Cairo – Cultural taboos and a lack of understanding can be a barrier for women to access healthcare in Egypt, alongside the cost of treatment. But the country's budding femtech sector is creating new pathways to help and inform.
A 2019 study by the independent Egyptian Center for Public Opinion Research (Baseera) found that only 20 percent of Egyptian women are covered by medical insurance.
Aside from emergency services and some essential medicines, including childhood vaccines, health services in Egypt are paid for out of pocket. While private medical insurance is an option, it is out of reach for the average Egyptian household.
With healthcare costs often prohibitive, forgoing seeking advice and treatment is not uncommon.
Technology, including artificial intelligence (AI), can plug the gaps – and in the case of women's health concerns such as those around menstruation, reproductive health and menopause, answer questions women may have been keeping buried for years.
However, users can spot when a bot lacks cultural context – something Nesma Amin wanted to address with her app, Aziza, which she founded in 2023. It focuses on menstruation, a topic still mired in misinformation and taboos in Egypt.
Language is pivotal
"I noticed that most foreign apps only reach a certain group of people who can be comfortable speaking English or speaking on this topic in a certain way – different from what we're used to in our culture," she said.
Spoken Arabic varies greatly across regions, reflecting the individual culture of a country, so while medical information is often delivered in fusha (formal Arabic), this is a far cry from the Egyptian dialect used in daily life.
Sohayla El Fakahany, an Egyptian medical anthropologist whose works focuses on sexual and reproductive health and rights, explains how the use of language is pivotal to delivering information.
"Language and cultural nuance are not simply added features, they are central to whether women and girls feel comfortable engaging with a digital health platform," she said.
"In many contexts, including Egypt, topics such as menstruation, infertility, vaginismus, menopause and sexual pain remain highly stigmatised. If an app uses judgemental, overly clinical or culturally insensitive language, users may disengage – regardless of the quality of the medical information."
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Femtech gains traction
Femtech – a sector which covers a range of women’s health services as well as physical products, from menstrual and fertility trackers to wearable devices to help with chronic conditions – is growing in the country.
For Amin, accessibility was a priority.
"With an Egyptian woman, you will always find that she prioritises her children, education and household needs. All these things come before her health, so it did not feel right at all to have a [paid] subscription [model] or any barriers to our features," she explained.
Her app's features include menstrual and pregnancy trackers as well as the ability to directly answering the user’s questions – and all are attuned to cultural sensitivities.
"A foreign app assumes certain things – that a user is sexually active, and so on. For instance, I've received feedback from our users who say they are glad that notifications are discreet and Aziza doesn’t send notifications or messages that may seem inappropriate."
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She says that feedback from users has been mostly positive, partly because social media had already opened the conversation around reproductive health.
However, she added: "On the ground we faced a lot of pushback, but because I worked in the field before, I know how to deal with these topics on the ground. And I train my team. We take a lot of training on how to handle tough conversations around menstruation, around sexual health, how to talk with young boys and how to talk with men."
Amin works with doctors in designing and developing features in the app, but insists that working with women and girls directly is just as important.
"We have more than 75 student ambassadors. They're also medical students. We focus on training people on the basics of menstruation, basics of self-care and women's health. Every workshop is tailored around a specific need."
Beyond software
The sector goes beyond software, with new physical products on the market too. While pads are more or less the only menstrual product used by the average Egyptian woman, period underwear has begun to appear.
Hatem Elkady, CEO of Shemsi, a Cairo-based period products maker, said: "In Egypt and the wider region, the menstrual care market has been stagnant for decades, dominated by disposable pads.
"While internal products like menstrual cups and tampons face strong cultural resistance and taboos, traditional pads bring their own set of challenges, like skin irritation and constant anxiety over leaks."
The data on tampon use in Egypt is limited, as large-scale reproductive health studies in the country chiefly focus on pad and pantyliner use. Small, local pharmacies seldom sell tampons and even larger chain pharmacies tend to display them less prominently.
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The driving force behind the continued market domination of sanitary towels is the stigma around loss of virginity. Unmarried women are warned that inserting any objects could compromise the hymen. Even after marriage, disdain for tampons persists.
According to Elkady, wearable period care assuages some of these fears – but not all.
"In a society conditioned for generations to believe that menstrual hygiene must be disposable, introducing reusable period underwear was met with a lot of initial scepticism. Women wondered, will it truly absorb? Is it hygienic? Will it leak? We overcame this by focusing heavily on transparency, open conversations and community education."
Budget constraints
Shemsi presents the fact that its products are environmentally friendly as a benefit, along with, crucially, their value for money – due to the fact that they are reused.
"They are designed to be washed easily alongside regular laundry and can be reused for up to 300 washes per garment," said Elkady.
However, while a large pack of pads costs roughly $2 (USD) in Egypt, a pair of Shemsi underwear is closer to $14 – a difference in initial outlay that could deter women on a tight budget.
"We understand that this initial upfront investment can be a shift for families during current economic times. To ensure our sustainable solutions are accessible to everyone and to ease the immediate financial burden, we offer flexible payment options, including instalment plans. This allows families to make a one-time investment in their health and budget without financial stress," says Elkady.
For El Fakahany, this recognition of the reality of women's lives is essential to success for companies in the sector.
"When women feel that a platform reflects their lived experiences and communicates with empathy and respect, they are more likely to trust it, continue using it and act on the health information it provides."