Bill Gates’ recent $2.5 billion commitment to women’s health represents an overdue and transformative investment.
But it’s not enough.
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I’ve spent years leading innovation in maternal and infant health technology businesses globally, researching the barriers that keep these technologies from reaching widespread use, and experiencing their pitfalls as a parent. Through that work, I’ve learned foundations, no matter how visionary, cannot shoulder this burden alone.
Real change will require a concerted effort from all of us — researchers, clinicians, regulators, policymakers, and investors — working in alignment to change the system where women’s health innovations go to die, no matter how promising or well funded.
Building the future our children deserve is more like building a cathedral than a clinic. It won’t be done in a day, or by one pair of hands. It will take vision, patience, and a collective, sustained effort across generations to create a foundation strong enough for lasting change.
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For me, the wakeup call was deeply personal. My son arrived blue and silent on a sleety Boston March day. The sudden hush in the delivery room and the team’s urgent whispers confirmed my worst fears as they worked to resuscitate him. The resuscitation worked — barely. After months of routine checkups and reassuring ultrasounds, no one saw this coming until it was seconds from too late. I later discovered that the electronic fetal monitors used to assess his risk during labor — technology used by 89% of mothers who experienced labor in U.S. hospitals, according to multiple studies — have remained fundamentally unchanged for decades.
These monitors are inefficient, overwhelmingly prone to false positives, and clinically unreliable. Ninety-nine percent of the time, when the fetal monitor alarms to signal that the baby may be in danger, it’s wrong. Interpreting fetal monitoring strips, it turns out, is similar to asking doctors to read tea leaves during one of the most important moments in a family’s life.
That experience led me to petition the company I worked at and eventually led: Philips’ global obstetrics monitoring business. I was determined to change the story, not just for my family, but for millions of others.
At first, I thought it would be just like scaling any other new product. We launched first-of-their-kind innovation partnerships and pursued upgrades to fetal monitoring systems. During Covid-19, we accelerated remote monitoring solutions to reach pregnant women who no longer felt safe coming to hospitals, developing solutions in just a few months versus the traditional years.
But then reality set in. Despite strong internal commitment and promising data, it was clear that widespread adoption would take long-term persistence against regulatory friction, reimbursement shortfalls, and structural barriers. It wasn’t a question of will, patients’ need for the product, or technical capability — it was a system calibrated to sustain the status quo. I set out to find out why.
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In a thriving innovation ecosystem — think breakthrough biotech — unmet needs attract ideas, funding, and iteration. As taught in MBA programs, identifying an unmet need is the startup’s ignition; capital simply gives it horsepower.
Not so in women’s health. Women’s health innovations fail to make it into practice at higher rates and earlier stages than other medical technologies. The reasons are maddening and cumulative.
Financial headwinds
Obstetrics departments are loss leaders at most hospitals, with clinicians fighting to maintain basic quality despite unreasonably low reimbursement. Hospital administrators have indicated in interviews that labor and delivery units are often in the red. Medicaid covers 50% of rural births, but reimbursement rates set by states do not cover the full cost of providing obstetric services. As one Alabama physician noted, Medicaid pays $1,000 for nine months of prenatal care, labor and delivery, and postpartum care, but one hour of a joint replacement gets paid $1,600.
Beyond direct technology costs, adopting new innovations takes time and resources that are already in short supply in these financially constrained departments. Unless these financial headwinds are fixed, there won’t be market pull from clinicians — which means no viable market for innovators to enter, or for larger companies to believe in when considering acquisitions.
Regulatory burden
Developing innovations in fetal monitoring faces a perfect storm of regulatory challenges. Pregnancy is treated as a “protected class,” a well-meaning but paternalistic approach that wrongly implies pregnant people can’t make informed decisions about their own care. This drives up research costs and delays potentially life-saving technologies.
The deeper problem lies in regulatory equivalence requirements. Since there hasn’t been truly transformational innovation in fetal monitoring, all widely adopted approaches still rely on the single vital sign of heart rate from the 1960s. Newer ideas like Raydiant Oximetry take different approaches, but any technology incorporating additional vital signs must bear the full regulatory burden of proving an entirely new paradigm.
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In my interviews with dozens of investors, I found widespread frustration about this innovation gap. AI-enabled health monitoring is exploding across health care — from cardiac arrhythmia detection to fall prevention — yet where are the breakthrough fetal health solutions? We’re stuck with 1960s heart rate monitoring while AI transforms many other area of patient care. The regulatory system, designed for incremental improvements in mature fields, becomes a massive barrier precisely where breakthrough innovation is most desperately needed.
