Women’s Health Outcomes

Baroness Jenkin of Kennington Excerpts
Thursday 8th July 2021

(3 months, 1 week ago)

Lords Chamber

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Department of Health and Social Care

Moved by

Baroness Jenkin of Kennington Portrait Baroness Jenkin of Kennington
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That this House takes note of the steps taken to improve women’s health outcomes.

Baroness Jenkin of Kennington Portrait Baroness Jenkin of Kennington (Con)
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My Lords, it is an honour to be introducing this debate on a topic so close to the hearts and other more intimate body parts of 51% of the population—and some men too, of course.

In my International Women’s Day speech this year, I departed from my usual topics of either women in Parliament or the reality of women’s and girls’ lives in the developing world to talk about women’s health. This change was a result of the Government’s very welcome launch of the first ever consultation and call for evidence to improve the health and well-being of women in England, designed to use women’s voices and experiences to write a new women’s health strategy. For the first time in years, I pondered a woman’s life cycle in terms of health, and I am grateful for the chance to expand on those thoughts today. What I found then, and again now, brought home to me all too graphically the experience of millions of women at different stages of their lives.

Let us start with puberty. It is a confusing time for any child but it is especially so for girls, who are entering puberty about a year earlier than they did back in the 1970s according to global data of 30 studies on breast development. Studies also show that early menstrual bleeding, the last clinical sign of puberty for girls, is associated with a higher risk of obesity, type 2 diabetes, heart disease and allergies. During this period—excuse the pun—I thank journalist Emma Barnett for her book, Period: It’s About Bloody Time, which asks why we are so uncomfortable talking about, and clam up about, menstruation—girls have their first introduction to expensive sanitary products, starting for many period poverty, which affects their school attendance. Estimates vary, but around one in five women of childbearing age suffers from painful, irregular or heavy periods, many to a truly debilitating extent.

Endometriosis manifests itself around this time as well. It is a long-term condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. The main symptoms are back and stomach pain, increased period pain, pain during or after sex, pain when peeing or during a bowel movement, feeling sick, constipation, diarrhoea, blood in pee and difficulty getting pregnant. There is a seven-year wait to get diagnosed, with 40% of women needing 10 or more GP appointments before being referred to a specialist.

At this age, social media pressure and social contagion start to have an impact on teenagers’ body image, including anorexia and self-harming. Since 2016, there has been a 45% increase in labiaplasty operations, a female genital cosmetic procedure flippantly referred to as “designer vaginas”. This coincides with a time when vulnerable girls are groomed on the internet and the effects of porn not only are felt on their mental health but lead to this irreversible surgical procedure.

I turn to STIs and birth control. Syphilis and gonorrhoea have almost doubled in the past five years in school-age girls. While chlamydia is decreasing thanks to the screening programme, it remains a problem because of the irreparable damage to girls’ fertility and chronic pelvic inflammatory disease. Avoiding pregnancy is still largely seen as a girl’s responsibility. Boys should be taught that using a sheath not only prevents unwanted pregnancies but also reduces STDs for girls.

I now move to the stage of planned pregnancies and hoped-for motherhood. One in four pregnancies ends in miscarriage, and these women feel let down. There is insensitivity and a lack of empathy in healthcare and arrogance among healthcare professionals, mainly male doctors, who will not and do not listen to patients. My friend had six miscarriages and finally visited a male Harley Street IVF doctor, who put her on a standard protocol for getting pregnant despite her arguing vociferously that getting pregnant clearly was not her problem. She got pregnant again and endured another avoidable miscarriage because she was not listened to. She then went to a female consultant and had a live birth on the first round of tailored treatment.

Antenatal care is inconsistent. Every woman should have the option of the same midwife throughout, up to their delivery. I wish my noble friend on the Front Bench today—she is probably very uncomfortable in her last two weeks—luck and an easy, quick birth, although I am afraid that there is no such thing as a pain-free birth. I also wish her access to the pain control that she wants and, ideally, no episiotomy. I am afraid that nothing can prepare her or other new mothers for the post-birth challenges of getting her body back to a reasonable condition, breastfeeding, disrupted sleep and so called “baby blues”, possibly followed by postnatal depression, which affects between 10% and 20% of women.

I come to motherhood next. In the vast majority of cases, women are the lead parent, combining most child- care with work, usually at a greater career cost than the father. This in turn leads to tension at home and often a relationship breakdown, leaving the mother as the major childcare provider, which in turn leads to increased mental health issues—I think other colleagues will talk about this—or the use of drugs or alcohol as crutches, which I think the noble Lord, Lord Brooke, may raise.

