Birth and Impact of the Women’s Health Initiative
For much of the 20th century, women were systematically excluded from medical clinical trials, with the 1977 FDA guidelines explicitly barring women of childbearing potential from participating in early-phase studies. This historical bias created a medical landscape where treatments were developed and tested predominantly on men, with results, despite fundamental biological differences, extrapolated to women.
To rectify this neglect, in 1991, the Women’s Health Initiative (WHI) was born as a large-scale longitudinal study of post-menopausal women, with more than 161,000 women enrolled at 40 clinical centers. Created under Dr. Bernadine Healy, the first female director of the National Institute of Health (NIH), the WHI was designed as the most extensive women’s health study ever conducted in the United States. Over the past 30+ years, it has produced numerous groundbreaking findings that have transformed medical practice and saved countless lives.
With an ambitious scope and a $625 million budget, the WHI has focused on the major causes of death, disability, and impaired quality of life in postmenopausal women – cardiovascular disease, cancer (particularly breast and colorectal), and osteoporosis. Perhaps most significant was the Hormone Therapy Trial, which challenged prevailing medical wisdom that Hormone Replacement Therapy (HRT) prevented heart disease and offered other protective health benefits.
Instead, the WHI Hormone Therapy Trial found in July 2002 that combined estrogen and progestin therapy increased the risk of heart disease, stroke, blood clots, and breast cancer. By 2005, HRT prescriptions had plummeted in most countries by 40 – 70%. In the U.S. alone, the HRT trial findings prevented an estimated 126,000 cases of breast cancer and 76,000 cases of cardiovascular disease, saving more than $35 billion in direct medical costs.
Additionally, the WHI is a treasure trove of postmenopausal women’s health data, with scientists having published more than 1800 papers using WHI data and nearly 300 separately funded research projects leveraging the program’s resources. WHI and subsequent ancillary studies have found that:
- Calcium and vitamin D supplements appear to lower the risk of dying from cancer by 7%, but slightly increase the risk of dying from heart disease by 6% in postmenopausal women.
- Low-fat diets reduce the risk of ovarian and breast cancer.
- Women who sleep less than 6 hours or more than 8 hours a night are at higher risk of cognitive decline.
Currently, the Women’s Health Initiative Strong and Healthy (WHISH) trial, which has a sample of nearly 50,000 women, is testing whether a physical activity intervention reduces major cardiovascular events in women.
Despite the success of the Women’s Health Initiative, funding for research on women’s health has been abysmally low, never exceeding 11% of National Institute of Health funding.
Research Under Attack: The Pattern of Systematic Defunding
In April 2025, researchers were stunned when the Department of Health and Human Services (HHS) under Robert F. Kennedy, Jr., announced plans to terminate contracts for the Women’s Health Initiative’s regional centers in California, New York, Ohio, and North Carolina by September 2025. This would end data collection from more than 42,000 women, ages 78 to 108, who represent the surviving, active participants from the original cohort of 161,000.
Suddenly, this landmark, three-decade-long study, which has been transforming post-menopausal women’s healthcare, was on the chopping block. While public outcry led to a hasty reversal days later, the threat exposed a troubling reality: the Trump administration’s systematic assault on women’s health research and health care.
Since Trump 2.0, funding cuts have been selectively aimed along ideological lines, as confirmed by an HHS spokesperson, to comply with the President’s executive orders on eliminating DEI (diversity, equity, and inclusion), and anything related to “gender ideology.”
Federal agency employees have been warned to avoid and not approve grants that contain an alarming list of 200+ words, including “female,” feminism,” “people+uterus,” “pregnant persons,” “LGBTQ,” “BIPOC,” “women,” “underrepresented,” “women and underrepresented,” and of course, “Gulf of Mexico.” “Male” and “Men” are OK.
Research applicants are forced into linguistic workarounds, substituting “individuals who recently had children” for “postpartum women” and “Spanish-speaking newcomer” for “migrant.” Furthermore, the Trump administration’s targeting of postdocs and students will create a long-term shortage of researchers trained in women’s health issues. Sadly, this potential loss is magnified for those passionate about researching women’s health, who are told they must now diversify. In addition, any research studying diverse populations will be limited. Already, HIV and LGBTQ grants have been eliminated entirely.
