lack of research on women's health

Making progress

Despite the late start in studying many aspects of women’s health, there has been progress in increasing the inclusion of women in medical research, says Maria Brooks, PhD, a professor of epidemiology and biostatistics and co-director of the Epidemiology Data Center at the University of Pittsburgh School of Public Health. Brooks leads several national, large-scale studies, including one focused on menopause.

“I’ve been working in the field for a long time, and I’ve seen clear progress over these last 30 years,” she says. “There’s an emphasis on including women, and a focus on health conditions that everybody has but [that] might manifest differently in women than in men.”

However, when it comes to understanding and properly treating disease, there is still ground to cover in order to achieve equity between men and women, and particularly women of color. Experts say these strategies could help move the needle:

Attract and retain a diverse group of women in leadership roles for medical and clinical research.

Celina Yong, MD, the director of Interventional Cardiology at the Palo Alto VA Medical Center and an associate professor at Stanford University, conducted a study analyzing the sex of principal investigators for cardiovascular clinical trials and found that just 18% of the trials were led by women, but those led by women enrolled more female participants.

“For a long time, the field of cardiology has been male-dominated,” Yong says. “But more and more, we’re seeing women pursue the field, which is changing the pipeline for future leadership.”

Incorporate how biological sex differences affect medical care into medical education.

Gulati, who gives lectures at medical schools about sex differences in the heart and in cardiology care, says many students tell her that they are learning about these differences for the first time from her lectures. Often, she says, male biology is still taught as the “default,” and learning about how female biology is different — from organ systems to hormones to cellular differences — is considered “special interest.”

“I think that’s where we can try to solve things,” she says. “In medical education, [students] need to be educated on sex differences, not just about heart disease, [but for] every organ system, there should be a component about what is the same, what differs, and what is unknown. Students need to leave medical school understanding these differences.”

More robust and inclusive research and data collection.

Just eight years ago, in 2016, the NIH instituted a policy that requires researchers with NIH funding to collect data on biological sex differences in preclinical research and animal testing, analyze the data, and report on differences in the findings. According to the policy, “Appropriate analysis and transparent reporting of data by sex may therefore enhance the rigor and applicability of preclinical biomedical research.”

Still, Gulati says there is a lack of accountability when researchers don’t follow through on their commitment to enroll a certain percentage of women in their clinical trials. Though the NIH’s policies have helped move the needle, she thinks there should be measures in place to further progress, such as requiring a pause in the research until the pre-specified number of women are enrolled.

Researchers can make further progress in recruiting women from other underrepresented in research groups (such as those with low socioeconomic status, older women, or those living in rural areas), by designing trials in a way that makes them more flexible and accessible for people with caretaking responsibilities or transportation issues, Brooks says.

It’s a challenge she hopes the field will embrace. “I feel hopeful and confident that, in general, the research community has become aware and is quite dedicated to ensuring that we enroll and retain a broader group of research participants.”

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Ending the neglect of women’s health in research

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• Liisa AM Galea , Treliving family chair in women’s mental health 1 ,
• Rulan S Parekh , professor of medicine and paediatrics 2
• 1 Centre for Addiction and Mental Health, Department of Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, Canada
• 2 Departments of Medicine, Paediatrics, Epidemiology, and Health Policy and Management Evaluation at Women’s College Hospital, Hospital for Sick Children, and University of Toronto, Toronto, Canada
• Correspondence to: L Galea Liisa.Galea{at}camh.ca

Dedicated funding and education for all researchers are urgently needed

The health inequities facing women and gender diverse people are well known. 1 Sex differences exist in both prevalence and manifestation of numerous disorders, 1 making it challenging to diagnose and treat these disorders without recognising sex based disparities. 1 2 3 For example, female patients are more likely than male patients to experience adverse effects from new drugs. 4

In recognition of such differences, as far back as 1993 the US National Institutes of Health (NIH) mandated that women (and ethnically diverse people) should be included in all NIH funded clinical trials. 5 Canadian and European funding agencies also implemented mandates for sex and gender diversity in health research. 6 Despite these efforts, sex and gender related inequalities remain in both research and practice. Leading contributors are the low levels of funding for diseases that disproportionately affect women, 7 8 lack of attention to sex or gender in analyses despite mandates from funding agencies, 5 9 10 and lack of research focused on improving the health …

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Gender bias in medicine and medical research is still putting women’s health at risk

Senior Researcher, University of Auckland, Waipapa Taumata Rau

Disclosure statement

Kelly Burrowes is founder of women’s health technology marketplace FemTech and a Senior Research Fellow at the Auckland Bioengineering Institute.

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University of Auckland, Waipapa Taumata Rau provides funding as a member of The Conversation NZ.

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International Women’s Day celebrates women’s achievements and raises awareness of the continuing mission towards gender equality. So it’s a good time to be reminded we still need to correct decades — centuries even — of gender bias in medicine and medical research.

It’s no secret men and women are different. It’s why we have a whole genre of books and jokes about why “men are from Mars and women are from Venus”.

Mentally, physically and biologically, men and women are simply not built the same way. It sounds obvious, but we have only really begun to understand why.

These differences have not been reflected accurately in the field of medicine. Women’s health has too often been considered a niche area — even though it involves roughly 50% of the world’s population.

Under-researched and under-diagnosed

What we do know is that being female puts us at higher risk of some of the most challenging conditions. Autoimmune diseases, for example, affect approximately 8% of the global population, but 78% of those affected are women .

Females are three times more likely than males to develop rheumatoid arthritis and four times more likely to be diagnosed with multiple sclerosis, an autoimmune disease that attacks the central nervous system .

Women make up two-thirds of people with Alzheimer’s disease, and are three times more likely to have a fatal heart attack than men. Women are at least twice as likely to suffer chronic pain conditions such as fibromyalgia, chronic fatigue syndrome and chronic Lyme disease.

As author Maya Dusenbery made clear in her book “ Doing Harm ”, these conditions are under-researched and often go undiagnosed and untreated.

Different sex, different symptoms

Heart disease is another example where sex — or perhaps sexism — still plays a huge determining factor. Women are less likely to experience the “classic” symptoms of a heart attack — symptoms that were discovered in research led by men, in which most of the participants were men.

Women’s most common heart attack symptom, as with men, is chest pain or discomfort. But women are more likely than men to experience some of the other common symptoms , particularly shortness of breath, nausea, vomiting and back or jaw pain.

Read more: Women's health is better when women have more control in their society

But because the diagnosis method still favours male biology, many women experience a delayed diagnosis or a misdiagnosis.

On average, women are diagnosed with heart disease seven to ten years later than men. This often results in other chronic diseases being prevalent by the time of the diagnosis.

Male bias affects clinical studies

The reasons for women being this over-representated in some conditions is not clear. But genetic and hormonal factors are likely to be involved. Historically, however, medical research has often excluded women.

In 1977 the US Food and Drug Administration (FDA) recommended women of childbearing age be excluded from clinical research studies. This was to protect the most “vulnerable” populations — unborn children — following the thalidomide scandal .

Read more: Women have heart attacks too, but their symptoms are often dismissed as something else

Another reason given for excluding women in clinical studies is that, depending on where a woman is in her menstrual cycle, the variation of her hormones “complicates” the results. This variability would mean more subjects were needed in clinical trials, thereby increasing costs.

Male-only studies were justified by a belief that what would work for men would also work for women. This erroneous assumption has had catastrophic results.

Every cell in a person’s body has a sex. This means diseases and medications used to treat them will affect women differently — as we have learned, often at a cost to their health.

Eight out of ten of the drugs removed from the US market between 1997 and 2000 were withdrawn because of side effects that occurred mainly or exclusively in women. Between 2004 and 2013, US women suffered more than 2 million drug-related adverse events , compared with 1.3 million for men.

Time to end the gender divide

The lack of recognition of sex differences in biology and medicine is a huge issue research has only recently begun to rectify.

In 1997, the FDA published a rule requiring manufacturers to show evidence of how their drug is safe and affected by age, sex and race.

When last measured in depth in 2016, it was clear there had been significant progress, with women accounting for roughly half of the participants in some clinical trials funded by the US National Institutes of Health ( NIH ).

Read more: NZ's Climate Change Commission needs to account for the huge potential health benefits of reducing emissions

Scientists are now required to account for the possible role of sex as a biological variable in both animal and human studies.

But the lack of funding for women’s health remains a huge issue. According to earlier analysis from the UK , less than 2.5% of publicly-funded research was dedicated to reproductive health. Yet one in three women will suffer from a reproductive or gynaecological health issue.

This means roughly 16% of the population will experience an issue that receives only 2.5% of the annual research budget. Although policies are being implemented to help address the huge gender divide in medicine, there is clearly still a long way to go.

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• New Zealand
• Heart disease
• Autoimmune diseases
• Gender bias
• Women's health

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Closing the women’s health gap: A $1 trillion opportunity to improve lives and economies

Over the past two centuries, the rise in life expectancy—for both men and women—has been a tremendous success story. Global life expectancy increased from 30 years to 73 years between 1800 and 2018. 1 Max Roser, “Twice as long—life expectancy around the world,” Our World in Data , October 8, 2018. But this is not the full picture. Women spend more of their lives in poor health and with degrees of disability (the “health span” rather than the “life span”). A woman will spend an average of nine years in poor health, which affects her ability to be present and/or productive at home, in the workforce, and in the community and reduces her earning potential (see sidebar “Terminology used in this report”).

Terminology used in this report

This report reflects women’s health as a market segment. The authors acknowledge the importance of healthcare to the transgender, nonbinary, and gender-fluid communities and that not all people who identify as women are born biologically female.

The authors have often used the term “sex and gender” to reflect inclusive language and recognize the need for future research into health issues that is inclusive of the transgender, nonbinary, and gender-fluid communities. They also acknowledge the profound differences for women based on factors such as race, ethnicity, socioeconomic status, disability, age, and sexual orientation. Additional work and research should reflect on how to tackle these barriers alongside the overall women’s health gap.

In this report, the term “woman” includes those under age 18.

Building on previous work from the McKinsey Health Institute and the McKinsey Global Institute, 2 “ Prioritizing health: A prescription for prosperity ,” McKinsey Global Institute, July 8, 2020. analysts quantified this health gap in terms of disability-adjusted life years (DALYs) 3 Global Burden of Disease Collaborative Network, “Global Burden of Disease Study 2019 (GBD 2019),” Institute for Health Metrics and Evaluation (IHME), 2020. and the extent to which this difference results from the structural and systematic barriers women face (see sidebar “Research methodology” ). Addressing the 25 percent more time that women spend in “poor health” relative to men not only would improve the health and lives of millions of women but also could boost the global economy by at least $1 trillion annually by 2040. This estimate is probably conservative, given the historical underreporting and data gaps on women’s health conditions, which undercounts the prevalence and undervalues the health burden of many conditions for women.

Research methodology

Assessment of the women’s health gap and the potential to reduce it

Analysts used the Global Burden of Disease data from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) to forecast disease burdens up to 2040. (The IHME Global Burden of Disease looks at mortality and disability, quantifying health loss from hundreds of diseases, injuries, and risk factors.) The forecast includes diseases leading to death and poor health conditions such as infectious diseases and chronic conditions. Analysts quantified this health gap in terms of disability-adjusted life years (DALYs) and the extent to which this difference results from the structural and systematic barriers women face. DALYs for a disease or health condition are the sum of the years of life lost (YLLs) due to premature mortality and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population.

To gauge how much the disease burden could be reduced, McKinsey thoroughly reviewed clinical evidence for the top 64 diseases affecting women, which account for nearly 86 percent of the global disease burden. 1 Measured in disability-adjusted life years (DALYs), comprising years lived with disability (YLDs) and years of life lost (YLLs). This review focused on around 180 interventions, based on guidelines from leading institutions such as the World Health Organization (WHO) and journals such as The Lancet .

For each intervention related to the 64 diseases, McKinsey examined the following factors:

• identification of potential reduction of morbidity and mortality, 2 Reduction per country, age group, disease, risk factor, year analyzed; measured in deaths, years lived with disability (YLDs), and years of life lost (YLLs). scaled up to all diseases, considering the differences between men and women to identify the women’s health gap
• projection of total population and working population baselines with the expansion from health interventions and labor force capacity interventions
• estimation of the duration to realize the full benefits, considering implementation time and the lag before health benefits appear

Cases with limited adoption data and correlated assumptions are detailed in the technical appendix.

Quantification of the economic impact

To determine the potential economic effects of the proposed health interventions, analysts used population and labor force predictions up to 2040. 3 “Global Burden of Disease Study 2019 (GBD 2019)” IHME; ILO labour force estimates and projections: 1990–2030 , International Labour Organization, November 2017. These health gains were converted into labor force involvement, productivity, and economic gains through four avenues: fewer early deaths, fewer health conditions, extended economic capacity to contribute, and increased productivity. The assumptions for estimating the impacts were based on academic studies and verified by experts.

This analysis acknowledges:

• Disease burden evolution. McKinsey does not forecast disease and acknowledges that unexpected events such as COVID-19 can change projections. The IHME’s disease burden data reflects the best available data.
• Intervention effectiveness. Given that evolving scientific evidence may be inconclusive, the research included input from academic and clinical experts.
• Future innovations. McKinsey focused on advanced-stage technologies and consulted field experts.
• Addressing the women’s health gap. Analysts assumed that if existing interventions are more effective for or more frequently adopted by men, the same rates could be achieved for women. If gender-based efficacy wasn’t monitored, the analysis assumed a similar gender gap to the ones for which data was available.
• Economic implications. The economic analysis makes assumptions about labor market choices—for instance, how age and health affect labor force participation. Evidence such as current labor force statistics and potential labor market changes were considered.
• Data gap. Undercounting and undervaluing of diseases and their health burden on women likely leads to an underestimation of the women’s health gap, both in health and monetary terms. Therefore, the true gap will likely surpass all estimates presented in this report.

Critically, better health is correlated with economic prosperity. The women’s health gap equates to 75 million years of life lost due to poor health or early death per year (Exhibit 1), the equivalent of seven days per woman per year. Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040. This has the potential to lift women out of poverty and allow more women to provide for themselves and their families. Addressing the drivers of this gap—namely, lower effectiveness of treatments for women, worse care delivery, and lack of data—would require substantial investment but also reflect new market opportunities.

While improving women’s health has positive economic outcomes, it is foremost an issue of health equity and inclusivity. Addressing the women’s health gap could improve the quality of life for women, as well as creating positive ripples in society, such as improving future generations’ health and boosting healthy aging.

The challenges women face when seeking healthcare play out in multiple different ways and in different diseases and sectors of society. In terms of the potential economic impact of addressing these challenges, all age groups and geographies could benefit, with most of the potential coming from women of working age (Exhibit 2).

Embracing the full definition of women’s health

Women’s health is often simplified to include only sexual and reproductive health (SRH), which meaningfully underrepresents women’s health burden. This report defines women’s health as covering both sex-specific conditions (for example, endometriosis and menopause) and general health conditions that may affect women differently (higher disease burden) or disproportionately (higher prevalence). 4 Consistent with the National Institutes of Health (NIH); see NIH, “Women’s Health.”

Research shows that SRH and maternal, newborn, and child health (MNCH) account for approximately 5 percent of women’s health burden, 5 “Global Burden of Disease Study 2019 (GBD 2019), IHME.” Used with permission. All rights reserved. although this is probably an underestimate (Exhibit 3). An estimated 56 percent of the burden comes from health conditions that are more prevalent and/or manifest differently in women. The remaining 43 percent stems from conditions that do not affect women disproportionately or differently based on current evidence.

Women are most likely to be affected by a sex-specific condition between the ages of 15 and 50. Other conditions occur throughout women’s lives, but nearly half of the health burden affects women in their working years, which often has an impact on their ability to earn money and support themselves and their families (Exhibit 4).

Pregnancy complications can increase risk for chronic illnesses; for example, gestational hypertension can portend chronic hypertension, 6 “Blood pressure and pregnancy,” Centers for Disease Control and Prevention. and women who have had gestational diabetes have a 50 percent risk of developing type 2 diabetes seven to ten years after the birth of the child. 7 “What is gestational diabetes?,” Joslin Diabetes Center, n.d. Good maternal health helps the mother and baby, with benefits extending beyond pregnancy and birth.

Learn more about how we are accelerating sustainable inclusive growth

Health equity encompasses access to the interventions and options that are right for each individual, regardless of their gender, sex, sexual identity, sexual orientation, age, race, ethnicity, religion, disability, education, income level, or any other distinguishing characteristic. For women, this can start with a better understanding of and access to interventions that lead to the best outcomes.

How to read this report

The analysis presented in this report includes an assessment of the health burden associated with the women’s health gap as measured in potential years of healthy life. This health improvement potential was then translated to economic potential, measured as contribution to gross domestic product (GDP). Sections 2 through 4 of this report focus on health improvement potential (measured in DALYs), broken down by three root causes related to disparities in science, data, and care delivery. The economic value of this combined health improvement potential is presented in section 6, where economic impact is measured in terms of additional GDP.

While this report focuses on the potential economic benefits of closing the women’s health gap, there is also a moral imperative to close the women’s health gap and to improve the lives of millions of women worldwide.

1. The role of science in addressing health disparities

Biomedical innovation builds on the basic understanding of science around body function and the cellular and molecular pathways involved in disease development and progression. Historically, men have both led and been the subject of the study of medicine and biology. 8 “Medical knowledge, including diagnostic criteria, is principally based on a male standard. Women patients’ symptoms are often labelled ‘atypical’, suggesting biases in diagnostic criteria.” L. Galea and R. S. Parekh, “Ending the neglect of women’s health in research,” British Medical Journal , 2023, Volume 381, Number 1303. The majority of animal models have been based on male specimens. 9 I. Zucker and A. K. Beery, “Males still dominate animal studies,” Nature , June 2010. Questions about sex-based differences were rarely investigated or recorded, with the assumption—now known to be false—that there are few important differences in the functioning of organs and systems in men and women beyond reproduction. To understand basic female biology better, fundamentally new research tools should be developed—for example, animal models, computational models, patient avatars and humanized models—that better classify women’s symptoms and manifestations of disease, as opposed to calling those “atypical.” 10 K. J. Schulte and H. N. Mavrovitz, “Myocardial infarction signs and symptoms: Females vs. males,” Cureus , April 2023, Volume 15, Number 4. This represents a tremendous opportunity for the healthcare and life sciences community to improve the lives of women around the world.

