What Gets Funded Shapes What We Know: 15 Years of Canadian Womens Health Research

An analysis of 15 years of Canadian women's health research funding reveals a persistent and narrow focus on cancer and pregnancy, leaving critical gaps in the study of other hormonal life stages and diverse populations despite their significant representation in the lifespan.

The Gist

The Big Picture: A Lopsided Menu

Imagine the Canadian government (specifically the CIHR) is a giant restaurant that funds research. They have a massive budget to buy ingredients (funding) for scientists to cook up new knowledge about women's health.

This paper is like a 15-year audit of the restaurant's menu. The researchers asked: "What dishes are we actually cooking, and what are we ignoring?"

The Verdict: The menu is incredibly narrow. For the last 15 years, the restaurant has been obsessed with cooking two specific dishes: Cancer and Pregnancy. While these are important, they are the only things getting the good ingredients, leaving the rest of the menu empty.

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The Two "Superstars" of Funding

The study found that nearly half of all money given to women's health research went to just two areas:

1. Cancer (specifically breast and gynecological cancers).
2. Pregnancy (and the time right after having a baby).

The Analogy: Imagine a school cafeteria that claims to serve "Nutrition for Everyone." But if you look at the lunch line, 70% of the food is just pizza and burgers. Sure, pizza and burgers are food, but what about the vegetables, the fruits, the grains, and the proteins that make up the rest of a healthy diet? The researchers found that women's health research is stuck eating only pizza and burgers.

The "Offspring" Problem

Here is a tricky part of the "Pregnancy" category. The study found that about 22% of the money given to pregnancy research wasn't actually studying the pregnant person (the mother). Instead, it was studying the baby or the fetus.

The Analogy: It's like a doctor treating a patient's child but ignoring the patient's own pain. If a pregnant woman is sick, stressed, or in pain, that research should focus on her health, not just how her baby is doing. The study found we are often ignoring the mother's health story in favor of the baby's.

The "Missing" Chapters of Life

Women live for about 84 years on average. The study looked at how much time women spend in different "chapters" of life versus how much money is spent studying those chapters.

• Pregnancy: Women spend about 1% of their lives pregnant. Yet, this tiny slice gets the majority of the funding.
• Menopause: Women spend about 40% of their lives after menopause (post-menopause). Yet, this huge chunk of life gets almost zero funding.
• Menstruation: Women spend about 45% of their lives menstruating. This gets almost zero funding.
• Puberty: This gets almost zero funding.

The Analogy: Imagine you are building a house. You spend 99% of your budget on the front door (Pregnancy) because it's the most dramatic part of the entrance. But you completely ignore the foundation, the plumbing, the kitchen, and the bedroom (Menopause, Menstruation, Mental Health), even though you will spend 99% of your time living in those rooms.

The "Other" Missing Pieces

The study also looked at other important areas:

• Lung Cancer: It is the second leading cause of cancer death in women, but it gets almost no research money compared to breast cancer.
• Mental Health & Aging: Women are twice as likely to get Alzheimer's as breast cancer, yet Alzheimer's research for women is severely underfunded.
• Indigenous & LGBTQIA+ Women: These groups are also largely missing from the research menu.

Why Does This Matter?

The authors argue that this narrow focus is dangerous for two reasons:

1. We don't know the whole story: If we only study pregnancy and cancer, we don't understand how hormones affect heart disease, brain health, or mood in women who aren't pregnant or fighting cancer.
2. It hurts everyone: Hormones (like estrogen) affect men and non-binary people too. By ignoring how these hormones work in women during menopause or menstruation, we miss out on medical breakthroughs that could help everyone.

The Bottom Line

The paper concludes that what gets funded shapes what we know. Right now, we only know a tiny, distorted slice of women's health because the funding is stuck on a few specific topics.

The Call to Action: We need to widen the menu. We need to invest in the "boring" but vital parts of life—like menopause, periods, and mental health—so that women's health research actually reflects the full, complex reality of being a woman.

In short: We've been studying the "highlight reel" of women's health (birth and cancer) for 15 years, but we are ignoring the "behind-the-scenes" reality that makes up the rest of a woman's life. It's time to fund the whole movie, not just the trailer.

Technical Summary

1. Problem Statement

Despite mandates from major funding agencies to incorporate sex and gender into research, women's health remains underprioritized and narrowly defined. Historically, "women's health" has been conflated primarily with reproductive health (pregnancy) and specific female-centric diseases (cancers), neglecting the broader lifespan, hormonal transitions, and conditions that disproportionately affect women. The authors aim to quantify the scope of funded research to identify where critical gaps exist, specifically examining whether funding aligns with the biological reality of the female lifespan and population health burden.

