Doctor G starts off in an uncomfortable position: a medical student with ambitions of becoming an orthopod is forced by family ties and middling exam scores to reluctantly pursue a specialty in gynecology. After mishaps, setbacks, and more than a few dramatic blunders, he sees the error of his former ways and embraces the practice. Doctor G is a Bollywood comedy, and it opened to positive reviews and a solid box office performance. But in India, the dire state of gynecology is no joke. The country of 1.4 billion people—now the world’s most populous—has around 70,000 gynecologists. If India has around 670 million women—less than 50% of the population due to skewed gender ratios—that means there are maybe 0.1 gynecologists for every 1,000 women in the country, a ratio even lower than that of the US (0.2 gynecologists for every 1,000 women), where concerns over declining gynecologist numbers are running high. When you consider that most gynecologists are concentrated in metropolises like Delhi, Mumbai, and Kolkata, the lack of even the simplest gynecological healthcare for many Indian women becomes stark.
One ascendant solution to making healthcare more accessible to Indian women is Pinky Promise, an app that promises “reproductive health on your fingertips” through app-based, software-assisted gynecological consultations, at-home pathology tests, and free symptom checkers, period trackers, and community support chat rooms. Less than two years old, the app has already garnered media coverage and international awards. Pinky Promise was born from the confluence of two factors: rising digital penetration across India and Divya Balaji Kamerkar YC ‘14—a Yalie who saw a problem that needed to be solved.
Kamerkar graduated from Yale in 2014 as an Ecology & Evolutionary Biology major with a certificate from the Global Health Studies Multidisciplinary Academic Program. Though she came in as a student on the verge of studying medicine, she credited Professor Richard Skolnik’s “Essentials of Global Health” for transforming her perspective on health when we spoke. “I was a sophomore, and I was woken up to the realities of social, behavioral, and other determinants of healthcare that are not just biomedical. Combined with my lived experiences as a woman growing up in Delhi, which is inherently unsafe for women, I started viewing women’s access to healthcare as something I’d be very interested in.” In the summer after her junior year, she followed that interest to Tanzania, where she worked as a research fellow in a study on a methadone program for women heroin users that became a published study on the impact of gender-based violence on access to treatment.
For Kamerkar, the impact of gender-based violence is personal and proximate. She grew up in Delhi, two minutes away from the site of the brutal 2012 Nirbhaya case, in which a female student was gang raped and murdered by six men while traveling home one evening. The case, which horrified India and the world, led to significant legal reforms. But Delhi is still ranked India’s most dangerous major metro for women. During a recent trip to India, the consensus among everyone I spoke to about the topic was that the city simply was not safe for single women to travel in.
Graduating in the aftermath of the Nirbhaya case, “it was very important that I went back and did something,” Kamerkar said. After a stint in rural Bihar, she worked for a year at the Delhi Commission for Women, where she lobbied for public safety legislation and became deeply familiar with women’s access to reproductive healthcare, before joining the Bridgespan Group, a nonprofit consultancy where she worked across Sub-Saharan Africa and India on healthcare issues.
Kamerkar credited her time at Bridgespan for spurring her to create Pinky Promise. “Telemedicine is doing so much to bridge barriers that people face when it comes to healthcare, but it’s still not where it’s supposed to be. Smart systems can be built to offer faster, cost-effective, high-quality diagnoses using protocols and data that we know about you. I felt that women could be the first movers and the first adopters of such technology because of the unfortunate social stigma that exists around reproductive healthcare. We are a lot more honest when it comes to our sexual behaviors and practices to a digital system as opposed to even talking to a non-judgemental person. So that was actually the thesis for Pinky Promise. My experience over all these things seeded that idea, and then I was able to work on it at Wharton.”
While Kamerkar was working toward her MBA at Wharton, Pinky Promise ended up winning multiple innovation grants from university programs. The beta version of the app was launched in June of 2021, a month after Kamerkar graduated. Pinky Promise now boasts over 40,000 users and an all-women team of eight. Users of the app pay a 50-rupee fee and answer a 15-minute questionnaire about the symptoms they’re experiencing, which is then sent to one of Pinky Promise’s three in-house gynecologists. The doctors review the questionnaire, check any other available information about the patient, and issue a diagnosis and prescriptions (if needed). The whole process is kept private, fast, and efficient through software assistance on questions, diagnoses, and prescriptions. Besides its consultation service, fee-based pathology tests, and subscription plans for chronic issues, Pinky Promise also offers free period tracking, symptom assessments, and chat rooms, and is seeking to expand into subscription pharmacy services and at-home testing kits for conditions like urinary tract infections. The app is currently available in English and Hindi, and the team has plans to launch in regional languages as well.
