Why The Five & One?
Because women make up 51% of the population — and the systems that shape our health still weren’t built with us at the center. The Five & One exists to make those systems visible, understandable, and changeable.
As we begin 2026, we’re excited to be back with a new year of reporting, analysis, and impact-focused work. This week’s issue looks at how structural gaps continue to shape women’s health today: growing OB-GYN shortages, the language that determines whether diseases are taken seriously, financial incentives closing hospitals, missed signals in routine screenings, and care models testing what happens when time and education are treated as part of medicine.
Taken together, these five stories reveal a familiar pattern: the science is often there, the need is clear, but systems lag — in policy, reimbursement, and design — leaving women to absorb the consequences.
Our goal with The Five & One is not just to inform, but to connect evidence, lived experience, and accountability. These are the issues shaping where we focus our work in 2026 and how we think about change across the women’s health ecosystem.
Thank you for being here, for reading closely, and for helping build 51& into a growing community committed to systemic progress. As we start the year, we also want to share that a very limited number of lifetime memberships are still available for those who want to support this work for the long term.
01. OB-GYN Shortages Are Getting Worse
OB-GYNs are the doctors who care for women during pregnancy, childbirth, and reproductive health across the lifespan. New research shows the U.S. is heading toward a growing shortage of OB-GYNs through 2035 — a trend that could mean longer wait times, rushed appointments, and harder access to routine and pregnancy-related care, especially outside major cities.
The Breakdown:
The U.S. already has fewer OB-GYNs than women need, and the gap is expected to widen over the next decade, meaning demand will keep outpacing supply.
By 2035, nearly every state is projected to experience an OB-GYN shortage, not just a handful of regions.
Rural and non-urban areas are expected to be hit first, expanding existing maternity care deserts where people already travel far for care.
The system issue: more OB-GYNs are retiring than entering the workforce, and training new doctors takes many years, so fixes must start early.
The Breakthrough:
These shortages are predictable and could be prevented with early action from health systems and policymakers.
Solutions include training more OB-GYNs, improving working conditions, and expanding team-based care so nurse practitioners and midwives can help close gaps.
Planning now can help protect access to prenatal care, preventive screenings, and routine women’s health visits before shortages worsen.
02. A historic shift in endometriosis language
For decades, endometriosis was treated as a painful but limited reproductive condition rather than a serious disease. In late 2025, the U.S. Senate urged federal health agencies to recognize endometriosis as a chronic, whole-body inflammatory disease — a shift that could influence how much research, funding, and clinical attention patients receive.
The Breakdown:
The Senate report calls on researchers to move beyond framing endometriosis as only a reproductive issue, so studies look at the whole body.
The disease can affect multiple organs and cause ongoing, debilitating pain that interferes with school, work, and daily life.
Federal definitions shape research priorities, clinical guidelines, and funding decisions, so wording changes can re-direct resources.
Advocates say the language change is meaningful, but only a first step unless it leads to new grants, better care, and policy change.
The Breakthrough:
Recognizing endometriosis as a whole-body disease helps validate patients’ lived experiences and counters the “just bad periods” narrative.
This shift strengthens efforts to secure better diagnostics, treatments, and disability protections for those with severe symptoms.
Patients and clinicians can now point to federal language when pushing for more comprehensive care and coverage.
Source: (2) Instagram
03. Private Equity Is Closing Hospitals
Private equity firms are big investment companies that buy businesses, try to squeeze out fast profits, and then sell them off. When they buy hospitals, they often load them up with debt, cut staff and services, and sometimes walk away with millions while the hospital is left weak or shut down. This matters because when hospitals close or cut back, patients lose nearby emergency rooms, maternity care, and other services they depend on to stay healthy.
The Breakdown:
In the last 20 years, private equity firms have bought hundreds of hospitals and other health care businesses in the U.S.
Their strategy often includes piling debt onto hospitals, cutting staff and budgets, and selling off the hospital’s land and buildings for cash.
