A plan for women’s health

The updated Women’s Health Strategy for England was launched in August 2022, with the previous version launched in July then withdrawn in August. HB takes a look at the strategy and talks to those working in women’s healthcare

When the Women’s Health Strategy for England was launched, then secretary of state for health and social care Steve Barclay and then minister of state for health Maria Caulfield said: “This country’s health and care system belongs to us all, and it must serve us all. However, sadly, 51 per cent of the population faces obstacles when it comes to getting the care they need.

“Although women in the UK on average live longer than men, women spend a significantly greater proportion of their lives in ill health and disability when compared with men. Not enough focus is placed on women-specific issues like miscarriage or menopause, and women are under-represented when it comes to important clinical trials. This has meant that not enough is known about conditions that only affect women, or about how conditions that affect both men and women impact them in different ways.”
    
In the ministerial foreword, they highlighted disparities in women’s health across the country, including a smoking during pregnancy rate of 1.8 per cent in Kensington compared to 21.4 per cent in Blackpool.
    
They also said that women’s voices are not listened to and in the call for evidence, 84 per cent of respondents felt this was the case.

Goals
The Women’s Health Strategy for England is the first of its kind and aims to set out how to improve the way in which the health and care system listens to women’s voices and boost health outcomes for women and girls.
    
The Strategy has used the call for evidence, which was published last year and received almost 100,000 responses, as it base.
    
The Strategy covers a period of 10 years and includes commitments to improve the health of women – these include a plan to transform women’s health content on the NHS website, a definition of trauma-informed practice for the health sector and plans to increase female participation in research.

Women’s health ambassador
Professor Dame Lesley Regan has also been announced as the women’s health ambassador for England. Through this role, she will support the implementation of the strategy.
    
Dame Lesley said: “I am honoured to be taking up the position as the first Women’s Health Ambassador for England. Having spent my career working with and caring for women, I see this newly created role as a unique opportunity to ‘get it right’ for women and girls.
    
“In the 2014 chief medical officer’s annual report ‘The health of the 51 per cent: women’, we identified the widening disparities for girls and women during their adolescent, reproductive and post-reproductive years. The issues raised then remain relevant today, and in some cases health disparities have widened and been further exaggerated by the pandemic. The Better for Women report published in 2019 by the Royal College of Obstetricians and Gynaecologists highlighted the need to adopt a life course approach, emphasising the importance of preventative health interventions, instead of focussing on the treatment of established disease.
    
“This first Women’s Health Strategy for England is the next step on the journey to reset the dial on women’s health. The call for evidence, which informs the ambitions of the strategy, reiterates what I hear repeatedly from women: that our healthcare systems are failing them because NHS services are not designed to meet women’s day-to-day needs.”
    
Dame Lesley said that her priorities will be to tackle health issues that affect most women for long periods of their lives, this includes menstruation, contraception, pregnancy, miscarriage and menopause.
    
Though these health issues affect trans, non-binary and other gender diverse people, only the term “women” is mentioned in the strategy.
    
According to the document: “While women in the UK on average live longer than men, women spend a significantly greater proportion of their lives in ill health and disability when compared with men. And while women make up 51 per cent of the population, historically the health and care system has been designed by men for men.”
    
This means there are gaps in data and evidence, and not enough is known about conditions that only affect people with uteruses, such as menopause and endometriosis. It also means that we don’t know enough about how conditions that affect all genders, affect different genders in different ways, such as cardiovascular disease or dementia.
    
The Strategy has the ambition that within the next 10 years, the strategy will have boosted health outcomes for all women and girls and radically improved the way in which the health and care system engages and listens to all women and girls. This will be achieved by taking a life course approach, focusing on women’s health policy and services throughout their lives, embedding hybrid and wrap-around services as best practice and boosting the representation of women’s voices and experiences in policy-making and at all levels of the health and care system.

Six-point plan
The strategy has a six-point long-term plan for transformation change, which as stated in the document is as follows:
    
“Ensuring women’s voices are heard – tackling taboos and stigmas, ensuring women are listened to by healthcare professionals, and increasing representation of women at all levels of the health and care system.
    
“Improving access to services – ensuring women can access services that meet their reproductive health needs across their lives, and prioritising services for women’s conditions such as endometriosis. Ensuring conditions that affect both men and women, such as autism or dementia, consider women’s needs by default, and being clear on how conditions affect men and women differently.
    
“Addressing disparities in outcomes among women – ensuring that a woman’s age, ethnicity, sexuality, disability or where she is from does not impact upon her ability to access services, or the treatment she receives.
    
“Better information and education – enabling women and wider society to easily equip themselves with accurate information about women’s health, and healthcare professionals to have the initial and ongoing training they need to treat their patients knowledgably and empathetically.
    
