The $2.5 Billion Bet on Women’s Health and the Gates Foundation’s Push to Close R&D Blind Spots 

Globally, research and development, R&D, on women’s health has been vastly neglected despite the integral role it plays in maternal survival, childhood health, and poverty reduction. To tackle this, the Gates Foundation recently announced a $2.5 billion commitment through 2030 to accelerate R&D-focused exclusively on women’s health. This fund will support the advancement of more than 40 innovations in five critical, chronically underfunded areas, particularly those affecting women in low- and middle-income countries. From AI ultrasounds to self-injectable contraceptives, Chiemelie Ezeobi writes that these new waves of solutions aim to close the blind spots in women’s health  

“Investing in women’s health has a lasting impact across generations. It leads to healthier families, stronger economies, and a more just world. 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. But we can’t do it alone.” 

Those were the words of Bill Gates, chair of the Gates Foundation, who is passionate about closing the persistent gaps in funding and research for women’s health. 

Big words one might say, but for the foundation, the overarching objective has always been to bring together governments, philanthropists, investors, and the private sector to co-invest in women’s health innovations, help shape product development, and ensure access to treatments for the women and girls who need them most. 

Tangible Commitment to Advance Innovation 

Undoubtedly, research and development on women’s health has been vastly neglected despite its central role in maternal survival, childhood health, and poverty reduction.

Backing words with action, the Gates Foundation recently announced the largest ever commitment to women’s health research and development (R&D), pledging $2.5 billion over the next five years to accelerate innovations in areas it says have been long neglected.

Essentially, the target of the foundation’s investment across five high-impact areas of a woman’s lifespan is on Obstetric care and maternal immunisation to make pregnancy and delivery safer; Maternal health and nutrition by supporting healthier pregnancies and newborns; Gynecological and menstrual health through advancing tools and research to better diagnose, treat, and improve gynecological health and reduce infection risk; Contraceptive innovation through offering more accessible, acceptable, and effective options; and Sexually transmitted infections (STIs) by improving diagnosis and treatment to reduce disproportionate burdens on women. 

Areas of breakthrough potential include research into the vaginal microbiome, first-in-class therapeutics for preeclampsia, and non-hormonal contraception. Included in the commitment are investments that will support data generation and advocacy to help ensure product uptake and impact upon approval.

Accordingly, the five priority areas 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. They also reflect the unique challenges faced in low-resource settings, making these areas especially ripe for broader public and private investment to drive meaningful, scalable impact.

Speaking during a media briefing on Monday, 4 August, Dr. Anita Zaidi, President of the Gender Equality Division, The Gates Foundation said: “We are committing $2.5 billion over the next five years to women’s health innovations, and this represents the largest ever commitment to women’s health R&D that has ever been made.”

She added: “I am proud, as the president of the Gender Equality division, that we are able to make this commitment to women around the world. This will impact positively the lives of hundreds of millions of women around the world.”

Dr. Zaidi, a paediatrician, who has been with the foundation for 12 years, explained that the Gender Equality Division, now almost five years old, had inherited a “long legacy” of maternal health work. That work, she noted, had contributed to a 40 per cent decline in maternal mortality since 2000.

“However, it hasn’t been enough and there are many areas of women’s health, beyond maternal health, that continue to remain extremely neglected and ignored. These are areas that have three things in common. They are very ignored for funding from an R&D perspective. They have a huge burden around the world. And in the next five years, we feel that there are innovations that can be accelerated to make these available and accessible to women around the world.”

She highlighted potential advances, including AI-enabled obstetric ultrasound that “may not need any technical person” and self-administered contraception such as patches. “Two-point-five billion sounds like a big number. It is a big number. But when you look at the need, it’s really just a drop in the ocean,” she added.

Gaps in Research and Access

Dr. Ru-fong Joanne Cheng, Director of the Women’s Health Innovations team and an obstetrician gynaecologist, said the objective was to reimagine R&D so that it was centred on the needs of women and girls, particularly in low-resource settings.

“Only one per cent of research and development funding goes to female specific conditions outside of oncology,” she said. “At the same time, more than 90 per cent of drugs approved for use in the United States lack adequate data for use in pregnancy. These gaps have real consequences. Women spend 25 per cent more of their time in poor health, and a woman dies in childbirth every two minutes. It’s time to change that.”

