Women’s health research is the study of health across a woman’s life course, including all health conditions for which women and men experience differences in risk, presentation, and treatment response, as well as health issues specific to women.1 The field has expanded beyond reproductive health and covers the study of health throughout the lifespan and across the spectrum from basic research to clinical trials.2 Recently, several countries, including the United Kingdom,34 the United States,5 and Canada6 established national strategies to broaden and deepen the landscape of women’s health research. As women have historically been underrepresented in clinical studies and trials,789 further evidence is required to fully understand women’s diseases or conditions throughout their life course. Globally, research for women’s health had primarily focused on the anatomical and biological differences between men and women,10 and yielded significant progress in the treatment of breast cancer, cardiovascular disease, and cervical cancer.11 The recent national strategies for women’s health research now aim to encompass the diverse health needs of women, along with evidence-based disease prevention and treatment tailored to women’s specific needs.11

Limited knowledge about sex- or gender-based differences and sex-specific health conditions adversely affects women’s health care. Without updated information on the topics and contents of women’s health research, research funders, policymakers, and researchers lack a basis for allocating resources required to address the problems of women’s health. In prior analyses in 2008 and in 2012, the majority of studies on women's health have concentrated on breast and cervical cancers in Korea.1213 Studies on health promotion, risk factors of disease, chronic diseases, or conditions relevant to women’s health are relatively scarce. It has been recommended that research topics in women’s health address a broader range of issues that affect Korean women’s lives.12

There are increasing demands for new research regarding women’s health issues in Korea. These issues, raised by civic or advocacy groups as well as established researchers, include research topics related to recent changes in social institutions and culture. Examples of new research demands may include safety issues regarding sanitary products, beauty products, or cosmetic procedures or surgery and their impact on health14151617; studies on the vulnerable subgroup among women, such as the disabled, migrants, sexual minorities, vulnerable workers, the elderly1819; and research on the physical and mental burden on the role of caregiver, which is mainly filled by women.2021 There is also new research interest regarding the impact of novel technology and its evolution on women’s health.22

Given these diverse research demands, it is necessary to analyze the recent status of women’s health research in order to determine future research directions. The present study aimed to examine the trend of women’s health research and to analyze research topics supported by the national funding program in 2012–2020. Through text mining and content analysis, we explored the national initiative for women's health research in Korea and discussed its limitations and possibilities.

Both the number and funding amount of women’s health research expanded between 2012 and 2020 in Korea. Despite its quantitative growth, the scope of research on women’s health in Korea has not significantly changed during that same period, except for the striking growth of sexual and reproductive health research. Most of the women’s health research has been on a limited range of research topics, especially cancer (including subcategories of breast and gynecological cancers) and sexual and reproductive health. In particular, sexual and reproductive health showed a steep increase in the number of projects and funding size, which might be promoted as part of the national initiative to reverse the trend of ever-decreasing fertility rates in Korea.27 In line with these results, the keyword network of 2020 showed a more complex pattern than that of 2012, while still focusing mainly on cancer and reproductive health. Using topic and text analysis, we present the linkage of research keywords of publicly funded women’s health research in Korea.

Overall, women’s health research has roughly doubled in terms of the number of projects and funding, but its share in the total health funding has increased by only 17% from 2012 to 2020. This would be attributed to that absolute amount of women’s health research funding was very small compared to the total healthcare investment during the period. For example, the total budget for the Korea Disease Control and Prevention Agency for ‘Women’s Health Technology Development and Research Project,’ the only targeted research project related to women’s health, was slightly above 1.5 billion won in sum in 2021.28 Although the National Assembly audit for the MOHW’s R&D have called for the activation of women’s health research and multidisciplinary research across the life cycle since 2010, it is unlikely that national interest in women's health research has increased for the last decade.29

In the current result, the majority of women’s health research projects in Korea during the last decade were similar to those of the prior period in terms of the topics.1213 We found fewer studies on chronic diseases and conditions, mental health, adolescent health prevention and risk factors, and policies and institutions, although these subjects embrace issues having a significant impact on morbidity and mortality for Korean women.13 The dominance of breast cancer research in the field of women’s health research appears to be attributable to several factors: public awareness of its higher incidence, the development of innovative anti-cancer drugs, a well-established research network, diverse funding resources, good accessibility to biomaterials, and the active participation of patients in clinical trials.1130313233 Given the high burden of musculoskeletal disorders, diabetes, urogenital disorders, and blood and endocrine diseases in Korean women, more attention is required to diverse health issues across the life course of women.34 The lack of diversity in women’s health studies was also illustrated shown by the current result of text analysis. The networks of research keywords in both 2012 and 2020, respectively, showed a higher occurring frequency and the centrality index of “cell,” “breast cancer,” “patient,” and “development.” The importance of those four keywords has even grown in 2020, showing a much higher occurring frequency and centrality index than other keywords. However, more various keywords were emerged in 2020 than 2012; there were only two keywords with occurring frequency of 100 or more (“cell,” “breast cancer”) in 2012, whereas it reached 15 keywords in 2020. Overall, the text network analysis revealed a continued dominance of breast cancer research, despite the expansion of research on other cancers and sexual or reproductive health, and an increase in the diversity of subtopics.

