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This Week in Global Development
Special episode: Pivotal Ventures on Funding the Future of Women’s Health
00:32:42
In this week’s special edition of the This Week in Global Development podcast, we explore how investing in women’s health is not just a health issue — it’s about power, agency, and opportunity. Women spend 25% more of their lives in poor health than...
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- [00:00]
Cecilia Conrad
Foreign.
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Kate Warren
Hi, everyone, and welcome to this special edition of this Week in Global Development, hosted in partnership with Pivotal Ventures. I'm Kate Warren, executive Vice president and executive Editor here at devex. And today we are talking about women's health, but not just as a health issue, but at its core, about power, agency and opportunity. When women can't access healthcare and their pain is dismissed or their needs are underfunded, it limits their ability to work and to lead and to influence decisions that shape everyone in our world. So health is not just a siloed vertical, but it's really the foundation for participation, productivity and leadership. And yet women spend 25% more of their lives in poor health than men. This compounded by underfunded R and D diagnostic biases that minimize women's pain and policy gaps, climate and displacement crises, and really a global funding model that treats women's health as a niche issue, despite us being half the population. So I'm really excited to dive into this topic today on talking about how we can invest in women's health. It's not just about healthcare, but it's really about unlocking power. Because women are healthy mentally and physically, they can drive change in their families and economies and their communities. And really delighted to be joined by two women who are doing just this. We have Haven Le, who's the Chief Strategy Officer at Pivotal Ventures, which accelerates social progress through high impact investments, philanthropy, partnerships and advocacy. And Cecilia Conrad, CEO of Love it for Change, which uses open calls for surfacing bold ideas and connecting donors and philanthropy with high impact solutions. So today we're going to talk about how we can reimagine women's health care to reshape opportunity not just for women, but for entire communities. So, Haven, Cecilia, thank you so much for joining me today.
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Cecilia Conrad
Thank you.
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Thank you.
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Kate Warren
So, Haven, I'm going to start with you. Women's healthcare has been overlooked for centuries. This is not necessarily new. But maybe you can help us set the scene, help our listeners understand what is the current state of women's health globally and where are some of those key gaps and inequities that we're seeing?
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Haven Le
It's a great question. And Kate, thanks again for having us on to talk about this issue. I mentioned earlier it's raining here in Seattle, so it's great to talk about.
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Cecilia Conrad
Something that feels a little bit more optimistic today day, if we can get there.
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Haven Le
You, I think, set the scene actually quite nicely. This is not a new story in.
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Cecilia Conrad
Terms of underinvestment in women's health. This is millennia And I think that there's important reasons not to gloss over why it's been underinvested in. And I think it's for so long that women have been expected to make do, to soldier on, to buck up. And our pain and to some degree our suffering has been completely undervalued by society, maybe in large part because we are asked to buck up and soldier on.
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Haven Le
And that has resulted, as you had.
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Cecilia Conrad
Suggested, in a gender gap between kind of the years in which that men and women live in poor health. And I think there's a study just recently out that women live kind of nine years in kind of ill health over the course of our average lives, and that's 25% more than men do.
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Haven Le
And that is a gap that's not.
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Cecilia Conrad
To be trifled with.
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Haven Le
I think the underinvestment in women's health is most starkly characterized when you just.
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Cecilia Conrad
Think about putting kind of capital on the table and kind of capital follows priorities.
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Haven Le
Only about 1% of the $200 billion in global health research, kind of outside.
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Cecilia Conrad
Of cancer research, kind of goes to your point. Women's health issues, which is just a vast, vast underinvestment kind of compared to that gap that you mentioned before about between men and women. That's like the old news. That's the standard bearer. That's not a great story. And I just have to start Brussels saying there's another kind of more recent bad news story, which is that global AIDS has been over the last four decades, a huge contributor to improving women's health globally. I mean, massive contributions to the reduction of maternal mortality, reproductive health, access, et cetera. And I would say the new story on top of the bad old story is that the cuts in decimation of global aid, certainly the United States, but more broadly, the reductions in that capital, is going to have, and perhaps already is having a negative effect on women's health, globally speaking. So we kind of have compounding problems right now that need urgent solutions.
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Kate Warren
Yeah.
