A new approach
The 10-year strategy aims to boost health outcomes for women and girls. Central to the Women’s Health Strategy will be a focus on women’s health across the life course. Unlike a disease-orientated approach, which focuses on interventions for a single condition often at a single life stage, a life course approach focuses on understanding the changing health and care needs of women and girls across their lives. It aims to identify the critical stages, transitions, and settings where there are opportunities to promote good health, to prevent negative health outcomes, or to restore health and wellbeing. Key considerations include the ways in which specific life events or stages of life can influence future health. For example, we know that women who have high blood pressure or pre-eclampsia during pregnancy are at greater risk of heart attack and stroke in the future. This approach has already been adopted by the World Health Organisation (WHO) and the Royal College of Obstetricians and Gynaecologists (RCOG) in their report Better for Women. The main benefit of this approach is that it allows us to intervene earlier in order to prevent negative outcomes and to improve intergenerational health outcomes, as well as to improve overall quality of life.
What Women Said
1. Taboos and Stigmas
We heard that damaging taboos and stigmas remain in many areas of women’s health. These taboos and stigmas can prevent women from seeking help and can reinforce beliefs that debilitating symptoms are ‘normal’ or something that must be endured.
2. Not feeling listened to by healthcare professionals
In the public survey, 84% of respondents said that there had been instances in which they had not been listened to by healthcare professionals. We heard that women had experienced this at every stage of the journey, from initial discussion of symptoms, to further appointments, discussion of treatment options, and follow up care. For example, in being told that heavy and painful periods are ‘normal’ or that the woman will ‘grow out of them’.
3. Women’s voices need within healthcare system
We heard the importance of listening to women at all levels of the healthcare system. This was a particular theme in some written submissions. We heard calls for more accountability and leadership for women’s health at local and national level. Some submissions also called for improved representation of women as individuals, or of women’s experiences, across different parts of the healthcare system. This included in the development of medical curriculums and training; in the design of specific healthcare services; on governance structures, for example boards; and in research career pathways. We heard about the importance of listening to individual women’s experiences and feedback, especially from groups of women who are usually under-represented in surveys and research studies.
Priority Areas identified in the Call for Evidence
1. Menstrual health and gynaecological conditions.
In the Call for Evidence public survey, menstrual health was the topic most selected by respondents aged 16-17 for inclusion in the Women’s Health Strategy, and gynaecological conditions was the number one topic selected by those between the ages of 18-19, 20-24 and 25-29. Older respondents tended to feel more comfortable talking to healthcare professionals about gynaecological conditions than younger respondents did, and also about gynaecological cancers, but only 8% of respondents felt that they had access to enough information on gynaecological conditions, such as endometriosis and fibroids. Women said that they persistently needed to advocate for themselves and to push for further investigation in order to secure a diagnosis, speaking to doctors on multiple occasions over many months or years for conditions such as endometriosis. These delays often had wider ramifications for their health and quality of life. This was representative of written submission evidence from organisations who highlighted that women with endometriosis and polycystic ovary syndrome (PCOS) report considerably long times to gain a diagnosis. Written evidence also reported that care needs can change over the life course, and that there needs to be more awareness and information on these conditions as women do not always realise that what they are experiencing is abnormal.
We will explore ways in which to improve awareness for, care of and treatment for those suffering with severe symptoms of conditions such as heavy menstrual bleeding, endometriosis and PCOS. The forthcoming Strategy will set out our plans across menstrual health, gynaecological conditions, and gynaecological cancers in more detail.
