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

Research on existing, locally relevant practices (i.e. “practice-based medicine”) may help to encourage clinically useful and achievable CPGs. In India, a randomized controlled trial in Mumbai demonstrated the effectiveness of education and clinical breast examinations to help achieve a lower stage at presentation (also known as “clinical downstaging”, indicating less extensive disease) in parallel with mammography.126 Standardized protocols and discharge checklists, for example, support better consistency and compliance with higher-quality care.127 More research is needed to develop CPGs that are effective within and across countries, recognizing both clinical evidence and local feasibility. Even when resources do exist, such as in HICs, CPGs may not be adapted in day-to-day practice due to other barriers, such as lack of education and training, overstrained workforces, local access and resource challenges and structural discrimination according to race, gender, income levels or other factors. Implementation of CPGs and clinical education are intimately linked. Medical education and training for the selected conditions – particularly around sex- specific differences across all selected conditions and diagnosis and treatment of conditions that affect health span – is limited, even for those in specialized programmes and in higher-income countries. For example, country-level CPGs for menopause and endometriosis are incomplete in the US. One US study found that only a third of obstetrics and gynaecology residency training programmes have a menopause curriculum, while another found that of almost 200 respondents, 20% reported not having any menopause lectures during residency.128,129 Another study found that out of 67 residents in US obstetrics and gynaecology training programmes, most were comfortable diagnosing endometriosis but far less comfortable with treatment options or medical/surgical management.130 Education and training on clinical best practices improve care. For example, one training for residents paired a podcast series on menopause with an in-class discussion, resulting in an 18.3 percentage point gain (60.8% to 79.1%) in answering knowledge-based questions correctly along with an increase in the residents’ self-ratings of knowledge, comfort and preparedness.131 CPGs for the selected conditions, even when present, are often not translated into clinical care for girls. For example, many of the selected conditions may affect children and adolescents, yet paediatric training on conditions that affect girls differently and disproportionately is minimal. Women-specific conditions often present with menarche,132 and continue through adolescence as symptoms change and regulate. Lack of timely intervention may lead to longer-term consequences; for example, adhesions from endometriosis may lead to chronic pain and infertility. Paediatric history and physical exams often lack sexual and reproductive health; the lack of attention given to menstrual cycles and changes in sexual and reproductive health throughout adolescence are often not discussed in paediatrics appointments; and lack of focus in paediatric medical education and training on the selected conditions is a disservice to girls. For example, a 2020 survey of US paediatricians found that many reported not providing anticipatory guidance or discussing menstruation with patients, with male paediatricians significantly less likely to give patient education regarding menstruation or ask patients about their menstrual cycle.133 Among obstetrics and gynaecology trainees in Europe surveyed in 2021, more than 40% said that no paediatric and adolescent gynaecology training (rotations, electives or lectures) were offered in their curriculum.134 Ultimately, a lack of knowledge and training can mean missed diagnosis for health-span conditions, resulting in girls missing school, having associated mental health conditions, chronic pain and a sense of isolation. As puberty is starting earlier for girls,135,136 ensuring provider knowledge and training on adolescent gynaecological health is critical. CPGs could be adaptable to populations and health systems while aligning with the latest evidence- based medicine. They could lead to sex-specific education and training, across country income levels. They could be understood, recognized and implemented across specialties and age groups to ensure both women and girls receive evidence- based care. CPGs, when fully representative of evidence-based practice and implemented appropriately, could result in multidisciplinary clinical management incentivized by adherence to guidelines, timely and coordinated diagnosis and treatment, the highest-quality care that is achievable for a woman in her community and pragmatic research into the effectiveness of CPGs and effect on clinical outcomes. Blueprint to Close the Women’s Health Gap: How to Improve Lives and Economies for All 25