In Brazil, nursing mothers feel comfortable taking out their breasts, asking questions and working with physicians and nurses to solve lactation problems.
This was a revelation to Anna Sadovnikova, an M.D. and Ph.D. student in nutritional biology at UC Davis, who interned in two dozen human donor milk banks in Brazil in 2014. She saw Brazilian mothers learn a slew of massage techniques to combat issues like nipple pain, low milk production and failure to latch.
It was a far cry from what Sadovnikova saw in the U.S. Through her research in mammary gland biology and breastfeeding medicine, she had heard from new moms distressed by hospital staff who relied heavily on breast pumps. Though often necessary, most pumps can’t mimic the complex movements of a baby’s mouth, which massage tissue and combat common problems that arise for nursing mothers. It also makes for healthier outcomes, Sadovnikova says, because hands-on techniques result in the milk’s increased fat content and volume. But, she adds, the average health care professional in the U.S. doesn’t feel comfortable or confident enough to support moms who want to nurse.
“It’s that physical connection between the health care provider and the mother, and the mother and her own body, that’s what I felt was missing in the U.S.,” she says.
In 2014, she cofounded LiquidGoldConcept, a breast health and lactation education company. One of her first ideas was an app called MomKit, designed to teach mothers various techniques to alleviate, improve or prevent common breastfeeding problems. As a founder, she was passionate about the importance of breastfeeding on infant and maternal health. She won a few startup competitions to develop proof of concept. She was in talks with breast pump companies about integrating their brands with her educational material.
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But she struggled to find investors. Every time she pitched her breastfeeding education products, she found herself dealing mostly with men. In 2015, during a workshop at UC Davis, she pitched to about 50 mentors; only one of them was a woman. Overall, she says selling investors on an educational tool was difficult.
“Many venture capitalists were looking for … a product that I could sell directly to the mothers,” says Sadovnikova, who is certified by the International Board of Lactation Consultant Examiners. “But I had to ask myself: Is this really a faulty business model, or are most financial firms filled with dudes who don’t understand women’s health issues?”
Ultimately, Sadovnikova took the feedback and expanded LiquidGoldConcept beyond the app, but her experiences build upon a long history of women’s health issues viewed largely through the eyes of men. In 1985, the Public Health Service Task Force on Women’s Health Issues concluded that the lack of women’s health research had “compromised the quality of health information available to women as well as the health care they receive.” It wasn’t until 1993 that the Food and Drug Administration even began allowing women to be included in trials for new drugs. The arena of women’s health is long overdue for a nuanced perspective.
Throughout the Sacramento region, both the public and private sectors are making moves to rethink approaches to women’s health. Entrepreneurs, public officials and health care specialists have made moves to expand and diversify their approach to maternal health and infant health, with targeted efforts to support women of color, women with low incomes and other groups that have gone under the radar for too long.
The Rise of Femtech
Sadovnikova has since begun selling Lactation Simulation Models through LiquidGoldConcept. The simulators are worn like a vest, giving mothers the opportunity to experience common breastfeeding issues and learn various lactation skills. Her buyers are hospitals, nursing schools and community support groups like the Women, Infants, and Children program. Now angel investors and venture capitalists make offers, but she would rather maintain control of the business.
“Sometimes it pays to go a little slower and bootstrap,” says Sadovnikova, who now has a 5-month-old son. “Every decision about spending money is that much more vetted by the team. Every dollar becomes so much more valuable. It’s taken a very long time, but we’re becoming a credible, trusted resource in the breastfeeding community.”
With market potential estimated to hit $50 billion by 2025, female technology (“femtech”) focused on the health and well-being of women has been booming in recent years, foreshadowing the future of health care that isn’t so male-centric. Products include fertility solutions, period-tracking apps and smart breast pumps.
This surging market brings overdue attention to women’s health, which has been historically underfunded and undervalued — a long-standing gender bias that advocates of women’s health attribute to investors being predominantly men who don’t take women’s issues seriously. Just 7 percent of venture capitalists at the top 100 firms are women, according to a 2016 CrunchBase Women in Venture report. For early-stage ventures, female founders raised an average of $77 for every $100 a male-founded team raised since 2010, TechCrunch reported.
Sacramento native Dr. Neil Ray is working to make inroads in hospitals with his femtech product: a sensor that tells physicians if a baby is struggling in the womb during labor. He says the idea for his Mountain View-based medical device startup, Raydiant Oximetry, came from “professional dissatisfaction” with how women were being cared for during childbirth.
“I saw this firsthand as a physician and as a new parent,” says Ray, a pediatric anesthesiologist. “We are using a technology to monitor babies that’s 50 years old.”
When a woman goes into childbirth, there is a brief moment during which the baby doesn’t receive oxygen. In 99 percent of cases, it’s a benign event, akin to holding the breath. But some babies don’t tolerate this and can suffer brain damage. Problem is, Ray says, physicians rely on a monitor that has the “accuracy of a coin toss” in determining whether a baby is tolerating labor. That can lead to false alarms or unreported problems.
“So now the family could have a baby with a brain injury that was never determined,” Ray says. “You can imagine the consequences of that: emotional turmoil, cost of litigation.”
