About 830 women and adolescents die daily due to preventable pregnancy and childbirth complications, according to the World Health Organization. Ninety-nine percent of all maternal deaths occur in developing countries and over half occur in sub-Saharan Africa.

To help upend those grim figures, in August, the Gates Foundation called on its vast endowment to launch a $2.5 billion global commitment over five years aimed at expanding research that focuses on women’s health and low-cost innovations to provide greater access to care. That’s according to Dr. Ru-fong Joanne Cheng, the director of Women’s Health Innovations at the Gates Foundation.

The investment, Gates’ largest yet for women’s health research and development, comes at a time when the United States has gone from being the top donor country in global maternal and child health, which the government has funded for more than a half-century, to negating vast swaths of such funding this year. The Trump administration’s 2026 fiscal year budget request did not include any funding for bilateral maternal and child efforts, according to a report by the Kaiser Family Foundation.

In a talk Bill Gates gave in early June in Addis Ababa, Ethiopia, he alluded to the United States pulling the plug on its global giving. He also said that as he donates his entire fortune over the next 20 years, “the majority of that funding will be spent on helping you address challenges here in Africa.”

“A lot of cuts are being made in foreign aid programs. Some of those cuts are being made so abruptly that there are complete interruptions in trials, or medicines are still sitting in warehouses and are not available,” Gates said. “And these cuts are something that I think are a huge mistake.”

The $2.5 billion global commitment is necessary because research into women’s health is an area that has been largely ignored, said Dr. Anita Zaidi, president of the Gates Foundation’s Gender Equality Division.

“The male body was the default answer [in research],” Zaidi said during a webinar. “[Women’s health has] been a blind spot in medical and bioscience research, with the result that only 1% of funding — that is, if we just leave out cancer — is directed to women’s health R&D for conditions that specifically affect women.”

In a recent New Yorker article on the dearth of research on pregnant women, Ruth Faden, the founder of the Johns Hopkins Berman Institute of Bioethics, said that one of the reasons that pregnant women haven’t been included in medical research is the ongoing belief that they’re “fragile” and need to be hidden away. “We need to protect women through research, not from research,” she said.

What work Gates aims to prioritize with its new effort

The Gates Foundation’s commitment will focus on developing research and low-cost innovations around obstetric care and maternal immunization, contraception, sexually transmitted infections, maternal health and nutrition, and gynecologic and menstrual health for women in sub-Saharan Africa and South Asia, where women are the most burdened by these health issues, according to Zaidi.

About half of all pregnancies around the world are unplanned. In response, the Gates Foundation will be supporting research into self-injectable patches that can provide six months of contraception, and a discreet birth control method.

“Many women in these communities want to have control over their reproductive health but do not use existing contraceptive methods because of male interference, concerns about side effects, or lack of access to options that meet their specific needs,” wrote Cheng in a blog post.

The Gates Foundation is also focusing on STIs. Instead of having women wait for lab results, Gates will continue funding research into developing a low-cost, portable diagnostic tool the size of a soda can that women can use to learn within minutes whether they have a sexually transmitted infection. That technology, wrote Cheng, “could be a game-changer in low-resource settings, where access to STI testing is often limited or nonexistent.”

Similarly, the new funding will be expanding development around a low-cost, handheld, AI-powered ultrasound machine to let community health workers conduct ultrasounds and refer high-risk cases to specialists. Two-thirds of women who are expecting don’t have access to ultrasound tests in their communities, according to a Gates Foundation video. “Bringing technology closer to women’s homes is where we can make a difference,” said Dr. Zahra Hoodbhoy, an assistant professor in the Department of Pediatrics and Child Health at Ağa Khan University in Karachi, Pakistan, in the video.

Besides further developing and improving existing diagnostic tools, Gates aims to shore up efforts to study how unhealthy changes in the vaginal microbiome can provide clues to understanding pregnancy complications. It’s supporting research like a study led by Dr. Moses Obimbo Madadi, a clinician-scientist at the University of Nairobi in Kenya.

The study, which began in 2021, involves collecting clinical data and vaginal samples from more than 1,200 pregnant women in Kenya and analyzing microbial content to get a complete profile of the vaginal microbiome. The data, in turn, will be used to develop AI-assisted prediction models that could help provide early screening tools to identify at-risk pregnancies.

Madadi’s idea for the research stemmed from a patient who was plagued with recurring vaginal infections that caused her such physical and emotional discomfort that she avoided going out much in public. While longer-term treatment was available, for lower-income patients like her, who are seen at a public hospital, the cost was out of reach, Madadi said.

“So when I saw this and how she was affected physically and psychologically, I thought, supposing she gets pregnant, how would recurring infections affect her pregnancy?” Madadi said. “It became very personal for me.”

As part of Gates’ new commitment, it is also providing funding to the Massachusetts-based Comanche Biopharm, which is working on a medication to mute a key protein that triggers preeclampsia.

Preeclampsia and eclampsia, a blood pressure disorder that strikes women during pregnancy or after they give birth, is a leading cause of maternal and infant mortality worldwide, according to the American College of Obstetrics and Gynecologists. There’s no way to prevent it; however, the World Health Organization recommends a number of treatments to lower the risk of symptoms, such as blood pressure medications, low-dose aspirin and calcium.

Earlier this year, the Gates Foundation announced a grant to Beech Biotech, which is developing a monoclonal antibody that also targets the protein linked to preeclampsia.

Gates approaching the commitment as “as a moment to catalyze the entire community”

The Gates Foundation, of course, has a long history of investing in global women’s health and working in collaboration with in-country experts and government health departments, as well as partnering with other philanthropies. Its billions will be even more vital in an era of diminishing public sector support for global health, and while Bill Gates’ own criticisms of Trump administration policies have often been muted at best, he has registered his displeasure at, for instance, the evisceration of USAID. He has also clapped back at the administration’s dangerous antivaccine stances, recommitting to funding Gavi, the Vaccine Alliance with $1.5 billion over another five years.

There are some hopeful signs the Gates Foundation will continue scaling up efforts the federal government has abandoned — ideally alongside other funders. This latest women’s health commitment follows another big move: Alongside other global health grantmakers, Gates is also backing the Beginnings Fund, a “nearly $600 million” commitment for maternal and infant health IP wrote about in June.

Separately from the Gates Foundation commitment, three other members of the Gates clan — Melinda French Gates and daughters Jennifer and Phoebe — recently joined ICONIQ Impact and a range of other donors to launch the Women’s Health Co-Lab, a collaborative fund focused on global health inequity for women and girls.

“I think one thing that’s different about the $2.5 billion is that we’re approaching it as a moment to catalyze the entire community, the global ecosystem around women’s health research and development,” Cheng said. “We’re saying, we think women’s health is worth investing in, and we want you all to come in, too, and it’s really a call to action, to highlight the urgency or the need. It’s not just that we’re investing in it and that’s it. It is truly a collective response that’s going to be required to move the needle here.”