Effectiveness of and access to medical therapies may vary

There are well-known cases where women and men experience important differences in the uptake or effectiveness of a medicine designed and approved for use in both sexes. This is true, for example, for some therapies used in asthma and cardiovascular disease. Analysts looked at 183 of the most widely used interventions across 64 health conditions representing roughly 90 percent of the health burden for women, reviewing more than 650 academic papers, to assess the extent of this phenomenon. Of the interventions studied 50 percent reported sex-disaggregated data. In cases where sex-disaggregated data was available, 64 percent of the interventions studied were found to put women at a disadvantage due to lower efficacy, more limited access, or both, while for men this was the case only for 10 percent of interventions (Exhibit 5).

Examples include:

• Asthma is a common respiratory condition affecting men and women at similar prevalence rates. Acute asthma exacerbations present as symptoms such as shortness of breath, wheezing, cough, or chest tightness. 11 University of Washington’s Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease estimates the prevalence rate globally at 3.3 percent for males and 3.5 percent for females in 2019. “Global Burden of Disease Study 2019 (GBD 2019),” IHME, (used with permission); “Acute asthma exacerbation in adults,” BMJ Best Practice , updated November 2, 2023. A mainstay of treatment is inhaler therapy with bronchodilators and corticosteroids, but studies indicate that this treatment is around 20 percentage points less effective in reducing exacerbations in women than in men. 12 Rik J. B. Loymans et al., “Comparative effectiveness of long-term drug treatment strategies to prevent asthma exacerbations: Network meta-analysis,” British Medical Journal , May 2014, Volume 348; K. E. Wells et al., “The relationship between combination inhaled corticosteroid and long-acting β-agonist use and severe asthma exacerbations in a diverse population,” Journal of Allergy and Clinical Immunology , May 2012, Volume 129, Number 5.
• Cardiovascular and cerebrovascular disease—particularly ischemic heart disease and stroke—is the biggest single contributor to disease burden globally for both men and women, accounting for 16 percent of DALYs globally for men and 14 percent for women. 13 Data for 2019. “Global Burden of Disease Study 2019 (GBD 2019)” , IHME, (used with permission). One German study found that, despite identical technical success of a percutaneous cardiac intervention for men and women, the age-adjusted risk of death or of cardiac events was 20 percent higher in women than in men. 14 T. Heer et al., “Sex differences in percutaneous coronary intervention—insights from the coronary angiography and PCI registry of the German Society of Cardiology,” Journal of the American Heart Association , March 2017, Volume 6, Number 3.

Research in women’s health primarily focuses on diseases with high mortality, overlooking diseases leading to disability

One way to assess research priorities is through pipeline assets. There is up to a tenfold higher volume of new therapies in development for some of the most common women’s cancers compared with debilitating gynecological conditions (Exhibit 6). One possible reason is the higher mortality rate of oncologic conditions. The solution is not to trim cancer funding, but to recognize the possibilities for advances in research related to other women’s health conditions—in particular, menopause, premenstrual syndrome, endometriosis, and polycystic ovary syndrome.

Additionally, maternal conditions should receive more attention. Compared with women-specific cancers, they contribute a similar share to overall suffering among women, but there is a large discrepancy in the pipeline of therapies in development. For example, even though postpartum hemorrhage (PPH) is the leading direct preventable cause of maternal mortality in low-income countries (LICs) and low- or middle-income countries (LMICs), only two new medicines shown to be effective in PPH management have been developed over the past 30 years. 15 A roadmap to combat postpartum haemorrhage between 2023 and 2030 , World Health Organization, 2023.

In all, when tackling women’s health, the solution is not to divide more slices of one pie: it’s to make more pie.

How the lack of sex- and gender-specific data and research affects safety

Since 2000, women in the United States have reported total adverse events from approved medicines 52 percent more frequently than men, and serious or fatal events 36 percent more frequently. 16 For adverse events, this was 12.9 million for women versus 8.5 million for men through 2022, according to the Food and Drug Administration Adverse Events Reporting System (FAERS). For serious or fatal events, this was 8.3 million for women versus 6.1 million reports for men. Healthcare professionals in the United States reported 4.4 million serious or fatal events for women, versus 3.8 million for men through 2022. 17 Food and Drug Administration Adverse Events Reporting System. An analysis of all medicines withdrawn for safety reasons—a process that requires objective scientific review—shows that, since 1980, products are 3.5 times more likely to be removed because of safety risks in women patients as compared with men (Exhibit 7).

The research conducted indicates that systematic lack of disease understanding created a women’s health gap of 40 million to 45 million DALYs per year, or four days per woman per year. This is equivalent to around 60 percent of the total gap due to sex-related biology differences (see Exhibit 1 above). This estimate includes the known gap for conditions that affect both sexes and an estimate of the gap represented by the average lower effectiveness for women-specific conditions relative to men. It also includes the “unknown” gap: this is where no sex-disaggregated evidence is available for specific conditions that could, if evidence existed, potentially demonstrate levels of effectiveness difference comparable to conditions where sex-based analysis is available. The longevity of women cannot explain the disparity, and the effectiveness gap has a disproportionate impact on women and girls between ten and 40 years old and in certain regions (Latin America and Central Asia).

Shining a light on the interventions for which this information was not reported would benefit both men and women by enabling innovators to develop interventions that are better suited for specific subpopulations.

2. Data gaps underestimate women’s health burden, limiting innovation and investment

Data can quantify problems and measure the impact of potential solutions. It is the critical ingredient of robust, evidence-based analysis and decision making. Yet many of the epidemiological and clinical data sets widely used today fail to provide a complete picture of women’s health because they undercount and undervalue the health burden. When women’s health is invisible, there are missed opportunities to improve lives, especially for women and girls in vulnerable populations. 18 J. H. Flaskerud and A. M. Nyamathi, “Attaining gender and ethnic diversity in health intervention research: Cultural responsiveness versus resource provision,” Advances in Nursing Science , June 2000, Volume 22, Number 4; M. Agénor et al., “Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: A cross-sectional study,” BMC Public Health , August 2016, Volume 16.

A lack of data also leads to potential underestimation of disease severity and health burden, influencing both the care that women receive and the level of innovation and investment in women’s health. For example, an emerging body of evidence indicates potential gender bias in the measurement of pain, where women’s pain is routinely under-investigated and undertreated, with implications for clinical and psychological outcomes. 19 “Analysis: Women’s pain is routinely underestimated, and gender stereotypes are to blame,” University College London, April 9, 2021; L. L. Zhang et al., “Gender biases in estimation of others’ pain,” Journal of Pain , September 2021, Volume 22, Number 9; D. Glowacki, “Effective pain management and improvements in patients’ outcomes and satisfaction,” Critical Care Nurse , June 2015, Volume 35, Number 3. Collectively, these incomplete data sets can influence decision making and have the potential to exacerbate the women’s health gap.

Gaps exist across the data value chain

Stage 1: pre-data generation.

The data gap starts at the very definition of women’s health. There is a lack of consistent and aligned definitions and measurement scales for conditions and symptoms affecting women. For example, definitions of health-related burden associated with menopause or menstrual syndromes differ, and pain instruments and scales lack consistency.

Stage 2: Data generation

This encompasses both epidemiological and clinical data, including the documentation of women’s specific symptoms and markers for diagnosis. There is little understanding of how some diseases manifest differently in women and a lack of data on the health-related burden associated with some women-specific conditions. For example, in the United States, 4 percent of healthcare-related R&D efforts are targeted specifically at women’s health issues. 20 “ Unlocking opportunities in women’s healthcare ,” McKinsey, February 14, 2022.

Stage 3: Data aggregation

Sex-disaggregated results are available in the public domain for only 50 percent of the interventions analyzed. One study found that a quarter of clinical trials in the United States had sex-disaggregated data. Further, clinical trial designs and end-point selection can fail to consider potential differences between sexes. Evidence for intervention effectiveness may be drawn from unrepresentative populations because researchers did not recruit adequate numbers of women (and minorities). In another study, in 2021, half of countries reported COVID-19 cases and deaths by sex, 14 percent reported COVID-19 hospitalizations by sex, and 10 percent reported COVID-19 intensive-care-unit admissions by sex. 21 The COVID-19 Sex Disaggregated Data Tracker: May update report , Global Health 50:50, May 2021.

Stage 4: Data analysis

The metrics selected for analysis and publication may hide or dilute the experience of specific groups relative to others. Data sets gathered during the digital age have led to growth in machine-learning (ML) algorithms, but neither the data nor the programs applied to it are de facto neutral. Without guardrails to protect equity, this technology could perpetuate structural disparities. Artificial intelligence (AI) experts have suggested that using counterfactual fairness and similar methods can mitigate bias in areas such as race and gender. 22 J. Manyika, J. Silberg, and B. Presten, “What do we do about the biases in AI?,” Harvard Business Review , October 2019; Matt J. Kusner et al., “Counterfactual fairness,” in Advances in Neural Information Processing Systems 30 , ed. I. Guyon et al., NeurIPS Proceedings, 2017.

Women can face barriers to timely and accurate diagnosis

There is evidence of significant and systematic differences in diagnostic assessments between men and women that can affect the accuracy of calculations of the prevalence and burden for several diseases affecting women. A study conducted in Denmark 23 “Across diseases, women are diagnosed later than men,” Faculty of Health and Medical Sciences, University of Copenhagen, news release, March 11, 2019. across 21 years showed that women were diagnosed later than men for more than 700 diseases. For cancer, it took women two and a half more years to be diagnosed. For diabetes, the delay was four and a half years. Analyses of US health records and studies indicate that fewer than half of women living with endometriosis have a documented diagnosis. 24 S. Westwood et al., “Disparities in women with endometriosis regarding access to care, diagnosis, treatment, and management in the United States: A scoping review,” Cureus , May 2023, Volume 15, Number 5; Andrew W. Horne and Philippa T. K. Saunders, “SnapShot: Endometriosis,” Cell , December 2019, Volume 179, Number 7.

Comparisons of endometriosis estimates also indicate unexplained variations. The WHO estimates that around 10 percent of women of reproductive age are living with endometriosis. 25 “Endometriosis,” fact sheet, World Health Organization, March 24, 2023. In contrast, the Global Burden of Disease estimates this figure to be 1 to 2 percent. 26 “Global Burden of Disease Study 2019 (GBD 2019)” IHME, (used with permission). This discrepancy—an eightfold difference—means there could be anywhere from 24 million to 190 million women affected worldwide.

For women, not only does the difficulty in getting a recorded diagnosis create a barrier to care, but the resulting lack of recorded diagnoses filters into how investors or researchers prioritize needs and assess market potential. In endometriosis, the data gap primarily reflects delays in diagnosis, which run to approximately ten years on average. 27 “Endometriosis: Guideline of European Society of Human Reproduction and Embryology,” European Society of Human Reproduction and Embryology, 2022; UK National Institute for Health and Care Excellence (NICE), Endometriosis: Diagnosis and management , NICE Guideline NG73, 2017. This leads to lower research investments: for instance, adenomyosis, the sister and highly co-morbid condition to endometriosis, has received two grants from the National Institutes of Health (NIH) yet affects hundreds of millions of women across the world. In menopause, the challenge is more fundamental. While it is understood that most individuals who are biologically female experience symptoms at some point during the menopause transition, 28 J. A. Clayton, “Sex influences in neurological disorders: Case studies and perspectives,” Dialogues in Clinical Neuroscience , December 2016, Volume 18, Number 4; J. Whiteley et al., “The impact of menopausal symptoms on quality of life, productivity, and economic outcomes,” Journal of Women’s Health , November 2013, Volume 22, Number 11. this is rarely counted or considered within classifications of health and disease. For example, the IHME Global Burden of Disease data set currently captures the health burden associated with menopause within a catch-all category of “other gynecological diseases.” 29 Other gynecological disorders include menstrual disorders and non-menstrual disorders, including absent, scanty, and rare menstruation, pain and other conditions, and inflammatory and non-inflammatory diseases of the breast, ovaries, and cervix. “Other gynecological diseases—level 4 cause,” Global Burden of Disease Summaries, Institute for Health Metrics and Evaluation (IHME), University of Washington, 2019. As a result, it is not possible to identify clearly the underlying prevalence or the symptom severity (or disability weight) associated with menopause in that data set. Furthermore, some of the symptoms experienced during menopause, such as mood swings or depression, are often associated with other conditions, leading to misdiagnosis. 30 Bruce Dorr, “In the misdiagnosis of menopause, what needs to change?,” American Journal of Managed Care , September 14, 2022.

Additionally, there is a lack of data on maternal health overall, especially in LMICs, which can lead to inadequate healthcare services for pregnant women and new mothers. The lack of data obscures the full picture of maternal health needs, making pregnancy and birth more dangerous for women and creating challenges around which interventions or policies to prioritize. The WHO reports that every day in 2020, approximately 800 women died from preventable causes related to pregnancy and childbirth. translating to a death every two minutes. Most of these deaths occur in LMICs. 31 The state of the world’s children 2015 , UNICEF and Partnership for Maternal, Newborn, and Child Health, November 20, 2014; Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division , World Health Organization, February 23, 2023.

Gaps in understanding the effectiveness of health interventions

Case study: covid-19 vaccine development.

The race to develop a COVID-19 vaccine required a massive number of experimental and observational clinical trials. Representation of women was equal to that of men (or better) across trials, but this was not reflected in consistent reporting of sex-specific results. One analysis examined 41 articles on COVID-19 research, of which 35 articles showed safety data, but only 12 of these presented data by sex or gender. 1 Amy Vassallo et al., “Sex and gender in COVID-19 vaccine research: Substantial evidence gaps remain,” Frontiers in Global Women’s Health , November 2021, Volume 2. In a review of 2,500 COVID-19 studies, less than 5 percent of investigators had planned for sex-disaggregated data analysis in their studies. 2 Lavanya Vijayasingham et al., “Sex-disaggregated data in COVID-19 vaccine trials,” Lancet , March 2021, Volume 397. In studies for which adverse effects and sex differences were published, adverse events were more common in women patients. 3 Vassallo et al., “Sex and gender in COVID-19 vaccine research,” November 2021.

One example of the gap in clinical evaluations can be seen in US clinical trials. The Food and Drug Administration (FDA) has issued guidance on gender differences in clinical evaluation of medicines since 1993. 32 US Food and Drug Administration, “Guideline for the study and evaluation of gender differences in the clinical evaluation of drugs,” Federal Register (58 F.R. 39406), July 1993. In clinical trials from 2000 to 2022, women’s participation in oncology trials improved. 33 K. Jenei et al., “The inclusion of women in global oncology drug trials over the past 20 years,” JAMA Oncology , 2021, Volume 7, Number 10. However, a comparison of women’s participation with their share of the disease burden finds that women remain underrepresented in surgical trials for cancers of the bladder, head and neck, stomach, and esophagus. 34 Nirosha D. Perera et al., “Analysis of female participant representation in registered oncology clinical trials in the United States from 2008 to 2020,” Oncologist , June 2023, Volume 28, Number 6. While women experience a greater share of the health burden for some diseases, such as in neurology, the ratio is not reflected in clinical trial participation. Additionally, equitable representation of women (and men) of different races and ethnicities has long lagged (see sidebar “Case study: COVID-19 vaccine development”).

Ensuring sex-differentiated results

Representative clinical studies capable of producing stratified results may involve larger and longer clinical trials, increasing costs and extending time to market. However, the results would likely lead to more effective interventions with higher uptake among patients. The risk/reward equation for investors becomes more balanced if payers (governments, insurers, and patients) and regulators insist on evidence for cohort-specific impact.

Today, some conditions, such as leukemia and meningitis, are believed to affect men and women equally. But the research to identify potential differences is lacking. Stakeholders may explore how a systematic and proactive approach to designing and reporting clinical outcomes could take sex and gender into account.

One route to start working with sex- and gender-specific data analysis in general is through meta-analytical techniques—those combining study results to draw conclusions about therapeutic effectiveness. These can be used to analyze sex-specific efficacy without increasing sample size. 35 K. A. L’Abbé, A. S. Detsky, and K. O’Rourke, “Meta-analysis in clinical research,” Annals of Internal Medicine , August 1987, Volume 107, Number 2. Other analysis has found that investing in women as investigators could lead to more women enrolled in trials. 36 Waldhorn et al., “Trends in women’s leadership of oncology clinical trials,” June 2022.

Addressing data gaps in women’s health would require concerted effort across multiple fronts, 37 More detailed discussion available in Burns et al., “Closing the data gaps in women’s health,” April 3, 2023. potentially including requiring sex- and gender-disaggregated data to further understanding.

3. Creating sex- and gender-responsive care delivery systems

Several studies have indicated that women are more frequent users of health services than men. 38 K. D. Bertakis et al., “Gender differences in the utilization of health care services,” Journal of Family Practice , February 2000, Volume 49, Number 2; Gretchen Berlin, Lucia Darino, Megan Greenfield, and Irina Starikova, “ Women in the healthcare industry ,” McKinsey, June 7, 2019; “Gender mainstreaming in health,” European Institute for Gender Equality (EIGE), January 2017. These differences, however, may be reduced substantially when adjusted for different levels of need, such as reproduction or differences in disease prevalence. 39 Yingying Wang et al., “Do men consult less than women? An analysis of routinely collected UK general practice data,” BMJ Open , 2013, Volume 3. The McKinsey analysis finds that some of this unbalanced usage may result from inadequate service. Compared with men, women who present the same condition may not receive the same evidence-based care. 40 Emily Paulsen, “Recognizing, addressing unintended gender bias in patient care,” Duke Health Practice Management, January 14, 2020. These delays can add unnecessary costs to health systems, not to mention costs and stress to the patient and their family.

Inequalities exist throughout the full pathway of care

Intersectionality and health outcomes.

This paper explores ways in which sex and gender influence an individual’s health chances and experience of health services. These differences are all too often exacerbated by overlapping levels of discrimination and disadvantage, such as race, ethnicity, socioeconomic status, disability, age, and sexual orientation. The effects are strikingly clear in maternal health (exhibit). Within the United States, Native American and Black women are up to four times more likely to die from a pregnancy-related cause than White women. For Black families, this holds true even after adjustment for differences in income levels. 1 Kate Kennedy-Moulton et al., Maternal and infant health inequality: New evidence from linked administrative data , NBER Working Paper 30093, 2022. In India, a woman of upper caste is three times more likely to use prenatal care and five times more likely to have a trained birth attendant than a woman of lower caste. 2 E. Saroha, M. Altarac, and L. M. Sibley, “Caste and maternal health care service use among rural Hindu women in Maitha, Uttar Pradesh, India,” Journal of Midwifery & Women's Health , 2008, Volume 53. A study in the United Kingdom indicated that women from ethnic minority backgrounds have an increased risk of postpartum hemorrhage. 3 Jennifer Jardine et al., “Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981,801 births in England,” BJOG: An International Journal of Obstetrics and Gynaecology , December 2021, Volume 129, Number 8. On a global scale, 94 percent of pregnancy-related deaths occurred in low‐resource settings, with 86 percent occurring in sub‐Saharan Africa and Southern Asia. 4 “Maternal health,” Pan American Health Organization, n.d.; Trends in maternal mortality, 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division , United Nations Population Fund (UNFPA), September 2019.

