IWD2025 - Innovation and law in women’s healthcare
Innovation and the law are intertwined in medical advancement. I have been thinking about this inter-relationship recently, considering why we have stasis in various areas of women’s healthcare and what might shift that. This includes eradicating medieval practices that don’t belong in modern medicine.
We have seen some incredible developments, particularly over recent decades, in AI driven diagnostics, IVF treatment, robotic surgery and the growth of femtech across all number of female health dimensions, which is fantastic. AI is improving breast cancer detection rates by up to 15% and ‘digital pathology’ and predictive analytics are cutting diagnostic times and readmission. The innovation opportunities are significant. The law is an integral part of making that happen, where public policy has to be set, investment has to flow and regulatory regimes have to be effective and efficient.
Yet when you look up major ‘breakthroughs’ in women’s health, we seem to have peaked in the 1960s and 70s around contraception and reproductive rights. That’s an oversimplification, but we are not sustaining enough pace in advancing female healthcare. The data is alarming. The Women’s Health Index shows worrying trends, such as a 5 year decline in maternity care and ‘emotional health’, and the UK dropping to number 37 in the index, below Kazakhstan, Thailand and Kosovo. Breast cancer rates are projected to increase by 25% over the next 20 years, where we will be at one cancer diagnosis every minute. If we don’t swarm around what is happening for women, we won't arrest these trajectories, and their massive impact on society.
Add to which, and actually the impetus for this blog, we have procedures in place today that are at best brutal, and at worst medieval. They belong in the past.
Take cervical screening, where you are expected every couple of years for your entire adult life as a woman, to consent to someone internally assaulting you with an implement. However carefully it is undertaken, it is an invasive ordeal. Bleeding is normal, but we’ll call it ‘spotting’ so it’s not supposed to count. The pain and discomfort are advised to be short lived.
The same with breast screening. You are required to hold your body still while a machine literally crushes your breast tissue to the point of searing pain. How is scraping a woman’s cervix or crushing her breasts legal medical practice in 2025?
Along with the physical assault is the psychological abhorrence, before, during and after. Have we even studied that and its impact on our lives? This includes being hounded if you don’t book your appointment - justifiably, but which takes you down a fear cycle for something about which we are supposed to have a genuine medical choice, as enshrined in the NHS constitution and healthcare legislation.
We accept brutality in the name of saving lives and that is of course how we got here. But for how long with no material shift in innovation?
Rates of cervical cancer have dropped 70% since the 1970s due to the incredible work of early pioneers in developing screening. That accounts for 5,000 fewer women dying every year. Mammograms have led to a 25% reduction in the rate of advanced breast cancers - that’s ~1,300 prevented deaths annually. These are critical numbers - every single one an entire universe. But where is the innovation in the physical experience for women? Removal of a claw on the end of the speculum and maybe plastic instead of metal are something, but the fundamentals of the experience have not changed. As we say in legal innovation, this is optimisation not transformation; from what base are we optimising?
What we saw during Covid 19 was the will to move mountains in medicine. Vaccines were spun up in months. Regulatory processes were accelerated. Why do we not have the same urgency and collaboration for female healthcare?
Urine testing for HPV (human papillomavirus) has been around for 20 years - literally 20 years. That’s 2 decades still in the research phase. A little less for HPV testing on menstrual blood, where that is an obvious opportunity: testing blood that passes across the cervix carrying the virus with it if there is any present. For prostate cancer there is the PSA blood test.
Why are we not demanding as women the movement of Heaven and Earth to deliver us non-invasive solutions? Why are men not demanding the same on our behalf? Do men know of the misery or hear our anxiety and abhorrence? Perhaps we do not talk about it or let ourselves think about it, because it’s just something we as women have to do - and that the government and men in white coats say is the way. When we are innovating, the choice stops being binary, between brutal practices and death. Even and perhaps especially in a challenging economic environment.
But we have to drive demand. If we accept brutality in female healthcare as normal and ‘just the way things have to be’ then that is how they will be. Supply and demand cycles have us focusing globally more on weight loss drugs than the wellbeing of our women. In this the law follows: as with innovation, it never leads. Law and innovation require us to have a shared vision, to initiate and bring about the change, re-coding that into our standards and way of living.
With ever greater numbers of women now leading in science, medicine and the economy, we can hold a higher standard for women, demanding and leading innovation in a way that serves and supports us all. We can also demand to know what sits underneath our illness and disease, as much as testing for and treating their appearance.
The simple answer I have right now on all remaining and legalised brutality in healthcare for women is no. From my body, no. As a woman, no. As a lawyer, no. What we have, including in preventative medicine, is nowhere near good enough for women today. It is perhaps ‘good’ as a standard that has been a problem from the start. With ‘good’ we could look at our progress compared to the past and say we are doing well. And we are by that measure. But with good you can then coast at that point of evolution, driving with less urgency or incrementally, because we have ‘a solution’.
If we apply instead ‘great’ - what is great for women - then we have something we can all work with and we won’t stop until we arrive there.