Yesterday, the long-awaited Women’s Health Strategy for England was published – the first document of its kind. The strategy itself is, ultimately, a substantive, but much needed, health related menu of all things ‘female’*. And yet we cannot help but wonder… why has it taken so long? Not to downplay this momentous day, but immense fanfare surrounding its launch in the media makes it even clearer how much has been ignored for so long.
In fact, the newly-appointed health minister states as much in the foreword, recognising that “there are far too many cases where women’s voices have not been listened to”. We can take it as an important indicator that, in the current political climate, the Government decided to publish the Strategy swiftly – or at least not delay further. This is despite other important publications, such as the Health Disparities White Paper, being delayed. The statement of intent is clear; women’s health must be a priority no matter who the next Prime Minister is.
The strategy sets a 10-year timeframe, recognising that achieving its ambitions requires long-term cultural and system changes. How it is implemented will require coordinated effort and commitment from those across the health and care landscape – including the NHS, local authorities and social care. Especially in an NHS facing ongoing, existential system pressures, workforce gaps and no foreseeable uplift in funding.
So, what’s good?
The recognition of the many different stages and specific health challenges women may face is a massive step forward, and long overdue. And it was welcomed by many individuals, groups and organisations publishing statements and posting on social channels yesterday. The long list of announcements is broad… pregnancy loss certificates, improvements for fertility services (including for female same-sex couples), specialist endometriosis services, a definition for trauma-informed practice in health settings, compulsory training for all new doctors (from 2024/25) on women’s health… to name but a few.
The commitment to all children receiving education on women’s health will have a substantial impact on shifting institutionalised negative behaviours, taboo and stigma in years to come. Taskforces focussed on tackling maternity disparities and menopause-related challenges will ensure laser focus on these important health areas – and action has also been promised on sexual health more broadly, with confirmation from Health Secretary Steve Barclay that a Sexual Health Strategy is due in the Autumn.
The additional focus on the importance of ‘voice’ is also hugely welcome, if not unexpected. The Strategy acknowledges the importance of primary care in the journey many women face by announcing urgent research by the National Institute for Health and Care Research (NIHR) into healthcare professionals’ experiences of listening to women in primary care, with a focus on menstrual and gynaecological symptoms. This exercise is intended to ensure women’s voices inform policy; again, the intention will be to help tackle the well-trodden taboo and stigma often attached to certain aspects of women’s health – particularly the reproductive aspects such as periods, endometriosis, menopause and pelvic floor issues. This is to be boosted with broader investment into research on women’s health, with a new NIHR policy research unit on reproductive health, an area with a myriad of challenges. The focus on unpicking these challenges to find solutions, as opposed to simply accepting ‘it’s hard to do’, is vital.
And, of critical importance, it recognises the need for a holistic approach to women’s health,. Rather than looking at single interventions, it commits to embedding hybrid and wraparound services – an approach that will be enabled with the expansion of Women’s Health Hubs around the country. Moving through the often multifaceted phases of ‘womanhood’ is a complicated and personalised process, with many different moving parts impacting the ability to engage with one’s own care. The more cohesive the approach from the health system, the easier it will be for women to access the care they need when they need it.
Some key considerations
Importantly, the Strategy acknowledges the impact of broader societal challenges in terms of disparities in health outcomes for women. The Strategy’s accompanying press release highlights steps that have already been taken by the Government, such as banning the availability of Botox and cosmetic fillers to under 18s, banning virginity testing and hymenoplasty, investing in family hubs and the Start for Life programme, abolishing the tampon tax, and offering protection against domestic abuse.
However, the need for a truly intersectional approach that considers wider socio-economic inequalities is key. For example, women are generally already under-represented in clinical trials, and the figures only get more concerning when broken down by demographics; those from LGBTQIA+ or ethnic minority communities are even less likely to be represented. Meanwhile, racial bias in pain assessment and treatment is well documented, with women from ethnic minority backgrounds being less likely to have their concerns listened to by doctors and, subsequently, have higher maternity mortality rates. These issues are longstanding and unacceptable.
It is vital that the roll-out of the proposed initiatives consider the interplay between sex and other demographics. This is, overwhelmingly, a medically-minded women’s health strategy – and addressing the wider systemic inequalities that affect health outcomes should not be left behind.
It also cannot be ignored that the COVID-19 pandemic exacerbated existing issues in women’s health, with the Royal College of Obstetricians reporting that gynaecology waiting lists have grown by over 69% across the UK since the start of the pandemic. In the context of a health system still recovering from COVID-19, a cohesive approach is critical to ensure NHS workforce and capital requirements can be met to turn these initiatives into reality on the ground.
With the FemTech revolution already well underway, the impact of increased research into women’s health could create an exponential shift in women and girls’ management of their health. However, clearly, how this will be implemented in practice is key to any progress. There has been decades of underfunding into women’s health-related research, and this is not something that can be transformed overnight.
Education is also critical – embedding improved education on women’s health for both medical students but also in school will be a platform to create a long term shift; and expediting these would have huge value for the empowerment of women in managing their own health.
It goes without saying that the devil is in the detail and the practical implementation of these important announcements is what really matters. As the NHS Confederation points out, the improvement of health outcomes for women requires “fundamental change in how the NHS provides care to women and listens to their needs”. And clearly there is a core question about how all of this will be funded – not only up front but, as pointed out by the Local Government Association, sustainable funding for public health is key to the success of the Strategy.
With the recent Roe v. Wade decision in America unsettling many of us, this does feel like a welcome, and very timely, commitment from the Government to the empowerment of women when it comes to their health. Now it is about turning words into reality.
*NB. A note on terminology; For brevity throughout this blog, we largely speak of “women” and “women’s health”. Of course, it is not only people who identify as women for whom it is necessary to access these health and reproductive services and who are affected by the issues raised here. We believe that progress in the space on these issues will also positively influence the lives of individuals whose gender identity does not align with the sex they were assigned at birth.
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