💰 TREATING MENOPAUSE COULD BE CHEAPER THAN NOT TREATING IT — A cost-effectiveness model found that putting 10,000 fifty-year-old women with hot flashes on five years of transdermal estrogen could save roughly $135 million and prevent 647 deaths, largely from cardiovascular disease. The model projected 87 additional breast cancer cases — but also 259 fewer cases of heart disease and 181 fewer hip fractures.

💊 FDA WANTS OPINIONS ON TESTOSTERONE FOR WOMEN — Off-label use of testosterone for menopausal women has climbed for a decade, so the FDA's Office of Women's Health is convening a public workshop on the topic with comments open through October 19. Beyond 24 months of use, the agency says safety data is limited — "particularly regarding cardiovascular and breast cancer risks."

👶🏽 DOULAS WORK, REVIEW FINDS — A review of 30 studies found doula support was associated with lower rates of preterm birth and C-sections, better birth experiences, and higher attendance at the 6-week postpartum check-up. The benefits held — and sometimes were strongest — among people facing racial, income, insurance, or incarceration-related disparities.

TOP CLICKED THIS WEEK

The Anti-Abortion Movement's Next Target: Surrogacy // Texas Tribune

Testosterone for Women Workshopping // Federal Register

Women Are Nearly 70% of the Health Workforce, and the Lowest Paid // Institution for Health Metrics and Evaluation

Wall Street Bets on Fertility Benefits // CNBC

I’m a Psychiatrist. I’m Hearing Something New From Young Women. // New York Times

Interpol Isn't Coming for Abortion Pills // The 19th

August 20, 2026

Tonight: the anti-abortion movement's new target and Wall Street's fertility bet.

— Meghan McCarthy

THE ANTI-ABORTION MOVEMENT'S NEXT TARGET: SURROGACY

Surrogacy has become part of the battle over reproductive rights and abortion. A surrogate in Texas who delivered a baby born with a severe heart defect is fighting the intended parents for custody, accusing them of wanting her to get an abortion. Anti-abortion groups including Live Action and Texas Right to Life are backing the surrogate, and state lawmakers are already floating limits on commercial surrogacy, starting with a ban on foreign nationals using Texas surrogates and restricting third-party egg and sperm donation.

WOMEN ARE NEARLY 70% OF THE HEALTH WORKFORCE, AND THE LOWEST PAID

Women now make up nearly seven in ten health workers worldwide and drove most of the sector's growth since 1990, yet they cluster in its lowest-paid, least-powerful jobs: 81% of nurses and 96% of midwives, but fewer than half of doctors. The first sex-disaggregated global count, published in The Lancet Public Health, spans 204 countries and lands as the world faces a projected shortage of 34 million health workers. Lead author Megan Knight said women “have transformed the global health workforce over the past three decades, but they continue to be concentrated in professions that generally offer lower pay and fewer opportunities for leadership.”

IN A PREGNANCY TRIAL, STRENGTH TRAINING BEAT GESTATIONAL DIABETES

A randomized controlled trial of just over 200 pregnant women who were overweight or obese found no women who stuck with a supervised strength-training program developed gestational diabetes, compared with 7.3% of the control group. No babies in the strength group were born oversized, versus 6.3% of controls, and the exercisers reported a better quality of life. The Spanish trial is small and hinges on sticking with the program, but the signal is worth more investigation.

WALL STREET BETS ON FERTILITY BENEFITS

Wells Fargo thinks Progyny, which helps employers offer IVF and egg-freezing benefits, is poised for growth. The bank recommended buying the company’s stock and predicted its price could rise about 45%, arguing that employers will continue expanding fertility coverage even in a tighter economy. Analysts said the company sits “at the intersection” of demographic pressures, corporate wellness priorities, and healthcare innovation. Nine of the 11 Wall Street analysts covering Progyny now recommend buying it.

THE GIRLS ARRIVE ALREADY DIAGNOSED

By the time many teenage girls and young women reach a psychiatrist, they have already found a name for what they are experiencing: ADHD, OCD, anxiety or depression. Psychiatrist Suzanne Garfinkle-Crowell writes that these labels, often researched on Instagram and TikTok, may function less as firm clinical claims than as borrowed language for pain. Her advice is to take them “seriously but not literally” and listen for what lies beneath the diagnosis. Roughly half of Gen Z reports having a mental-health condition, with girls both driving the trend and experiencing the worst mental-health outcomes.

