This report highlights the importance of embracing a culture of change in the design and delivery of women’s health to achieve national systems and local services fit to meet the expectations and needs of the 21st century woman. It describes the many failings of health services across the world whose default position is to treat women as second-class citizens and place unnecessary barriers to the delivery of high-quality accessible care.
The report sets out recommendations, founded on common sense and rooted in the belief that women should be in control of their own bodies.
An overview of the recommendations
- Sexual and reproductive health services must be prioritised to counter patchy healthcare service provision – and access must be made available, in and out of hours.
- NICE should re-examine guidelines that recommend routine appointments for oral contraception users – with a view to limiting unnecessary medical checks that may only serve to limit contraception access.
- Progestogen-only pill (POP) should be made available on general sales (off the shelf) and not require consultation with a pharmacist unless the woman wishes.
- Those who plan and purchase healthcare must ensure provision of full range of contraception services to all women that is person centric and at all reproductive ages, with a particular focus on targeting women of low socioeconomic status (SES) and minority ethnic women. This should include ensuring emergency hormonal contraception is free in 100 per cent of healthcare service provision.
- While Long Acting Reversible Contraception(LARC) should be encouraged, the greatest impact for reducing unplanned pregnancies must focus on influencing women who use no contraception to begin using any form of reliable contraception.
- Post birth contraception must become an integrated part of maternity services and funded appropriately. Women should be routinely offered a choice of contraception post delivery and given information about the importance of birth spacing to improve their health and that of their baby/family.
- To further increase access to telemedicine abortion, health providers should enable a greater number of staff to undertake telemedicine abortion and prescribe the medications – this should include enabling training nurses and pharmacists to undertake the clinical consultation.
- Post-abortion care can be self-managed by the woman and this should be advocated for within local sexual and reproductive health services.
- Access to telemedicine should be enhanced and obstacles to access removed wherever possible. This should include removing the need for women to have a routine scan within a clinical setting in order to qualify for a telemedicine abortion.
- Abortion should become further integrated with contraception services and wider sexual and reproductive health service provision. Health providers should ensure that contraception is offered at the time of abortion if desired by the woman.
3. Assisted conception
- Access to fertility treatment should be determined based on need, not by geographical location. Disparities in funding levels between different Clinical Commissioning Groups (CCGs) and soon to be integrated care systems must be addressed so that women are able to access the recommended three cycles of IVF treatment from anywhere in the country.
- Those going through fertility treatment must be provided with far clearer information and assisted conception ‘add-ons’ must be regulated with patients clearly informed when treatment options are not fully evidence based. The reproductive genomics sector must be subject to greater structure and regulation – women should receive independent advice about their options from genomic experts before they are referred to commercial providers.
- A large proportion of the genomics of women’s fertility lies outside of existing NHS England and PHE governance structures. This should be addressed as a priority by ensuring it is brought into the remit of existing structures.
4. Menstruation and menopause
- The UK government must promote menstrual equity by ensuring that girls and women of reproductive age have access to adequate menstrual hygiene, including basic facilities and products.
- Menstrual period products should become free in England thereby following the framework set by Scotland’s successful campaign to end ‘period poverty’.
- The UK government tampon tax relief fund should be replaced with another women’s health relief fund, ensuring that organisations previously reliant on this funding are supported.
- Governments must place greater priority upon menstrual health within educational settings, encouraging dialogue with boys and girls of all ages to break down historical taboos. Building on this enhanced knowledge and understanding of menstrual health, educators, clinicians and policy makers should phase outdated terminology with regards to menstrual health.
- Each interaction women and girls have with healthcare systems should be used as an opportunity by clinicians to understand how menstrual health is impacting their lives. Health providers must receive greater support to engage in dialogue around women’s health and be supported by a comprehensive data infrastructure that records comments and scales best practice.
- Policymakers must continue to support the health sector in supporting campaigns that end misinformation around Hormone Replacement Therapy (HRT). Women should be presented with the risks and offered HRT consistently in order to make the decision themselves. There needs to be a specific focus on targeting women of low SES.
5. Breast cancer
- Governments should prioritise producing preventative strategies targeted at lifestyle change, as well as focusing on producing screening guidelines that can be adapted to suit local resources. In the UK, the NHS recovery programme needs to assess extensive waiting lists and overhaul the breast screening programme and shift the focus within breast cancer strategies away from screening towards prevention.
- Breast density should be routinely measured within breast screening clinics as part of the NHS recovery programme’s overhaul of screening programmes.
6. Cervical cancer
- When governments with limited resources are looking at strategies to eliminate cervical cancer, prioritising HPV vaccination of girls should be advocated for as recommended by the World Health Organization.
- The UK’s Women’s Health Strategy must focus on targeting ethnic minority groups to improve cervical screening uptake. A holistic approach is needed to address the widening cervical cancer inequality gap.
- In the UK, cervical screening services should be integrated with regular sexual and gynaecological health services for ease of access.
- Efforts to introduce self-sampling need to be scaled up in low-to-middle-income countries. Following the YouScreen study in London, HPV self-sampling should be implemented across the UK targeting groups with lower screening uptake.
7. A gendered lens: Research, data & policy
- Women of childbearing age and pregnant women should be given the choice to participate in clinical trials themselves, rather than being excluded from the outset. Male, especially white male, participation in clinical trials should be capped to ensure participation from underrepresented groups, notably women and pregnant women.
- To increase sex and gender integration in the health and biomedical research funding and regulation in the UK must advocate for mandatory inclusion of sex and gender analysis plans on application forms, resources to train and educate applicants, funders and evaluators, and reward proposals that engage deeply with sex and gender analysis.