The co-founders of Ruth Health wanted to provide telehealth services for pregnant women to talk about incontinence, sex and other adjustments that come with giving birth.
Like most cash-strapped startups, Ruth Health began leveraging social media to advertise the company. But the content proved “offensive” to those platforms: Early in 2020, Instagram took down a post that used the word “vagina.” On Pinterest, one of Ruth Health’s ads showing a breastfeeding woman was flagged for inappropriate content.
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“It just doesn’t make any sense,” Wu said. “Then we tried a different set of pictures and those were rejected as well. And it just becomes difficult. Like, how do you actually show a woman feeding her child?”
Ruth Health isn’t the only startup struggling with this dilemma. The billion-dollar femtech sector is full of startups in their infancy. In fact, 40% of funded femtech startups in 2022 are at their seed stage, according to Crunchbase data. Armed with a small marketing budget, they rely on widely used social media platforms to grow an audience and show proof of concept to investors. Without that access to widely used marketing platforms, attracting funding can be challenging
“It quite frankly puzzles us, but unfortunately if we want to do this on the platform, we have to abide by the rules they set,” Wu said.
Trouble getting investors on board
For a long time, femtech (read: female-driven health technologies) have sat on the back burner of venture funding from a mostly-male VC pool. Since the term was coined in 2016, the sector broke the $1 billion mark in venture capital raised for the first time in 2021, per Crunchbase data.
Now it’s facing a new hurdle: Getting venture firms on board as startups struggle with a go-to-market strategy.
Emmeline Ventures, which invests in women-centric startups, has a portfolio of startups tackling ovarian cancer, sexual health and even a sportswear startup that allows for ventilation around the pelvic area.
“We have to talk about it right upfront because we know these issues are out there, and (founders) need to have a plan around how they’re going to market what they’re building, given where the hurdles are,” said Naseem Sayani, cofounder and managing director at Emmeline Ventures.
Dipsea, a sexual wellness startup that provides a wide range of audio erotica, has a history with Meta dating back to 2018 that involves a rotating cast of Facebook representatives. Weeks would go by when Facebook allowed Dipsea’s content, the company said; on other weeks, posts would get slashed frequently.
“We believe that a pleasure-first product, the product that creates erotica, is a sexual wellness product,” said Gina Gutierrez, co-founder and chief creative officer at Dipsea. “And we think that separating pleasure outside of healthy sex is actually really problematic.”
As Dipsea began pitching its sexual health platforms to primarily male investors, the same questions arose: How can Dipsea be less beholden to Facebook and Instagram and still get in front of a large volume of customers? Would it be possible to scale the platform without Facebook? Could it survive if it were unable to advertise on Meta?
“I can confidently say that it makes investors second-guess investing in sexual wellness businesses,” Gutierrez said.
But venture firms won’t be able to ignore the femtech industry much longer. The sector is growing as more companies in pharma and digital health build fertility drugs, health-tracking apps and sexual wellness products.
Funding peaked during the second quarter of 2021 at $892 million, an $807 million jump from the previous quarter. That momentum hasn’t stopped despite the recent economic downturn.
The Lowdown, a London-based femtech startup, also experienced getting flagged on Meta platforms. The sexual health platform crowdsources peoples’ experiences with different types of contraception so patients can better understand side effects and pick the right birth control method.
Despite this seemingly noncontroversial objective, the platform has to use an @ symbol when discussing the vaginal ring on social media.
Once the team posted “Who’s up for some Sunday sex chat?” on an Instagram story to promote a panel discussing libido, vaginal dryness and uncomfortable experiences with intercourse. Instagram took it down for violating what it called “adult sexual solicitation guidelines.”
“We don’t allow people to facilitate, encourage or coordinate sexual activity on Instagram,” the platform said.
“It’s just another barrier for women trying to find information about this kind of stuff,” said Matilda Lucy, digital marketing strategist at The Lowdown.
Social media platforms employ advertising and content regulations to help monitor posts as the platform scales. Sexually suggestive content is not allowed on Meta platforms (in the handful of examples given, a naked statue of David is compliant but a woman eating a banana isn’t).
Tiktok bans ads focused on “intimate” body parts. Instagram doesn’t allow nudity either, even in the form of art, but will allow female nipples in the context of breastfeeding, health-related content or as a form of protest.
Navigating the specific rules for each platform is difficult. Algorithms have trouble digesting the full context of an image: Is a photo of female nipples a form of art? Protest? Health awareness? Or all three? But it also has thousands of human eyes scanning the internet, witnessing things too terrifying for Facebook’s platform, and making split-second decisions on whether or not to allow that.
But those split-second decisions can cripple startups that rely on social media to market their early-stage startups.
“(Now) we have done it long enough that we have a sense of what’s ‘safe,’ but that requires us to talk around our product in a way that arguably isn’t the best experience for Facebook users,” Gutierrez said. “Because if people are advertising products to you without using the truth of what the value proposition is like, is that a best case scenario?”
Despite the barriers to social media marketing, startups have found ways around big platforms.
“It’s a barrier to growth and conversion, but it’s not a dealbreaker because there’s so many ways to reach that end consumer … it actually becomes about, how creative is that founder being around navigating around those hurdles?” said Emmeline Ventures’ Sayani
From the startup perspective, Dipsea has invested a larger share of marketing dollars in podcast ads, capitalizing on the shared audio platform. Meanwhile, The Lowdown has in its armory a strong SEO strategy for organic searches, bringing people directly to its platform.
Ruth Health found its home on Tiktok, garnering thousands of views per video on breastfeeding, patient advocacy and life postpartum. In fact, Tiktok is one of the biggest traffic drivers to its site.
“We end up having to take these to other places because, can you do an Instagram live about this?” Wu said. “I don’t know. We haven’t tried. And quite frankly, why bother, right?”
Illustration: Dom Guzman
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