Why are women still having to deal with undiagnosed gynaecological conditions, untreated maternal mental health issues, struggles in the workplace and unequal care? Journalist Jo Waters investigates.
Hailed as a landmark for improving women’s health, the Women’s Health Strategy for England (Department of Health and Social Care (DHSC) was launched by the former Conservative government in 2002 (DHSC, 2022). At the beginning of 2024, the then health and social care secretary Victoria Atkins made an announcement on priorities for the coming year. These included menstrual health, menopause, maternity care, birth trauma, pregnancy loss, investment in more women’s health research (historically women have been underrepresented in medical research in general) and more one-stop women’s health hubs (DHSC, 2024a).
‘We’ve made huge progress – enabling almost half a million women access to cheaper HRT, supporting women through the agony of pregnancy loss and opening new women’s health hubs – but I absolutely recognise there is more to do,’ Victoria acknowledged at the time.
Other UK nations have also drawn up their own strategies or started to consult (see The UK women’s health plans table, below) with varying degrees of implementation.
But factors such as last summer’s change of government, a seemingly never-ending NHS funding crisis and a shift in government priorities for the NHS in England have cast doubts on some of the ambitious plans.
In November 2024, the Royal College of Obstetricians and Gynaecologists (RCOG) and 10 other health organisations stated that women’s healthcare has been under prioritised and under resourced for too long in the UK. They claimed that vital opportunities to offer timely and high-quality care, and to help women live longer in good health, were being missed (RCOG, 2024a).
GYNAECOLOGICAL GRIEF
The RCOG also published a damning report last November, revealing that 763,694 women in the UK were currently waiting months and years for treatments with serious gynaecological conditions (RCOG, 2024b). That’s enough women to fill Wembley Stadium eight times over, and an increase of 33% since 2021, the charity said. The RCOG survey of more than 2000 women and 300 healthcare professionals found that more women now also require emergency care to manage severe symptoms. While 76% reported worsening health, and 69% said they were unable to take part in daily activities including work (RCOG, 2024b).
Unfortunately, these are not new issues. For instance, treatment waiting times for gynaecology in England alone had the second largest waiting list increase of any specialty, at 223%, from May 2014 to May 2024 (Nuffield Trust, 2024).
RCOG president Dr Ranee Thakar says: ‘We know that women are still not getting the vital care when and where they need it, and plans and strategies are not shifting the dial far or fast enough for women. Plans and strategies must be backed up by sustainable long-term government funding.’
As a result, the RCOG is ‘still calling for urgent funding to tackle gynaecological wait lists – as well as a broader approach to improving women’s health across the board’. Dr Thakar continues: ‘This government was elected on a manifesto promise of improving women’s health. However, we are yet to see concrete action on this promise. In fact, in the recently released NHS Operational Guidance there was no mention of women’s health at all.’
‘CLEARING GYNAECOLOGY WAITING LISTS SHOULD BE A PRIORITY AND WOMEN’S HEALTH HUBS COULD HELP WITH THIS TOO – WOMEN SHOULDN’T HAVE TO WAIT TO GET CANCER RULED OUT’
Meanwhile, Helen Hyndman, nurse coordinator at charity The Eve Appeal, says waiting times for gynaecology appointments are getting worse instead of better. ‘I speak to women all the time who have waited more than 52 weeks for their appointments – some of them with worsening symptoms such as abnormal bleeding and significant pain. While the majority won’t turn out to have cancer, some of them will and this delay could affect their chances of survival.’
Waiting can also significantly affect women’s mental health, Helen explains, with some having to ‘take periods of sick leave from work which obviously affects the economy too’. These delays are, of course, deeply worrying for healthcare professionals, she says. ‘Improving gynaecology waiting times is a matter of urgency and should be made a priority.’
The impact on women’s working lives doesn’t stop there. ‘I think women with heavy periods really struggle at work particularly those who are on their feet all day and don’t have enough access to toilets,’ says Taryn Trainor, Unite women’s and equalities officer for Ireland. ‘It is the same with menopause [issues]. I think there’s a lot more employers could do to support them.’ Taryn also reveals that there are no endometriosis clinics in Northern Ireland. ‘Access to abortion is still limited here – not every trust provides it, so women still have to travel, and the abortion pills are not available here.’
