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.
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.
My Lords, I am delighted to take part in this debate on women’s health issues, so ably introduced by the noble Baroness, Lady Jenkin.
A common issue coming out of all the briefings, and particularly from the report by the noble Baroness, Lady Cumberlege, FirstDo No Harm, published last year, is the need to listen to women when they talk about their health. We all heard the noble Baroness talking movingly in this House, when we first debated her report, about how upsetting it was when she really listened to the women who had been damaged, or whose babies had been damaged, by valproate, Primodos or vaginal mesh and how relieved the women were to be listened to at last. Can the Minister say when the Government will implement all her recommendations?
Information is vital because, without it, women cannot exercise proper choice. In the case of the anti-epilepsy drug valproate, we heard from women with epilepsy when we debated the report last year that women were still not being fully informed of the risks in case they become pregnant. Let us remember: about half the pregnancies occurring in the UK are unplanned.
So information is key, but so is listening. I am horrified when I hear that women who eventually get a diagnosis of endometriosis have usually been to their GP 10 times before they finally get a proper investigation, diagnosis and treatment—just one example of where women’s pain is not taken seriously. I recognise that the non-specific symptoms are of course difficult to diagnose, but I would like to know what training trainee doctors get in actively listening to women.
As we just heard, women are also underrepresented in clinical trials, even for drugs specifically aimed at women. This is completely unscientific when you understand the differences between women’s and men’s biology. Can the Minister say why the regulator allows this?
My Lords, as the first male Member of your Lordships’ House to speak in the debate, I welcome very much what the noble Baroness, Lady Jenkin, had to say. Her opening speech was, frankly, awesome—that is how I would describe it.
I do not apologise for returning to the Marmot review, which the Minister has heard me speak about before. Inequalities in life expectancy have increased since 2010, especially for women. Female life expectancy declined in the most deprived 10% of neighbourhoods between 2010-12 and 2016-18. Female life expectancy decreased in every region save for London, the West Midlands and the north-west. Life expectancy in England has stalled since 2010, which has not happened since 1900. When health has stopped improving, it is a sign that society has stopped improving. That is all from the Marmot Review 10 Years On, published in February 2020.
Of course, health is linked to all the other conditions in which people are born, grow, live and work, together with inequalities in power, money and resources. Frankly, the Government have not prioritised health inequalities, despite the concerning trends, and there has been no national health inequality strategy since 2010. This is a national UK issue and cannot be shoved off as a devolved matter.
I have not mentioned Northern Ireland. It has suffered the same as the other three nations but one figure, set out on page 12 of Build Back Fairer: The COVID-19 Marmot Review, isunique in respect of female health. The table is titled: “Relative cumulative age-standardised all cause mortality rates by sex, selected European countries, week ending 3 January to week ending 12 June 2020”. Of the eight countries where the situation got worse—as opposed to the 11 where it got better—the UK’s four nations were in the eight, and in only one of all the countries where it got worse, it got worse for females compared to males. That was Northern Ireland. There is quite clearly something badly wrong in health inequalities between men and women in Northern Ireland for it to stick out like that among all those countries. The recommendations for change are all well known. They are listed in both the Marmot reports I have used.
My Lords, I welcome today’s debate on women’s health outcomes and thank the noble Baroness, Lady Jenkin of Kennington, for bringing this Motion to the House today in an extraordinarily moving way.
We know that there are many conditions where women are overrepresented—for example in mental health, where 26% of young women have experienced anxiety, depression or eating disorders. We know that with gynaecological conditions it often takes seven to eight years to receive a diagnosis of endometriosis, with 40% of women needing 10 or more GP appointments before being referred to a specialist.
In one area of women’s health, I became aware late last year that there was a national shortage of widely used contraceptive preparations and hormone replacement therapy products. In response to my Written Question, the Minister, the noble Lord, Lord Bethell, responded that this shortage was due to
“Issues such as regulatory or manufacturing problems, problems accessing supplies of pharmaceutical raw ingredients and commercial decisions to divest certain products”,
which
“can affect the supply of medicines.”
