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The government recently appointed Dame Lesley Regan, professor of obstetrics and gynaecology at Imperial College London, as the first women’s health ambassador for England. The new role has been created to help close the gender health gap.
Women make up 51% of the population in England and Wales, yet persistent gender-based inequalities in health, social care, living standards and employment mean women spend more years than men in poor health. And for the first time in a century, their life expectancy is declining – and women in deprived areas are the most affected.
Women from underserved and underrepresented racial and ethnic groups face consistently poor outcomes, even after taking socioeconomic factors into account. Black mothers are four times more likely to die in pregnancy and childbirth than white mothers.
Timely, inclusive and relevant research based on woman-centred care is key to addressing the above problems. Regan has highlighted the immediate need to focus on areas that affect almost all women – such as menopause, menstrual problems, and contraception. She has also highlighted the importance of empowering women to access the healthcare they need across their whole life.
Across the lifespan
Women’s health needs to be viewed across the whole lifespan. For example, conditions such as polycystic ovary syndrome have different symptoms at different stages of a woman’s life. Menstrual irregularities and facial hair are common in adolescence, but other symptoms – such as infertility, diabetes during pregnancy, and even complications such as high blood pressure and type 2 diabetes, stroke, and heart attack – are common in the long term. A single strategy targeting polycystic ovary syndrome across the woman’s life will have a positive effect on her short and long-term health.
Another important area that needs more attention is pregnancy in women with underlying complications, such as epilepsy. Compared with more than 200 randomised trials involving the general population with epilepsy, there is only one trial involving pregnant women. Despite improvements in maternity care, maternal deaths are increasing in women with epilepsy, mainly because seizure risks in pregnancy are not being properly identified.
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Effective communication of the risks, benefits, and treatments during pregnancy is an essential component of woman-centred care. The recent Cumberlege review on complications in babies exposed to the drug valproate (an epilepsy drug) in pregnancy highlights the lack of communication with women about the risks. For women to make informed decisions about the treatments they are offered, they need reliable information on the long-term effect of drugs taken during pregnancy.
Pregnancy and breastfeeding should not be reasons for excluding women from drug trials. The recent report Safe and Effective Medicines for Use in Pregnancy sets out how research can be managed to mitigate safety concerns and give confidence to women and their doctors.
Racial and ethnic disparities
To optimise the health of all women, we need to tackle the disparities in health outcomes arising from race, ethnicity and socioeconomic factors. The first step is to really understand the burden of the problem facing women across different regions and for specific conditions, and provide targeted funding. We need to identify those women at risk of ill health early, and target interventions to prevent complications. Moreover, complications in pregnancy adversely affect babies in the long-term. This intergenerational impact can further widen race and ethnicity related inequalities.
It will also be important to invest more in research that promotes women’s health. This can be achieved by drawing on academic expertise in the UK, putting more robust financial investment into these areas, building infrastructure within the NHS and providing training opportunities for early career researchers and clinicians. Seamless integration of academic and health services is critical to the successful delivery of the research.
Any effort to improve women’s health can only succeed when women and their families are involved from the start to the end of the research. Women should guide, support, lead and disseminate research. We need dedicated, inclusive, and representative patient and public involvement groups to promote women’s health research.
The appointment of a dedicated women’s health ambassador is the first step toward achieving the ambitious goal of removing gender, race, and income-based health inequalities to benefit all women and future generations.
Shakila Thangaratinam receives funding from NIHR, MRC, WHO.