The care pathway runs from awareness of a health issue to access to services and preventive care, timely and accurate diagnosis and effective treatment and follow-up. At each segment of this pathway, inequalities exist, especially for women who are disadvantaged in ways beyond their gender (see sidebar “Intersectionality and health outcomes”).

Awareness and prevention

Health education, including menstrual education, is one of the most effective ways to help women learn about their bodies. 41 M. M. Khan, “Menstrual health and hygiene: What role can schools play?,” World Bank, May 27, 2022. Countries vary in the types and amount of health education, but around the world, women who experience conditions such as painful periods, endometriosis, polycystic ovary syndrome, or uterine fibroids may have limited awareness of what is normal and when to seek medical advice. 42 F. Ní Chéileachair, B. E. McGuire, and H. Durand, “Coping with dysmenorrhea: A qualitative analysis of period pain management among students who menstruate,” BMC Women’s Health , October 2022, Volume 22, Number 1; A. Jabeen et al., “Polycystic ovarian syndrome: Prevalence, predisposing factors, and awareness among adolescent and young girls of South India,” Cureus , August 2022, Volume 14, Number 8; Chandler Dykstra et al., “‘I think people should be more aware’: Uterine fibroid experiences among women living in Indiana, USA,” Patient Education and Counseling , February 2023, Volume 107. Education can also improve school attendance, teach effective management strategies that reduce symptom severity, and reduce potential fertility problems in the future, which are often excluded from health insurance policies. 43 Y. T. Yang and D. R. Chen, “Effectiveness of a menstrual health education program on psychological well-being and behavioral change among adolescent girls in rural Uganda,” Journal of Public Health in Africa , April 2023, Volume 14, Number 3; Catherine Kansiime et al., “Menstrual health intervention and school attendance in Uganda (MENISCUS-2): A pilot intervention study,” BMJ Open , 2020, Volume 10, Number 2; Parisa Khalilzadeh et al., “Evaluating the effect of educational intervention based on the health belief model on the lifestyle related to premenstrual syndrome and reduction of its symptoms among the first-grade high school girls,” BMC Public Health , May 2023, Volume 23.

Prevention and promotion are also needed for better health. The human papillomavirus (HPV) vaccine, for example, is proven to reduce the incidence of cervical cancer by nearly 90 percent, particularly if women are vaccinated when they are younger. 44 Jiayao Lei et al., “HPV vaccination and the risk of invasive cervical cancer,” New England Journal of Medicine , October 2020, Volume 383. In 2020, the WHO launched the 90-70-90 targets, which aim to have 90 percent of girls vaccinated against HPV, 70 percent of women screened for HPV by age 35 and again at 45, and 90 percent of women with precancer treated or with invasive cancer managed. According to the WHO, great disparities exist among countries: less than 25 percent of LICs and less than 30 percent of LMICs have introduced the vaccine, compared with 85 percent of high-income countries (HICs). 45 Global strategy to accelerate the elimination of cervical cancer as a public health problem , World Health Organization, 2020. Some 36 percent of women worldwide have been screened for cervical cancer in their lifetime—84 percent in high-income countries and less than 20 percent in LMICs or LICs. 46 L. Bruni et al., “Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: A review and synthetic analysis,” Lancet Global Health , August 2022, Volume 10, Number 8 (erratum in Lancet Global Health , July 2023, Volume 11, Number 7. In this report, the analysis began with the projected baseline disease burden by sex, age group, year, and country for 195 countries. For more on methodology, see the technical appendix.

The importance of increasing awareness goes beyond patients. Many doctors are unaware of how diseases can affect or manifest differently in women, so they are unable to provide proper care to many patients.

Accessibility and affordability of care

Women may encounter barriers related to access and affordability. Healthcare spending and insurance premiums have historically been higher for women. For instance, in Switzerland, healthcare insurance premiums are more expensive for women because they are considered to have higher healthcare costs. On average, Swiss women pay more than 12 percent extra for supplementary hospital insurance, with greater disparities in specific age groups. A 31-year-old woman pays, on average, 37 percent more than a man of the same age. 47 Daniel Dreier, “Financial inequalities between women and men in Switzerland,” Moneyland, January 23, 2023. Similarly, Indian private insurers employ gender-based premiums, leading to higher expenses for women. 48 “How health insurance premium varies by gender?” Future Generali, February 11, 2022. Further McKinsey analysis of US copay rates finds American women have an average of $135 more out-of-pocket expenses per year than men. Of that, $55 goes to higher copay rates for conditions predominantly affecting women.

Affordability means more than paying for direct healthcare services; it also means being able to afford hygiene products. For instance, around 500 million people worldwide lack access to menstrual products and hygiene facilities. 49 “Menstrual health and hygiene,” World Bank, May 12, 2022. In Bangladesh, a study conducted by the HERproject showed that 73 percent of women employed by a textile factory in Bangladesh missed work for an average six days a month. 50 K. Tull, “Period poverty impact on the economic empowerment of women,” University of Leeds Nuffield Centre for International Health and Development, January 23, 2019. This absenteeism negatively affects not only business but also the lives and the livelihoods of women who are not paid for days they do not work. However, when the HERproject provided menstrual pads and other work-based interventions (sharing information regarding menstruation, reducing stigma, etcetera), absenteeism dropped to 3 percent. 51 K. Tull, “Period poverty impact on the economic empowerment of women,” University of Leeds Nuffield Centre for International Health and Development, January 23, 2019.

Family planning also is highly relevant. Women of childbearing age who are sexually active must evaluate the cost of contraceptives, many of which are not covered by insurance. An estimated 257 million women in developing regions who want to avoid pregnancy are not using safe and effective family-planning methods, for reasons that include a lack of access and support, according to the 2023 Global Contraception Policy Atlas. 52 “Launch of the Global Contraception Policy Atlas at Women Deliver 2023,” European Parliamentary Forum for Sexual and Reproductive Rights, July 18, 2023. For any woman, a lack of contraception—which can lead to sexually transmitted diseases (STDs) or unintended pregnancy—can, in the long run, result in job loss, career setbacks, diminished ability to support oneself or one’s family, and higher levels of “family dysfunction.” 53 Joseph M. Boden, David M. Fergusson, and l. John Horwood, “Outcomes for children and families following unplanned pregnancy: Findings from a longitudinal birth cohort,” Child Indicators Research , March 2014, Volume 8.

These disparities can be tackled. Alternative models and systems are helping to increase accessibility and affordability of care for women while also reducing costs for healthcare systems and individuals. Examples include the US Affordable Care Act and women’s health hubs in the United Kingdom. 54 “Women’s health hubs cost-benefit analysis,” UK Department of Health & Social Care, July 22, 2023.

Timely diagnosis

The male-centric models of disease described earlier can contribute to delays in care and lower-quality treatment decisions once a woman is within the care system. One study found women were up to seven times more likely than men to have a heart condition misdiagnosed and be discharged during a heart attack. 55 J. Hector Pope et al., “Missed diagnoses of acute cardiac ischemia in the emergency pepartment,” New England Journal of Medicine , April 2000, Volume 342, Number 16; Elizabeth G. Nabel, “Coronary heart disease in women—an ounce of prevention,” New England Journal of Medicine , August 2000, Volume 343, Number 8; Harvard Health Blog , “Women and pain: Disparities in experience and treatment,” October 9, 2017. More sensitive biomarkers to detect heart attacks in women have been identified, 56 O. Ola et al., “Clinical impact of high-sensitivity cardiac troponin T implementation in the community,” Journal of the American College of Cardiology , 2021, Volume 77, Number 25; Arash Mokhtari, Ulf Ekelund, and Ulf Ekström, Riktlinjer för användning av Siemens högkänsliga troponin I vid handläggning av patienter med bröstsmärta (Guidelines for the use of Troponin I (Siemens) in the management of patients with chest pain), Region Skåne (Skåne County, Sweden), November 6, 2023. and studies are ongoing to validate the impact on health outcomes, but medical school curricula and residency and fellowship trainings need to be updated to reflect these differences.

For maternal care, untreated tuberculosis may have a mortality rate of up to 40 percent in high-risk areas, 57 A. Zumla, M. Bates, and P. Mwaba, “The neglected global burden of tuberculosis in pregnancy,” Lancet Global Health , 2014, Volume 2, Number 12. where women often have lower uptake of treatment, probably as a result of societal norms. One possible solution is the integration of tuberculosis screening in antenatal care for pregnant women. This strategy was tested in Pakistan and proved to be feasible and effective. 58 Rozina Feroz Ali et al., “Integrating tuberculosis screening into antenatal visits to improve tuberculosis diagnosis and care: Results from a pilot project in Pakistan,” International Journal of Infectious Diseases , July 2021, Volume 108.

Choice of treatment

Accurate diagnosis should prompt delivery of evidence-based treatment. But sex and gender can affect care, even for common conditions. For example, upon discharge, women cardiac patients are less likely to be prescribed secondary prevention to reduce the risk of further events. This (along with other risk factors) contributes to women being twice as likely to die from a serious heart attack. 59 “Women more likely to die after heart attack than men,” press release, European Society of Cardiology, May 22, 2023.

Outcomes after an acute cardiac event could potentially improve via sex- and gender-adapted protocols for guideline-directed management. This begins at admission and continues through the procedure and until discharge. One health system reduced outcome disparities with a standardized systemwide protocol that includes emergency department catheterization lab activation, a STEMI (ST elevation myocardial infarction) safe-handoff checklist; transfer to an immediately available catheterization lab, and a radial-first approach to percutaneous coronary intervention. 60 C. P. Huded et al., “4-step protocol for disparities in STEMI care and outcomes in women,” Journal of the American College of Cardiology , 2018, Volume 71, Number 19. A discharge checklist for guideline-directed medical therapy has been shown to reduce mortality in heart failure patients by 65 percent for both sexes. 61 H. Rismiati et al., “The role of discharge checklist in guideline-directed medical therapy for heart failure patients,” Korean Journal of Internal Medicine , 2023, Volume 38, Number 2.

While some efforts to achieve gender parity require heavy investment, there are budget-conscious solutions with potentially huge impact. UNICEF’s Côte d’Ivoire Country Office, for example, produced a low-cost version of a uterine balloon tamponade device to treat maternal hemorrhage. The product, which uses a catheter and a condom, has a 95 percent success rate and has been scaled nationally. 62 “Uterine balloon tamponade,” UNICEF Office of Innovation, n.d.

Creating solutions to tackle care disparities

Overall, the gap in care delivery contributes 34 percent to the women’s health gap (see Exhibit 1 above). Consider how sex- and gender-appropriate care delivery could reduce the women’s health burden by 25 million DALYs per year globally, corresponding to 2.5 days per woman per year.

Global public health programs are increasingly being designed and improved from a sex- and gender-informed perspective. This involves an investigation of the role sex and gender play in health outcomes, including health-related stigma, barriers to accessing health services, and vulnerabilities to different health risks. For example, the Stop TB Partnership developed a gender-responsive tuberculosis delivery program and associated investment package. 63 Gender and TB: A Stop TB Partnership paper, Stop TB Partnership, 2021 ; Gender and TB investment package: Community, rights and gender , Stop TB Partnership, 2020. One pillar of this approach is the routine collection, analysis, and use of sex-disaggregated data and inclusion of sex and gender in monitoring and evaluation.

Improvements in the diagnostic tools available would represent a major step forward for patients. Yet even without innovative tools, it would be possible to improve care and bridge the gaps in diagnosis with more consistent and standardized screening and data collection. Earlier diagnosis and a more holistic, patient-centric treatment approach could help improve disease and symptom management, prevent uncontrolled progression and resulting complications, and reduce unnecessary treatments.

When it comes to affordability and access, counteracting the rise in healthcare costs while benefiting patients and insurance providers could be achieved through approaches such as value-based care (VBC). VBC aims to link healthcare payments to the quality of outcomes, shifting incentives for healthcare providers from performing more treatments to delivering better treatments. These models seek to enhance care quality and reduce healthcare expenses by emphasizing prevention and high-quality results. 64 “‘What is CMMI?’ and 11 other FAQs about the CMS Innovation Center,” KFF, 2018.

VBC models in the United States include accountable care organizations (ACOs), voluntary networks of healthcare providers operating under Medicare. This includes the Medicare Shared Savings Program (MSSP), which returned $1.9 billion in net savings to Medicare in 2020. 65 “Medicare Shared Savings Program saves Medicare more than $1.8 billion in 2022, continues to deliver high-quality care,” news release, US Department of Health and Human Services, August 24, 2023; Corinne Lewis et al., “The impact of the payment and delivery system reforms of the Affordable Care Act,” Commonwealth Fund, April 28, 2022. Outside of the United States, the European Hospital Alliance’s nine hospitals have offered a blueprint that includes measuring costs and outcomes for every patient and bundled payments for care cycles. 66 Y. Cossio-Gil et al., “The roadmap for implementing value-based healthcare in European university hospitals—consensus report and recommendations,” Value in Health , 2022, Volume 25, Number 7. Value-based models are designed to reduce costs while improving quality outcomes for patients. For example, given the amount of time, number of tests, and number of providers a woman may see before an endometriosis diagnosis, a revised model of care could offer a holistic and patient-centric approach that provides a faster diagnosis, reduces costs for a healthcare system or payer, and ultimately improves outcomes.

At a global level, AI, unbiased data sets, and interoperable electronic records are potential options for enhancing care delivery. Ultimately, a combination of innovation, investment, and ability to scale could unlock better care delivery solutions for women.

4. Directing investments toward women’s health

There has been a historical underinvestment in women’s health research from the public, social, and private sectors. Funding sources typically overlook the fact that many conditions manifest differently in each sex, creating variances in outcome.

Closing the health gap will require increased investment not only for understanding sex-based differences but also for addressing unmet needs in women’s health. Further, additional funding and new business models could support sex- and gender-appropriate care.

Research funding neglects women’s health

One approach to redirecting investments is to examine policies based on actual population needs. This approach is pertinent for public funding, which continues to be one of the primary investment sources for scientific research. In the United States, up to 45 percent of basic and applied life-sciences research is funded through federal and nonfederal government sources. 67 U.S. research and development funding and performance: Fact sheet , Congressional Research Service, September 13, 2022; Mark Boroush and Ledia Guci, “Research and development: US trends and international comparisons,” Science and Engineering Indicators, National Science Board, April 28, 2022. The importance of public funding is even higher if we consider that for life sciences companies to reach later-stage development, they rely on results from basic and applied research. 68 E. Cleary, M. J. Jackson, and F. Ledley, “Government as the first investor in biopharmaceutical innovation: Evidence from new drug approvals 2010–2019.” Institute for New Economic Thinking Working Paper Series No. 133, November 18, 2020; E. G. Cleary et al., “Contribution of NIH funding to new drug approvals 2010–2016,” Proceedings of the National Academy of Sciences of the United States of America , 2018, Volume 115, Number 10.

Women’s health funding data by country can be scarce. In the United States, the National Institutes of Health (NIH) allocates 11 percent of its budget to women’s-health-specific research. Thus, despite women having a 50 percent higher mortality rate in the year following a heart attack, only 4.5 percent of the NIH’s budget for coronary artery disease supports women-focused research. 69 Perspectives on advancing NIH research to inform and improve the health of women , National Institutes of Health, Office of Research on Women’s Health, 2021. In Canada and the United Kingdom, 5.9 percent of grants between 2009 and 2020 went to research that looked at female-specific outcomes or women’s health. 70 K. Smith, “Women’s health research lacks funding—these charts show how,” Nature , May 3, 2023.

In another example as of 2015, there were five times more scientific studies on erectile dysfunction than premenstrual syndrome. 71 ResearchGate Blog, “Why do we still not know what causes PMS?,” August 12, 2016. In a trial where the medication sildenafil citrate was shown to relieve menstrual pain, research stopped due to a lack of funding. 72 R. Dmitrovic, A. R. Kunselman, and R. S. Legro, “Sildenafil citrate in the treatment of pain in primary dysmenorrhea: A randomized controlled trial,” Human Reproduction , November 2013, Volume 28, Number 11; “There’s a gender gap in medical data, and it’s costing women their lives, says this author,” CBC, August 17, 2019.

These examples reflect how underfunding certain research leads to and augments the women’s health gap. One goal could be for existing budgets to be more fairly distributed to reflect the disease burden and unmet need. When governments and nonprofits evaluate resources and policies across populations, they create an opportunity to advance health equity and benefit society. They could consider which investments reap the highest socioeconomic return, including in medical research. One example of targeted investment is the 3not30 campaign by Women’s Health Access Matters, which aims to increase women’s health research and accelerate investment in sex-based research over the next three years. 73 “WHAM launches #3not30 Campaign to call for doubling the funding for women’s health research in the next three years,” news release, Women’s Health Access Matters (WHAM), January 19, 2023.

Many attractive opportunities in women’s health remain untapped. Currently, global life sciences R&D efforts primarily focus on conditions with a high contribution of years of life lost (YLLs) to the overall disability-adjusted life years (DALY). This has often disadvantaged women since they have a higher probability of being affected by conditions that affect quality of life—measured as years lived with a disability (YLDs)—rather than length of life. Among these conditions are rheumatoid arthritis, endometriosis, uterine fibroids, and diabetes. The disability weight for someone with moderate abdominal pain and primary infertility due to endometriosis is 0.121; for moderate rheumatoid arthritis, it is 0.3017. This translates to a person being willing to trade a year of their life to avoid 8.3 years of living with endometriosis or to trade a year of life to avoid 3.2 years with rheumatoid arthritis. Additionally, gynecological conditions, such as endometriosis and uterine fibroids, which affect up to 68 percent of women, 74 Zheng Lou et al., “Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study,” BMC Public Health , May 2023, Volume 23, Number 916. have 33 assets in the pipeline , while other conditions that affect a lower percentage have more assets (Exhibit 8).

Women often face conditions that are not fatal but can cause disability and impede their quality of life.

Some conditions, such as colon or liver cancer, affect men and women differently, and on average, women are more likely to develop a more serious or severe form of these conditions.

Certain conditions, such as Alzheimer’s and other dementias, affect women disproportionately. A 2019 report found that, globally, women with dementia outnumbered men with dementia 100 to 69. 1 GBD 2019 Dementia Forecasting Collaborators, “Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the Global Burden of Disease Study 2019,” Lancet Public Health , February 2022, Volume 7, Issue 2.

