Women are the ‘Chief Healthcare Officers’ of the home, so why does healthcare design exclude them—and how can we enact positive change? 

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3 Approaches to Women’s Healthcare Design

Women hold significant decision-making power for household expenditure, typically taking the role of ‘Chief Health Officer’ of their households. In the U.S., women make <a href="https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/women-and-job-based-health.pdf" target="_blank" rel="noopener">80% of all healthcare spending decisions</a>. Furthermore, women are <a href="https://www.frost.com/frost-perspectives/femtechtime-digital-revolution-womens-health-market/" target="_blank" rel="noopener">75% more likely</a> than men to use digital tools for healthcare. Despite women’s influence over healthcare spending and use of health technology, they continue to be overlooked in design and suffer as a result of this <a href="https://carolinecriadoperez.com/book/invisible-women/" target="_blank" rel="noopener">gender data gap</a>.
The market for healthcare products and services for women is fertile yet underdeveloped. Recently &#8220;femtech” has gained momentum with companies such as <a href="https://www.mavenclinic.com/" target="_blank" rel="noopener">Maven Clinic</a>, <a href="https://www.instagram.com/modernfertility/?hl=en" target="_blank" rel="noopener">Modern Fertility</a> and <a href="https://www.instagram.com/flotracker/?hl=en" target="_blank" rel="noopener">Flo Health</a> among those leading the charge. However, there is not only a significant need for increased investment, but also an equally important need to change the way in which we approach product design and development. At frog, we have designed products and services for a range of women&#8217;s healthcare experiences from <a href="https://www.frog.co/work/yona-humanizing-the-medical-pelvic-exam" target="_blank" rel="noopener">reimagining the pelvic exam</a> to improving the journey of those with <a href="https://www.frog.co/work/a-biopharmaceutical-company-that-puts-the-patient-first" target="_blank" rel="noopener">triple negative breast cancer.</a> Most recently, we worked with a major U.S. healthcare provider to design a digital application and in-person service offering to navigate the maternity experience, including postpartum support.
From our experience, creating human-centered healthcare products and services for women requires embracing three critical paradigm shifts in approach to design: normalize “taboo” women’s health topics, focus on intersectionality and co-create with the community.

Normalization and destigmatization of historically “taboo” women’s health challenges is a critical first step in effectively designing for women’s healthcare experiences. It is necessary to destigmatize first as we cannot begin to create solutions for challenges that we do not openly talk about, acknowledge as valid or invest in as priorities. It is a significant opportunity for healthcare systems and digital health product and service providers alike to change perceptions across three life-changing health journeys experienced by many women: maternity, postpartum and menopause. In particular, in postpartum care, there is a need to normalize the challenges of postpartum depression (PPD), body image and sexual health. This need is growing as prenatal and postpartum anxiety has <a style="text-decoration: underline; font-weight: bold;" href="https://www.hsph.harvard.edu/news/press-releases/pregnant-postpartum-covid19-post-traumatic-stress/" target="_blank" rel="noopener">risen by 31%</a> during the COVID-19 pandemic.
In our work designing postpartum products and services, we observed that lack of normalization is associated with lack of care resources and psychological barriers to seeking support. We heard through interviews with women that they have been conditioned to dismiss their feelings and question the possible abnormality of their mental and physical health. This results in their hesitation to seek support or even to recognize the need for support. We spoke with healthcare providers who identified that there is a lack of services that cater to women’s mental health support. For example, there is a need to better support women through postpartum depression through benefits such as paid parental leave for miscarriages, which are unfortunately <a style="text-decoration: underline; font-weight: bold;" href="https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298#:~:text=Miscarriage%20is%20the%20spontaneous%20loss,even%20know%20about%20a%20pregnancy." target="_blank" rel="noopener">not uncommon experiences</a>.
In this context, normalization and destigmatization not only mean increasing the sheer amount of dialogue on these topics in the public domain, but also—and more importantly—reframing the conversations around these topics so that they are validating and drive change. These conversations should enable women to perceive their challenging health experiences as not uncommon, shared by others in similar circumstances and acceptable to discuss. For healthcare solutions providers and employers, this means recognizing the significance of these three health experiences in women’s lives. Furthermore, incorporate behavioral research into the design process to understand what factors drive and inhibit behaviors. Solutions should incorporate behavioral interventions to reduce frictions to seeking support. Solutions should also include mechanisms to directly connect individuals to mental and physical health resources that are tailored to their unique health journeys.
Action points:
<ul>
<li>Create a safe space for women to speak frankly about their health challenges.</li>
<li>Design interventions that reduce frictions to seeking support.</li>
<li>Tailor resources to women’s specific psychological and physical needs (rather than of the <a style="text-decoration: underline; font-weight: bold;" href="https://www.youtube.com/watch?v=CVdn-2KE2bs" target="_blank" rel="noopener">Reference Man</a>.)</li>
</ul>