August 18, 2026

Tonight: the hormone the FDA has never approved for women, a new plan to choke off abortion pills, and more.

— Meghan McCarthy

TESTOSTERONE FOR WOMEN WORKSHOPPING

The FDA's Office of Women's Health is convening a public workshop next month on testosterone use in menopausal women, with comments open through October 19. There is no FDA-approved testosterone product for women in the country, though the agency's notice acknowledges off-label use has climbed for a decade. It's approved for low sexual desire in the UK, Australia, New Zealand and South Africa. Beyond 24 months, the FDA says, safety data is limited, "particularly regarding cardiovascular and breast cancer risks."

INTERPOL ISN’T COMING FOR ABORTION PILLS

The 19th reports that an attorney working for an anti-abortion group is preparing a paper on how Attorney General Todd Blanche could use Interpol, an international law enforcement agency, to disrupt mifepristone distribution inside the United States. Called Operation Pangea, the lawyer said Blanche had already agreed to make restricting the abortion drug a priority. Experts say it’s unlikely this plan would work and instead is a sign of desperation from anti-abortion activists, since the Trump administration has not had any success banning the pill.

IT'S CHEAPER TO TREAT MENOPAUSE THAN NOT TO

If 10,000 fifty-year-old women with hot flashes went on five years of transdermal estrogen, it would save about $135 million and prevent 647 deaths, according to a model published in Obstetrics & Gynecology. The biggest benefit was preventing cardiovascular disease. While they projected it could cause 87 additional breast cancer cases, they also found 259 fewer cases of heart disease and 181 fewer hip fractures.

THE DOULA STUDIES POOL

Researchers looking at 12 randomized trials and 18 non-randomized studies found doula support is associated with lower rates of preterm birth and cesarean delivery, better birth experiences, and higher postpartum visit attendance. Four of the five studies conducted entirely among people at risk of disparities, such as race, income, insurance status or incarceration, reported at least some benefit.

TEN YEARS BEFORE THE DIAGNOSIS, THE PRESCRIPTIONS START

Women with endometriosis filled 29% more antidepressant prescriptions and 16% more anxiety prescriptions—a decade before they ever got diagnosed, according to a Danish study of nearly 137,000 women. The gap didn't close after diagnosis, widening to 40% and 46%, respectively. Researchers point to prolonged pain, uncertainty about the cause and fertility problems as plausible explanations, but the study doesn't establish what drives the strain, or whether diagnosing women sooner would ease it.

Here are the most interesting things we saw in women’s health this week:

🏥 ONE IN THREE COUNTIES HAS NOWHERE TO GIVE BIRTH: A March of Dimes report found that nearly 6 million women and 350,000 infants in the United States live in counties without full access to maternity care, and it's getting worse. At least 96 hospital labor-and-delivery units closed across 35 states since 2024, and in nearly 60% of those counties, the shuttered unit was the only place to give birth.

🩻 KNOWING YOU HAVE DENSE BREASTS ISN'T ENOUGH: State laws requiring providers tell women they have dense breast tissue led to more people getting a follow-up ultrasound or MRI, but the rates were still low, even in states where insurers were required to cover the screenings. A JAMA Network Open analysis of 12.5 million women found that notification alone isn't closing the gap. Dense tissue both raises breast cancer risk and hides tumors on a standard mammogram, which is why the supplemental scan matters.

🌍️ WHEN THE AID STOPS, THE DYING STARTS: The human cost of gutting USAID is not abstract. The AP documented it in Nepal, where the shutdown of nutrition and reproductive-outreach programs has left pregnant women without services. One 20-year-old woman died at 28 weeks pregnant after U.S. cuts eliminated the nutrition and maternal-health outreach that had supported her during an earlier pregnancy.

TOP CLICKED STORIES THIS WEEK

Nowhere To Go: Maternity Care Deserts Across the U.S. // March Of Dimes

Dense Breast Legislation and Supplemental Breast Imaging Among Women Undergoing Mammography // JAMA Network Open

Where women live may influence ovarian cancer survival, especially among Black women // University of Pittsburgh

USAID Fallout: In Nepal, When the Aid Workers Stopped Coming, The
Women And Babies Started Dying // The Washington Post

Social disadvantage greatly amplifies risk of mortality in women with early menopause // The Menopause Society

Ocasio-Cortez Opened Up About Freezing Her Eggs. She Got Women Talking. // The New York Times

August 13, 2026

Tonight: the 82% miscarriage lie returns, AOC's egg-freezing, and more.

