New Approach
A life-course approach will mean the Women’s Health Strategy prioritizes women’s health at every stage of their life course. It means a conception that looks to understand women’s and girls’ evolving health and care needs over the life course, rather than a disease-oriented approach with specific life-stage interventions for particular conditions. This framework is proposed to emphasize such critical phases, transitions, and contexts associated with the promotion of good health, prevention of adverse health outcomes, and restoration of total health. Important considerations will include how certain life events or stages can influence future health. For instance, research shows that women with high blood pressure or pre-eclampsia in pregnancy are exceptionally vulnerable to an attack and stroke later in life.
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.
A life course approach also enables action on wider determinants of health, for example social, economic and environmental factors. It is important to consider such factors in the round alongside opportunities for preventative action to support women and girls in improving their health outcomes, or to reduce the risk of ill health later in life. We know that there are disparities between different groups of women in terms of access to services, experiences of healthcare, and health outcomes. A key priority of the Women’s Health Strategy will be to better understand and tackle disparities in experience and outcomes throughout women’s lives.
Visionery Document
This document, Our Vision for the Women’s Health Strategy for England, sets out what we were told in the Call for Evidence, and the key themes and areas of focus that make up our ambition. The thematic chapters set out in both the Call for Evidence, and now outlined in this Vision, were chosen because they are relevant to women’s health across the life course.
These themes are:
1. women’s voices (section 3)
2. healthcare policies and services (section 4)
3. information and education (section 5)
4. health in the workplace (section 6)
5. research, evidence and data (section 7).
Collectively, these themes set out the government’s vision for the health of women and girls going forwards. Against each theme, we have set out a summary of what we have heard in the Call for Evidence, followed by an outline of our ambition and next steps. This sets the bar for action across the health sector and wider government. We expect to be held to account against this action over the coming months. The Vision then focuses on priority areas relating to specific conditions or areas of health where the Call for Evidence highlighted particular issues or opportunities.
1. Menstrual health and gynaecological conditions
2. Fertility, pregnancy, pregnancy loss and post-natal support
3. The menopause
4. Healthy ageing and long-term conditions
5. Mental health
6. Health impacts of violence against women and girls.
As with against the themes, against each topic we have set out what we have heard in the Call for Evidence, alongside government ambition and next steps. In Spring 2022 this Vision will be followed by the Women’s Health Strategy, which will build on our vision and ambition, and which will set out in detail our plans for specific health needs and conditions that women experience at different stages.
We will bring forward concrete action both on issues that only affect women, and on issues that affect everyone but that are more prevalent in women or where women have systematically poorer outcomes. At the same time, work is underway on the government’s forthcoming Sexual and Reproductive Health Strategy. Next steps for the Women’s Health Strategy are set out in section 9 of this publication.
Women’s voices
Cultural Taboos and Stigmas
In the Call for Evidence 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. In the public survey, respondents felt more comfortable speaking about general health concerns such as diabetes or heart disease, compared with female-specific issues such as gynaecological conditions or the menopause. Respondents felt even less comfortable speaking about disability and mental health conditions. Some of these conditions are specific to women, such as postnatal depression. We also heard about are conditions that may present differently in women compared to in men, such as autism.
listening to 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. We heard concerns that women had not been listened to in instances where pain is the main symptom, for example in being told that heavy and painful periods are ‘normal’ or that the woman will ‘grow out of them’. We have also heard concerns from respondents that some healthcare professionals have reportedly used gendered stereotypes around women’s wish for children in order to deny procedures such as sterilisation.
Women’s voices in healthcare system
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.
Our ambitions
⦁ women feel comfortable talking about their health, whether that be with healthcare professionals, friends or family; women know when they can seek help for symptoms; and women’s health issues are no longer taboo topics.
⦁ women feel better listened to and heard by healthcare professionals, and women’s concerns and symptoms are taken seriously.
⦁ women’s voices and experiences are represented and listened to at all levels and in all areas of the healthcare system.
Healthcare policies & services
What we’ve heard
Women’s reproductive health services over the life course
In the Call for Evidence we heard the importance of women being able to access services that meet all their reproductive health needs, from the routine (for example choosing the right contraception) to the more specialist (for example specialist endometriosis care). We heard that it can be difficult for women to access the reproductive healthcare services they need in ways that are convenient to them. We also heard concerns about geographical variation in access to some services, for example menopause clinics and NHS fertility treatment. We heard concerns that the pandemic made it more difficult to access some services such as cervical screening or procedures for long-acting reversible contraception (LARC). We also heard of some positive changes, for example the offer of virtual or telephone appointments alongside face to face appointments.
Incorporating Women’s Health in Policy and Service Development
In the Call for Evidence we heard concerns that services for specialities or conditions which only or primarily affect women, for example reproductive health services, are perceived to be of lower priority compared to other services. However, in the public survey respondents also provided examples of a number of general health conditions where they thought that services could be improved, such as fibromyalgia, myalgic encephalomyelitis or chronic fatigue syndrome, irritable bowel syndrome, autism, ADHD, and mental health services. We also heard that some general health conditions, for example attention deficit hyperactivity disorder (ADHD) and autism, are sometimes perceived as ‘male’ issues, and that women can face additional barriers to referral and diagnosis in these areas as services do not feel designed for women.
