I did not begin by asking how to invest in women’s health. I began with a diagnosis.
A woman I once admired had died shortly after undergoing surgery for fibroids. So decades later, when I received the same diagnosis, the word carried more than its clinical meaning. It carried a memory. I wanted to understand my options, and that search sent me down a rabbit hole that yielded more questions than answers.
Many years later, I discovered Sonata, an incision-free treatment that uses radiofrequency energy to treat certain fibroids. The procedure was developed by Gynesonics.
Learning that an alternative existed was reassuring. But it also raised a more troubling question: why had it been so difficult to find?
As I looked more closely at Gynesonics, I began to understand how long and uncertain the journey from healthcare innovation to patient can be. A company can develop a useful technology, produce strong clinical evidence and secure regulatory approval and still struggle to attract investors, gain adoption among clinicians and reach the patients who might benefit.
The problem was not simply whether better treatments could be invented. It was whether the companies building them could obtain the capital, commercial support and distribution required to survive.
I began to realise that this was also a story about how healthcare innovation is financed. That realisation eventually led me to write The Billion Dollar Blindspot.
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While researching the book, I encountered company after company addressing a different part of the same problem.
Some were trying to shorten the years women waited for a diagnosis. Others were developing treatments for conditions that affected millions of women but had attracted limited research and investment. Some were revisiting diseases in which differences between women and men had been poorly understood. Others had already built products that worked but were struggling to change established clinical practice.
Women’s health was frequently described as underfunded. That was true but it was incomplete. Underfunding described what had happened. It did not tell an investor what was becoming possible or how to participate in it.
Today, women’s health is already a substantial commercial market. PwC estimates that core women’s health and major adjacent conditions represent a global market of approximately $420–470 billion, projected to exceed $600 billion by 2030.
The opportunity extends far beyond fertility and maternal health. It includes conditions unique to women, conditions that affect women disproportionately and conditions that present differently in women. That means looking not only at fibroids, endometriosis, fertility and menopause, but also at cardiovascular disease, autoimmune disorders, migraine, metabolic disease, osteoporosis, dementia and other areas in which sex-specific differences matter.
At the same time, advances in diagnostics, medical devices, drug discovery, data and artificial intelligence are changing what can be detected, treated and delivered.
The gaps remain real. But those gaps are increasingly producing companies with real products, clinical evidence, intellectual property and commercial potential.
Once I became convinced that something important was happening in women’s health, I could not stop at saying that the sector deserved more capital.
I have spent more than 20 years making investment and allocation decisions. During that time, I have assessed more than 1,000 managers and fund opportunities and sponsored more than 90 allocations across public and private markets.
Early in my career at Credit Suisse, I helped build a manager-selection and due-diligence framework that supported allocations to hedge funds, mutual funds and private-market funds. I did not know then how severely that framework would be tested during the 2008 global financial crisis.
The framework held up and I went on to evaluate managers and companies within Credit Suisse’s approximately $100 billion multi-asset-class platform and to structure investment solutions for high-net-worth individuals, family offices and institutional investors.
So as I looked at the women’s health opportunity, the allocator in me began asking a different set of questions.
Should an investor back individual companies, specialist venture funds or some combination of the two?
In a world where the top ~5% of investments drive ~90% of returns and in a world where at the earlier stages (until around Series B) the good companies look a lot like the bad ones, how do you build a portfolio that makes sense?
How many underlying companies would be needed before the portfolio was genuinely diversified and where should an investor accept concentration because it reflects genuine conviction, and where does concentration simply create avoidable risk?
How should exposure be spread across diseases, technologies, scientific disciplines, company stages, regulatory pathways and geographies?
They also became the questions at the heart of the firm we are building.
For the past several months, I have been quietly building Calabar Capital.
Calabar is based on a simple observation: many of the companies shaping the future of women’s health are being built in private markets, but access to them is fragmented.
The relevant companies sit across different clinical disciplines, technologies, stages and geographies. The managers with the deepest access to those companies are similarly dispersed. Even a sophisticated investor would struggle to capture representative opportunity through one direct investment or one venture fund.
Calabar is therefore being designed as a platform that offers access to specialist fund managers, direct co-investments and secondaries from early stage through to pre-IPO. Our focus is women’s health and the healthcare AI and technology infrastructure enabling its development and delivery.
Calabar is currently in formation and we are building it with the same disciplines I used when underwriting another institutional platform: a defined investment process, independent challenge, appropriate governance and an operating structure designed for long-term stewardship.
For me, Calabar is a natural continuation of the work I have done throughout my career: translating complex investment opportunities into structures that sophisticated investors can actually access.
This new chapter will also shape what I write. Here at The Billion Dollar Blindspot, I will continue to write about what is changing in women’s health and why it matters. In my sister publication, Diary of an Allocator, I will write from the other side of the table. It will contain observations from my work of allocating capital over 20 years: what allocators look for when assessing managers, prepare for due diligence and consider an allocation.
Diary of an Allocator will make more of that thinking visible alongside some field notes from my current work at Calabar Capital.
The personal question that began this journey “what options are available to women like me?” eventually became an investment question: “how should capital be allocated to the companies and managers capable of creating better options?
That is the question I am now working to answer through Calabar Capital.
If you want to follow the companies, technologies and market shifts changing women’s health, subscribe to The Billion Dollar Blindspot.
If you want to follow the allocator’s work behind the capital (manager selection, due diligence, portfolio construction, access and the decisions made when the evidence is still incomplete) follow Diary of an Allocator.
If you are an institutional investor or family office considering the role that women’s health and healthcare technology could play in your private-markets portfolio, I’d love to have a conversation.
And if you are a venture manager investing in these areas, I would also love to understand what you are building. Just hit reply.
My new book, The Billion Dollar Blindspot is now available on Amazon and in bookstores.
About Maryann Selfe
Maryann Selfe is an institutional investor and the Founder and Chief Investment Officer of Calabar Capital. She is the author of The Billion Dollar Blindspot and writes about women’s-health investing and capital allocation.
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The Billion Dollar Blindspot is an independent publication. Its content is provided for informational and educational purposes only and does not constitute financial advice, an investment recommendation or an offer to buy or sell any security.