Here's how we can get better access to sexual and reproductive health to women around the world

From a lack of trained staff to an inability to source or fund medicines and contraceptives, women around the world face patchy access to sexual and reproductive health.

The pandemic has made the problem worse, affecting access to and use of contraceptive services and testing for sexually transmitted infections (STIs) for example.

But there is also a more fundamental problem – the science doesn’t yet exist to treat many of the issues women and girls face, according to the 2022 Access to Medicine Index – Special Report on Women’s Health and Sexual and Reproductive Health and Rights (SRHR).

The report finds that while breast, ovarian, cervical and uterine cancers are comparatively well-addressed diseases, there are some women’s health conditions that fall through the gaps, with no treatments in development. Maternal health is particularly overlooked.

This development pipeline mirrors a general trend that sees drug companies focus on non-communicable diseases, which are likely to give greater commercial returns in comparison to other health needs like contraceptives or maternal health.

For women’s sexual and reproductive health, this lack of commercial incentive has translated to a research and development product gap for human papillomavirus (HPV) diagnostics and medicines for postpartum haemorrhage, for example.

Shyam Bishen, head of Shaping the Future of Health and Healthcare at the World Economic Forum, acknowledges the scale and severity of the problem.

“There is urgent need to focus on investing and innovation in Women`s health. There were a total of 37 prescription drugs approved by the FDA [U.S. Food and Drug Administration] in 2022, only two were for women`s health. This is not just limited to 2022 but more like an ongoing challenge of low number of new solutions developed for women," he says.

In low- and middle-income countries the lack of access to women’s healthcare can be particularly acute. Women’s health services are often not provided at a level that meets minimum medical and human rights standards.

In these countries there are 11 disease or health needs relating to women’s health that need addressing as a priority but are currently not even being researched. These include hypertensive disorders during pregnancy like preeclampsia, some STIs and contraceptives.

However, research is under way to address some gaps, for example, a vaccine to prevent chlamydia, an STI.

The Forum's Bishen believes progress will come with increased collaboration:

"To achieve better investment and innovation in women`s health issues, strong partnerships must be built between private and public sectors as conversations across sectors is essential to improve long-term women’s health.”

Maternal mortality is disproportionately high in low-income countries, averaging 462 deaths per 100,000 live births, compared to 11 deaths per 100,000 in high-income countries, the World Health Organization reports. Part of this is down to structural and systemic issues such as distance to hospitals or a lack of access to existing medicines.

It is statistics like this that contribute to a gender divide, with the World Economic Forum’s 2022 Global Gender Gap report estimating it will take another 132 years to reach gender parity based on current progress.

But while addressing health system barriers will help solve part of the problem, ongoing R&D investment is also crucial to improving maternal survival rates, the report says.

Pregnant and breastfeeding women have historically been excluded from clinical trials for the development of any non-childbirth related treatments. This has resulted in a dearth of information to aid clinical decisions and prescribing to pregnant women. There is also a lack of understanding as to how the physiological changes during pregnancy affect the absorption and metabolism of medicines.

The report notes the WHO and several other bodies issued a call to action in 2021 to pharmaceutical companies, urging them to accelerate the development of medicines for use by pregnant and breastfeeding women.

Even where products do exist, they are not necessarily approved for use in all markets.

Middle-income countries are the most likely to register products, but under half of the products the report looked at were registered in low-income countries.

Pharmaceutical companies should take on some of the burden to ensure more products are filed consistently in low-income countries, the report says, focusing in particular on countries with a high burden of the disease targeted.

Another way companies must help improve access is by increasing the availability and affordability of products in low and middle income countries.

This could include pooled procurement mechanisms at a supranational level, allowing large volumes of products to be purchased for use in multiple countries. Although these purchasing agreements do exist, they tend to be limited to a small group of products.

Weak health and regulatory systems in low- and middle-income countries can add to the complexities of getting products to market. The report suggests that thinking beyond transitional routes to market can help here – this could include non-exclusive voluntary licensing, allowing other companies to manufacture and sell generic versions of a product.

Beyond the creation and supply of women’s health treatments, overcoming sexual and reproductive health barriers also relies on breaking down a lack of awareness, improving healthcare worker training, addressing supply chain issues and strengthening healthcare systems.

To achieve this, partnerships must be built between the private sector and bodies such as the United Nations’ Population Fund – the UN’s sexual and reproductive health agency – to build supply chain capacity, improve demand forecasting and address issues related to the storage and distribution of medicines.