The five-year survival rate for breast cancer in the United States rose from 76% in 1975 to 94% in 2023. This was no accident; it was the result of sustained investment in research, and it shows how remarkable progress can be achieved when women’s health is prioritized.

Women are talking about menopause — health systems must listen

Breast cancer research funding at the US National Institutes of Health (NIH) dwarfs what is spent on any other condition that exclusively or disproportionately affects women. Unfortunately, the US national research enterprise has not adequately advanced the treatment and prevention of many other conditions that lead to premature mortality, disability or diminished quality of life for women.

In October, US President Donald Trump signed an executive order creating a task force on women’s health and directing the NIH to establish a Women’s Health Division in an existing institute. This could be a meaningful step. But what comes next? White House attention and support is important, but making good progress will require expanded funding from the US Congress and structural change at the NIH.

The country has been here before. In 1993, then-president Bill Clinton signed the NIH Revitalization Act, a law that was intended to address gaps in women’s health research and formally established the Office of Research on Women’s Health (ORWH). Two years ago, then-president Joe Biden launched an all-of-government initiative and established an NIH-wide task force to improve women’s health research and redirect federal funds to gaps in it. Biden also called for Congress to allocate US$12 billion to support NIH research into women’s health, but that funding was not included in the final appropriation.

There is no question that NIH-supported research has helped to improve women’s health, but large gaps persist. Endometriosis, polyendocrine metabolic ovarian syndrome, uterine fibroids, menopause and ovarian and endometrial cancers are all examples of conditions affecting women that have been poorly funded and underprioritized.

Neglecting sex and gender in research is a public-health risk

Furthermore, the understanding of human biology and disease has historically been based on male models — whether laboratory animals or human participants. Even when women are included in clinical trials, those who are pregnant or lactating are generally excluded, and sex-specific analyses are still too rare. There is also a lack of understanding of many fundamental aspects of female physiology, and of sex differences in conditions such as migraines, autoimmune diseases, Alzheimer’s disease and depression, as well as the safe management of health concerns during pregnancy.

As a policy researcher, I have spent much of my career focused on the barriers that limit women’s access to care. I have also been part of committees that develop recommendations to shape US insurance coverage, and seen at first hand how research gaps affect the guidelines for women’s health conditions. In 2024, I had the privilege of co-chairing a congressionally mandated consensus committee at the National Academies of Sciences, Engineering, and Medicine tasked with assessing the status of women’s health research at the NIH and making recommendations to improve it.