One of the UK’s top doctors is leading an effort to revolutionise health services for women, from helping them prevent unplanned pregnancies to staving off disease in old age.
Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists, is co-chairing a women’s health task force with government minister Jackie Doyle-Price, which aims to help the 51% of the population who are women get joined-up care and attention to their needs throughout the lifespan.
Regan says women have to make multiple appointments to see healthcare staff in different clinics and GP practices about related issues, because the services are not focused around their needs. Contraception and sexual healthcare, for instance, “are core to girls and women’s health and they are so fractured and lots of women are falling through the cracks not able to access very simple things,” she tells the Guardian.
In an ideal world, “an adolescent girl can go along to a well-woman clinic, facility or shop and she can access her smear, her contraceptive advice, she will get very simple, preferably infographic, information about what she needs to do to prepare herself to have safe sex and when she wants to get pregnant to have the best possible outcome for her pregnancy,” says Regan.
The college will publish its own women’s health strategy in the autumn. Regan pressed first Jeremy Hunt when he was health secretary, and then Matt Hancock, his successor to produce one. Adopting a life-course approach to women’s health would even save money, she argues. The task force was set up as a result in November.
Women “carry a massive load of caring responsibilities,” she says. “So it’s not just that they are the majority of the population and they tend to use healthcare resources not just when they’re ill but when they’re doing normal things like having contraception and having a baby and getting their cervical screening. They then influence all of their children and their families and often in later life they have caring responsibilities for elderly relatives.”
There is a lot more to women’s health than maternity services, Regan has told ministers. “I used the analogy that we’ve got past the Margaret Atwood days and the Handmaiden’s Tale where women are all about incubating babies and then after they’ve delivered them that’s the end of them,” she says.
The health service has opportunities to intervene to help women stay well. In the adolescent and young adult years, women come for contraceptive and sexual health advice, which could allow a nurse or doctor to discuss pregnancy planning. “Success means that every young woman understands that by having a problem-free pregnancy, she is giving her child the very, very best start in life,” she says. “Most pregnant women don’t really understand that what happens during the pregnancy lasts a lifetime for that child and then moves across to the next generation.”
According to Regan, when women come to give birth, doctors have a chance to pick up on health issues that could cause problems in the years to come. “If during my pregnancy I had a premature delivery or some gestational diabetes or a mental health problem, that’s almost like a prescription for what is going to happen to me 20 years on.
“We collect all this information after the baby but we don’t do anything with it. So wherever you go for your postnatal check they tend to focus on the baby, which I understand.”
But if they focused on the woman, Regan says, they could suggest she might lose weight, because she is at risk of becoming a type 2 diabetic, or help her to get support for common mental health problems that will otherwise recur.
It’s also another opportunity to help women prevent unplanned pregnancies. Regan cites a successful project she started in South Africa, where women are offered the coil after giving birth. “I’d just love it if we could persuade our midwives and our doctors here to think about this – providing post-pregnancy contraception. It would help if somebody talked to every woman after delivery about contraception. The midwives and health visitors used to do it and the GP used to do it and now it’s nobody’s business whereas it ought to be everyone’s business,” she says.
“My third point was to develop the 51 club – 51% of the population and 51 is the average age of menopause in the western hemisphere. Most women become menopausal and are not offered anything. One or two get a bit of HRT [hormone replacement therapy] if they are lucky,” she says.
They also need support, she says, to avoid heart disease and bone fractures. “The physicians talk about this massive group of women enlarging all the time who are well in terms of longevity, but they are becoming increasingly more dependent and frail.”
So far, the task force has had two meetings to start to plan a strategy. Regan believes the revolution is possible. “There’s a realisation among our politicians and policy makers in the department of health that lots of people have fallen through the cracks. My argument has always been that women have been disproportionately disadvantaged by the cuts in public health because so many of the services that women need to access for general body maintenance, if you like, as opposed to poor health, fell under that public health umbrella and they’ve been viciously cut,” she says.