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Cecilia Conrad
Something to ask just a little, because as I was thinking as Haven was talking, when we look at the underinvestment in women's health, I think we have to also acknowledge that a lot of that has to do with the historical pattern of undervaluing the work that women do, because it's, you know, historically, not necessarily in the paid informal labor market, but when a woman has a health issue, it impacts the family because she's unable to care for either the elderly or the children in the same way that she was before. It impacts nutrition in Many countries, because the women are the ones who are growing the food that the family eats. It has impacts that are much broader than what I think have been traditionally acknowledged. So they're not necessarily the one bringing home a paycheck. And we've tended to focus on the paycheck bearer as the whose health is the most important, but that's just not true. Great point, great point.
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Kate Warren
Yeah. And I think as you mentioned, Haven, just the reduction in traditional global health funding has a lot of people wondering, okay, well, how are we going to fund these challenges? And maybe also making and bringing to light that this is not just a health issue, it is an economic issue and a democratic issue and helping societies grow. And Cecilia, you know, you are running these open calls, right, globally for big ideas. And I think a lot of people are really looking at what are these big ideas and what are some innovative ways that we can do a lot with little and bring in other donors, whether it's other kind of capital and philanthropy. But I'd love to hear, you know, what are some of the patterns you see in how maybe women's healthcare needs are being addressed or, or not by some of these traditional funding structures?
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Cecilia Conrad
Yes, I think some of the traditional funding structures that exist kind of replicate what we just described in terms of not necessarily, you know, typically it's a top down model. Someone decides, here's the problem, I want you to go work on this problem. And the people deciding the problem aren't necessarily identifying the problems that are most important to those on the ground, particularly the women who may not be represented in the decision making around that. And so by doing these open calls, we sort of flip this. First of all, we are providing a space to discover all of the initiatives and great ideas that may otherwise not come under the radar for institutional funders or individual donors. But we're also giving an opportunity, the space for those on the ground to tell us what the key problems are. And you know, we have, we had earlier, we ran, we've run some open calls where women's health projects have been submitted. And it was interesting to see some of the topics that emerged. And we've seen this again with Action for Women's Health. For example, there are, you know, cervical cancer, menopause, postpartum depression. These are all critical issues that affect women's daily lives that have not historically been the topic of a big foundation initiative.
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Kate Warren
Yeah, absolutely. And you know, Haven, you touched on this a little bit. But you know, this is not just about healthcare, but it's really about helping to Expand women's power and influence. Right. And healthcare really being the underpinning of being able to help women realize their power. And you know, and it's a double edged sword, Right. As you said, a lot of these issues are overlooked because women aren't making the decision, they're not at the decision making table. Right. And so being able to invest in their health gives them the environment to have more influence. So, yeah, I'd love to hear kind of a little bit more about that connection and why you see this art so fundamentally interconnected.
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Haven Le
I mean, it's essentially interconnected. And maybe I'll bring Melinda French Gates into this picture because I think she's the one who's kind of painted this path for Pivotal and kind of engendered this approach and partnership that we have.
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Cecilia Conrad
The letter for change right now for action for womenself.
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Haven Le
Listen, expanding women's power and influence has.
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Cecilia Conrad
Been the animating value of Melinda's philanthropy and leadership for her career as a philanthropist over the last three decades. Certainly first the Gates foundation, continuing at Pivotal, and now solely at Pivotal. One of her practices as a philanthropist consistently and dutifully has been really deep listening. So she consistently goes out every year, multiple times a year to go listen and speak to women mostly who are either engaging in economic enterprise or running in pivotal schemes, running for public office or thinking about caregiving solutions for their families. And you know, I think oftentimes she goes in to talk to families and to women, whether it's here in the United States or in the global south about the thing. Talk to me about running for public office. Talk to me about economic, economic development.
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Haven Le
I was, I first got to know.
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Cecilia Conrad
Melinda as a program officer working in Small smallholders Citizens agriculture in sub Saharan Africa. We go talk to women farmers about what they were doing to raise poultry and to raise and to grow legumes. And inevitably that conversation would circle back around to health kind of chronic issues, why they weren't having access to family planning, Depravara shots anymore, mental health and well being for themselves and their families. So while we were beginning to engage.
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Haven Le
Them in these kind of other enterprises.
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Cecilia Conrad
That is the manifestation of women's power running for public office, you know, earning a living, earning your own wages, feeding your family, inevitably it came back to health, either as a barrier to manifesting that destiny or making these different economic choices or because it was enabling them to do something different.
