From having to attend antenatal check-ups alone, to reduced sexual health services, women’s healthcare in the UK has undeniably been hit hard by COVID-19. We, therefore, decided to hold a fireside discussion with some key leaders in the sector to explore what the impact has been and understand what a post-COVID society for women’s healthcare needs to look like.
I was joined by Vanessa Apea, a consultant in sexual health and HIV Medicine at Barts Health NHS, Manjit K. Gill, founder and CEO of Binti International and Dame Lesley Regan, a renowned clinical and academic leader whose work has transformed care for women experiencing recurrent miscarriages. Here’s what we learnt.
When we refer to women’s healthcare, it’s important that we acknowledge that it is not only people who identify as women for whom it is necessary to access women’s health and reproductive services. We are inclusive of individuals whose gender identity does not align with the sex they were assigned at birth.
The ‘incurable optimist’ Lesley, expressed that “you can always get something good out of a crisis”. Because healthcare decisions in the UK are largely bureaucratic, the pandemic has seen quick wins because bureaucracy has been less of a barrier. For instance, the introduction of telemedicine and virtual consultations so that women can have abortions in the comfort of their own homes. The government has also pledged £76m for charities to help domestic abuse victims. Most decisions are made on an economic basis and instead of being angry, we must focus on economic solutions that provide first-class, swift care.
Both Vanessa and Lesley have found through their work that young people are more prepared to speak openly with them because they don’t need to show their face in public, especially if they’re feeling self-conscious to discuss more sensitive issues. There has been a shift in personal advocacy where young women are being vocal in saying certain services are not right for them.
If you give women the information they need to look after themselves, the vast majority do it very well. There is a need to review and highlight the gap in services for women and girls, sexual health services for example. If we give women a safe space to talk, we’ll have greater insights than we do now. If there are some groups hard to reach, we will just have to be more creative to engage with them. Women are the best ambassadors for themselves. If we empower 51% of the population, it will positively affect the health behaviours of everyone else.
| SETBACKS FOR THE SECTOR
Within the healthcare system, the changes needing to take place to adapt to the pandemic in the UK were vast. Services changed so quickly that there was a real need to get the updated messaging out there to people quickly so that they could understand these changes.
Of course, meetings would now have to be done virtually by default, and having Zoom meetings at home is a privilege as you have to have a phone or laptop with a certain internet speed which has meant some of the most vulnerable people are unable to have these consultations with doctors. The pandemic has also meant that treatments and operations have had to be postponed, in some cases where individuals are hugely suffering.
Equally, as toilet paper left our shelves at the start of lockdown, so too did menstrual hygiene products. Manjit explained that this had the effect of amplifying issues of access. Those who received their menstrual hygiene products from schools, work or elsewhere, now had this line of contact cut off and then found it increasingly difficult to pick up products in store, as they were either sold out or simply too expensive.
According to Vanessa, it became increasingly evident how COVID-19 accentuated pre-existing inequalities within the healthcare system. In a recent Women and Work APPG session, Joeli Brealey, founder of Pregnant then Screwed, shared that 31% of BAME pregnant women that work for the NHS have felt unsafe during the pandemic. There are also a disproportionate number of BAME people in key worker roles. This led Meenal Viz, a pregnant NHS doctor we recently worked with, to launch a campaign demanding better PPE for the NHS.
We know that COVID-19 has disproportionately affected black and minority ethnic people on a global scale. These health inequalities are not new, they are long-standing, but COVID has brought it to the forefront and magnified what’s been there already. This is also the case when it comes to death during pregnancy, Lesley explained, with black women 5x more likely and Asian women 2x more likely to die than white women. These maternal mortality statistics are a result of both social and medical inequalities. The social inequalities are even more deep-rooted which impinges on medical inequalities. There is a need to speak to communities and learn from them what the drivers are to understand how to support them – there are a number of layers to this, Vanessa explained.
| GOVERNMENT RESPONSE & NEXT STEPS
Despite potential opportunities and learnings from this period the important factor that all our panellists agreed on is making sure recent wins in women’s health are not reversed. The pandemic has exposed the “stark naked truth”, according to Lesley, and we now have to “build systems that address all those inequalities and level the playing field”.
This point is important in that we have an opportunity to essentially level up health outcomes (as opposed to levelling things downwards) and ensure we embed a human-centred approach to our services. There has been a lot of mistrust in communities directed at services at the moment, especially since the report on BAME disparities was released by the government. The government and public sector need to address this mistrust with tangible action and be intentional about their response, according to Vanessa.
There was also a consensus that there is a need for gender to be prioritised in health. One example that Lesley shared was at the beginning of lockdown, she had persuaded Matt Hancock’s team to allow abortion medicine to be over the counter. However, 8 hours later, that decision was rescinded. It took 8 days for her team to get that reappointed and the argument that won him over was that it would be better for the NHS, as opposed to the ‘it’s better for women argument’ which she’d have preferred to use.
There is a need for MPs to have women’s healthcare issues at the forefront of their minds and to make impactful decisions accordingly. Part of this will be having more open and honest conversations around women’s healthcare, and menstruation as Manjit vocalised, because this is something that affects most women, 9-12 times a year and so we need to push for it to be something that’s talked about all the time.
What is clear having spoken with the panellists is that women have been disproportionately disadvantaged in the healthcare system. Local authorities, CCGs and NHS England all work in silos with no one being responsible for decisions made which means there’s an existing disincentive to get things right. When Lesley was President of the Royal College of Gynecology and Obstetricians, they launched a report full of recommendations to take to improve healthcare for women and girls. The main takeaway is to have a life course approach so if we can get it right early, it impacts the next stage, which is more economically friendly for the government.
This is a time for recovery and a learning phase. Whilst we want to see a recognition of the impact of all changes that have been made, we need to pay particular attention to the long-term changes too. When funding is so tight, we need to ensure we don’t make quick decisions, the government should be more cautious in seeing the short, medium and long-term effects of COVID-19 on women’s healthcare.
Watch the full discussion here:
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