Challenges and Opportunities in Reproductive Health Investment: an Interview with Ruth Shaber

We speak to Ruth Shaber MD, founder and president of Tara Health Foundation, and co-founder of Rhia Ventures about the ongoing importance of access to reproductive health in the United States, and the ways in which private investment has responded to protect this access in the wake of the pandemic.

Tell us about your work with the Reproductive Health Investors Alliance (Rhia Ventures), and how that's progressing? 

When we set out to do private investing in the reproductive health space, we had a very tight investment thesis. We started with the science and assessed where the biggest systemic barriers and gaps for access to contraception, abortion and quality maternal healthcare were in the United States. We then set out to find companies that overcame these barriers or closed the gaps. 

Over the past year and a half, Rhia Ventures has done diligence on over 100 companies. Finding an adequate pipeline has not been an issue: we have eight companies in the portfolio so far.  And, the companies invested in have shown appropriate growth with subsequent funding rounds, with larger valuations each time. While we haven't had any exits yet, there are strong signals that the portfolio will perform very well. The second worry we had around competing with traditional venture capitalists has not been an issue at all. In fact, traditional VCs often go out of their way to make sure that mission-driven investors can be at the table because they value what our human capital can bring in terms of knowledge of the market and the technologies.

Rhia Ventures is now launching a fund. While they have this portfolio of individual companies, they’re now raising for a $30 million fund. And all of the pipeline that they source going forward will be included in this fund. 

How has your private investment work been affected by the pandemic?

I’m happy to report that most of our portfolio companies are well positioned for the post COVID 19 world. They either include telemedicine platforms or alternative access models. However, we are recognising the need to consider opportunities that are outside of our previous investment thesis.  So we are considering companies that are pivoting to COVID 19 scientific development or diagnostic access. We also know that the pandemic has made women and access to reproductive health even more vulnerable than ever.  We are doing what we can to provide support to organisations that support access to abortion, contraception and safe maternal health care - both through investments and philanthropy. 

You mentioned a 10M USD commitment to private investing at the 2018 GenderSmart Investing Summit...

We're just about at that mark. We've put in about 4.5M to individual companies so far. And then we just made a commitment to be an anchor investor in the new Rhia Ventures fund at 5M. We're saving half a million to be follow-on capital for those other companies that won't be part of the fund. 

Rhia Ventures has four thematic pillars - maternal health, contraception, abortion, and then corporate engagement - which of those has been more challenging or yielded the most opportunity? 

It's like trying to pick your favourite child, but the shareholder engagement work has the potential to be more transformative than any of the other work we're doing in the US. It's the highest risk, but we are working with other organisations such as As You Sow that have a lot of experience with shareholder action. We've filed a letter of engagement with over 30 companies, with more than 200B assets under management in the investor letters, asking for dialogue around the quality of coverage of reproductive healthcare, and also political spending on anti-choice candidates. 

We've had around eight conversations so far: I've been the filer on one action with one company and we've been partners on several others. The resolutions are doable - we are asking companies to 1) decrease political spending on egregious candidates that have funded or supported abortion bans and 2) have equitable reproductive health care coverage across all employees, regardless of where they live. 

“We’ve filed a letter of engagement with over 30 companies, with more than 200B assets under management in the investor letters, asking for dialogue around the quality of coverage of reproductive healthcare, and also political spending on anti-choice candidates”

All of these companies are headquartered in States that have passed abortion bans. And if Roe v Wade is overturned, and these abortion bans go into effect, then these national companies will have inequitable access across the country for their employees. So a woman living in Georgia won't be able to get services that are covered in her insurance plan. Whereas if you lived in California or New York, you would. So we're asking companies to address that inequity and to make provisions for their employees to be able to get services that they need, just like they would if there were other covered benefits that were not accessible. If you had an employee that needed a kidney transplant, and they had to go to a different city to get it, the insurance company would pay for it. The same should be true for reproductive health. 

Many of the companies have been willing to engage in the conversation, and we see this as a huge milestone.  We have had several companies ask what other companies are doing regarding access across states - so we think there’s an opportunity for corporate leadership and we’ll get to a tipping point soon. We hope to recreate a lot of the good work that happened with gay marriage and LGBTQ rights by having public companies be the leaders and speak out. We know that the population overwhelmingly supports access to abortion and they expect their companies to be aligned with them. 

We are considering expanding our conversations with companies in 2020 to include broader workplace equity issues beyond just reproductive health access, including paid leave, living wage and fair housing.  We know that all of these equity issues are fundamentally important to how women are able to fully contribute to the workforce and want to help companies understand their role as employers. 

Complete this sentence: How might we?

How might we overcome barriers? How might we take the leap together? I often get frustrated with commitments if there’s no real action associated with them. Now is the time for us to implement what we’ve been talking about.  There is no more urgent time to be moving money than now. Whether you consider yourself a philanthropist, investor or both, we need to be sure that every dollar under our control is doing good. There is no longer an excuse to be sitting on large endowments that are only invested for financial profits. 

We're all on our own journey so I don't mean to imply that we should all be doing exactly the same thing. But I would like to see us all, as a community, really accelerate the absolute number of dollars that are invested for women. That number should be going up logarithmically. 

Tara Health Foundation promotes health, well-being, and opportunity for women and girls through innovative evidence-informed programs. Rhia Venture is a group of foundations and investors that collaborate to bring new types of capital and enterprise to the field of reproductive health in the United States. For more on reproductive health as an investment opportunity, read Rhia Ventures’ paper Hidden Values: The Business Case for Reproductive Health

This conversation took place on February 18, 2020 and is the second in a two-part interview series. It was edited in April 2020 to provide a perspective on COVID-19. You can read part one here

Image credit: Reproductive Health Supplies Coalition