The gray areas of women’s health are pathways to progress
The gray areas of women’s health are pathways to progress

Gray is one of my favorite colors. It is considered “achromatic” or “colorless” even though it is formed by mixing black and white. It is considered neither traditionally masculine nor feminine and provides an element of ambiguity.

We use the term “in the gray area” to describe the ambiguity. In medicine, it enables clinicians to think outside the norm while treating a patient. The patient may have signs and symptoms that do not fit well with an established disease. Conventional approaches may not work in this case.

This is no more evident than in the world of women’s health. Over the years, one party over another has been seen as the champion of protecting and improving women’s health. State and federal legislation and court decisions have affected the delivery of care and the funding of research and technological advances, making it easier to identify an enemy versus a defender. But it may not be that simple.

Reproductive health care in particular is politicized by this approach. Instead of building on the achievements of decades of work, women’s health has become a target for one party to destroy or enhance. Ironically, there is a popular saying in the United States about the love of “baseball, mom, and apple pie,” but apparently not maternal health care.

There have been rays of light over the years.

In April 1977, Reps. Elizabeth Holtzman (DN.Y.) and Margaret Heckler (R-Mass.) convened a bipartisan group of women lawmakers to form what would become the Congressional Caucus on Women. Over the decades, they championed the Pregnancy Discrimination Act (1978), the Breast and Cervical Cancer Mortality Prevention Act (1990), the Mammography Quality Standards Act (1992), and the on Violence Against Women (1994) among many other notable pieces of legislation. They also codified women’s health services across government.

In 1990, during the administration of President George H.W. Bush, a watershed moment for women’s health occurred when members of both parties marched to the National Institutes of Health to demand that clinical trial research include women and the establishment of the NIH Office of Research on Women’s Health.

This was followed by the formation of the Office of Women’s Health at the Department of Health and Human Services in 1991 to coordinate through policy, education, and innovative programs. That year, under the leadership of Dr. Bernadine Healey, the NIH launched the Women’s Health Initiative, a $625 million study to address health problems causing morbidity and mortality in postmenopausal women.

More groundbreaking women’s health programs were created through bipartisan support, including Sen. Arlen Specter (R-Pa.), who introduced legislation in 1996 to create cutting-edge national centers of excellence in women’s health modeled after after the Veterans Administration centers, to provide comprehensive, multidisciplinary health care, research, education and leadership opportunities in women’s health.

In the early 21st century, agencies, even NASA, are seeing exciting developments in women’s health. In 2002, NASA supported the first of two decades of research on the effects of sex and gender on space adaptation, adopted the NIH’s inclusion language for its clinical trials, and implemented a new policy to cover “assisted reproductive technology” for both men and for female astronauts.

After the George W. Bush administration, support for women’s health grew in the private sector with the formation of the Laura W. Bush Institute for Women’s Health and other women’s health centers and lines. However, government appointments and support remain catalysts for innovation.

The Biden White House recently issued an executive order to advance women’s health research and innovation at the NIH and across federal agencies. The President asked Congress to support $12 billion in funding to establish a new interdisciplinary research program and national research centers. This is in addition to ARPA-H’s new $100 million Sprint for Women’s Health program, which accelerates research through the lens of sex and gender, leading to the commercialization of products designed to improve health outcomes.

Skeptics may ask what is the motivation behind these actions? Is it politically motivated to appeal to voters angry and disenfranchised by the removal of reproductive health freedom? That may be so, but it wouldn’t be the first time a president made a bold decision for reasons beyond scientific or humanitarian goals.

Moreover, it will take years to create a legacy of these measures that will emerge during another administration. Consider the space program. President Kennedy established it, but the US landed on the moon during the Nixon administration under a new Congress.

We can live in a state of gray where all parties can once again work together to improve the health and well-being of every American. We may not agree on everything, but in the long run, everyone wins. It’s so simple.

Sarahlyn Mark is the author of Stellar Medicine: A Journey Through the Universe of Women’s Health and the founder and president of iGIANT (sex/gender impact on innovation and emerging technologies) and SolaMed Solutions, LLC. She is a former senior advisor for medical policy at the White House, the Department of Health and Human Services, and NASA.

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