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Haven Le
And so I think for Melinda, and I think certainly for Pivotal, like these.
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Cecilia Conrad
Things go hand in glove together.
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Haven Le
I think there's another Reason, though, Kate, too, which is, I think the Dobbs.
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Cecilia Conrad
Decision here in the United States, which actually saw a rollback of women's rights in the United States in terms of accessing reproductive decisions and choices.
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Haven Le
There's actually a diminishment.
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Cecilia Conrad
Right. Of women's power as kind of codified by that. By that ruling.
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Haven Le
And I think the degree to which.
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Cecilia Conrad
You, again, have a diminishment of women's power, that is the power to control our own decisions about our bodies, is also another manifestation of how these two things are inextricably linked right now.
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Kate Warren
Absolutely. And so Pivotal and Lover for Change, you are launched this Action for Women's health. It's a $250 million global open call to find and support organizations around the world that are working to improve women's mental physical health. So I'd love to hear more about this. And you know, Cecilia, I think you've received over 4,000. Is that right? Applications from 119 countries.
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Haven Le
Yes.
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Kate Warren
So obviously, there's a lot of ideas out there. So can you talk about this model and what you're hoping to do with that?
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Cecilia Conrad
Yes. So, as I said earlier, one of the real values in doing this open call is the opportunity for discovery. And the first step in that is to try and do a very broad outreach effort to make sure people know about the opportunity and that you have created a process that allows organizations of different sizes and types, representing different populations to apply and be considered. And so we capture these initial set of applications. They then go through a participatory review where each applicant gets to read other applications and to use the rubric to score and comment on those. And this is a step in the process that turns out to yield a lot of value to the participants because they get a sense of what else is out there, what are some of the other good ideas that are being done. And they also get an opportunity to give feedback to each other that is sometimes more practical than what you might get from a panel that was more of a kind of academic or foundation program officer kind of panel. The second stage in the process is this what we call our expert panel review. That's a broad cross section of policymakers, implementers, academic researchers, people who are funders, who also then use this rubric to assess the proposals themselves. And then finally, we work very closely with the pivotal team to help identify those organizations that are going to get these grants.
- [14:02]
Kate Warren
Yeah. And so, you know, we were talking before about some of the changes, I guess, to the funding structures, traditional funding structures, that traditionally have Been a very top down approach. This to me seems like a very bottom up approach and being able to surface those ideas. So yeah, Haven, maybe you can talk a little bit about how you see this approach being able to, you know, better center equity and women's real needs in some of the solutions.
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Haven Le
Yeah, absolutely. And you know, this is our second rodeo with Cecilia and Love for Change. We partnered with them. Cecilia, what, six years ago, seven years ago?
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Cecilia Conrad
Yeah, I guess so pre Covid some of the.
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Exactly. Some of the early days of Love for Change's model emerging.
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Haven Le
And we did it, Kate, just by way of context and history at the outset of Melinda committing her first of.
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Cecilia Conrad
Kind of over $2 billion to this agenda of expanding women's power and influence. And we partnered Liberty for Change then to think about like what were new solutions that people were doing domestically in the United States to think about expanding women's power. We had a great forum, the process was wonderful and equitable, as Cecilia has has illuminated. And I think when Melinda committed her second billion to women's power and influence just last year and explicitly kind of carved out some of that capital to go to women's Health, we immediately thought of Lever for Change as another way to think about getting voices, ideas, innovations and leaders that we necessarily couldn't see from our fairly lean team here in Seattle and kind of up and out and to draw some spotlight onto innovations that were at work now and simply need solutions. So the idea was that we were going to kind of invert and not come up with a top down strategy for what we were going to do, for instance, on cervical cancer or another kind of issue related to women's health, but really unearth what was going on on the ground and use some of those applications and certainly the winners to kind of think through trends. What are we seeing, what are we learning? What are these leaders and women and community members telling us about what matters for women's health on the ground right now?
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Haven Le
And that was really the animating principle.
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Cecilia Conrad
To kind of go in partner for change like this at this time.
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Haven Le
And I hope we can talk about.