CPHVA Executive chair Janet Taylor, believes a gynaecology waiting list ‘blitz’ is needed, like those tackling hip and knee replacements, and cataracts. ‘Clearing gynaecology waiting lists should be a priority and women’s health hubs could help with this too – women shouldn’t have to wait to get cancer ruled out.’
UK WOMEN’S HEALTH PLANS |
Scotland was the first UK country to launch a Women’s Health Plan (Scottish Government, 2021) laying down 60 actions to ensure every woman enjoys the best healthcare. The plan included a menopause and menstrual health workplace policy, which was to be promoted across the private, public and third sector. Other priorities included improving information and public awareness relating to heart disease symptoms and the risks facing women. Meanwhile, a women’s health research fund would ‘close gaps in medical and scientific knowledge’. See Progress on Periods?, page 27, for some of the work done to date. |
NHS Wales published a Women’s Health Plan last December (NHS Wales, 2024) to run from 2025-35. The priority areas include menstrual health, endometriosis, contraception (including postnatal contraception and post-abortion), preconceptual health, pelvic health and incontinence, violence against women and girls, ageing well and long-term conditions. |
Northern Ireland’s Department of Health announced a plan to develop an action plan for women’s health last year (Department of Health, 2024) and consultation is now underway. |
England The Women’s Health Strategy was launched in 2022 (DHSC, 2022) – with ‘progress made’ but more to do, and doubts cast on some of the plans (see main feature). |
WHAT’S HAPPENED TO WOMEN’S HEALTH HUBS?
Setting up women’s health hubs in every integrated care board (ICB) by the end of 2024 was one of NHS England’s key priorities (DHSC, 2024b). A total of £25m was committed for 2023-4 and 2024-5.
The hubs (DHSC, 2024b) were meant to bring women’s health services – such as menopause, gynaecology and contraceptive health – under one roof. They were intended to make it easier and quicker for women to access appointments and for the NHS to tackle health inequalities in some areas (NHS England, 2024). However, a freedom of information request made by a national newspaper revealed that six ICBs had missed the December 2024 deadline (Dimsdale, 2024).
‘INVESTING IN HUBS IS NOT JUST INVESTING IN WOMEN, IT IS INVESTING IN THE NHS AND THE WIDER UK ECONOMY’
Responding to reports that the government was considering removing the requirement for ICBs to fund and establish women’s health hubs, the RCOG voiced its ‘deep concern’ in January this year (RCOG, 2025). In a letter to secretary of state for health and social care Wes Streeting, Dr Thakar and Kate Lancaster (RCOG president and chief executive) said women’s health hubs had demonstrated their value. They referred to the Modality GP service in Birmingham, which cut onward referral rates to secondary care to less than 10%, while delivering speedy access to 1000 appointments every month. ‘This is the type of model that the government should surely be looking to scale up and replicate for other areas of healthcare rather than to withdraw support for it.’ They added: ‘Investing in hubs is therefore not just investing in women, it is investing in the NHS and the wider UK economy.’ (See the table below for examples of how investing in women’s health benefits all).
Speaking in the House of Commons on 30 January, Karin Smyth, health minister for secondary care, denied claims that the government was closing women’s health hubs. She said targets were no longer required as nine in 10 ICBs had already opened hubs (Hansard, 2025).
INVESTING IN WOMEN’S HEALTH BENEFITS EVERYONE |
For every additional £1 of investment in obstetrics and gynaecology spent in England, the return on investment is £11, with an overall benefit to the economy of £319m |
The cost of absenteeism for severe period pain, heavy periods, endometriosis, fibroids and ovarian cysts is estimated to be nearly £11bn annually |
Unemployment due to menopause symptoms costs the economy approximately £1.5bn a year with 60,000 not in employment because of symptoms |
Investments to narrow the heart health gap could help 3.9 billion women live healthier lives and boost the global economy by $1 trillion annually by 2040 |
NHS Confederation, 2024; World Economic Forum, 2025
WHAT ABOUT MATERNITY SERVICES?