Certain women-specific conditions, such as ovarian cancer, cause less disability because the fatality rates are higher. Ovarian cancer is the most lethal gynecological cancer, with a five-year relative survival rate of 17 percent for a patient diagnosed at an advanced stage. 1 Lauren A. Baldwin et al., “Ten-year relative survival for epithelial ovarian cancer,” Obstetrics & Gynecology , September 2012, Volume 120, Number 3.

Certain conditions affecting men, such as testicular cancer, have a low number of assets and share of suffering caused by disability.

Certain conditions affect men and women equally in terms of suffering caused by disability, such as diabetes and liver disease.

Market potential of treatments for endometriosis and menopause

Globally, 190 million women are suffering from endometriosis. 1 “Endometriosis,” World Health Organization, March 24, 2023. Currently, no cure exists, and treatments focus on symptom management. Based on prevalence and unmet need, the market potential for endometriosis treatments is estimated at $180 billion to $250 billion globally (exhibit), given today’s share of endometriosis patients seeking treatment. Innovation in this space, including faster diagnosis rates and earlier access to treatment, could increase the market potential.

Menopause is another area of high unmet need globally. Based on the age distribution of the population and share of symptomatic cases, it is estimated that more than 450 million women worldwide have menopausal or perimenopausal symptoms. 2 Estimate based on global population of women between ages 45 and 55 and more than 90 percent of women experiencing at least one symptom during the menopausal transition. Based on the prevalence of menopause, its impact on women’s life, the high unmet need, and the share of women seeking treatment today, estimated global market potential to treat symptoms ranges from $120 billion to $350 billion globally. 3 Aja Mangum, “The $600 billion market for women in menopause is fit for disruption,” Bloomberg, March 28, 2021.

Addressing sex-specific conditions can pay off. For example, the debut of Viagra for erectile dysfunction, which affected an estimated 152 million men in 1995, generated $400 million in sales revenue within its first three months in the US market in 1998. 75 I. A. Ayta, J. B. McKinlay, and R. J. Krane, “The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences,” BJU International , July 1999, Volume 84, Number 1; Berkeley Lovelace Jr., “Pfizer still holds the lead in the erectile dysfunction market even as Viagra sales falter,” CNBC, February 14, 2019. By 2012, worldwide sales hit a record $2.1 billion. 76 “Viagra outdoes competition with Q3 sales,” Pharmaceutical Technology , December 18, 2020. Globally, given the similar prevalence and high unmet need for conditions such as endometriosis and menopause, there is enormous potential for innovative treatments (see sidebar “Market potential of treatments for endometriosis and menopause”).

Enormous potential also exists for treatment of breast cancer. There is high interest in breast cancer R&D (646 assets in the pipeline), and sales revenues from breast cancer treatments were at $18 billion in 2022 (comparatively, sales for prostate cancer treatments were $11 billion in 2022). 77 Evaluate Pharma database, accessed 2023. An opportunity remains to improve outcomes of breast cancer in LMICs, where the fatality rate of 72 percent has been higher than the incidence rate (62 percent). 78 S. Al-Sukhun et al., “Breast cancer priorities in limited-resource environments: The price-efficacy dilemma in cancer care,” American Society of Clinical Oncology Educational Book , Volume 42, June 22, 2022. Globally, endometriosis, uterine fibroids and menopause are among the conditions with high unmet need and economic potential.

Private equity/venture capital investors are increasing investments in women’s health, with excitement about digital health solutions

Private equity and venture capital investments in women’s health are starting to grow quickly as opportunities in women’s health become clearer and more female technology (FemTech) start-ups set out to disrupt the healthcare market. 79 E. Kemble et al., “ The dawn of the FemTech revolution ,” McKinsey, February 14, 2022. Within the FemTech space is concentrated activity concerning maternal health patient support, consumer menstrual products, gynecological devices, and fertility solutions. 80 E. Kemble et al., “ The dawn of the FemTech revolution ,” McKinsey, February 14, 2022.

The start-ups making the top deals in the past four years mainly focus on men’s sexual and overall health. A McKinsey analysis found that 11 start-ups addressing erectile dysfunction, among other men’s health concerns, secured $1.24 billion in 2019–23, while eight start-ups addressing endometriosis received $44 million. Funding for companies focusing on erectile dysfunction was six times greater than for companies focused on endometriosis. However, investors may be starting to see the potential. In the past four years, women’s health newcomers received $2.2 billion in funding. Some 60 percent of the top deals exclusively addressed women’s health, specifically endometriosis, fertility, and maternal and neonatal health. 81 E. Kemble et al., “ The dawn of the FemTech revolution ,” McKinsey, February 14, 2022.

Another potential avenue for innovation is digital health, which has the potential to make health more equitable. 82 D. Argyres et al., “ Digital health: An opportunity to advance health equity ,” McKinsey, July 26, 2022. In the digital healthcare space, FemTech companies received 3 percent of the total digital-health funding. 83 “FemTech Revolution: Which start-ups are transforming women’s health?,” EIT Health Ireland-UK, March 8, 2023.

Given the large unmet need and resulting opportunity, those who continue to forgo investing in women’s health may find themselves left behind by the players that tap into this high-potential market.

5. Closing the gap in women’s health could boost the global economy

The disparities in women’s health affect not only women’s quality of life but also their economic participation and ability to earn a living for themselves and their families. Health is intricately linked to economic productivity, prospects for prosperity, and contribution to economic output. Economic growth over the past 70 years has been closely tied to women’s increased labor force participation. Therefore, it is not surprising that the gap in women’s health results in lost economic potential.

Addressing the health gap women face could boost the global economy by adding at least $1 trillion to the global economy by 2040. This means a 1.7 percent increase in the average per capita GDP generated by women.

Women’s economic participation has been and will be a major driver of economic growth

Extended participation by women boosts economies and GDP growth. 84 E. Ortiz-Ospina, S. Tzvetkova, and M. Roser, “Women’s employment,” Our World in Data , 2018. The rise in the number of women in formal economic activities since the 1950s has been a major driver of economic growth and wage increases. 85 A. Weinstein, “When more women join the workforce, wages rise—including for men,” Harvard Business Review , January 31, 2018. Ability to participate in the economy also benefits women individually. In a 2023 poll, when women around the world were asked if they preferred to work in paid jobs, care for their families, or do both, 70 percent said they preferred to work in paid jobs or do both. 86 That is, the 70 percent combines responses from women saying they would prefer to work at paid jobs with responses from those saying they prefer to both work at paid jobs and care for their homes and families. Towards a better future for women and work: Voices of women and men , International Labour Organization/Gallup, 2017.

Endometriosis and menopause have a substantial impact on women’s ability to work and earning potential

Menopause and endometriosis not only cause women pain and reduce their quality of life but also substantially affect their ability to work and their earning potential. Roughly 80 percent of affected women state that menopause interferes with their lives, and one-third of these women also experience depression. 1 Burns et al., “Closing the data gaps in women’s health,” April 3, 2023. Further, menopause is linked to premature departure from the workforce. 2 Lizzy Burden, “Women are leaving the workforce for a little-talked-about reason,” Bloomberg, June 18, 2021; S. D’Angelo et al., “Impact of menopausal symptoms on work: Findings from women in the Health and Employment after Fifty (HEAF) study,” International Journal of Environmental Research and Public Health , December 2022, Volume 20, Number 1. Similarly, endometriosis is linked to loss in productivity and absenteeism. 3 Kelechi E. Nnoaham et al., “Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries,” Fertility and Sterility , August 2011, Volume 96, Number 2. This analysis factors in the actual economic impact for both conditions. Studies have found that up to 90 percent of women reported menopausal symptoms during the transition. 4 Ginger D. Constantine et al., “Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries,” Post Reproductive Health , September 2016, Volume 22, Number 3. This leads to a global prevalence of more than 450 million women and highlights the vast underestimate (versus 35 million in the IHME database). For endometriosis, IHME places the number of cases at 24 million, whereas the WHO puts the prevalence at 190 million. 5 WHO, “Endometriosis,” March 24, 2023.

Based on these adjusted numbers, improving effectiveness, uptake, access, and delivery of care for these conditions alone could give a $130 billion uplift to the global economy by 2040 (exhibit).

Conversely, the women’s health gap limits individual women and directly affects the global economy by impairing women’s economic participation and productivity. Chronic diseases are often linked to extended absences from work, 87 Paul Hemp, “Presenteeism: At work—but out of it,” Harvard Business Review , October 2004. and poor health is a cause of “presenteeism,” where individuals go to work but cannot perform at their full capacity, reducing productivity. Finally, disabilities and informal caregiving obligations hold back affected individuals, often women, from full workforce participation (see sidebar “Endometriosis and menopause have a substantial impact on women’s ability to work and earning potential”).

Addressing the gap could generate the equivalent impact of 137 million women accessing full-time positions by 2040. This would enable women to secure an income to support themselves and their families and has the potential to lift more women out of poverty.

Better health often enables individuals to work more effectively

The health disparities outlined in this report affect individuals of all age groups, with about 50 percent of the burden affecting women of working age. Closing the women’s health gap could allow women to add 1.7 percent to GDP . Comparatively, the World Bank estimates that if the status quo remained, GDP growth could reach 2.7 percent, 2.9 percent, and 3.4 percent in 2023, 2024, and 2025, respectively. 88 Global economic prospects , World Bank, June 2023.

Looking at the different channels affecting GDP, the largest impact, amounting to around $400 billion or avoiding 24 million years with disability, would be created through fewer health conditions (Exhibit 9). Expanded participation and increased productivity could each contribute more than 20 percent of total impact.

Treating ten health conditions would contribute more than half of the economic impact

On a global level, effective treatment of ten conditions—for example, premenstrual syndrome (PMS), depressive symptoms, and migraines—could make up more than 50 percent of the economic impact (Exhibit 10). This impact suggests which conditions to consider prioritizing globally. For example, addressing PMS has the potential to contribute $115 billion to the global economy. Rather than defaulting to PMS being a “part of life,” there are ways to manage symptoms. A 2020 analysis found that women who took calcium supplements experienced fewer PMS symptoms, such as anxiety or water retention, than women who took a placebo. 89 Arman Arab et al., “Beneficial role of calcium in premenstrual syndrome: A systematic review of current literature,” International Journal of Preventive Medicine , September 2020, Volume 11. A study in Iran found that the severity and frequency of PMS symptoms was significantly lower in an intervention group that offered education and coping strategies. 90 Farzaneh Babapour et al., “The effect of peer education compared to education provided by healthcare providers on premenstrual syndrome in high school students: A social network‐based quasi‐experimental controlled trial,” Neuropsychopharmacology Reports , March 2023, Volume 43, Number 1. Addressing PMS with effective interventions could allow women to experience less pain, experience better quality of life, and feel more able to work.

The conditions having the greatest economic impact in different countries will differ from one geographic region to another based on each region’s disease burden and healthcare status. The examination of economic impact, rather than DALY impact, gives more weight to conditions that affect people during years of working age, as that is when economic contribution is highest. Conditions such as ischemic heart disease may affect more people, but if the burden of morbidity and premature mortality happens after the usual age of retirement, the economic impact is more limited.

Additionally, other conditions not listed could be the underlying cause for the top ten conditions. For example, infertility can lead to significant anxiety, depression symptoms, and other psychological distress. 91 Cedars-Sinai Blog, “How infertility impacts mental health,” September 8, 2020.

Generally, a reduction in health conditions is tied to a woman’s economic potential, with allowances for regional socioeconomic and healthcare factors (Exhibit 11). The top two conditions by contribution to GDP impact of the women’s health gap are always a combination of two of the top four global conditions: PMS, depression, migraine, or other gynecological conditions. Larger differences among regions are observed when looking at the top ten or more conditions.

Across the four channels, the highest GDP impact relative to women’s GDP is observed in HICs and LICs (Exhibit 12). For LICs, most of the impact comes from fewer early deaths and fewer health conditions. Both upper-middle-income (UMIC) and lower-middle-income (LMIC) regions exhibit an overall lower projected GDP impact.

Investing in women’s health shows positive return on investment (ROI): for every $1 invested, approximately $3 is projected in economic growth

Investing in improving women’s health not only improves women’s quality of life but also enables them to participate more actively in the workforce and make a living. The potential value created through women’s higher economic participation and productivity exceeds the costs of implementation by a ratio of $3 to $1 globally. This estimate is based on the net annual costs associated with the additional uptake of interventions required to address the women’s health gap, including all relevant interventions considered cost-effective in each setting. 92 To identify the incremental or net steady-state cost of each intervention, we identified the cost per DALY averted from the scientific literature (primarily WHO, DCP-3, and the Tufts Cost-Effectiveness Analysis Registry) for each intervention and income archetype and converted to standardized US dollars. To calculate the total cost for each country, we multiplied the unit cost (cost per DALY averted) by the volume of DALYs averted by that particular intervention in 2040. For further discussion of the strengths and limitations of this approach, see the technical appendix. The analysis compared this to the additional economic potential that could be unlocked by the health improvements associated with these interventions.

The expected economic return varies by region. The ROI is greatest in higher-income settings, where it is around $3.50 returned for every $1 invested. More investment is probably needed in some LICs to establish the basic health infrastructure required to support low-cost delivery of high-quality health services, as well as to create better and more rewarding economic opportunities for women. Still, the analysis indicates that the overall benefit would exceed the costs even in these settings, at a rate of around $2 returned on $1 invested.

The analysis examines only the direct costs of addressing the gaps in care delivery identified. In the longer term, a range of greater positive returns is possible, given that improvement in the lives of women influences the health and resilience of their families and communities.

Where to start tackling the women’s health gap to reap the greatest benefit for all

Globally, the top ten conditions by economic impact account for more than 50 percent of the total GDP impact. This highlights areas with high unmet needs and potential, aiding decision makers in prioritizing efforts to address health disparities. Specific conditions and their socioeconomic contexts vary among regions, influencing their contribution to the economy. This information could guide tailored strategies toward health equity.

The content and sequence of each action will need to be tailored to regional conditions. Building on the knowledge developed throughout this report, a fact-based strategic assessment can lead to better health equity for each country.

6. Call to action: How to close the women’s health gap

As noted in this report, women’s health has been under-researched, and women face different challenges from men in affordability and access to treatment. This health gap creates unnecessary suffering and preventable economic losses.

It does not have to be this way. Through collaborative efforts on five fronts, a more equitable and healthy future is possible. There is an opportunity to close the women’s health gap by (1) investing in women-centric R&D, (2) strengthening the collection and analysis of sex- and gender-disaggregated data, (3) enhancing access to gender-specific care, (4) encouraging investments in women’s health innovation, and (5) examining business policies to support women.

Invest in women-centric research to fill the knowledge and data gaps in women-specific conditions, as well as in diseases affecting women differently and/or disproportionately

The women’s health gap could be narrowed by increasing funding to achieve equality with investments in funding for men’s health and using protocols that set standards of equity and diversity. Scientists, life science companies (pharma, biotech, medtech), healthcare providers, and others in the healthcare ecosystem may consider how the traditional understanding of disease is focused primarily on the male body. A more in-depth understanding of these differences would enable more effective care interventions and improved health outcomes. One example of venture-capital-backed funding addressing this disparity is Repro Grants, which allots up to $100,000 for research projects aimed at deepening understanding of female reproductive biology.

For conditions that affect women differently or disproportionately, more effective interventions start with clinical trials designed with inclusivity at their core, informed by preclinical research using female animal models. Specifically, there should be stronger diversity, equity, and inclusion guidelines for clinical trial design . Guidance could incorporate male versus female disease prevalence mix and use sex-specific thresholds for biomarkers to yield an adequate patient representation in clinical trials.

Equitable representation by prevalence also implies more diverse research organizations. Life science companies, academic institutions, and educational bodies should ensure that women and people of color not only find representation but be actively involved in research, leadership, and decision-making roles. For example, women form almost 70 percent of the global health and social workforce, but it is estimated they hold only 25 percent of senior roles. 93 “10 key issues in ensuring gender equity in the global health workforce,” WHO, March 20, 2019. The benefits of increasing women’s representation are manifold: for example, teams boasting diverse gender representation have been associated with higher levels of accountability and effectiveness. 94 Jennifer Asuako, “Women’s participation in decision making: Why it matters,” UN Development Programme, December 4, 2020. In one study that analyzed more than 440,000 medical patents filed from 1976 through to 2010, patented biomedical inventions created by women were up to 35 percent more likely to benefit women’s health than biomedical inventions created by men. The patents from women were more likely to address women-specific conditions such as breast cancer and postpartum preeclampsia, as well as conditions that disproportionately affect women, such as lupus. 95 Rembrand Koning, Sampsa Samila, and John-Paul Ferguson, “Who do we invent for? Patents by women focus more on women’s health, but few women get to invent,” Science , June 2021, Volume 372, Number 6548.

Systematically collect and analyze sex-, ethnicity-, and gender-specific data to have more accurate representation of women’s health burden and the impact of different interventions

The prevalence of conditions such as endometriosis and menopause is underestimated, leading investors and life science companies to underestimate the market potential of these conditions and underinvest. By accurately assessing and reporting on the prevalence of such conditions, national health institutes and other authorities may direct additional funding to the research and treatment of these underserved conditions.

• Beyond epidemiological data, today’s technology makes the systematic collection and analysis of sex-, race-, and gender-disaggregated data simpler at all stages of the R&D process. Life science companies could harness this capability to strengthen the collection, analysis, and reporting of disaggregated data at each stage of the process. This approach to data has the potential to enable life sciences companies to evaluate the safety and efficacy of their pipeline products more accurately, including by adjusting formulations and dosages. This could yield better health outcomes and a higher probability of success. To further encourage the shift toward disaggregated data, the Women’s Health Innovation Opportunity Map 2023 proposes establishing sex as a biological variable. 96 Women's Health Innovation Opportunity Map: 50 high-return opportunities to advance global women’s health R&D , Bill & Melinda Gates Foundation and National Institutes of Health, October 2023. This would enable national health departments and international health organizations to develop and enforce guidelines regarding disaggregation of data by sex and gender in research studies and health surveys.
• Biotech, medtech, and FemTech enterprises also have exciting opportunities related to AI and ML, which ensures that these models do not exacerbate existing biases or violate patient privacy rules. Developing robust, secure, and holistic data sets could enable companies to differentiate in an overcrowded marketplace.

