When I was the chief of pediatrics at Aga Khan University hospital in Karachi, Pakistan, I spent a lot of time caring for the babies of new mothers suffering from preeclampsia. Too often, the babies were born too early and too small—and I couldn’t save them.
The hardest part about being a pediatrician is having to tell the parents their precious baby did not survive. The second hardest is not being able to explain why.
Preeclampsia is a significant cause of death for mothers and newborns in places like Karachi and in Seattle, where I live now, yet we do not know what causes it and there is no cure.
The primary reason for this deadly gap in our knowledge is neglect. According to a 2021 analysis led by McKinsey & Company, just 1% of healthcare research and innovation is invested in female-specific conditions beyond oncology. And for conditions that affect women and men, women are severely underrepresented in clinical trials, so we’ve barely scratched the surface of understanding how women experience common conditions like cardiovascular diseases.
As a result, there is a long list of serious and pervasive conditions without good solutions, including autoimmune diseases, heavy menstrual bleeding, and endometriosis. Endometriosis causes severe pelvic pain and affects one in 10 women globally, but it’s so misunderstood that 65% of women are initially misdiagnosed.
This is why, despite living longer than men, women spend more time in poor health—no matter where in the world they live.
Finding answers to longstanding questions about women’s health is a big driver of our gender equality work at the Gates Foundation. This also is fundamental to achieving our 20-year goals of helping end preventable deaths of moms and babies, reducing suffering from deadly infectious diseases, and lifting millions out of poverty onto a path to prosperity.
We’re proud to have contributed with our partners to the incredible progress made over the last 25 years: maternal mortality declined by 40%, expanded access to the HPV vaccine has prevented over 1 million future cases of cervical cancer, and advancements in contraceptives have given women better tools to help them decide whether and when to get pregnant. We still have a long way to go, which is why I am pleased the foundation announced today that it is committing $2.5 billion to women’s health innovation over the next five years.
That commitment is a good start. But it’s also a drop in the bucket compared to what’s needed. I think the rest of the bucket can and should be filled up by private sector partners.
That’s because women in high-income countries have many of the same health problems in common with women in low- and middle-income countries. There is a massive untapped market opportunity to invent and deliver the solutions women everywhere need. Biotech, consumer health, and pharmaceutical companies should be doing more in women’s health. Above and beyond the moral reasons, it simply makes good business sense.
McKinsey & Company estimates that investing in treatments for endometriosis, for example, has a market potential of $180 billion to $250 billion, comparable to the market for big-ticket conditions like diabetes.
Or consider the many use cases for an AI-powered portable ultrasound, which the foundation helped to develop for the two thirds of women in low- and middle-income countries who don’t have access to expensive ultrasound machines. It’s a wand that plugs into a tablet running an algorithm trained with thousands of ultrasound images, and it can be used by workers who haven’t been trained in obstetrics. Research shows this simple device can identify high-risk pregnancies early and even identify gestational age with more accuracy than humans.
This tool is very useful in remote Kenya, one of the areas where the AI ultrasound was tested. But it’s just as useful in, say, North Dakota, where one in four women have to drive for over an hour to reach the nearest birthing hospital. In 2022, about 2.3 million U.S. women of child-bearing age lived in “maternity deserts,” defined as counties without a hospital, birth center, and doctors and nurse midwives with experience delivering babies.
Thanks to advances in AI, this tool can be adapted for uses beyond obstetric care. Today, people travel to specialty care or emergency rooms to get screened for conditions like breast cancer and heart disease. With portable imaging devices, those screenings could one day be done at local primary care facilities in both high- and low-income countries.
The list of opportunities goes on. Preeclampsia is tricky to diagnose, because women can present with the main symptoms of high blood pressure and proteinuria for many reasons. False positives lead to long, unnecessary hospitalizations, while false negatives can result in a last-minute scramble with fatal consequences. The state-of-the-art sFIt-1PIGF ratio test removes the uncertainty by measuring the levels of two proteins that play a role in the development of new blood vessels in the placenta. In 2024, the FDA approved the test for use in the United States, and the Gates Foundation is supporting studies to adapt it for use in low- and middle-income countries.
Last year, a colleague of mine at the foundation was concerned she might have preeclampsia. She’d been monitoring her blood pressure on her own, but the results were inconclusive. She took the sFIt-1PIFG test at 26 weeks, and it confirmed she had preeclampsia and predicted how much time she had left until she would have to deliver. She was immediately hospitalized and intensely monitored. Six weeks later she gave birth to a beautiful baby girl whose name, Mihika, means “dew drops.”
This test can save the lives of women like my colleague, and it can also save the lives of women like those I used to care for back in Karachi.
And the test is just the beginning. There is still no cure for preeclampsia, and preeclampsia is just one of many woman-specific issues that need solving. If we could close the gap for nine major conditions, it would create 27 million years of healthy life per year—or about three extra healthy days every single year for every single woman on the planet.
That’s the right thing to do. It’s also a great opportunity for entrepreneurs, innovators, and investors. Women around the world have waited too long for better solutions. Together, we can deliver.
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