The $2.5 billion will support more than 40 innovations across maternal health, nutrition, STIs, gynaecology and contraception, alongside efforts to fill data gaps, strengthen reproductive biology research and ensure product introduction strategies are in place.

“When we improve health for women, we also improve health for their families, for their communities, and for the economy,” Dr. Cheng said. “For every $1 invested in women’s health yields up to $3 in economic growth.”

African Perspective

Dr. Moses Obimbo Madadi, Professor at the University of Nairobi, described the announcement as “very good news” and “a good starting point” for addressing women’s health crises in low- and middle-income countries. In 2023, for example, about 182,000 women were lost because of pregnancy-related complications,” he said. “Excessive bleeding after childbirth… contributed about 40 per cent of this number.

He noted that pre-eclampsia accounts for about 20 per cent of maternal mortality in the region, but “these challenges are made possible because we lack tools for timely diagnosis” and face shortages in skilled healthcare workers and strong referral systems.

Dr. Madadi called for more investment in emerging fields like microbiome science, which could help prevent preterm births and stillbirths, and said: “We should be able to deploy AI and… change the trajectory of our women and health indicators to make sure that our women herself and every child is also safe.”

Addressing Barriers

In addressing barriers, Dr. Zaidi said women’s health had long been ignored in medical research, with “the male body… the default answer.” She explained that the foundation had consulted widely to produce a public “opportunity map” for women’s health R&D, informed by women themselves and advocates from the Global South.

Dr. Cheng added: “It’s only been since 2016 that the NIH… required that researchers report out the results in a disaggregated way… We do have some catching up to do, and there’s some urgency to it.”

Dr. Madadi remarked: “If this condition were to be suffered by men, there would be a G7 meeting held to try and get a solution… We treat it as a peripheral issue, other than making it a centrepiece of our research.”

Unique Aspects of the Commitment

Dr. Zaidi noted that compared to the last five years, the new pledge represents “an increase of one-third” and focuses on underfunded, high-burden areas like the vaginal microbiome and heavy menstrual bleeding.

Dr. Cheng said the initiative was intended “as a moment to catalyse the entire community… It’s truly a collective response… The solutions we’re investing in are… designed to be very inexpensive and low cost.”

The geographic focus will be Sub-Saharan Africa and South Asia, with applicability to low-resource settings worldwide. Partners include governments, the private sector, civil society, academia, and philanthropic collaborations such as the $500 million Beginning Fund in Africa.

Innovation Examples

One project will develop a six-month injectable contraceptive for discreet, self-administered use. “It also helps to relieve any stress on the healthcare system,” Dr. Cheng said.

Dr. Zaidi described pre-eclampsia as “one of the toughest areas for research” in the portfolio, with the goal of developing treatments to avoid preterm deliveries.

On the vaginal microbiome, Dr. Cheng explained: “When that normal balance is disrupted… it makes it easier for sexually transmitted infections to be transmitted and for HIV acquisition to occur.” The foundation is also funding gut microbiome research linked to maternal nutrition and newborn health.

Scaling Innovations

In Kenya, AI-enabled portable ultrasounds are being deployed to primary healthcare facilities. Dr. Madadi said these “simple, low-cost methods… can be deployed in rural settings to improve women’s and maternal health outcomes”, just as Dr. Zaidi acknowledged cost as a barrier but said the foundation was working with manufacturers to reduce prices, aiming to make the technology “accessible all over.”

Funding Breakdown and Measures of Success

Dr. Zaidi said 60 per cent of the funding would go to obstetrics and 40 per cent to other areas, with 70 per cent allocated to R&D, 13 per cent to data generation, 10 per cent to product introduction, and smaller portions to manufacturing support and advocacy.

Success, she said, would be measured by “a robust pipeline” of late-stage innovations, the number of women reached, and whether “we changed the system” for women’s health R&D.

Dr. Cheng added: “We want to see women prioritised… It has to be intentional, it has to be deliberate, and it needs to be done in a way that’s sustainable.”

Dr. Madadi concluded: “One investment in women’s issues is just not a women’s issue, but it’s a humanities issue… We need our healthy mothers, and we need our healthy women.”

For the Gates Foundation, which is guided by the belief that every life has equal value and is passionate about helping all people lead healthy, productive lives, this 

transformative investment in women’s health, which is a rare, large-scale commitment targeting an area that’s historically underfunded in global health R&D,

would not only to save lives but to transform how the world invests in the health of half its population.