The Trump administration’s ideological lens also extends to universities, with hundreds of millions in health research grants frozen at institutions nationwide, including approximately $250 million at Columbia University, even after the school made policy changes to placate the administration. Its threatened cuts to Harvard alone eliminate over $2.7 billion so far, a devastating blow to research into breast cancer, infectious diseases, and other conditions that disproportionately affect women.
One vulnerable research effort is maternal mortality, a national disgrace, with rates in the US far exceeding those of other high-income countries and with stark racial disparities. Nearly every demographic group of American mothers dies at a higher rate than all mothers in peer nations. Norway, for instance, remained constant over the last five years at 2 maternal deaths per 100,000. The United Kingdom, which conducts an in-depth investigation into every death, counted an average of 12.7 maternal deaths per 100,000 from 2021 to 2023. The U.S. rate in 2023 was 18.6 per 100,000.
Most disturbing, in 2023, white mothers in America died at a rate of 14.5 per 100,000, while Black mothers died at a rate of 50.3 per 100,000, or roughly 3.5 times the rate of white mothers. Notably, most of the deaths of American mothers – more than 80% – are preventable.
As the administration’s budget axe continues to fall, research on conditions that predominantly affect women, from autoimmune disorders (which affect women at rates two to ten times higher than men) to Alzheimer’s disease (where nearly two-thirds of patients are women), to endometriosis, menopause, and complications related to pregnancy, and particularly research about women of color, face uncertain futures.
The Pushback: How Resistance Is Working
Despite this grim landscape, there are some signs that resistance can be effective — public outcry matters. In a rare move, widespread condemnation from researchers and medical professionals, and Maria Shriver’s direct appeal to top officials at NIH and HHS, forced the Trump administration to retreat from eliminating the WHI. Nevertheless, it should not take a family member of the head of HHS to reverse a Trump or DOGE decision to defund women’s health.
Legal challenges are also proving vital. Twenty-two states have successfully blocked the HHS revocation of research funds and the freeze on grant approvals. Researchers whose NIH grants were terminated are seeking reinstatement of funding for studies on LGBTQ health, COVID-19, and vaccine hesitancy. However, in most cases, these court-imposed injunctions temporarily blocking the termination and freezing of health research funding are on appeal. While these legal suits are still in process, with uncertain outcomes, much of the funding apparatus is disrupted and researchers remain in a precarious situation
The Path Forward
The Women’s Health Initiative stands as a testament to what can be accomplished when research addresses historically neglected areas of health. From its inception as a corrective to decades of exclusion, the WHI has produced findings that have saved lives, improved health outcomes, and fundamentally changed medical practice for women in the US and worldwide.
As we continue to push back against cuts to women’s health research, we must remind decision-makers and the public that these are not abstract budget items but investments in knowledge that save lives. When we defund women’s health research, we are choosing ignorance over understanding, and ultimately, preventable suffering over health. That is a choice no just society should make.
What You Can Do to Make a Difference
- Contact your representatives. Call, email, or write to your congressional representatives and senators. Lawmakers respond to constituent pressure, and bipartisan support for women’s health is possible.
- Amplify affected voices. Share stories of researchers whose work has been defunded. The human impact of these cuts is powerful, and personal stories resonate with the public and legislators alike.
- Support state-level initiatives. As federal funding becomes unstable, state-level funding for women’s health becomes increasingly essential. 13 states have already introduced more than 20 bills focused on menopause care. Advocate for similar legislation in your state.
- Follow the money and demand transparency. Monitor NIH grant announcements, HHS budget decisions, and data availability. Public scrutiny can prevent quiet defunding of critical research and the erasure of essential health data.
- 5. Support affected organizations directly. While private funding cannot replace federal investment, it can help sustain critical services during funding gaps.
- Join advocacy organizations. Groups like the Society for Women’s Health Research, the National Women’s Health Network, and Planned Parenthood Action Fund advocate for policy change and funding restoration. Their collective voice amplifies individual concerns.
- Educate others about the scope of cuts. Many people remain unaware of how comprehensive these cuts are, from research to basic healthcare services to global programs. Share information about the full range of impacts on women’s lives.