Enhance access to gender-specific care, from prevention to diagnosis and treatment

• Women deserve the same high-quality level of care from their healthcare providers as men, which doesn’t mean the same care per se. There is a pressing need to redesign medical curricula as well as residency and fellowships to reflect sex and gender differences. In addition to medical schools, continuing medical education organizations and credentialing entities could assess whether healthcare providers are receiving the latest information and training on the women’s health gap and sex- and gender-based differences. Current and future healthcare professionals of all specialties must be equipped with accurate and updated knowledge of biological differences, including sex-specific manifestations of symptoms. Future certification or tests could include questions meant to address whether providers have internalized this knowledge.
• Next, the path to excellence in clinical care lies in acknowledging and rectifying inherent equity disparities. Gender- and sex-responsive services benefit patients, healthcare providers, and society at large. Health systems could implement new guidelines and protocols (for example, sex-specific cutoffs for biomarkers, discharge checklists) to guide decision making and minimize biases. Similarly, life science companies could include sex-specific evidence and outcomes on product package inserts and labels to inform healthcare professionals on the best regimens for different subpopulations. 97 Women's Health Innovation Opportunity Map: 50 high-return opportunities to advance global women’s health R&D , Bill & Melinda Gates Foundation and National Institutes of Health, October 2023.
• To reduce maternal mortality globally, investing in the training and upskilling of midwives could save an estimated 4.3 million lives per year and prevent roughly two-thirds of maternal deaths, 64 percent of newborn deaths, and 65 percent of stillbirths while contributing to the economic development and empowerment of women. 98 Christina Östberg Lloyd and Christian Sand Horup, “Leaders in women's health call for more investment in midwives to prevent 4.3 million deaths each year,” World Economic Forum, May 5, 2023.
• Governments, educational bodies, philanthropic institutions, and many other stakeholders can use this moment to raise awareness of the sex-specific manifestations of disease—for example, ensuring that newly diagnosed endometriosis patients have access to up-to-date resources, including which trials they could potentially participate in. Healthcare entities, philanthropic organizations, or community health workers could start or reinvigorate in-person support groups for conditions such as endometriosis or menopause or for mental health support. Collectively, better education and resources, plus new diagnostics, are among the ways to potentially elevate the quality of healthcare women receive.

In addition, two things to enable closing the gap include:

Create incentives for new financing models to close the women’s health gap

• Historically, given lower levers of investments overall for women’s health under the traditional financing model schemes, new financing models have a critical role to play. These models can accelerate innovation. One example is the advance market commitment (AMC) geared to COVID-19 vaccine development and deployment.
• Research and reliable data on the women’s health landscape can help spur investment. For investors, the gender-based healthcare landscape presents a mosaic of unexplored opportunities. By pivoting toward this opportunity, investors can channel funds into high-impact areas, bridge the data gap, and enable more investment and innovation.
• Governments could explore policies that encourage sex- and gender-responsive health research and services—for example, by earmarking funds, providing tax incentives, lowering application fees, and expediting the drug approval process. Philanthropic organizations, donors, and international bodies could offer grants and prizes at a national or local level to spur innovation while supporting capacity building in regions where gender-based health disparities are highest. Examples might be launching a grant or award program geared toward reducing rates of respiratory illnesses in areas where there is a high percentage of women smokers, or toward a technology-based solution for women in vulnerable populations to access transportation to healthcare services.
• Private-sector stakeholders could help develop new financial products and investment vehicles, such as gender-lens investing, to attract capital to projects that directly address the women’s health gap. Governments could further promote private-sector investments by creating tax incentive programs for angel investors and venture capitalists that invest in women’s health. 99 Women's Health Innovation Opportunity Map: 50 high-return opportunities to advance global women’s health R&D , Bill & Melinda Gates Foundation and National Institutes of Health, October 2023.
• With collaboration, stakeholders have the potential to encourage investments and inspire the development of innovative financing models in women’s health.

Establish business policies that support women’s health

As previously outlined, healthcare disparities also lead to economic losses due to absenteeism, presenteeism, and reduced productivity overall. Employers could consider how their workplace policies and benefits support women’s health, examine ways to better involve women in decision-making processes, provide health and wellness benefits that support women’s health, and create safe working environments in which women can speak openly about their health needs. By better understanding employee demographics, employers could invest in the areas with higher impact and potential. For example, if a workforce includes women between 45 and 55 years old, high impact could come from flexible work policies that recognize menopause. Given the fact that women are more than twice as likely as men to have depressive symptoms in their lifetime, 100 “Depression in women,” Mental Health America, n.d. employers may explore how mental-health programs can help employees find evidence-based mental health resources that meet their needs.

Often, leaders create change in the workplace based on their own experiences, knowledge, or vision. If the decision makers are predominantly men, the workplace tends to benefit men. Previous McKinsey research has found a “broken rung” in women’s advancement throughout industries: for every 100 men promoted from entry-level to manager roles, 87 women are promoted and only 73 women of color are promoted. 101 “ Women in the workplace 2023 ,” McKinsey, October 5, 2023. Overall, due to gender disparities in early promotions, men end up with 60 percent of manager-level positions in a typical company. More women in senior leadership positions may be able to advocate for policies that support women’s health, and companies may ultimately benefit from a healthier and more productive workforce.

Data-driven, scalable actions to improve women’s health may vary widely, but the critical component is to determine how each stakeholder can contribute to narrowing the gap.

If health equity efforts sit within a tree of principles, they can be watered by research, flourish in the sun of business investments, and grow far-reaching branches that stretch into the economy.

Achieving health equity is a collaborative and ongoing endeavor that relies on the active participation of governments, healthcare institutions, nongovernmental organizations, individuals, and all stakeholders vested in this cause. Tackling the women’s health gap depends on addressing the interconnected factors outlined in this report: the deficit of women-specific knowledge in science, the glaring data gaps, the disparities in healthcare delivery, and the insufficient investment in women’s health.

Recognizing the vast potential to improve the lives and livelihoods of half the global population while boosting the economy serves as the catalyst for closing the women’s health gap. Every facet of this gap, from limited education to suboptimal treatments, offers an opportunity for transformation with the active involvement of governments, life science innovators, educational institutions, philanthropists, activists, and more.

In this endeavor lies an opportunity of $1 trillion in economic potential driven by improved women’s health and economic participation. The question is not whether this wealth of opportunities exists but rather who will take the initiative to seize it and drive change.

Women’s health is not a stand-alone issue; it is a cornerstone of societal well-being and progress. Better health and well-being for women creates a ripple effect that extends to families, communities, and nations. This holistic approach, supported by collective action and sustained investment, will not only narrow the health gap but also contribute to the betterment of a shared global future.

Kweilin Ellingrud is a senior partner in McKinsey’s Minneapolis office and a director of the McKinsey Global Institute. Lucy Pérez is a senior partner in the Boston office and an affiliated leader of the McKinsey Health Institute. Anouk Petersen is a partner in the Geneva office. Valentina Sartori is a partner in the Zurich office.

The authors wish to thank the following individuals for their contributions to this report.

World Economic Forum

Shyam Bishen Head, Centre for Health and Healthcare

Amira Ghouaibi Project Lead, Women’s Health Initiative

Judith Moore Head, Healthcare Initiatives

Christian Sand Horup Project Fellow, Women’s Health Initiative

Other organizations

Anshu Banerjee Director, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO)

Sarah Barnes Director of the Maternal Health Initiative, Woodrow Wilson International Center for Scholars

Jeff Bernson Senior Vice President and General Manager, Mathematica

Sanjana Bhardwaj Deputy Director, Global Policy and Advocacy, Bill & Melinda Gates Foundation

Bineta Diop Founder and President, Femmes African Solidarité

Samukeliso Dube Executive Director, Family Planning 2030

Charlotte Ersbøll Senior Advisor, Ferring Pharmaceuticals

Anna Frellsen Chief Executive Director, Maternity Foundation

Katy Geguchadze Senior Manager, Public Relations, Maven Clinic

Patricia Geli Founding Partner and Chief Operating Officer, C10 Labs

Mark Hanson Chair of Knowledge and Evidence Working Group, PMNCH

Katja Iversen Chief Executive Officer, Museum for the United Nations

Kristy Kade Chief Executive Officer, White Ribbon Alliance

Keren Leshem Chief Executive Officer, OCON Healthcare

Sofiat Makanjuola-Akinola Director, Health Policy and External Affairs, Roche Diagnostics Solutions

Divya Mathew Director, Policy and Advocacy, Women Deliver

Alexandra Plowright Community Health and Wellbeing Lead, Anglo American

Vivian Riefberg Professorship Chair and Professor of Practice , University of Virginia

Elizabeth Rowley Senior Global Advisor, PATH

Noha Salem Executive Director, Global Public Policy, Organon

Stephanie Sassman Portfolio Leader, Women’s Health, Genentech

Nandini Selvam Vice President and General Manager, IQVIA

Dilly Severin Executive Director, Universal Access Project, United Nations Foundation

Kathleen Sherwin Chief Strategy and Engagement Officer, Plan International

David Wofford Senior Director, United Nations Foundation

Michelle Williams Professor of Epidemiology and Public Health, Harvard T. H. Chan School of Public Health

Alice Zheng Principal, RH Capital

The authors also would like to thank Sharmeen Alam, Carolin Baumgartner, Marie Busson, Natalia Camargo, Ada Cierkowska, Erica Coe, Michael Conway, Sarah Dewilde, Grail Dorling, Anas El Turabi, Tracy Francis, Donna Gan, Carlota Gorosabel, Simone Graf, Megan Greenfield, Lars Hartenstein, Alexander Hedfjäll, Ananya Karanam, Anne Koffel, Pooja Kumar, Elisabeth Leo, Dan Levine, Kate Midden, Lorenzo Pautasso, Taylor Rose, Roxanne Sabbag, Nikhil Sahni, Devika Sandill, Anna Schmutz, Kate Simon, Shubham Singhal, Talley Snow, Jana Staffa, Emma Summerton, Nicole Szlezak, Isabella Tagliaferri, Pooja Tatwawadi, and Kirsten Westhues.

This report was edited by Elizabeth Newman, an executive editor in the Chicago office.

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The U.S. decides it’s time to invest in women’s health research

Experts can speak about new Biden initiative to better represent women in health research

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• Release Date: November 15, 2023

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CHICAGO --- First lady Jill Biden will now lead a new initiative announced Monday to improve how the U.S. federal government funds health research about women, who historically have been and currently still are underrepresented in medical research.

Myriad experts at Northwestern University Feinberg School of Medicine have had numerous studies published that highlight the lack of sex inclusion in scientific and clinical research. Some have developed technology to help address the gap. The experts can address why there has historically been a lack of sex inclusion in biomedical research, why including more women in health research is so necessary and what this means for scientists going forward. Contact Kristin Samuelson at [email protected] to arrange an interview with the scientists.

“I am passionate about women’s health and making sure that we consider sex in biomedical research instead on continuing along with the assumption that everything works exactly the same in men and women, despite so many very obvious differences in health and disease,” said Barbara Stranger, associate professor of pharmacology at Feinberg who will appear on a Nov. 30 virtual panel, “Sex as a Biological Variable ,” convened by the National Institutes of Health (NIH) Office of Research on Women’s Health.

“I’m thrilled our administration has recognized the need for dedicated and sustained investment in women’s health research,” said Nicole Woitowich, executive director of the Northwestern University Clinical and Translational Sciences (NUCATS) Institute and a research assistant professor in the department of medical social sciences at Feinberg. “Historically, women have been unrepresented in clinical research and this acknowledgement is a tremendous step forward in advancing health equity.”

Below is a brief introduction to several Northwestern experts in this area, along with some of their recent relevant work:

• 2023 study in Lab on a Chip : Device can simulate disease and test how drugs and diseases affect people (including women) differently
• Kim also was involved in an earlier project, EVATAR (a mini female reproductive tract in a dish) , which enables scientists to conduct much-needed testing of new drugs for safety and effectiveness on the female reproductive system.
• June 2021 study in JAMA Network Open: Women and men are each underrepresented in clinical trials of different medical fields : “Neglecting one sex in clinical trials — the gold standard scientific exploration and discovery — excludes them from health innovation and skews medical evidence toward therapies with worse efficacy in that sex.”
• May 2023 study in Cell: She developed a guide outlining best practices for studying and testing for sex-dependent genetic effects.
• 2020 study in Science: Sex influences gene production in every human tissue
• June 2020 study in eLife, Females still an afterthought in research: A 10-year follow-up to  a 2009 groundbreaking study that found females were left out of biomedical research because of how their hormones might skew fragile study designs, an idea that has repeatedly been proven false.  
• Co-launched the Illinois Women’s Health Registry in 2019, which links women to scientists and clinical trials throughout the state to uncover why diseases affect women differently than men.

Improving women’s health and care through research

• 08 March 2023

Dr Gail Marzetti, Director of Science, Research and Evidence at the Department of Health and Social Care (DHSC), discusses the best ways to address the under-representation of women across health and care research.

Last year, DHSC published its first Women’s Health Strategy for England . The strategy sets out a 10-year ambition to boost health outcomes for all women and girls and radically improve the way in which the health and care system engages and listens to them.

Although women in England live longer than men on average, they spend a significantly greater proportion of their lives in ill health and disability .

I am glad to see research and evidence featured throughout the strategy. In particular, I welcome the long-term focus on addressing the lack of research into women’s health conditions; improving the representation of women of all demographics in research; addressing key evidence gaps; and ensuring that data are broken down by sex.

When I was working in humanitarian aid in Mozambique 30 years ago, I attended a UNICEF conference where we discussed the vital importance of disaggregating research findings by sex and it’s frustrating that this continues to be an issue.

The Strategy highlights that NIHR expects to commission a new  Policy Research Unit for Reproductive Health to inform government policy. This is taking a life course approach to reproductive health and is inclusive of groups currently under-represented in research.

I’m proud of this development but I know that more is needed. In particular, it’s important to remember that women’s health needs are not only reproductive. Not enough is known about how conditions that affect both men and women may impact women in different ways.

Since the launch of the strategy, colleagues in DHSC and NIHR have been discussing four priority areas that are vital if we are to realise its ambitions:

• How can we improve the representation of women in research, including clinical trials and disaggregation of results?
• How can we increase the representation of diverse women across NIHR awards and committees?
• How can we ensure research prioritises women’s health, care and wellbeing, and addresses evidence gaps?
• How can we more effectively disseminate research to women, practitioners, decision makers, community leaders and the general public

To help answer these questions, Professor Lucy Chappell, DHSC Chief Scientific Adviser and CEO of the NIHR, recently hosted a roundtable meeting with representatives from DHSC, NIHR, NHS England and the Medical Research Council as well as leading academics.

This explored the best ways to address the under-representation of women across health and care research, including in clinical trials. Four key themes emerged from the discussion.

• Insight: We need to reach people who are persistently under-served by health research. To achieve this, we need to require that results and findings are disaggregated by sex (and other protected characteristics) to understand unmet need.
• Simplicity: We must address system complexity and break down barriers to inclusion. This will rely on a recognition that women’s health is everybody’s business.
• Networks: To ensure that we hear a diversity of women’s voices, we need to encourage and enable our research community to build relationships and trust with women’s networks and the voluntary, community and social enterprise sectors.
• Inclusion: When women - or indeed any other group - are not fully included in health research, their specific needs are not addressed and this ultimately costs the NHS money.

The roundtable marked our first exploratory consultation. There will be opportunities to contribute and we will widen our engagement with other sectors as we proceed.

The consultation for the Women’s Health strategy repeatedly heard from women that our healthcare systems are failing them because NHS services are not designed to meet women’s day-to-day needs. This is echoed in our NIHR Collection about Women’s Health . We are working hard to address this imbalance through research.

As Women’s Health Ambassador Dame Lesley Regan has said, “When we get it right for women, everyone in our society benefits”.

• DHSC Women's Health Strategy for England
• Find out more about how NIHR is promoting inclusive research
• Read Professor Lucy Chappell’s blog for International Women’s Day 2022
• TV presenter and menopause awareness advocate Davina Mcall stressed the importance of women’s health research at a recent NIHR event
• Discover NIHR-funded studies, and other important research, that could support women's health and improve maternity care

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Women’s Health is Suffering Due to Lack of Research and Funding, Experts Say

Women’s health has been historically underfunded — in terms of both research dollars and venture capital investment. Lawmakers can’t craft effective policy nor can startups innovate in the women’s health space without good data and research, said panelists at a recent healthcare conference in Washington, D.C.

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Women’s health has been historically underfunded — in terms of both research dollars and venture capital investment — according to a panel that took place Wednesday at the Milken Institute ’s Future of Health Summit in Washington, D.C. 

Until the healthcare industry dedicates more time and money to understanding female-centric issues, women’s health outcomes will continue to suffer, the panelists said.

Get Ready for HLTH 2024: A Preview Guide

HLTH 2024, scheduled for October 20-23 at the Venetian Expo Center in Las Vegas, will highlight new programming, a physicians roundtable, generative AI, the shifting landscapes of telemedicine, retail health, women's health, and lots more.

Only about 5% of capital invested in digital health startups goes toward companies focused on women’s health, said Elizabeth Galbut, the co-founder and managing partner of SoGal Ventures . She pointed out that we’re slowly starting to see more capital flow to women’s health startups — such as online abortion clinic Hey Jane ’s $6.1 million fundraise in October and the launch of menopause startup Upliv last month. But women’s health funding “needs to be way more than 5%,” Galbut declared.

“[Hey Jane] has seen 10 times growth in demand on the patient side. As a venture capitalist, I look at this and think that a company like that is going to need a lot of resources in order to succeed in this environment from both a policy and commercial perspective. And unfortunately, there isn’t a ton of capital in the marketplace supporting these types of companies,” she said.

It’s important to remember that lawmakers can’t craft effective policy nor can startups innovate in the women’s health space without good data and research, said Janine Austin Clayton, director of the National Institutes of Health ’s office for women’s health research, who was on the panel with Galbut.

Diseases manifest in women in different ways than they do for men, and the healthcare sector needs more funding to study those sex and gender differences, Clayton pointed out.

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“We see differential rates in many of the chronic diseases, and women are more likely to have multiple diseases and more likely to be affected by pain conditions,” she said. “In fact, if you look across the country at data, you can see changes in life expectancy for women that are different for that of men. Even though women generally live longer than men do, they spend many more years in ill health or disability.”

Clayton called for more studies that are designed to study the differences between disease states in men and women. She also called for the healthcare sector to do more data reporting that accounts for men and women separately.

Additionally, it’s critical that researchers dedicate more focus to female-specific health issues, such as menopause, preeclampsia and polycystic ovarian syndrome. These issues have an immense impact on the health of women throughout the country, yet very little research centers on these conditions, Clayton said.

Social media can make this unfortunate reality worse, Galbut pointed out. Since women lack access to reliable information about how to deal with conditions like polycystic ovarian syndrome and menopause, they often rely on unvetted online information.