Given the area of women’s health research covers gender difference and health determinants, our results highlight the paucity of health research considering sex and gender specificity in common diseases, as well as women-specific diseases or conditions. Taking sex and gender specificity into account is important for improving diversity in women’s health research. For example, clinical and epidemiological manifestations an d responses to treatment of common cancers would differ between women and men depending on health behaviors, dietary risk factors, and the sensitivity of the reproductive system.353637 In its commitment to the Gender Equality Plan, the European Commission (EC) requires all research and innovation projects funded by the EC to integrate the gender dimension.38 Since 2016, the National Institutes of Health (NIH) of the US has asked grant applicants to explain how sex and gender are factored in research designs and analyses for studies in vertebrate animals and humans.39 In reference to these cases, we suggest adding an item about the contribution of the research to the knowledge of sex or gender differences in the application for health research grants by the government, as the same preventive measures, diagnostic, and treatment protocols may have different effects or be utilized differently depending on sex.

It is noteworthy that sexual and reproductive health showed a steep increase in the number of projects and funding size, which suggests the possibility that public investment in this research field to increase the fertility rate have been carried out as the low birth rate in Korea has deepened. The MOHW have established the Health and Medical Technology Fostering Basic Plan every five years since 2012, and it included the development of responding technologies to low birth rates and population aging as a detailed task.40 Accordingly, the MOHW has invested research funds in the development of fertility preservation technology, the research for miscarriage and premature birth, or fertility-reducing disease treatment and technology.41 As of October 2017, furthermore, artificial reproductive technologies began to be covered by the National Health Insurance, which might greatly facilitate research on fertility treatments by increasing patient participation.42 Similar to the research subjects of funding from MOHW, pregnancy-related topics predominate in the research field of sexual and reproductive health in our study. The visualization of keyword networks showed that research topics were mainly focused on issues related to pregnancy, centering on keywords such as preeclampsia, preterm delivery, placenta, or prenatal diagnosis. However, providing comprehensive health services that cover not only the health of women during pregnancy but also the prevention of pregnancy or preparation for pregnancy is essential.43 World Health Organization recommends a more comprehensive approach to research on sexual and reproductive health, which requires an evidence-based, respectful, and positive approach to sexuality and sexual relations free from all types of coercion and violence.44 Reproductive health can include a wider range of issues, from the physiology of puberty, postnatal rehabilitation, cultural meanings, and vulnerable populations to unwanted pregnancies, abortion in safe conditions, and gender inequities in the local context.4546 Beyond the issue of low birth rate and pregnancy, research on women’s health in Korea should broaden its scope to utilize a comprehensive approach in sexual and reproductive health, based on women’s needs.4748

To examine research topics conducted without funding in Korea may provide insight to understand the scope of research topics that have requested public research funds. According to the prior results of analyzing women’s health studies in major nursing journals in Korea, in which unfunded studies account for about 70%, topics focused to motherhood research, menstrual issues, sexuality or sexual life, plastic surgery and violence, and other social influence on health.49 Although it was not disclosed whether studies were funded or not, 302 studies searched using ‘women’s health’ from 2010 to 2020, in Korea, had research keywords including marriage migrant woman, mental health, multicultural, female worker, etc. The authors argued that it is necessary to expand the scope of research issues to various topics by reflecting social trends and changes.50 To cover such diverse topics and expand the scope of topics in women's health research, the role of government agencies as a major funder is pivotal.33 Despite uncontrollable factors influencing research priorities and funding, public research institutions can maintain awareness of the uniqueness of women’s health and the disease burden. In the US, the Office of Research on Women’s Health (ORWH) provides funds through NIH to augment new research initiatives, and adequately address high-priority issues concerning women’s health.495152 To pursue the research priority required by women of all groups, the government agency should be able to converge the research demands from diverse interest groups and find topics that are under-studied in the field.335354555657

This study has limitations that require the findings to be interpreted with caution. First, although the search terms for women’s health research were selected in a structured manner, the search results might not be the complete list of all women’s health research. However, considering a search strategy based on the criteria of the US IOM, we believe that our analyses covered almost all eligible projects on women’s health research nationwide. Second, the classification of the research topics was based on the title and abstract, which may lead to misclassifications when they do not fully reflect the content of the project. However, given that project researchers are required to present the methodology and key findings in their abstracts, the major characteristics of the studies should be properly reflected. Third, we did not analyze the detailed process of the review and allocation of funding by governmental entities. With more detailed information on the review and decision process, we will be able to identify the factors that have influenced the scope of women’s health research in Korea.

In summary, the topics of women’s health research in Korea need to cover more diverse health challenges faced by women in varying stages of their lives. To better understand women’s health needs and include both gender and public health perspectives, the implementation of corresponding guidance in funding policies is required. Several policies can be proposed to advance women’s health research in Korea. First, the public research program should focus on topics that are the main causes of morbidity and mortality for Korean women but remain under-researched. Second, a government research agency dedicated to women's health should enhance research by setting research priorities and principles, institutionalizing communication channels with various interest groups, and building a research network with a long-term perspective.