The mortality rate for women who tragically died during or soon after pregnancy showed a slight (but statistically non-significant) decrease from 13.14 deaths per 100,000 to 12.67 in 2021-3 compared to 2020-2, according to the latest investigation into UK maternal deaths by MBRRACE-UK (National Perinatal Epidemiology Unit (NPEU), 2025a).
But why are there any? For Alison Spencer-Scragg, Unite national officer for women (equalities), a key issue is a shortage of midwives. This leads to stretched resources and overworked staff, with some women reporting feeling rushed through appointments due to time constraints, she suggests.
‘Postnatal visits and support vary widely by location,’ says Alison. Some women feel abandoned after giving birth, with limited access to midwives or health visitors. Mental health support for new mothers can be inadequate, with long waiting times.’
She said Black and Asian women are at a higher risk of complications and maternal mortality. Health disparities and a systemic bias in maternity care contribute to worse outcomes for minority groups.
‘We need more training for midwives and doctors in racial bias awareness and community-led initiatives to support Black mothers, as well as improved data collection on ethnic disparities in maternity care and improved provision for all women.’
‘CPs NEED TO ADVOCATE FOR WOMEN AND ENGAGE WITH LOCAL POLITICIANS TO HIGHLIGHT WHAT’S HAPPENING ON THE GROUND, AS WELL AS FLAGGING ISSUES TO MANAGEMENT AND GPs IF APPROPRIATE’
Meanwhile, women experiencing complications can face delays in accessing emergency care, while specialist care, such as for perinatal mental health or complicated pregnancies, is not always easily accessible. ‘Some maternity units have closed, restricting options for home births or midwife-led care,’ Alison adds. ‘Epidural and pain relief options can be inconsistent depending on hospital resources.’
Taryn from Unite says maternity services in Northern Ireland are a ‘disgrace’. Some women are being sent home from hospital too soon after C-sections due to a lack of capacity in the system, she explains. While others receive little or no help with breastfeeding if the ward is busy – as is very often the case, says Taryn. ‘I had one young mum who was asked to go home the next day because they needed the bed. She’d had a C-section and had gestational diabetes, did not feel well and had a one-year-old at home. Fortunately, she had a husband who could help.’
UNCHECKED PERINATAL MENTAL HEALTH
The recent MBRRACE-UK study found that mental health-related issues continue to be the leading cause of deaths (34%) at between six weeks and one year after pregnancy, with deaths due to suicide or other psychiatric causes (such as drugs and alcohol) occurring in equal proportions (NPEU, 2025b).
While a progress report on maternal mental health services in England published last autumn by the Maternal Mental Health Alliance (MMHA, 2024) said that demand for MMHA services was high, while access was patchy and waiting times were lengthy. The charity called for an expansion in maternal mental health services to meet demand and noted that one local service had already closed due to funding issues. The MMHA aims to fill a gap in maternal mental health services in the UK by focusing on treating women with birth trauma, pregnancy loss, and tokophobia, and supporting women who have lost custody of their babies.
Hilda Beauchamp, a HV by background who is perinatal and infant mental health lead at the Institute of Health Visiting (IHV), says that the results of the recent IHV annual survey were revealing (IHV, 2025). The IHV received 1400 responses, with 84% of respondents saying that demand for HV support increased in the past year. ‘Ninety per cent of those said the top reason for families needing extra support in all four [UK] nations was perinatal mental health, which is really quite significant,’ says Hilda.
‘We can refer to perinatal mental health services for women with serious mental health problems, but what we are hearing from HVs is that the thresholds for referral are quite high and if the women don’t quite make the thresholds, then they are held [back].’
| HEALTH INEQUALITIES BEYOND ‘WOMEN’S ISSUES’ |
| – 8200 more women in England and Wales could potentially have survived heart attacks had they received the same quality of treatment as men – Researchers (University of Leeds, 2018) found that women were more than twice as likely to die in the 30 days following a heart attack than men (5.2% compared to 2.3%). The authors said this may be due, in part, to women being less likely to receive guideline recommended care |
| LESS FUNDING – Research into women’s health conditions has traditionally received less funding and women have not been included in studies for some drugs – Just 2% of medical research funds is spent on pregnancy, childbirth and female reproductive health (Cawthera, 2023) |
| WOMEN’S PAIN IS ROUTINELY UNDERESTIMATED by the medical profession, according to a study at University College London (UCL, 2021). This is due to the false belief that women are overly sensitive to pain and express or exaggerate it more easily |
PROGRESS ON PERIODS?