“Most of us no longer have appointments with a doctor that lasts 60 minutes where they can really explain things,” she said. “And we’re waiting sometimes months upon months to even get in to see specialists. So in that void, we all have the internet. We say ‘we’re going to Google this, we’re gonna go on Instagram, and we’re gonna find these solutions.’”

To remedy this problem, Galbut called for healthcare providers and experts to insert “actual data and research” into social media channels “where people already are.”

Photo: Choreograph, Getty Images

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Closing the gap: Two national networks secure $10M in funding for women’s heart and brain health research

From: Canadian Institutes of Health Research

News release

Women experience distinct heart disease and stroke symptoms and risk factors that remain under-researched and misunderstood. With these new investments, we’re closing the gap and moving toward a future where all women receive the high-quality heart and brain health care they need.

Research will shed light on how to reduce and prevent death and serious illness from heart conditions and stroke in women

September 23, 2024 | Ottawa, Ontario | Canadian Institutes of Health Research

Today, the Honourable Mark Holland, Minister of Health, announced that the Government of Canada and partners, Heart & Stroke and Brain Canada, are investing $10M to establish two new national research networks for women’s heart and brain health.

The networks will be led by Dr. Rohan D'Souza at McMaster University, whose team will create a Canada-wide collaboration aimed at reducing deaths and serious illness from heart conditions during and between pregnancies, and Dr. Amy Yu at the Sunnybrook Research Institute whose team will work on improving evaluation, diagnosis, and outcomes of stroke in women across Canada.

Each network will receive $5M in funding over five years to better understand women’s risk factors for heart and brain conditions and to improve the diagnosis and treatment of conditions more common among women or that are less well studied.

“We know that women can have conditions that affect them disproportionately or differently, like heart disease and stroke, but these conditions remain under-researched and misunderstood. By investing in these research networks, we can fill persistent knowledge, practice and policy gaps in women’s heart and stroke health – so women across Canada can get the care they need.” The Honourable Mark Holland Minister of Health

“A strength of the Research Networks of Excellence is the intersectional approach being used to examine how women’s heart and brain health differ by social factors including Indigeneity, race and sexual orientation, as well as how social processes like racism, sexism and homophobia may further shape risk and health outcomes. This type of research is necessary to inform precision medicine approaches to greatly improve women’s care and save lives.” Dr. Angela Kaida Scientific Director, CIHR Institute of Gender and Health

“Heart & Stroke is proud to accelerate advances through these national networks to drive new knowledge and innovation in women’s heart and brain health. Certain types of heart and brain conditions are more common in women, and women can be impacted differently by heart disease and stroke. We are excited that this new research will reflect the various life stages women go through and will include additional considerations for gender and racial identity, disability and social economics. These new research networks will allow us to further develop and use research evidence in women’s heart and brain health, and ultimately help save more lives.” Doug Roth CEO, Heart & Stroke

“As Canada’s only research funder focused exclusively on the brain, we are committed to advancing sex and gender science. Brain Canada is pleased to match the $2.4-million investment by Heart & Stroke in the first Canadian research network dedicated to the study of women and stroke. This research examines why stroke affects women differently than men, and identifies variations in treatment, access to rehabilitation, and risk of recurrent stroke. Findings will lead to new therapies and improved stroke recovery for women.” Dr. Viviane Poupon President and CEO, Brain Canada

Quick facts

This type of research is crucial, as some risk factors for brain and heart conditions in women are under-recognized, not only by women themselves, but by health care professionals and the general public, including risk factors related to the use of oral contraceptives, gestational diabetes, disorders related to pregnancy, pre-term delivery, premature menopause, hormone replacement therapy and polycystic ovary syndrome, among others.

There is a persistent lack of awareness and understanding around the heart and brain health of women, transgender, non-binary, intersex, Two-Spirit and people marginalized on the basis of their gender, as historically most research has focused on men’s hearts and brains.

The use of the term “women’s health” reflects an evolving concept, broadly including the multidimensional concepts of sex and gender. It refers to physical, biological, reproductive, psychological, emotional, cultural, and spiritual health and wellness across the lifespan in the context of the unique intersecting concerns related to bodies, roles, social locations, and identities. This goes beyond sex and gender binaries and welcomes the experiences and needs of all people who identify as a woman, girl, intersex and/or under-represented gender identity, including but not limited to Two-Spirit, trans, non-binary, gender fluid and agender people.

Related products

• Backgrounder: Research Networks of Excellence in Women’s Heart and Brain Health

Associated links

• Research Networks of Excellence in Women’s Heart and/or Brain Health

Matthew Kronberg Press Secretary Office of the Honourable Mark Holland Minister of Health 343-552-5654 Media Relations Canadian Institutes of Health Research [email protected]

Alicia D’Aguiar Heart & Stroke [email protected] 647-426-8410

Kate Shingler Brain Canada [email protected] 514-550-8308

At the  Canadian Institutes of Health Research  (CIHR) we know that research has the power to change lives. As Canada's health research investment agency, we collaborate with partners and researchers to support the discoveries and innovations that improve our health and strengthen our health care system.

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Health System

Healthcare for women in the U.S. - statistics & facts

Coverage and access to healthcare services, gender gap in healthcare costs, key insights.

Detailed statistics

U.S. population by sex and age 2023

Maternal mortality rates in the U.S. from 2018 to 2022, by race/ethnicity

Share of reproductive aged women insured by Medicaid in the U.S. 2022, by state

Editor’s Picks Current statistics on this topic

States ranking for women's health care and safety in the U.S. in 2024

Share of uninsured low-income women ages 19-64 in the United States in 2022, by state

Women's health insurance coverage by type U.S. 2022

Further recommended statistics

• Premium Statistic States ranking for women's health care and safety in the U.S. in 2024
• Premium Statistic States ranking for having a baby in the United States in 2024
• Premium Statistic Distribution of adult women in the U.S. in 2022, by age groups

States ranking for women's health care and safety in the U.S. in 2024

Ranking of states from best to worst for women's health care and safety in the United States in 2024

States ranking for having a baby in the United States in 2024

Ranking of states from best to worst for having a baby in the United States in 2024

Distribution of adult women in the U.S. in 2022, by age groups

Distribution of women aged 19 years and above in the U.S. in 2022, by age group

Healthcare coverage

• Basic Statistic Women's health insurance coverage by type U.S. 2022
• Basic Statistic Distribution of Medicaid/CHIP enrollees 2022, by ethnicity
• Premium Statistic Share of reproductive aged women insured by Medicaid in the U.S. 2022, by state
• Premium Statistic Women reporting select types of health insurance coverage in the U.S. 2018-2022

Women's health insurance coverage by type U.S. 2022

Distribution of U.S. women between the ages 19 and 64 years with health insurance coverage in 2022, by coverage type

Distribution of Medicaid/CHIP enrollees 2022, by ethnicity

Distribution of Medicaid/CHIP enrollees in the United States in 2022, by ethnicity

Share of women between ages 15 and 49 years insured by Medicaid in the United States in 2022, by state*

Women reporting select types of health insurance coverage in the U.S. 2018-2022

Percentage of U.S. women with select types of health insurances from 2018 to 2022

Maternal health care

• Basic Statistic Median driving time to rural hospitals with maternity care in 2024, by state
• Premium Statistic Number of obstetricians and gynecologists employed by U.S. state 2023
• Premium Statistic Share of U.S. women with a primary care physician or OB/GYN they routinely saw 2022
• Premium Statistic Number of U.S. births with Medicaid as source of payment 2022, by state
• Premium Statistic Share of U.S. births with Medicaid as source of payment 2016-2022
• Basic Statistic Number of U.S. hospitals meeting national c-section standard as of 2022
• Basic Statistic Main source of payment for childbirth in the U.S. in 2021, by maternal race
• Premium Statistic Main source of payment for childbirth in the U.S. in 2021, by maternal age
• Basic Statistic Funding for maternal and child health globally by the U.S. 2006-2020

Median driving time to rural hospitals with maternity care in 2024, by state

Median driving time to the nearest rural hospital in the U.S. with maternity services as of April 2024, by state (in minutes)

Number of obstetricians and gynecologists employed by U.S. state 2023

Number of obstetricians and gynecologists employed in the United States in 2023, by state

Share of U.S. women with a primary care physician or OB/GYN they routinely saw 2022

Percentage of women in the United States who reported having a primary care physician or OB/GYN they routinely saw as of 2022

Number of U.S. births with Medicaid as source of payment 2022, by state

Number of births in the U.S. in which Medicaid was the source of payment for the delivery in 2022, by state

Share of U.S. births with Medicaid as source of payment 2016-2022

Share of births in the U.S. in which Medicaid was the source of payment for the delivery from 2016 to 2022

Number of U.S. hospitals meeting national c-section standard as of 2022

Number of U.S. hospitals that are meeting or failing the national cesarean section target as of 2022

Main source of payment for childbirth in the U.S. in 2021, by maternal race

Distribution of main source of payment for childbirth in the U.S. in 2021, by maternal race

Main source of payment for childbirth in the U.S. in 2021, by maternal age

Distribution of main source of payment for childbirth in the U.S. in 2021, by maternal age

Funding for maternal and child health globally by the U.S. 2006-2020

U.S. funding for maternal & child health (MCH) and nutrition from FY 2006 to FY 2020 (in million U.S. dollars)*

Preventive healthcare

• Basic Statistic HPV vaccine coverage among U.S. female adolescents as of 2023, by age
• Premium Statistic Share of U.S. women 18 to 64 years who had a Pap test in 2022, by insurance coverage
• Premium Statistic U.S. females who visited a dentist in the past year as of 2022, by state
• Premium Statistic U.S. women that have had a mammogram within the past 2 years from 2020-2022, by state
• Premium Statistic Percentage of U.S. women 50-74 years who had a mammogram by race/ethnicity 2021
• Premium Statistic Share of U.S. women 50-64 years who had a mammogram in 2022, by insurance coverage
• Premium Statistic Share of U.S. women 45 to 64 years who had a colonoscopy in 2022, by insurance status
• Basic Statistic Reasons why U.S. women used contraception in 2022

HPV vaccine coverage among U.S. female adolescents as of 2023, by age

Percentage of female adolescents in the U.S. who had received an HPV vaccine as of 2023, by age*

Share of U.S. women 18 to 64 years who had a Pap test in 2022, by insurance coverage

Share of U.S. women aged 18 to 64 years who received a cervical cancer screening/Pap test in the past two years as of 2022, by insurance coverage

U.S. females who visited a dentist in the past year as of 2022, by state

Percentage of women in the U.S. who visited a dentist or dental clinic within the past year as of 2022, by state

U.S. women that have had a mammogram within the past 2 years from 2020-2022, by state

Percentage of U.S. women aged between 50 and 74 years that reported having a mammogram within the past 2 years from 2020 to 2022, by state

Percentage of U.S. women 50-74 years who had a mammogram by race/ethnicity 2021

Percentage of U.S. women aged 50-74 years who received a mammogram in the past two years as of 2021, by race and ethnicity

Share of U.S. women 50-64 years who had a mammogram in 2022, by insurance coverage

Share of U.S. women aged 50 to 64 years who received a mammogram in the past two years as of 2022, by insurance coverage

Share of U.S. women 45 to 64 years who had a colonoscopy in 2022, by insurance status

Share of U.S. women aged 45 to 64 years who received a colon cancer screening/colonoscopy in the past two years as of 2022, by insurance coverage

Reasons why U.S. women used contraception in 2022

Percentage of U.S. women that used contraception for select reasons as of 2022

Unmet needs

• Premium Statistic Share of U.S. adults without health insurance by gender 2015-2023
• Premium Statistic Share of uninsured low-income women ages 19-64 in the United States in 2022, by state
• Premium Statistic Uninsured U.S. women in 2022 by parent status
• Premium Statistic Uninsured U.S. adult women in 2022 by age
• Premium Statistic Types of preventive services women had to forgo in the U.S. as of 2022
• Premium Statistic U.S. women who have not had a mammogram within the past 2 years in 2022, by state
• Basic Statistic Share of U.S. women who were unable to get birth control on time as of 2022, by race
• Basic Statistic Share of reasons women in U.S. could not access mental health services in 2022

Share of U.S. adults without health insurance by gender 2015-2023

Share of adults aged 18–64 years without health insurance in the United States from 2015 to 2023, by gender

Share of uninsured low-income women aged between 19 and 64 in the United States in 2022, by state

Uninsured U.S. women in 2022 by parent status

Number of adult women without health insurance in the U.S. in 2022, by parent status (in millions)*

Uninsured U.S. adult women in 2022 by age

Number of adult women without health insurance in the U.S. in 2022, by age (in millions)

Types of preventive services women had to forgo in the U.S. as of 2022

Share of types of preventive health services women had forgone in the past year in the U.S. as of December 2022

U.S. women who have not had a mammogram within the past 2 years in 2022, by state

Share of U.S. women aged between 50 and 74 years who reported not having a mammogram within the past 2 years from 2020 to 2022, by state

Share of U.S. women who were unable to get birth control on time as of 2022, by race

Percentage of contraceptive-using women in the U.S. who had missed taking their birth control on time due to a lack of supply as of 2022, by race and ethnicity

Share of reasons women in U.S. could not access mental health services in 2022

Distribution of reasons women in the U.S. could not get an appointment for needed mental health care in the past two years as of 2022

• Premium Statistic Share of Title X funded family planning users in the U.S. in 2021, by gender and age
• Basic Statistic Contraceptive methods used by female users of Title X program in the U.S., by age
• Premium Statistic Share of Title X funded family planning users in the U.S. in 2021, by income
• Basic Statistic Title X program users who had private insurance in the U.S. in 2021, by state
• Basic Statistic Title X program users who were uninsured in the U.S. in 2021, by state

Share of Title X funded family planning users in the U.S. in 2021, by gender and age

Distribution of Title X funded family planning service users in the U.S. in 2021, by gender and age

Contraceptive methods used by female users of Title X program in the U.S., by age

Share of family planning methods used by females using the Title X program in the U.S. in 2021, by age

Share of Title X funded family planning users in the U.S. in 2021, by income

Distribution of Title X funded family planning service users in the U.S. in 2021, by income level

Title X program users who had private insurance in the U.S. in 2021, by state

Share of Title X funded family service users who have private insurance in the U.S. in 2021, by state

Title X program users who were uninsured in the U.S. in 2021, by state

Share of Title X funded family service users who were uninsured in the U.S. in 2021, by state

• Premium Statistic Total personal healthcare spending in the U.S. 2002-2020, by gender
• Premium Statistic Total personal healthcare spending by women in the U.S. in 2020, by type of service
• Premium Statistic Share of personal healthcare spending by American women in 2020, by age and service
• Premium Statistic Total spending OOP by women on personal healthcare services in the U.S. 2020, by age
• Basic Statistic Share of adults in the United States who have medical debt 2022, by gender
• Premium Statistic Women OOP healthcare spending per person in the U.S. in 2020, by age
• Premium Statistic Out-of-pocket spending per childbirth by vaginal delivery in 2020, by U.S. state

Total personal healthcare spending in the U.S. 2002-2020, by gender

Annual personal healthcare spending in the U.S. from 2002 to 2020, by gender (in billion U.S. dollars)

Total personal healthcare spending by women in the U.S. in 2020, by type of service

Total spending by American women on personal healthcare in 2020, by type of service (in billion U.S. dollars)

Share of personal healthcare spending by American women in 2020, by age and service

Distribution of total personal healthcare spending by women in the U.S. in 2020, by age and type of service

Total spending OOP by women on personal healthcare services in the U.S. 2020, by age

Out-of-pocket (OOP) expenditure by women on personal healthcare services in the U.S. in 2020, by age group (in millions U.S. dollars)

Share of adults in the United States who have medical debt 2022, by gender

Percentage of adults in the United States who have medical debt in 2022, by gender

Women OOP healthcare spending per person in the U.S. in 2020, by age

Average per person out-of-pocket (OOP) healthcare spending by women in the U.S. in 2020, by age (in U.S. dollars)

Out-of-pocket spending per childbirth by vaginal delivery in 2020, by U.S. state

Average out-of-pocket spending per childbirth by vaginal delivery in the United States in 2020, by state (in U.S. dollars)

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DoD Commits $500 Million for Women's Health Research, Supports Better Care for All Women

The Department of Defense (DoD) is working to ensure that research conducted across the Department addresses health disparities faced by women, including conditions that affect women uniquely, disproportionately, or differently. As part of the Department's broader efforts to support the health of women Service members, veterans, and beneficiaries (such as spouses and dependents) to enhance the medical readiness of the force—and consistent with the President's Executive Order on Advancing Women's Health Research and Innovation—DoD is publicly announcing a series of new actions and commitments to advance women's health research by:

• Spending half a billion dollars each year on women's health research, primarily through the Congressionally Directed Medical Research Programs (CDMRP);
• Adopting a new research policy to ensure that women's health is considered during every step of the research process that will apply to relevant research funded through the CDMRP beginning on October 1, 2024;
• Standardizing CDMRP and Military Health System Research funding opportunity announcements to encourage applicants to consider research on health areas and conditions that affect women; and
• Committing DoD's Small Business Innovation Research (SBIR) program and the Small Business Technology Transfer (STTR) program to increase its investments in supporting innovators and early-stage small businesses engaged in research and development on women's health.

These new announcements build on recent work that DoD has already done to advance women's health research—including the establishment of a joint collaborative to improve women's health research with the Department of Veterans Affairs (VA), DoD's new Military Women's Health Research Program, and the appointment of Dr. Lynette Hamlin as the first-ever dedicated Director of the Military Women's Health Research Program at the Uniformed Services University of Health Sciences—as well as DoD's prior investments in women's health research.

Investing in women's health research and evidence-based care is critical to meeting the health care needs of the women served by DoD. The DoD provides medical care to more than 230,000 active-duty Service women, nearly 2 million women military retirees, and to the family members of the active force and of retirees. Compared to men, this population experiences more than twice the rate of conditions in hematological, genitourinary, endocrine, nutrition, and immunity-related disorder categories. Additionally, women's rates for illness and injury-specific diagnoses, such as those associated with the musculoskeletal system and connective tissue, are more than 1.5 times those of male rates. DoD's systematic surveillance and research of health conditions among Service women at a population level will bolster treatment options, improve patient care, and support breakthrough technologies and resources for women inside and outside of the military health system. Information on specific DoD policy efforts can be found below.

