Amber Vodegel: Designing for 150m global users

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People are the sum of their experiences.
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Those experiences, whether good or bad, shape who we are today.
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So when we create better experiences, we can create better lives, and it's that belief that's driving today's guest.
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She's using design and technology to transform how women's health is understood, taught and supported.
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By building a new business model grounded in dignity, equity and privacy, she's creating a movement that challenges how health technology works and who it really serves.
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Hello, this is Problems Worth Solving the podcast where we meet people transforming health and care through human-centred design and digital innovation.
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I'm Sam Mentor, founder and Managing Director at Healthier, the collaborative service design consultancy.
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If you enjoy listening, you can subscribe to this podcast and the accompanying newsletter at healthierservices.
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So today I'm joined by Amber Vodahol.
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Founder of the world's largest pregnancy app, pregnancy Plus.
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She's now CEO of a new venture, 28x.
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Amber has built digital products used by millions of people worldwide and successfully exited.
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But instead of stepping back, she's taken on a bigger challenge.
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Amber combines an ambition for global product design with a determination to solve some of the most overlooked problems in women's health.
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Today, we're talking about everything from what it means to design for trust, who should own your data and how tiny on-device AI will change the future of digital health.
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Amber.
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Thank you so much for joining us today.
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What's the big problem you've?
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been trying to solve.
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First of all, thank you for having me.
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It's an important topic and I'm glad that I can share some of the work we're doing in this area.
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So 800 million people menstruate every day, but most women and girls don't have access to safe and accurate information.
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So the biggest problem that's a really good question three pillars it's access, it's trust and equality, and I think too many are still forced to trade their data for it as well, and that comes down to trust again.
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Why are we having to trade our data in order to get insights?
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Why do we need to pay for a subscription to learn about our health?
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I think these are big pillars that we can try to solve in today's world.
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Can you paint a picture of what menstrual health, education and access looks like globally today?
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Well, it's widely uneven day.
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Well, it's widely uneven In the UK 70% of women.
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They lack basic menstrual health knowledge and also basic health knowledge really, and globally, millions of girls.
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They miss school because of stigma or of lack of products.
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And the access is also differently distributed.
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For example, if you download any of the main commercial period trackers, women are faced with a paywall and for some women, five pounds a month is nothing and they happily sign up for a subscription.
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But for others there's a choice between a meal and a subscription, and that makes it very unfair.
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And especially the underserved in our society are most hit by all these apps that are driven by commercial subscriptions.
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And why is there a gap in education?
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It's inconsistent.
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So education schools are inconsistent, not always deliberately, but a lot of teachers and a lot of schools struggle with culturally sensitive and age-appropriate content.
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Then there's a lot of period apps that focus purely on fertility and not on health, because fertility and menopause is where the big bucks are made.
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Nobody's worried about the 12-year-old girl in those commercial apps because they convert less into subscriptions, vitamins and minerals and expensive fertility treatments.
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Most of these are also ignorant of neurodivergent, low literacy or non-English speakers and, of course, they collect their data without proper consent.
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So menstrual health education must vary hugely around the world.
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I can remember when I was at my school, the class got split into two at a certain age and the girls all went off and came back giggling and the boys wondered what had been going on and it was assumed that, okay, there's some education that has gone on at that point, and I don't know how it is today in the UK, but you're trying to do this on a global scale.
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What does good menstrual health education actually look like?
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It's not rock science.
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So my previous app, pregnancy Plus, was live in 100 countries in 25 languages and we have about 2 million pregnant women a day on the platform and after seeing 150 million women pass through that app, you learn that sometimes the most basics of information is the most important.
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So I always say, if you say to 2 million women a day, please don't drink any alcohol while you're pregnant, that's a lot more healthy moms and babies.
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And the same goes for period education.
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Women don't know what the definition is of heavy bleeding or what pain levels are normal, and we need to be able to provide globally a way for women to understand when it's a concern and when they should talk to a healthcare professional or to their mother or to a teacher at school, because it can be quite serious in certain cases and what is normal for one person, or considered normal, might actually be something that needs to be flagged.
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So you're tackling a global problem.
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How are you going about tackling that problem with 28x?
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What does it do and how are you helping with education?
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You have to split up the high-income countries from the low-income countries.
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So in high-income countries like the UK, the US and most countries in Europe and certain parts of the world, there is a good level of education, but what you see is that the average reading level is low.
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What we are trying to do is provide a solution that is engaging but with clinical, validated content to increase the health literacy of users.
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When it comes to lower middle-income countries, some women do not have access to mobile phones or smartphones, so first of all, we're making a version that can run on low-end devices, that is localized to specific countries but where there's no digital access.
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We also distribute funds, so profits from 28X will be given to communities for free period products and to help with teacher modules in schools.
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So it's a little bit of a Robin Hood model, where profits generated from high income countries gets distributed to lower income countries.
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So it's much more than an app.
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You're trying to solve a whole problem.
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It's much more.
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It is a movement because we also.
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What we are building is a privacy safe backend.
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So for the very first time in history, I think, with these apps we have no cloud servers anymore to backend, so it's completely privacy-safe.
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No government and no hackers can access any data, and that means that if this works for women's health, which is my specialism as an app developer, we can then also create this for mental health apps and for apps for men and cancer care apps, because we need a better, safer solution for all these products.
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And we'll talk a bit more about data in a minute.
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One thing I wanted to dig into in a bit more detail was you've described 28x as sitting between the NHS and TikTok.
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What do you mean by that?
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Our app is just as engaging as TikTok, but with clinically validated content like the NHS.
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So the NHS has brilliant content, but ultimately it's taxpayers' money, so they can't build something equally engaging.
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Like TikTok it's white pages with black letters and a lot of women find that incredibly daunting or boring because ultimately, the average reading age in the UK is nine years old.
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So they flock to systems like TikTok which are super engaging.
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But of course, it's really hard there to distinguish what's true and validated content and what's a myth.
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So we're trying to be that bridge between engagement and clinically validated content and what's a myth.
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So we're trying to be that bridge between engagement and clinically validated content.
