Ten years ago, we were reeling from a recession in the U.S., the Affordable Care Act was a complex healthcare reform plan making its way through Capitol Hill, and the ‘octomom’ propelled IVF into global headlines. Only 37% of companies offered healthcare coverage for a same-sex domestic partner, and in terms of women’s health, the most commonly offered benefit was contraceptive coverage, with just 68% of companies covering the cost. From her office in London, our founder and CEO Kate Ryder was working in venture capital wondering why more healthcare technology companies weren’t focused on the needs of women and families.

Join us as we reflect on all that has changed and where we still need to push for progress since the last time we turned the page on a new decade.

A decade of highs and lows

Employer maternity costs rose by 50 percent in the last decade, fueled by the rising C-section rate in the U.S.

Maternity spend is typically one of the top three healthcare costs for employers, based on our experience, and the latest research reveals that these costs have climbed by 50 percent since 2008. This is part of overall growth in annual premiums for employer-provided healthcare benefits, which hit a record high in 2019 at $20,576 with employers bearing 71% of that cost, on average—compared with $13,770 ten years ago. But the reason that maternity spend is on the rise is in large part due to the growing number of C-sections. In the U.S., approximately one-third of babies are born via C-section, while the World Health Organization recommends a rate closer to 10-15 percent. Of the C-sections in the U.S., research suggests that nearly half of these are not medically necessary. Layer on top of this the reality that C-sections are not linked to better health outcomes for women or babies. So, what does this mean? Aside from driving up costs for employers and individuals, the increase in unnecessary C-sections points to the need to equip women with better access to information and holistic care during pregnancy to help them manage any risks, create their own birth plans, guide them to physicians and hospitals with lower C-section rates, and empower them with the right questions to raise as they consider the best delivery option for them.

Egg freezing is no longer considered experimental, and egg freezing benefits have gone from controversial to in-demand

Two years after the American Society of Reproductive Medicine declared egg freezing safe and legal in 2012, lifting the ‘experimental’ label, Facebook and Apple stirred controversy when they rolled out a new reimbursement benefit covering the procedure. "Surely what they meant to say was, 'We want women at Apple to spend more of their lives working for us without a family to distract them,'" Jessica Cussins of the Center for Genetics and Society wrote in a Huffington Post editorial. But since then, egg freezing has become more widely understood and embraced by employers as a key offering within a broader fertility benefit to empower women. Today, egg freezing benefits are in high demand by employees as it grows in popularity. According to the Society for Assisted Reproductive Technology, in 2009, 475 women froze their eggs, compared with nearly 11,000 women in 2017.

Companies are leading the way with progressive parental leave policies, despite continued debates at the federal level

Employers are filling gaps left by the lack of a paid federal leave policy and the patchwork of local and state laws. Over the last decade, global employers have taken steps to demonstrate their commitment to families: increasing paid parental leave policies, improving lactation rooms, and offering adoption, egg freezing, and fertility benefits. We’re also seeing a marked shift away from implementing policies or benefits that are limited to a mom or from defining policies for a designated “primary caregiver”. In fact, 40% of U.S. employers now offer gender-neutral paid parental leave, up from about 25% in 2015. As the new Great Place to Work 2019 Best Workplaces for Parents reveals, the top companies for working parents are doing more than just offering paid parental leave—they’re taking a holistic view of supporting new parents including through adoption, flexible schedule, childcare, and dependent healthcare benefits.

Gay marriage is legal in the U.S. as of 2015 and while discrimination against LGBTQIA+ individuals and parents remains, we have made some impressive advancements for inclusion

It’s hard to believe that same-sex marriage was not legal in the U.S. a decade ago—it was just passed in the landmark Supreme Court decision in 2015. In a separate decision two years later, the Supreme Court clarified that same-sex parents deserved equal treatment, specifically through state-issued parent birth certificates for children born to same-sex spouses. Yet, there are state laws that embed discrimination against LGBTQIA+ couples and individuals when it comes to adoption and foster care, as well as for diverse paths to parenthood like surrogacy, which is illegal in New York but legal in California. While these limitations in parental rights have gained attention in recent years, employers are implementing benefits that are far more inclusive for all paths to parenthood than any federal or state policies, and the top companies are creating cultures that empower everyone to be their full selves at work.

