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A women’s health agenda (Part 1)
In the first of a two-part series on women’s health, Professor Clare Gerada talks to Kathy Oxtoby about a new project that aims to put women at the centre of their own health and address health gender inequalities.
Treatments for women’s health conditions may have come a long way, but it seems that women still live in a world where they face stigmatisation in accessing medication that is not readily available or given.
“Women today have no more rights than women 30 years ago,” says Professor Clare Gerada, a London based GP. “They might have better treatments, but they are still treated as inferior objects that need to be patronised, and who can’t possibly be intelligent enough to make their own choices about their health,” she says.
From contraception to managing the menopause with Hormonal Replacement Therapy (HRT), women’s issues are medicalised and women are “not trusted” to make their own decisions, Professor Gerada believes. She cites the example of the contraceptive pill, “which has been around for 70 years yet is still seen as a medical issue”, the misdiagnosis of menopause as depression, and women’s lack of access to HRT to relieve its symptoms.
She says this “stigmatisation” that women face is an issue that requires “urgent attention if we are to take seriously the vision of a gender-equal world”.
Reproductive health and women’s cancers need international priority
To help raise awareness of and address women’s health inequalities, the Public Policy Projects (PPP), a global, independent, subscription-based public policy institute, is working on a major new report entitled State of the Globe: Redressing the Balance – A Women’s Health Agenda. Findings of the report will be launched at the UN Commission on the Status of Women, New York, in March 2022.
The project aims to put women at the centre of their own health and will be chaired by Professor Gerada and Professor Lesley Regan, professor of Obstetrics and Gynaecology at Imperial College’s St Mary’s Hospital campus, and honorary consultant at the Imperial College NHS Trust.
This project identifies two specific areas as needing international priority: reproductive health and women’s cancers, both of which are interlinked. The focus is on answering central questions relating to the accessibility of reproductive health and the preventability of female cancers using international voices and expertise applicable to both the developed and developing world.
To ensure the report produces recommendations that are focused and specific, “it will consistently evaluate the central areas within reproductive health and women’s cancers through the lens of data, research and policy”, says Professor Gerada. “We have identified this three-pronged approach as essential to ensuring the health issues covered are meticulously understood through a gendered lens,” she continued.
The project’s findings will be informed by a series of roundtable discussions run by PPP, and chaired by Professor Gerada and Professor Regan. Themes of this women’s health series are: reproductive health, gender, ageing and health, and racial disparities in women’s healthcare. Topics in the series include: contraception, abortion, assisted conception, prevention and treatment of cervical and breast cancers, menstruation, and menopause.
The sessions will look at the issues central to each topic and ask some key questions. For example, the session on breast cancer assesses how far the work on dealing with this condition has come and what needs to be done. It highlights that there is evidence to suggest that mammography screening is not only expensive, but is also not effective in screening for breast cancer.
However, low-cost screening approaches can only be developed when necessary evidence becomes available. A key question for the session is how to ensure data and research is focused on alternative ways to screen for breast cancer to improve early detection.
Redressing the gender imbalance
Another session focuses on issues surrounding the inevitability of womanhood – namely menstruation and menopause. It highlights that across the world, women and girls suffer from the shame and stigma of menstruation, often without adequate access to sanitary products.
Like menstruation, menopause will affect every woman at some point in her life, but is often a forgotten period in a woman’s reproductive life that requires greater awareness. The roundtable considers these issues holistically, using a ‘lifecycle approach’, with the emphasis on prevention and early intervention at every stage of life.
The final roundtable for the report will focus on taking a “gendered lens” to data, research and policy. It will focus on issues and solutions to ensuring these areas are as inclusive as possible. Key questions will include: ‘how can we ensure diversity within the dataset when engaging patients for clinical trials?’, and ‘how do we change the systems and structures within data, research and policy that disadvantage female patients before they have even received treatment?’
In addition to the roundtable sessions, PPP’s report will “harness strategic thought leadership, compile case studies of best practice and identify key recommendations for both UK and international application,” says Professor Gerada.
“This project is confident of its ability to begin redressing the balance with a women’s health agenda,” she says.
On a personal note about the project, she adds: “It’s very exciting, and so different to do something like this. I’m an experienced GP, and experienced in the area of women’s health. But I’m shocked about how little I knew. And I have learned so much already.”
Kathy Oxtoby is a medical journalist.