Decolonising women’s health innovation

and colleagues set out how a decolonial feminist approach to innovation could produce greater gender equality and health equity T he field of women's health innovation is growing rapidly, yet it has focused mainly on technological solutions.Despite the global scope and ambition of advocates and innovators, feminist and decolonial perspectives remain largely absent.These perspectives are vital to discover whose voices and priorities shape innovation, and to improve how the field allocates funding, directs investments, and ensures inclusive representation and leadership.For too long, communities have had "innovative" solutions imposed on them under the banners of novelty and progress, without regard for contextual fit 1 or alignment with local priorities. 2In addition to being a potential waste of often scarce resources, such interventions often reinforce power imbalances, sustaining top-down decision making and restricting opportunities for affected communities to shape the solutions that affect them.In many cases they have perpetuated, rather than dismantled, the inequities they claim to tackle.Centring decolonial feminist values in gender and health innovation is not a new idea.Where activists, community leaders, researchers, and funders have rejected exclusionary, top-down processes in favour of collective, inclusive ones, tangible improvements in health and wellbeing have followed. 3Building on that tradition, this article, part of the BMJ Collection on Women's Health Innovation (bmj.com/collections/womens-health-innovation), calls for a deliberate reimagining of how women's health innovation is defined, developed, and delivered.To understand why such a shift is necessary, it is essential to consider how the enduring structures and logics of coloniality shape health systems, research, and innovation and, in turn, the health and wellbeing of women and gender diverse people worldwide. Coloniality as a social and structural determinant of healthColoniality refers to the enduring systems of power, knowledge, and being that emerged from colonisation and which continue to shape the modern world.These structures extend far beyond formal colonial rule, operating through economic arrangements, political institutions, cultural norms, and knowledge systems that privilege certain worldviews while marginalising others.In the context of health, coloniality functions as a deep rooted social and structural determinant. 4 5It shapes which health issues receive attention and resources, whose knowledge is considered legitimate, and who holds decision making power.For women and gender diverse people, especially those in formerly colonised regions, this often means facing intersecting forms of discrimination based on factors including, but not limited to, gender, race, class, and geography.The effects are both material and epistemic.Materially, coloniality entrenches economic inequities, limiting access to resources, infrastructure, and services.Epistemically, it devalues indigenous, local, and experiential knowledge, favouring biomedical and technological approaches developed in high income settings.These dynamics are often reproduced in global health innovations that fail to critically examine their underlying assumptions and power structures, even in initiatives that claim to be inclusive or equitable.Recognising coloniality as a determinant of health makes visible the historical and systemic forces that shape inequities.It also opens the door to transformative approaches that centre the voices, priorities, and leadership of those most affected, an imperative at the heart of a decolonial feminist vision for women's health innovation.