Episode 50: Women’s health research and funding - what the numbers actually show

How underfunded is women’s health research really, and does the research that does get done give women the answers they need?

In this solo episode for episode 50 of The World’s Tightest Community, host Mathilde Olstad, who worked in finance before starting the podcast, goes behind the headline statistics on women’s health funding. She separates two questions that usually get blurred together: whether the health problems affecting women receive enough research attention, and whether studies are designed to produce useful evidence for women. Along the way she covers what common figures actually measure, how sex bias shows up in animal studies and clinical trials, and where vulvodynia and pelvic pain fit into the picture.

Is women’s health underfunded? What the 5% figure and NIH funding data actually measure

You may have seen the claim that only 5% of research funding goes to women’s health. It comes from a 2022 McKinsey analysis, but that analysis measured the biopharmaceutical development pipeline, not total research spending. Women’s cancers made up 4% of that pipeline, which leaves around 1% for other conditions specific to women. McKinsey did not break down the remaining 95%, so the figure can’t tell us how much goes to men’s health or how small 5% really is.

The NIH numbers point in a different direction. In fiscal year 2025, about $3.3 billion was classified as women’s health research, compared with $768 million for men’s health. These are overlapping categories of projects that explicitly focus on one sex, not a split of the whole budget, so they don’t show whether women’s health is adequately funded either. Mathilde breaks the question into three parts: how much funding carries the women’s health label, how much attention each condition gets relative to the harm it causes, and whether research meant for everyone produces reliable answers for women. Labelled funding only answers the first.

That’s useful information, but it’s not the same as saying only five percent of medical research funding benefits women. And those two claims are just very different.

Sex bias in medical research and clinical trials: whose biology is the evidence built on?

Research starts long before a clinical trial. A 2014 review of five surgical journals found that 80% of animal studies reporting sex used males only, and 76% of cell studies did not report sex at all. Those findings cover publications from 2011-2012 in one field, so they can’t be applied to all biomedical research today, but they show how findings can become accepted medical knowledge on evidence from male models. Caroline Criado Perez makes the same point in Invisible Women: male bodies have often been treated as the default. Policy has responded, with 1993 legislation strengthening inclusion requirements for NIH-funded clinical research and a 2016 policy requiring researchers to consider sex in study design, analysis and reporting.

Including women in a study is not the same as analysing whether results differ for them. A 2026 review of 574 NIH-linked publications found that 61% included both sexes, but only 44% of those accounted for sex in their analysis. Across 1,433 US drug and device trials, women made up 41.2% of participants on average, with cardiovascular trials at 41.9% against 49% of the patient population, and psychiatric trials at 42% against 60%. The 2013 FDA dosing change for zolpidem shows why this matters: women clear the drug more slowly, which raised the risk of next-morning impairment. Mathilde also asks which women are being studied. In 2024, the maternal mortality rate was 44.8 per 100,000 live births for Black women, compared with 14.2 for White women.

Just because a study isn’t explicitly about men’s health doesn’t mean it has necessarily studied female biology adequately.

Disease burden and private investment: why vulvodynia and pelvic pain stay neglected

Disease burden measures how much health a condition takes away, including years lived with illness or disability, not only deaths. That matters for conditions like vulvodynia, which doesn’t shorten life but can affect work, exercise, sitting comfortably and sex. A 2021 analysis by Arthur Mirin compared NIH funding with disease burden and found that 25 of 34 sex-predominant conditions followed a funding pattern favouring males. Breast cancer was an exception, with higher funding than its burden predicted. “Underfunded” here is relative to the study’s model, not a single correct amount.

Private money shows a similar pattern. A 2026 World Economic Forum and Boston Consulting Group report found that 6% of identified private healthcare investment went to women’s health, and about 90% of that went to cancers, reproductive health and maternal care. Endometriosis, menopause, PCOS and menstrual health together received less than 2%. Pelvic pain shows how the cycle works: many women spend years with sexual pain and no diagnosis, so diagnosis counts understate the market, poor data makes the problem hard to quantify, and that makes it harder to attract investment.

A poorly documented need isn’t necessarily a small need.

