Intended for healthcare professionals

Opinion

The Women’s Health Strategy: ambitions need action and accountability

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2059 (Published 19 August 2022) Cite this as: BMJ 2022;378:o2059
  1. Kate Womersley, research fellow and core psychiatry trainee1 2,
  2. Carinna Hockham, research associate1,
  3. Edward Mullins, clinical lecturer and consultant obstetrician and gynaecologist3 4
  1. 1The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
  2. 2Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK
  3. 3Imperial College London, Department of Metabolism, Digestion and Reproduction and The George Institute for Global Health, London
  4. 4Imperial College Healthcare NHS Trust, London

The Women’s Health Strategy for England, published in July 2022, acknowledges that the health of women and girls over the course of their lives has long been neglected.1 We were pleased to read the government’s ambitions to drive systemic changes so that the health needs of women and girls will be better met. But it’s the how, not the why, of this strategy that now needs detail, resources, and accountability.

The Women’s Health Strategy results from a call for evidence, which received over 110 000 responses from the public, charities, researchers, and institutions reflecting on women’s health priorities and gender health inequalities across England. Respondents focused on several key areas, which are now summarised as ambitions in the strategy report: ensuring women’s voices are heard without stigma or deprecation; improving women’s access to medical services for female-specific illnesses, as well as universal conditions such as dementia and stroke; and addressing intersectional disparities that affect women, such as age, ethnicity, and disability, among many others.

Welcome commitments of the strategy include removing barriers to in vitro fertilisation (IVF) for same-sex couples and those disadvantaged by a postcode lottery, formal support and recognition after miscarriage, and an additional £10 million funding for a breast cancer screening programme. There are promising plans to commission a new policy research unit dedicated to women’s health, as well as efforts to standardise medical student education to achieve a higher baseline of knowledge about women’s health. Increasing participation of women in research, particularly women from ethnic minority groups, pregnant women, and lesbian and bisexual women is an important suggestion, and initiatives such as NIHR INCLUDE are at the centre of this.2 The strategy also seeks to encourage disaggregation of data by sex (thus showing, for example, where interventions have different efficacies in females and males), which dovetails with our research at The George Institute and the launch of our recent MESSAGE project.3 The results of this work will bring the UK’s public research funders in line with the US, Canada, and the EU, where reporting research results for men and women separately is expected, or its omission has to be justified. In sum, the ambitions of the Women’s Health Strategy, if achieved, would radically improve—in fact transform—the health and wellbeing of women and girls in this country.

But there is currently little new funding to deliver the strategy. Large investments that do exist are often not specific to women, and so, without measures in place to monitor who is benefiting, we have no way of knowing whether impacts will be equitable. The word “ambition” is used 55 times in the Women’s Health Strategy, but details on implementation and accountability—two things that are central to these ambitions being enacted—are thin. Measurable indicators to guide and monitor change are omitted or perhaps yet to be decided, and there is a notable vagueness about measuring the impact of the strategy on non-communicable disease outcomes for women despite dementia, acute coronary syndromes, and cerebrovascular disorders being the leading causes of death for women in the UK.

It is also unclear who is responsible for translating the ambitions of the strategy into actions. From what we can tell, three new appointments will be made to implement the strategy: Professor Dame Lesley Regan as England’s first Women’s Health Ambassador (WHA), an incoming deputy WHA, and an NHS clinical women’s health lead. However, the scope of the strategy is far beyond the capacity of what three people can deliver, even if all match the high calibre of the WHA. The strategy acknowledges that organisations, particularly NHS England, NIHR, NICE, and Health Education England have substantial roles to play, along with industry in the form of FemTech, but these roles, and accountability, are not explicitly delegated. Moreover, a timeline of three years for the first review of the strategy diminishes impetus to act promptly on delivery. This is especially relevant for initiatives such as post-birth contraception, featured in the strategy, where evidence for effectiveness and return on investment already exists but implementation has been delayed due to a deficit in funding and lack of priority for the organisations delivering care.

To make the strategy a reality, we propose the following. There need to be clearly delineated areas of responsibility for data, research, healthcare, public health, and school education in women’s health. Routinely collected data, quality assured, and as near to real-time as possible should be used to monitor access to, and uptake of, key services by population groups. For example, the ambition for integrated, life-course reproductive health could be evaluated using routinely collected data on uptake of contraception, termination of pregnancy rates, and the newly rolled out national pre-conception report card, which measures preparedness for pregnancy.4 Regarding data, we champion sex disaggregation as standard. We call for a national approach to women’s health data, mandating reporting of all research and audits by sex and gender. An annual review of research spend in key areas of women’s health, such as the RAND analysis of research spend on pregnancy, would improve transparency, and this should be funded and performed for sex and gender disaggregated research.5

Healthcare organisations are best served to deliver this strategy by the mandating of safe staffing levels, delivered cohesively through sufficient undergraduate places and financial support for training to provide a sustainable workforce, and by working conditions and career development which retain staff in the NHS. The strategy’s ambition that the NHS should be an exemplary employer with respect to women’s health to improve staff recruitment and retention (especially in nursing and midwifery, which are in crisis) is welcome, but it will require sustained resources for occupational health and buy-in at the level of trust boards that must go beyond a box-ticking exercise.

Political ownership for implementing the Women’s Health Strategy is vitally important. Its delivery will require motivated and enlightened ministerial leadership. The Secretary of State for Health and Social Care in a new cabinet under a new prime minister in September will be responsible for a strategy to which they may not have contributed. Women’s health is unlikely to be seen as politically profitable unless deliverables of demonstrable benefit to society, tangible to the Treasury, are promptly developed for this strategy. It will be up to researchers, clinicians, and the public to hold our government to account, citing their ambitions back to them and ensuring women in England are indeed heard.

Footnotes

  • Competing interests: none declared

  • Provenance and peer review: not commissioned, not peer reviewed.

References