Why we invested: Clue — improving reproductive health for all
“The health of women and girls determines the health and well-being of our modern world”.
This statement, published over a decade ago, is now widely accepted: women’s education and health leads to widespread societal benefits, including in areas like climate change, where educating women and girls is now proven to be one of the most powerful levers available for avoiding emissions.
Yet, after decades of progress towards gender equality, a global study revealed that women were hit socially and economically much harder than men during the Covid-19 pandemic. “The evidence suggests that Covid-19 has tended to exacerbate previously existing social and economic disparities,” argued its authors, “society is at a pivotal moment where investment in the empowerment of women and girls is critically needed to ensure that progress towards gender equality does not get stalled or reversed because of the Covid-19 pandemic”.
In this context, we’re thrilled to announce our first investment in femtech — in Clue, a Berlin-based company that empowers women on their journey to self-discovery, agency and health through better information and science-based recommendations at each stage of their lives.
Clue is one of very few companies we have found with the potential to impact billions of lives (literally), and define a new era of healthtech and women’s education and empowerment.
We co-led this investment with Balderton in 2021, and existing investors like USV and Molten (ex-Draper Esprit) reinvested too. We are sharing it today as Clue has launched a crowdfunding campaign so anyone in their community (and beyond!) can become a co-owner of the company.
The context & the size of the opportunity
Scientists agree that women’s health patterns are very different to men’s. Nonetheless, while 50% of our global population are women, the women’s health market represents a mere 0.3% of the $10 trillion spent on health annually. The opportunity for products and services that cater to women is enormous. Women want (and need) better health information and services at each stage of their lives, yet female health remains vastly underfunded and underserved.
Technology can play a major role in briging this gap. This is the root of the “femtech” movement. Femtech defines a group of technological products and services designed to support and advance women’s health. These include fertility solutions, period and fertility tracking apps, reproductive system health care, women’s sexual wellness products, pregnancy, post-pregnancy and nursing care, period care goods, at-home fertility monitoring devices, or next generation breast pumps. The Femtech market is now on track to become a $60 billion industry by 2027, following a CAGR of 15.6%, and 2021 was a foundational year for femtech as global investment reached 1 billion dollars.
Why do we need female-focused solutions in health?
Over the last couple of decades, papers like Sex bias in neuroscience and biomedical research and other epidemiological research carried out over several decades have demonstrated the bias the scientific community has had for male health across biology and medicine. “Studies of both sexes frequently fail to analyze results by sex,” the paper states, “underrepresentation of females in animal models of disease is also commonplace, and our understanding of female biology is compromised by these deficiencies.”
The lack of historical research focused on female health contrats with — and is sometimes a cause of — the higher risk that women face with some of the most challenging conditions. Autoimmune diseases, for example, affect approximately 8% of the global population, but 78% of those affected are women. Women are 3x more likely than males to develop rheumatoid arthritis and 4x more likely to be diagnosed with multiple sclerosis, an autoimmune disease that attacks the central nervous system.
These male-female disparities are present across the medical world — for pathologies like Alzheimer’s, heart attacks, or chronic pain conditions. The innate differences between male and female, and the deficiencies in research, have sometimes led to terrible consequences. 80% of the drugs removed from the US market from 1997 to 2000 were withdrawn because of side effects that occurred mainly or exclusively in women.
This is all starting to change. Women accounted for roughly 50% of the participants in some clinical trials funded by the US National Institutes of Health (NIH) when this was last measured in 2016, and scientists are now required to account for the possible role of sex as a biological variable in both animal and human studies. This change is even more important in a post-Covid world. As the Pan American Health Organization recently highlighted when they were commenting on the Covid-19 data:
“gender does not feature in analyses of the direct and indirect effects of the pandemic, making it difficult to recognize and understand the different consequences COVID-19 has had on men and women. The pandemic demands a radical transformation in the generation, analysis and use of disaggregated data to identify health inequalities… Without quantitative and qualitative data and evidence, our efforts in gender equity and other aspects of health are significantly compromised”.
But even if the scientific establishment resets proper parity, it will take time for our scientific and medical understanding to integrate the variation that occurs in female bodies, from first period to menopause as well as other factors such as socio-economic background.
Technology can play a critical role here in providing personalized insights to each woman that caters to her specific physiological and mental requirements.
Meet Clue: the pioneer in Femtech
Founded by Ida Tin, the visionary woman who coined the term “femtech”, Clue is the company that pioneered the femtech movement.
After delivering the world’s first digital period tracker, Clue is now on a mission to provide trustworthy information, data-driven tools, and emotional support for anyone with a menstrual cycle — as an empathetic, scientific companion from first period to menopause and beyond. They exist to empower and support women through every stage of their reproductive lives.
They have over 11 million monthly active users in 190 countries, and cater to a very diverse population in an inclusive way, striving to create an app that’s accessible and takes into account gender, age, race, ethnicity, accessibility, education, country of origin, socioeconomic status, and all the other aspects of an individual’s background.