— Meghan McCarthy

THE 82% MISCARRIAGE LIE

After the release of Anthony Fauci's 2021 text messages, Republican Sens. Rand Paul and Ron Johnson revived the false claim that COVID-19 vaccines caused an 82% miscarriage rate among women vaccinated early in pregnancy. The figure is an intentionally misleading interpretation of data from a single 2021 study, which actually reported a 12.6% miscarriage rate. (To get the 82% number, they only looked at women who had gotten the vaccine earlier in their pregnancies. But the study only looked at “completed” pregnancies when it closed, and at that point, an early pregnancy appeared in the data table mainly if it had ended in miscarriage.) A meta-analysis of 21 studies covering more than 123,000 pregnancies ultimately found no increased risk. The claim spread widely on X before fact-checkers caught up.

FOUR IN TEN AREN'T SURE THE ABORTION PILL IS SAFE

Only 44% of adults say medication abortion is safe when taken as directed, while 15% call it unsafe and 41% say they simply aren't sure, according to KFF's latest health tracking poll. Just 26% know that pills account for most abortions in the U.S. today. The uncertainty comes as anti-abortion groups push a widely criticized paper claiming mifepristone contaminates wastewater, an argument with no evidence behind it.

IVF SHOTS ON CAPITOL HILL

Rep. Alexandria Ocasio-Cortez, 36, posted an Instagram video of herself injecting fertility medication before a TV hit, framing egg freezing as reproductive freedom and calling out the "political tax" that comes with talking about it. Egg-freezing cycles climbed from about 6,090 in 2014 to nearly 39,000 in 2024, per the Society for Assisted Reproductive Technology. Doctors used the moment to caution that the process can be grueling, and not shockingly, Republicans accused AOC of selling women a fantasy.

IN NEPAL, THE AID STOPPED AND THE DYING STARTED

The Trump administration's move to dismantle USAID gutted maternal and child health programs worldwide. The AP meticulously documented the human cost in Nepal, where the shutdown closed nutrition and reproductive-outreach programs that had kept mothers and infants alive. Health workers and families described pregnant women dying after services vanished, including one woman who died in December while 28 weeks pregnant. The State Department says it still supports maternal-health programs in the country.

FOR EARLY MENOPAUSE, MONEY IS PART OF THE PROGNOSIS

In a study of roughly 20,000 women who went through early natural menopause, social disadvantage predicted worse long-term outcomes, and unemployment was the single strongest predictor of both death and dementia over a median of nearly 11 years, researchers reported in the journal Menopause. The Menopause Society team tracked all-cause mortality and cognitive decline, finding that economic circumstance, not just biology, shaped how early menopause played out.

August 11, 2026

Tonight: Massachusetts drops its abortion limit, a third of counties can't deliver a baby, and coaching that lowers postpartum blood pressure.

— Meghan McCarthy

MASSACHUSETTS DROPS ITS 24-WEEK ABORTION BAN

Gov. Maura Healey signed legislation that replaced the state's 24-week limit with a standard that lets physicians use their own medical judgment on abortions later in pregnancy. The law is aimed at patients who receive devastating fetal diagnoses or face serious complications and who, under the old rules, often had to leave the state for care. Massachusetts becomes the 10th state, along with D.C., to set no gestational cutoff.

ONE IN THREE U.S. COUNTIES IS A MATERNITY CARE DESERT

A March of Dimes report out today found that nearly 6 million women and over 350,000 infants live in counties without full access to maternity care. At least 96 hospital labor-and-delivery units closed across 35 states since 2024, and in nearly 60% of those counties the shuttered unit was the only place to give birth, adding an average 25 minutes of travel to reach care. The group warns that looming Medicaid cuts could push more rural hospitals over the edge.

DENSE-BREAST LAWS AREN'T GETTING WOMEN THE SCANS THEY NEED

State laws requiring women to be told they have dense breast tissue nudged more of them toward follow-up ultrasound or MRI, but the added screening rates stayed low even where insurers were required to cover it, a JAMA Network Open analysis of 12.5 million women found. Dense tissue both raises breast cancer risk and hides tumors on a standard mammogram, which is exactly why the supplemental scan matters. Notification alone, the authors conclude, isn't closing the gap.

