By Rachel Crumpler

Despite making up more than half of the population, women have long been understudied and underrepresented in health research.

The Center for Women’s Health Research at UNC Chapel Hill has prioritized learning more about diseases, disorders and conditions that affect women only, women predominantly and women differently than men for over two decades. In the past five years, the center has brought in more than 25 million research dollars for projects focused on women’s health.

Now, the White House shares the same priority. 

Earlier this month, President Joe Biden announced a White House initiative focused on bolstering women’s health research. The effort will be led by first lady Jill Biden and the White House Gender Policy Council.

The goal: to improve how women’s health research is approached and funded.

“Every woman I know has a story about leaving her doctor’s office with more questions than answers,” Jill Biden said in a statement announcing the initiative. “Not because our doctors are withholding information, but because there’s just not enough research yet on how to best manage and treat even common women’s health conditions. In 2023, that is unacceptable.”

Kavita Arora, director of the Division of General Obstetrics, Gynecology and Midwifery at UNC Chapel Hill, is conducting research on contraception disparities through grants housed at the center.

NC Health News spoke with Arora about the White House initiative, the need for more women’s health research and knowledge gaps that currently exist. The conversation has been edited for length and clarity. 

NC Health News: What was your reaction to the announcement that the White House was establishing this initiative? Does this feel like a significant step?

Arora: This is a very big step, and it’s a very needed step. Funding for women’s health has lagged behind funding for other health care. Women are underrepresented in clinical studies and clinical trials as well.

When we are making decisions as physicians, it is unclear whether the data that was largely derived from a male patient population can apply to women. This impacts the treatment that we are prescribing and discussing, day in and day out. There’s been a giant push by many women’s health organizations for a long time to have increased funding and awareness about the need for more research in women’s health, especially in the last couple of years. I think this really represents the logical next step.

NCHN: The Center for Women’s Health Research at UNC has already been prioritizing women’s health research. What’s happening locally at the center at UNC to address women’s research gaps?

Arora: About 95 percent of the grants that go through the center come from the OB-GYN department. We are very active in research, with faculty who are invested in bettering the health of women. There are a lot of large projects, whether it’s on maternal health, contraception, the impact of the Dobbs decision, GYN cancers as well as fibroids and urinary incontinence. Research being done is all with clinical impact as the ultimate aim. The goal is to make health care for women better.

NCHN: Why is there a need for more women’s health research?

Arora: For example, in cardiovascular health, ER physicians used to be taught that heart attacks presented with crushing substernal chest pain radiating to the left arm. That may be true for the majority of presentations for men, but it is not true for many women. Women were being underdiagnosed when actually having heart attacks.

It wasn’t until we started focusing on women’s health — and understanding that even things like heart attacks that have nothing to do with reproductive organs still have different incidences, different symptoms, potentially even different prognoses and treatments in women than men — that the need for doing research in women became much more apparent.

NCHN: Has that been a recent shift of people realizing that conditions and diseases — ones not related to the reproductive system — may present and affect women differently than men?

Arora: For the last 20 years, this awareness has been gaining momentum. But really in the last five years, there has been increased urgency around it. 

For example, the National Institutes of Health required discussion of sex as a biological variable in its research submission only a few years ago. So even if you’re putting in a proposal on an autoimmune condition or heart disease, how may sex and the differences between males and females impact your results? And how are you intentionally thinking about that in your science and recruiting a diverse patient population to be subject for your research study? 

NCHN: What’s been the effect of these knowledge gaps on women’s health? Have there been problems that come up with patients where you just don’t have an answer because of these research gaps?

Arora: Absolutely this comes up in my daily clinical practice as an OB-GYN. There is a lack of funding in many gynecologic conditions, whether it’s fibroids, endometriosis, GYN cancers or pelvic pain. Oftentimes we’re working with an evidence base that is not robust to guide our treatment decisions. 

This is particularly even more true in obstetrics, where pregnant people are often excluded from clinical trials because they are pregnant. Therefore, we don’t have data to guide decision making about very common conditions in pregnancy or people with chronic diseases that they bring into pregnancy regarding their treatment. This is day in and day out. This is as simple as Tylenol. There’s never been a randomized control trial on most of the meds that we prescribe in pregnancy. Up to 80 percent of pregnant people take some medication in pregnancy, but generally we don’t have high-quality data to inform that discussion.

NCHN: What are some of the areas of women’s health that you’d like to see addressed with better research? 

Arora: For me, it really is about the life course perspective of women’s health. To her unique needs in sexual and reproductive health — pregnancy, lactation, contraception, menstrual health, pelvic pain — but also all of the other aspects of health that are impacted by being female rather than male that are not even sort of considered part of our reproductive organs. 

NCHN: So when we talk about advancing women’s health research, it seems like there also needs to be nuance in the study of women, as white women may be affected differently than women of color. Can you elaborate on the importance of representing all women in research and how we might have different results based on that?

Arora: At the same time as there’s been a growing awareness of the need for sex and gender diversity in research, there’s also been a growing awareness of the need for racial and ethnic diversity in research. That is because race and ethnicity as social constructs are part of our social determinants of health, and how those social determinants of health interplay with the biological factors is understudied and under known.

For example, there might be different blood pressure medicines that are better for patients of one race than another given all of this complexity of race in terms of social factors, diet and epigenetics. In women’s health, we know that people who are marginalized have a higher risk of chronic health diseases, higher risk of maternal morbidity and mortality. 

Paying attention to the diversity of our study sample will impact its ability to apply to all patients, as well as point out unique differences that we need to be mindful of when we are making management and treatment decisions. It’s also about maximizing the benefit to society — ensuring that research helps the most vulnerable in society who have the worst health outcomes. 

NCHN: What do you hope can be accomplished through this White House initiative, along with other centers like UNC’s that are prioritizing advancing women’s health research?

Arora: The heightened awareness that comes from a White House initiative is really important. As the working group or committee that gets established as a result of this directive meets and decides on what the implementation will be in terms of research priority areas and research funding mechanisms, I know that UNC — especially through the Center for Women’s Health Research — will be poised to be responsive to those requests in order to impact the health of women and the patients we care for.

Republish This Story

Republish our articles for free, online or in print, under a Creative Commons license.