Studies have found more patient safety problems and higher risks of death in some private equity–owned hospitals, especially in emergency rooms.
When the firms are done making money, they can leave, while the hospital is stuck with debt, missing assets, and sometimes forced into bankruptcy and closure.
The Breakthrough:
Journalists and researchers are shining a light on how these deals hurt patients and communities, especially in places that already have few hospital options.
Some lawmakers and watchdog groups are pushing for rules that would make it harder for private equity to quietly strip hospitals and then disappear.
Knowing who really owns local hospitals helps communities organize, demand transparency, and fight to keep lifesaving care open close to home.
04. Your Mammogram May Have the Key to Your Heart Health
We all know the importance of mammogram screenings for the detection of breast cancer. But did you know researchers have also found that mammograms can reveal arterial calcification — a marker associated with cardiovascular disease risk in women. In a system where coronary artery calcium (CAC) scans are underutilized, this is a classic women’s health problem: the science exists, the signal is visible, and the system hasn’t caught up to act on it.
The Breakdown:
Traditional cardiovascular risk calculators were built on male populations and often underestimate risk in women, especially younger women or those without “classic” symptoms.
Coronary artery calcium (CAC) scans can identify hidden risk, but they’re often not covered by insurance, unevenly available, and rarely discussed with patients.
Research linking breast arterial calcification on mammograms to future cardiovascular disease has existed for nearly a decade and continues to be validated.
Despite this, mammograms are routinely performed without sharing potentially actionable heart-health information with patients.
The Breakthrough:
The breakthrough isn’t new technology — it’s using data already being collected.
Mammograms are widespread, trusted, and normalized across women’s health care.
Reviewing scans for arterial calcification could enable low-cost, opportunistic cardiovascular screening.
Growing use of AI-assisted mammography makes integrating this insight more feasible at scale.
05. What If the Doctor’s Visit Wasn’t Just You and the Clock?
If you’ve ever left a doctor’s appointment with more questions than answers, you’re not alone. Fifteen-minute visits were never designed for menopause, autoimmune disease, or metabolic health. That’s why the Cleveland Clinic is testing Shared Medical Appointments — a care model that brings small groups of patients together for education and treatment. It reflects a growing recognition that health isn’t just clinical — it’s contextual — and women, especially, do better when care makes space for understanding and shared experience.
The Breakdown:
Most medical visits are structured for quick decisions, not education or long-term condition management.
Women are expected to “advocate for themselves” without adequate time, context, or clinical guidance.
Health education often shifts outside the system — to Google, forums, or social media — increasing confusion and misinformation.
Clinician burnout and patient frustration reinforce each other, leading to poorer outcomes and repeat visits.
The Breakthrough:
Shared Medical Appointments replace one-patient, one-clock care with group-based visits.
Patients with similar conditions meet together in sessions facilitated by a clinician.
Care includes education, discussion, and peer learning alongside medical management.
Cleveland Clinic has shown this model improves understanding, confidence, and adherence to treatment plans.
And Your +1
January comes with big “new year new you!” energy. Or - depending on your point-of-view - “new you” pressure. We live in a culture that treats rest like a reward and stillness like failure. At 51&, we spend a lot of time talking about systems, and one of the most pervasive systems is the one that tells us our worth is tied to output — even when our bodies, minds, or lives are asking for something quieter.
The “new year” narrative leaves little room for grief, fatigue, transition, or healing. And if there’s one thing that we have learned from our community this year, it’s how many of you are here because you are in the midst of grief, fatigue, transitions, and healing.
So instead of some life hack pro tip, we have a reading recommendation for you.
In her book Wintering, Katherine May writes about seasons of withdrawal, illness, loss, burnout, and reframes them not as detours, but as necessary cycles. Winter, she reminds us, is not a problem to solve. It’s a phase to be honored.
The book doesn’t promise transformation through hustle.
It offers something rarer: relief.
Relief from the idea that you’re behind.
Relief from the pressure to bloom on command.
Relief in knowing that rest, reflection, and even retreat can be productive in their own way.