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That's really interesting.
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How did you learn that people weren't necessarily engaging with the NHS content?
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Well, in Pregnancy Plasma previous app, we did a lot of testing and we had, for example, we had headers that say the relationship between oral health and miscarriages and we found that those kind of articles, even though they're super interesting, get very low click-through rates.
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And when we changed the headers with a nice image and it said underneath, should I brush my teeth more often during pregnancy, we had 800 times more uptake on these articles.
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So we discover that the way you present these topics is ultimately super important and, of course, we do a lot of user testing and user interviews.
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But I even see that my own teenage daughters they flock to systems like TikTok and Snapchat and YouTube Shorts for their information.
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They don't visit these government websites because they do find them incredibly daunting.
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That's really interesting.
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I think for a long time there's been a guideline that text is better than video for government communication, and I think that's come from the bandwidth thing, which is probably slightly outdated now.
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But actually we did some research as well that found a similar thing.
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That found people were much more engaged by video content and yet it's not being produced centrally.
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Correct, and it has, of course, accelerated over the last few years with platforms like TikTok and YouTube Shorts, that people got more used to short form content and visually engaging content, so it is a massive shift in how people consume it, but also in their attention span, which is much shorter than it used to be.
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And how much is the balance in the app between the tracking side of it and the education side of it, and is one of them a way of getting people to the other?
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So the cycle tracking is a reason to come back.
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With every app and every digital product, you always have to have a reason to come back, because otherwise you'll use the app for a few months and then you'll never open it again.
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So cycle tracking is at the core, because women simply want to know when is my next period due.
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So they log their symptoms every month, or sometimes more often, but they log their period every month and their symptoms may be more frequently.
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So they come back to this app over and over again and on the back of that, whilst they're there, we try to educate them on serious topics in an engaging way.
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So if they declare they have heavy bleeding, we will try to serve them articles to better understand what is normal and what isn't.
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So your mission is about education, really.
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It's about health literacy indeed.
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And how's it going?
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Well, this is not, as I said before, a standard of project.
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This is more a movement.
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We've had incredible support, but it's been the hardest working year of my life because we're trying to disrupt quite a few pillars.
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So, ultimately, to create a product that is free at the point of use for all users, no matter where you live in the world.
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To create a product that's free to the NHS, a product that is in over 33 languages, is clinically validated and engaging, is incredibly difficult to build.
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But we have an amazing team and we have amazing support.
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We are backed by the Philips Foundation, which is an incredible foundation with access to thousands of healthcare workers all over the world, and all that support means that we can build something truly unique.
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But it is not easy.
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If you want to build great tech, a lot of things have to go right.
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How does that business model work without end users paying any money?
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Initially, I always said I don't care about making money and that I still believe that because, ultimately, the core of your intention should be to build the best product and once you're the biggest in the world, you can solve how to make money in an ethical way.
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But you should never start a product from the intention to make money of it.
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Your intention should be to build the best solution for the user.
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So we have worked on a commercial model because it is important to be sustainable.
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So we have various models that we can use.
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We have ethical sponsorships.
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We have a pay-forward system, so we allow users who are passionate about women's health to contribute to a pay-forward system to support modules for lower-middle-income countries.
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It's a bit like Wikipedia.
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Once a year you get a message from Wikipedia saying would you please support this incredible source of information, and they make around 165 million a year from those donations.
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So we only need a few percent of people to pay for it and that will result in quite a lot of support commercially.
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Then there's the option to have.
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You can order contraception through the app and there's an option to donate your data.
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That is completely up to you.
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You can select some research projects you want to donate your data to, and then we'll package it up securely.
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You can also contribute to clinical trials and you can register for that.
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So there's a lot of lead generation, but it's completely transparent to the user why they would send their data to that entity or why they would sign up for something.
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So it's all very transparent and open.
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You told me that you don't believe direct-to-consumer apps should be backed by VC money.
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Can you explain a bit more about this?
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B2C healthcare apps should ideally not be backed by large venture capitalists simply because I mean it can go right, but quite often you see that these developers receive an awful lot of money.
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To put it in perspective Clue, which is a period tracker that received over $60 million in funding, flow Health, received $275 million in VC funding for one app, and although that is incredible and they've done a great job at building this tech, it comes at a price because ultimately those venture companies they need their money back and they want a valuation of 10, 20x the money they put in.
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And the problem with that is, if you want to earn that much money back, you either need to sell data or share data, or whatever the model is that they may use, or you have subscriptions in the app.
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So ultimately, the user becomes the product, and when it comes to health, I think users should never be the product.
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Health should be safe and free, accessible to everyone and never sit behind a paywall.
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So whether that's a meditation app or a cancer care app or a period tracker, I do not believe that we should paywall these kind of solutions.
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In the UK that aligns with NHS mentality.
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In the USA, for example, that's a very radical position.
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Have you encountered resistance to that?
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Ultimately not, because lots of governments no longer want their citizens' health data stored on cloud servers abroad.
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So when you speak to governments in the Middle East and Asia, they say that they no longer want their citizens' data health data and Asia, they say that they no longer want their citizens' data health data stored on European or Californian cloud servers.
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So the actual governments in every country are quite pleased that their health data is not stored abroad anymore, but it is all processed locally and ultimately, if you provide health information to their citizens, everyone is actually quite pleased, because nobody is looking for an unhealthy nation.
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No, I think it's an amazing model and it's what we should be doing 100%.
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And I'm curious as to pushback that you might experience going against the VC model.
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One of the insights we had was that we've been taught by various commercial entities that data equals money.
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So the more data you collect, the more valuable your company is.
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And I would like to challenge that, because if you have hundreds of millions of users on your platform that track their cycles, for example, their cycles, for example you only need a data of a few percent of that women to improve your algorithm or to recruit for studies.
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What you don't need is a data of 100 million women constantly on servers.
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The reason why most of these products collect this is for marketing purposes, so we should let go of the idea that the more data the better.
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You need high quality data of a few percent of your user base that is willing to donate that data.
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You don't need all the data from everyone all the time.