Ensuring equitable access to services and reducing disparities in health outcomes between women
In the public survey we heard that 40% of respondents said that they, or the woman in mind, could conveniently access the services they needed in terms of location, and 24% said the same in terms of timing. In the Call for Evidence written submissions, we heard that some groups of women face additional barriers regarding access to and experience of services, and that there are disparities in health outcomes. For instance, we heard that women with physical or learning disabilities can face additional barriers in accessing services such as contraception and cervical screening. We also heard that women in particular settings, such as the criminal justice system, face additional barriers to accessing healthcare, and have poorer health outcomes compared with women in general. We heard about disparities in health outcomes between different demographic groups.
Our ambitions
⦁ women can access services that meet their reproductive health needs across the life course, and women’s experiences of services and reproductive health outcomes are improved.
⦁ National healthcare policy and services consider women’s needs specifically, and by default
⦁ All women, including those with additional risk factors or who face additional barriers in accessing services, have equitable access to and experience of services, and disparities in outcomes are reduced
Information for women and wider society.
In the Call for Evidence we heard of the importance of high-quality information provision, from school education for girls and boys, through to support for adults. With regards to school education, respondents to the public survey placed importance on making sure that the relationships, sex and health education (RSHE) curriculum is taught to both girls and boys, so that boys are also educated on female health conditions. Respondents who stated that they were teachers also reflected that they were not adequately equipped to teach certain topics effectively, with suggestions including the introduction of modern teaching tools (for example webinars). While we heard that the NHS website is a useful and trusted source of information, some women and organisations highlighted that it would be helpful if this website had a central area signposting up-to-date information on various aspects of women’s health. We also heard calls for more information on certain women’s health conditions, for example adenomyosis. More widely, we heard calls for more trusted and easier to understand information regarding a range of women’s health issues such as fertility, the menopause, gynaecological conditions and gynaecological cancers. We heard that this information should be prepared and distributed in formats that are accessible in a range of ways, such as blogs or social media.
Education and training for healthcare professionals
Through the Call for Evidence we heard about the need for healthcare professionals to receive better education and training on women’s health conditions. This includes female-specific conditions and treatment options, in particular the menopause and hormone replacement therapy (HRT). We also heard about a lack of awareness amongst some GPs of the causes of infertility, miscarriages and their relationship with infertility, and the reasons for in vitro fertilisation (IVF) failure.
There was emphasis on education for GPs in particular, as GPs are often the first port of call for many women, and gatekeepers to other services. Some responses called for compulsory training for GPs on women’s health, and noted that this would create an empathetic, supportive and informed environment in which women would feel comfortable coming forward to discuss issues.
Our Mission
⦁ Women have access to high-quality information and education, starting from childhood and continuing through to adulthood, to empower women to make informed decisions about their health and wellbeing across the life course.
⦁ Women receive accurate and up-to-date advice from healthcare professionals, supported through high-quality training for professionals, ensuring that clinical guidelines represent the latest evidence on women’s health conditions and consider differences between men and women; and healthcare professionals are supported in implementing these guidelines
Health in the workplace
Through the Call for Evidence we heard that health conditions and disabilities can impact women’s experience in the workplace, and can increase women’s stress levels and impact their mental health and productivity. In order to support women with particular conditions, respondents called for a continued uptake of flexible working arrangements which, for some, were not available prior to the pandemic.
Another theme highlighted the importance of raising awareness and understanding of women’s health in the workplace, as well as of normalising discussions surrounding this topic. Organisations highlighted the need for more conversation on taboo topics including periods, and increased dialogue on the impact of the menopause at work to ensure that women can remain productive and supported. We also heard many examples of good practice, whereby employers have worked with employees and external experts to introduce new workplace policies and other support, and have encouraged open conversations in the workplace.
Finally, on average just 11% of respondents to the public survey said that they were aware of any provision of policies and/or protection by their current or previous workplace regarding domestic abuse. This dropped to 5% for respondents in the private sector, marking the need to progress this further.
Menstrual health and gynaecological
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.
Health Consequences of Violence Against Women and Girls (VAWG)
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.
Developing the Women’s Health Strategy
Throughout this document, we set out our Vision for the Women’s Health Strategy. This Vision introduces a new strategic framework for women’s health based on a life course approach and five key themes that link different sections of women and girls’ health and various conditions and issues arising in life.
The action outlined in this Vision is a first step in our continued commitment to improving health experiences and health outcomes for women and girls as part of reducing health disparities in women.
In line with this Vision, we will publish a Strategy that details more detailed implementation plans in relation to each of the themes, and specific health needs and conditions. It will contain specific proposals on issues that affect only women and girls, and those that affect all, where there are differences for one sex or the other in terms of prevalence, experience, or outcome.
