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Advancing Women’s Health Research and Innovation: A Conversation with Janine Clayton, Director of the NIH Office of Research on Women’s Health (ORWH)

In March 2024, President Joe Biden signed an Executive Order directing the most comprehensive set of executive actions ever to expand and improve women’s health. Its actions prioritize the integration of women’s health throughout the federal research portfolio and budget, galvanizing new research initiatives on various topics, including menopause and women’s midlife health.

The order outlines a set of actions across the federal government, including at the National Institutes of Health (NIH), to drive a cutting-edge, interdisciplinary research agenda on women’s health, address research gaps, and make investments to prevent, diagnose, and treat health conditions in women.

The Office of Behavioral and Social Sciences Research (OBSSR) has a history of supporting research initiatives addressing issues such as health disparities, opportunities for women in scientific fields, improvements in research inclusivity, and policy matters affecting women. We look forward to building on our collaborations with the Office of Research on Women’s Health (ORWH) to accelerate research to prevent, diagnose, and treat conditions that uniquely or disproportionately impact women.

I recently had the opportunity to connect with the Director of ORWH, Janine Clayton, M.D., FARVO about the importance of behavioral and social sciences research to women’s health and how the Executive Order can help address how we will work together to close gaps and accelerate the advancement of women's health research.

What are some of the major challenges in women’s health research that the Executive Order aims to address? 

The Executive Order focuses on five key areas to support women’s health. These include prioritizing and enhancing investments; fostering innovation and discovery; expanding and leveraging data collection and analysis; strengthening coordination, infrastructure, and training; and improving women’s health across the lifespan.

By increasing funding and focusing on women’s health across the lifespan, there is an opportunity to better understand the diseases and conditions associated with women’s midlife and later years.

What role does behavioral and social science research play in improving health outcomes for women? 

Much of the research at the NIH focuses on the biological perspectives that influence women’s health at the genetic, molecular, and physiological levels. However, it is imperative to understand how these internal factors interact with the external ones, such as social constructions of gender and sexuality and social determinants of health. These interactions have broad implications for women’s health outcomes.

Research has shown that lifestyle behaviors, such as healthy eating and regular physical activity can prevent conditions like heart attack and stroke. Simply recommending that women eat whole foods and exercise regularly does not consider how the social world influences individual behaviors. For example, some women may not have access to healthy foods because they live in an area without a grocery store. They may have physical disabilities that limit their ability to exercise or live in a neighborhood where it is not safe to be outside due to violence or air pollution.

Continued and expanded support for behavioral and social science research can enhance our understanding of the factors that influence women’s health. This support can help develop effective interventions that address health disparities and advance equity for women.

How is women’s health research linked to health equity?

To conduct equity-focused health research for women, we need to take an intersectional approach. This means looking at the differences among groups and understanding how various social factors influence women’s health outcomes.

Recognizing that women's experiences vary, it's important to tailor strategies for improving women’s health to account for these differences. For example, cultural factors significantly influence women's perceptions of menopause and affect their acceptance of biomedical approaches during this transition. Additionally, racial and ethnic minoritized groups may face obstacles in accessing proper care and can have challenges in finding menopause-related information and support.

To support equity-focused research, ORWH recently coordinated the release of a Notice of Special Interest on women’s health that highlights the NIH’s interest in receiving research applications focused on diseases and health conditions that predominantly affect women.

The Executive Order aims to improve the recruitment, enrollment, and retention of women in clinical trials. How do behavioral or social science play a role in achieving this goal?

As the focal point for women's health research, ORWH strives to ensure that women from understudied, underrepresented, and underreported (U3) populations are included in biomedical research to reduce health disparities. Behavioral and social science can shed light on the various obstacles that affect women’s willingness and ability to participate in clinical trials, such as caregiving responsibilities, work obligations, or concerns about discomfort.

For instance, historically there has been insufficient representation of African American women in clinical research. The Executive Order aims to reduce these gaps in representation by prioritizing the inclusion of women from all racial, ethnic, and socioeconomic backgrounds in clinical research.

OBSSR and ORWH promote implementation science to enhance the impact of research findings. Are there specific areas within women's health where implementation science is particularly important?

Implementation science is critical for ensuring the retention of women in clinical trials. The Executive Order recommends using technological and data science advances to reduce women’s barriers to access. Implementation science can investigate the multiple contextual factors that could impact women’s uptake of these advances.

Integrating user-centered design and community-based participatory research approaches in the development of innovative technological and data science strategies can increase the successful implementation of these tools and potentially increase women’s participation in clinical trials.