Most of the company’s growth has been focused in the “smaller” cities where most urban Indian women live—places like Nagpur (2.4 million), Jabalpur (1.1 million), and Gwalior (1.1 million). Cheap data pricing and equally affordable mobile devices have led to what Kamerkar characterizes as an “explosion” of women who are using smartphones as their main way of searching for information on their reproductive health. “In India in a given month, reproductive healthcare keywords are searched more than 100 million times in English alone,” Kamerkar told me. That’s remarkable given that even though English is India’s lingua franca, it’s barely anyone’s mother tongue. “You have a vast swathe of women who are internet capable, who are aware, who know that they have reproductive healthcare issues, but are not able to access it because most of the gynecologists are concentrated in metros where there are super-specialty centers. That’s the target audience we’re going after right now.”
Kamerkar emphasized that Pinky Promise has also made its way into rural India, where mobile access is less widespread, and women especially may have difficulty getting online. “There’s a lot of word of mouth. Our app offers high quality instant consultations with gynecologists at just 50 rupees, which is just 80 cents. Something like this is a no-brainer. So we’re seeing it spread in rural areas of India because sisters-in-law are sharing their phones with the other younger women in the house, or people are consulting for their mothers on the app.”
Sharing app access can pose problems. In India, as elsewhere, reproductive health remains an oft-untouched, frequently stigmatized topic. When Pinky Promise first launched, Kamerkar remembers concerns about an uninstall rate of 10%, even after women had used the app. “If 20 women downloaded our app, why are two people uninstalling it after getting a diagnosis? And we realized it was because they were sharing devices and they wanted their privacy. So we’ve been very careful about how we communicate with our users, notifications we send, etc.” That caution spills over into the physical world, too. To circumvent stigmas and increase healthcare access, the company offers door-to-door pathology tests and is seeking to expand into more self-conducted tests.
Kamerkar explained that some of the problems they’ve faced are behavioral as much as they are societal. “In general, women have poor health seeking behaviors and a lower tendency to pay for their healthcare, as opposed to men. And this is because we’re so used to seeing our mothers, our sisters, struggle and suffer with chronic pain. They take us to the clinic, but they don’t go themselves. It’s a behavioral reality that we have to contend with.” But once users are hooked, they stay. Kamerkar recalled, with some excitement, a message the Pinky Promise team had gotten from a user the day before we talked. “Yesterday someone messaged us saying, ‘I’ve told all my friends to install Pinky Promise and I will never uninstall it. I love your doctors. Thank you so much!’ And we feel good, because it feels like the hard work pays off.”
The contrast with India’s regular public healthcare system is stark. Kamerkar explained that “if you go to a public health center in a Tier 2 city, there’ll be one female general practitioner, not even a gynecologist. Five people will be sitting around her waiting to be seen. So your ability to get follow-up care is not that present. The average time taken for a consultation in India is two minutes. So we’re reducing the supply side constraint and we’re also evaluating you against very standard protocols, and people are satisfied. We’ve had people in Hindi telling us, ‘Two years ago I had a yeast infection and my doctor asked me three questions and you asked me 15 questions and I’m very happy.’”
Despite the low cost of its consultation services, Kamerkar says that thanks to low customer acquisition costs and high volumes of users, Pinky Promise will grow revenues as its numbers of users increase and turn to the app for more solutions to more complex healthcare needs—solutions that don’t currently exist outside of India’s biggest cities. The company has already grown rapidly thanks to a combination of grit, bootstrapping, and targeting an untouched market looking for what Pinky Promise offers. It was stunning to hear Kamerkar describe her own personal investment of time and energy into the company’s product. “The first 5,000 people that downloaded our app all got calls from me and my colleague Anam Sajan to figure out whether that chatbot/symptom checker experience was even something that made sense to them.” That effort is paying off. Between media coverage, a small group of angel investors, and increased grant funding, the company has gone from a free symptom checker to much more. Kamerkar said, “we have a free symptom checker, we have anonymous chat rooms where every day there are more than a thousand messages, we have a period tracker, we have this whole doctor consultation system that is very novel. There’s nothing like that today.” In the future, Kamerkar envisions Pinky Promise going even further beyond the vital but basic steps of symptom checks and 50-rupee consultations. “It’ll be all your healthcare requirements in one place for women.”
Goodbye, Doctor G; Pinky Promise will see you now.