PRB

Women in the United States don’t live as long women in other high-income countries, and progress on many women’s health measures has stalled or reversed. Yet a new report by the National Academies of Sciences, Engineering, and Medicine concludes that research on American women’s health is underfunded and that “breakthroughs to improve health and well-being for half the population in the United States—women and girls—have lagged.”¹

The report committee calls for Congress to fund a new Women’s Health Research Institute at the National Institutes of Health (NIH) to prioritize and advance women’s health and longevity.

U.S. Women Have Lower Life Expectancy Than Women in Other High-Income Countries

In 2021, U.S. women’s life expectancy was around 79.3 years. That’s about four years lower than the average life expectancy among women in Costa Rica (83.3) and eight years lower than the average in Japan (87.6 years). The United States ranked 33rd out of 38 OECD member countries for women’s life expectancy that year (figure).²

Figure. Women’s Life Expectancy at Birth in OECD Countries, 2021

Source: OECD Data Explorer.

American women’s life expectancy didn’t always rank so low. Susan Short and Meghan Zacher of Brown University suggest that improvements in U.S. women’s life expectancy slowed in recent decades, and as a result, “the gap in life expectancy between women in the United States and those in other high-income countries increased.”³ While no single factor can explain these patterns, smoking, obesity, drug and alcohol use, and suicide contribute to higher rates of premature death among American women, Short and Zacher say.  These “proximate” causes of death reflect broader societal issues like sexism and racism that contribute to disparities in health, the researchers emphasize.

Women Live Longer Than Men—But With More Disability

Women in the United States continue to outlive men, on average, but they’re spending an increasing share of their later years living with a disability, research suggests.

“Women may be living longer but not healthier lives than men,” says Eileen Crimmins of the University of Southern California.⁴ Her team examined life expectancy and disability rates from 1970 to 2010. Their analysis of U.S. vital statistics shows that both men and women saw lifespan increases over the 40-year period, but women are spending a larger share of the additional years with a disability than men.

Other researchers found similar patterns. Vicki Freedman of the University of Michigan and colleagues examined data on disability trends among older adults enrolled in Medicare, a federal health insurance program, from 1982, 2004, and 2011.⁵ Over the 30-year period, the time adults ages 65 and older could expect to live without physical or activity limitations (called active life expectancy) increased more than twice as much for men than for women.

Maternal Mortality Rates in the United States Remain High, and Black Women Are Most at Risk

U.S. maternal mortality rates are higher than those of peer nations, and increased sharply during the pandemic, according to Amanda Jean Stevenson of the University of Colorado Boulder. 

In the United States, non-Hispanic Black women were 3.5 times more likely to die during pregnancy or shortly after childbirth than non-Hispanic white women in 2016 and 2017, according to a recent study.⁶ Ending Black maternal mortality in America involves addressing structural racism—that is, those aspects of social, political, economic, and health care systems that reinforce inequity, argues study coauthor Marie Thoma of the University of Maryland.

“Further research into the experiences of people of color can inform efforts to improve health care systems and, thus, improve the birthing experience for all,” Thoma says. “We need new models of care before, during, and after birth to address these inequities.”

The U.S. Centers for Disease Control and Prevention determined that 84% of all maternal deaths from 2017 to 2019 were preventable, in a study using data from 36 states.

Young Women Face Greater Health Risks Than Previous Generations

Young women in the United States are also more likely to be murdered or die by suicide than previous generations were at the same age, according to a recent PRB analysis.

Among women ages 25 to 34, suicide rates have risen from 4.4 deaths per 100,000 for Generation X to 7 deaths per 100,000 for Millennial women. In recent years, suicide rates have declined among young white women, but they have increased for young women of color; American Indian and Alaska Native young women face a suicide rate three times that of their white peers.

Millennial women ages 25 to 34 have a homicide rate of 4.5 deaths per 100,000 women compared to 4.3 deaths for young women of Generation X. The homicide rate is particularly stark for young Black women, at 14 deaths per 100,000 women in 2019-2021 compared to 9 per 100,000 in 1999-2001—a nearly 60% increase in 20 years.

In a comprehensive literature review of research on restrictive abortion policy, Paula Lantz and colleagues from the University of Michigan argue that the 2022 U.S. Supreme Court decision to overturn Roe v. Wade is likely to reduce or eliminate many women’s access to essential reproductive health care, increase their risk of serious pregnancy complications and outcomes, and increase the risk of families experiencing serious financial hardship and children living in poverty.⁷

“Increased rates of suicide and homicide, and a lack of access to health care services like safe abortion, have the combined effect of reversing the health and safety gains women of previous generations experienced, especially women of color,” said Diana Elliott, a coauthor of the PRB report.

Experts Call for Prioritizing Women’s Health, Finding a New Approach

Over 30 years ago, the NIH established the Office of Research on Women’s Health (ORWH) to help close these gaps in women’s health in the United States.”⁸

For three decades, the ORWH has invested in innovative research that has improved and saved many women’s lives. But the National Academies report, requested by Congress and sponsored by the ORWH, listed several research and funding gaps that need to be addressed to further advance U.S. women’s health.⁹

Their new report, requested by Congress and sponsored by the ORWH, identified five main issues:

1. The share of NIH spending focused on women’s health research is less than 9%, and has decreased over the past 10 years.
2. The NIH uses a reporting system to show Congress and the public how tax dollars are being spent, but this system does not show the proportion of the NIH budget devoted to women’s health or women’s health issues.
3. Most NIH institutes and centers have a strategic plan to inform research priorities, but women’s health is rarely mentioned in these plans.
4. The NIH needs to invest more resources to support the next generation of women’s health researchers—especially those focused on interdisciplinary research.
5. Including experts with women’s health expertise is essential during the NIH grant review process, yet many reviewers don’t have the appropriate experience to review grant proposals addressing women’s health.

The National Academies committee suggests significant changes to current ORWH practices and programs. Strengthening the “oversight, prioritization, and coordination for women’s health research across NIH” may be most important, the authors report.

ORWH should be elevated from an NIH office to a new “Women’s Health Research Institute,” the committee argues, to support research across the female life course.

The committee also recommends providing more support for interdisciplinary research on women’s health through a new fund in NIH’s Office of the Director, who will provide broad oversight of women’s health research across NIH institutes, centers, and offices.

“Girls, women, families, society, and the economy all pay a price for the gaps in knowledge about women’s health,” the report authors wrote. “Addressing these needs will require more than increased funding for women’s health research; it will require dedicated action, careful prioritization, and oversight to ensure objectives are achieved.”