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So with 28x, you're proposing something radically different.
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You're talking about investors getting a five times return and then pledging the profits to other causes.
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Can you walk me through the model a bit, and who are the likely investors if it's not VC people?
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So I'm one of the larger investors in 28X because I wanted to give something back to society.
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So my personal pledge is, as being the major shareholder in this company, that I would donate a majority of all profits back into the system.
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I personally will donate back to free period products, to education, to clinical research For our investors.
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I'll try to make them 28x back.
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28x is the name of our company.
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I'll get them 28x the returns.
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28x back.
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28x is the name of our company.
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I'll get them 28X the returns.
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But we have a mission statement and my question to the investors we have, which are mostly philanthropic investors, is that if you have received five times your money back, would you be open to then the future dividends to donate them back to the foundation that sits above our limited and then we can collectively fund other women that have amazing companies.
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We can collectively fund clinical research or donate free period products, and the majority of all our investors are very open to making that pledge alongside me.
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And who are the likely investors?
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alongside me and who are the likely investors.
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So we have the Phillips Foundation, which is a foundation that does amazing work for healthcare workers, for health all over the lower middle income countries, and they are our lead investor.
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And then we have about 45 investors that are often either linked to healthcare or tech that really want to see a change in this world, and that's why they're backing 28X.
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So it's much more of an emotional investment and a philanthropic investment, but I also know that the team that is building this have done it multiple times before and there's a good chance of getting very decent returns.
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So at this stage, we are very well funded and oversubscribed More support than I could ever have imagined and we have a dream cap table, and I honestly hope that we don't need to do another round and that we can just focus on building products rather than raising money.
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What's the reaction been when you've talked to people about the model that you're building?
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Refreshing.
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I said to them listen, I'm an exited founder and I was going to retire and play tennis and looked after the kids and I read this book called Moral Ambition and it basically said if you combine the ambition of an entrepreneur with the morals of an activist, you can really make a difference.
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And that book made me think that maybe I should do one more company, but give something back to society and show a better example of how tech can actually serve the nation better when it comes to health.
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So when you talk about the ideation behind a 28X, people get super excited and, besides the fact that it's a really good investment, they also feel they're part of a movement that is long overdue.
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You've said you're not structuring for an exit.
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What does building a circular company mean to you now?
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So a lot of investors.
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Of course they would like to have an exit as soon as possible so they can recuperate their returns.
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I'm not against an exit, but I'm against an exit to a commercial company which will then take 28X and then kind of exploit women again.
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So then we're back to square one.
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So if there's a way we can have an ethical exit, I'd be okay with that.
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But I would rather return really good dividends over time and the money we, the profits that we have, we can distribute back into closing the gap in women's health research, but also in backing other female founders.
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The lack of period support in lower middle income countries, period poverty as a whole, period stigma.
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So there's so much we can do.
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So I'd rather build a circular company for the next 20 years where we can keep donating profits back.
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Don't forget in the old days people would create companies for life.
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Their children would work in the companies we set up.
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But somehow in the last 20 years we only see one model and that is you pick up a lot of money, you scale your company quickly and then you exit and then use the funds to sit on a boat or buy another house.
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That's not what I think After reading the Moral Ambition book I thought we can do morally better and build companies for life rather than for quick, short exits to create excessive wealth for just a few individuals 100%.
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You know, if you're doing work that is interesting and stimulating, you're working with people who share values, you're having an impact on society and life.
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I mean, that is living, surely.
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It is and trust is broken.
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People don't have trust in governments anymore, they don't have trust in tech, they don't have trust in companies.
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So it's time to show that we can rebuild trust with society and that there are companies that are trying to do better and that are not exploiting you or misusing you.
00:23:35.509 --> 00:23:47.102
It became quite apparent when you go to all these tech shows where they show all these gadgets and all these solutions and it looks amazing, but ultimately, who can afford it?
00:23:47.102 --> 00:24:03.711
That's my first question, always because you see aura rings and watch trackers and expensive consultation solutions, which is great for that 5% of society, but 95% of society can't afford those solutions or doesn't have access to them.
00:24:03.711 --> 00:24:23.810
And secondly, lots of these models do not have great values at core or trust, because they're just focused on returns and we need to show people that we can do better and hopefully this is one of many companies that we can show that we have the ability to create better models and better business models.
00:24:24.461 --> 00:24:26.749
Have you come across a book called Small Giants?
00:24:28.361 --> 00:24:29.846
I've heard of it, but I haven't read it.
00:24:30.759 --> 00:24:42.051
I'll send you a link to it after the podcast, but it talks about exactly what you're describing the fact that companies used to be built for the long term and be sustainable and have a positive impact on society.
00:24:42.051 --> 00:24:45.484
Not all of them, of course, but there are case studies through the book of different examples.
00:24:45.826 --> 00:24:46.648
I'd love to read it.
00:24:46.648 --> 00:25:00.210
And then there are some good companies Patagonia, wikipedia, tony Chocolonely there's loads of companies popping up that are really thinking about new models to create a better world.
00:25:00.210 --> 00:25:03.051
We just don't see it so much in digital health apps yet.
00:25:03.673 --> 00:25:06.214
You know the scale of these digital giants now.
00:25:06.214 --> 00:25:09.616
It's almost like they have more potential to influence society than the government.
00:25:10.819 --> 00:25:11.019
Absolutely.
00:25:11.019 --> 00:25:14.509
Our governments are bankrupt and the large tech companies?
00:25:14.509 --> 00:25:29.012
They hold all the power but they have no social responsibility, and that is quite a how do you say that Interesting set up that all the power lies with companies that have no social responsibility?
00:25:29.839 --> 00:25:33.263
Yes, have you tried approaching some of the giants about what you're doing?
00:25:33.825 --> 00:25:35.709
They're actually really supportive.
00:25:35.709 --> 00:25:47.809
So I've spoken to Google, spoken to Apple, and they're actually really supportive of these new technologies the on-device AI giving women the power back to control their own data.
00:25:47.809 --> 00:25:55.671
So, surprisingly, they are looking for solutions as well, and the support has also from these companies, been overwhelming.
