As the COVID-19 vaccination program is successfully rolled out in the UK, a glimmer of hope emerges. Maybe we really can learn from this pandemic and start to build back better? How do we show that we value our keyworkers in healthcare, social care, education and childcare - a whopping 80% of whom are female? How can we pool resources to improve global health and build resilience against future pandemics?
The answers aren’t easy but it is clear that we do not do this by reducing overseas aid spending, as was announced recently by the UK government. In this global pandemic, reducing overseas aid spending will disproportionally affect women and girls in low- and middle-income countries. COVID-19 has severely affected women’s health outcomes and this reduction in spending sets a tone that women’s health does not feature highly on the UK’s recovery agenda.
As a consultant gynaecologist and women’s health researcher, it is obvious to me that investment in women’s health is crucial. Improving the health of women is good for women, men, children, the economy and society. But all too often women are not prioritised at an international, national or local level and the care we provide falls short.
The UK has the largest female health gap in G20, meaning UK men are healthier than women. The reasons behind this discrepancy are complex, involving societal, cultural, gender and biological issues. A reluctance by women to disclose their health issues and dismissal of symptoms by medical professionals rank high in the reasons proposed. Troublesome periods provide a good example of correctable causes.
"All too often women are not prioritised at an international, national or local level and the care we provide falls short"
Up to one in three women will experience problematic periods at some point in their lives. Many can’t leave the house for one week out of every month, they miss school or work and are unable to fulfil caring roles. The financial impact is huge and period poverty is very real, with many unable to buy the products they need to manage their menstruation.
But menstruation remains taboo. Shame. Stigma. Silence. How can people know when to seek help if they don’t know what is typical? Not infrequently, I see women present as an emergency with menstrual blood loss so severe that they require blood transfusion. The COVID-19 pandemic has compounded this issue of not seeking the help that is needed, and we know that periods don’t stop for a pandemic.
'Part of being a woman'
When women do seek medical help, they can be dismissed without a diagnosis of the root cause of their period problems. All too often, those attending specialist menstrual clinics are tearful and tell me they have been suffering for decades. I wonder if this is because some doctors have not been adequately equipped during their training? Instead of being able to help, are stressed doctors shifting the responsibility back to women with comments like ‘it’s part of being a woman’ and ‘you’ll just have to cope with it’? I fear this lack of understanding is stopping appropriate referrals and contributing to the female gender health gap.
"Investing in women’s health research will enable women to function at their best and increase the future health of the global population."
To compound the problem, the treatment options in our armoury are heavily reliant on hormones and surgery. These work brilliantly for many, but hormonal treatments can have intolerable side effects such as mood alterations, breast tenderness and bloating. Surgery can remove fertility – an unacceptable consequence for many. Chronic underfunding for women’s health has meant new, improved treatments are slow to emerge and waiting lists for current treatments have recently skyrocketed.
A 'one stop' clinic
So, what can we do? As medical professionals we need to communicate the importance of women’s health to policy makers. We have to ensure women’s health remains heavily featured in the undergraduate medical curriculum, that we maintain our skills and that we listen to the people who seek help.
To quote Winston Churchill “attitude is a little thing that makes a big difference”. As doctors, we won’t provide excellent care if we don’t master this hard but vital skill. Empowering women to back themselves in healthcare settings starts with better education and information for all, but simply asking women to advocate for themselves when they are at their most vulnerable will exacerbate health inequalities. Reproductive aged women often work and have caring responsibilities; they put themselves last. Gynaecology services must be streamlined to minimise multiple attendances whilst maintaining patient choice. We have a duty to make access to excellent care easy for all who need it. It is no use saying ‘We’re doing our best’, we need support to succeed in doing what is necessary.
"Reproductive aged women often work and have caring responsibilities; they put themselves last"
It is very clear that research improves clinical care. Funding for good quality research will improve diagnosis and develop more precise, effective treatments. Collecting and analysing data can highlight unmet needs and transform the patient journey, both locally and globally. We all came from a womb and there is indisputable evidence that the experience we have there contributes to our health in later life; risk of diabetes, obesity and cardiovascular disease are all affected by the in utero environment.
Investing in women’s health research will enable women to function at their best and increase the future health of the global population.
Listening to women's voices
Frank, open conversations about periods will enable women to identify problems, seek advice when needed and access treatments that help. Involving boys and men in these conversations will facilitate menstrual friendly workplaces, create supportive partners, competent parents, understanding teachers and doctors. To facilitate the discourse surrounding menstruation the menstrual health website ‘Healthy Optimal Periods for Everyone’ provides reliable information for the public, teachers, policy makers and clinicians.
Recent bills passed in Scotland and New Zealand have ensured access to free period products to anyone who needs them. We don’t have to carry toilet roll around with us and women in these countries no longer need to worry about being ‘caught out’. It is a relatively inexpensive policy that sets a tone for respecting and accommodating women and girls in our society.
The decisions the UK government have to make in the recovery phase of this pandemic are extremely difficult. However, they must be taken with appreciation of their significant off-target effects. Women and girls have been hit excessively hard by COVID-19 and have worked excessively hard in keyworker roles throughout it. Perhaps the most fitting tribute to these women is that we start listening to voices from all aspects of society to create effective policies to improve lives.
If we involve women rather than exclude them and listen instead of dictate, perhaps we really can build back better.
Dr Maybin is Senior Research Fellow and Consultant Gynaecologist at the MRC Centre for Reproductive Health, University of Edinburgh.
The Men's Health Gap
National Heavy Menstrual Bleeding Audit - Royal College of Obstetricians and Gynaecologists
Report: Heavy Menstrual Bleeding – breaking silence and stigma