Congressionally Directed Medical Research Programs CDMRP funds a wide variety of specialized health research areas that affect women, such as Alzheimer's disease, multiple sclerosis, lupus, orthopedic and musculoskeletal injuries, and various cancers. In Fiscal Year (FY) 2022 and FY 2023, CDMRP funded 751 grants, produced 625 studies, and supported 706 researchers. For FY 2024, depending on the applications received, DoD anticipates investing more CDMRP funding for women's health research than in previous years. These funds will be used to support research on topics such as rheumatoid arthritis, chronic fatigue, eating disorders, and gynecological cancers.

In addition to this new commitment, DoD adopted a new policy that will require researchers interested in CDMRP funding to consider sex as a biological variable in study design and analysis. Intentional consideration of biological variables, like sex, in medical research improves our understanding of health and disease in men and women. Under the new policy, CDMRP-funded research must consider the known and potential sex differences in disease prevalence, presentation, and outcomes. Peer and programmatic panels will review applications for how sex as a biological variable is incorporated into the proposed research and data analysis plans.

This new policy aligns with a similar policy adopted by the National Institutes of Health and will take effect on October 1, 2024. The new policy will apply to applications submitted for FY 2025 CDMRP funding opportunities, contingent on FY 2025 funding for CDMRP-managed programs. White House and DoD officials highlighted this change at DoD's 2024 Military Health System Research Symposium, the Department's premier scientific meeting.

Accounting for Women's Health Across DoD's Research Programs and Processes DoD has taken action to ensure that women's health is considered throughout the research application process. For instance, the CDMRP, the Uniformed Services University of Health Sciences (USUHS), and the Military Health System Research Program have all included standardized language in their FY 2024 funding opportunity announcements to encourage research on women's health, including consideration of sex as a biological variable and its relationship to socioeconomic factors in affecting health outcomes. Additionally, for these programs, DoD has implemented policies to ensure that reviewers consider women's health when evaluating research proposals, where appropriate.

Uniformed Services University of Health Sciences The USUHS established the Military Women's Health Research Program (MWHRP) in 2023, under the leadership of Dr. Lynette Hamlin, the program's inaugural Director. The MWHRP funds $1.67 million in research grants annually, sponsors publications and webinars to share important research findings, and encourages women to participate in the SBIR program and the STTR program. Over the last five years, USUHS has sponsored 76 grants, and produced 32 presentations and 152 publications specific to women's health research.

USUHS also established the Military Women's Health Research Consortium to develop and guide best practices for the clinical care of women in the Military Health System. Recent research focus areas include studying interventions for physical and emotional pain due to uterine fibroids, evaluating treatment options for women with low back pain, and studying the effects of prenatal mental health support.

Defense Health Program Small Business Innovation Research and Small Business Technology Transfer Programs The Defense Health Agency (DHA) SBIR and STTR programs are statutorily required programs established to increase the participation of small businesses in federal research and development. These programs enable DHA to spark the development of future technologies to improve warfighter health and survival. DHA SBIR and STTR revised the DoD Broad Agency Announcement (BAA), the funding mechanism utilized for these programs, to encourage participation in innovation and entrepreneurship by women. Additionally, to enhance investments in applied research and practice focused on women's health, SBIR and STTR have requested women's health research topics from stakeholders as part of the FY 2025 BAA development process.

DoD/VA Women's Health Research Collaborative To further our collaboration and partnership with the VA, the joint DoD/VA Health Executive Committee established a Women's Health Research Collaborative in 2024, which will explore opportunities to promote joint efforts to advance women's health research and improve evidence-based care for the women they serve: Service members, veterans, and their spouses, surviving spouses, dependents, and family caregivers. Additionally, the Collaborative will increase coordination with the goal of improving care and care delivery across the lifespan of women Service members, veterans, and other beneficiaries. The Collaborative will also advance research on key women's health issues and develop a roadmap to close pressing research gaps, including those specifically affecting Service women and women veterans.

Moreover, the Department ensures our providers are trained in gender-specific care. Through the DoD/VA Women's Health Working Group, two mini-residencies are held annually to build provider proficiency. The DoD/VA Women's Musculoskeletal Mini-Residency and DoD/VA Women's Mental Health Mini-Residency offer health care providers, from both departments, opportunities to learn about the latest research while strengthening skills and knowledge in how to assess, diagnose, and treat women Service members, veterans, and other beneficiaries.

The DoD/VA also developed a Women's Midlife Health Concerns Working Group to develop a needs assessment tool that will be deployed to women Service members, veterans, and other beneficiaries to gather their input on their midlife health concerns, including menopause and cardiovascular health. This group will make recommendations and develop tools to build provider proficiency in appropriately assessing and treating midlife health concerns.

Additional DoD actions to support the health needs of women Service members, retirees, and their eligible family members include the establishment of the Women's Midlife Telehealth Clinic - the first U.S.-based study examining birth outcomes between births attended by Certified Nurse Midwives and physicians focused on births within the MHS - and the provision of world-class cancer care and translational research at the Murtha Cancer Center at Walter Reed Gynecological Cancer Center of Excellence.

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Jill Biden reveals $500 million plan that focuses on women’s health at Clinton Global Initiative

FILE -A World Food Programme (WFP) truck backs up to load food items from a recently landed UN helicopter, in Yida camp, South Sudan, Sept. 14, 2012. (AP Photo/Mackenzie Knowles-Coursin, File)[ASSOCIATED PRESS/Mackenzie Knowles-Coursin]

NEW YORK (AP) — First lady Jill Biden on Monday unveiled a new set of actions to address health inequities faced by women in the United States, plans that include spending at least $500 million annually on women’s health research.

Jill Biden made the announcement at this year’s Clinton Global Initiative annual meeting in New York, moments before the organization honored President Joe Biden with the 2024 Clinton Global Citizen Award.

“He’s provided a playbook for getting things done,” former President Bill Clinton, said as he presented the award. “We honor him today, not just for what he’s accomplished, but for the way he has done it.”

President Biden, standing next to his wife, former Secretary of State Hillary Clinton and Clinton Foundation Vice Chair Chelsea Clinton, joked, “This is what you call being trapped.”

In his short remarks, he then called Jill Biden’s announcement one of the most substantial of his administration.

FILE -Bill Clinton, third left, speaks as Cindy McCain, Executive Director, World Food Programme, second right, Jose Andres, Founder and Chief Feeding Officer, World Central Kitchen, right, President of the Republic of Malawi, Lazarus Chakwera, second left, and Louise Emmanuelle Mabulo, Founder, The Cacao Project, left, listen during the Clinton Global Initiative, Sept. 19, 2023 in New York. (AP Photo/Andres Kudacki, File)

Photo: ASSOCIATED PRESS/Andres Kudacki

The additional government spending will mainly come from the Department of Defense, which provides medical care to more than 230,000 active duty military women and nearly 2 million military retirees, as well as their family members. The research will focus on why these women experience endocrine, hematological and other immunity-related disorders twice as often as men.

“Women are really hungry for this kind of information,” Jill Biden said. “We don’t have the answers.”

Another change will take effect next week, with a new policy that includes women’s health at every step of the research funded by Congressionally Directed Medical Research Programs, which funded 751 grants last year to study Alzheimer’s disease, multiple sclerosis, lupus, orthopedic and musculoskeletal injuries, and various cancers.

The commitment was among the largest of the more than 100 expected at the two-day meeting of political, business and philanthropic leaders gathering to address some of the world’s most pressing issues. The Clintons have set this year’s theme as “What’s Working,” a way to look for potential solutions and effective programs in tumultuous times.

“You don’t look at a problem and say, ‘That’s impossible,” Bill Clinton said in his opening remarks. “You don’t just throw up your hands. You roll up your sleeves.”

An example of that strategy came from the announcement that a wide-ranging group of 15 nonprofits, humanitarian aid organizations and other funders will join forces to address the humanitarian crisis in Sudan following more than a year of conflict.

The Coalition for Mutual Aid in Sudan – which includes The Bill & Melinda Gates Foundation, Global Giving, Global Fund for Women, and The Unitarian Universalist Service Committee — will donate at least $2 million to mutual aid groups in the country by the end of the year. It also pledged to raise another $4.5 million for those groups within the next two years.

Patricia McIlreavy, president of the Center for Disaster Philanthropy, which has been representing the coalition, said that, while much more aid is needed, the collaboration and problem-solving of the group is an important step forward.

“It gets us started,” McIlreavy told The Associated Press. “And it models the behavior you want to see from others. If you wait until it’s the perfect opportunity, you’ve missed many of the opportunities that were good enough.”

World Food Program director Cindy McCain said earlier this month that “ Sudan’s nearly a forgotten crisis ” and that 25 million people there already face acute hunger. Last week, the top United Nations humanitarian official said fighting is escalating in the conflict that began in April 2023 when long-simmering tensions between Sudan’s military and paramilitary leaders broke out in the capital Khartoum and spread to other regions. The U.N. says more than 14,000 people have been killed and 33,000 injured.

“With ongoing impediments to a large-scale international aid response, Sudanese community groups have become the primary frontline responders and are currently the most effective means of reaching millions on the brink of starvation,” Patricia McIlreavy, president of the Center for Disaster Philanthropy, said in a prepared statement on behalf of the coalition. “With so many lives on the line, the imperative to support local aid efforts in Sudan has never been more urgent.”

The Center for Disaster Philanthropy says more than 12 million people have been forced from their homes in Sudan, creating what is now the world’s largest displacement and hunger crisis. The danger from the conflict has prevented most international aid agencies from delivering supplies to those in need.

Greg Milne, the Clinton Global Initiative CEO who convened a panel in April to raise awareness and support for the Sudanese people, said the new coalition is an example of what bringing organizations from varied sectors can do.

“We know strong, diverse partnerships can help address often overlooked and even dire challenges, and develop unexpected and innovative solutions,” he said.

Philanthropic leaders, including Bill Gates, World Central Kitchen founder Jose Andres, Open Society Foundations President Binaifer Nowrojee, and Rockefeller Foundation President Raj Shah will share information about their work during CGI, as will Prince Harry , who will discuss the launch of The Archewell Foundation Parents’ Network, which supports parents of children harmed online. In his Tuesday appearance, the Duke of Sussex will also address his work with the World Health Organization and others to reduce violence against children, an issue he and his wife Meghan outlined on a recent trip to Colombia .

Brazilian President Luiz Inacio Lula da Silva, Barbados Prime Minister Mia Mottley, Kosovo President Vjosa Osmani Sadriu, and Latvian President Edgars Rinkevics are set to address the conference, as are CEOs from Pfizer, Mastercard, IKEA, Pinterest, Sanofi and Chobani.

Associated Press coverage of philanthropy and nonprofits receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy .

Copyright 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

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WRI 2024 — The Role of Policy in Access to HIV Research and Services Among Women Living with and Vulnerable to HIV

The Well Project and the WRI use the term "women" to describe anyone who identifies as such across the gender spectrum.

On March 21-24, 2024, The Women's Research Initiative on HIV/AIDS (WRI), a program of The Well Project, convened a meeting focused on The Role of Policy in Access to HIV Research and Services Among Women Living with and Vulnerable to HIV . The meeting sought to examine the ways that law and policy affect health outcomes for women living with and vulnerable to HIV.

While HIV research and service provision in the US have always been affected by the policy environment, recent legal and policy changes are poised to have a particularly negative impact on women living with and vulnerable to HIV. This year's WRI convening brought together 35 multidisciplinary, multisectoral key stakeholders (see below) to address critical aspects and potential implications for women living with and vulnerable to HIV of laws and policies related to HIV criminalization; abortion; gender-affirming care; and affirmative action/diversity, equity, and inclusion (DEI) programming – and to make recommendations for mitigating their injurious effects. To learn more, please see the WRI 2024 Issue Brief: Implications of Federal and State Policy on HIV Research and Services for Women Living with and Vulnerable to HIV . Click here to view more photos from WRI 2024.

"Every one of these issues is rooted in surveillance and control, limiting who gets to decide what happens to their body and what options they have for their future." – Tiommi Luckett, Transgender Law Center

The combined impact of HIV criminalization, abortion restrictions, bans on gender-affirming care, and the elimination of affirmative action/DEI programming will have profound consequences for access to HIV and sexual and reproductive healthcare services and HIV research among women living with and vulnerable to HIV across the gender spectrum. They will also limit the ability of providers and scientists to conduct programming and research to advance the field. As many of these policies are already in effect, it is crucial to raise awareness about their potential implications and undertake collaborative efforts to mitigate their negative effects and optimize HIV research and care.

WRI 2024 Meeting Participants

*2024 WRI Advisory Board Member

The WRI 2024 convening received sponsorship support or grants from Gilead, Merck, and ViiV Healthcare.

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Institute of Medicine (US) Committee on Women's Health Research. Women’s Health Research: Progress, Pitfalls, and Promise. Washington (DC): National Academies Press (US); 2010.

Women’s Health Research: Progress, Pitfalls, and Promise.

• Hardcopy Version at National Academies Press

Women make up just over half the US population and should not be considered a special, minority population, but rather an equal gender whose health needs require equal research efforts as those for men. Historically, however, the health needs of women, apart from reproductive concerns, have lagged in medical research. In 1985, the Public Health Service Task Force on Women’s Health Issues concluded that “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive.” Since the publication of that report, there has been a transformation in women’s health research—including changes in government support of research, in policies, in regulations, and in organization—that has resulted in the generation of new scientific knowledge about women’s health. Offices on women’s health have been established in a number of government agencies. 1 Government reports and reports from other organizations, including the Institute of Medicine (IOM), have highlighted the need for, and tracked the progress of, the inclusion of women in health research. A number of nongovernment organizations have also provided leadership in research in women’s health. And women as advocates, research subjects, researchers, clinicians, administrators, and US representatives and senators have played a major role in building a women’s health movement.

• CHARGE TO THE COMMITTEE

Given the research activities occurring in women’s health over the last 2 decades, in the Consolidated Appropriations Act of 2008 (Public Law 110-161) Congress provided the Department of Health and Human Services Office on Women’s Health (OWH) with funds for the IOM “to conduct a comprehensive review of the status of women’s health research, summarize what has been learned about how diseases specifically affect women, and report to the Congress on suggestions for the direction of future research.” In response, the OWH requested that the IOM conduct a study of women’s health research; the charge to the committee for the project is presented in Box S-1 .

Charge to the Committee. An Institute of Medicine committee will examine what the research on women’s health has revealed; how that research has been communicated to providers, women, the public and others; and identify gaps in those areas. The (more...)

In response to that request, the IOM convened a committee of 18 members who had a wide variety of expertise, including expertise in biomedical research, research translation, research communication, disabilities, epidemiology, healthcare services, behavioral and social determinants of health, health disparities, nutrition, public health, women’s health, clinical decision making, and such other medical specialties as cardiovascular disease (CVD), mental health, endocrinology, geriatrics, and immunology.

THE COMMITTEE’S APPROACH TO ITS CHARGE

The committee met six times, including two open information-gathering sessions at which the members heard from stakeholders and researchers, and conducted extensive literature searches of publications from the last 15–20 years. The committee approached women’s health as a concept that has expanded beyond a narrow focus on the female reproductive system to encompass other conditions that create a significant burden in women’s lives. The committee focused on health conditions that are specific to women, are more common or more serious in women, have distinct causes or manifestations in women, have different outcomes or treatments in women, or have high morbidity or mortality in women. Numerous conditions could be included in such a list. The committee could not review all such conditions and, therefore, highlights a number of such conditions as examples that are specific to women; that have differences in prevalence, severity, preferred treatment, or understanding for women; or that the condition is prominent in women or there is a research need regarding women, whether or not there are sex-differences. Searches included research on factors that are determinants of health (biologic, psychologic, environmental, and sociocultural factors), especially factors that might affect women disproportionately or uniquely, and on the translation of research findings into practice and the communication of research findings to the public.

When considering health end points, the committee did not present a comprehensive review of findings of all research on all diseases, disorders, and conditions that are women’s health issues. The committee identified a number of conditions that have a large impact on women, reviewed the literature related to them, and categorized them as conditions in relation to which there has been major, some, or little improvement in women’s health.

The committee developed a series of questions to focus deliberations and ensure appropriate response to the charge. Those questions and the committee’s responses to them are presented below.

IS WOMEN’S HEALTH RESEARCH STUDYING THE MOST APPROPRIATE AND RELEVANT DETERMINANTS OF HEALTH?

Determinants can range from a woman’s genetic makeup to her behaviors to the social, cultural, and environmental context in which genetic vulnerabilities and individual traits and behaviors are developed and expressed. Over the last 20 years, much has been learned about what the determinants of women’s health are.

The committee found that many behavioral determinants (such as smoking, eating habits, and lack of physical activity) are risk factors for most of the conditions under consideration. Those behavioral factors, in turn, are shaped by cultural, social, and societal contexts. Marked differences in the prevalence of and mortality from various conditions in women who experience social disadvantage due to race and ethnicity, lack of education, low income, and other factors have been documented. The differences stem from a variety of social determinants, including differential exposure to stressors and violence, which are more common in more disadvantaged communities. Such exposures are related to wide-ranging outcomes, including injury and trauma, depression, arthritis, asthma, heart disease, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and other sexually transmitted infections.

The underlying determinants of health and their relative power may differ by sex and gender, and tailored interventions might be more effective than generic treatments. As discussed in Chapter 2 , few studies have tested ways to modify behavioral determinants in women, and even less research has been conducted on the effects of social and community factors in specific groups of women.

IS WOMEN’S HEALTH RESEARCH FOCUSED ON THE MOST APPROPRIATE AND RELEVANT HEALTH CONDITIONS?

The committee discussed the research of a number of conditions as examples of conditions that greatly affect women. It categorized those conditions as having major, some, or little progress (see Table S-1 ).

Conditions Discussed by Committee, Categorized by Extent of Progress.

Conditions on Which Research Has Contributed to Major Progress

The committee identified breast cancer, CVD, and cervical cancer as the conditions on which major progress has been made.

Mortality from breast cancer has decreased in the last 20 years. Consumer demand and involvement and increased funding have spurred breast-cancer research at the molecular, cellular, and animal levels as well as clinical trials and observational studies in women. That research has led to the development of more sensitive detection methods, biomarkers of risk and of more aggressive tumors, identification of risk factors, and treatment options that improve survival and posttreatment quality of life. The finding in the Women’s Health Initiative (WHI) of increased risk of breast cancer from hormone therapy led to changes in practice, and a substantial drop in the incidence of breast cancer has been attributed to those changes in practice. Progress has not been seen to the same extent in all groups of women, however; for example, black women have higher mortality from breast cancer than white women despite a lower incidence.

CVD is the leading cause of death of both women and men. As in men, age-adjusted mortality from coronary heart disease was reduced by half in women from 1980 to 2000. About half the decline is attributable to changes in behavioral factors, including a drop in smoking; the other half is attributable to new clinical treatments that emerged from research. Studies led to recognition of CVD in women and, subsequently, extension of diagnosis and treatments for CVD to women. Awareness of CVD among women has increased, in part because of educational campaigns. However, the history of years of the study of CVD only in men has delayed greater progress.

