Progress toward overcoming barriers

Historically, women’s health in global settings has been under-researched and underfunded.1 The damaging consequences of this include maternal deaths from preventable causes; chronic diseases that go undiagnosed or poorly managed for years; and a lack of affordable, accessible tools that reflect women’s lived realities and preferences across their lifespans.23

We know the fundamental changes that are required in study design and systems to substantially improve women’s health. First, the data must be improved. In October 2023, the US National Institutes of Health (NIH) and the Gates Foundation supported the launch of the Innovation Equity Forum (IEF), bringing together over 250 global experts to identify 50 high impact research opportunities. This resulted in publication of the Women’s Health Innovation Opportunity Map 2023,4 which highlighted persistent data gaps—most notably that women worldwide are still under-represented in clinical trials relative to disease prevalence, and that sex disaggregated outcomes are often not reported. Addressing these issues will also require updates to academic curriculums to better prepare researchers to generate and apply inclusive evidence.4

Second, health systems must centre women not just as beneficiaries, but as builders of healthcare ecosystems that affect their lives. Health programmes, services, research, and innovations that are designed without the input of women—especially those in underserved communities—often fail to meet their needs. Participatory approaches ensure relevance, increase adoption, and strengthen impact.

Third, research and healthcare need more women in the talent pipeline—from the laboratories and clinics to academia, in leadership, and beyond. To do that, educational institutions must create environments that encourage girls to enter the sciences and nurture female leaders whose lived experiences can inform their work.

Investments to unlock progress

In addition, funding for women’s health has not kept pace with their needs. Globally, 1% of research and development funding is allocated to female specific conditions beyond oncology, and conditions that mostly affect women receive disproportionately low funding relative to their burden.5 For example, between 2013 and 2023 only 8.8% of NIH funded research focused exclusively on women—even though women compose more than half the population and experience higher burden from several diseases.6 There are signs of increasing investment, particularly in high income countries. Between 2018 and 2023, venture capital investment in women’s health grew by 300% but still only represents 2% of all venture capital health investments.7 We need more investment capital and for it to be distributed more widely to all areas of women’s needs.

Philanthropic support of women’s health can be catalytic. At the Gates Foundation, our recent research and development investments show strong potential for meeting women’s needs in low and middle income countries. These investments include a lower cost hormonal intrauterine device to treat heavy menstrual bleeding, which negatively affects millions of women globally and contributes to anaemia, and new contraceptive technology such as a subcutaneous injection of depot medroxyprogesterone (DMPA-SC) that can be self-administered.89

Innovation without equity is not innovative

Worldwide, momentum is growing for advancing women’s health through various coalitions and initiatives. Continuing to build this global community and bringing new voices and partners into the fold is key to maintaining urgency amid cuts to government budgets.

The IEF is among the groups continuing to document progress and setbacks globally. In its 2024 progress report on the Women’s Health Innovation Opportunity Map 2023, it cites substantial advances in six areas—such as inclusion of pregnant and lactating people in clinical trials for tuberculosis and new drug approvals for uterine fibroids and polycystic ovary syndrome—but modest or no advances in the rest of the 50 opportunities.10

Despite this uneven progress, one aspect of the report that stands out is collaboration. None of us can do this work alone, and organisations from the UK to Pakistan are proving that working together is essential to drive change globally.

The opportunity map is a guide for anyone interested in investing in women’s health, providing an entry point for collaboration and funding. It also reinforces the vision of women’s health centred on increasing inclusion in research and development, ensuring diverse female populations are represented from the start; demonstrating the potential for new technologies to leapfrog research and care to accelerate insights about women’s health over the lifespan; and advancing women’s leadership in health systems and care.

From these 50 opportunities, the Gates Foundation has prioritised funding research on the basic science of gynaecological health. This is a chronically underfunded area with potential to increase researchers’ knowledge and drive new ways to prevent and treat conditions such as disruptions to the vaginal microbiome, which are linked to increased risk of infections, adverse pregnancy outcomes, and reduced contraceptive efficacy.

The scope for change and progress is large—and gaps in data and policies are substantial—but we also have more knowledge and tools than ever before. The Gates Foundation is partnering with The BMJ to assemble a collection of independent scholarly articles on topics related to women’s health innovation globally. We hope these contributions will further drive the investments and cross-sector collaborations that are needed to create the future that women everywhere deserve.