I turn to the eventual emptying of the nest, which is another time of stress in a relationship and often comes at the same time as caring for elderly parents. This is close to my heart because last year we lost my mother, whom we lived with, aged 96.

I now move on to the menopause, which is a “big one”. Some 34 years ago, I ran the Amarant Trust, a menopause charity funding ground-breaking research into HRT with the team at King’s College Hospital, which also ran our self-referring clinic. Women attended in droves, largely because of hostile, and in some cases misogynistic, GPs. I was pregnant at that time so my own hormones were in turmoil, although not lacking in oestrogen and the myriad of miserable symptoms that so many women experience at that time. I can still remember the distress that so many patients suffered in silence and how debilitated they were by the onslaught of flushes, sweats, sleeplessness, vaginal dryness, discomfort during sex and problems with memory and concentration.

A couple of years ago, I attended a round table with the then Women’s Health Minister and campaigners. I was astonished to find that the situation for menopausal women is no better than it was all those years ago when I was actively involved. Indeed, 23% of women who visit their GPs with symptoms are prescribed antidepressants instead of HRT. I was one of the lucky ones—I sailed through—but those suffering symptoms should of course be given the informed option of taking HRT, a transformational drug that makes life worth living again for so many women. I give a big shout-out to James Timpson, who wrote in last weekend’s Times of the need to

“stop the menopause hijacking careers”.

One newish MP told me that, before she was prescribed HRT, she thought that she would have to give up her job as an MP because it was impossible for her to do it properly. I am delighted to be a founder member of the new APPG for the menopause and look forward to its forthcoming inquiry.

In between all this, we have a miserable list of prolapses, cystitis and thrush. Although I have been comparatively lucky in my own health journey, the latter two caused hours of itching and discomfort, including of course painful sex. This is not always easy to discuss with a partner.

Then we have the female cancers. Cancer Research’s most recent figures, from 2015 to 2017, report about 75,000 new cases of breast, cervical, uterine and ovarian cancers. The Government’s sustained good work with the introduction of HPV vaccination is very welcome. Since then, infections of HPV in 16 to 18 year-old women have reduced by 86% in England. Considering that around 80% of all cervical cancers are caused by HPV, we hope for big reductions in that cancer in the years to come, but let us keep the pressure on for improving the treatment and life expectancy of women suffering these diseases.

I turn to the final countdown, once we have passed the period of caring for aging parents and the move towards osteoporosis, leading to life-changing fractures caused by brittle bones, and then finally dementia.

Even with the generous 12 minutes that I have today, I can only touch the surface of women’s health issues. I pay credit to Health Ministers for taking our problems seriously and, in particular, to Nadine Dorries for driving this agenda, and whose own personal challenge with having an IUD fitted 36 years ago—which in the end she failed because of the intensity of the pain—was laid bare in the Daily Mail earlier this week. Many women are unable even to have a cervical smear because of the agony, but they now feel emboldened to speak out because of other women talking publicly, including the campaigner Caroline Criado Perez.

I am not alone among women in wondering whether, if these debilitating conditions afflicted men, better treatments would have been found by now. Less than 2.5% of publicly funded research is dedicated solely to reproductive health, despite the fact that one in three women in the UK will suffer from a reproductive or gynaecological health problem. There is five times more research into erectile dysfunction, affecting 19% of men, than into premenstrual syndrome, which apparently affects 90% of women.

Women are underrepresented in clinical trials even though biological differences between males and females can affect how medication works. The general assumption is that women do not differ from men except where their reproductive organs are concerned, and data obtained from clinical research involving men is simply extrapolated to women. This has important implications for health and healthcare. I understand that over 100,000 women have responded to the Government’s consultation and that they are currently unpacking the data. On behalf of women everywhere, I thank the Government for the initiative and for the forthcoming sexual and reproductive health strategy.

Noble Lords may not be aware that instances of domestic abuse increase by 26% when England play football and by 38% if they lose. So those who may not be looking forward to Sunday’s game will be especially welcoming the actions that the Government are taking on violence against women and girls.

I look forward to hearing from my noble friend the Minister about how these initiatives will improve life for millions of women who are suffering in at least some of the ways that I have described today.

Baroness Massey of Darwen Portrait Baroness Massey of Darwen (Lab) [V]
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My Lords, I thank the noble Baroness, Lady Jenkin, for introducing this important debate. I know that many important issues relating to inequalities in health will be addressed. I am delighted that the noble Baroness spoke eloquently about young women’s health; I shall raise concerns about young women’s mental health in particular.