FOR BLACK WOMEN WITH OVARIAN CANCER, THE NEIGHBORHOOD MATTERS MORE

Women in socially vulnerable communities faced a 20% higher risk of death after an ovarian cancer diagnosis, and Black women a 45% higher risk than white women, according to a study of 2,544 patients published in JAMA Network Open. Researchers used the CDC’s vulnerability index, which looks at measures such as poverty, housing conditions, transportation access, and educational attainment. The two effects compounded: being Black and living in a high-vulnerability neighborhood was worse than either factor alone. Only about half of ovarian cancer patients survive five years, and fewer than 40% of Black women do.

A LITTLE COACHING KEPT POSTPARTUM BLOOD PRESSURE IN CHECK

Pairing at-home blood pressure monitors with health coaching and care navigation significantly improved blood pressure control a year after delivery for women who'd had hypertensive disorders of pregnancy, a University of Wisconsin randomized trial of 140 patients found in JAMA Network Open. High blood pressure in pregnancy is a leading driver of maternal deaths, many of them in the weeks and months after birth. The relatively low-tech intervention produced meaningful results, although the preliminary findings will need to be tested in larger, more diverse health system.

August 6, 2026

Tonight: The reality of the training pipeline for abortion providers, a uterine scan that may hold up for Black women, and more.

— Meghan McCarthy

WHAT WOMEN TELL REDDIT BUT NOT THEIR DOCTOR

Women increasingly sort out what's normal and what's alarming about their bodies on Reddit before they ever book an appointment, according to a survey of about 890 women that Reddit commissioned with PR firm Weber Shandwick. It's a self-interested report, but the numbers are big: 81% said they're more comfortable discussing sensitive health topics on Reddit than with family or friends, and seven in ten walked into appointments feeling better prepared. Traffic backs it up, with the over-60 women's subreddit up nearly 2,000% in a year and r/menopause up 53%. Researchers tie the shift to a real gap: only 11% of NIH priority projects between 2018 and 2020 focused on conditions specific to women.

FIBROIDS DON'T BREAK THE ULTRASOUND FOR BLACK WOMEN

Clinicians often assume transvaginal ultrasound can't reliably rule out endometrial cancer in Black women because fibroids can obscure the view, sometimes leading to more invasive biopsies. A Montefiore and Albert Einstein team found otherwise: in a diverse cohort published in JAMA Network Open, the scan visualized the endometrium 76% of the time in Black women and, when completed, still excluded cancer with excellent accuracy. Completion rates ran lower for Black women, mostly because of fibroids, but the test held up when it did run. That matters because Black women die of endometrial cancer far more often than white women.

HALF THE COUNTRY IS SHORT ON MATERNITY CARE

Nearly half of the US now sits in a maternal-health workforce shortage, and the National Governors Association just mapped how states plan to spend their new federal rural-health dollars to close the gap. The report tracks first-year plans under the Rural Health Transformation Program, which sent money to all 50 states: Delaware is opening its first medical school and a "train here, stay here" residency, Alabama is wiring rural clinics for telerobotic ultrasound and emergency deliveries, and Georgia wants to add GLP-1s to a Medicaid program for women at risk of dangerous pregnancy complications.

ANOTHER THING DIABETES MAY WORSEN: MENOPAUSE SYMPTOMS

Women with type 2 diabetes or prediabetes reported more menopause symptoms, and more severe ones, than women without it, according to a study of nearly 300 midlife women published in Menopause. The gap reached statistical significance only after menopause, and the cohort was entirely Korean, so treat this as an early signal rather than a settled finding. Still, the authors and The Menopause Society's medical director argue it's a reason to fold symptom checks into diabetes care, since midlife weight gain and hormone shifts already push the two conditions to feed each other.

45% OF OB-GYN RESIDENCIES NOW SIT IN BAN STATES

Independent clinics train many of the country's future abortion providers, and roughly 100 of them have closed since the fall of Roe. Those clinics perform 58% of US abortion care and double as the only place to learn skills that many nursing and medical programs skip. And it’s getting harder: 45% of OB-GYN residencies and 30% of family-medicine programs now sit in states with severe restrictions or outright bans, forcing trainees to travel cross-country. Training one provider through Repro TLC has climbed from $3,500 to about $10,000, and the group turns away six of every ten applicants.