“Greater understanding of how women’s health affects their experience in the workplace – normalising conversations on taboo topics, such as periods and the menopause, to ensure women can remain productive and be supported in the workplace, and highlighting the many examples of good practice by employers.
    
“Supporting more research, improving the evidence base and spearheading the drive for better data – addressing the lack of research into women’s health conditions, improving the representation of women of all demographics in research, and plugging the data gap and ensuring existing data is broken down by sex.”

Reception
Following the launch of the Women’s Health Strategy for England and the appointment of Dame Lesley Regan as Women’s Health Ambassador, we asked those who work in women’s health or connected industries what needs to be done to tackle the gender health gap.


Bloody Good Period
Bloody Good Period, a charity that campaigns for menstrual equity and provides period products to those who can’t afford them and menstrual education to those less likely to access it, said: “There is a significant gender health gap around menstruation. Rising numbers of women and people who menstruate are unable to access period products, and strong shame and stigma continue to surround this entirely normal bodily function - with huge consequences. This is entirely missed by the Women’s Health Strategy, which only discusses menstruation as it relates to medical conditions. It talks about endometriosis, fibroids, and heavy menstrual bleeding - all of which of course are vital to recognise and address. But the strategy doesn’t consider the everyday, wide-ranging impact of menstruation - on education, employment, finance, activity, inclusion and much more.
    
“It also fails to acknowledge the growing issue of period poverty. One in eight feel it’s likely they won’t be able to afford period products in the next year. BGP is seeing a 150 per cent higher demand for period products than this time last year. The cost-of-living crisis will only make this worse - yet period poverty is hardly mentioned in the strategy.
    
“For the people we work with, navigating the ever-increasing cost of period products (which have risen 57 per cent in price in recent months), as well as balancing the shame, stigma and taboo society places on menstruation, is a monthly reality. The system is rigged against those who menstruate. Without acknowledging this, we cannot hope to overcome the gender health gap.
    
“At Bloody Good Period, we believe the following steps need to be taken in order to ensure that menstrual equity is achieved:
    
“Universal, free period product provision. Currently, those who menstruate are being taxed because of a normal bodily function. The current measures put in place by the government (school’s provision program, removing VAT on period products, free products via the NHS) are failing to meet the huge levels of need. The Women’s Health Strategy needs to address this, with clear deliverables.
    
“Increase the quantity and quality of menstrual education. This is something which the Women’s Health Strategy set out to achieve - but only focuses again on menstrual health conditions rather than the basics of menstruation. We need everyone in society to understand the reality and impact of periods, so we can develop policies to support the needs of women and people who menstruate.
    
“Eradicate shame, stigma and taboo. This is something activist organisations such as Bloody Good Period have already been doing, without a budget or governmental support, for years. We know there is both need and appetite for periods to be seen as completely normal. Ensuring that employers and educational institutions play a role in this normalisation will be key to its success.
    
“In 2019, the UK Government made a commitment to ending period poverty and shame by 2025. The Women’s Health Strategy should have been its action plan for delivering this commitment, and while commendable in many ways, it ultimately falls short. We urge the UK Government to acknowledge growing period poverty as a serious issue, and to recommit to its vision for 2025, with the right resources, community engagement and deliverables also in place.”

Endometriosis UK
Endometriosis UK is a charity that campaigns to ensure those with endometriosis get access to the right care at the right time. Head of Campaigns and Communications Faye Farthing said: “The New Women’s Health Strategy for England is long awaited and much needed for the endometriosis community. There is much to be welcomed in the Strategy, but there are also notable gaps.
    
“We welcome the commitment within the Strategy to reduce the time it takes to get a diagnosis of endometriosis. It currently takes an average of 8 years to get a diagnosis of endometriosis in the UK – a statistic that shockingly hasn’t changed in a decade. The new women’s health hubs mentioned in the plan could help contribute to turning this around. Another investment area the government has promised are new Integrated Care Systems (ICSs), a promising opportunity to provide integrated pathways for those with endometriosis. However, the Government has lacked ambition in its commitment to reducing diagnosis times. We are disappointed that a timeframe has not been committed to, unlike the Scottish Government’s Women’s Health Plan, which took up our recommendation target of less than a year, by 2026. The new ICSs are also only ‘recommended’ rather than mandated, leaving it up to individual NHS Trusts to incorporate these within service plan strategies. This could lead to varying degrees of implementation and therefore service quality across England. “We are also pleased that the Government has called on NICE to update its guideline on endometriosis – a guideline which, if updated to address the gaps within it such as ensuring those with endometriosis outside the pelvic cavity have access to the right care, and all those with the disease can access mental health support if needed, could, if properly implemented by healthcare practitioners, improve care for the 1.5 million women and those assigned female at birth with the disease.
    
