Chapter 06

A history of erasure — and the fight back

The gender health gap is not new. It stretches from ancient Greece to the present day. Understanding this history is essential to understanding why change is so hard — and so necessary.

How we got here

Ancient Times – 19th Century
The philosophical roots of medical misogyny
Ancient Greece

Hippocrates' "inferior" female body

Hippocrates considered the female body less perfect than the male. This philosophical premise — that women's bodies were defective versions of men's — was embedded into the foundations of Western medicine.

Throughout history

Menstruation as "impurity"

Religious traditions stigmatised menstruation as impure. Male dominance in medicine reinforced the marginalisation of women's bodies and their health concerns. The concept of "hysteria" pathologised any female behaviour that deviated from norms.

19th century

Forced sterilisation and invasive procedures

Medical androcentrism led to extreme, harmful practices — including forced sterilisation and extreme invasive procedures — performed on women labelled as mentally ill or "hysterical."

Late 19th century

First women enter medicine

Women begin to enter medical schools in small numbers, challenging the entirely male-dominated field. However, they faced systemic barriers to career advancement and research leadership that persist today.

20th Century
Clinical trials, tragedy, and the male default
Mid-20th century

The "normal" subject is male

Clinical research adopts the Caucasian male as the default study population. Female participants are excluded due to "hormonal complexity" — but this scientific rationale masks deep-seated gender bias.

1960s

The Thalidomide Tragedy

Pregnant women given thalidomide for morning sickness gave birth to babies with severe limb defects. The disaster, while important, had an unintended consequence: it reinforced the blanket exclusion of pregnant and potentially pregnant women from all clinical trials for decades.

1980s–90s

Women excluded from cardiovascular and AIDS research

Major cardiovascular trials and HIV/AIDS research almost entirely exclude women. Treatments developed are based on male physiology and later applied to women without evidence of their safety or efficacy.

1993

US NIH Revitalization Act

US legislation requires inclusion of women and minorities in NIH-funded clinical research. A landmark moment — though compliance remained inconsistent and enforcement weak for many years.

2000s – 2020s
Growing awareness, fragmented response
2014

EU Clinical Trials Regulation (536/2014)

Requires proportionate gender inclusion in EU clinical trials and mandates sex-disaggregated analysis. A major step forward — but implementation varies widely and implicit bias is not addressed.

2016

SAGER Guidelines adopted

Sex and Gender Equity in Research (SAGER) guidelines provide international standards for reporting sex and gender across all stages of research — helping close the knowledge gap from within science.

2021

80% of preclinical studies still male-only

Despite decades of advocacy, over 80% of preclinical drug safety studies are still conducted solely in male mice. The structural bias remains deeply embedded in how science is done.

2021

EU recognises obstetric violence

The European Parliament resolution on sexual and reproductive health explicitly acknowledges obstetric violence as a form of gender-based violence for the first time at EU level.

2022

ACT EU initiative launched

European Commission, EMA, and national regulatory agencies launch ACT EU to increase clinical trial activity and diversity. Target: 10% increase in EU trials over 5 years.

2024

EU Directive on Violence Against Women

Directive 2024/1385 on combatting violence against women and domestic violence must be transposed in all member states by June 2027. Criminalises forced marriage and genital mutilation; guarantees SRH services for victims.

2025
A critical moment for change
March 2025

EU Roadmap for Women's Rights

Adopted March 7, 2025. Outlines principles for a gender-equal society: full access to quality healthcare including sexual and reproductive care, protection from violence, financial independence, and representation in public life.

November 2025

European Parliament Study PE 778.519

The most comprehensive EU study to date on gender inequalities in medical research, drug development, and access to care. This website is based on its findings. It calls for sweeping reforms across data collection, clinical trials, education, and healthcare systems.

2025

EMA New Guideline on Pregnant Women

New EMA guideline calls for inclusion of pregnant and breastfeeding individuals in development of all new drugs — a paradigm shift toward protecting and including, rather than excluding, these groups.

2025

EUmetriosis & CARAMEL initiatives

New EU-funded projects: €7M for endometriosis research, €11M for AI-powered cardiovascular risk assessment in menopausal women, and €30M for medication safety during pregnancy and breastfeeding.

What has been done — and what remains

EU Legislative Progress

  • EU Clinical Trials Regulation (536/2014) requires gender inclusion
  • European Health Data Space (EHDS) to facilitate secure data sharing
  • EU4Health Programme (2021–2027): €5+ billion for health equity
  • Horizon Europe: €2 billion in 1000+ women's health projects
  • Roadmap for Women's Rights (2025) with health as a key pillar
  • Implementation of clinical trial regulation still varies widely by country
  • No enforceable protections against implicit bias in trial access

Research Advances

  • SAGER Guidelines adopted for sex/gender reporting in research
  • EMA 2025 guideline on including pregnant women in all drug trials
  • All-female research teams 35% more likely to develop women's treatments
  • New targeted initiatives: EUmetriosis, CARAMEL, ConcePTION
  • ACT EU initiative to increase clinical trial diversity
  • Female trial participation still only 41.2% — no significant increase despite reforms
  • 80% of preclinical studies still use only male mice

Policy & Awareness

  • EU recognised obstetric violence as gender-based violence (2021)
  • Gender Equality Strategy 2020–2025 includes health dimensions
  • Directive 2024/1385 on violence against women and domestic violence
  • UN SDG 5 (gender equality) and SDG 3 (health) as frameworks
  • Growing public and political awareness of the gender health gap
  • No harmonised definition of obstetric violence across member states
  • Only 35% of OECD countries have comprehensive SDG monitoring systems (2020)

The moment for transformation

The 2025 European Parliament study represents both a comprehensive assessment of how far we've come — and an urgent call to close the remaining gaps. The convergence of new regulation, new funding, and growing political will creates a unique window for structural change.

But without enforcement, without mandatory sex-disaggregated data, without investment proportionate to disease burden, and without addressing the cultural attitudes that underpin the gap — the statistics in this website will remain the same a decade from now.

2025

EU Roadmap for Women's Rights

Adopted March 7. Full healthcare access as a core principle.

2027

Violence Directive Deadline

All member states must transpose Directive 2024/1385 by June 2027.

2027

EU4Health Programme End

€5 billion programme concludes — will results show measurable improvement?

2040

$1 Trillion Opportunity

Closing the women's health gap could add $1 trillion to the global economy annually by this year — if we act now.