Care Pathways Shape Women’s Health Gaps

Care delivery gaps remain a major contributor to poorer health outcomes for women, particularly when screening, diagnosis, referral and follow-up are inconsistent. A 2026 analysis from the World Economic Forum and the McKinsey Health Institute links stronger sex- and gender-appropriate care delivery with a potential reduction of 26 million disability-adjusted life years globally by 2040. Focusing on breast arterial calcification, pregnancy-related cardiovascular risk and perinatal depression, the CARE framework sets out one approach to improving care through clinical touchpoints already used across many health systems.

Where Care Pathways Break Down
Care delivery gaps cluster around missed screening, delayed diagnosis and insufficient treatment. Underscreening includes missed opportunities for early detection of cancer, mental health conditions and cardiovascular risk, as well as limited standardisation in screening guidance. Underdiagnosis includes delayed recognition of conditions such as heart attack when women present with atypical symptoms, alongside limited sex- and gender-specific diagnostic criteria. Undertreatment includes lower use of guideline-recommended interventions, delays in escalation and limited provider awareness of available care options.

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The three pathways show how gaps arise across different parts of care delivery. Breast arterial calcification, visible on standard mammography, has links to future cardiovascular risk, yet reporting and referral pathways remain inconsistent. Pregnancy complications such as preeclampsia and gestational diabetes indicate elevated long-term cardiovascular risk, but postpartum monitoring and lifelong follow-up remain fragmented. Perinatal depression can impair daily function during and after pregnancy, while screening and referral vary across countries and care settings. Existing clinical encounters can identify risk, but they do not always connect women to timely prevention, diagnosis or treatment. Cardiovascular diseases account for the largest share of care gaps for women, followed by cancer, gynaecological conditions, maternal disorders and mental health conditions.

Making Screening and Follow-Up More Consistent
The CARE framework starts with stronger clinical evidence. More evidence is needed to establish best practices that reflect sex-based differences and local populations. For breast arterial calcification, limited consensus remains on scoring, reporting and integration into cardiovascular risk assessment. For pregnancy-related cardiovascular risk, preeclampsia and gestational diabetes are recognised as risk enhancers, but optimal postpartum assessment and long-term monitoring remain unsettled. Pregnancy complications are not integrated into cardiovascular disease calculators such as the American Heart Association’s PREVENT or HeartScore, recommended by the European Society of Cardiology, despite evidence supporting their relevance.

Aligned care and integrated referral pathways form another priority. Mammography currently focuses on breast cancer screening, so follow-up based on breast arterial calcification findings often lacks defined ownership. Responsibility for postpartum cardiovascular risk monitoring after adverse pregnancy outcomes may also fall on patients themselves. In perinatal mental health, limited collaboration between obstetric and psychiatric care can prevent sustained support. Clear reporting standards are also central. Breast arterial calcification is not routinely quantified or included in mammography reports. Obstetric and primary care records may not feed into long-term cardiovascular risk profiles. Perinatal depression screening may rely on informal conversations rather than clinically validated tools.

Adapting Care Models to Local Systems
Implementation depends on health system capacity, digital infrastructure, access to care and financing. Practical steps can include expanding access to mammography, increasing cardiovascular risk assessment for pregnant women with preeclampsia or gestational diabetes and introducing screening tools for perinatal depressive disorders. More advanced models integrate risk assessment into routine care and connect obstetrics, primary care, cardiology, radiology and mental health services.

Several examples point to the importance of local adaptation. A Portuguese assessment of more than 2,000 women identified positive depression screening in 10%, with 48% refusing psychiatric referrals. In Austria, a 2025 assessment found that one-third of healthcare providers counselled women on cardiovascular risk reduction only when known cardiovascular risk factors were present, while 11% said they did little to no counselling because of lack of time. In Canada, more than 57% of provider respondents said they did not receive or were unsure whether they received, specialised training in perinatal mental health. In the Netherlands, research initiatives have supported further understanding of cardiovascular health in women, including those with preeclampsia and other pregnancy complications. These examples underline the need for pathways that account for workforce capacity, referral structures, patient engagement and available infrastructure.

Women’s health care delivery gaps remain concentrated in screening, diagnosis, treatment, referral and follow-up. The CARE framework provides a structured way to address those gaps through stronger evidence, integrated pathways, clearer reporting and patient-centred engagement. Breast arterial calcification, pregnancy-related cardiovascular risk and perinatal depression show how existing touchpoints can support earlier intervention when clinical information flows into action. Better care delivery can improve outcomes, reduce avoidable costs and support system planning, while using pathways and infrastructure that many health systems already have in place.

Source: McKinsey Health Institute

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