Dr Melanie Nana, outgoing co-chair of the RCP Trainees Committee, National Institute for Health and Care Research (NIHR) clinical research fellow at King’s College London and obstetric medicine registrar at Guy’s and St Thomas’ NHS Foundation Trust, blogs about the lack of priority given to women’s health during the 2024 UK general election campaign.
A focus on women’s health throughout their life cycle has never been more important for physicians. Maternal death rates in the UK have increased to levels not seen for almost 20 years, and there is now widespread recognition that women are more likely to die in pregnancy from medical causes (primarily heart disease) than from obstetric causes (such as haemorrhage or sepsis).
In later life, while women have a lower prevalence of cardiovascular disease than men, they are more likely to die from it. In a study of 884 patients with a myocardial infarction, the number of women who died within 30 days was almost three times higher (11.8% vs 4.6%) than men.
Risks at all stages of a woman’s life are increased for those living in deprived areas, living with obesity or belonging to an ethnic minority, and when these characteristics and factors intersect for individual patients, the cumulative risk is more than merely additive. These challenges are confounded by a long history of inadequate inclusion – and, in the case of pregnant and breastfeeding women, active exclusion – of women in clinical research.
Recognising the importance of this agenda, the RCP recently endorsed the FSRH Hatfield Vision, which outlines what needs to happen to improve the health of 51% of the UK’s population and tackle the inequalities that women and girls face across their lifetime. The college has also established a Joint Committee for Obstetric Medicine with the MacDonald Obstetric Medicine Society and launched a diploma in obstetric medicine, while RCP fellows have been instrumental in developing obstetric medicine networks across England.
Doctors working in the relatively new field of maternal medicine are working to ensure that women in pregnancy have access to specialist advice, regardless of where they live. The RCP plays an integral role in training these physicians and has joined forces with the charity Wellbeing of Women to fund early-career researchers interested in addressing research priorities in women’s health and reducing the inequalities that women face.
It's not just the RCP that is taking this seriously. A diverse range of champions for women’s health are speaking up and advocating for long-overdue improvements, such as the MESSAGE project, which is working to improve inclusion of women as participants in UK biomedical research and ensure that data are disaggregated by sex and gender to improve understanding of sex differences across the life course. A plethora of chief medical officer reports, maternal inquiries and women’s health strategies repeat the same message: more inclusive research, acting on the data that are already available, and listening to women about their healthcare priorities. But little of this can be implemented without the support of government and adequate funding.
A new Labour government offers the opportunity to lobby for more funding and new priorities in women’s health, but also risks losing the gains that we’ve already made, like the current Women’s Health Strategy for England (2022).
Recently, I joined a group of academics, clinicians and patients to analyse the political party manifestos for the 2024 UK general election. We wanted to find out whether existing policy and strategy for women’s health had cut through – would a future government prioritise these issues?
Using a Delphi process, we distilled the recommendations from major UK reports, inquiries and strategies from the past 10 years into 15 key ‘asks’. We then scored the manifestos for strengths and weaknesses regarding their inclusion (or not) of these priorities.
In a write-up of the research in the BMJ (Womersley, Mullins et al, 2024) during the 2024 UK general election campaign, colleagues from the George Institute for Global Health UK at Imperial College London described the political party manifestos as ‘disappointing’ and explained that:
‘… furthering women’s health has been held back by inadequate inclusion of women in clinical research and trials, failure to fund and ensure safe maternity care, minimisation of ‘benign’ conditions such as endometriosis and the menopause, and a dearth of women’s voices in economic and policy arenas.’
We found that there was little to choose from between major parties’ coverage of women’s health in their manifestos. The leading three parties scored 8 or 9/30, while Reform UK scored 0.
Ultimately, our analysis found that women’s health was not a priority in any of the major party manifestos this year. Two issues did score well across the manifestos: the provision of affordable and accessible childcare for women returning to work after pregnancy and tackling violence against women and girls. It should not be a surprise that these issues have received impressive levels of advocacy from healthcare professionals, campaigners and the public.
Speaking as a trainee passionate about the future of women’s health, the outlook is pretty bleak based on the content of these manifestos. The Labour government must take women’s health seriously, collaborate across the floor on good ideas – such as the Women’s Health Strategy for England – beyond short-term political cycles, and commit to policies that have an evidence base. Otherwise, there is a real risk, as the authors describe in this research, that ‘women’s health in the UK could fall off the political radar.’ And we can’t let that happen.
Dr Melanie Nana
Outgoing co-chair of the RCP Trainees Committee
NIHR clinical research fellow, King’s College London
Obstetric medicine registrar, Guy’s and St Thomas’ NHS Foundation Trust