardson, at Harvard. Their article was called "Women's Health, Inc."

All the words below are theirs. All I am doing is pulling a few lines out and allowing them to stand alone, so that you can better appreciate their full impact.

3 minute read

"[T]ensions between profitability, innovation, quality and equity are already surfacing within the USA, signalling what other nations may soon encounter."

"During the 1970s, women's health was a social movement that operated at the margins of mainstream medicine to empower and inform women, and to lift up women's voices and needs. Today, the phrase [‘]women's health[‘] travels different corridors..."

"[I]nvestors perceive women's health as a lucrative market... Financial firms are rapidly investing..."

"[B]etween 2010 and 2020, 1340 obstetrics, gynaecology, and fertility offices in the USA gained a private equity affiliation. Today, almost 30% of all fertility cycles in the USA occur at private equity-affiliated fertility practices. Of the four major companies that staff US obstetrics emergency departments, three have private equity affiliations."

"Femtech companies often champion their health-care technologies as serving social justice and equity aims, appropriating the feminist empowerment discourse of the 20th-century women's health movement."

"[W]omen's health has also become a strategic platform for boardrooms to project corporate social responsibility... signalling to business leaders that pivoting into this industry can unlock profit opportunities and enhance brand marketing strategies."

"[I]t is now also a platform for new profit expansion..."

"[W]hat is best for profit may not always be best for patients."

"Many patients in the USA are unaware that their obstetrician, gynaecologist, or fertility specialist is part of a multi-layered corporate investment firm with major financial motives and explicit bottom-lines."

"Research on private equity in other specialties in the USA, such as dermatology, ophthalmology, and gastroenterology, finds that private equity-owned practices charge more after acquisition."

"[W]hile for-profit femtech companies market themselves as destigmatising women's reproductive and sexual health and enhancing wellness, the reality is that their main aim is to maximise profit for their investors."

"[O]ver time, hospital WHCs [women's health centres] shifted from women-centred to revenue-centred services as they became corporate-owned."

"[D]uring times of financial uncertainty... the US women's health industry is likely to deprioritise those whose health is deemed unprofitable, such as people living in poverty, those with disabilities, immigrants, racially minoritised people, and transgender and non-binary people."

"Early women's health activists brought visibility to the accelerating medicalisation and technologisation of women's bodily processes."

"[F]inancialisation is changing how women's health care is delivered, marketed, and financed for patients. Clinicians, researchers, and policy makers need to scrutinise the emerging women's health industry and to engage with it with care, ethics, and vigilance."

"Clinicians who choose to join boards or consult for women's health companies should work to ensure that quality health-care delivery and access remain integral to the vision of the company."

"Scholars of medicine and public health must attend to the growing entanglement between the financial sector and women's health, examining the implications for cost, access, bodily autonomy, quality of care, and gender inclusion and equality."

"Antitrust regulators and policy makers have a responsibility to ensure that business priorities do not undermine the medical needs and rights of patients."

"In this crucial moment that could define the future of health care for women and gender minorities, we must pay attention to where health is improved and where it is simply monetised."

Read the full article, which is open access:

Joseph Dov Bruch and Sarah Richardson. "Women's Health, Inc." The Lancet. 15 Apr 2023.