Market reality
The combination of regulatory costs, reimbursement gaps, and infrastructure requirements creates an impossible business case. Any genuinely innovative fetal monitoring technology requires building entirely new supply chains — from specialized sensors to maintenance protocols to staff training programs. Even when hospitals want to adopt better technology, innovations often go unused without ongoing technical support, regular calibration, and replacement parts that traditional medical device companies take for granted.
Nuvo, which built promising Food and Drug Administration-cleared fetal monitoring tools, recently went bankrupt despite impressive technology, unable to meet investors’ expected returns. The company faced not just the cost of proving their innovation worked, but the massive undertaking of building an entirely new ecosystem to support it. For many women’s health startups, supporting these infrastructure requirements on top of all the other systemic barriers becomes the final straw that breaks their backs.
The funding cliff is real
In my interviews with roughly 50 investors, entrepreneurs, and industry experts over the past year, one theme emerged consistently: the broken business model for women’s health innovation at the growth stage. The data backs up what these founders experience daily. Women’s health startups face a documented “growth-stage cliff,” according to investor Halle Tecco’s analysis. While early-stage funding has increased — women’s health saw a 55% year-over-year increase in 2024 — companies struggle to scale beyond initial rounds when the systemic barriers hit hardest.
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Although Silicon Valley Bank’s recent analysis offers a somewhat brighter picture of the number of women’s health companies progressing through to growth phase, it also underscores that the shortage of successful exits is creating a bottleneck that ultimately slows the speed of these companies’ progress. Every investor and entrepreneur I spoke with pointed to the same fundamental problem: You can prove your technology works and secure initial funding, but you can’t build a sustainable business model when the entire system is designed to prevent adoption at scale.
Cultural stigma
As a society, we find it very difficult to think, let alone talk about things when they go wrong, dismissing complications by calling childbirth “the most natural thing in the world.”
Yet the health care system doesn’t tell cancer patients their tumors are “natural,” or refuse to treat heart attacks because cardiac arrest occurs in nature. Research shows there is a “pervasive global culture of silence and taboos around pregnancy, pregnant body and postnatal care,” and that many parents suffer devastating loss largely in silence, due to persistent stigma and taboo. Indeed, about 21,000 babies are stillborn annually in the United States — roughly equivalent to every seat in Madison Square Garden being filled and lost. Over the years, I’ve been struck by how often, once people learn about my work, they share rarely spoken stories of loss. Perhaps because of this lack of dialogue, Americans don’t demand improvement and innovation the way we would if adults were dying under hospital care of preventable illness.
We cannot afford to keep funding upstream R&D without system readiness downstream. Bill Gates and Melinda French Gates have demonstrated that transformative health outcomes require more than scientific breakthroughs — they demand systematic approaches that address structural barriers before they kill innovation. Their success in global health shows us the policy levers needed to save money and create better outcomes through holistic innovation ecosystems. Structural fixes must accompany any surge in investment:
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1. Adopt integrated innovation assessments. ARPA-H’s approach addresses structural barriers by ensuring solutions have “regulatory and adoption pathways” so everyone can benefit, recognizing that health innovation has three components: the science, the regulatory environment, and the person who needs that solution. Applying system dynamics modeling to understand the innovation should be table stakes for all public research funding. This type of mapping includes and goes beyond the Gates model of identifying system-level bottlenecks upfront, before funding research — not after innovations are already developed and failing.
2. Reform reimbursement to reflect value and complexity. Establish fair-value models that recognize pregnancy as a unique health care need, fundamentally different from treating any other “illness” since it involves multiple people and poses heightened risks to multiple lives simultaneously. My “Medi-Mom” framework provides a compelling example of how this could work — moving beyond Medicaid’s fragmented approach to create comprehensive programs that reflect the clinical and social importance of women’s health.
3. Create innovation-friendly regulatory pathways. Revisit pregnancy’s “protected class” designation to empower pregnant people with agency while reducing unnecessary trial costs. Expand FDA flexibility for maternal technology through broader use of the De Novo pathway and pilot reimbursement codes that support early adoption of proven innovations.
Women’s health has become a movement. Now it must evolve through deliberate, collective effort over years. We should begin with a strategic vision of where change is needed and the structural barriers preventing it, and then measure our progress against them.
The time to start laying those stones is now — because our children cannot wait another generation for women’s health to be more than a movement.
Veronica Adamson is a health technology business executive, a system-dynamics doctoral researcher at Harvard T.H. Chan School of Public Health, an advocate for maternal and infant health innovation, and the founder of InnovaHer, a system-level think tank advancing impactful health technologies in areas where progress has stalled.