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A greater society for all - why women's health matters

Published: 04 March 2024

Throughout March, we will be publishing a series of blogs by guest authors around gender inequalities within healthcare, as part of International Women's Day on 8th March.

In the first of this series, Dr Hannah Tharmalingam delves into the critical issues surrounding women's healthcare and what this means in the context of cancer.

Dr Hannah Tharmalingam, Consultant Clinical Oncologist and Macmillan National Clinical advisor.

Dr Hannah Tharmalingam National Clinical Advisor for Macmillan

"When we get it right for women, everyone in our society benefits." - Professor Dame Lesley Regan, Women's Health Ambassador in England

The Gender Gap in healthcare

Over 800 women across the world are still dying every day as a result of avoidable causes related to pregnancy and childbirth.

Current healthcare systems, both in the UK and around the world, are failing women. In the UK, although women have a slightly longer life expectancy than men, they spend a greater proportion of their lives facing ill health and disability (1).

While the historical emphasis of women’s health has been intrinsically linked to society’s focus on their reproductive role, this does still represent a key health need for the huge numbers of women.

For example, maternal mortality, having been identified as one of the United Nations (UN) Millennium Development Goals in 2000 (2), still falls short of the original target of reduction by 75% (3). As of 2020, over 800 women across the world were still dying every day as a result of avoidable causes related to pregnancy and childbirth (4).

Breaking taboos: overcoming stigma in women's healthcare

In 2018, over 7,500 women surveyed said they had experienced severe reproductive health issues, and less than half sought medical help. 

Exacerbating the challenges for women navigating the healthcare system is the persistent stigma surrounding gynaecological and reproductive health which can negatively impact on their ability to communicate with healthcare professionals about symptoms and their care-seeking behaviour in general.

A Public Health England survey of over 7,500 women in 2018 showed that nearly a third had experienced severe reproductive health issues in the last year but less than half of those had sought medical help (7).

Problems relating to menstruation, fertility, menopause, incontinence and sexual health that can all have a hugely debilitating impact on women’s well-being are still seen as awkward taboo subjects, discouraging open discussion and creating barriers for seeking support and treatment. This is reflected by a lack of prioritisation of women’s health conditions at an institutional policy and research level.

For example, there have been no new non-hormonal interventions for heavy menstrual bleeding developed within the last 30 years (8) whilst the treatment for severe cases of pre-menstrual syndrome remains the removal of the ovaries, the same archaic advice given to women in 1931 by gynaecologist Robert Frank when the condition was first described.

Addressing the failures in patient communication

A failure to listen to women remains a core issue across all aspects of women’s healthcare, with 84% of respondents to the Department of Health and Social Care’s (DHSC) call for evidence for their recently launched Women’s Health Strategy reporting this was the case (5).

Examples include those related to menstrual disorders with women told heavy, painful periods were normal or a minor issue they would simply grow out of, whilst others report waiting years for a diagnosis of endometriosis having repeatedly being dismissed by health care professionals (6).

Whilst it is indeed positive to see the Government’s Women’s Health Strategy commissioned and published, the views and expert testimonies expressed within it show concerning trends that need to be addressed.

Closing the gender research divide in medicine

A 2014 report showed only 2.5% of publicly funded research in the UK was dedicated to reproductive health.

High-quality research is fundamental to driving improvements in medicine.

The gender research gap is clear to see across the healthcare spectrum. Remarkably, the inclusion of women in clinical trials only really started in the late 1980s and was only mandated by National Institutes of Health guidelines in the United States from 1993 (9) (10). Over 30 years later, there remains a huge imbalance with, for example, according to one estimate, 80% of research evaluating pain being conducted in human men or animals, despite 70% of those afflicted by chronic pain conditions being women (11).

Furthermore, there is a disproportionate allocation of resources away from conditions affecting women with a 2014 report showing only 2.5% of publicly funded research in the UK was dedicated exclusively to reproductive health (12). In comparison, according to one estimate from 2016 there is five times as much research into erectile dysfunction, a condition affecting around 1 in 5 men, compared to pre-menstrual syndrome which is thought to affect up to 90% of women at some point in their lives (13).

A research infrastructure so heavily burdened with gender bias ultimately builds a healthcare system that negates the needs of women. There is also a severe lack of research into the health needs and experiences of trans men and people who are non-binary who were assigned female at birth, as well as trans women.

Conversely, the positive developments in men’s health that have arisen as a result of prioritisation and funding of research into common conditions demonstrate the transformational impacts on health and wellbeing this can have, and it is really critical that progress is made in bridging the gender gap.

Impact on cancer care

2.3 million women die prematurely from cancer each year, of which 1.5 million premature deaths could be prevented by prevention and early detection.

A recent Lancet Commission created to evaluate the interconnection of women, power and cancer reports in detail the considerable impact of the disease on women globally (14).

2.3 million women die prematurely from cancer each year, ranking it in the top three causes of premature mortality in women worldwide (14). Of these, 1.5 million premature deaths could be prevented through more robust primary prevention and early detection strategies, whilst the remainder could potentially be avoided if all women could access optimal cancer care.

Overall, cancer appears to be less responsive to primary prevention in women than in men, with the gender research gap significantly hampering progress in understanding the causes of cancer in women.

For women living with cancer, a number of issues relating to reproductive and sexual health can be disease or treatment related. Conditions such as menopause, infertility, sexual dysfunction, and incontinence have a considerable impact on their own but can often be even more devastating when intrinsically linked with a cancer diagnosis.

The importance of more menopause support has been explicitly mentioned in the England National Cancer Patient Experience survey with younger women often feeling unprepared and alone in navigating treatment-induced menopause and its considerable impact on their physical and mental wellbeing (15).

When looking at sexual health, men living with prostate cancer, for example, can often access support for treatment-related erectile dysfunction with a number of units running dedicated specialist clinics. Such similar support structures for women experiencing sexual health issues following pelvic radiotherapy are few and far between.

Seemingly, the taboos and stigma surrounding women’s gynaecological and sexual health have not escaped cancer care and our services are falling short. And, as with overall health, there are specific challenges when it comes to cancer care for people who are transgender or non-binary which we cover more in our supporting transgender patients blog.

How Macmillan can support everyone living with cancer

Health inequalities in accessing and receiving the right care and support are unacceptable. Macmillan provides a range of emotional, financial and physical support for everyone living with cancer.

The Macmillan Support Line is available with specialist advisers who may be able to assist and help navigate needs. Our tailored information resources are written by experts and cover a number of topics affecting women living with cancer. Further support is available through our Online Community and at our Cancer Information and Support Centres

At a national level, we continue to advocate for an inclusive, systems-level approach to addressing women’s health within cancer care so that everyone, no matter their gender, can live well with cancer. We also have information tailored specifically for people who are transgender or non-binary.

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More blogs from our International Women's Day series

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