What needs to change in women’s health research: vulvodynia, sex-specific analysis and women in research leadership

Mathilde sets out three priorities. The first is sustained, long-term research into conditions with basic unanswered questions. For vulvodynia, we still don’t fully understand why some people develop persistent pain, why treatments work for some and not others, or how to improve diagnosis. The second is better analysis of sex differences, because including women in research and testing whether results differ between women and men are two separate things.

The third is who leads the research. In the 2026 analysis, papers with women as first authors accounted for sex in their analyses more often than papers with men as first authors, at 50% versus 39%. A separate analysis of 10,708 trials linked women principal investigators with higher female enrollment, at 54.1% versus 46.9%. That is an association, not proof of cause, but it points to who decides which questions get asked. The next time you hear an announcement about new funding for women’s health, ask where the money is going, what researchers are learning from it and what changes for patients. If you work in women’s health research, particularly in pelvic pain or sexual health, Mathilde wants to hear from you.

Sources and references

1. McKinsey (2022) - Unlocking opportunities in women’s healthcare. Source for the 5% of the biopharma pipeline figure: 4% women’s cancers and 1% other female-specific conditions. This measures pipeline composition, rather than total research spending.

2. NIH - Research, Condition, and Disease Categories funding table. FY2025 figures: $3.334 billion for Women’s Health Research and $768 million for Men’s Health Research. These are overlapping research categories, not a division of the entire NIH budget by sex.

3. Arthur A. Mirin (2021) - Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. The disease-burden analysis finding that 25 of 34 sex-predominant conditions followed a funding pattern favouring males. Breast cancer was an exception. “Underfunding” here is relative to the study’s statistical model.

4. World Economic Forum and Boston Consulting Group (2026) - Women’s Health Investment Outlook. Source for 6% of identified private healthcare investment going to women’s health, with approximately 90% concentrated in cancers, reproductive health and maternal care. Endometriosis, menopause, PCOS and menstrual health together received less than 2% of the women’s-health investment identified.

5. Yoon et al. (2014) - Sex bias exists in basic science and translational surgical research. Review of five surgical journals: 80% of animal studies reporting sex used males only, and 76% of cell studies did not report sex. These findings concern publications from 2011-2012.

6. Warden et al. (2026) - Incorporation of the NIH sex as a biological variable policy by R01 grant awardees. Among 574 publications, 61% included both sexes; only 44% of those accounted for sex in their analyses. Papers with women first authors did so more often: 50% versus 39%. The analysis definition included using sex as a statistical covariate.

7. Sosinsky et al. (2022) - Enrollment of female participants in United States drug and device phase 1-3 clinical trials between 2016 and 2019. Across 1,433 trials, average female enrollment was 41.2%. Cardiovascular trials: 41.9% versus 49% of the relevant patient population. Psychiatric trials: 42% versus 60%.

8. Gupta, Jena and Sun (2025) - Gender Diversity of Research Teams and Clinical Trial Enrollment. Analysis of 10,708 trials linking women principal investigators with higher female enrollment: adjusted proportions of 54.1% versus 46.9%. This establishes an association, not causation.

9. Vogel et al. (2021) - The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. The commission report behind the discussion of gaps in cardiovascular research, recognition, diagnosis and treatment for women.

10. FDA - Zolpidem and next-morning impairment. The explanation behind the 2013 dosing changes: women eliminate zolpidem more slowly, increasing the risk of impairment the following morning.

11. Donna L. Hoyert / CDC (2026) - Maternal Mortality Rates in the United States, 2024. Maternal mortality rates were 44.8 per 100,000 live births for Black women versus 14.2 for White women, more than three times higher.

12. NIH - History of Women’s Participation in Clinical Research and Sex as a Biological Variable policy. Sources for the 1993 inclusion legislation and the policy implemented in 2016 requiring consideration of sex in study design, analysis and reporting.

13. Caroline Criado Perez (2019) - Invisible Women. The book referenced in the discussion of male bodies being treated as the default in data and research.

14. Hansilla Alaigh / WISE-R. The speaker and company acknowledged as inspiration through Women’s Health Advocates.