Advancing Health Equity: Celebrating Milestones and Addressing Challenges in Sex and Gender Research
By Dr. Janine A. Clayton
World Health Organization Adopts SAGER Guidelines
Recognizing the intricate interplay of sex and gender in research is essential for achieving equitable health care outcomes. Recently, I presented at a webinar to discuss the World Health Organization’s (WHO) adoption of the Sex and Gender Equity in Research (SAGER) guidelines, which strongly reinforced the importance of this issue. Originally published in 2016, these guidelines underscore the importance of integrating sex and gender factors into research design, implementation, and reporting. Historically, limited recognition of these factors has constrained the applicability of research findings, significantly impacting clinical approaches to treating all individuals. WHO’s endorsement and subsequent translation of the SAGER guidelines into multiple languages signals a pivotal moment and reinforces the importance for other institutions to prioritize inclusivity in data collection and analysis.
A cornerstone of ORWH’s mission is advancing our knowledge of how sex and gender influence health and disease and accelerating the application of this knowledge across research and clinical practice to improve the health of all people. Since spearheading the NIH Policy on Sex as a Biological Variable (SABV), ORWH, in collaboration with NIH partners and other federal agencies, has continued to create and disseminate resources that encourage researchers and clinicians to consider SABV at all stages of research. Building upon this commitment, I recently co-authored a research paper titled “Ensuring accountability for consideration of sex as a biological variable in research,” which serves as a call to action for nurse researchers to actively embrace and apply the principles of the SABV policy—from laboratory experimentation to patient care—to advance the equity and health of all people.
To further support this mission, ORWH has developed e-learning courses, including Bench to Bedside: Integrating Sex and Gender to Improve Human Health, which aim to educate and empower researchers and health care providers with the knowledge and tools needed to integrate SABV into their work. Additionally, ORWH leads and supports several research programs that explore the influences of sex and gender in health and disease, such as the Specialized Centers of Research Excellence (SCORE) on Sex Differences program and the sex and gender research project grant (R01).
Intimate Partner Violence Among Birthing People: Rural–Urban Differences
Intimate partner violence (IPV) is a contributor to maternal mortality. Approximately 6% of pregnant individuals experience some form of IPV; however, this prevalence is likely underestimated because of gaps in screening. Among those who experience violence and receive any prenatal care, more than a quarter are not screened for IPV at any time during pregnancy. In rural communities, accessing resources for IPV victims can be challenging because of geographic isolation, limited-service availability, and societal stigma. Pregnant individuals in rural areas may face additional barriers such as lack of transportation, scarcity of health care facilities, and cultural norms that discourage seeking help from outside the community. On June 3, 2024, the NIH Office of Disease Prevention hosted a presentation that explored rural–urban differences in IPV and the distinct risks faced by rural birthing people. The presentation, which was part of the larger webinar series, Prevention in Focus, discussed research findings based on data from the Pregnancy Risk Assessment Monitoring System, revealing higher rates of IPV and lower rates of abuse screening among rural residents versus those living in urban areas. Insights were provided from key informant interviews with IPV victim advocates who support rural individuals and families.
Violence presents a significant public health challenge, necessitating comprehensive and culturally sensitive approaches to ensure the safety and support of all people, including those in rural areas. Addressing IPV in rural communities, particularly among pregnant individuals, requires urgent and targeted interventions. Resources such as the NIH Fact Sheets on Women’s Health Research and the Health of Women of Understudied, Underrepresented, and Underreported (U3) Populations Data Book highlight the critical need for these services. By raising awareness and advocating for accessible resources and culturally sensitive support systems, we can work toward creating safer and healthier environments for everyone, regardless of their geographical location.
Women’s Health and Innovation
As mentioned in President Biden’s Executive Order on Advancing Women’s Health Research and Innovation, private-sector innovation is a key aspect of accelerating and improving women’s health research. NIH is committed to further increasing its investments by 50% to support innovators and early-stage small businesses engaged in research and development on women’s health. This commitment was underscored on June 26, 2024, when ORWH hosted an engaging virtual webinar to discuss Small Business Opportunities for Innovative Women’s Health Research. This event served as a pivotal platform for exploring avenues within the NIH Small Business Program, which offers funding exceeding $1.3 billion. The webinar featured insightful presentations from representatives of the SEED Office and various NIH institutes and centers, who provided a comprehensive overview of the program. They delved into essential topics such as the application process, highlighted unique research priorities, and addressed audience queries in real time.
Attendees gained invaluable insights into leveraging these funding opportunities to advance research in women’s health. The event also underscored NIH’s commitment to supporting innovative projects that address critical gaps and opportunities in the field. These resources will serve as invaluable references for entrepreneurs, researchers, and innovators keen on making impactful strides in women’s health research through small business initiatives.
