We must close the ‘shocking’ knowledge gap in women’s health

When I was a paediatrician in my native Karachi, Pakistan, I treated so many babies who were born too early because of preeclampsia. They fit in the palm of my hand, their little chests working hard to breathe. We couldn’t always save them.

Pregnancy risks like preeclampsia are a black box. We still don’t know preeclampsia’s root cause, or how to avoid preterm birth more generally. This lack of knowledge contributes to maternal and newborn deaths around the world – every day, more than 700 women and 6500 newborns die from pregnancy and childbirth complications. The toll is highest in sub-Saharan Africa and South Asia, often due to strained health systems, unequal access to care, extreme poverty and poor infrastructure.

A shocking gap in knowledge exists across nearly every women’s health issue, including menopause – the fact that women feel out of sorts for as long as 10 years seems so normal that it is barely even intelligible to doctors and researchers as a problem. This isn’t because the science is too hard, but because of a prevailing sense of indifference. Discounting women’s experiences of their own bodies has shaped what is studied and what is overlooked. When a problem is treated as unremarkable instead of unacceptable, finding solutions will never be a priority.

Less than 1 per cent of healthcare research and innovation goes towards women’s health conditions, if we exclude cancers. As a result of this and the fact fewer women are included in clinical trials, there is a long list of fundamental questions about women’s health that researchers have yet to properly study. We know that heart disease, the leading cause of death in women worldwide, presents differently in women, but we don’t know why. We know how drugs get into the brain, for example, but not how they enter the female reproductive system. This isn’t the case for men – for example, we know a great deal about the effects of Viagra.

Glimmers of hope

Things are – slowly – starting to change, and I have noticed glimmers of hope in the past few years. At conferences and roundtables I have attended on topics from global health to healthcare innovation, there are serious conversations happening among serious people about the need to invest in women’s health. I see decision-makers and investors recognise not just the size of the problem, but also the potential windfall that could come from addressing it after decades of underinvestment.

But acknowledging the problem doesn’t fix it. We must start investing the resources and attention needed to meet the breadth and complexity of the challenges facing women’s health as soon as possible.

What excites me is the incredible potential for advanced research, tools and products. An excellent example of a potential research area is the vaginal microbiome, which describes the mixture of good and sometimes bad bacteria living in the vagina. The world started studying it in earnest only a decade ago.

Now, my team at the Gates Foundation is supporting research to understand how the vaginal microbiome affects pregnancy outcomes like preterm birth, alongside women’s susceptibility to HIV and other sexually transmitted infections. We are still in the early discovery phase, but we can already see the outlines of exciting innovations that could help millions of women.

For example, interventions that would help good bacteria to become and stay dominant in the vagina could prevent STIs. They could also treat bacterial vaginosis, a common infection that is mild on its own but can lead to serious pregnancy complications, including preterm birth, and increase the risk of conditions like pelvic inflammatory disease and postpartum endometriosis, which can lead to chronic pain and even infertility.

Last year, the Gates Foundation committed $2.5 billion to women’s health innovation, but it still isn’t enough. We need partners across the public and private sectors around the world to step up, too. For the UK, this moment offers a chance to lead, building on its track record in health innovation, helping people at home and around the world live healthier lives, and strengthening one of its most dynamic and economically important industries.

Investing in women’s health is investing in their lives and livelihoods. Women simply can’t do well if they can’t be well. When women are healthy, they are more creative at work, more present with family and more active in society. That’s true in principle. This International Women’s Day, let’s also make it true in reality, by continuing to remind those in power that women’s health matters, and that now is the time to put in the resources.

Anita Zaidi is president of gender equality at the Gates Foundation