Dr Rathi Guhadasan offers some reflections for International Women’s Day.

Two years ago, former Socialist Health Association (SHA) Vice Chair Vivien Walsh wrote an article entitled “Women’s Lives Before the NHS”. Today, as we celebrate International Women’s Day, the article is a timely reminder of what our predecessors in the SHA (or Socialist Medical Association as it was then) and labour movement achieved and why it was so important.

One such predecessor was Dr Edith Summerskill, a founding member of the SMA and a minister in the Attlee government. In addition to fighting for universal healthcare provision through the NHS and passing legislation for pasteurised milk, she campaigned on issues such as equal pay for women, birth control, abortion rights and pain control during childbirth.

What would Dr Summerskill say to us today, on this International Women’s Day?

We’ve certainly come a long way from the pre-NHS circumstances described in Vivien’s article, when deaths in childbirth were four times higher than deaths from coal mining – the most dangerous job for men at that time. Today, however, UK maternal mortality rates are the highest for 20 years, with an over 50% increase in 2020-22 figures compared with 2017-19; and black and Asian women and those from the most socioeconomically deprived areas face the greatest mortality risks compared to their white and more affluent counterparts. Last year’s All Party Parliamentary Group Birth Trauma report was a devastating indictment of the state of maternity care in the UK and this has been reinforced by a succession of scandals from Shrewsbury to Nottingham.

The crisis in women’s healthcare is not limited to maternal health but extends across their lifespan. Unlike men, healthy life expectancy for women has fallen since 2014 and they spend a greater proportion of their lives in ill health and disability. According to Professor Dame Lesley Regan, women have been disproportionately impacted by the NHS funding cuts of the past 15 years:

“The net result is that we now have a 45% unplanned pregnancy rate, cervical screening is at an all-time low, while abortion rates are at an all-time high, mostly explained by the fact that women face numerous barriers when trying to access routine health maintenance services…. Women’s health services like cancer screening, contraception, abortion and maternity services have been in three silos of commissioning – Clinical Commissioning Groups, local authorities and NHS England… None of those three funding pots picks up the pieces when they don’t get it right; the people that don’t give you contraception aren’t the ones to pick up the maternity bills or the abortion bills.”

To make matters worse, women and children are often not represented in research. Many treatments for pregnant women, babies and children are used off-licence, having never been tested in clinical trials, so that any potential adverse effects will only become apparent through clinical experience. The COVID-19 vaccine is a notable example, where the conditions of pregnancy and breastfeeding were illogically conflated and both pregnant and lactating women were denied the vaccine when it was first licenced.

This ‘gender data gap’ is dangerous for women, who are continually compared to a male ‘default’ when they present to health services, not listened to or understood. For example, women presenting with heart attacks are routinely misdiagnosed when they don’t show the ‘classic’ symptoms which are taught in medical school, and which are only classic in men.

The last government’s Women’s Health Strategy call for evidence found that 84% of women surveyed reported feeling they were not listed to by health professionals. Within this shocking statistic, however, is a tangle of intersectional inequalities which need to be addressed, such as those relating to ethnicity, disability, sexuality and socioeconomic background. It should be remembered that women also disproportionately carry the burden of caring responsibilities in this country, in the face of a broken social care system, and bear the greatest impact on their employment and earning potential.

The NHS today remains largely an intervention service rather than a prevention service, missing opportunities to empower women and girls to take control of their health. SHA’s maternal health group last year called for exactly this: “Services should be focused on preventative health, reducing inequalities, and meeting the needs of women across the lifespan.” We suggest to “staff the women and not the wards”, implementing midwifery continuity of care models, delivered via integrated community-based women’s health hubs; coupling this with programmes such as Sure Start to target inequalities, addressing pay and working conditions in order to retain trained staff, and redesigning training curriculums to meet the needs of all marginalised and vulnerable women.

The situation for women and girls globally also needs urgent attention. According to UNFPA, about one in three women worldwide experience physical and/or sexual violence in their lifetime. The indefensible cuts in aid spending will hit women and children the hardest. More than 60% of all maternal deaths occur in fragile contexts and humanitarian crises. When mothers die, their children are much more likely to die, and if they survive, their nutritional and educational outcomes are nevertheless impacted. Yet every $1 invested in maternal health and family planning yields $8.4 in economic benefit.

Women give us hope

I think Dr Summerskill would still see reasons for hope today. We still have inspirational women in the labour movement, from Diane Abbott to Apsana Begum and Zarah Sultana, who tirelessly and fearlessly fight inequalities and stand up for the vulnerable. Within the SHA, we have great women leading on important policy work, from fighting NHS privatisation to women’s health, abortion rights and social care.

If you’d like to learn more about our work on these issues or get involved, please contact us at admin@sochealth.co.uk.

Dr Rathi Guhadasan is Chair of the Socialist Health Association.