There’s been a lot of news surrounding women’s health recently and unfortunately most of it has not been positive. I’ll start with the good news first that Scotland now has it’s first ever Women’s Health Champion, Anna Glacier. I wish her all the luck and success in her role as she has an up-hill battle from here. Unfortunately it took 18 months to appoint Anna, as the Scottish Government dragged their feet from when first announcing that they were establishing a Women’s Health Champion, in that time we’ve seen the health inequalities between men and women grow even more.
The NHS is struggling right now, there’s no two ways about it and with the backlog and ramifications of Covid nearly everyone in Scotland and the rest of the UK has seen the negative effects. Be that longer wait times, an inability to see your GP, to loved ones dying as diagnosis came too late, yet just like in any hardships women seem to be affected even more. Although men seem to suffer more of the rarest and most severe symptoms of long-covid, women are over-represented when it comes to those suffering the effect of long-covid, this is even more worrying as the inability to work can leave women in a more perilous financial situation. Among this is the disproportionate rise in women being diagnosed with late-stage cancer, when compared to men and the increase in waiting times where targets are rarely met, rendering them almost completely futile.
Women’s health has always been under-researched, under-funded and under-valued as a segment of healthcare that deserves more attention. We’ve had progress in recent years as we’ve all seen a more open attitude towards menopause, Scotland now has free sanitary products available in public settings and the tampon tax has been dissolved. Yet these headline grabbing stories are still overshadowing the bigger picture in women’s health, so how bad is it really?
Well in Hologic’s annual Women’s Health Index the United Kingdom placed 30th, it places Saudi Arabia higher than us and gave the same ranking to Kosovo and Kazakhstan. Think about it. We are in and among the top five economies in the world, overall our healthcare system dances around the top ten but when you specifically look at women’s health we drop down to 30th. The women’s health index takes into account topics such as cancer, maternal care, reproductive healthcare, violence against women, mental health and age-related issues, at no point are we in the top five best countries in any of these areas, apart from mental health as we are among the top five fastest declining. What an achievement.
This is why the Scottish Government taking their sweet time to address problems in women’s health is almost criminal. Healthcare can be unnecessarily slow to change, progress in women’s health can move at a glacier pace, especially at the monster of bureaucracy that is the NHS. This week saw the recommendation to both the UK and Scottish governments that we should introduce at home cervical cancer testing kits in a bid to increase those testing and decrease the amount of women dying every year. After several successful trials being administered it seems about time this was implemented, especially since they’ve been available in the private sector for some time, with some high-street chemists selling them for the steep price of £50.
Research is an area that can’t be under valued in health care, and often it is when it concerns women. The 2020 Pregnancy Research Review found that for every £1 spent within the NHS for pregnancy only 1p of that is for research. As it stands in the UK there is no requirement for women to even be represented in medical studies, only a suggestion that at a minimum women should be represented in trials in proportion to their frequency in the medical condition. There are so many reasons why medical research including or aimed at women can be riddled with problems, gender bias, misogyny or underfunding, it’s an issue entrenched in historical biases that often still rears its head. Unless we really look to tackle this issue trying to get better treatments, care and technologies will be slow to come by.
Yet there’s no way we can mention this without also acknowledging that different women encounter vastly different experiences when trying to access healthcare in Scotland and the UK. Socio-economic backgrounds as well as race often creates differences, these also need to be drastically addressed. Currently the state of maternity care in the UK puts Black and Asian women at a two to three times higher risk of dying during childbirth than that of white women. That again is a serious statistic but quite often when the reports come out, like this one from the Care Quality Commission the explanation as to why this is the case isn’t delved into, the very thing that could help us change this isn’t included.
The postcode lottery of health has always been prominent in Scotland, with life expectancy differing up to fifteen years between the most deprived and affluent areas in Glasgow. The term postcode lottery is often used in this way, but that makes it seem as if people have a fair chance of being lucky at birth, a very misleading phrase to dress-up the word poverty in that case. Yet just this week we’ve been reminded of the issues women can face when trying to access maternity care due to the rurality of where they live. Residents living in the Highlands and Islands of Scotland have always been accustomed to more travel than the rest of us living on mainland Scotland yet you would like to think that in this day and age when they’re trialling drones to deliver packages to the Hebrides, providing pregnant women with comprehensive care that doesn’t involve a 200 mile trip would be of a higher priority.
Sadly not, it’s getting worse in fact. This week saw a call to review the care Caithness general hospital can provide, as they’ve seen their maternity ward downgraded from consultant led to midwife led in 2016. Meaning that first-time mothers are encouraged to make the three hour trip (in good weather, four and a half in bad weather) to the nearest hospital in Inverness. What happens if there are further complications or a shortage in beds, they are transported to Aberdeen, and if the baby has a heart condition, they’re off to Glasgow. Not only is this increasing the risk of those women giving birth mid-transport but it’s a scary situation to be in, ending up several hundred miles away from family or friends, at a complete disadvantage and often out of-pocket.
Road closures, cancelled trains, rail strikes all make this a horrendously inconvenient situation worse. However, this doesn’t just affect pregnant women but those that need to see a specialist or gynaecologists, any specialist treatment for those living further than Inverness often includes a great deal of travel. You couldn’t be blamed for putting off the gynaecologist appointment or fertility treatment if it includes a nine hour round trip when you have a job, and/or a family.
In a country like Scotland it should never be expected that women need to choose between a high-risk labour or hundreds of miles of travelling, this is the 21st century if I’m not mistaken.
When talking of women’s health It would be foolish to not bring up Menopause. The subject of menopause has thankfully become a little less taboo in the past year or so. Through-out your lifetime you will either go through menopause or know someone who will, therefore this effects everyone, yet the platform for women to openly talk about how this effects their life has been lacking. A study conducted by Nuffield found that the majority of women struggled to cope with life due to menopause symptoms, making work life extremely hard, while 67% found it hard to access support and help while going through menopause.
We’ve been living in a world that pretends that menopause doesn’t exist, slowly though we’re starting to wake-up. This is evident in some workplaces that have trialled menopause support schemes, like the one at Nottingham Hospital where staff can access lighter uniforms, ask for shift changes, fans to be installed in offices, specialist support and more time to complete tasks. This applies to 24% of their staff, so by no means is this a small amount. Yet this week the government have rejected a proposal to trial menopause leave in England as well as four other recommendations formed by the Women and Equalities Committee, and although they have stated they do have ambitious plans to help, they are yet to share what that would look like. The workforce in Scotland and the rest of the UK is lacking the support to help women stay in work when they face some of the worst symptoms of menopause.
At its very worst the symptoms of Menopause can cause suicidal thoughts, yet some women in the UK are still facing the effects of a shortage of the hormone replacing drug HRT. In some cases this drug is a lifesaver, at the peak of a shortage last year people were reported to have travelled abroad to access it or trade it in carparks. I once again question if we are in the 21st century.
We are. So let’s get our act together and take a serious stance so that 51% of the population can have access to comprehensive treatments that continue to be improved upon and are backed up by a continuing flow of R&D. So women don’t have to travel hours to be seen by a specialist, wait for years to be diagnosed for something common like endometriosis or gain support for Menopause.