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Cecilia Conrad
It a little bit. I mean, of the 4,000 applications, I think completely exceeded Cecilia and I's wildest imagination. I mean, there is a lot of demand. And Kate, this is before a lot of the global aid cuts actually became fully known. So just to say that the demand was there and those thousands of applications from over 110 countries prior, we can only imagine what it would be like today. So I'm kind of imploring other funders.
- [16:48]
Haven Le
To kind of think through what might.
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Cecilia Conrad
Be needed on the ground today. But we are seeing some interesting trends and lessons and obviously new and innovative models that have existed for a long time that simply need more resources. Right?
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Kate Warren
Yeah. And you know, I want to get into what some of those are, but also just thinking about, you know, pivotal, you take this kind of multi pronged approach to, you know, funding these community driven ideas, also advocating for policy change, seeding innovation and investments. And how do you see all of these levers working together to augment the impact?
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Haven Le
Yeah, I mean, this is really central to how we've set pivotal up to be a multifaceted funder using different levers to think about the issues that we work on in a ecosystem approach. I think the reason to do it is like an acknowledgement that not one.
- [17:38]
Cecilia Conrad
Lever is going to make the difference.
- [17:40]
Haven Le
This is not silver bullet philanthropy, but.
- [17:44]
Cecilia Conrad
Also we really, really deeply are interested in durable and lasting change. And when you take an ecosystem approach, it means that the system itself is working together to create change.
- [18:09]
Adva Saldinger
Are you interested in the intersection of business and social impact? Do you want to know how corporate sustainability, esg, impact investing and more can contribute to development finance? My name is Adva Saldinger. I'm a senior reporter at devex and I've been reporting on these issues for nearly a decade. I'm the author of Devex Invested, our free weekly newsletter dedicated to development finance. Every Tuesday we explore how companies, investors and market mechanisms are reshaping the world of development finance. Visit devex.com newsletters and join us on Tuesdays.
- [18:52]
Cecilia Conrad
And so in this case, I'll just give you a couple of examples. You named it. One way to immediately think about funding at scale, a variety of different community driven and community designed models for women's healthcare and healthcare access is to do a partnership like we've done through leverage for change. Incredibly important for us to do that. But there's other levers that also need to be pulled in the ecosystem of women's health. And we're pulling a few of them today and we might do more in the future. Advocacy and policy change is going to be essential both domestically here in the United States and certainly globally. And we've been investing in long term partners who kind of inform and educate policymakers about the importance of investing in women's health, really shifting those kind of resource priorities into a different place. So groups like the National Women's Law center, the National Partnership for Women and Families are all great researchers and advocates. To this end, we also have an investment arm at Pivotal. And so we will be investing in early stage companies and in venture capital funds that invest in early stage companies that support women's health, kind of using market driven solutions. I mean, the market is another way to sustain change over time. And so we are investing there as well.
- [20:09]
Haven Le
And then most recently, and I think we just made this announcement, or freemium.
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Cecilia Conrad
Melinda made this announcement a few weeks ago, is that we will invest upstream.
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Haven Le
So we know that R and D does take time to engender new solutions for women.
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Cecilia Conrad
And you have to think about changing.
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Haven Le
Those capital flows to getting innovations that work for women. And some of that takes years, but.
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Cecilia Conrad
We'Re a little bit more impatient than the usual R and D cycle.
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Haven Le
So we are partnering with welcome Leap and particularly with their CEO Regina Dugan.
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Cecilia Conrad
Who is wonderful former exec of darpa.
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Haven Le
To really think about how you accelerate.
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Cecilia Conrad
R and D solutions using their really incredible innovative model for issues that are plaguing women, but have been kind of completely discounted on the slow burn in terms of R and D innovation, like issues like chronic disease, hypertension disease, osteoporosis, and menopausal treatments as well. So those are some of the levers that we're kind of bringing to barricade for women's health. And there will be more in the future that we'll have to look at.
- [21:11]
Kate Warren
Yeah. And talking about kind of how to create, you know, long lasting change, not just, you know, a short term project that you fund and then the funding goes away and the project goes away. And so, Cecilia, now your experience working with various funding models, you know, where do you see the role of philanthropy and philanthropic interventions helping to play in creating that long lasting, durable, sustainable change?
