Introducing this series + Part 1: Why You Can't Scale Demand

Hint: It has nothing to do with good, quality care

Hello friends and colleagues—

Last month, I wound down my femtech startup. We had a killer team—an ex-FDA director and head scientist from a Nobel-winning lab—but like many others, we couldn’t recalibrate fast enough after the recent funding cuts.

Along the way, I had hundreds of conversations with VCs, founders, and operators tin women's health and it's inspired me to launch a four-part series: Why Your Femtech Startup Will Fail.

I’ve seen a steady stream of content about the opportunity gap in women’s health, but very little on why the startups trying to close it keep failing. This series is a synthesis of what I’ve learned during my first 9 months in Silicon Valley, and what I’m still figuring out.

Below is part 1, just a 2-min read to kick things off.
👇 𝗣𝗮𝗿𝘁 𝟭: 𝗪𝗵𝘆 𝘆𝗼𝘂 𝗰𝗮𝗻’𝘁 𝘀𝗰𝗮𝗹𝗲 𝗱𝗲𝗺𝗮𝗻𝗱 (hint: it has nothing to do with providing good, quality care.)

If you're currently building in femtech, I'd love to interview you! Please drop a comment below or introduce yourself in the chat!

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Part 1: Why you can’t scale demand

Most femtech founders are deeply mission-driven. The problems they’re solving are substantial and urgent—delayed diagnoses, chronic conditions, rising maternal morbidity. Many have lived it.

But here’s the fatal assumption new founders make:

“If I solve an important problem for a large population, the market will reward me.

It won't. Because distribution wins, good care (alone) doesn't.

Take Flo. Flo reached unicorn status by using a simple cycle tracker with minimal clinical depth to create a daily habit. That habit became data. That data became leverage. Suddenly, Flo had a low-cost engine to reach, retain, and monetize 70+ million monthly active users globally.

Compare that to startups solving maternal mortality or menopause—providing life-changing solutions to some of the most under-addressed, high-need cohorts. And yet, they're forced into a far slower growth curve. Why? The care is high-touch. The user doesn’t show up every day. There’s little viral loop. The CAC is high, and the LTV is bounded by episodic need. And there’s no flywheel. You might save lives, but you don’t retain users.

High-value care does not scale just because it’s high-value. It scales when it rides on top of behavior that compounds.

So what’s the play if you’re building in these care-heavy categories? You have one of two options.

Option 1: Build your own distribution

Create a behavior loop that compounds:

• Subscription products

• Daily trackers and behavioral nudges

• Lightweight check-ins or feedback loops

These mechanisms convert clinical care into recurring interaction. Each refill, each symptom, becomes a touchpoint. Done well, this creates retentive distribution—a channel you control. That's what companies like Hims and Grüns do extraordinarily well.

Option 2: Borrow distribution

If you can’t build it, plug into an existing channel with reach:

• Employers offering women’s health benefits

• Value-based contracts with health plans

• Embedded services within other health platforms

This is how companies like Maven and Carrot scaled—not by owning demand, but by embedding in trusted ecosystems with built-in distribution and spend authority.

The Next Hurdle: Turning Demand into Dollars

Finding demand is only the first test. The next is tougher: can you find someone who’ll pay you? That’s where most femtech startups stall—and where we pick up in Part 2 for a longer post. Stay tuned.

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What do you think? Have you seen or heard something different? What's your recipe to success ?

If you’re a founder, operator, or investor in women’s health or simply an interested reader, I’d love to hear your views.

Drop a comment—or reach out: kmanoj@stanford.edu