2. Fertility, pregnancy, pregnancy loss and post-natal support
In the Call for Evidence public survey, the topic of fertility, pregnancy, pregnancy loss and post-natal support was the 2nd most selected topic that respondents picked for inclusion in the Women’s Health Strategy, and the most selected topic for respondents aged 30-39. Responses to the public survey and written submissions covered a wide range of issues, including contraception, preconception health, fertility and infertility, pregnancy loss and stillbirth, support for expectant and new mothers and their partners, pelvic floor health, and patient experience and safety. Many of the written submissions in particular also spoke of the importance of continuing to tackle disparities in maternal and neonatal outcomes. Information was another key theme, with calls for more information on the causes of infertility, the likelihood of a successful pregnancy at a later age, information relating to women’s health prior to pregnancy, and the realistic success rates of fertility treatments. Another key issue raised was miscarriage and pregnancy loss. Women who responded to our public survey shared accounts of the devastating impact of pregnancy loss and the variation in the level of support available from healthcare services and employers. Finally, some written submissions also focused on the ways in which pregnancy can be a key intervention point in a woman’s life course, and the ways in which pregnancy provides an opportunity to support improvements to women’s health, for example regarding advice on smoking, obesity, and specific interventions such as postnatal contraception.
We will maintain our efforts to improve outcomes for mothers and babies, including a strong focus on reducing maternal and neonatal disparities. Improving our understanding of the underlying causes of pregnancy complications, as well as improving data collection and disaggregation, is vital in tackling these disparities. In the Strategy, we will consider how we can strengthen healthcare and workplace support for women and partners affected by pregnancy loss and other pregnancy and fertility-related issues. We will also consider the recommendations of the DHSC-commissioned Pregnancy Loss Review once published. We will work with the forthcoming Sexual and Reproductive Health Strategy to ensure that the two strategies together set out our approach to improving women’s sexual and reproductive health.
3. The menopause
In the Call for Evidence public survey, the menopause was the 3rd most selected topic that respondents picked for inclusion in the Women’s Health Strategy, and the most selected topic for respondents aged 40-49 and 50-59. In the survey, respondents reported that their comfort when talking about the menopause with friends, family and healthcare professionals was lower than when they were talking about other female-specific issues such as gynaecological conditions or pregnancy, demonstrating that for many the menopause may remain a taboo topic. In addition, only 9% of respondents felt that they had enough information on the menopause, and many responses reflected that respondents had not learnt about or been educated on the menopause until they themselves were experiencing it. Another important theme was access to treatment, where we heard about challenges in accessing high quality menopause care. Respondents reported that symptoms were not taken seriously or recognised as the menopause, and that there were difficulties in accessing Hormone Replacement Therapy (HRT), with some GPs reluctant to prescribe HRT. Women also called for more information on the menopause, and on treatment options, in particular in cases where HRT is not suitable. We also heard calls for healthcare professionals to be better educated on the menopause and HRT. This was primarily in relation to GPs as the first port of call. Some submissions also spoke of the need for all healthcare professionals, not just GPs and menopause specialists, to be well informed about the menopause. Menopause in the workplace was another key theme, with responses to the survey and written submissions calling for more support through workplace policies and other initiatives such as staff training, and many examples of best practice were submitted.
We will work to take a holistic approach to improving care and support for people experiencing the menopause and will set out our approach in the Strategy. We will work to implement recently announced reforms, including: measures to reduce the cost of and improve access to HRT, the establishment of the UK Menopause Taskforce, and the development of a Civil Service menopause workplace policy. We will consider the recommendations in the Women and Equalities Select Committee inquiry into menopause in the workplace, and the inquiry of the All-Party Parliamentary Group on menopause, when the reports are published.
4. Healthy ageing and long-term conditions
In the Call for Evidence public survey, healthy ageing was the 9th most selected topic that respondents picked for inclusion in the Women’s Health Strategy (23%), and the top topic for respondents aged 60 and over. A number of respondents to the survey also highlighted that they would like the Women’s Health Strategy to cover long-term conditions such as musculoskeletal conditions (8%) and heart disease and stroke (7%). We also heard of the importance of supporting women and girls at all stages of the life course, and of supporting women in relation to non-female specific health concerns as well as in relation to reproductive health. High-quality information to support women in making healthier choices throughout the life course and to promote healthy ageing was highlighted. Respondents also talked of the importance of recognising female-specific risk factors, for example the ways in which conditions such as gestational diabetes and hypertension during pregnancy can increase risk of health problems in later life. Many written submissions focused on the link between menopause, healthy ageing, and risk of future health issues such as musculoskeletal conditions. Some also focused on specific conditions which are more prevalent in women or where there are disparities in access to service or outcomes, such as osteoporosis. Some responses said that health in the workplace can be particular challenge for older women, who may experience menopause symptoms and other long-term conditions, and who may have caring responsibilities.