00:25:57.420 --> 00:26:00.250
I mean for those founders as well, the Zuckerbergs of this world.
00:26:00.250 --> 00:26:06.989
There must come a point in life where you realize that you know you've got more money than you can ever spend or your family can spend for the next 20 generations.
00:26:06.989 --> 00:26:08.346
What's the purpose of life?
00:26:08.346 --> 00:26:09.221
What am I doing here?
00:26:09.221 --> 00:26:12.007
What am I trying to do with all the stuff that I've built?
00:26:12.548 --> 00:26:13.430
Yeah, exactly yeah.
00:26:13.430 --> 00:26:26.604
And the whole longevity piece I find interesting, where people spend a fortune to make it to 120, which I find quite a narcissistic model, whereas I'd rather drop dead at 80.
00:26:26.604 --> 00:26:30.492
And, given everything, I had to make a slight difference here.
00:26:30.492 --> 00:26:32.279
There will be something in the middle.
00:26:36.467 --> 00:26:46.011
This ties in nicely to thinking about your journey to 28x as well, and I'm always curious as to what drives founders of very successful businesses and your background.
00:26:46.011 --> 00:26:52.070
Can you tell me a bit about your journey and what drove you to your original startup, pregnancy Plus?
00:26:52.632 --> 00:26:53.314
A curiosity.
00:26:53.314 --> 00:27:03.647
So I was working in an advertising agency and my boss was very entrepreneurial and he encouraged everyone in the office to set up companies.
00:27:03.647 --> 00:27:16.237
Alongside 2008, the iPhone was launched and shortly thereafter, the App Store, and I was just super curious if I could build an app that would resonate in the store.
00:27:16.237 --> 00:27:29.844
And so I launched the first app in 2009, early 2009, and was literally one of the first developers launching apps, and it was just curiosity.
00:27:29.844 --> 00:27:30.364
And it was just curiosity.
00:27:30.364 --> 00:27:57.112
And the reason why we chose pregnancy was because I wanted to be in a space that was evergreen, no matter if there's an economic downturn or not, and I wanted to be in a space that was less competitive, so games, for example, were super competitive A lot of money went in Whereas back in the days, in 2009, pregnancy apps was right at the start and there were only a handful of pregnancy apps launched, so it was less competitive.
00:27:57.839 --> 00:28:05.162
How much was it about finding financial independence and how much was it about just curiosity and making it was pure curiosity.
00:28:05.522 --> 00:28:14.746
It was just super cool to be like a publisher and publish those apps and then get the response and I was the first reviews.
00:28:14.746 --> 00:28:24.505
I was thrilled that people say, oh, you made such a difference, loved your app, really made the difference in my pregnancy journey, so it's the excitement of the users that kept me going.
00:28:25.007 --> 00:28:26.832
So tell me a bit about Pregnancy Plus.
00:28:26.832 --> 00:28:28.503
What was it and why was it successful?
00:28:29.066 --> 00:28:31.622
Well, ultimately, there were three companies.
00:28:31.622 --> 00:28:35.394
So the first company I set up was in 2009, which was experimental.
00:28:35.394 --> 00:28:37.020
It was a very simple app.
00:28:37.020 --> 00:28:38.465
I've learned a lot.
00:28:38.465 --> 00:28:43.642
I set it up with a friend, so lesson number one was do not start companies with friends.
00:28:43.642 --> 00:28:47.467
That doesn't work so close.
00:28:47.467 --> 00:29:07.051
And the second app that we launched in the second limited company reached a million downloads, learned a lot from the first, but it wasn't structured well enough in terms of data privacy, security, account handling, because it was all very new and I was very unexperienced.
00:29:07.051 --> 00:29:15.684
So in 2012, I thought, rather than changing the current app that I had, let's start from fresh.
00:29:15.684 --> 00:29:17.130
It's always better to start fresh.
00:29:17.130 --> 00:29:34.653
So the third company that was launched in 2012, which was Pregnancy Plus, was one of the apps in that company and it had all the learnings from the previous two companies, but with a lot better tech, better structures, better legal information in there.
00:29:34.653 --> 00:29:37.367
And that's what we built in 2012.
00:29:37.367 --> 00:29:41.351
And we exited five years later without any external funding.
00:29:43.080 --> 00:29:45.248
And I read you got to 150 million users.
00:29:45.248 --> 00:29:45.670
Is that right?
00:29:46.099 --> 00:29:47.791
To date 150 million users.
00:29:48.538 --> 00:29:48.880
Amazing.
00:29:49.099 --> 00:29:56.034
To put it in context, there is about 10 million pregnancies a year in the whole of North America and Europe altogether.
00:29:56.034 --> 00:30:01.413
So to have 2 million pregnant women a day on the platform, that's huge.
00:30:01.413 --> 00:30:05.872
I believe 70% of all the first-time mums in the UK use Pregnancy Plus today.
00:30:06.859 --> 00:30:09.125
You got to that scale by bootstrapping.
00:30:10.550 --> 00:30:13.449
Yes, I didn't have the funds, to be honest.
00:30:13.449 --> 00:30:17.131
We started with a budget of £10,000, so there was nothing.
00:30:17.131 --> 00:30:27.740
But when I watched women and men use mobile apps, I quickly found out that they they don't discover those apps, mostly in the app stores.
00:30:27.740 --> 00:30:31.619
What happens is someone tells you should download this app.
00:30:31.619 --> 00:30:39.420
So if you look at all the apps on your phone, you'll see that 90% of these apps you've downloaded because someone recommended that app to you.
00:30:39.420 --> 00:30:51.451
So my philosophy was if I make an app that's good enough and that really excites users, then every woman will tell at least another five women to download it.
00:30:51.451 --> 00:30:56.403
And that turned out to be the case, because 90% of our app installs were organic.
00:30:56.403 --> 00:30:58.994
It's just women telling women.
00:30:59.737 --> 00:31:01.922
Focusing on quality was what drove the success.
