Monrovia — The largest pledge ever by the Gates Foundation for research work into “chronically underfunded areas” of women’s health was announced by the foundation on Monday. The foundation’s commitment is U.S.$2.5 billion for health research and development, and will support more than 40 innovations, particularly those affecting women in low- and middle-income countries.
“Investing in women’s health has a lasting impact across generations,” Gates Foundation Chairperson Bill Gates said, while stressing the connection between healthy women and strong economies. He said: “Too many women still die from preventable causes or live in poor health”, and that, Gates said, needs to change.
In a statement, the foundation said the funding will help advance work in five critical areas of “high-impact” on women’s lifespan: obstetric care and maternal immunization, maternal health and nutrition, gynaecological and menstrual health, contraceptive innovation, and sexually transmitted infections.
These areas were prioritized based on “data and evidence about where innovation can save and improve the most lives” and also as a result of “direct insights” from women in low- and middle-income countries about their needs and preferences.
At a media briefing announcing the commitment, Professor of Anatomy and Medical Physiology at the University of Nairobi, Moses Obimbo Madadi, said the new funding is crucial for countries in Africa. “Sub-Saharan Africa, which accounts for a quarter of global births, accounted for more than 50% of women’s health-related challenges, and women, maternal mortality and, of course, morbidities associated with it,” Madadi said.
In 2023, he said, about 182,000 women were lost because of pregnancy-related complications. Among the reasons he cited were excessive bleeding after childbirth and postpartum hemorrhage.
Madadi said the announcement was welcome news for the wider African region and personally. The professor was awarded the Gates Foundation’s Calestous Juma (CJ) Science Leadership Fellowship, which brings together experts in the sciences to work together and boost health research.
Madadi is expected to form a coalition of researchers that will develop tools to study the “vaginal microbiome and metabolites” during pregnancy to identify intervention strategies for improving pregnancy outcomes in Kenya.
“We know that women’s health issues, especially where we come from, the low and middle income countries, is really facing a staggering crisis,” Madadi said during the briefing, noting the challenges to women’s health in the region, is not just from adolescence, “it’s all the way to motherhood and to menopause”.
“There’s an issue of burden of disease, like neglected tropical diseases, that no one really invests any funds to make researching non-communicable diseases like hypertension, gestational diabetes, gender-based violence that we hardly talk about, and harmful traditional practices that affect our women daily as well.
“In Africa, we account for about 18% of the global population, about 20% of all the births that we have. But incidentally, Sub-Saharan Africa accounts for more than 50% of women’s health-related challenges, and women, maternal mortality, and, of course, morbidities associated with it. In 2023, for example, about 182,000 women were lost because of pregnancy-related complications. This is a big number, and out of that, excessive bleeding after childbirth, postpartum hemorrhage, what we call, contributed about 40% of this number. That’s very high.
“The other condition that really affects most of our women and has received very little research is preeclampsia or hypertension during pregnancy. This is a condition that, if were diagnosed early enough, treated and managed, the woman is able to deliver a baby and go home healthy. But in most cases, about 20% of all our maternal mortality result from preeclampsia infection as it is, as well. … Sometimes we just have the weak health systems that need quite a lot of investment, including referral systems that need to be put in place to make sure that women are guaranteed health,” the professor said.
Responding to a question on how the funds will effectively translate to the desired health outcomes, Dr Anita Zaidi, head of the gender equality division at the Gates Foundation, said the foundation intentionally chose areas that are the most underfunded and have the most burden associated with them. “What’s new is the focus, for example, on vaginal microbiome, on gynecological conditions such as heavy menstrual bleeding, which causes anemia,” Zaidi said.
Professor at the College of Medicine in Lagos, Bosede Afolabi, said under-investment in women’s health resulted in “needless” suffering, the foundation statement said. Afolabi lauded commitment, saying it reflects a recognition that “women’s lives, and the innovations that support them, must be prioritized everywhere”.
When asked specifically about Kenya and how these innovations are going to be used in low-resource settings, in rural facilities, especially for obstetric care in Kenya, and how innovations like the portable ultrasound can be used, Zaidi had this to say: “One barrier here is going to be cost, because how much do these ultrasounds cost? We’re working very hard with the companies that make these ultrasounds to bring down the cost as much as possible. That will take two to three years to keep innovating on the hardware side of the machines to bring the cost down. We have many partners: Philips, GE, and local manufacturers in India that are working on this issue.
“It’s also a part of that Beginning Fund that I talked about, where that is to support countries in innovation and production, especially when the innovation will save so many lives and can be used for triaging, for example, in a primary care setting where you would be able to tell what is the baby’s gestational age? Is this a single baby or twins? Is the placenta in the right place?
All of this is information that can be so helpful in deciding on this baby, can the mother deliver in the primary care setting, or does she need more care? Yes, cost is a barrier. That’s one of the things that we are working very hard on to bring down and then also working with other partners to make the technology accessible all over. Kenya is one of the first countries that is trying to do this.”
Gates Foundation is already working with partners like Madadi in Kenya, who is trying to “make accessible diagnostic tools that can be able to predict pregnancies that are at risk early enough before these pregnancies”.
“You’re trying to develop tools that will be able to predict a chance of a mother getting a baby who is born too soon before they mature, prematurity or getting a death of a baby within the womb before they actually delivered, stillbirth, and those who do not grow as per the spectrum. We are, through the funding from the Gates Foundation, being able to do metabolomics so that we can be able to utilize this as a diagnostic tool, but also deploy artificial intelligence to assist in early prediction and early diagnosis of these particular patients.
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Madadi said one of the challenges they’re facing in their research is patients with asymptomatic infection. “They have vaginal discharge, which they think is a normal discharge, but then you check and it’s not a normal discharge anymore. The burden of cervical cancer that’s easily preventable and can be screened. This woman gets treated early enough so that they shouldn’t go into cancer.
“These are some of the solutions that we’ve been able to gain from partnering with the Gates Foundation and through their funding programs. But then again, I’ve been very much inspired by the new advocacy outfits that we formed because we realized you could be working on the bench, treating patients at the bedside, but then you have no woman to treat because they all died because of this preventable complication.
“We need to advocate, make sure that the government is accountable. Other people get annoyed because the roads have been blocked … women are dying of preventable causes, so we advocate so that the women’s voices are heard. We started an end initiative program that’s also receiving quite a lot of support from the Gates Foundation.”
The latest commitment from Gates – expected to run through 2030 – supports its long-term goals for 2045, which, among other things, is aimed at ending the preventable deaths of mothers and babies, ensuring the next generation is free from deadly infectious diseases, and lifting millions out of poverty.
Edited by Juanita Williams