Why women’s health innovation needs long-term investment

As global funding plateaus and maternal mortality remains high, women’s health continues to be largely overlooked — from menstrual health and chronic conditions to the often-hidden effects of gender-based violence.

Women and girls make up half of the world’s population, yet their health remains chronically underfunded, understudied, and undervalued. Globally, women spend 25% more of their lives in poor health than men, and each day more than 700 women die from preventable causes related to pregnancy and childbirth.

Against this backdrop, Devex — in partnership with Pivotal — convened global health leaders, grassroots advocates, and innovators for a virtual discussion on how to accelerate meaningful, system-level progress. The event marked a milestone in Action for Women’s Health, the $250 million global open call funded by Pivotal in partnership with Lever for Change, which surfaced more than 80 awardees across six continents.

Yet the initiative just scratches the surface. Across the conversation, it was clear that transformative ideas already exist — from community-led models to feminist legal strategies. But turning those ideas into system-level change will require flexible, long-term funding, stronger partnerships, and a commitment to centering women’s lived experiences.

“There are so many ideas, solutions, leaders, and organizations … that could dramatically turn the tide on women’s health if they got the funding, attention, and sustained support they need,” said Haven Ley, Pivotal's chief strategy officer.

Here are five key takeaways from the event.

A shift toward a life-course approach

Dr. Avni Amin, unit head for rights and equality at the World Health Organization, suggested that we need to consider a woman’s health holistically across her life cycle — from birth through childhood, adolescence, the reproductive years, then menopause — because everything is interrelated. “The body keeps score. A lot of what happens to women in older ages is the cumulative impact of the physical, mental, and emotional traumas they’ve suffered.”

A life-course approach matters because poor outcomes in later life often reflect decades of cumulative neglect. Addressing health early and consistently can reduce long-term morbidity, improve well-being, and ease pressure on already strained health systems. “So I think we need to address both the risk factors and the determinants, as well as the evolving health needs,” Amin emphasized.

She added that this perspective is increasingly reflected in WHO’s evolving guidance, pointing to the organization’s newly released consolidated postpartum hemorrhage guidelines and ongoing work to update recommendations across antenatal, intrapartum, and postpartum care — including new guidance on respectful maternity care, diabetes in pregnancy, and supporting positive pregnancy experiences.

Community-rooted, culturally relevant models

One of the strongest examples of systems-level innovation came from Dila Perera, executive director of Open Arms Perinatal Services in Washington state. Her organization’s community-centered doula model, now almost 30 years old, has delivered dramatic improvements in maternal outcomes, especially among historically marginalized communities.

“Our preterm birth rate is half of what it is for the United States and half of what it is for Washington State,” she said, with the most significant differences among African American, Indigenous, and foreign-born families.

Their approach pairs birthing people with culturally matched birth companions who navigate traditions, language, and trust. Beyond improved outcomes, that model also shows how community health work can be generational. Perera noted how some of those first served have returned to become doulas, nurses, midwives, or lactation consultants themselves. That matters at a time when many countries face chronic shortages of midwives, primary caregivers, and culturally competent providers.

“One of the things that we all know is that when we have providers that look like us, we often can associate that with more trust and better care. And so the fact that it's a multigenerational, long-term shift is something that I'm incredibly proud of,” Perera said.

A rights-based, feminist health approach

In the Philippines, Dr. Junice Lirza Demeterio Melgar, executive director of Likhaan Center for Women’s Health, has spent three decades working at the intersection of human rights, community organizing, and service delivery. She described two central barriers: persistent patriarchal structures within government systems and the influence of conservative religious groups on public policy.

The organization’s three-pronged approach — community organizing, women-centered clinical services, and policy advocacy — has generated significant change. Beyond expanding contraceptive access and improving implementation of the reproductive health law, she also highlighted the effect on community health workers.

“Some started as docile wives who never went out of their home,” Demeterio Melgar said. “With socialization, modeling, and interaction with other women who have the same problem, they have risen to be leaders … talking in Congress, the Senate, and [about the future of reproductive health law].” Likewise, she said their daughters are more independent-minded and whole communities are experiencing social transformation.

That combination of rights-based, community-led service plus advocacy offers a blueprint for sustainable, systemic change that governments or development agencies alone cannot deliver.

Strategic litigation as a lever for accountability

Legal advocacy is an underutilized, but increasingly vital, strategy for advancing women’s health. In Uganda, the Center for Health, Human Rights and Development, or CEHURD, has demonstrated how litigation can shift entrenched systems when policy dialogue alone falls short.

CEHURD Executive Director Fatia Kiyange explained that their approach combines courtroom action with community-level legal empowerment to address persistent gaps in access, quality, and rights.

A landmark example Kiyange cited is Petition 16, a maternal health case that challenged government inaction and ultimately contributed to major reforms, including increased maternal health budgets, better-equipped facilities, and improved health worker training and surveillance systems. “Over that period, our maternal mortality has dropped by 44%,” she said.

Yet Kiyange emphasized that accountability work extends far beyond legal victories. Many women and girls struggle to access justice at all — often because of basic financial or logistical barriers.

“We see delays for girls and women to access justice because they don’t have $3 to get to a health facility for a medical exam or reach the police to report a case,” she explained. “Many fear the justice system. They don’t know where to start.”

Flexible, long-term funding for sustainable impact

Throughout the discussion, speakers stressed that funders must shift away from short-term, highly restricted grants and toward unrestricted, multiyear support.

“It creates the safety to innovate, to try new things, to push for longer-term change,” said Perera, underscoring how flexible funding allows community-rooted organizations to evolve and deepen their impact. She added that multiyear support also provides crucial visibility for small, often informal groups doing frontline work. “It gives us a platform to show what we’re capable of. Flexible, multiyear funding is often what launches [organizations like mine] into sustainability and allows them to become trusted, grounded resources in their community for years to come.”

For many feminist, grassroots, and litigation-focused initiatives, short project cycles simply do not match the timelines required to confront entrenched inequities. Demeterio Melgar described multiyear support as “an affirmation” for groups often dismissed as too radical or too small.

This call extends far beyond philanthropy. Speakers emphasized that bilateral donors, multilaterals, and public funders must also rethink how they structure grants — prioritizing flexibility and institutional strengthening over quick wins or rigid metrics.

For organizations such as CEHURD, litigation can take years, and the inequalities driving harm — from gender norms to poverty and discrimination — cannot be undone through short-term, activity-based funding, noted Kiyange. “If we are going to get to where we want to be with women’s health, we need to invest in flexible, long-term funding, but also invest in these institutions so they can be sustainable and resilient.”

Explore the full list of Action for Women’s Health grantees here.

This content is sponsored as part of Bold Ideas — a series celebrating health breakthroughs and spotlighting the bold, grassroots solutions putting the power back in women’s hands. Click here to learn more.