The government is committed to extending healthy life expectancy by 5 years by 2035, while narrowing the gap between the experience of the richest and poorest. The NHS Long-Term Plan also has a focus on ageing well and ensuring that older people receive the right support to help them live as well as possible. We will explore specific conditions and areas of healthcare in which disparities between men and women are greatest, including long-term conditions such as osteoporosis, and will set out this work in the Strategy. We will also work alongside other programmes of work to share insight from the Call for Evidence, and to ensure greater consideration of women’s health-specific implications.
5. Mental health
In the Call for Evidence survey, mental health was in the top five most popular topics selected by respondents for inclusion in the Women’s Health Strategy, (selected by 39% of respondents), and this was consistent across every age group. Overall, 65% of women felt, or were perceived to feel, comfortable talking to friends about mental health conditions. This dropped by 13 percentage points to 52% when talking to family members. Only 34% of respondents said that they, or the woman they had in mind, had access to enough information on mental health conditions; however, this varied by age, gender identity, and health status. Mental health was also a common example used when respondents were asked to give an example of an area in which they felt that they had not been listened to by a healthcare professional. We heard from respondents that mental health should be given equal consideration to physical health, and that a focus should be given to disparities to access and experiences of mental health care. Responses also highlighted the impact of domestic abuse and violence against women and girls (VAWG) on the mental health of women across the life course, and the ways in which this intersection should be addressed. Many respondents flagged that they would like to see improved access to mental health services, and that they had struggled to access mental health services and support during the pandemic. More specifically, respondents highlighted that better mental health support in the workplace would help them, or had helped them, to reach their full potential.
We recognise that mental health is a key issue for women, which intersects across the whole life course. In the forthcoming Strategy we will set out our broader approach and aim to examine further the ways in which differential factors such as sex, pre-existing mental or physical health conditions, or ethnicity may impact the likelihood of a woman developing a mental health condition, and the outcomes they experience.
6 The health impacts of violence against women and girls (VAWG)
What we’ve heard In the Call for Evidence survey, the health impacts of violence against women and girls was the 8th most selected topic that respondents picked for inclusion in the Women’s Health Strategy (30%). For those who belong to the mixed/multiple ethnic group, and those who identify with a gender different to their sex registered at birth, and those in younger age groups (aged 16-17, 18-19, 20-24 and 25-29), the health impacts of violence against women and girls featured in their top five topics selected for inclusion in the Strategy (rather than the menopause, which took precedence for other groups). Respondents highlighted that the effects of domestic abuse and VAWG on women’s health are wide ranging and extensive, and can have long-term impacts on an individual’s physical and mental health. We also heard that health settings should be a trusted environment which provide a primary interface for victims and survivors to access support. However, in the public survey, only 9% of respondents felt that they had enough information about specialist NHS services such as female genital mutilation (FGM) clinics or sexual assault referral areas. We heard from organisations that access to services for domestic abuse survivors is lacking, and that more local, free services are needed. We also heard from organisations that women who have experienced sexual violence and abuse may have a range of health needs, and that these may vary depending on their ethnicity, disability, income, age and sexual orientation.
In the Strategy we will set out our plans to build the evidence base on the impacts of trauma-informed practice and to better support victims of VAWG. We will also take forward work to consider the ways in which workplaces can be made more supportive and safer for women and other victims of violence and abuse. We will continue to implement our commitment to ban virginity testing through the recent government amendment to the Health and Care Bill. We will also commit to introduce legislation to ban hymenoplasty at the earliest opportunity, following the recommendations of the Expert Panel on Hymenoplasty which we established to investigate this procedure.