00:31:02.349 --> 00:31:16.502
It's always because if you can push a product to number one with a lot of marketing budgets, but ultimately it's quality, that gives you long-term retention how are you applying the design lessons from pregnancy plus to 28x?
00:31:17.131 --> 00:31:17.432
a lot.
00:31:17.432 --> 00:31:20.838
You've been basically replicating a lot of what we've done before.
00:31:20.838 --> 00:31:28.780
Of course, tech changes, so we will have updates and into user experiences and and technical.
00:31:28.780 --> 00:31:39.900
But a lot gets reused the way we structure our customer service, the way we localize content in over 100 countries, the way we build the content and validate it.
00:31:39.900 --> 00:31:46.577
So a lot of what we've learned we're just applying again, and that's why it's for me.
00:31:46.577 --> 00:31:59.295
Of course, your choice to work with 28X was because it's another women's health app, so it's quite in a similar space I want to talk a bit about privacy, because this is something that's really important to your, your model.
00:32:00.178 --> 00:32:09.561
After row versus wade, why is data sovereignty important for women's health, and maybe if you could explain a bit about the Roe versus Wade point and why that is relevant.
00:32:17.849 --> 00:32:19.034
So when data lives within an app, it has a password.
00:32:19.034 --> 00:32:19.454
Nobody can get to it.
00:32:19.454 --> 00:32:27.936
But as soon as it lives on a cloud server, then potentially, and especially in the US government can request a company like Flow Health to release that data.
00:32:27.936 --> 00:32:40.694
So if a woman is accused of potentially having an abortion, they can then back that up with data that they get from these companies to prove that there was a gap in their period.
00:32:40.694 --> 00:33:05.040
So women's reproductive data is therefore being weaponized and that period data can be used in court and we must stop storing it in the cloud where it can be solvent or hacked potentially and Roe versus Wade was one of those examples there about how we must be super careful that we give the power of the data back to women.
00:33:05.809 --> 00:33:11.338
So you've got no cloud servers, the data is on the device and you also have on-device AI that you're doing.
00:33:12.070 --> 00:33:14.619
Yes, we're developing that so it will be released in stages.
00:33:14.619 --> 00:33:16.990
We're using tiny language models.
00:33:16.990 --> 00:33:23.344
So you have large language models like TGPT, and they're trained on all the knowledge of the world.
00:33:23.344 --> 00:33:25.617
We have tiny language models.
00:33:25.617 --> 00:33:31.911
They are trained on just 100 health topics language models.
00:33:31.911 --> 00:33:58.261
They are trained on just 100 health topics, so things like obesity and cancers and HPV vaccine and sexual transmitted diseases and endometriosis and PCOS and heavy periods 100 topics and that model knows everything about that in lots of different languages and that is stored and processed within the binary on the device so it doesn't need any links to the internet or to cloud service.
00:33:59.183 --> 00:33:59.364
Wow.
00:34:01.413 --> 00:34:01.755
Pretty cool.
00:34:02.912 --> 00:34:06.659
That's really cool, and what sort of file size does that create?
00:34:07.411 --> 00:34:13.855
Well, currently they're still quite large, but every month that goes by, these models get smaller and smaller.
00:34:13.855 --> 00:34:22.820
So I reckon that in a few years from now, we can serve this in over 200 languages in a quite small binary.
00:34:23.463 --> 00:34:24.023
That's amazing.
00:34:24.023 --> 00:34:34.824
So you can then combine that tiny language model with the health data, the personal health data, and this is all running on the device to give personalized insights.
00:34:34.824 --> 00:34:35.465
Is that right?
00:34:36.329 --> 00:34:38.755
Yes, that's correct, although we are not a medical device.
00:34:38.755 --> 00:34:42.224
So we will educate, but we don't diagnose.
00:34:42.224 --> 00:34:50.965
So what we do is we will serve content based on what's on the device and we will introduce women to a lot of different topics.
00:34:50.965 --> 00:35:10.284
But if they feel they have certain symptoms that we list, we will recommend that they would either visit another website that can go further and deeper For example, endometriosis there's lots of great charities that are really good at taking you to the next level or you should visit your healthcare provider.
00:35:10.284 --> 00:35:14.181
It's information on a general information basis only.
00:35:14.181 --> 00:35:19.719
We just educate on a very high level and then we direct people to the right sources.
00:35:21.530 --> 00:35:25.222
How would you summarize your approach to ethical technology in practice?
00:35:26.510 --> 00:35:30.599
It means asking not just can we build it, should we build it?
00:35:30.599 --> 00:35:40.514
It's building for trust, it's building for transparency and equity and it's not just building for scale and not just building for exploitation.
00:35:41.275 --> 00:35:43.202
And what are some of the barriers to working in that way?
00:35:43.889 --> 00:35:44.570
The business model.
00:35:44.570 --> 00:35:53.224
You need to become quite creative, and if your revenue depends on selling data, then privacy becomes a problem.
00:35:53.224 --> 00:35:55.918
So you can't bolt on ethics later.
00:35:55.918 --> 00:35:58.097
You have to think of it upfront.
00:35:58.097 --> 00:36:03.282
So it requires a bit more thinking time to get the business model right.
00:36:03.282 --> 00:36:16.929
But I challenge companies to go to that next stage because you can actually work out quite some cool models if you spend a bit longer on what should really be there in the first place.
00:36:16.929 --> 00:36:19.077
It's not about sainthood, it's just about standards.
00:36:24.550 --> 00:36:33.605
One of the factors that's influenced your success I'm speculating is the fact that you've taken a very human-centered approach to your business design and to your product design.
00:36:33.605 --> 00:36:41.871
You've previously said stressing over your customers is key, and I wondered how you maintain that obsession at the scale you're working.
00:36:42.954 --> 00:36:48.632
I think every CEO should spend at least one hour a week reading customer support tickets.
00:36:48.632 --> 00:36:54.003
No matter how big your company is, you have to stay very close to the user.
00:36:54.003 --> 00:36:55.074
You have to feel the pain.
00:36:55.074 --> 00:36:58.920
I always spent at least an hour a week reading customer service tickets.