2. Methodology

• Data Source: The study analyzed publicly available abstracts from the Canadian Institutes of Health Research (CIHR) Project Grants (the primary mechanism for investigator-driven research in Canada, analogous to NIH RO1 grants) over a 15-year period (2009–2023).
• Sample Size:
  • Total CIHR abstracts analyzed: 10,629.
  • Female-specific abstracts identified: 681.
  • Total funding analyzed: $441.18 million CAD.
• Coding Framework: Abstracts were coded for:
  • Hormonal Transition Periods: Puberty, menstrual cycle, pregnancy/postpartum, perimenopause/menopause.
  • Exogenous Hormone Use: Contraception, fertility treatments, menopause hormone therapy (MHT).
  • Female-Specific Conditions: Endometriosis, PCOS, catamenial epilepsy, Turner Syndrome, etc.
  • Demographics: Indigenous health and 2S/LGBTQIA+ populations.
  • Thematic Grouping: Remaining abstracts were grouped by common themes (e.g., cancer, mental health).
• Statistical Analysis:
  • Linear Regressions: Used to test for significant increases in funding or representation over time (with FDR correction).
  • Fold Difference Calculation: A metric calculated by dividing the percentage of grants/funding for a specific category by the percentage of the female lifespan spent in that stage (or population prevalence).
    • Value = 1: Proportional funding.
    • Value > 1: Over-representation/Over-funding.
    • Value < 1: Under-representation/Under-funding.

3. Key Contributions

• Quantification of Bias: Provides the first comprehensive 15-year quantitative audit of Canadian women's health funding, revealing a stark misalignment between research investment and the female lifespan.
• Reproductive vs. Lifespan Distinction: Highlights that while pregnancy is heavily funded, it is often studied in the context of the fetus rather than the birthing parent, further devaluing maternal health outcomes.
• Lifespan Disparity: Demonstrates that non-reproductive hormonal stages (menopause, menstruation) which constitute the vast majority of a woman's life, receive negligible funding compared to pregnancy.
• Cancer Funding Imbalance: Reveals that while breast and gynecologic cancers receive the majority of cancer funding, lung cancer (the second leading cause of cancer death in women) is severely underfunded relative to its prevalence.

4. Key Results

• Concentration of Funding:
  • Nearly 50% of female-specific grants focused on cancer (breast/gynecologic) or pregnancy.
  • These two categories collectively received approximately 70% of all women's health research funding ($307.88 million).
  • There was no significant increase in funding or representation for these areas over the 15-year period.
• The "Pregnancy Paradox":
  • Pregnancy accounts for only ~1.1% of the female lifespan, yet received 37% of female-specific grants and 35.3% of funding.
  • Fold Difference: Pregnancy is over-represented by a factor of 33 in representation and 31.5 in funding.
  • Maternal vs. Fetal Focus: Of pregnancy-focused grants, ~22% examined outcomes only for the fetus/offspring, ignoring the birthing parent.
• Neglect of Other Life Stages:
  • Menopause: Women spend ~39.2% of their lifespan in menopause, yet only 0.18% of all CIHR abstracts (19 grants) focused on menopause. The funding fold difference was 0.06 (severely underfunded).
  • Menstrual Cycle: Women spend ~45.6% of their lifespan cycling, yet only 0.03% of abstracts focused on this. Funding fold difference was 0.007.
  • Puberty: Only 0.04% of abstracts focused on puberty.
• Cancer Disparities:
  • Breast/Gynecologic Cancers: Received 94.5% of female cancer funding despite representing a smaller proportion of total cancer cases compared to other types.
  • Lung Cancer: Accounts for 14.2% of cancer cases in women but received only 0.8% of funded cancer grants.
• Underfunded Conditions:
  • Conditions like Endometriosis (10% prevalence) and PCOS (6.7% prevalence) received funding fold differences of 0.24 and 0.13, respectively.
  • Indigenous Women's Health and 2S/LGBTQIA+ populations were significantly underrepresented (Fold differences of 0.51 and 0.30, respectively).

5. Significance and Implications

• Scientific Validity: The narrow focus limits the understanding of female biology. Hormones like estrogen and progesterone affect all sexes; ignoring them in non-reproductive contexts (e.g., neurodegeneration, cardiovascular health) hinders medical breakthroughs for everyone.
• Clinical Impact: The lack of research on menopause and menstrual cycles ignores critical windows for intervention in aging, dementia, and chronic pain. For instance, women in their 60s are twice as likely to be diagnosed with Alzheimer's as breast cancer, yet Alzheimer's research in women is underfunded relative to this risk.
• Economic and Social Cost: The authors cite economic analyses suggesting a potential $1 trillion annual saving if the gap in women's health research were closed.
• Policy Recommendation: The study calls for a strategic shift in funding mandates to embrace the heterogeneity of women's health across the entire lifespan. It argues that funding agencies must move beyond a "reproductive health" model to a "life-course" model to address critical gaps in menopause, mental health, and chronic conditions affecting women.

Conclusion: The paper concludes that current funding mechanisms in Canada perpetuate a skewed view of women's health, prioritizing pregnancy and specific cancers while systematically neglecting the majority of the female lifespan. Addressing this requires removing barriers to research and aligning investment with the actual biological and demographic realities of women's lives.