In the newly released 2020 Global Women’s Health Index, Taiwan scores highly in general healthcare and fertility treatment, much remains to be done to improve preventive care.
On September 21, multinational women’s health company Hologic Inc., released the 2020 Hologic Global Women’s Health Index, as part of the Gallup World Poll.
The survey includes data on five dimensions of women’s health: preventive care, emotional health, opinions on health and safety, basic needs, and individual health. According to Hologic, those five factors explain more than 80% of women’s average life expectancy at birth.
Jon McMillan, general manager of Hologic North Asia, a global medical technology company primarily focused on women’s health, notes that Taiwan has set the bar high in terms of healthcare standards for its people and the care it offers through the National Health Insurance scheme, which covers the vast majority of society.
“We’ve been able to offer our solutions to Taiwan for around 20 years thanks to our strong business partnerships and strategic collaboration with the Ministry of Health and Welfare and local governments,” he says.
The global women’s healthcare market is continuously expanding. In 2019, the size of the market was estimated to be around US$35 billion, and it is expected to reach US$41 billion by 2027, according to market research firm Fortune Business Insights.
This projected expansion is driven by several factors, including the growing prevalence of polycystic ovary syndrome (PCOS) and endometriosis, the increasing incidence of women-specific diseases, and changes in individual lifestyles.
Preventive care needed
Despite Taiwan’s major accomplishments in many areas of women’s health, it received a score of just 24 in preventive care, which was measured based on screenings undergone in the past 12 months for cancer, high blood pressure, diabetes, and sexually transmitted diseases/infections.
Taiwan is not alone in its inadequate attention to preventive health. An estimated 1.5 billion women globally have not been tested in the past year for critical diseases, according to the report. The worldwide average score on preventive health was 19 out of 100, and only one in three women are estimated to have had their blood pressure tested in the last year, despite the prevalence of heart disease.
Although there is a potential for more widespread screenings, McMillan stresses that Taiwan is doing impressive work to diagnose and treat breast cancer, which is the second most common cancer globally and the most common cancer among women. The data collected by the government has allowed key stakeholders to make decisions on reimbursement, assess younger age brackets, and provide education on prevention and detection.
“Taiwan is an example that the other markets in the APAC region are looking to in many ways,” he says. “We hosted a delegation last year from Hong Kong with various stakeholders from the government, different legislators, and the breast cancer association, who came to learn about Taiwan’s reimbursement system and breast cancer treatments.”
Due in part to the government’s commitment to expanding the reach of breast cancer screenings, Hologic has made heavy investments in Taiwan during its 20 years on the island, with a primary focus on mammography and cervical cancer diagnostic testing.
“We’re very fortunate in Taiwan because all mammograms are covered by the island’s national health insurance,” says McMillan. “We’ve been able to work with the government and major hospital networks here to get our solutions and platform in place, and we’re expecting continued growth as education and opportunities in the healthcare system continue to expand.”
McMillan is particularly impressed with Taiwan’s effort to make mammograms accessible to all Taiwanese women through the implementation of mammography buses, adding that early detection is a deciding factor for giving patients the best possible outcome.
Improved technology is also driving better screening results. In the last decade, the use of 3D mammograms has enabled an increased detection rate of breast cancer in people with no signs or symptoms of the disease, as well as the investigation of suspicious lumps or thickening of the skin. 3D mammograms also reduce the need for follow-up imaging and improve detection in dense breast tissue.
“We just celebrated our 10th anniversary in the Asia-Pacific with our 3D mammography solution,” says McMillan. “Compared to 2D, it provides more solidified imaging that can give patients a more detailed and earlier diagnosis.”
But while Taiwan’s nationwide breast cancer screening focuses on women over 50, more than 30% of new breast cancer cases in 2017 were found in younger women, according to the Taiwan Breast Cancer Society. In contrast to Taiwan’s screening program, the American Cancer Society advises women to begin annual cancer screenings as early as age 40.
Meanwhile, cervical cancer is one of the most common cancers in Taiwan, a major concern given this type of cancer has a five-year survival rate of just 66%. The human papillomavirus (HPV) is the cause of 70% of all cervical and oropharyngeal cancers and can largely be prevented through vaccination.