“A glaring omission from the Strategy is a lack of dedicated funding on how to ensure there is the right resources and capacity to deliver the plan. We know that there are geographical disparities in how endometriosis care is provided, which has become even more prevalent since the pandemic began. The NHS continues to be under huge pressure, and the Government have a responsibility to ensure that the capacity is there to ensure those with endometriosis are not left behind, and that the NHS has the resource it needs.
    
“Inclusivity is also vital. It is widely recognised that transgender and non-binary people, as well as other minoritised groups, experience additional barriers to accessing healthcare. Endometriosis UK is disappointed in the use of non-inclusive language, and endometriosis services must always be welcoming to those who were assigned female at birth but who do not identify as a woman.  
    
“We would also have liked to have seen a commitment to invest in endometriosis research. For the 1.5million women and those assigned female at birth with endometriosis, research is vital to improving all aspects of living with the disease. There are huge barriers in accessing care due to a lack of government investment into endometriosis research. We do not know the cause of the disease, treatment options are limited, and there is currently no cure. Investment in research is vital to turning this around.
    
“To summarise, the Women’s Health Strategy for England is a step forward. It comes at a critical time when waiting times are soaring, and the average diagnosis time remains a shocking 8 years. We now look forward to working with the Government and Dame Lesley Regan to ensure that all those with endometriosis or suspected endometriosis receive the right care at the right time. “


Stowe Family Law
Gemma Davidson, a senior associate at Stowe Family Law, who also has a masters degree in medical ethics said: “The government’s strategy on women’s health acknowledged that there is a significant data gap. Historically medical research has not adequately considered the different health needs of men and women and crucially women’s reproductive health. In years gone by topics such as miscarriage, inf ertility, abortion, endometritis, and the menopause were taboo; partly due to social stigma and because our health system did not understand women’s needs. In addition women’s health needs have evolved over time, partly as a reflection of social and economic change but also due to advances in assisted reproductive technology providing women with a greater perceived choice of options. Our health system however has not kept pace with such changes, consequently the day-to-day experience of women receiving health care services now requires investment and improvement.
    
“The government’s strategy focuses upon the need for research, investment and change in our health care system. However, I am not a medical professional, nor am I a politician instead I see this from the viewpoint of a lawyer and a woman. I have over 15 years of experience practicing as a family solicitor, have a Masters in Medical Ethics and specialise in surrogacy and fertility law.
    
“I advise and support an increasing number of people who have started or are now looking to have a child via surrogacy, IVF, donor conception, as a single parent by choice or with a platonic co-parenting arrangement. A keystone of our laws on health care is the concept of consent and respect for the autonomy of individuals. The law does so in the context of a right to a private family life. There is a tension between our reproductive laws and the impact that has upon a person’s options for starting their family.
    
“The repeal of Roe v Wade in America sent shockwaves across the pond and consequently our own abortion laws were discussed in the House of Commons and across the media placing a spotlight on reproductive health law.  This act is now over 50 years old and therefore not without the need for review considering medical advancement and societal change. The Human Fertilisation and Embryology Act 2008 and the Surrogacy Arrangements Act 1985 are now over 20 years old, which in the landscape of important medical advancement in recent years is significant. Consequently, when these issues go before the Court, the law can be insufficient leading to complicated case law and more calls for reform. The Law Commission’s consultation paper on surrogacy laws to protect surrogates, intended parents and the child commenced in 2019, but the draft bill is still awaited and is now expected in autumn this year. It is anticipated that the changes will include the intended parents being the legal parents at birth, rather than the surrogate. Legal parenthood across reproductive and fertility laws is particularly complex, with relationship status and method of conception impacting upon who is recognised as a legal parent. For example, while the strategy comments on removing costs barriers to artificial insemination for same sex female couples if such a couple avoids the costs of a fertility clinic via artificial insemination at home they must be married or in a civil partnership for the woman who does not carry the child to be recognised as the legal parent at birth.
    
“The tension between our laws and our private life creates an intrusion. Many people do choose to seek advice and they are wise to do so in such a complicated area of the law. In other circumstances people seek advice when things unfortunately go wrong, for example when an intended mother who (unlike the surrogate) is biologically linked to a child cannot obtain a parental order which would legally recognise her as the child’s mother because she did not meet the law’s criteria or a same sex female couple who find that only one mother is legally recognised due to their relationship status and method of conception.
    
“The strategy is a start, but it is not the full picture.”

While the Women’s Health Strategy for England is a step in the right direction, it is clear there is still much to be done to reduce the gender health gap and ensure women and those assigned female at birth get access to the healthcare they need.

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