00:36:58.920 --> 00:37:10.943
With Pregnancy Plus, one woman would email me saying she lost her pregnancy diary, that she meticulously been entering into the app over the last six months and she lost her data.
00:37:10.943 --> 00:37:18.916
That was incredibly painful to read and I would literally walk over to the developers and say could you please solve this as quick as possible?
00:37:18.916 --> 00:37:20.378
Try to find their data?
00:37:20.378 --> 00:37:22.311
What is the cause of this problem?
00:37:22.311 --> 00:37:24.335
How can we show this never happens again?
00:37:24.335 --> 00:37:33.882
If you do not read them personally, it just becomes another JIRA ticket for the developers to solve and there's no emotional connection.
00:37:33.882 --> 00:37:48.532
And the other thing I recommend is do in our case, we do school workshops or we test across different literacy levels there's lots that you can do to stay very close through the broader group of your users, through the broader group of your users?
00:37:48.552 --> 00:37:51.541
And what do you do around discovery research when you're trying to work out?
00:37:51.541 --> 00:37:55.096
Well, which direction should we go with this feature or the broader strategy?
00:37:56.889 --> 00:38:03.478
Well, user testing is key and user testing on diverse audiences is key and really listening to your audience.
00:38:03.478 --> 00:38:05.637
But it's pretty standard.
00:38:05.637 --> 00:38:07.217
I think a lot of companies do that.
00:38:07.217 --> 00:38:10.114
I think they've got a good feel of what women want.
00:38:10.114 --> 00:38:14.423
It just sometimes doesn't get executed because it doesn't work with the business model.
00:38:14.423 --> 00:38:18.139
For example, a minority language might not be profitable.
00:38:18.630 --> 00:38:22.561
At what points do you involve customers or your users in the design of the service?
00:38:23.389 --> 00:38:24.032
Oh, from the beginning.
00:38:24.032 --> 00:38:27.440
So it is new app even with the Figma files that we created.
00:38:27.440 --> 00:38:39.518
So before there is even an app, you create those layouts and the designs and we already user test that with a diverse audience to see do you like what we've built so far?
00:38:39.518 --> 00:38:42.934
You can't start early enough because it can't slow down your.
00:38:42.934 --> 00:38:45.777
You have to build it in because it can't slow down your development process.
00:38:45.777 --> 00:38:47.777
You do that at stages and different sprints.
00:38:48.550 --> 00:38:50.157
Do you work in an agile process?
00:38:50.157 --> 00:38:59.101
Yes, we often work alongside development teams and one of the challenges is integrating research in the right way alongside that agile development process.
00:38:59.101 --> 00:39:00.226
What's worked for you?
00:39:00.648 --> 00:39:09.817
We've been having conversations with various stakeholders and we did a lot of user testing almost a full year before we started the actual product development.
00:39:09.817 --> 00:39:21.780
So, again, because we were not VC backed, there is no time pressure, so we had the full year to explore a lot of different scenarios before we actually start building.
00:39:21.780 --> 00:39:26.177
Because once you start building, these alterations are really hard to make.
00:39:26.177 --> 00:39:29.731
So the more time you spend upfront, the better it is.
00:39:30.532 --> 00:39:33.275
A year of design before build is pretty unusual in this world.
00:39:33.996 --> 00:39:39.282
Yes, but because we are here to make a change, not to make some quick money in the first few months.
00:39:39.282 --> 00:39:40.804
We want to get it right.
00:39:40.804 --> 00:39:41.885
You have to take that time.
00:39:44.911 --> 00:39:49.036
Can you describe an example of something you learned through that process that significantly influenced the business model or the service design?
00:39:55.771 --> 00:39:57.356
Yeah, we watched how girls would use the current apps, for example.
00:39:57.356 --> 00:40:15.257
So all the current period trackers have a circle and a date at the front of their screen and we noticed that girls were incredibly embarrassed when they would open that at school or in the bus or in the train, or even women like myself, when there's a business meeting, you do not open your period tracker openly and look when your next period is due.
00:40:15.257 --> 00:40:28.302
So we felt we needed to change the way the front page worked to make it accessible to women and they were comfortable opening it wherever they are, at any time without feeling embarrassed.
00:40:28.302 --> 00:40:36.943
So that was one of the observations we had, because we were watching how women use these period trackers on a day-to-day basis.
00:40:37.829 --> 00:40:41.601
Is that a symbol that's become known as a period tracker app, this circle you mentioned?
00:40:42.130 --> 00:40:58.641
Yeah, the current model is some sort of egg timer that they have on the front, which is some sort of countdown system, which I think is incredibly technical and definitely not suitable for 12-year-old girls, and we also noticed that when we did testing at schools that they're confused about that.
00:40:58.641 --> 00:41:02.300
And these apps quite often display colors as well.
00:41:02.300 --> 00:41:08.496
So they have red when women are on their period and then green when they're fertile and gray in between.
00:41:08.496 --> 00:41:16.503
And then these girls who are 14, 15 years old they think, oh, it's gray, so I'm not fertile, so I can have unprotected sex.
00:41:16.503 --> 00:41:20.664
And then they forget that sperm can live eight days and they get pregnant.
00:41:20.664 --> 00:41:25.177
And it's incredibly sad that it's displayed as some sort of traffic light.
00:41:25.177 --> 00:41:26.900
Women are not binary.
00:41:26.900 --> 00:41:34.057
If you're ill or you're stressed, your period is delayed or early and you can't rely on a traffic light system.
00:41:34.057 --> 00:41:36.362
But there's a lot of education to do there.
00:41:37.010 --> 00:41:43.137
How did you discover women wanted content like can I paint my nails while pregnant, as well as serious health information?
00:41:43.809 --> 00:41:44.271
It's funny.
00:41:44.271 --> 00:41:47.576
Ultimately, humans like to be entertained.
00:41:47.576 --> 00:41:53.704
So if your app only has serious content, people get quickly bored.
00:41:53.704 --> 00:41:56.117
And you see that in magazines as well.
00:41:56.117 --> 00:42:02.820
People want the gossip, they want the glamour, and then amongst that they are happy to read some serious content.