August 4, 2026

Tonight: abortion bans and teen girls' mental health, a third of community health centers have no prenatal care, and more.

— Meghan McCarthy

A ROADMAP FOR GETTING WOMEN'S HEALTH INNOVATIONS PAID FOR

Even proven women's health products stall because no one will cover them, and a Milken Institute report maps nine structural reasons why — from missing billing codes to fragmented public programs. The authors dig into reimbursement through employers and public programs like Medicaid, showing what it takes to move a product through each byzantine process. It's a policy blueprint aimed at the investors and founders who keep hitting the coverage wall after regulatory approval.

MENOPAUSE BENEFITS JUST JUMPED AT U.S. EMPLOYERS

The share of employers offering menopause support climbed to 27% this year from 18%, according to SHRM's 2026 benefits survey of 5,472 organizations, Kathryn Mayer reported. Mayo Clinic has pegged untreated menopause symptoms at about $1.8 billion in lost work time a year, and $26.6 billion counting medical costs. In 2025, Rhode Island became the first state to require menopause accommodations.

ABORTION BANS TRACK WITH A RISE IN TEEN GIRLS' SUICIDAL THOUGHTS

The 19th reports that high school girls in five states with near-total abortion bans had higher suicidal ideation rates after abortion bans took effect, compared to girls in ten states without bans. The analysis of federal survey data from 2017 to 2023, led by Wendy Sheldon of Verge Research, found no equivalent pattern among boys, and the link to actual suicide attempts wasn't statistically significant.

A THIRD OF COMMUNITY HEALTH CENTERS DON'T OFFER PRENATAL CARE

Only around two-thirds of the over 1300 federal health centers operating in 2024 provided prenatal care on site, according to an Annals of Internal Medicine study flagged in Contemporary OB/GYN. The centers serve roughly 8 million reproductive-age women, and those centers with higher shares of Black, Hispanic, and Medicaid patients were the most likely to offer prenatal care. The maternity deserts with the least obstetric access often had no health center at all.

REFERRAL RULES MISS UP TO 95% OF YOUNGER WOMEN WHO GET BREAST CANCER

Britain's current family-history referral criteria would have flagged almost none of the women under 50 who went on to develop breast cancer within a decade, missing up to 95% of them, per a British Journal of Cancer analysis of over 1,200 women from Cambridge and the Institute of Cancer Research. A multifactorial risk model that looked at genetics, lifestyle, reproductive history, and hormones alongside family history identified eight times as many women. Nearly three-quarters of the under-50 cases had no family history at all.

July 30, 2026

Tonight: Louisiana locks up a hemorrhage drug, the operation that prevents most ovarian cancer, and more.

— Meghan McCarthy

REMOVING THE FALLOPIAN TUBES CUTS OVARIAN CANCER RISK BY NEARLY 80%

Nearly all fatal "ovarian" cancers actually begin in the fallopian tubes, and taking the tubes out during any abdominal surgery, from a hysterectomy to a gallbladder operation, lowers the risk by almost 80%, the New York Times reports. The five-minute procedure is now backed by the American Cancer Society, which is planning a national awareness campaign. Ovarian cancer kills most of the 20,000 U.S. women diagnosed each year because no screening test catches it early.

LOUISIANA LOCKED UP THE DRUG THAT STOPS POSTPARTUM BLEEDING

A 2024 state law that reclassified misoprostol and mifepristone as controlled substances has pushed Louisiana hospitals to pull misoprostol off the mobile carts used to treat postpartum hemorrhage and store it in a locked room instead. Doctors told KFF Health News and Verite News the extra steps cost minutes when a hemorrhage can turn fatal fast. Misoprostol is cheap, shelf-stable, and a frontline treatment for one of the most common childbirth complications.

HORMONE THERAPY USE HAS NEARLY DOUBLED

Menopausal hormone therapy use among women in outpatient care rose from 1.7% to 3.6% between 2017 and 2026, and nearly tripled among women aged 45 to 54, according to an Epic Research analysis of more than 163 million women. Use stayed flat until 2023, then accelerated after further analysis softened the perceived risks and the FDA moved to strip the decades-old black-box warning off estrogen products last November. Patches and gels grew fastest of all.

