Blueprint to Close the Women%E2%80%99s Health Gap 2025

Providers caring for women with ischaemic heart disease often lack the education, guidance and support needed to deliver sex-specific clinical care,115 and as a result, women are less likely to receive evidence-based recommendations and treatment for ischaemic heart disease when compared to men.116 This is further exacerbated by disparities and inequities in care delivery, including quality and access. CPGs for migraine lacked complete evidence- based and practice standards in all of the 15 studied countries. CPGs exist for 10 of the 15 countries studied; of those, only seven country- level CPGs included migraine treatment guidelines adapted for menstruation, pregnancy and lactation. An example that reinforces this is that only about a quarter of adults in the US with episodic migraine receive treatment.117 Even when medications are prescribed, clinical guidelines and healthcare payers often set a high bar for receiving them; patients often have to demonstrate failure to improve on multiple medications before access to third-line therapy is provided.118 For example, calcitonin gene-related peptide (CGRP)-targeted medications are now considered an early option for migraine treatment,119 but less effective and less well-tolerated generic treatment options are often prescribed first, sometimes due to prior authorization guidelines from payers. Many women’s healthcare providers reported in 2020 that they were not aware of non-medication treatments with Level A evidence, including the effectiveness of biofeedback, cognitive behavioural therapy and lifestyle changes as treatments for migraines used in conjunction with medications.120 For the conditions affecting health span – migraine, PMS, endometriosis and menopause – more than half of the studied countries were entirely missing CPGs describing either prevention, diagnosis or treatment of the condition. Of the selected conditions, menopause was one of the lowest- performing in the CPG analysis, despite affecting most women globally at some point in their lifetimes. For PMS, a condition that affects 20–40% of women of reproductive age, 60% of the studied countries lacked CPGs entirely; of the countries with CPGs, most had comprehensive guidelines. 2.3.2 Global benchmarks may mask disparities within HICs while often creating less feasible expectations in LICs Breast cancer and cervical cancer have higher CPG scores in most countries, although the high scores and the presence of CPGs across geographical areas and income levels may not equate to equitable implementation of the guidelines. Mammography, for example, is a globally recognized guideline for breast cancer screening included in most CPGs, although in HICs, access to screening can differ across race, ethnicity, socioeconomic class and geographical area. In LICs, access to mammography may be limited by the presence or lack of a mammography machine, reliability of electricity and availability of a workforce of technicians and radiologists (and surgeons and pathologists for women with a positive screen). Some LICs and LMICs highlight the challenges and feasibility of mammography within their CPGs. According to India’s CPGs, for instance, “population-wide mammographic screening […] of asymptomatic women is neither feasible [nor] as useful”.121 Additionally, CPGs may not reflect the evolution of clinical evidence that could help to address these inequities. In LMICs and LICs, educating women and the broader society on the signs and symptoms of breast cancer and when and how to seek care or support someone to seek care may promote early detection and intervention. In HICs, in which mammography has become routine, more precise approaches to screening, diagnosis and treatment may be beneficial, including earlier and easier access to stage-appropriate treatment and personalized, precision medicine.122 The sensitivity of mammography differs for women with dense breast tissue; both unnecessary biopsies and missed cancer can be risks when other technologies such as MRI are not made available or reimbursed.123 Implementation science and research and increasing awareness among communities can help reduce access and adherence challenges and demonstrate effective solutions. For example, using artificial intelligence (AI) to identify and connect with patients with gaps in care, communicating through text and phone calls in a patient’s primary language, identifying and addressing health-related social needs and enrolling women in rural areas or through primary care into decentralized clinical trials may help all women to find and adhere to the highest- quality care. 2.3.3 Adoption and implementation of CPGs can vary within and between countries CPGs may not be realistic in a country’s current reality.124 For example, the HPV vaccine needs continuous refrigeration, which may be difficult during a widescale power outage, or those with heart disease may benefit from visiting a cardiac rehabilitation centre but struggle with the accessible transport needed to get there. These cases reflect potential challenges in adopting CPGs for cervical cancer and for ischaemic heart disease, respectively.125 Given the limited pragmatic research into the implementation of practice standards within LICs, CPGs – often developed based on research in HICs – may feel unattainable for some providers and health systems, creating a sense of futility. Blueprint to Close the Women’s Health Gap: How to Improve Lives and Economies for All 24