Aligned with this initiative, ORWH has collaborated with the Bill & Melinda Gates Foundation to establish the Women’s Health Innovation Opportunity Map 2023. Developed by a forum composed of more than 250 experts and stakeholders from diverse sectors and countries, this report serves as a comprehensive guide for stakeholders in the women’s health research and development ecosystem—from researchers and entrepreneurs to investors, government bodies, biopharmaceutical companies, and civil society. The report aims to foster strategic investments that will notably improve women’s health over the next 15 years. Be sure to explore the map for actionable insights and opportunities in advancing women’s health globally.
ORWH Fiscal Years 2021-2022 Report
I am pleased to share that ORWH has published the Report of the Advisory Committee on Research on Women’s Health: Office of Research on Women’s Health and NIH Support for Research on Women’s Health: Fiscal Years 2021-2022 . This comprehensive biennial report not only chronicles significant scientific achievements but also illuminates the transformative impact of workshops and the application of SABV across a diverse array of disciplines.
The report serves as a testament to the concerted efforts of NIH institutes, centers, and offices (ICOs) in advancing research that profoundly acknowledges the intricate roles of sex and gender in health and diseases. The report highlights pioneering research initiatives that have catalyzed innovative approaches to biomedical research.
Of particular note is the introduction of a new section focusing on ICOs’ collaborative endeavors in integrating crosscutting research themes. This strategic initiative aims to enhance collaboration across disciplines, fostering synergistic partnerships that drive innovation and deepen our understanding of biomedical research.
From groundbreaking studies elucidating sex-specific mechanisms of disease to initiatives promoting inclusion in clinical research, the report showcases a dynamic landscape of discovery and collaboration. This report reflects NIH’s proactive stance in addressing complex health challenges with evidence-based solutions, thereby paving the way for a future where personalized medicine and equitable health care for women are not just aspirations but realities. I encourage you to explore this insightful report, because it not only celebrates past achievements but also sets a visionary course for future advancements in women’s health research.
NIH Revitalization Act of 1993
On June 10, 2024, we commemorated the 31st Anniversary of the NIH Revitalization Act of 1993, a pivotal milestone in women’s health research. Over the past three decades, this act has catalyzed a transformative shift, ensuring the prioritization of diverse health needs in biomedical research, thereby enhancing treatment efficacy. A significant achievement has been the deeper understanding of gender-specific differences in disease presentation and treatment response. Prior to the Act, many clinical trials primarily enrolled males, leaving a gap in understanding women’s health.
This landmark legislation has profoundly influenced research, policy, clinical practice, and public health initiatives, embedding inclusion in medical product development and advancing health care outcomes for women. As we reflect on its anniversary, we celebrate the strides made while recognizing ongoing efforts to address health disparities and consistently prioritize women’s health across the biomedical research spectrum. ORWH remains committed to advancing women’s health research for equitable access to scientific progress.
Gender, Power, and Health Publication
Exploring the critical intersections of gender dynamics and public health is essential for comprehensively understanding and addressing the diverse factors influencing health outcomes. ORWH is sponsoring a new supplement in Social Science & Medicine on “Gender, power, and health: Modifiable factors and opportunities for intervention” that will expand on conversations from the “2022 Gender and Health: Impacts of Structural Sexism, Gender Norms, Relational Power Dynamics, and Gender Inequities Scientific” Workshop. ORWH Associate Director for Interdisciplinary Research Elizabeth Barr, Ph.D., along with her fellow authors, provides a multidisciplinary understanding of the complex issues inherent in researching gender, power, and health. The supplement brings together established and emerging leaders from the fields of epidemiology, gender studies, men’s health, graphic medicine, demography, clinical medicine, social work, and sociology. The diverse perspectives included in this supplement underscore the methodological, conceptual, and practical challenges and opportunities for advancing a research agenda that acknowledges the multiple pathways through which gender influences health. Covering various themes such as the health consequences of structural sexism, gender health equity, structural gendered racism, and maternal cardiovascular morbidities, the supplement underscores NIH’s commitment to rigorous and interdisciplinary research on gender and health.
Closing
As we reflect on the progress made in advancing women’s health research and advocacy, I am excited to announce the upcoming July 2024 session of Diverse Voices: Intersectionality and the Health of Women, titled “Nutrition and Health Disparities.” The session will feature presentations on “3E Study: Economic and Educational Contributions to Emerging Adult Cardiometabolic Health” and “Urban Revitalization and Long-Term Effects on Diet, Economic, and Health Outcomes.” I eagerly anticipate the insights and discussions that will emerge from this session, as we continue our collective journey toward understanding and addressing the complex intersections of health disparities. By engaging in these discussions, ORWH remains steadfast in its dedication to amplifying voices and fostering collaboration to create environments where everyone, regardless of background or circumstance, can access the resources and support needed to thrive. Together, let us strive for a world where health equity is no longer a distant goal, but a reality for all.