Sarah Nurgat

Mind the gap: The true extent of neglect in women’s health research

March 15, 2024
By Sarah Nurgat

For decades, studies and commentators have spoken of the neglect of women’s health in medical research. But as with any such received wisdom, regular critical appraisal is essential to ensure that conclusions are based on comprehensive research from reputable sources.

Gender-related health inequalities are not homogenous around the world. In fact, in countries where stereotypical gender roles are strongest, women tend to have healthier lifestyle habits, being less prone to smoking, alcohol and substance abuse, for instance. Nevertheless, while female life expectancy is higher in some countries, over half of the G20 countries studied in a 2020 analysis had healthier men than women.

As this example highlights, it is important that positions are tested and validated to prevent any progress from being undermined. This will also help to ensure that women are not further exploited as commercial activity accelerates.

Women’s health: a balanced view
There are various measures that can be used to investigate the extent to which women’s health is (under)researched, such as the number of research papers published and the amount of funding dedicated to women’s health versus male-specific conditions. To give just one example, in the five years from 2014, the UK Medical Research Council spent the same amount on women’s health as on cardiovascular disease (£96 million out of an overall annual budget of £325 million for health research).

However, these measures do not paint the full picture, as they do not take into account the incidence and impact of individual diseases. They also fail to consider conditions that disproportionately affect women or are experienced differently by women.

In an attempt to obtain a more accurate picture, a 2023 assessment based on a study by US applied mathematician Arthur Mirin applied a ‘disease burden’ approach, looking at the amount of death and disability caused by diseases. This revealed that “Of the conditions that are dominant in one sex, those that create the highest burden, such as depression and headaches, tend to affect women more”. Going on to assess NIH funding allocation, the study concluded that “when ranked by funding amount, diseases that affect mainly women drop down. They are underfunded compared with the burden.”

Given the opportunity to improve quality and length of life for the greatest number of people, it makes sense for research funding to be allocated according to disease burden – in addition to other important factors such as urgency of need.

Bringing balance to clinical research
Although funding allocation is clearly of great importance, it is not the only factor in the neglect of women’s health research. As Dr Janine Austin Clayton, Director of the Office of Research on Women’s Health at the US National Institutes of Health (NIH), has pointed out, “We literally know less about every aspect of female biology compared to male biology.” And one reason for this is the deliberate, decades-long exclusion of women from clinical trials.

The justifications for this were multiple: medical and liability concerns about the potential for drug-induced damage to fetuses; the widespread view that including women in clinical trials would introduce additional variables in the form of fluctuating hormones; and the somewhat contradictory yet equally widespread belief among (predominantly male) researchers that women would respond to treatments in the same way as the men on whom they were tested.

The rise of femtech
In recent years, policy changes mandating the inclusion of women in health research and growing awareness of the market potential have led to an explosion of activity in women’s health. And nowhere is this clearer than the rise of ‘femtech’.

First coined in 2016 to refer to technology for women’s reproductive and sexual health, the term was redefined by Femtech Focus in 2020 as “solutions to conditions that solely disproportionately or differently affect females, women and girls” – thus widening its scope to cover a number of conditions that present differently in men and women. The unprecedented demand for digital reproductive and gynecological health solutions during the COVID-19 pandemic provided the market with a strong impetus for growth. Global VC investment crossed the $1 billion mark for the first time in 2021.

Some argue that the femtech label may be doing women’s health companies a disservice, preventing them from being seen as equals to their peers in the wider healthtech industry and reducing them to a ‘niche’ market. For the moment, however, the term femtech provides visibility for this underserviced segment and allows its growth to be measured.

Maintaining accountability, increasing momentum
As activity increases and new areas of women’s health emerge as markets of interest, it is essential that ethical concerns, including medical accuracy, data privacy and the potential incongruity between companies’ feminist empowerment discourse and their financial motives, continue to be addressed.

It is also clear that the current research momentum must be capitalized on and increased if progress is to be continued. For this to happen, stakeholders in healthcare research, including funding organizations, clinical research bodies and pharmaceutical companies, should transparently set targets for research dedicated to women’s health. Regulatory bodies and governmental organizations must also play their part in critically appraising research distribution and holding industry accountable.

Further research into women’s health - covering long-overlooked conditions specific to women as well as differences in how women experience ‘shared’ conditions and react to treatments - will not only right the wrongs of the past but also improve health outcomes for half the world’s population, with the potential for far-reaching positive impacts for society as a whole.

About the author: Sarah Nurgat is client services director at ThoughtSpark. Sarah has extensive experience working with life science businesses, gained over a decade working in public relations and marketing. Sarah works closely with clients to strengthen their visibility in national and international media. A linguist with a background in French translation, she understands the subtleties of working with global markets.