The Gates Foundation is investing $2.5 billion in research and development (R&D) on women’s health over the next five years, focusing primarily on maternal care and sexual health.

This comes amid a massive defunding of global health led by the United States, which is threatening progress in key areas such as maternal health, sexual and reproductive health and HIV.

The foundation has selected five priority areas: obstetric care and maternal immunisation; making pregnancy and delivery safer; maternal health and nutrition; gynaecological and menstrual health; and contraceptive innovation and sexually transmitted infections (STIs).

These were selected “based on a combination of data and evidence about where innovation can save and improve the most lives, direct insights from women in low- and middle-income countries about their needs and preferences, and the persistently high rates of misdiagnosis caused by gaps in medical knowledge and training,” according to the foundation in a media release.

Dr Anita Zaidi, president of the Gates Foundation’s Gender Equality Division, added: “For too long, women have suffered from health conditions that are misunderstood, misdiagnosed, or ignored. We want this investment to spark a new era of women-centred innovation – one where women’s lives, bodies, and voices are prioritised in health R&D.”

Dr Bosede Afolabi, professor of obstetrics and gynaecology at the College of Medicine, University of Lagos in Nigeria, said: “We see the consequences of underinvestment in women’s health innovation every day when women suffer needlessly, and sometimes lose their lives, because of the gaps in how we understand and treat conditions that uniquely affect them.”

Under-researched areas

A 2021 McKinsey analysis found that just 1% of healthcare research and innovation is invested in female-specific conditions beyond oncology.

Meanwhile, the US National Institutes of Health (NIH) allocated 13.5% for research related to women’s health in 2005, whereas this year, that figure has declined to around 10%, according to Guttmacher.

The foundation’s research will include HIV pre-exposure prophylaxis (PrEP), a field where several breakthroughs have occurred recently – only to have these research wins undermined by defunding by the United States government.

It will also examine “deeply under-researched” critical issues such as “preeclampsia, gestational diabetes, heavy menstrual bleeding, endometriosis, and menopause”.

“Investing in women’s health has a lasting impact across generations. It leads to healthier families, stronger economies, and a more just world,” said Bill Gates, chair of the Gates Foundation. 

“Yet women’s health continues to be ignored, underfunded, and sidelined. Too many women still die from preventable causes or live in poor health. That must change.”

US defunding women’s health services

The foundation’s investment comes as the US under the Trump administration has sharply reduced its spending on global health, threatening to reverse progress in several fields, including maternal and child health and HIV.

For example, this year, the US cut all funds to UNFPA, the United Nations sexual and reproductive health agency. 

Aside from around $180 million in annual funding, the cut affects $377 million in aid for “maternal health care, protection from violence, rape treatment and other life-saving care in over 25 crisis-stricken countries and territories, including Afghanistan, Chad, the Democratic Republic of the Congo, Gaza, Haiti, Mali, Sudan, Syria and Ukraine”, according to UNFPA.

It has also dismantled the US Agency for International Development (USAID), and slashed the budgets of the US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Centers for Disease Control and Prevention (CDC)’s Maternal and Child Health Branch and Global Health Center, cutting millions of dollars in aid to low and middle-income countries for health programmes affecting women.

As a result of these cuts, Guttmacher estimates that “47.6 million women and couples will be denied modern contraceptives, resulting in 17.1 million unintended pregnancies and 34,000 preventable pregnancy-related deaths”.

US gynaecologists decline federal funds

The Trump administration is also defunding domestic groups supporting US women’s sexual health, including Planned Parenthood, which primarily provides contraceptive services (only 5% of its activity involves providing abortions).

This is despite the fact that maternal deaths in the US are “more than double, sometimes triple, the rate for most other high-income countries”, according to a 2024 Commonwealth Fund Study.

Nearly two-thirds of US maternal deaths occur during the postpartum period, up to 42 days following birth, when US women are least likely to get follow-up care in comparison to other high-income countries. The US was also the only country in the study without mandated maternity leave, and where all pregnancy costs were not covered by medical insurance.

Meanwhile, the maternal mortality rate for Black US women in 2022 was more than double that of the national average  – 49 deaths per 100,000 in comparison to the average of 22 deaths per 100,000.

However, programmes targeting Black women have largely been dismantled by the Trump administration, which has outlawed any spending on “diversity, equity and inclusion” (DEI).

Last week, the American College of Obstetricians and Gynecologists (ACOG) announced that it would no longer accept federal funds as the Trump administration’s policies “prevent it from providing evidence-based guidance”, Axios reported.

“Recent changes in federal funding laws and regulations significantly impact ACOG’s program goals, policy positions, and ability to provide timely and evidence-based guidance and recommendations for care,” ACOG told members in an email quoted by Axios.

ACOG represents around 60,000 board-certified obstetrician-gynaecologists and its vision is “an equitable world in which exceptional and respectful obstetric and gynaecologic care is accessible to all”.

The Trump cuts primarily affect the delivery of services – particularly for sexual and reproductive health and HIV – while the Gates Foundation’s investment is in R&D.

However, the foundation hopes that, by addressing gaps in women’s health, their investment will “unlock broader social and economic gains”. 

“Research shows that every $1 invested in women’s health yields $3 in economic growth, and closing the gender health gap could boost the global economy by $1 trillion per year by 2040,” it noted.

Image Credits: ©Gates Foundation/ Prashant Panjiar, UNFPA Afghanistan, Commonwealth Fund.