The Association for Young People’s Health, of which I am a patron, has welcomed the proposal to develop a women’s health strategy for England, stating that this must take account of the diversity of young women’s health issues, and that young women and girls must participate in the development and implementation of the strategy. Young women’s experiences of healthcare are affected by general factors, such as deprivation, ethnicity and geography, and by specific issues, such as sexual and certain kinds of reproductive health issues, mental health, and gender-based violence. In general, young women’s health outcomes are less favourable than those of young men.

As the Mental Health Foundation states,

“There is no health without mental health”.

Mental health affects physical health and the data on mental health and well-being, self-harm, suicide and eating disorders show that the link between body image and life satisfaction is twice as strong for girls as for boys. Young women’s mental health gives specific rise to concerns: 43% of young women aged between 16 and 29 experience some depressive symptoms, compared with only 26% of men of the same age. Girls between the ages of 11 and 17 have had more emotional difficulties than boys during periods of school closures. As we know, Covid has had an unequal impact on different groups and individuals. Young people generally have been less likely to become infected with the virus, but have faced enormous upheavals in education, employment and social interaction during what is often a difficult period in their lives.

Given the different mental health needs of boys and girls, the Royal College of Psychiatrists has suggested that, to deal with these needs, different interventions and methods for supporting different young people are required. It recommends that an extra £500 million of investment is needed to address the mental health needs of children and young people. These needs, including treatment, have intensified to an alarming degree during Covid-19.

Can the Minister say whether the strategy for women’s health will take account of the importance of maintaining and improving research and data collection on young women’s health? Will the views of women and girls be taken into account as the strategy develops? Both these issues are important in ensuring access to services and appropriate, high-quality preventive measures and treatment. I look forward to the Minister’s reply.

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Lord Bethell Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
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My Lords, I join all those who have commended my noble friend Lady Jenkin of Kennington for tabling a debate on this incredibly important matter. I congratulate her on smashing through dozens of anatomical taboos in such a splendid fashion in her extremely important opening remarks.

I believe that, as has been discussed today, the problem statement under debate is very clear—Nadine Dorries said it in another place earlier today, and it was echoed by the noble Baroness, Lady Bull: for generations, women have lived with a health and care system that is mostly designed by men for men. That is the problem. As a result, despite making up 51% of the population, women have been underrepresented in research, face damaging taboos about their health and, despite living longer than men, spend a greater proportion of their lives in ill health and with disabilities. For these reasons, there has never been a better time to put an emphasis on women’s health.

So I am extremely pleased that, on International Women’s Day, the Minister of State for Patient Safety, Suicide Prevention and Mental Health announced in another place the launch of the women’s health strategy for England. As noble Lords have mentioned, it asked for responses across six themes, and I think it is worth mentioning them, because they are the architecture of how we will approach this strategy. The first is

“Placing women’s voices at the centre of their health and care”;

the second is

“Improving the quality and accessibility of information and education on women’s health”;

the third is

“Ensuring the … system understands and is responsive to women’s health and care needs across the life course”,

and this was so articulately explained by my noble friend; the fourth is

“Maximising women’s health in the workplace”;

the fifth is

“Ensuring research, evidence and data support improvements in women’s health”,

as was explained very well by the noble Baroness, Lady Brinton; and the sixth is

“Understanding and responding to the impacts of COVID-19”.

As has been mentioned, we had 112,000 submissions, which is an absolutely remarkable number and speaks well of the engagement that has gone on around this important issue. There have also been focus groups, and departmental Ministers have led a number of engagement exercises. I was delighted to chair two very important and revealing round tables and a series of one-to-ones with leading women in healthcare. This engagement is why we launched the call for evidence in the first place.

There are a number of challenges that cut across the area of women’s health, and I will mention two or three of them. We have a world-class research and development system in the UK, but, as the noble Lord, Lord Hunt, quite rightly pointed out, we know that women have been underrepresented in research and clinical trials, particularly women from ethnic minorities—as the noble Baroness, Lady Uddin, pointed out—older women, women of child-bearing age, women with disabilities and LGBT women.

Women are not a homogenous group, and research must continue to understand and tackle specific dimensions of inequality to ensure equitable health outcomes across the population. While researchers and regulators have historically believed this to be good for women and babies, largely due to legitimate concerns about potential risks to an unborn child, too often women have been excluded from these discussions and have not been given the choice to participate in trials and studies. I agree with the noble Baroness, Lady Ritchie: we absolutely must work hard to change this and give women the choice to partake in clinical trials.