…AND THE PATCHES TO MEET THAT DEMAND KEEP RUNNING OUT

That surge is colliding with supply. Pittsburgh-area pharmacies report estradiol patch shortages that have dragged on for six to eight months, with some patients driving 40 minutes to fill a prescription and pharmacies paying double when stock appears, the Pittsburgh Post-Gazette found. The FDA says patches haven't met its threshold for a national shortage and that all six manufacturers are running at full capacity. Patients are being switched to gels and alternate doses in the meantime.

PREGNANCY HIGH BLOOD PRESSURE HAS JUMPED 73% SINCE 2016

The share of U.S. births complicated by gestational hypertension rose from 6% in 2016 to 10.4% in 2024, and CDC data shows the rate climbed in all 50 states. Axios reports the roughly 73% jump cuts across age groups and races. High blood pressure in pregnancy raises the odds of preeclampsia, stroke, preterm birth, and lasting heart disease, and it's one of the clearest early warnings clinicians have.

July 28, 2026

Tonight: a new anti-abortion weapon, drinking in pregnancy climbs, and the 716-page Medicare rule pricing women's health.

— Meghan McCarthy

THE 716-PAGE RULE THAT DECIDES WHAT WOMEN'S HEALTH IS WORTH

Medicare's proposed 2027 physician pay rule is 716 pages of policy proposals so dense, almost no one will ever read it (except those who are paid to). But thankfully we have a 51& analysis that reads the rule through a women's health lens…and finds the words "menopause," "hormone," "osteoporosis," and "postpartum" appear zero times. Buried in the same pages: the biggest maternity-coding overhaul in decades, Medicare's first lactation-payment codes, and an 86% cut to the pelvic-exam supply pack. Valuation is the quiet mechanism that decides whose care the system pays for, and the public comment window to fix the omissions closes September 14. Check out more in our interview with 51& founder Jodi Neuhauser.

p.s. have something newsy you want to talk about in women’s health? email me at [email protected]

ANTI-ABORTION GROUPS ARE NOW “TESTING” THE WATER

Students for Life spent two years sampling wastewater and this week released a study claiming "significant levels" of mifepristone in the water systems of Austin, Blacksburg, Virginia, and Carbondale, Illinois. But the researchers never actually tested for mifepristone: as Jessica Valenti reported, their method only detects whether something is blocking progesterone, which could just as easily be sunscreen, an insecticide, or a flame retardant. The paper ran in a journal published by the anti-abortion group that once sued the FDA over mifepristone, and its authors are not water scientists. Even if the drug were present, you'd have to drink roughly 5 million liters, about two Olympic pools, to swallow the equivalent of a single clinical dose. The campaign is a response to Biden-era rules allowing abortion pills by mail; in 2025 lawmakers in seven states filed nine bills tying medication abortion to water pollution, and 25 members of Congress asked the EPA to start monitoring.

A RURAL MATERNITY EXPERIMENT SERVED 8,600 WOMEN

A federal program funded three rural maternal-health networks in Minnesota, Missouri, and West Virginia, and a new HRSA report says they reached more than 8,600 women between 2021 and 2025. Leaning on telehealth, remote monitoring, patient navigation, group prenatal care, and doulas, the networks reported gains in first-trimester prenatal care, postpartum visit rates, and infant outcomes. The strategies were built to route around the provider shortages and transportation gaps that make rural pregnancy so dangerous, exactly the kind of care that keeps disappearing as rural hospitals close.

HEAVY DRINKING IN PREGNANCY HAS NEARLY TRIPLED

The share of pregnant women who report drinking rose from 9% in 2011 to about 15% by 2023, a 59% jump, according to a Columbia analysis of CDC survey data covering nearly 34,000 pregnancies. Binge drinking climbed 77% over the same stretch and heavy drinking 166%. But the biggest increase was in tobacco use: among pregnant women who drank at all, 68% of those who also smoked reported binge or heavy drinking, versus 31% of those who didn't.

MATERNAL-HEALTH STARTUPS RAISED $978M. FEW TOOK MEDICAID.

Investors put $977.5 million into 172 venture-backed maternal-health startups between 2014 and 2022. A University of Pennsylvania team found the single biggest slice, $520 million, went to maternal and fetal diagnostics, and the most common company was virtual or hybrid "wraparound" pregnancy care. But few of the startups mentioned maternal mortality and few accepted Medicaid, which pays for more than 40% of US births. The gaps the market is rushing to fill, the authors note, are mostly not the ones killing women.