Has the Women’s Health Strategy listened to what women really need?

The Women’s Health Strategy promises to address the poor experiences and worse health outcomes that women endure. The underlying cause of these issues is that the health system has historically been built by men for men. Consequently, women are often not listened to or believed by the health and care system. So, the crucial question is, will this strategy change the culture in the NHS of women not being listened to about their health and wellbeing?

Importantly, the strategy is underpinned by the findings of a listening exercise that generated nearly 100,000 responses from women across England. This exercise was an important step in grounding policy in the experience of women and issues they identified, for example the focus on endometriosis, which despite impacting 1 in 10 women has seen alarming waits for diagnosis and treatment, or the welcome decision to remove additional barriers to fertility services that female same-sex couples face. Beyond specific measures like this and a wide range of ambitions, commitments and priorities for action, it calls for a reset in how the health and care system listens to women in order to boost health outcomes. The strategy openly admits it doesn’t have all the answers yet and there are some gaps and missed opportunities to embed listening to women’s voices going forward. Embedding women’s voices requires further work, and mechanisms to do this should be designed with and for women.

'There needs to be a broader emphasis on addressing the intersectional inequalities of being a woman...'

While the strategy has engaged with women as service users, it’s not yet engaged with health and care professionals. As a result, the strategy admits ‘it was not always clear why [women not feeling listened to] occurs or what the best solutions are for improving women’s experiences’. Consequently, there are very few initiatives focusing on ensuring women are listened to by health professionals. Compulsory training on women’s health for undergrads and postgrads is positive step forward. However, there is less focus on the much bigger task of changing the culture of the entire workforce. And the dynamic between health professionals and women needs to change sooner rather than later.

The strategy also acknowledges the need to do more on listening to women from marginalised groups. It acknowledges that the disparities between different groups of women are important. But the actions to address this are focused on only a couple of specific groups of women. There needs to be a broader emphasis on addressing the intersectional inequalities of being a woman and being a woman facing other social barriers, such as those relating to ethnicity, socio-economic background or disability.

Listening to and understanding women are intrinsically linked, and the strategy may have missed another opportunity to further the health system’s understanding of women. Although the strategy commissions a new policy research unit at the National Institute for Health and Care Research (NIHR) dedicated to reproductive health, there are wider issues with how research takes account of women that this measure will not tackle. Underrepresentation of women in clinical trials and medical research has resulted in a ‘gender data gap’ in which male bodies are seen as the default, with little to no analysis of sex or gender difference.

'Underrepresentation of women in clinical trials and medical research has resulted in a ‘gender data gap’ in which male bodies are seen as the default, with little to no analysis of sex or gender difference.'

This gap results in poorer outcomes for women, with a typical example being heart attacks, which are routinely misdiagnosed in women as the more widely known ‘classic’ symptoms are only ‘classic’ for men. While the strategy points to the NIHR’s own equality and diversity strategy as a mechanism for addressing these wider issues, it seems like a missed opportunity to go further as, for example, the National Institutes of Health in the United States has – mandating that scientists consider sex as a biological variable across the research spectrum. The benefit of this is that women have to be included in research, moving away from male research subjects being the default, which has resulted in less effective treatment and more side effects for women.

So, has the strategy listened? It has the right message at heart and is a good starting place for changing cultures at all levels to ensure women are heard. Over the past year at The King’s Fund we’ve heard from people currently working in the system who are amazingly passionate about this topic including Dame Lesley Regan, whose appointment as the government’s Women’s Health Ambassador is really welcome given her experience and passion for working with and caring for women. But it can’t be down to just a small number of individuals to implement change. Local health systems, whose core duties include the need to tackle inequalities, should use the strategy as the basis for how they listen to women and include their voices in their own local plans and strategies. So, while the strategy doesn’t have all the answers, it is a strong foundation to make sure the health and care system is truly listening to all women. It is time that listening to women becomes a continuous practice, not a one-time event.