We spend a lot of time in this newsletter covering what’s being built - new diagnostics, new platforms, new care models. But a new report from Cleveland Clinic is a reminder of a more fundamental question: Who actually gets to use any of it?
The State of Women’s Health 2026 report, based on a national survey of 2,000 women in the U.S., found that 45% of women say their biggest health concern as they age is not cancer, not heart disease, not Alzheimer’s - it’s whether they can afford care at all. That number should sit uncomfortably alongside the billions flowing into women’s health innovation.
What the Data Shows
The Cleveland Clinic findings go beyond a single headline. They paint a picture of how cost functions as a social determinant of health - shaping not just whether women can afford treatment, but whether they seek care in the first place.
45% of women rate their financial health as fair or poor. Women who report financial strain are less likely to feel empowered to advocate for their own health (62% vs. 73% among those in better financial shape) and more likely to skip preventive measures entirely. 17% of women who haven’t seen a gynecologic specialist in the past year cite cost or lack of insurance as the reason. And the Deloitte data cited in the report adds a structural layer: Women spend approximately $15.4 billion more than men annually on out-of-pocket healthcare costs - 18% more - even when pregnancy-related services are excluded. Being female carries a financial penalty in the U.S. healthcare system.
The caregiving dimension compounds this. Women who provide unpaid care - and women disproportionately do - report higher levels of stress (53% vs. 46%), fatigue (49% vs. 42%), and guilt about prioritizing their own health (34% vs. 21%) compared to non-caregivers. The pattern is clear: The women most likely to delay their own care are often the ones managing care for everyone else.
Perhaps most striking are the generational dynamics. 58% of women overall haven’t seen an OB-GYN in the past year. Among women 60 and older, that rises to 76%. The report suggests this isn’t because older women don’t care about their health - it’s that a lifetime of deprioritization has normalized not seeking it. 4 in 10 women overall say they simply don’t believe gynecologic care is necessary for them, a number that rises to 59% among Boomers.
The Knowledge Gap - and What Happens When You Close It
The report also surfaces a finding that’s directly relevant to anyone building in this space: Knowledge drives action. Only 19% of women know that Alzheimer’s disproportionately affects women, even though women account for nearly 2/3 of cases. But among those who do know, 87% are actively taking preventive steps. 42% of women don’t know that menopause can affect the heart, brain, and bones - but those who do engage with their health differently.
This is the flip side of the cost problem. Even when care is accessible, gaps in health literacy mean many women aren’t equipped to act on what’s available. Cost and knowledge aren’t separate barriers - they reinforce each other. Women under financial pressure are less likely to seek out information, less likely to see a specialist who might provide it, and less likely to take preventive action as a result.
How the Industry Is Responding
The good news is that a growing number of companies are building specifically around affordability and access - not just clinical outcomes. Several models are emerging.
Employer benefits are expanding beyond fertility perks. The first wave of employer-sponsored women’s health benefits was largely limited to fertility coverage at large tech companies. That’s broadening. Maven Clinic now works with over 2,000 employers and payers globally, covering fertility through midlife. Sword Health expanded Bloom into a full life-stage women’s health platform for employers. Vira Health launched a global employee benefits platform covering hormonal health, fertility, pregnancy, postpartum, and menopause in over 100 countries and 20 languages. Maven’s own 2026 State of Women’s & Family Health Benefits report found that employers expanded women’s and family health benefits by 39% on average year-over-year - though notably, 10% fewer employees said those benefits support them “very well,” suggesting that access and awareness of what’s available remain a challenge even when benefits exist.
Insurance-first models are decoupling coverage from employers. Flora Fertility raised $5 million to build individually owned fertility insurance starting at $15 per month - portable, not tied to an employer, and designed for women aged 20-34 who want to plan proactively rather than pay reactively when treatment costs hit $50,000+. Midi Health reached a $1 billion valuation by building an insurance-covered midlife care model. These approaches address a structural problem the Cleveland Clinic data highlights: When coverage depends on your employer, changing jobs, going freelance, or working for a small company can mean losing access entirely.
Medicaid is becoming a women’s health innovation channel. As we covered in our recent analysis of the doula care trend, three doula-focused startups raised a combined $27 million in a single week - all building for Medicaid populations. This matters because Medicaid covers more than 40% of U.S. births, and the populations it serves face the worst maternal outcomes. When innovation is built for Medicaid from the start rather than trickling down from private-pay markets, it reaches the women the Cleveland Clinic report identifies as most at risk.
Beyond the U.S.: A Different Set of Challenges
The Cleveland Clinic report is U.S.-focused, and the dynamics it describes are shaped by the specifics of the American healthcare system - employer-dependent insurance, high out-of-pocket costs, fragmented coverage. In countries with public healthcare systems like the UK, Canada, or much of Europe, the affordability barrier looks different. Out-of-pocket costs are lower, but access challenges persist in other forms: Long wait times, limited specialist availability, and women’s health services that are often underfunded relative to demand. The knowledge gaps the report identifies - around menopause, Alzheimer’s risk, the value of ongoing gynecologic care - are not unique to the U.S. Those are global.
In emerging markets, the picture is different again. Access to women’s healthcare is often constrained not just by cost but by infrastructure, geography, and cultural barriers. This is where we’re seeing interesting models take shape. ONTO Health’s Gulf region expansion is bringing AI-enabled fertility care to markets where specialist access is limited. Flora, the Japan-based women’s health platform, is building across Asia with a corporate wellbeing model that bundles consumer health data with employer benefits - an approach adapted to markets where employer-provided healthcare plays a central role.
The Question This Raises
The women’s health industry has made extraordinary progress in building better products, better diagnostics, better care models. But the Cleveland Clinic data is a reminder that innovation without access is innovation for the few. 45% of women worrying about affording care - more than worrying about cancer or heart disease - is not a problem that better AI or a new diagnostic will solve on its own.
The companies and models that are starting to address this - through employer benefits, insurance innovation, Medicaid integration, global platforms - are doing important work. But the gap between what’s being built and who can actually use it remains one of the most important challenges in women’s health. It deserves at least as much attention as the next fundraise.
