Women’s health is a broad and multifaceted concept that extends far beyond reproductive anatomy and sexual health. Historically, the focus of women’s health care and research has centered on reproduction, often overshadowing other critical aspects of physical and mental health and wellness. However, women’s health encompasses a wide array of issues, from cardiovascular and autoimmune diseases to mental health and aging-related challenges, all of which intersect with systemic inequities and biases that exist. Furthermore, women play a pivotal role in healthcare at multiple levels. They are more likely to utilize healthcare services, act as primary caregivers within families, and make a majority of the healthcare spending decisions in their households. These roles underscore the importance of redefining women’s health to address comprehensive care needs while also addressing the social and structural barriers that influence health outcomes.
Overcoming Historical Gaps in Women’s Health
For decades, clinical trials under-enrolled women and minorities—a gap that persisted until as recently as 1993 and whose impact we still feel on women’s health today. Congress passed the NIH inclusion policy into federal law through a section in the NIH Revitalization Act of 1993 entitled ‘Women and Minorities as Subjects in Clinical Research.’ While Congress may have put this inclusion policy into legislation, the commitment to enforcing this adoption has been inadequate amongst sponsors, which include organizations (such as pharmaceutical companies), federal offices and agencies, and academic institutions, even now, almost 32 years later. Women are disproportionately underrepresented in the clinical trials for these conditions. This persists despite being overrepresented as patients in areas like cardiovascular disease, psychiatric disorders, and cancer.
The literature demonstrates both under-representation of women in certain therapeutic areas and consistent exclusion of women of color from clinical trials. However, it is not all that shocking considering that a recent Brigham and Women’s Hospital study examined over 20,000 US clinical trials across a 20-year timespan and found that less than half of trials reported race and ethnicity data. Current research gaps hinder our understanding of how diseases uniquely, disproportionately, and differently affect women. They may obscure the origins and progression of disease. And they may bias the true effectiveness of drugs and medical devices, leading to delays in accurate diagnosis and appropriate treatment tailored to women’s needs.
The Importance of Addressing Whole Body Health Across the Lifespan in Women
Women face a diverse range of diseases and conditions that affect their health across the lifespan. For one, women are about twice as likely as men to receive a diagnosis of depression. This disparity is influenced by several factors. That includes hormonal fluctuations across the lifespan, including puberty, menstruation, pregnancy, postpartum, and menopause, as well as societal and cultural pressures. Women with depression are also more likely to experience comorbid conditions, further worsening their overall health outcomes.
Autoimmune diseases disproportionately impact women, with nearly 80% of autoimmune patients being women. Such a wide disparity is due to factors such as hormonal changes, X chromosome influences, and unique environmental factors. Because women experience significant hormonal changes during critical life stages such as puberty and menopause, and often during pregnancy if they decide to have children, these hormonal shifts have profound effects on the immune system and, as a result, can alter women’s susceptibility to autoimmune diseases.
Cardiovascular disease is the leading cause of death among women in the United States, claiming the life of a woman every minute and accounting for one in five female deaths. This condition affects women throughout their lives and is often influenced by things like hormonal changes during pregnancy and menopause, stress, and other comorbidities. A new demographic that has emerged in recent studies reveals a rising rate of heart attacks among young women aged 35 to 54.
Whole Body Cascade of Reproductive Health
Currently, the general public’s awareness of gynecologic health conditions is in the context of how they impact menstruation, fertility, and overall reproductive health. However, conditions such as polycystic ovary syndrome (PCOS) and endometriosis can not only affect fertility but also have significant implications for cardiovascular, mental, and overall health. For example, women with PCOS have a 19% higher risk of cardiovascular disease, particularly in their 30s. In addition, endometriosis leads to a high burden of comorbidities and significant healthcare costs. The delayed diagnosis, often by an average of 6.7 years, exacerbates the adverse effects of endometriosis, such as a decreased quality of life due to severe pain, fatigue, depression, and anxiety. Given the wide-reaching impact of these conditions beyond fertility, an inclusive lifespan approach to women’s health is needed.
It is also important to note that while refocusing the conversation, we do not entirely eliminate reproductive health from the table. The pregnancy and postpartum period can significantly impact long-term health outcomes, influencing both individual well-being and broader public health. Long-term impacts of pregnancy and pregnancy complications, such as gestational diabetes and pre-term births, have been tied to elevated cardiovascular and metabolic disease risk later in life, poor mental health, and higher risks of death even as long as 50 years later. Addressing these outcomes requires viewing reproductive health as more than an isolated period in a woman’s life and incorporating it into the larger conversation of women’s health across the lifespan.
Research Funding
Women’s health is underfunded historically, perpetuating health inequities that leave millions of women underserved. In 2023, less than 10% of NIH funding went to research on women’s health. Advancing women’s health requires equitable research funding, which has not been a priority in years past.
In November 2023, President Joe Biden and First Lady Dr. Jill Biden launched the White House Initiative on Women’s Health Research to elevate the needs of women’s health research to the national stage. Among the priorities, First Lady Dr. Jill Biden launched ARPA-H’s Sprint for Women’s Health, the first major deliverable of the White House Initiative on Women’s Health Research earlier this year. Awardee projects will tackle topics such as endometriosis, menopause, brain health, ovarian cancer, preeclampsia, and chronic pain, to name a few.
This past October, Dr. Biden announced $110 million in funding for women’s health research and product development for ARPA-H’s Sprint for Women’s Health awardees to accelerate new discoveries and innovation. This opportunity will allow research and innovation to support the long-term goal of closing the gap in women’s health. Supporting research means that evidence-based policy becomes accessible to everyone and will allow policymakers to actively engage in the implementation of closing the women’s health gap at the local, state, and national levels.
Conclusion
Expanding our everyday understanding of women’s health beyond reproductive health is essential to addressing the full spectrum of conditions that impact women throughout their lives. A paradigm shift toward holistic care recognizes the interconnectedness of physical, mental, and social well-being. It ensures that issues like cardiovascular disease, autoimmune disorders, and mental health become general knowledge, receive specific funding, and gain multi-stakeholder support. Advocacy for comprehensive and accessible care, investment in diverse research, and open discussions are critical. The status quo must change to improve health outcomes for all women. By broadening our perspective, we can better support women’s health. Improving the health of 51.1% of the population in the US is an instrumental aim of a healthy country and society.
Syreen Goulmamine