When diving deep into the history of women's health, it becomes clear that systems within the medical field weren't created for women's best interests. Medical products and procedures have seen little to no innovation until recent decades, and data research around women's health is at a comparative deficit due to, for one, a historic lack of female representation in clinical trials. With this in mind, Smart Design and Core77 partnered together to explore through a virtual panel that took place on December 14th, 2021, how the design of better experiences play a role in creating solutions that speak to women's wants and needs in healthcare. Where can technology come into play and how can we conduct open-ended research that reframes women's health away from the traditional, biased historical lens of women simply as reproductive bodies?
Maria Lalli is the VP of Design & Development at Ceek Women's Health, an organization with the goal of modernizing the healthcare industry and improving the pelvic exam experience. With a core executive team of women, from experienced designers to health care experts, Ceek finally brings a woman's perspective to devices used in the OBGYN field.
Alyssa Meza is the Design Manager at Upstream USA, a nonprofit working to expand opportunity by reducing unplanned pregnancy across the U.S. They work in partnership with health centers to strengthen reproductive care and autonomy by increasing equitable access to the full range of contraceptive options.
Colleen Newland is a Senior Design Strategist at Philips, a health technology company with the purpose of improving people's health and well-being through meaningful innovation. They aim to improve 2.5 billion lives per year by 2030, including 400 million in underserved communities.
The evening's discussion was co-led by Smart Design Strategy Director Jamie Munger, and informed by Smart's work in the sector including Upstream's patient-centric toolkit for birth-control counseling, and Project Junior, a personalized digital service to help single women navigate the fertility process. Along with Allison Fonder, a senior producer at the design editorial platform Core77, we invited all the panelists to share both their professional expertise and the personal experiences that influenced their engagement in the field. Topics included ways to reduce the knowledge deficit in women's health, innovations that are currently in the pipeline, and how simple interventions can have an outsized impact.
Here are the key takeaways from the evening:
Create women's healthcare experiences that redress past harms
Panelists agreed that significant inequities in treatment and services continue to exist in women's healthcare with negative consequences on their overall health. Emerging solutions must therefore center on designing better healthcare experiences that take into account the damage done to women in the past. For example, a new line of gynecological-care products from Ceek Women's Health—including a patient-centric speculum—is sensitive to the distress women have historically felt during these exams. Unlike the traditional model which Maria Lalli characterized as "sharp, jangly, scary—a medieval torture device," the new speculum has a narrower shape (about the size of a tampon) to increase comfort, and comes with a light to give providers more visibility. With its focus on reducing anxiety, the new speculum is not just more functional but also acknowledges prior bad experiences.
Alyssa Meza of Upstream USA shared that her organization is focusing on how patients experience educational materials during counseling sessions about birth control. Working with Smart Design, Upstream created an informational tool for birth control—known as a Decision-Making Wheel—to facilitate conversations about reproductive care. Patients can easily compare methods based on their preferences and are provided with more details about possible bleeding changes that might occur in order to give them a better idea of what to expect.
Colleen Newland from Philips Healthcare told the salon that she is working on a "vision concept" for a next-generation NICU, or neonatal intensive care unit, describing it as "an adaptive environment with advanced analytics and lots of technology to help babies born prematurely." The goal is to look at how technology can support new workflows and, ultimately, better experiences for patients, infants, and their clinicians. An offshoot of the NICU project is rethinking lactation rooms, which Newland said are an overlooked space, "usually like a closet—if they exist at all."
Target research to long-neglected areas of women's health
Progress in healthcare depends on data, and so the lack of research and data in women's health has stymied advances in technology, products, and treatment protocols, leaving many types of care tragically stuck in the past. Underscoring the need for more research, Newland mentioned a National Institutes of Health survey of its own practices that found a disproportionate share of its resources are allocated to diseases that affect primarily men—such as prostate cancer, ranked 1st—at the expense of those that affect primarily women, including gynecological cancers ranked much lower.
Another striking example is the common and excruciatingly painful condition endometriosis—which, because of bias, stigma, and a general misunderstanding of women's pain, takes on average eight years to diagnose. Newland also recalled an OBGYN telling her that "we're in the dark ages in obstetrics," as most of the research around pregnancy was performed in the 1940s and 1950s.
Meza says that one such study in 1955, by Dr. Emanuel Friedman of Columbia University, looked at 500 Caucasian women and how long it took these first-time mothers to give birth, based on cervical dilation and fetal descent (about 14 hours). This subsequently became the standard known as the Friedman's Curve to measure how long births should take. "If you weren't on that schedule, they would introduce interventions such as a C-section," Meza noted. This model was only phased out in the 2000s after researchers found that many different factors may shorten or lengthen birth times for modern women. But as Meza added, it remains a striking example of "the harm that can be done from using outdated research."