A trusted brand
To start with, Clue is the most trusted femtech brand on the market, best represented by their 4.8-star review on Trustpilot across over 2 million reviews.
Since day 1, they have prioritized user and data privacy, evidence-based research, educational content, and a proximity to users through support and social media that nurtures close relationships with its user base.
As an example, Clue’s Science team is constantly creating content for both the Clue app and their web-based education platform helloclue.com. These articles cover areas like pregnancy (with over 40 in-app articles for each week of pregnancy and new content for pregnancy outcomes such as miscarriage and abortion), birth control, and health disparities, mental health, and gender & sexuality. This content is science-based and written by reproductive healthcare clinicians and science writers to provide users and visitors with clear and evidence-based education.
Furthermore, trust is embedded in the very fabric of Clue’s product and data infrastructure. The company has committed never to sell customer data or share sensitive health information with third parties and ad networks. This separates Clue from competitors.
The importance of data privacy became clear in 2022 in the aftermath of Roe v. Wade. In a 6–3 decision on June 24, the US Supreme Court voted to overturn Roe v. Wade, eliminating the United States’ right to abortion. As concerned citizens launched protests across the country, calls arose on social media for women to delete their period tracking app, so their personal data could not be used against them in potential criminal proceedings.
Clue stood out as an exception. With its focus on privacy, data de-identification and data encryption as well as its business model that does not rely on selling data to third parties, the company emerged organically as a trustworthy option.
“While we navigate this new reality,” Clue wrote in their blog post at the time, “we promise to squarely face the challenges it brings, to listen and do everything we can to make every single Clue user’s experience as positive and safe as it can be.”
Constant innovation
This trust is partly enabled by the company’s focus on innovation, which is deeply embedded in this company’s DNA. Since they launched their very first product, the team has been pushing barriers to develop an ever-growing body of research on female health, and leverage that to build products that are difficult to develop and truly serve their users.
When we invested, for instance, Clue has just received clearance from the FDA to launch the world’s first, regulated, non-invasive contraceptive product with Clue Birth Control. Though launching this product comes with its fair share of challenges (as Clue had to meet the most stringent medical standards to obtain approval), we believe it’s a worthwhile pursuit as it sets the highest standards of quality for the company’s technology stack and approach to product development.
Accessibility and potential health challenges with other contraceptives are well-documented, and have left women (and couples) feeling helpless. With typical use, Clue Birth Control is 92% effective at preventing pregnancy; with perfect use, it is 97% effective. For comparison, the pill is 93% effective with typical use and 99.7% effective with perfect use while external/male condoms are 87% effective with typical use and 98% effective with perfect use. The fact that a digital, non-invasive method is effectively as good as invasive biological or mechanical methods is revolutionary. It opens the door for billions of women who do not have access to contraceptives but do have access to smartphones, in developing countries of course but also in developed countries’ contraceptive deserts, to feel empowered and make informed decisions.
Science excellence
One of the bedrocks of Clue’s capacity to innovate is the company’s commitment to furthering research in menstrual and reproductive health. Over the years, the company has partnered with over a dozen of the world’s premier research universities and organizations on women’s health.
These have included Stanford and Columbia who used Clue data to publish scientific papers on the impact of menstrual cycles vs daily, weekly and seasonal cycles on mood, behavior and vital signs, and predicting upcoming cycle start dates using tracking data; Harvard University to submit a paper on using Clue as a research recruitment tool for a menstruation study; the Bill & Melinda Gates Foundation to collect data on contraceptive preferences, and with results soon to be published in scientific journals; and the University of Montpellier, Johns Hopkins, the Oregon Health & Science University, Columbia, and Stanford on the impact of the Covid-19 pandemic and/or Covid vaccinations on menstrual cycles, including two projects funded by the National Institutes for Health (a gold standard for US life sciences research, awarded only to high quality, high impact projects of great importance to society). Other institutions they have worked with in the last twelve months include the University of Amsterdam, King’s College London, or the University of Oslo.
This commitment to science has cemented Clue’s reputation as an expert organization in menstrual health (and health tech more broadly) and now serves as a proof of concept for larger scale strategic partnerships.
Data insight
Finally, the underlying key to their scientific excellence is the breadth and depth of their data set. With 290 million periods tracked and over 10 billion health data points, Clue’s data gives the company an understanding of the female body that is unparalleled. This is one of the main reasons why research institutions are keen to partner with the business. In other words, not only is Clue’s data set serving their users by improving bespoke recommendations and insights, but it is also making a material contribution to the medical world by helping researchers understand how health practices need to change depending on one’s sex.
We believe this company is at a turning point, where they can capitalize on the years-long commitment to building a loyal community by building a trusted brand, developing scientific excellence, and pushing research and innovation to build user-centric products, to grow into the leading company in the femtech sector, a true category leader.
At Future Positive, we are seeking to support 20 iconic European companies that apply technology to solve a global need. Clue is one of those. If you’re interested in what we’re doing, please get in touch.
