Women’s health is not constrained by a lack of scientific progress, but by systems that fail to recognise, prioritise, and translate it. Until those systems evolve, even the most promising innovations will struggle to reach meaningful impact.
The Women’s Health Gap
The women’s health gap is well documented. Women spend approximately 25% more of their lives in poor health than men [1], while many conditions affecting millions, from endometriosis to menopause-related complications, remain underdiagnosed, underfunded, and poorly understood. In recent years, awareness has grown. Investment into women’s health and femtech has increased, and scientific progress is accelerating. Yet outcomes have not improved at the same pace.
The question is no longer whether the gap exists. The real question is why it persists despite this momentum.
The Origins of the Gap
Part of the answer lies in how healthcare and research systems have evolved.
These systems were not intentionally designed around women’s biology, health needs, or lived experiences. Until the early 1990s, women were not routinely included in clinical trials [2,3]. While this has since changed, representation remains inconsistent, and sex-specific analysis is still not systematically applied. For example, a 2020 review of 740 cardiovascular trials found that 38.2% of participants were women, despite women representing half the population [4]. The consequence is not theoretical: women continue to experience poorer outcomes, including lower survival rates following myocardial infarction, with the burden falling disproportionately on minority populations [5].
More broadly, medical research -and practice- has historically treated male biology as the default, with women’s health considered a deviation rather than a reference point. This is reflected in fragmented research priorities, investment incentives that do not align with women’s health needs, and innovation pathways that often push solutions toward consumer health rather than medical integration. Clinical structures, meanwhile, frequently fail to reflect the complexity of women’s health journeys, which cut across specialties and life stages.
These structural dynamics shape not only how care is delivered, but also what science is prioritised in the first place.
The Vaginal Microbiome – an example of structural neglect
The contrast between how we study the vaginal compared to the gut microbiome illustrates this clearly.
Over the past two decades, billions have been invested in understanding the gut microbiome, a system that is complex, difficult to access, and composed of hundreds to thousands of bacterial species interacting in highly variable ways. By comparison, the vaginal microbiome presents a far more defined and accessible environment. In a healthy state, it is often dominated by a single strain of Lactobacillus, sometimes accounting for over 90–95% of the microbial composition [6]. This relative simplicity, combined with direct accessibility, makes it uniquely suited for study, monitoring, and intervention.
And yet, despite its clear relevance to reproductive health, infection prevention, fertility, pregnancy outcomes, and broader systemic conditions, research into the vaginal microbiome remains comparatively underdeveloped. Emerging evidence continues to demonstrate its potential, from enabling earlier and more precise diagnostics to informing targeted therapeutic strategies and advancing understanding of host–microbe interactions in women’s health.
So why has progress been slow? The answer is not scientific complexity. It is structural neglect.
Historically, women’s biology has been under-prioritised in research agendas. Reproductive and vaginal health have often been treated as niche or secondary domains. Funding decisions, shaped by legacy assumptions and incentive structures, have not consistently recognised the scale of opportunity in this space. Even now, women’s health receives just 6% of private investment with less than 1% flowing to companies focused exclusively on women’s health needs. [7]
At some point, it became impossible to ignore that the issue wasn’t a lack of scientific opportunity. It was what we were choosing to prioritise, and what we were not.
As a result, areas with significant potential, both in terms of health impact and economic value, remain underexplored. This is not an isolated gap. It is a reflection of how innovation priorities are set.
What This Reveals About the System
The underdevelopment of the vaginal microbiome field is not simply a missed scientific opportunity. It is indicative of how the broader women’s health ecosystem operates. Progress in healthcare innovation depends on a network of actors: researchers, biotech innovators, investors, regulators, healthcare systems, and policy makers. Each plays a critical role in shaping what is studied, developed, approved, and ultimately adopted in practice.
However, these actors rarely operate in a coordinated way. Research priorities are often disconnected from clinical realities. Investment flows do not always align with long-term health impact. Regulatory and reimbursement pathways lag behind emerging science. And healthcare systems are not always structured to integrate new types of innovation.
The result is a system in which promising insights can remain fragmented, advancing within individual domains but failing to translate into scalable, real-world solutions. In this context, the challenge facing women’s health is not only one of discovery, but of translation and coordination.
XX innovation was founded to drive action and rebuild the women’s health ecosystem
Addressing this challenge requires more than isolated interventions. It requires working across the ecosystem that shapes women’s health innovation. XX innovation is a non-profit organisation created to help address these structural gaps.
The organisation focuses on identifying barriers that limit the development and adoption of women’s health solutions, and on connecting the actors needed to overcome them, across research, policy, industry. investment, and healthcare delivery.
Rather than advancing a single technology or approach, XX innovation works to create the conditions under which innovation can succeed. This includes fostering cross-sector collaboration, aligning stakeholders around shared priorities, and supporting clearer pathways from scientific discovery to implementation.
The ambition is not to add another layer to an already complex landscape, but to break barriers to translation and help bring coherence to it – moving from parallel efforts to coordinated action.
Women’s health is entering a period of significant scientific progress. From microbiome research to digital diagnostics and new therapeutic approaches, the pipeline of innovation is stronger than it has ever been. But innovation alone is not enough. If the systems surrounding it continue to work in silos, even the most promising advances risk failing to reach the women who need them.
The future of women’s health will depend not only on the breakthroughs we make, but on whether we build the structures capable of delivering them.
To learn more about XX innovation visit: https://xxinnovation.com/
References
- World Economic Forum. (2024). Closing the women’s health gap to improve lives and d economies.https://www.weforum.org/publications/closing-the-women-s-health-gap-a-1-trillion-opportunity-to-improve-lives-and-economies/
- National Institutes of Health Revitalization Act of 1993. Public Law 103-43. June 10.
- Notice of the “NIH Guidelines on the Inclusion of WomenMinorities as Subjects in Clinical Research.”. Federal record. 1994;59(Part VIII):14508–14513.
- British Heart Foundation. (2021). Women’s Health Strategy: BHF Response to Call for Evidence. https://www.bhf.org.uk/-/media/files/what-we-do/influencing-change/womens-health-strategy_bhf-response_june-2021_final.pdf
- Diversity and Inclusion in Clinical Trials. (n.d.). NIMHD. https://www.nimhd.nih.gov/resources/understanding-health-disparities/diversity-and-inclusion-in-clinical-trials.html
- Da Silva AS, Anwar S, Park S, Park S, Goodfellow L, Sergaki C. The untapped potential of vaginal microbiome diagnostics for improving women’s health. Front Cell Infect Microbiol. 2025;15:1595182. Published 2025 Aug 7. doi:10.3389/fcimb.2025.1595182
- Boston Consulting Group & World Economic Forum (BCG-WEF) Project: Closing the Funding Gap in Women’s Health (2026)