00:42:02.820 --> 00:42:13.405
So in Pregnancy Plus we discovered that if you have a healthy mix of fun articles and serious articles, your retention engagement is much bigger.
00:42:13.405 --> 00:42:24.019
So we have, as you said indeed we have articles on can I still paint my nails when I'm pregnant, or what if my mother-in-law doesn't like the baby name that I'm going to choose?
00:42:24.019 --> 00:42:25.463
Can I still have a tattoo?
00:42:25.463 --> 00:42:32.833
These are not really essential health articles, but they are questions and people love reading about them.
00:42:32.833 --> 00:42:40.876
But then every sixth article is a serious one on gestational diabetes or preeclampsia or mental health and pregnancy.
00:42:40.876 --> 00:42:45.192
So they consume the serious content amongst the fun articles.
00:42:45.192 --> 00:42:47.315
And it's how life works.
00:42:47.315 --> 00:42:51.603
People ultimately want to learn, but they also want to be entertained.
00:42:52.610 --> 00:42:58.918
So those topics, was that through doing kind of keyword research and ad word research so you can find out what are the things people are actually searching for?
00:42:59.550 --> 00:43:13.452
Yes, and we had so much content in the app I think we have 11 million words in Pregnancy Plus and what we did is we ranked all the articles in terms of engagement and then the top 20% articles.
00:43:13.452 --> 00:43:18.041
We would create more of those and then the bottom 20%.
00:43:18.041 --> 00:43:22.302
We would then reconsider if they should be still in the app and refresh them.
00:43:22.302 --> 00:43:28.498
So it was almost a constant iterating process to find out what users like and don't like.
00:43:28.498 --> 00:43:39.742
So when they say we like the article on can I paint my nails while I'm pregnant, we would then think, oh, if they really like that, they probably also wonder if they can still have a tattoo while they're pregnant.
00:43:39.742 --> 00:43:43.514
So it's building on what they like and what they don't like.
00:43:44.257 --> 00:43:47.835
You mentioned earlier that you're designing for, I think, a nine-year-old reading level.
00:43:47.835 --> 00:43:49.760
How do you test and validate that?
00:43:49.780 --> 00:43:51.907
earlier that you're designing for, I think, a nine-year-old reading level.
00:43:51.907 --> 00:43:53.010
How do you test and validate that?
00:43:53.010 --> 00:43:57.382
There's really good software that can track and evaluate the reading level that you're creating content for.
00:43:57.382 --> 00:44:04.717
But what we do in the app is and we test it, of course, with users but what we do is we set different reading levels in the app.
00:44:04.717 --> 00:44:09.641
So when you're on board, we ask the user what reading style do you prefer?
00:44:10.530 --> 00:44:14.360
Do you prefer very simple text with short sentences and lots of emojis?
00:44:14.360 --> 00:44:21.244
Do you prefer standard text or do you like clinical text, more like clinical and medical terms?
00:44:21.244 --> 00:44:33.771
And we show them three little examples of how the text looks and then you can decide yourself what your preferred reading style is, and then the whole app changes accordingly.
00:44:33.771 --> 00:44:38.019
If you want to change at any point, you can.
00:44:38.019 --> 00:44:39.581
So it's just a setting.
00:44:39.581 --> 00:44:59.601
But what it allows is that if you're dyslectic, or if you maybe just prefer simple text because you're just don't read much, or you prefer seeing images, there's no judgment to what level you choose, and I think that is the freedom that you give users and let them decide how they consume that content.
00:44:59.601 --> 00:45:02.398
Ultimately, it's the same content, it's just written differently.
00:45:07.210 --> 00:45:10.561
One other thing you talked about is you know you're not going for small scale here.
00:45:10.561 --> 00:45:13.500
You're going for over 100 countries and 25 languages.
00:45:13.500 --> 00:45:20.623
How do you design for cultural sensitivity when you're designing for so many different groups?
00:45:22.251 --> 00:45:23.074
We've done that before.
00:45:23.074 --> 00:45:27.038
Pregnancy Plus was in 100 countries, so we'll copy the model like we did.
00:45:27.038 --> 00:45:38.300
So it means that you'll have a lot of local people on the ground who not only support the translations but also the localizations, local customer support, local content edits.
00:45:38.300 --> 00:45:43.081
So there's a lot that we can replicate from what we've done before.
00:45:44.130 --> 00:45:54.083
Have you actively recruited female designers and developers to work on this, because so many apps are developed by men, even the apps that are for women I love your question.
00:45:54.123 --> 00:46:09.442
Yes, our lead coder is a woman and when we are, one day I hope we'll be the biggest peer tracker in the world and then I'd love to see her on stage promoting to other women that they can make an amazing career as a coder or a lead engineer.
00:46:09.442 --> 00:46:16.402
So, yes, we have lots of women working and I also made sure I believe 70% of our cap table are women.
00:46:16.402 --> 00:46:21.155
We were quite quickly oversubscribed with men and then my partner.
00:46:21.155 --> 00:46:24.938
He said Amber, do you realize that it's all men on your cap table?
00:46:24.938 --> 00:46:26.242
And I said you're right.
00:46:26.242 --> 00:46:27.394
He said well, you can't have that.
00:46:27.394 --> 00:46:29.958
You need women to support you.
00:46:29.958 --> 00:46:31.452
So then we went back.
00:46:31.452 --> 00:46:42.940
I did 60 calls with incredible women in the industry and we got a lot of them now as our investors and I'm super proud that the majority of our cap table is a high majority is women.
00:46:43.869 --> 00:46:46.179
I want to zoom out a bit and think about the sector as a whole.
00:46:46.179 --> 00:46:49.612
You've mentioned that we don't really educate people to be entrepreneurs.
00:46:49.612 --> 00:46:51.735
What do you think needs to change in education?
00:46:52.436 --> 00:46:55.878
We don't teach system thinking or resilience.
00:46:55.878 --> 00:46:57.159
We train employees.
00:46:57.159 --> 00:46:59.141
We don't train problem solvers.
