The Government has launched what it called a "landmark survey" to seek women's views on their experiences of reproductive healthcare. The Department of Health and Social Care (DHSC) said that women's responses would help to shape future healthcare policy.
The move is part of the Women's Health Strategy, a 10-year programme announced last summer "to tackle the gender health gap" and improve the health and wellbeing of women and girls in England. The survey delivers on a "key commitment" to ensure the health and care system "prioritises women's voices", the Department said. "Vital information" gathered "will inform current and future Government decision-making".
Survey questions probe women's experiences of menstrual health; contraception, fertility, and pregnancy; reproductive health conditions, such as endometriosis and polycystic ovary syndrome, and menopause.
"For most women, it can be nearly 40 years from their first period to menopause," said Rebecca French, associate professor of sexual and reproductive health research at the London School of Hygiene & Tropical Medicine, which has been commissioned to deliver the survey biennially.
Too many "Taboo Topics"
"Unfortunately, many areas of reproductive health, including abortion, miscarriages, infertility, and menstrual issues, continue to be taboo topics and many women feel unheard, even when they have sought professional help," she explained.
Women have described difficulties accessing contraception or fertility treatment, or obtaining gynaecology appointments. "Often, health services are not 'joined up', leading to multiple visits and appointment delays." Yet poor reproductive health has negative effects on health in general, including mental health, and on relationships and finances, Dr French said.
She highlighted numerous disparities including 'period poverty', with increasing numbers of women unable to afford menstrual products; a 'postcode lottery' in fertility treatment, and higher maternal mortality among Black compared with White women. A pilot survey in 2021 had attracted 11,578 complete responses, and "the majority felt unsupported in their reproductive life course", she said.
"No Point Bolstering Services if They Can't Be Accessed"
Dame Lesley Regan, professor of obstetrics and gynaecology at Imperial College London , and appointed as women's health ambassador under the strategy, said: "We need to make healthcare work for women and girls – and for it to fit around their lives. There's no point bolstering services if they can't be accessed, or the support available doesn't work for them and meet their needs."
The strategy includes a new artificial intelligence tool to identify early risks in maternity units, given that the UK has one of the highest maternal mortality rates in Europe and there have been numerous scandals involving deaths in maternity units. The survey proclamation comes in the wake of the announcement this week that a criminal inquiry has now been launched into dozens of baby deaths at Nottingham University Hospitals NHS Trust, which was fined £800,000 earlier this year in relation to two charges and is subject to yet another review of maternity care failings by senior midwife Donna Ockenden.
An assessment of the strategy itself last year by policy adviser Charlotte Wickens and analyst Danielle Jefferies at independent think tank the King's Fund pointed to the underlying cause of women's poor experiences and worse health outcomes being that the health system was historically "built by men for men". Women were therefore often not listened to or believed, they said, and there remained "some gaps and missed opportunities", with further work needed "to embed listening to women's voices".
"While the strategy has engaged with women as service users, it's not yet engaged with health and care professionals," they added. "The dynamic between health professionals and women needs to change" and this should be "sooner rather than later."
Women Underrepresented in Medical Research
As well as the gender health gap, they highlighted a "gender data gap", with underrepresentation of women in clinical trials and medical research resulting in male bodies being seen as the default, with little to no analysis of sex or gender differences. An important example was that heart attacks are routinely misdiagnosed in women because the 'classic' symptoms are only 'classic' for men.
It was a "missed opportunity" that the strategy failed to follow the US approach to mandate that health scientists consider sex as a biological variable across the research spectrum. Nonetheless, the strategy had "the right message at heart" and was "a good starting place for changing cultures at all levels to ensure women are heard", they concluded.
According to the DHSC: "There are currently disparities in women's health across the country, and far too many cases where women's voices are not being heard. Along with the strategy, the new survey will play a key part in changing this." Minister for women's health strategy, Maria Caulfield, said: "I would encourage every woman to complete the survey on reproductive health as soon as they're able and ensure their voice is heard."
The survey is open to all women in England aged 16-55 years and will run for 6 weeks.