Both young men, who spread the virus, and women can be inoculated against HPV, and Taiwan in late 2018 launched a program subsidizing school-based HPV vaccination for girls entering junior high. In 2020, the program achieved a vaccination rate of just 60%, showing that much remains to be done before reaching the World Health Organization (WHO) global target of 90%.
As with any malignancy, the survival rate of cervical cancer increases with early detection. To help with increasing screenings for common diseases in Taiwan, including HPV, Hologic took the opportunity it received during the pandemic to expand its presence at hospitals around the island.
“Over the last few years, we have stepped our focus on the diagnostic front by building relationships with hospitals and thought leaders,” says McMillan. “As we fight COVID-19, we have been very pleased to help by offering our COVID-19 diagnostic tests during this period. The government and CDC are very clear on the direction of testing, and we have been extremely humbled to have the opportunity to bring our testing solution into Taiwan to help.”
This, he continues, has enabled the company to enter numerous major medical centers that they previously lacked a presence in, which will allow Hologic to perform testing in the future for diseases such as hepatitis B, hepatitis C, HPV, and HIV.
IVF on the upswing
Not covered by the Global Women’s Health Index but affecting many women’s health is the increased access to and success rate of in vitro fertilization (IVF). Research shows that the process of assisted reproduction is associated with increased anxiety, depression, and stress for many clients. But while undergoing IVF can be a costly, lengthy, and emotionally overwhelming process, the success rate of IVF procedures is increasing with the introduction of new technology.
The global market for IVF is expected to reach US$31.6 billion by 2027, a significant increase from its estimated market size in 2020 of US$14.2 billion. This projected growth is attributed to increasing cases of male and female infertility and the rise of reproductive tourism – or “reprotourism” – in which women or couples travel to other countries to undergo IVF procedures.
This presents Taiwan with a potentially lucrative opportunity. Taiwan enjoys an international reputation of offering high-quality IVF at competitive rates and has thus become a popular destination for couples looking for reproductive assistance. Taiwan has the second-highest implantation rate globally, while offering prices lower than Hong Kong, China, Japan, Singapore, and the Philippines, prompting many couples from those countries to travel to the island for IVF.
Lee Women’s Hospital, located in Taichung, is a popular choice for reprotourists and has successfully assisted more than 25,000 families from 36 countries conceive with its internationally renowned artificial reproductive technology. The hospital estimates that its reproductive services’ annual total output value is currently around NT$300 million (about US$10.7 million) and is expecting this number to grow.
Lee Women’s Hospital told Taiwan Business TOPICS in a written statement that one in seven women in Taiwan has issues with infertility. “Between 1998 and 2019, the average age of women undergoing artificial reproduction increased by five years,” the hospital noted. “This is a warning sign for future infertility issues because fertility is inversely proportional to age.”
On the other hand, in 2020 more than 5% of the hospital’s female patients under the age of 30 had an alarmingly low egg count, indicating an increase in infertility among younger women as well. Given this trend, many women now choose to freeze their eggs to preserve their fertility.
“We recommend that women freeze their eggs [before turning] 34 years old to increase their chances [of conceiving],” said Lee Women’s Hospital. “This way, women can focus on their career and take their time to find a partner,”
But male fertility is also dropping rapidly and today represents almost half of total infertility cases. The WHO estimates that the standard value of male sperm count has dropped from 60 million three decades ago to 15 million today.
Up to two-thirds of male infertility cases are caused by declining sperm quality, while the rest are mostly due to azoospermia – the absence of sperm caused primarily by hormonal problems, genetic diseases, and chromosomal abnormalities. For this reason, men are also encouraged to freeze their sperm if they plan to have children later in life.
Among the new tools improving IVF success rates is one that Lee Women’s Hospital has recently invested in – an artificial intelligence-powered big data calculation platform that gives each embryo a score and selects the best ones for implantation. According to the hospital, this technology increases the overall pregnancy rate to over 80% and lowers the miscarriage rate to around 5%. “This procedure is good news for many couples,” said Lee Women’s Hospital. “It drastically increases the pregnancy success rate among infertile couples, people with genetic diseases, geriatric patients, and those who are prone to miscarriage. With the continuous improvements of IVF, we expect great future benefits for both Taiwanese and overseas couples.”