- [21:38]
Cecilia Conrad
Well, first is the wonderful aspect of what Pivotal is doing here in that where we need something that works at every level. So we need the upstream research, we need the stage that develops that research into practical tools that can be used to address health. We need the organizations on the ground who need to be strong and resilient and need durability in order to be able to make those innovations actually translate into improvements in health itself. And so what's critical there is that you have something happening at every level there. The second thing that's wonderful is the fact that this is largely flexible kind of funding. So it gives organizations the ability to figure out what they need to do to make the best decisions for what their situation in their community needs. And to do that with some, particularly the size of these grants will give them something that looks a little more like durable Capital. You know, if you were a firm that was starting up, you would look at different types of funding at each stage of your operation. In the nonprofit world, philanthropy historically has done a lot at the beginning and then kind of counted on something adopting it, and it's scaling on its own. But the family honors.
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Haven Le
You come in behind.
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Cecilia Conrad
Yes, that's right. That's right. And so what's wonderful here is that these are grants that, relative to the size of these organizations, are significant enough to give the organizations the Runway they need to develop, to solidify their work that they're doing, to perhaps share it with others. Because in this space, I think there's a lot of need for sharing best practices across organizations. So this is what's so exciting about this partnership.
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Kate Warren
And I want to talk a little bit about. I mentioned that the 4,000 applications. So many great ideas. And what are. Maybe give away exactly some of the ideas, but what are some of the trends that you saw when you look across the totality of them? Haven. I'll. I'll.
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Cecilia Conrad
You want to start?
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Haven, Can I start? Because I'm excited about a couple of them, and if you can jump in, um, two of them, two trends, or @ least a really surprising number of applicants that came in are related to two, I think, profoundly underinvested in areas of women's health. We talked about it being broadly underinvested in. And I think there's two that I think need special honors. That is the most neglected. And we saw some, a lot actually, of innovations in these spaces. The first is on mental health. And I think, you know, I think we can agree that mental health, broadly speaking, mental illness is chronically underfunded, no matter who you are globally. Billion people suffering with mental illness around the world at any given time. And we contribute a paltry amount to mental health treatments.
- [24:37]
Kate Warren
Like 1% of health funding, I think.
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Haven Le
Goes to mental health.
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Cecilia Conrad
Exactly. Just paltry. Paltry compared to the need. But when you actually kind of cut the data, women disproportionately are affected by a mental illness. And tying this back to kind of what are the knock on effects for us all when women are suffering, it's like mental illness actually does pull women out of the workforce. It reduces productivity. And Cecilia's point, even when you're not in the workforce, it certainly inhibits your ability to care and to contribute, even to your family and your community. And so we know that women, for instance, are twice as likely to suffer from clinical depression, like a major driver of global disability worldwide. And in times of emergency where women are often the backbone of ensuring that there is family and community survival through emergencies. Like women are the ones who are expressing deep, deep clinical crises and depression. And in a more minor way, right in the United States, women were three times as likely to describe those feelings during the pandemic for reasons we can probably all imagine. So we did see a lot of really interesting innovations for mental health. Both standalone treatments, but also integrated treatments, I.e. physical health models that were integrating mental well being models as well. Super exciting for me.
- [25:56]
Haven Le
Second one I will say is also.
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Cecilia Conrad
Underfunded, but maybe this is changing and I'll give a weird anecdote to say why that's true is the physical effects of women aging. You know, I think I'm in my like late 40s. These things are happening to me. Brain fog, inability to sleep and concentrate, like real things that inhibit my quality of life and my productivity. I mean I was talking to my mother about them, just kind of asking for advice of how she navigated through her own menopausal life and she didn't have much to say. Well, I kind of just put my.
- [26:31]
Kate Warren
Head down, bucket up that you were talking about.
- [26:35]
Cecilia Conrad
Exactly. Buck up. I didn't really talk to my doctor about it. I didn't think he would have much to say and I didn't really talk to my friends about it. Now that lack of awareness knowledge, solution set is changing. There's more of a conversation around the quality of life for women in aging. But as Cecilia mentioned, like we did see solutions working on this problem that had come up through lever for change applications. So while we might not be talking about it or prioritizing investment in it, there are solutions and innovations working right now trying to support women through it.
- [27:13]
Haven Le
And I will say that, you know, there's going to be a billion women who are going to live through their.
- [27:18]
Cecilia Conrad
Postmenopausal lives in the next five years and that number is only going to increase as our societies age. If we don't start thinking about solutions to these problems, it is going to have a knock on effect in the economy, never mind our quality of lives. So those are just two kind of.