Reductions in the incidence of and mortality from cervical cancer began as early as the 1960s and continued over the last 20 years as diagnosis and screening have improved further. In addition, during the last few years a vaccine that is effective in preventing infection by human papillomavirus, the virus that causes most cervical cancer, was developed. The vaccine was developed and brought into clinical practice through research on the basic biology of the virus and its relationship to cervical cancer in human cells and animals and through epidemiologic studies of cervical cancer’s etiology. Although overall gains have been seen in mortality from cervical cancer, rates remain higher in black and Hispanic women than in white and Asian women.

Conditions on Which Research Has Contributed to Some Progress

The committee identified depression, HIV/AIDS, and osteoporosis as conditions on which some progress has been made as a result of women’s health research.

The incidence and consequences (such as effects on educational attainment) of depression are higher in women than in men. Advances have been made in the treatment of depression in the last 20 years, although their impact has not been maximized, because of inadequate translation particularly in relation to primary providers. There have been rapid and major advances in the treatment of HIV/AIDS in the last 20 years, mostly through research in men. The rapid development of treatments has benefited women despite the focus of the research on men; however, the predominance of male-focused studies has limited some of the benefits for women. For example, issues with the toxicity of HIV/AIDS treatments in women (for example, increased risk of anemia and acute pancreatitis as compared to men) are only now being identified through women-based research. Over the last 20 years there have been advances in the knowledge of the basic science underlying osteoporosis and in the diagnosis and treatment of osteoporosis. That includes the identification of genes whose expression affects the risk of osteoporosis. Recent trends show a decrease in the incidence of hip factures. Osteoporosis remains, however, a condition that greatly impacts the quality of life of a large number of women, particularly as they age.

Conditions on Which Little Progress Has Been Made

The committee identified a number of conditions on which little progress has been made in reducing incidence or mortality, including unintended pregnancy 2 and autoimmune disease. The risk factors for unintended pregnancy are known, and effective contraceptives are available to prevent pregnancy. The fact that unintended pregnancies continue to occur at a high rate points to the need for research on the use of contraceptive regimens, the need for development of new contraceptives, including non-hormonal contraceptives, that are more acceptable to groups of women in which unintended pregnancies occur with greater frequency, and the need for social and community-level interventions to decrease unintended pregnancies. Autoimmune diseases constitute about 50 diseases, most of which are more common in women. As a group, they are the leading cause of morbidity in women, and they affect women’s quality of life greatly. Despite their prevalence and morbidity, little progress has been made toward a better understanding of those conditions, identifying risk factors, or developing a cure.

Looking at the set of conditions on which little progress has been made—including unintended pregnancy; autoimmune disease; alcohol-addiction and drug-addiction disorders; lung, ovarian, endometrial, and colorectal cancer; non-malignant gynecologic disorders; and Alzheimer’s disease—the committee tried to identify characteristics or explanations for the lack of progress. The committee could not determine specifically why progress was seen for some conditions and not others, but it considered a number of potential reasons, including degree of attention and subsequent research funding from government agencies, consumer advocacy groups, and Congress; availability of interested researchers trained in a given field; adequacy of understanding of the underlying pathophysiology of a condition; availability of sensitive and specific diagnostic tests and screening programs to identify persons who are at risk for or who have a condition; morbidity, rather than mortality, as the outcome of a disease; and barriers associated with political or social concerns.

IS WOMEN’S HEALTH RESEARCH STUDYING THE MOST RELEVANT GROUPS OF WOMEN?

Many of the conditions that the committee reviewed are more common or have poorer outcomes in women who are socially disadvantaged than in women who are not. They include the three diseases on which there has been major progress—breast cancer, CVD, and cervical cancer. The fact that subgroups of women are not benefiting from the progress that has been made could indicate that the most relevant groups, the groups that have the greatest burden of disease, are not being adequately studied and research results are not being translated into practice and policies.

ARE THE MOST APPROPRIATE RESEARCH METHODS BEING USED TO STUDY WOMEN’S HEALTH?

The women’s health research reviewed includes basic research (studies in animals and at the molecular and cellular levels), epidemiologic or clinical research (research conducted or observed in human subjects), and studies of health systems. All those study types have contributed to progress in women’s health, and all yielded important findings on the conditions on which there has been major progress—breast cancer, CVD, and cervical cancer.

The committee identified a number of issues specific to the studies reviewed or to women’s health. Large observational studies—such as the observational arm of the WHI, the Nurses’ Health Study, and the Study of Women’s Health Across the Nation (SWAN)—were coordinated among multiple research centers to accrue large and diverse samples and were especially useful for generating hypotheses for further testing. The postmenopausal hormone therapy and the calcium and vitamin D components of the WHI were randomized clinical trials that were based on the findings from such observational research. In addition, the observational studies led to animal and in vitro studies aimed at elucidating the pathophysiology of conditions and identifying potential treatments.

Different study types have different limits, and results from diverse study designs can combine to provide extremely useful information that is directly relevant to the health of women and some have led to clear improvements in women’s health. The committee recognizes that there are drawbacks to different study types. For example, observational studies and clinical trials can be expensive, can have subject attrition, can be of long duration, and, in the case of observational studies, can have difficulty in finding appropriate comparison populations and in controlling for potential confounders. Large human studies, such as the WHI, are further hindered by complex study designs and associated pitfalls. Despite those drawbacks, the committee concluded that information from large, complex observational and clinical studies could not be obtained with other study designs and are integral to progress in women’s health. New study designs that yield similar levels of certainty would be valuable. Smaller studies, in contrast, provide different information and can often be better controlled, potentially faster (depending on the end points studied), and less expensive. Internal validity (for example, the ability to establish causal relationships) is generally stronger in such studies, but this may be at the cost of external validity (that is, generalizability). Smaller studies are important to provide information on which to base large studies and to test specific hypotheses.

Although women are now routinely included in clinical research, the initial design often is not optimal for obtaining data on women, including problems in the inclusion criteria and selection of end points that do not apply to women. Sample size and the ability to recruit adequate numbers of women in studies to allow appropriate analyses can be challenging. Sex- and gender-specific analyses must be published and used for drug development or clinical guidelines. Even when sex-specific analyses are conducted by researchers, the analyses are not always included in publications, because of page limitations or journal restrictions.

Studies often use incidence and 5-year survival rates as end points; fewer studies look at morbidity or quality of life after treatment and survival. Given that women tend to report worse overall health than do men and tend to emphasize quality of life when considering their health, the lack of assessment of quality of life in studies of women’s health is problematic.

• ARE THE RESEARCH FINDINGS BEING TRANSLATED IN A WAY THAT AFFECTS PRACTICE?

It can take 15–20 years for research findings to be incorporated into practice. Barriers to translation of findings on women’s health include barriers that impede translation of science to practice more generally, such as the iterative nature of research in which inconsistent or contradictory results often are published before a clear picture emerges; social and cultural opposition to some new treatments or approaches; entrenched financial or other interests that favor the status quo or a specific approach; and lack of reimbursement for new treatments or practices. Patients themselves faced with a multitude of research findings and complex decisions can have difficulty in weighing new options for their health.

Other barriers, however, differentially affect the translation of research into better care for women. They are derived from the fragmentation of care that results when women see multiple providers for different health concerns, failure of performance measures to include many conditions that are specific to women, and failure to analyze sex-based differences in care, which undermines the use of incentives to implement research findings in women’s health care.

• ARE THE RESEARCH FINDINGS BEING COMMUNICATED EFFECTIVELY TO WOMEN?

Complex and sometimes inconsistent or contradictory results present challenges to the communication of research findings, including those relevant to women. Often, the implications of a given finding are complex, so it is difficult to give a clear, concise message. The emergence of the Internet and the World Wide Web has increased the amount of and access to health-related information for the general public, but it has also added to the confusion about the findings and to concerns about the validity of the available information. Communication is complicated by competing forces, for example, when health messages compete with the marketing forces of industries.

GAPS IN WOMEN’S HEALTH RESEARCH

Relatively few studies have been published on a number of conditions important to women, including ovarian and endometrial cancer, pre-eclampsia (a major cause of maternal morbidity and mortality), and conditions that affect elderly women, including frailty. There is little information on many autoimmune diseases, such as lupus. Research on prevention of and treatment for Alzheimer’s disease, obesity, and diabetes has rarely examined sex differences. Despite the prevalence of co-occurring conditions and the need to evaluate risk–benefit tradeoffs across multiple outcomes, such issues are rarely incorporated into studies of specific conditions. More information on how the physical and social environment affect health is needed, including an understanding of how they may result in health disparities in disadvantaged groups. In some cases, particularly reproductive health, strong data supporting the safety and efficacy of treatments may be insufficient to fuel their use if there is social or political opposition on nonmedical grounds. Advances in women’s health may require attention to such obstacles in addition to those inherent in the research.

COMMITTEE’S KEY FINDINGS AND RECOMMENDATIONS

Substantial progress has been made since the expansion of investment in women’s health research. Research findings have changed the practice of medicine and public-health recommendations in several prominent contexts, including changes in standards of care for women. There have also been decreases in mortality in women from breast cancer, heart disease, and cervical cancer. In other contexts, however, there has been less progress, including research on other conditions that affect women and identification of ways to reduce disparities among subpopulations of women.

Several barriers to further progress in improving the health status of women were identified. For example, there has been inadequate attention to the social and environmental factors that, along with biologic risk factors, influence health. There also has been inadequate enforcement of requirements that representative numbers of women be included in clinical trials and that women’s results be reported. A lack of taking account of sex and gender differences in the design and analysis of studies, and a lack of reporting on sex and gender differences, has hindered identification of potentially important sex differences and slowed progress in women’s health research and its translation to clinical practice. The committee recommends that all published scientific reports that receive federal funding and all medical product evaluations by the Food and Drug Administration present efficacy and safety data separately for men and women.

Poor communication of the results of women’s health research has in many cases led to substantial confusion and may affect the care of women adversely. Research findings will have a greater impact if they are coupled with a well thought-out plan for communication and dissemination. Development of a plan for communication and dissemination should be a standard component of federally sponsored women’s health research and the clinical recommendations that are made on the basis of that research.

The committee’s specific findings and recommendations follow.

Investment in women’s health research has afforded substantial progress and led to improvements in women’s health with respect to such important conditions as some cancers and heart disease. Greater progress in women’s health has occurred in conditions characterized by multipronged research involving molecular, animal, and cellular data; in observational studies to identify effects in the overall population; and in clinical trials or intervention studies from which evidence-based conclusions on treatment effectiveness can be drawn.

Recommendation 1

US government agencies and other relevant organizations should sustain and strengthen their focus on women’s health, including the spectrum of research that includes genetic, behavioral, and social determinants of health and how they change during one’s life. In addition to conducting women-only research as appropriate, a goal should be to integrate women’s health research into all health research—that is, to mainstream women’s health research—in such a way that differences between men and women and differences between subgroups of men and women are routinely assessed in all health research. Relevant US government agencies include the Department of Health and Human Services and its institutes and agencies—especially the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Agency for Healthcare Research and Quality, and the Substance Abuse and Mental Health Services Administration—and such others as the Department of Veterans Affairs, the Department of Defense, and the Environmental Protection Agency.

Women who experience social disadvantage as a result of race or ethnicity, low income, or low educational level suffer disproportionate disease burdens, adverse health outcomes, and barriers to care but have not been well represented in studies of behavior and health.

Recommendation 2

The National Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention should develop targeted initiatives to increase research on the populations of women that have the highest risks and burdens of disease.

The incidence, prevalence, morbidity, or mortality associated with a number of conditions—for example, unintended pregnancy, maternal mortality and morbidity, nonmalignant gynecologic disorders, alcohol- and drug-addiction disorders, autoimmune diseases, and lung, ovarian, and endometrial cancer—have not improved. Most of those conditions substantially affect the quality of life of those who experience them. The major focus of health research has been on reducing mortality; a singular focus on mortality, however, can divert attention from other health outcomes despite the high value that women place on quality of life.

Recommendation 3

Research should include the promotion of wellness and quality of life in women. Research on conditions that have high morbidity and affect quality of life should be increased. Research should include the development of better measures or metrics to compare effects of health conditions, interventions, and treatments on quality of life. The end points examined in studies should include quality-of-life outcomes (for example, functional status or functionality, mobility, and pain) in addition to mortality.

Social factors and health-related behaviors and their interactions with genetic and cellular factors contribute to the onset and progression of multiple diseases; they act as pathways that are common to multiple outcomes. Considerable progress has been made in understanding the behavioral determinants of women’s health, but less is known about how to change them and about the broader determinants of women’s health that involve social, community, and societal factors.

Recommendation 4

Cross-institute initiatives in the National Institutes of Health—such as those in the Division of Program Coordination, Planning, and Strategic Initiatives—should support research on common determinants and risk factors that underlie multiple diseases and on interventions on those determinants that will decrease the occurrence or progression of diseases in women. The National Institutes of Health’s Office of Research on Women’s Health should increase collaborations with the Office of Behavioral and Social Sciences Research to design and oversee such research initiatives.

Limitations in the design, analysis, and scientific reporting of health research have slowed progress in women’s health. Inadequate enforcement of recruitment of women and of reporting data by sex has fostered suboptimal analysis and reporting of data on women from clinical trials and other research. That failure has limited possibilities for identifying potentially important sex or gender differences. New methods and approaches are needed to maximize advances in promoting women’s health.

Recommendation 5

• Government and other funding agencies should ensure adequate participation of women, analysis of data by sex, and reporting of sex-stratified analyses in health research. One possible mechanism would be expansion of the role of data safety monitoring boards to monitor participation, efficacy, and adverse outcomes by sex.
• Given the practical limitations in the size of research studies, research designs and statistical techniques should be explored that facilitate analysis of data on sociodemographic subgroups without substantially increasing the overall size of a study population. Conferences or meetings with a specific goal of developing consensus guidelines or recommendations for such study methods (for example, the use of Bayesian statistics and the pooling of data across study groups) should be convened by the National Institutes of Health, other federal agencies, and relevant professional organizations.
• To gain knowledge from existing studies that individually do not have sufficient numbers of female subjects for separate analysis, the director of the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services should support the development and application of mechanisms for the pooling of patient and subject data to answer research questions that are not definitively answered by single studies.
• For medical products (drugs, devices, and biologics) that are coming to market, the Food and Drug Administration should enforce compliance with the requirement for sex-stratified analyses of efficacy and safety and should take those analyses into account in regulatory decisions.
• The International Committee of Medical Journal Editors and other editors of relevant journals should adopt a guideline that all papers reporting the outcomes of clinical trials report on men and women separately unless a trial is of a sex-specific condition (such as endometrial or prostatic cancer). The National Institutes of Health should sponsor a meeting to facilitate establishment of the guidelines.

The translation of research findings into practice can be delayed or precluded by various barriers—the complexity of science and research and challenges in communicating understandable and actionable messages, social or political opposition to advances for nonmedical reasons, fragmentation of health-care delivery, health-care policies and reimbursement, consumer confusion and apprehension, and so on. Many of those barriers are seen in connection with translation of research in general, but some have aspects that are peculiar to women, and few studies have been conducted to examine how to increase the speed or extent of the translation of findings related specifically to women’s health into clinical practice. Methods of translation that have been used and that warrant evaluation for translating research findings in women include clinical-practice guidelines, mandatory standards, reimbursement practices, laws (including public-health laws), health-professions school curricula, and continuing education.

Recommendation 6

Research should be conducted on how to translate research findings on women’s health into clinical practice and public-health policies rapidly. Research findings should be incorporated at the practitioner level and at the overall public-health systems level through, for example, the use of education programs targeted to practitioners and the development of guidelines. As programs and guidelines are developed and implemented, they should be evaluated to ensure effectiveness.

The public is confused by conflicting findings and opposing recommendations that emerge from health research, including women’s health research. Conflicting results and work to resolve disagreements are part of the scientific process, but that iterative aspect of scientific discovery is not clearly conveyed to, or understood by, the public. The resulting uncertainty and distrust of research may affect women’s care adversely. Relevant knowledge from studies of communication often is not used by researchers, funders, providers, and public-health professionals to target health messages and information to women.

Recommendation 7

The Department of Health and Human Services should appoint a task force to develop evidence-based strategies to communicate and market health messages that are based on research results to women. In addition to content experts in relevant departments and agencies, the task force should include mass-media and targeted-messaging and marketing experts. The strategies should be designed to communicate to the diverse audience of women; to increase awareness of women’s health issues and treatments, including preventive and intervention strategies; and to decrease confusion regarding complex and sometimes conflicting findings. The goals of the task force should be to facilitate and improve the communication of research findings by researchers to women. Strategies for the task force to consider or explore might include

• requiring a plan for the communication and dissemination of findings of federally funded studies to the public, providers, and policy makers; and
• establishing a national media advisory panel of experts in women’s health that would be readily available to provide context to reporters, scientists, clinicians, and policy makers at the time of release of new research reports.

During the preparation of this report the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148) was passed, which formally codifies the Offices of Women’s Health within the Department of Health and Human Services (HHS). The act also formally establishes an Office of Women’s Health in the directors’ office of the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration; an HHS Coordinating Committee on Women’s Health; and the National Women’s Health Information Center.

The committee considered whether to discuss unintended pregnancy as a health outcome or a determinant of health. It decided to discuss it as an outcome, along with maternal mortality and morbidity, and also to discuss the determinants that increase the rate of unintended pregnancies in Chapter 2 .

• Cite this Page Institute of Medicine (US) Committee on Women's Health Research. Women’s Health Research: Progress, Pitfalls, and Promise. Washington (DC): National Academies Press (US); 2010. Summary.
• PDF version of this title (2.6M)

In this Page

• THE COMMITTEE’S APPROACH TO ITS CHARGE
• IS WOMEN’S HEALTH RESEARCH STUDYING THE MOST APPROPRIATE AND RELEVANT DETERMINANTS OF HEALTH?
• IS WOMEN’S HEALTH RESEARCH FOCUSED ON THE MOST APPROPRIATE AND RELEVANT HEALTH CONDITIONS?
• IS WOMEN’S HEALTH RESEARCH STUDYING THE MOST RELEVANT GROUPS OF WOMEN?
• ARE THE MOST APPROPRIATE RESEARCH METHODS BEING USED TO STUDY WOMEN’S HEALTH?
• GAPS IN WOMEN’S HEALTH RESEARCH
• COMMITTEE’S KEY FINDINGS AND RECOMMENDATIONS

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