Maternal mortality rates have worsened in the U.S., reaching crisis levels for black women, directing much-needed attention on improving access to postpartum care

The maternal mortality rate in the U.S. has been climbing over the past 30 years. More than half of these deaths and near-deaths are from preventable causes, highlighting the need for better access to comprehensive postpartum care focused on mothers. What is most alarming is that African American women are four times more likely to die during or after delivery compared with white women. In recent years, the experiences of prominent black women (including Serena Williams who nearly died after the birth of her daughter, Olympia) have helped to shine a light on the real stories behind these dire statistics, the significant gaps in postpartum care, and the role that unconscious bias plays in screening, treating, and even listening to women following delivery.

Digital health startups exploded onto the scene

2014 was deemed “The Year Digital Health Broke Out” by Startup Health, after a record year for venture funding to startups. Indeed, for us, 2014 was a big year: Kate Ryder founded Maven to transform women’s health by creating a digital solution with women and families at the center. “There aren’t many women’s healthcare companies in the market (yet), so we have the competitive advantage of being an early mover in the space,” Kate Ryder said in 2017 in an interview. Now, as we enter 2020, just as Maven has grown exponentially over the last five years to cover every path to parenthood with holistic care, the market for women’s health startups has expanded in amazing ways as well, covering everything from smart tampons that help to diagnose endometriosis to at-home fertility tests and so much more. Alongside this, venture funding for women-led businesses is continuing to grow as well: it’s up 15x compared with 2010.

There’s been a shift in understanding mental health as a critical part of overall physical health and well-being

As a society, we’re talking openly about mental health—with celebrities and athletes like Olympian Michael Phelps opening up about struggles with depression or anxiety and advocating for awareness. The healthcare industry has also made strides in acknowledging the importance of mental health as a key driver of overall health, and in improving access to mental health care through telemedicine and digital health solutions like Maven. Importantly, over the last few years, employers have also stepped up to improve access by covering mental health costs for their employees to improve employee satisfaction, drive outcomes, and reduce absenteeism. Recent studies dedicated to mental health in the workplace have supported this approach, including a global study led by the World Health Organization that shows a return of $4 for every $1 invested by employers in mental health treatment.

The fight for reproductive rights continues to rage on

The last decade has seen a multitude of federal and state policy battles over reproductive rights, leading to a growing gap in access, services, and support for basic women’s health needs, including preventive care and birth control, which hits low-income and rural women hardest. As federal funding restrictions under Title X have tightened, women are being left without access to essential services like breast and pelvic exams, STD screenings, pregnancy testing, and prenatal and postpartum care. In rural areas, where hospitals are shuttering at an alarming rate, access is especially dire: fewer than half of all rural counties have a practicing obstetrician or gynecologist. As these issues play out through legal battles and in the courts, we’ll continue to see women facing longer wait times, increased costs, and reduced access to reproductive health services.

Looking ahead to 2020

We’re experiencing some déjà vu from a decade ago as healthcare reform and reproductive rights are once again a hot topic for the 2020 U.S. presidential election. One of our main predictions for the year ahead? We expect conversations around paid parental leave to reach a breaking point. Momentum is already building after the U.S. federal government—the country’s largest employer with 2.1 million employees—is poised to enact 12 weeks paid parental leave after passing in the House and Senate. We’ll also see more employers invest in supporting parents through the critical return-to-work transition and beyond as they navigate the realities of working parenthood, and spearhead efforts to train managers and workforces to be more supportive and inclusive for all families.

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