Throughout 2020, thousands of women were not able to access their normal oral contraceptive or hormone replacement therapy products. This is one recent example of women not having access to the pharmaceutical products they regularly used, though this also happens, as we know, with various medicines that both men and women take.
I declare my interest in the register as co-chair of the All-Party Parliamentary Group on Bladder and Bowel Continence Care. Women are five times more likely to develop urinary incontinence than men. This is something many women feel uncomfortable talking about or raising with their GP. For many women, bladder continence issues can result in a loss of independence, as they feel unable to leave their homes unless they know there are accessible public toilets near to where they are going. Much like gynaecological conditions, issues with continence care can take time to diagnose and cannot always be treated. Much greater awareness is needed of these conditions and, in particular, how they impact on women’s lives.
My Lords, I am afraid I am going to have to remind the noble Baroness of the time limit for Back-Bench contributions, given the number of speakers we have in this very important debate.
My Lords, I thank the noble Baroness, Lady Jenkin, for leading this debate, an initiative wholly consistent, if I may say so, with her long record of campaigning on behalf of women.
Even in these days of deliberately stoked and exaggerated culture wars, there can be few who do not agree that millennia of structural inequalities have undermined women’s health worldwide. Further, it is obvious that the current devastating pandemic has magnified every such inequality on the planet. This includes the shocking, yet predictable, rise in domestic violence during necessary lockdowns, reduced access to sexual and reproductive healthcare and other vital women’s health and social services internationally.
Women are more likely to be involved in childcare, social care and cleansing, whether in the home or outside it, placing millions of them on the front line of infection. While older men seem more likely to die of Covid-19, it seems that women who survive it may be more likely to suffer from the chronic symptoms associated with long Covid. That means that every current decision in the debate about how best to either combat or live with the virus is likely to have a gendered impact.
The extent to which casting off the mask has become associated with one’s love of freedom is unfortunate indeed. I worry about the way in which some in government have become so wedded to irreversible “business as usual” from a particular date that they are risking more than necessary and perhaps forgetting that, for many, business as usual, even before the pandemic, was far from free, fair, safe or healthy.
If the Government want to honour their promise to vaccinate the planet and an earlier pledge for a new era of global Britain, they must stop siding with Germany in blocking the TRIPS waiver at the WTO and join the United States, India, South Africa and most of the Commonwealth—celebrated here earlier this afternoon—in demanding that industry shares know- how around vaccines, tests and treatment manufacture so these can be decentralised and scaled up to meet global demand.
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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.
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.
I am, like the noble Baroness, Lady Massey, very concerned about women’s mental health services, particularly since the pandemic has isolated so many women in their homes with sole responsibility for caring for their children and sometimes elderly relatives. A listening ear has been more important than ever during the pandemic and many kind members of the community have stepped up, but they are no substitute for clinical services. Asking questions and listening to the answers is particularly important in antenatal clinics, where mental health issues and domestic violence can often be detected early. I ask the Minister: will women’s mental health be specifically included in the new Secretary of State’s plan for mental health?
Another factor of women’s health which has worsened over the past year is nutrition and obesity. We have seen an increase in poverty, which is linked to obesity, and an increase in eating disorders. When will we get Henry Dimbleby’s long-awaited national food strategy? This is really important for women themselves and for those they feed and care for.
I note the BMA has highlighted more targeted issues, such as those relating to domestic abuse, pregnancy and maternity services, which male Secretaries of State keep ignoring. However, the first move has to be an acceptance that things have gone really badly since 2010, when the coalition Government imposed swingeing cuts to public expenditure without any analysis of the consequences. One consequence is the stalling of life expectancy, where women have been affected worse than men.
My final point is to draw attention to some depressing findings from the 2020 Marmot report, about which the noble Lord, Lord Rooker, spoke so movingly just now. According to Sir Michael’s 2020 report on health disparities, women living in the most deprived 10%—
19 July is not “freedom day”, but it could yet be solidarity day in a global race against vaccine-resistant variants and even more deaths.