I will say a word about women’s conditions that are not being researched enough, which was highlighted by the noble Baroness, Lady Thornton. She is entirely right: there are still too many conditions about which we know too little. A key example of this is endometriosis, raised by the noble Baroness, Lady Brinton, in her personal testimony. A number of noble Lords have articulated the key fact that it takes seven to eight years for a diagnosis, with 40% of women needing 10 or more GP appointments before being referred to a specialist. If it was a man, I fear that it would be very different indeed. Menopause, mentioned by my noble friends Lady Jenkin and Lady Altmann, is another good example of this.

This lack of understanding of female conditions has implications for the health and care that women receive. Data is key and data saves lives—I am a big believer in that. To reassure my noble friend Lady Fraser of Craigmaddie, that is why

“Ensuring research, evidence and data support improvements in women’s health”

was one of the key themes of the call for evidence, and it will be a key theme of the strategy going forward. I completely agree with my noble friend that we must work hard to ensure that women, and women’s health issues, are included in research and data collection, finally ending the gender data gap that sadly exists.

Men are too often the default, and we do not know enough about the conditions that manifest differently in men and women. This can and does lead to poorer health outcomes, as vividly explained by my noble friend—I think it was Lady Bottomley; I cannot read my own writing. A University of Leeds study showed that women with a total blockage of a coronary artery were 59% more likely to be misdiagnosed than men and found that UK women had more than double the rate of death in the 30 days following a heart attack. I completely agree with the noble Lord, Lord Hunt: this just is not good enough. I would be glad to meet with the noble Lord, Lord Young of Norwood Green, to discuss the issue of mixed wards.

Too often, women are not listened to, and unfortunately we see this at all levels of the healthcare system, whether it be reports of women having their pain ignored during gynaecological procedures—such as IUD fittings or hysteroscopies—or the sobering findings from independent reports such as the Cumberlege review or the Paterson inquiry. One of the driving forces behind the decision to launch a women’s health strategy was the findings of the Cumberlege review; this is one of the manifestations of our response. I am enormously grateful to my noble friend for her work on this report and to many others in the House who have championed its work. The report powerfully highlights how the system did not listen to women. I am aware that today is the review’s first anniversary, and a debate has just taken place in another place to mark the occasion.

The Written Ministerial Statement of 11 January provided an update to Parliament. This included that the department had accepted the report’s flagship recommendation: the establishment of a patient safety commissioner. We also announced in this Statement that we had accepted recommendations concerning specialist mesh centres, MHRA reform and the establishment of a medical devices information system. I reassure the noble Lord, Lord Brooke, the noble Baronesses, Lady Bryan and Lady Brinton, and others who asked that we are carefully considering the remaining recommendations and 50 actions for improvement. It is imperative, for the sake of patients and especially those who have suffered greatly, that we give this independent report the full consideration it deserves. In the January Statement, we announced that we would establish a patient reference group to work alongside the department to develop a full response. I am happy to confirm that the group was established earlier this year and has been working closely with officials to consider the report’s recommendations. I can assure Members that we will publish a comprehensive government response later this year.

On a positive note, can I say a few words about the good things that are happening in this area? The National Institute for Health Research is actively seeking to improve participation of underrepresented groups, and I would like to highlight the work of the NIHR INCLUDE programme. INCLUDE provides a design framework for clinical research proposals and gives examples of good practices and resources. The move towards virtual trials, due mainly to the pandemic, will accelerate that. The NIHR funds a wealth of research on women’s health and their outcomes. A couple of examples are the recently funded £2 million trial on endometriosis and the Policy Research Unit in Maternal and Neonatal Health and Care.

On long Covid, I completely agree with the noble Baroness, Lady Thornton: this is a gender challenge. The statistics are quite clear about that. I reassure the noble Baroness that the Government are doing everything we can to listen to and learn from all those suffering from the long-term effects of Covid, including women. I have heard first-hand the insights and experiences of people living with this new and debilitating condition. The noble Baroness, Lady Chakrabarti, is right: long Covid is a new challenge for healthcare systems around the world. I am proud that the UK is leading the way on excellent research, treatment and care. We are investing heavily in research. REACT Long COVID—REACT-LC—aims to better understand the genetic, biological, social and environmental signatures and pathways for long Covid. Through its efforts, supported by £50 million of research funding, we are learning more every day about long Covid. We have 89 new specialist assessment centres opening up around the country, and they are having a huge impact.