- [27:34]
Haven Le
Really interesting trends that I saw that.
- [27:35]
Cecilia Conrad
I'm quite excited about.
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Kate Warren
Well, I'm excited here that I think my group of friends and I that are all our mid-40s to early 50s have a like our perimenopause chat, right? And that's where we're getting a lot of our healthcare is through community, through each other. Because we, we can't get it from the traditional healthcare systems. And it's such a market potential, you would think as well. And, you know, you see a lot of this happening, I think more in the global north, but less, I think, in some of the, the global south conversations, budgets. I mean, it is a, is an economic challenge. So, so happy to hear there's some good ideas there. Cecilia, what about you? Are there any trends that have stuck out to you?
- [28:15]
Cecilia Conrad
I was intrigued by some of the organizations that are working in the intersectional space. The ways in which health challenges may manifest themselves differently for women who also have disabilities, the need for culturally responsive mental health care, the focus on some populations, like what happens when you're a refugee and there's this health crisis. I was intrigued by many of those and found those really exciting.
- [28:47]
Kate Warren
Well, I know that we are going to be spotlighting some of the winners of this in some future episodes of our podcast, so really look forward to learning more about those ideas and being able to share them with our community. But before we wrap up, I would just love for each of you to kind of share what you would love for our listeners to take away and think about as it relates to really investing in women's health and the, the, you know, the power of that, both in helping women, but also communities and. Hey, Ben, I'll start with you.
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Haven Le
Well, I appreciate the time. And I think, you know, another reason.
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Cecilia Conrad
Why PIVOTAL has partnered Liver for Change in this way is also because Liver for Change does an incredible job capturing and spotlighting all of the incredible kind.
- [29:40]
Haven Le
Of vetted projects that come through kind.
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Cecilia Conrad
Of their incredible process. It makes it really easy for other.
- [29:48]
Haven Le
Donors who might have an interest, but.
- [29:50]
Cecilia Conrad
You know, have a very small kind of apparatus to give giving. It makes it really easy to access high quality, fully vetted due diligence projects.
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Haven Le
And I think one of the reasons that we're excited about doing this is that we hope that while we'll contribute.
- [30:05]
Cecilia Conrad
Kind of this incredible $250 million amount.
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Haven Le
To a host of winners, those winners.
- [30:11]
Cecilia Conrad
You know, need more capital than we were able to give them. And there are some groups who did not emerge as winners from this challenge, but who also are incredibly deserving of capital and resourcing. And they're doing the work today as we speak, sitting on this podcast. They are out there in their communities delivering health services to women in communities, and they need additional resources now.
- [30:33]
Haven Le
So, honestly, Kate, part of this is.
- [30:35]
Cecilia Conrad
A bit of a call to action that donors don't need to pull back, need to lean forward. There are easy ways to get capital where it needs to go, if you care about kind of rethinking how resources are prioritizing women's health.
- [30:49]
Haven Le
And I really think that donors should.
- [30:50]
Cecilia Conrad
Ask boldly, act urgently and start moving the capital as needed right now.
- [30:55]
Kate Warren
And the ideas and the works there.
- [30:58]
Haven Le
It's all there.
- [30:59]
Cecilia Conrad
What are you waiting for?
- [31:01]
Kate Warren
Yeah, Cecilia, how about you?
- [31:04]
Cecilia Conrad
I have to double down on what Haven said. I was going to make the point that our work on this particular open call does not end when the awardees get announced. We will be working with the organizations over time to help strengthen their case for funding, to help elevate them with other fundings under other funders. We stand ready to provide information to any donor who wants to kind of find something now and act now, because the need is now. So I'm hoping that people will heed this call to action and reach out.
- [31:43]
Kate Warren
Great. Well, well, that's it for today's conversation. I'm really excited that we will be continuing it and we will be spotlighting some of these grantees and the really amazing the work they're doing in future episodes of this week in Global Development. So for our listeners, make sure you're subscribed and you stay tuned for those stories to come. But in the meantime. Hey, Van. Cecilia, thank you so much. This was a really lovely, enjoyable conversation. And thank you to Pivotal Ventures for helping us really spotlight the importance of this work. And thank you to our listeners for tuning in.
- [32:24]
Cecilia Conrad
It.