Research on Women's Health at the NIH and the Journal of Midwifery & Women's Health's Commitment to Evidence and Inclusion in Scholarship

As the premier biomedical research funding agency in the United States, the National Institutes of Health (NIH) conducts intramural research and supports extramural research through 21 institutes and 5 centers.¹ Examples of funded studies that have contributed substantially to improved health outcomes include studies developing and testing innovative cancer treatments that inform treatment protocols.

The NIH-Wide Strategic Plan for Women's Health Research was published in December 2024.² This document provides a broad approach to guide scientists and others engaged in the federal enterprise for women's health research. Overall, the NIH commitment is to expanding knowledge about women's health across all disease states and health conditions, enhancing women's inclusion in clinical trials, examining how sex and gender influence health, and conducting research within a context of health across important life phases such as pregnancy and menopause. As experts in women's health, this document is valuable for midwifery researchers, clinicians, and policy experts alike.

The strategic plan is far-reaching, encompassing goals related to research, data systems, research training, basic and translational science, and community engagement. These goals emphasize the need to understand impacts of disease on women's health, including a focus on sex, gender, and health disparities, as well as social and cultural influences on women's health. The use of cutting-edge research methods, data analysis and interpretation, and evolving artificial intelligence tools is encouraged. Research training is recommended to focus on enhancing preparation of new researchers who will generate new knowledge about the impact of sex and gender on health, as well as increasing the number of women scientists conducting research. The enhancement of women's health research should also include understanding the influence of sex and gender on cellular function as well as system level physiologic processes, including those that are specific to pregnancy and menopause. The focus on community includes research training in community-engaged research approaches, implementation science, and a systemic approach to understanding how sex and gender impact women's health, including health disparities.²

The NIH strategic goals for women's health research are important to research conducted by midwives and thus to midwifery practice. More midwives prepared to conduct research as principal investigators is critical to advancing the scholarly basis for our practice and model of care. Midwifery scientists, doctoral students, and postdoctoral fellows may find guidance in the strategic plan to inform their programs of research.

As we began to analyze the strategic plan to present its potential to guide midwives and midwifery research for the future, the very foundation of federal research funding of the NIH was called into question. At the time of this writing, NIH research funds are frozen.³ The first 2025 meetings of the research institute advisory councils that review grant proposals have been cancelled.⁴ On February 7, 2025, under new administrative leadership, the NIH published a policy statement reducing indirect costs on new and future grants from approximately 50% of the total direct costs of the research to 15%.⁵ Indirect costs are an administrative supplement that support the institutional infrastructure such as buildings and labs, supplies and equipment, and grant and budget management personnel. The significant reduction in indirect costs threatens the ability of universities and other research institutions to continue to carry out their work.^{4, 5}

Disparities in health outcomes for Black and Indigenous people compared with White people are rooted in racism and discrimination as well as social and economic inequalities.^{6, 7} Thus, the aims and scope of much contemporary women's health research seeks to address these issues in an effort to improve outcomes. The January 2025 Executive Order directs federal agencies to “coordinate the termination of all discriminatory programs, including illegal DEI and ‘diversity, equity, inclusion, and accessibility’ (DEIA) mandates, policies, programs, preferences, and activities in the Federal Government, under whatever name they appear.”^8(p1) This Executive Order seeks to reverse federal policies that had finally achieved significant momentum. This was closely followed by the removal of the Food and Drug Administration guidance document on the requirements for clinical trials of drug and medical devices to include study participants from underrepresented racial and ethnic populations.⁹ Another Executive Order on gender declared that sex shall list male or female, and shall not request gender identity, and removed guidance documents on transgender equality, stating that federal funds cannot be used to promote gender ideology.¹⁰ As this editorial goes to press, the status of the executive orders and policy changes described here are in various stages of court review with some funding and meetings possibly moving forward. The most recent news of the directors of multiple NIH institutes reportedly being placed on administrative leave, including the National Institute of Child Health and Human Development, the National Institute on Minority Health and Health Disparities, and the National Institute of Nursing Research, all institutes that have funded midwives or women's health research, has surprised and shocked many.¹¹

Such dramatic actions and shifts in federal policy, along with the NIH funding cuts, have far-reaching implications for women's health research and thus future understanding of the influence of sex and gender on health. The changes also put the brakes on the momentum proposed in the 2024 NIH strategic plan and thus to midwifery and women's health research. Given the importance of research to the midwifery profession, the Journal of Midwifery & Women's Health (JMWH) affirms 3 principles consistent with the JMWH Aims and Scope¹² and the JMWH Statement on Inclusivity¹³: (1) research and scholarship based on the best available evidence with author freedom to set their research agendas using accepted ethical principles, (2) the use of inclusive language so that the work published in JMWH and Journal leadership reflect respect for the many differences among midwives and those for whom we provide care, and (3) scholarship that supports equity and patient centeredness in planning and providing health care.

These JMWH affirmations are in step with partner publishing organizations. The Council of Science Editors has confirmed its support for diversity¹⁴ and ethical approaches to questions related to authorship, article revisions, and retractions.¹⁵ The Committee on Publication Ethics, an international organization followed by most scientific journals, has affirmed its strategic priorities of “integrity; education; collaboration; and diversity, equity, inclusivity and accessibility,” including journal consistency with publication decision policies unchanged by governmental policies unless such actions would be counter to existing law or impact human health.¹⁶ Similarly, the International Committee of Medical Journal Editors has communicated its positions on ethical issues such as authorship changes, confidentiality, revisions, and retractions.¹⁷

Research that intentionally includes participants who reflect all populations served is paramount to midwifery practice, education, research, and policy. Racism, discrimination and the social determinants of health must continue to be intentionally addressed in the aims of current and future scientific investigations. The perspectives of participants from historically marginalized and disadvantaged populations are needed to develop effective interventions and strategies to reduce inequities in health outcomes.⁶ More midwife researchers representing all social identities are critical to help shape future research, assuring full voice and meaning to the values of diversity.

JMWH strongly supports ongoing federal funding for midwifery and women's health research to enable midwives and our colleagues to grow the knowledge base to improve care for those we serve. We urge all midwives to remain alert to changes to NIH research funding and engage with their elected legislators to prevent the loss of research funding and ethical freedoms for scientists. Furthermore, we call on the NIH to restore full funding and reestablish policies that put decisions about the nature of the research in the hands of scientists. For 70 years JMWH has published articles to support quality practice based on the best available evidence, inclusion of all persons we care for, and patient centeredness. Within that framework, the NIH-Wide Strategic Plan for Women's Health Research is an invaluable resource to midwives and others as we continue to build the best foundation for excellence and equity in health care.