Understanding and addressing a wide range of women’s gynecological and reproductive health issues are priorities for NICHD. In the maternal health space, we seek evidence-based solutions to reduce preventable causes of pregnancy-related deaths and improve health before, during, and after delivery.
Last month, we celebrated the 5th anniversary of the NIH-wide IMPROVE initiative, launched in 2019 in response to high rates of pregnancy-related complications and deaths in the United States. The rate of maternal deaths in our country exceeds those of other high-income nations, and most of these deaths are preventable. There are stark disparities in maternal health outcomes for racial and ethnic minorities, underserved rural residents, and people with low socioeconomic status.
Through the IMPROVE initiative, we have established a nationwide network of Maternal Health Research Centers of Excellence 
to design and implement culturally appropriate research projects to address the biological, environmental, and structural factors that affect pregnancy-related complications and deaths. We also welcome proposals for research focused on understanding how health care access and quality affect maternal health disparities.
In addition to grants, NICHD and partners have leveraged prize competitions to bring in diverse voices and expertise to innovate and problem-solve. In September, eight nonprofit organizations participating in the Connecting the Community for Maternal Health Challenge were awarded for their efforts to develop, implement, and conduct research projects to improve maternal health outcomes in their communities. Participating organizations were encouraged to build the infrastructure and capabilities to conduct community-focused maternal health research. Several organizations plan to continue leveraging the research capacity they created during this two-year challenge.
A second competition, the Rapid Acceleration of Diagnostics Technology (RADx® Tech) for Maternal Health Challenge, helped spur development of postpartum maternal health diagnostics for use in regions that have limited access to maternity care. Equitable access to diagnostics can lead to timely and potentially life-saving treatments. The eight winning teams developed home-based and point-of-care technologies to improve health outcomes during the period when most maternal deaths occur—up to one year after the end of a pregnancy.
Other NICHD research focuses on improving quality of life during the postpartum period. As November is Bladder Health Awareness Month, it is an opportune time to acknowledge that bladder leakage—common after childbirth—can be embarrassing, interfere with daily life, and contribute to anxiety and depression. An NICHD-supported study is exploring how different ways of strengthening the pelvic muscles might improve postpartum urinary incontinence. Participants in the Training for Urinary Leakage Improvement After Pregnancy (TULIP) study will receive education about lifestyle changes with or without additional training in pelvic muscle strengthening.
TULIP is one of many studies led by NICHD’s Pelvic Floor Disorders Network (PFDN) to improve care and quality of life for women with pelvic floor disorders (PFDs). In addition to childbirth, common risk factors for PFDs include genetics and aging. Urinary incontinence is among the most common PFDs, along with fecal incontinence and pelvic organ prolapse, when the organs sag into and sometimes through the vaginal canal.
Results from a PFDN study reported earlier this year found that three common surgeries to repair pelvic organ prolapse are generally comparable and safe, providing healthcare providers and patients with information to help guide individual decision-making. Researchers are also making advances in nonsurgical treatments for pelvic organ prolapse, including pessaries—removeable devices inserted into the vagina to support the pelvic organs. An early-stage study comparing an investigational, collapsible pessary with currently available options suggested that the novel pessary was not only equally effective in providing prolapse support, but most participants found it less painful to insert and remove.
These studies exemplify the broad range of maternal and women’s health research encompassed in NICHD’s portfolio. I look forward to continued innovations to support and optimize the health of women throughout their lives.
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