He is developing a sensor that will integrate with existing monitors to increase accuracy of fetal distress. In September 2018, Ray’s technology received the coveted designation as a “Breakthrough Device” by the FDA, putting the startup on a fast track to the federal review process. Raydiant Oximetry raised $1.25 million from angel groups, about half a million in grants, and Ray expects to hit the target of $4.5 million in a Series A round by the end of April.
“I thought there was synergy. Then he said, ‘Women’s health care issues don’t excite me.’” Dr. Neil Ray, founder, Raydiant Oximetry
Even with that interest, Ray says he still runs into resistance. In January, he attended the annual J.P. Morgan Healthcare Conference in San Francisco and pitched his idea to a VC at The Westin St. Francis hotel.
“We were talking privately, and I thought there was synergy,” Ray recalls. “Then he said, ‘Women’s health care issues don’t excite me.’”
Most of the funding for Raydiant Oximetry has come from physicians, not venture capitalists, he says. But one of his key backers is Portfolia, a Menlo Park-based venture investing platform run by women. Its FemTech Fund is reportedly the first fund in the nation to invest solely in women’s health companies.
“Men don’t have the body parts women have, and they also don’t want to talk about those body parts in their weekly meetings,” says Nola Masterson, lead investor in Portfolia’s FemTech Fund, who has over 30 years of venture capital experience. “If you have a solution for vaginal dryness, menopause, birthing, newborn babies, men won’t think it’s an investable strategy because they don’t see it as a problem. But half the world is women, and they need investments, solutions and technology.”
CULTURALLY COMPETENT CARE
Investments in women’s health are desperately needed now, at a time when more mothers are dying from pregnancy-related issues today than they were 25 years ago. Each year, about 700–900 maternal deaths occur in the U.S., which is one of only 13 countries in the world where the rate of maternal mortality is worse than it was in 1990. For black women, the situation is even more dire. The Centers for Disease Control and Prevention notes that black women are three to four times as likely to die from pregnancy-related causes than white women — a maternal health crisis that also impacts the lives of black babies.
Dr. Flojaune Cofer is a women’s health epidemiologist and senior director of policy for Public Health Advocates, a Davis-
based nonprofit. She says that historical trauma, unstable living conditions and racial bias take a psychological toll on black women, which can affect mothers physically and impact the health of babies in utero.
In 2013, Sacramento County decided to get serious about an issue plaguing certain communities within its borders, launching a massive multimillion dollar community effort to address the mortality of black children, who from 1990 to 2009, died at twice the rate of other racial groups. The County established the Steering Committee on Reduction of African American Child Deaths to address systemic inequality and reduce black infant deaths by 10-20 percent by 2020. According to Sacramento County’s most recent data, the death rate for black infants dropped 45 percent between 2013 and 2016.
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The Child Death Review team identified key causes related specifically to infants: perinatal conditions and sleep-related deaths. The Steering Committee, through its Black Child Legacy Campaign, set up community incubators in the seven most impacted neighborhoods to provide resources and wraparound services, such as counseling, housing, health insurance and safe-sleeping practices. These incubators also work with “ cultural brokers,” who are trusted members of the community, to ensure they’re providing culturally relevant services.
WellSpace Health, a community-focused health care provider, has linked with the Black Child Legacy Campaign to train health workers to meet women in their communities, create peer groups, and provide counseling and education seminars, all part of an effort to customize the perinatal experience for low-income, uninsured women.
“We’re trying to overcome this ethnic and cultural gap, which has come with a lot of biases and misunderstandings and characterizations that aren’t necessarily accurate,” says Jonathan Porteus, CEO of WellSpace Health and a licensed clinical psychologist. “The women of color we serve have been undervalued, treated less than … and here they are making a life.”
Providing health care spaces in which women of color can see themselves is fundamental to fostering better outcomes for them and their children, experts say.
“When black women show up to hospitals, their pain is not recognized as being as significant, symptoms not perceived to be as severe, opportunities to intervene are missed,” Cofer says. Something as simple as a supplement to address vitamin D deficiencies, more common in women of color and a primary contributor to low birth weight, can be lifesaving.
By engaging women of color in their own communities — and not in formal systems where they have often felt marginalized — mothers can feel safer and connected, Porteus says. A nurturing environment with culturally similar staff, he adds, helps their babies to be born healthy.
This vital emphasis on customizing patient care also inspired Sadovnikova to diversify her lactation simulators. When developing the vests, she found a disproportionate emphasis on white breasts in all the images, textbooks and learning tools.
“Our patients are not equally supported by physicians and nursing staffs,” she says. “If the health professionals do get breastfeeding education, they only see pictures of white breasts. How can they support diverse breastfeeding families if they never get practice doing that?”
Sadovnikova’s vests come in four different skin tones so patients can wear simulators that match their own bodies. Her training tools also feature a variety of skin colors, and she’s working on developing teaching scenarios to highlight cultural differences that impact how patients view nursing. Understanding cultural nuances will help health professionals provide “culturally competent care” that make mothers feel cared for, which Cofer calls a critical piece in the maturation of maternal health.
“Prenatal care is one piece of the wheel. Same thing for postpartum care,” Cofer says. “Of course, the goal is not to have unhealthy people in the first place, so care is not the linchpin on whether they live or die.”