I will say a word about maternity services. The Government are committed to reducing inequalities in health outcomes and experiences of care. This was articulated very persuasively by the noble Lord, Lord Boateng, and the noble Baroness, Lady Uddin. In September 2020, the Minister for Patient Safety established the Maternity Inequalities Oversight Forum to bring together experts to address the inequalities for women and babies from different ethnic backgrounds and socioeconomic groups. We are working to ensure that, by 2024, 75% of black and Asian women, and a similar proportion of women who live in the most deprived areas, will receive continuity of care from their midwife throughout pregnancy, labour and the postnatal period.

Maternal healthcare is absolutely critical, as the noble Baroness, Lady Massey, rightly alluded to, and maternal mental health has been neglected. Five years ago, 40% of the country had no access to specialist perinatal mental health care. I am proud to say, in response to the questions on training from the noble Baroness, Lady Walmsley, that there are now specialist community perinatal mental health services in every CCG area in England, with more than 700 specialist front-line staff recruited in the last two years. We are committed to transforming specialist perinatal mental health services across England.

By way of winding up, and on a personal note, I will point to my own experiences in this area and tell the story of my mother, who was hard hit by postnatal depression. It is a condition that we now recognise to affect 15% of mothers, as the noble Baroness, Lady Thornton, said. In the days when I was born, this condition was neither diagnosed nor treated. My mother developed mental illnesses, drug addiction and alcoholism, and was therefore stigmatised by the healthcare system and separated from her children by the courts. Her treatments were barbaric, including electric shock treatment and drugs that made her bloated and sick. She had a relationship with her GP—something that would absolutely not be tolerated now and did nothing to help her then. No one listened to her, the diagnosis was flawed and the treatments were medieval. The system abused her, and she passed away in her bath. I think it is fair to say that she died of being a woman. It had a profound effect on me, and I would not want that to happen to any woman or child again.

Those times have largely passed. The world has got better, but it has not changed enough. That is why my noble friend Lady Jenkin’s debate is so important: it demonstrates that the outline of the problem definition is very clear. It is why this consultation is so important: it ensures that we really have all the details from the people whose voices have not been heard. It is why this women’s health strategy is so important: it will give us a common plan to do something about a problem that has dogged our healthcare system for too long.

Baroness Jenkin of Kennington Portrait Baroness Jenkin of Kennington (Con)
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My Lords, I thank all noble Lords who have participated in this debate and used such a wide variety of their experience to educate us and to plead their different causes—particularly the seven male noble Lords who have supported us. I rather like the idea of it being the seven ages of woman; I will stick with that one. I particularly thank my noble friend the Minister, not only for his comprehensive reply to us today but for his deeply moving description of his and his mother’s experiences. I challenge anyone not to have a lump in their throat hearing this very moving story. He has always been a great supporter of women and of the causes I have supported, and I am extremely grateful to him for that.

I will touch on a couple of the topics we have discussed; they have all been run through by other noble Lords. Like the noble Baroness, Lady Ritchie, I have participated in a clinical trial; it happened to be about endometriosis. I have no idea whether the drug we were testing is currently on the market, but it was a very long time ago so the answer is probably not yet. One of the lessons Covid has perhaps taught us is that clinical trials can be sped through and happen more quickly than we originally thought. I am very glad that other noble Lords raised this as an issue.

A number of noble Lords talked about mental health. The fact that so many people talked about it made us aware of what a big issue it is. Although the noble Baroness, Lady Cumberlege, is not with us today, I suspect that a large number of people—probably more people than are listening to this debate—heard her on the radio this morning. I was very struck by the dignity of the victims: the mother of one victim spoke particularly eloquently and with such dignity about her experience.

A number of noble Lords talked about Sir Michael Marmot and his work on inequality. It is a massive wake-up call for all of us, and the theme of inequality is so clear in the work that he does. It is tempting to think that this debate has been a rather miserable litany of bad experiences, but I think it was my noble friend Lady Bottomley who said—as the Minister has just said—that there have been massive improvements in so many areas. We must not forget that.

I return to the point I mentioned at the beginning. I changed my usual topic of International Women’s Day, but the noble Baroness, Lady Nicholson, raised the hideous plight of so many women across the world. We must remember to count our blessings that we live in such a wonderful country, where we have access to healthcare that is so much better than in so many places across the world.

I will end by again wishing my noble friend Lady Penn good luck. With her typical efficiency, she is actually due on the day we rise, two weeks today—and with her typical efficiency, she will probably have the baby on that day or the day after.

I know the Government are serious about this agenda, and they know that we will be watching them.

Motion agreed.