Women make up half the world’s population, yet their health continues to be undervalued, underfunded, and under-researched. Even when proven solutions exist, they often fail to reach the women who need them most, especially women living in low income settings. The problem is rarely a lack of knowledge or tools. More often, it is fragmented systems and misaligned priorities that treat women’s health as a series of disconnected issues rather than a lifelong continuum of care.

In recent years, major philanthropic and global health actors have renewed their focus on women’s health, recognizing that investing in women is fundamental to economic growth, healthier families, and stronger societies. This momentum is both welcome and overdue. But momentum alone will not translate into better outcomes unless it is matched by smarter coordination and delivery.

At the Eleanor Crook Foundation, we focus on prenatal nutrition—one of the most critical investments in both maternal and child health. Adequate maternal nutrition during pregnancy can reduce complications, improve birth outcomes, and shape a child’s lifelong health and development. Yet as we have expanded our engagement, one reality has become increasingly clear: the maternal health ecosystem is full of missed opportunities for collaboration that could dramatically improve care for women and newborns.

From Parallel Programs to Integrated Care

Across many countries, antenatal care systems are designed to deliver a package of services that protect mothers and babies. In reality, however, these services are often implemented in isolation rather than as part of a coordinated system.

For example, screening and treatment for syphilis can prevent severe pregnancy complications and adverse birth outcomes. Malaria prevention protects pregnant women and newborns in regions where the disease is endemic. Prenatal nutrition programs provide supplements to prevent maternal anemia and support healthy fetal development, while additional iron supplementation including intravenous iron therapy is used to treat anemia when it occurs.

Although these interventions frequently target the same women during the same pregnancies—and are often delivered in the same clinics—they are commonly supported by separate funding streams. Each program may manage its own supply chains, data systems, and training processes. This fragmented approach places strain on antenatal care systems, with multiple actors addressing different components of care independently. In many instances, it incurs additional, unnecessary costs. As a result, opportunities to provide coordinated, patient-centered services are often missed. In some cases, such as anemia prevention and treatment, the lack of integration limits progress toward improving overall maternal health.

This fragmentation represents a significant missed opportunity. Encouragingly, new initiatives such as the Beginnings Fund are starting to promote more integrated models that deliver multiple services through a unified platform. As global health budgets become increasingly constrained, integration is no longer just beneficial—it is essential. By aligning investments across maternal health, nutrition, and infectious disease programs, health systems can operate more efficiently and provide comprehensive care to women throughout pregnancy.

The Overlooked Role of the Private Sector

Another opportunity lies in better engaging the private sector. In many low- and middle-income countries especially with mixed health systems, a significant share of antenatal and delivery care already occurs outside the public system. Analyzing data from 57 low- and middle-income countries, Campbell et al. show that private-sector market share among users of antenatal care was 13-61% across regions with an overall mean of 44%.

Women’s choices about where to seek care are shaped by many factors: distance and convenience, cost, perceived quality, and trust in providers. In Bangladesh, these dynamics are particularly clear: despite strong public health programs, about 64% of women in the poorest wealth quintile receive antenatal care from private providers.

Ignoring this reality limits our ability to reach women effectively within the existing system. Instead of narrowly focusing on a public option — which remains critical, especially for the poorest populations — global health partners should ask how private markets can be strengthened to expand access, improve quality, and ensure reliable supply. One useful lesson comes from family planning. Through social marketing programs, governments and NGOs have applied commercial marketing principles—product, price, place, and promotion—to make contraceptives more accessible and affordable while maintaining a public health focus. Similar approaches could help expand access to other essential maternal health products and services.

Building Sustainable Markets for Maternal Health

Ensuring long-term access to maternal health products will require moving beyond donor-funded free distribution toward models that build demand and sustainable financing. One promising approach is understanding what families are willing and able to pay. In Senegal, for example, ECF is supporting willingness-to-pay studies for prenatal supplements to better understand the intersection of demand, affordability, and pricing. The goal is to help policymakers design systems that balance financial sustainability with equitable access. In Ghana, our foundation is also working with partners to explore including key nutrition commodities—including prenatal supplements—within the national health insurance system.

More efforts like these are needed to test co-payment models, insurance coverage, and market-based approaches. Global health has successfully used such mechanisms before. A notable example is the Affordable Medicines Facility–malaria (AMFm). It expanded access to ACTs, the main malaria treatment medicines, by negotiating lower prices with manufacturers and subsidizing them at the factory gate, allowing private importers to purchase quality-assured medicines at much lower cost. Combined with provider training, public awareness campaigns, and clear pricing guidance, the program significantly increased ACT availability and reduced prices across both public and private markets.

Approaches like these can ease pressure on overstretched public health systems by shifting those who can afford to pay toward private-sector channels, while preserving subsidies for the most vulnerable. While sustainable markets for maternal health cannot replace public systems, the right mix of policy, financing, and demand-generation strategies can complement them—helping ensure life-saving products reach more women, more reliably, over the long term.

Paul Farmer once said, “The biggest failure we have in providing healthcare to mothers and children is a failure of imagination.” The challenge today is not a lack of effective interventions, but our failure to imagine - and build - systems that deliver them together, equitably, and at scale. That will require breaking the funding silos that still define global health.