by Karen and Erica

For many of us, the emergence of the Pill was a big part of our coming of age, in a time when feminism seemed almost inevitable. Being able to engage in sexual activity without fear of pregnancy was a true breakthrough. Without the Pill, our path to equality would have been much more difficult.

Of course, we now see there remain many obstacles in the path to full equality, but we rather assumed that reproductive health would actually be inevitable, and might even advance, like other areas of medicine.

But no. We were very surprised to learn that the options available today are pretty much exactly the same as the options available when we were teenagers, in the dawn of time when dinosaurs ruled the earth. The only thing that has changed is that the rights we took for granted when we were teenagers are now under greatly increased pressure, especially for underserved women. Which makes it even more important that reproductive health options get updated. And fast.

Yet science and technology, which have changed everything, have not changed this. Why? We were disconcerted, so we investigated. The story is undoubtedly complex, but two factors strike us as likely to be important: first, women have not been seen as economic players who want specific products and have the resources with which to pay for them, and second, there is a huge gender bias in health data, which probably creates biased outcomes. (John Oliver puts it well.) Just as one example, lab rats are usually male, so they don’t typically get pregnant. Or get other male lab rats pregnant. Reproductive health is just not on the map where these lab rats are concerned.

But things are changing. Reproductive health is at last being brought into the twenty first century. Investors are aligning with scientists and health professionals, and breakthrough technologies are becoming reality.

A key player is RHIA Ventures: The Reproductive Health Investors Alliance, a group of investors and philanthropists trying to change the face of reproductive health in the United States. RHIA Ventures is focused on bringing together smart investment and good science. It was formed in 2017 when a group of foundations and investors realized the size of the market for reproductive health products—estimated at $38 billion now and at $50 billion by 2025. They commissioned an assessment of the landscape, and RHIA was born.

RHIA Ventures put its resources into answering this question: What if we collaborated to creatively solve the most difficult problems in reproductive health in the United States using private sector business models? The answer seems pretty clearly to be: excellent ideas and solid investments. The work sponsored by the group is truly groundbreaking, including entirely new methods for controlling conception—methods that can be used by women, and (hallelujah!) methods that can be used by men. (We learned that there is a $21 billion market for a male pill.) On-demand contraceptives and non-hormonal pills for women, and spermicides for men. Ideas that may reduce our dependence upon the continued vitality of Roe v. Wade. Diagnostic tools that will allow women to determine precisely what is going on in their bodies so that they will have a greater ability to control their health and their options. And more.

Another forward thinking enterprise is TwentyEightHealth. TwentyEightHealth offers contraceptives over the internet. Imagine that! Using technology everyone uses for everything else to make reproductive health products more accessible to those who need it—especially the young and underserved. TwentyEightHealth is also a leader in thinking about mobile health—bringing health options to the places where they are lacking rather than requiring people to travel to get what they need. Another rather simple, revolutionary idea.

The efforts of TwentyEightHealth and RHIA and others could not come at a more important time for women. It is estimated that 45% of pregnancies in the U.S. are unintended. Unsurprisingly, the rates are much higher among impoverished and uneducated women—and among the twenty million women who live in contraceptive deserts. These facts point to a foundational need for affordable, available and easily managed contraceptives. It is not obvious why anyone would want to impose unwanted children on mothers who cannot raise them successfully. In the United States, in 2019, that’s pretty crazy. And, if an unintended pregnancy turns out to be unwanted, women need options, and they need to know what options they have. Women of our age remember the bad old coat hanger days, and we really do not want to go back down that path, ever again.

Control over one’s body is fundamental to everything else. We learned that fifty years ago. We just haven’t brought the whole concept forward since then—until now. Kudos to RHIA and TwentyEightHealth for seeing ahead and forging a path to the future.