Normalize “taboo” women’s health topics 

Many products that are designed for women cater to a narrow idea of womanhood. In order to truly design for all women, we must be inclusive of all those who identify as women, such as those of different ethnicities, sexual orientations and gender identities. A lack of consideration for these differences has led to negative healthcare experiences and outcomes such as <a style="text-decoration: underline; font-weight: bold;" href="https://www.liebertpub.com/doi/10.1089/trgh.2020.0017" target="_blank" rel="noopener">feelings of discrimination</a> and <a style="text-decoration: underline; font-weight: bold;" href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm?s_cid=mm6835a3_w#T1_down" target="_blank" rel="noopener">unequal treatment</a>. We have seen <a style="text-decoration: underline; font-weight: bold;" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182298/" target="_blank" rel="noopener">too many products </a>assume that their users are cisgender women in heterosexual relationships, thereby alienating and excluding people who may not fit into these categories.
When starting to design an experience “for women”, make sure to use a broad and inclusive definition of womanhood. During research, intentionally find participants that represent a diverse range of women—making the time and effort to capture their varied perspectives and lived experiences to inform and inspire more comprehensive solutions.
As you define the experience, avoid making assumptions about the user’s gender, family dynamics and cultural norms—especially when building a product specific for maternity and family care experiences. Instead, allow your users to self-identify and avoid any gender-specific or heteronormative terminology throughout the product. Additionally, when adding any visual representations in your products, ensure you depict different women in the <a style="text-decoration: underline; font-weight: bold;" href="https://createherstock.com/" target="_blank" rel="noopener">stock photography</a> and <a style="text-decoration: underline; font-weight: bold;" href="https://www.blackillustrations.com/" target="_blank" rel="noopener">illustrations</a>, showcasing a range of cultures and ethnicities, physical conditions and ages.
Actions points:
<ul>
<li data-stringify-indent="0" data-stringify-border="0">Keep the definition of womanhood broad and inclusive. For example, make sure it includes those of different ethnicities, socioeconomic status and sexual orientations.</li>
<li>Capture historically underrepresented perspectives when conducting research.</li>
<li>Avoid making assumptions of the user’s gender, family dynamics and cultural norms.</li>
<li>Include a diverse range of women in any visual representations in the experience.</li>
</ul>

Consider the needs of all who identify as women 

Designing effective women’s healthcare experiences requires bringing in their voices as decision-makers on the executive level and as co-creators throughout the design and development process. First and foremost, there is an overarching need for more female representation in leadership roles. Women are underrepresented in influential global health leadership roles, accounting for only <a href="https://www.google.com/url?q=https://www.statista.com/statistics/1102621/females-global-health-workforce-by-role/&amp;sa=D&amp;source=docs&amp;ust=1647383213795237&amp;usg=AOvVaw3nH-yho66Gwh226CunkVKn" target="_blank" rel="noopener">3.7% </a> of Fortune 500 Healthcare CEO’s and <a href="https://www.statista.com/statistics/1102621/females-global-health-workforce-by-role/" target="_blank" rel="noopener">25%</a> of heads of global health organizations boards. Gaps in leadership trickle down to lack of investment in women’s healthcare products and oversight in the design and development process, which puts women’s health at risk. Women have been underrepresented in drug and disease treatment studies for years and, as a result, have <a href="https://www.nature.com/articles/550S18a" target="_blank" rel="noopener">suffered disproportionately</a> more side effects and risk of receiving ineffective therapies.
In addition, in order to design and build equitable experiences for a diverse set of women, we must ensure that our design and development teams are diverse. At the start of a project, consider spending time to intentionally consider the identities of those on the project team. How do the members of the team identify themselves and how might those identities influence decision making? If there is a gap, consider leveraging <a href="https://vimeo.com/235081825" target="_blank" rel="noopener">radical empathy exercises</a> to help individuals on the team better understand and relate to different perspectives other than their own. During the design process, make a point of establishing which perspectives might be missing and create opportunities along the process to directly engage with those voices at a regular cadence. Give those voices decision-making power in the design process so they can have a direct impact on the experience itself.
Action points:
<ul>
<li>Take action to reduce biases and consider how the different points of view of team-members influences product design assumptions.</li>
<li>Leverage radical empathy exercises within the project team.</li>
<li>Identify gaps in perspectives and bring those voices directly into the design process.</li>
</ul>
&nbsp;
<h3>Care for those who have cared for you </h3>
Over the past year, we have seen a heightened demand to design for women’s healthcare experiences. In <a href="https://www.frog.co/sector/healthcare-service-strategy">frog’s healthcare practice</a>, we have collaborated on multiple products and services with partners across the healthcare landscape from digital application developers and diagnostic device manufacturers to leading U.S. hospital systems and insurers. Through this experience, we have learned—and urge others—to focus on embracing these three paradigm shifts in approach to design: destigmatization of historically “taboo” women’s health challenges, inclusion of the needs of all women and, most importantly, co-creation with (not just for) the community.
The first step to co-creation is listening. Ask your grandmothers, mothers, sisters, aunts, daughters, teachers and caretakers about their experiences. Then genuinely engage them directly throughout your design process as shared decision-makers. They have cared for you, so care for them.

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Eugenia Ho

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