00:46:59.141 --> 00:47:03.505
We educate that there is only one answer right.
00:47:03.505 --> 00:47:06.333
You remember that from school.
00:47:06.333 --> 00:47:10.630
It's either A, b, c or D or there's only one answer that was right when you ask the question.
00:47:10.630 --> 00:47:18.454
That's got to shift, because we need much more creativity if we want to have a place alongside AI in the future.
00:47:18.454 --> 00:47:19.958
The jobs will change.
00:47:19.958 --> 00:47:24.871
We don't train our kids to set up YouTube channels or podcasts.
00:47:24.871 --> 00:47:35.106
Maybe we don't educate our kids to think beyond what's currently there, because everything we teach our kids will probably be done by AI in the future.
00:47:35.106 --> 00:47:49.487
So we really need to create a different way of thinking which is all around problem solving, all around being able to adapt to new situations, about working together, team up, how to build a network.
00:47:51.489 --> 00:47:55.739
These are the skills that we need in the future and thinking about the way we tackle health in the UK.
00:47:55.739 --> 00:48:00.275
If you could wave a magic wand, what's one thing you'd change about the way we tackle health?
00:48:01.820 --> 00:48:05.695
Well, it has nothing to do with my app, it's just my own personal answer.
00:48:05.695 --> 00:48:08.262
I would start a war on sugar.
00:48:08.262 --> 00:48:11.048
We're all addicted to sugar, including me.
00:48:11.048 --> 00:48:23.298
Whether that's the sugar in our bread or in smoothies or anything that has high carbohydrates or sugar contents is incredibly addictive and it causes a big issue.
00:48:23.298 --> 00:48:25.164
It's not that the NHS is broken.
00:48:25.164 --> 00:48:26.813
The nation is broken.
00:48:26.813 --> 00:48:34.398
We are living a very unhealthy lifestyle and I think if we don't start tackling sugar first, we have a very big issue.
00:48:34.398 --> 00:48:54.255
I was at A&E, luckily with my daughter not too serious issue, luckily in the end and we waited there for three, four hours and right in front of us was a big vending machine with Snickers and Mars bars and you just think how did this vending machine enter the NHS waiting room?
00:48:54.255 --> 00:48:57.302
It's so unhealthy to have that sitting there.
00:48:57.710 --> 00:49:00.460
I guess at least they're not selling cigarettes in the hospitals anymore.
00:49:01.610 --> 00:49:02.092
You're right.
00:49:02.092 --> 00:49:05.541
Yeah, that would be hilarious.
00:49:06.811 --> 00:49:07.775
What's next for you, Amber?
00:49:07.775 --> 00:49:08.657
What are you excited about?
00:49:09.771 --> 00:49:11.157
I'm excited about launching this.
00:49:11.157 --> 00:49:15.001
I'm excited about creating the biggest women's health app on the planet.
00:49:15.001 --> 00:49:32.373
I like to do things large because only then we can make a difference, and I'm excited that once we are up to speed, we could potentially have a user base of 100 million monthly active users, which is a voice, and that means that we can really change some opinions.
00:49:32.373 --> 00:49:40.858
We can change education, bring it to a higher level, but we also can do really cool things like menstrual stem cell donation.
00:49:40.858 --> 00:49:49.072
Women, when they're on their period, they're shedding blood and there's stem cells in there and which can be used for regenerative medicine.
00:49:49.072 --> 00:49:55.840
I'd love to contribute to to stem cell donation, just like people now donate their blood for blood transfusions.
00:49:56.300 --> 00:50:07.371
So there's so many cool things we can do, but that's in the work in the lower middle eastern countries the question I'd like to end on is there something you know to be true but that others might not agree with?
00:50:07.371 --> 00:50:09.534
So this doesn't have to be related to health and care.
00:50:09.534 --> 00:50:18.402
Previous guests have talked about everything from non-human intelligence in hearings in the US Congress to ways to build better culture in big organisations.
00:50:18.402 --> 00:50:20.514
Is there something that's pertinent to you?
00:50:21.094 --> 00:50:22.237
Interesting question.
00:50:22.237 --> 00:50:31.724
I don't believe that data equals money and therefore is justified to be harvested in any form or way.
00:50:31.724 --> 00:50:36.422
So in the last 20 years, we were led to believe that data is money.
00:50:36.422 --> 00:50:52.036
A lot of business plans and startups have been funded based on that belief and some health apps, for example, have hundreds of millions of users on their platform and claim they need all of that data to optimize the algorithms, and I fundamentally disagree.
00:50:52.630 --> 00:50:58.222
What these platforms really need is an honest conversation with their users about trust and choice.
00:50:58.222 --> 00:51:06.298
Because these platforms they kind of use the veil of personalization and accuracy to justify mass data harvesting.
00:51:06.298 --> 00:51:14.563
Because, let's be clear, those algorithms they don't require millions of users' intimate health data to work well.
00:51:14.563 --> 00:51:19.581
In fact, they can run beautifully on just 1% of voluntary donated data.
00:51:19.581 --> 00:51:26.284
So what these platforms are really doing and these health tech companies are building ad tech, advertising tech.
00:51:26.284 --> 00:51:32.592
They're not building health tech tag, advertising tag they're not building health tag.
00:51:32.592 --> 00:51:42.282
So at 28X, we've chosen a different path, where we process all the data on device and not in a cloud, because we fundamentally believe that your body, a woman's body, should never be a business model.
00:51:43.550 --> 00:51:45.054
Amber, it's been a pleasure talking to you.
00:51:45.054 --> 00:51:47.360
Thanks so much for taking the time to join us today.
00:51:47.849 --> 00:51:49.134
Thank you so much for having me.
00:51:49.134 --> 00:52:04.074
It's been a brilliant conversation and I really hope that I've inspired some other people to either start a similar journey or maybe contact me on LinkedIn if you want to be part of our ambassador network to show that we can build tech for good.
00:52:14.583 --> 00:52:22.880
Problems Worth Solving is brought to you by Healthier, the collaborative service design consultancy for transformation in health care and public services.
00:52:22.880 --> 00:52:28.951
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