Postmenopausal women are also neglected, according to Lalli, mainly because "we just don't talk about menopause very much." She acknowledged that this is changing as taboos are being broken and it has become more acceptable to discuss the nuances of medical treatments. Lalli also talked about new technologies to treat conditions such as vaginal atrophy and diagnose and treat postpartum hemorrhaging, all good examples of "taking a look at very discrete problems and trying to solve them."
Finally, Newland returned to how behind the U.S. is on maternal health, noting that we have one of the highest morbidity rates in the developed world, with about 52 percent of deaths occurring right after birth. Added Newland: "There's a saying that the mom is the wrapper and the baby the candy, and once the baby is out, we discard the mom. It's a crude way to put it, but the stakes are very clear. We just don't have a good grip on what's happening to postpartum women."
Listen to women, finally
As part of a wider effort to expand the scope and depth of research, Meza recommended a sometimes overlooked approach: "talking to patients more and asking how they are going to experience this intervention, this medical procedure." For example, after fielding questions about its potential benefits and side effects, and the use of hormones, she learned from patients that birth control is a complicated and highly nuanced topic that goes beyond the primary goal of preventing pregnancy. Birth control materials are therefore now designed to answer these questions and facilitate conversations.
With the medical field moving away from a monolithic approach to "precision health," which targets treatments based on individual characteristics, panelists emphasized the importance of including a wider range of variables into diagnosis and treatment.
For instance, consider the sexual orientation, race, language, and culture of the patient into the assessment. Lalli suggests that providers should also take into account when a patient has a higher body mass, citing a study at MedPage Today that found that overweight and obese patients have an increased risk of cervical cancer despite lower rates of pre-cancer. Knowing this, "If the tools and techniques were designed for [obese] patients, we would be able to catch cervical cancer earlier," she concluded.
A recent review in The Economistof the book "Unwell Women" by Elinor Cleghorn highlighted that ignoring what women say is a problem as old as medicine (along with sexism and condescension). Citing an anecdote from the book, it says that when champion Serena Williams struggled to breathe after giving birth in 2017, nobody believed her when she suspected the pain was linked to a pulmonary embolism she had endured six years before. She eventually convinced the doctors to do a scan, revealing clots in the arteries of her lungs—yet another example of how listening to women is still far from a best practice today.
Understand the power of simple interventions
While technology and good product design are priorities, solutions needn't be complicated or expensive. Meza said that small steps and non-medical interventions can be equally powerful. Redesigning an exam room to ensure the bed isn't directly facing the door and exposing the patient to passersby while undressed, or providing a hook in the room so they can hang up their clothes, are among the "very small things that ring very true from my own experiences," she acknowledged.
In a similar way, Newland said her experience of giving birth prematurely—and those of other moms at Philips—fueled her passion for redesigning the NICU and lactation room, often in simple ways.
For the NICU, this involved changing the artwork to challenge the more traditional, idealized images of motherhood: based on studies showing that images of happy, healthy, chubby babies are upsetting to parents, she suggested adding pictures of skinny, sick, or disabled babies in order to portray different experiences. To increase social support in the lactation room, Newland's Philips colleague came up with a low-tech idea to have new moms sketch out their experiences on Post-it notes and place them on the wall. Then, when other women used the room, just reading the post-its—which spoke to the isolation and tedium of lactation, as well as what she called "the hilarious moments"—they would know "I'm not alone," Newland said.
Panelists were encouraged by some of the recent changes in women's health. These include an increased focus on human- and patient-centered design and evidence-based practice that are showing up in medical schools, health clinics, hospitals, and at-home devices and procedures. Eventually, Newland noted, women's health will "start to feel less niche and maybe a little bit more commonplace and a little more exposed to the world."
Tools for now
Uncover "hidden moments" in healthcare Understanding a patients' needs is critical to help reduce inequalities. Talking to women in-depth, and listening closely to every detail of their experiences, builds empathy and helps empower them to determine what they want their healthcare to be.
Close the knowledge and data gapsEnsure that research explores both the common and long-neglected areas of women's health that can lead to poor treatment and outcomes. Challenge conventional approaches by including a wider range of patient variables such as sexual orientation and even body mass.
Introduce small steps with big impactWith complex tech a top priority, simple, low-cost (and non-medical) interventions can be easily overlooked. Consider all the components of the patient journey—be it decor or personal interactions—that can be easily adapted to gain significant benefits.
Aim for holistic solutionsTo design the best healthcare products specifically for women, think holistically about how and in what contexts those products will be used. And make sure providers and partners are on board to integrate them into their practices.