Melinda French Gates left the Gates Foundation in 2024, after two decades at the organization she co-founded, but she hasn’t stopped her work in philanthropy. She’s now focused on expanding Pivotal, a group of organizations that she founded in 2015 to accelerate social progress for women and families.

On June 4, French Gates announced $215 million in additional funding to Pivotal to focus on women’s reproductive and midlife health, bringing her total support of women's health to $600 million over the past two years. She shared with TIME why she feels investing in women’s health is critical for ensuring women’s power in society.

This interview has been condensed and edited for clarity.

Why did you want to start Pivotal, even while you were at the Gates Foundation?

My inspiration for Pivotal was really wanting to make sure that we lift up all women, because women are the bedrock of society and of their families. What I know is when you lift up women, they lift up everyone else, including their families, so I want to make sure that we get to more equity for women throughout society.

Why has women’s health been so neglected and underfunded?

If you look back at scientific research or medical research, we funded things around the human body as if the man's body was the default body and the woman's was just a slight change from that. But that isn't true. We now know that men and women have very different bodies. I think you also have to look at who was moving the money—who was doing the research 50, 70 years ago. But now we have the opportunity to say, "No, no, no, let's not neglect women's health. Let's look at a woman's whole entire lifespan and make sure we're making investments on her behalf so she can live up to her full potential and do whatever she wants to do in society."

A woman can't step into her power if we neglect her health. If you think about that on the converse side, if the woman gets the right care at the right time, she can live a full healthy life and do what she wants to do, whether that's having children and raising them and working, whether that's caring for her elderly parents, whether she wants to be an athlete or she wants to be a star in her own life or if she wants to be the CEO of a company or start a business. But if you neglect her health, and she can't get the information or the tools or medicines that she needs, you put her on her back foot, and she's often leaving work, not able to care for her children in the way that she would like, not able to start the company that she would like because she's dealing with her own health conditions. That just shouldn't be, not in this day and time.

First of all, I am thrilled to see that there's more attention to midlife. Women go through their reproductive years—whether they choose to have children or not—and then we all go through this natural transition of midlife. For many women, it starts actually in their forties—sometimes their early forties—and we go through perimenopause and menopause. For too long, it was as if in society this was an invisible issue, and we didn't focus on it. When in fact, all women, 50% of our population, go through it.

There is so much work to be done on perimenopause and menopause. I don't even know where to tell people to begin. Everybody needs to chip away at a piece. The piece that I'm focused on with Pivotal is: How do we make sure that women get accurate information about what we do know about this phase of life? And how do we make sure that all providers are trained?

Where specifically do you see Pivotal making an impact?

We're signaling this is a really, really important area for women's health that has been neglected for far too long. It's been under-researched, it's been underfunded. We should have so many more tools than we have today to be dealing with this time in life. But what we're going to do is work with the Menopause Society. They are the providers of accurate information and training.

They are going to do the training to make sure we get this in far more ob-gyn residency programs, far more primary-care doctor programs, into nurses' hands. They will be the partner that gets the accurate information that we have out there to women so that everybody can access this kind of information, and not just a few women who can find the right doctor or have the right access to the health care system.

How much of the gap in women’s health care is due to a lack of scientific data because it’s been understudied, and how much is due to lack of equitable access to available knowledge or services?

I think they're different by how you segment it. In women's reproductive health, we know a lot. We know a lot about contraceptives, yet that system has been under attack—recently, by the Dobbs decision, which has caused some confusion in that area. That just shouldn't be. We know what to do in that area.

In maternal health, where you're talking about women going into clinic and giving birth—showing up before and after the baby's born—I would say a lot of that is us not knowing what to do. The implementation in the system is not done well. The way women are treated if they're on Medicaid is not a good system. Conversely, what we're learning is if you put in community health care clinics and you do wraparound services, such as mental-health services, we can keep women from dropping into postpartum depression. You can grab them, reach them early, put wraparound solutions in, and keep them from ever getting to that point. Then, the woman is healthier all the way through the pregnancy, and the baby's healthier.

In midlife, I would say we both don't have enough knowledge or tools. The research should have been started more than 50 years ago. We should have had many, many, many studies about this period of life, so that we have different tools, not just hormone replacement therapy (HRT). Then we have a lack of provider training, which is the piece I'm going to work on with this particular amount of funding.

How much ripple effect has the Dobbs decision had on access to women’s reproductive services?

Let me first say this. A woman's body belongs to her and her alone. Decisions that she's making about her health—those are private decisions. There shouldn't be a political discussion about a woman's health and a woman's body.

We're living at a time when commitment and prioritization of health in general in the U.S. is at a low. We've seen cuts to our biomedical research infrastructure. What role do you see philanthropy playing to maintain the momentum and the leading role that the U.S. has traditionally had in innovating in health?

Well, philanthropy can never, never fill the gaps that government leaves behind. One of the reasons the U.S. is a place people do want to come to get our type of health care is because we have a vibrant National Institutes of Health. We have funded it well; we have looked at the forefront of some of these biological issues for the human body, and we are bringing out new medications that people want. So to cut that back just doesn't make any sense. But philanthropy can never fill the gap on any of these issues. They're just so enormous.

What we can do is shine a light on these areas we ought to be investing in. These are models we are either setting up or seeing that can work. But then it really comes [down to] government funding these areas. Philanthropy, in my view, sits alongside government, civil society, and the private sector.

What are some of the criteria that you use to decide which projects Pivotal should support?

What rises to the top for me is who's really doing top-notch work, who's really thinking about these issues in the best possible way, who's bringing out credible information. I did a grant last year in women's health, which is part of an overall $600 million commitment, with Wellcome Leap. And we both committed money to heart disease for women. Women are facing heart symptoms, but they're going into the system and they're not diagnosed well. But Wellcome Leap has a model to come out with tools and solutions much quicker. It's a proven model by DARPA, our government defense agency.

We will also very likely take a stream of research up towards the end of the year around chronic illness, because so many women are dealing with chronic illnesses at a very high rate.

If we were to reconnect in five years, how do you hope women's health will have changed?