Since relationship and sex education was made compulsory in secondary schools in England (Department for Education, 2023), school nurses (SNs) have supported teaching staff in some areas of the UK, says Rhian Ogden, children’s nursing lecturer at the University of Leeds, CPHVA Executive member and former SN. ‘While teaching staff are very good at the biological side of things, they are perhaps less equipped to deal with things like teaching young girls about the wider aspects of the menstrual cycle,’ says Rhian. It varies across the country whether teachers or SNs deliver lessons.
‘In my opinion, delivering sex education is a really nice fit for SNs, as they have the knowledge and training for this, but resourcing is another matter entirely and that’s the challenge. Much of the school nursing workload these days is taken up with safeguarding and I don’t think contributing to the PHSE [personal, social, health and economic] curriculum is achievable with the number of SNs at the moment.’
In Scotland, an e-learning module on menstrual health is available on Turas Learn, which is open to all practitioners (NHS Education for Scotland, 2025). ‘Scotland has also improved access to consistent, reliable information for women and girls by launching a specific Women’s Health Platform on NHS Inform [Scotland’s national health information service] and ensuring there is a specialist menopause service in every mainland health board,’ says a Scottish Government spokesperson.
Other Scotland initiatives include a ‘buddy’ support system in the island health boards, women having access to contraception at community pharmacies, if they choose, and increasing support for women in the workplace through an NHS Scotland [interim]menopause and menstrual health workplace policy, the spokesperson adds.
WHAT NEEDS TO HAPPEN NOW?
‘Women have been let down for too long and we are determined to change that as we reform the health service,’ says a DHSC spokesperson. The current government inherited an NHS in which women wait up to 10 years for an endometriosis diagnosis, one in two wait more than 18 weeks for gynaecological care, and half of maternity units are inadequate or require improvement, the spokesperson notes.
‘We have set out plans to use the independent sector to cut gynaecological waiting lists and for GPs to directly refer women with post-menopausal bleeding for tests and scans, and we have invested an extra £57m for Start for Life services to help expectant and new mothers with their infants.’
The spokesperson adds: ‘We are working with [the current] NHS England to take forward the Women’s Health Strategy – through our investment and reforms, we will make sure the NHS can be there for all women when they need it.’
CPHVA’s Janet, who is also a HV manager in Northern Ireland, says CPs need to advocate for women and engage with local politicians to highlight what’s happening on the ground, as well as flagging issues to management and GPs if appropriate.
‘If CPs have ideas for improving things they should be putting them forward and asking for more resources – it’s important to keep making a noise and escalate things on behalf of our clients.’
In fact the 11 health organisations who have urged more investment in women’s healthcare are also encouraging all those working in women’s health services (as well as the public) to speak up (see Resources).
Janet says women’s health hubs should remain a priority and HV numbers should be restored to safe levels ‘so that they can focus more time on issues such as perinatal mental health and maternal wellbeing. We also need more SNs to help with sex and period education in schools.’
More support is also needed for perimenopause and menopausal women at work including the NHS, which is the biggest employer of women in Europe, states Janet: ‘We lose thousands of women a year who become too ill to work with “brain fog” and hot sweats because they don’t get the right treatment and support,’ she says.
‘We are all “strategy-ed out” when it comes to women’s health – we’d like to see some action now!’
- RESOURCES
- Just a Period a recently launched period tracker campaign
- Women’s health hubs
- Unite advice on Menopause in the workplace
- Get involved The government in England wants to hear people’s views, experiences and ideas to help shape the 10 Year Health Plan for England
- RCOG Maternal mental health – women’s voices
- MMHA Mental health support for mothers and families
- Endometriosis UK information and support
- Eve Appeal has facts for clients and practitioners
SHARE YOUR EXPERIENCES
What are you seeing on the ground? How do you think real progress can be made? Email editor Aviva Attias aviva@communitypractitioner.co.uk
Image | SHUTTERSTOCK
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