Challenging inequalities in reproductive healthcare
By Integrated Care Journal-
As the debate continues on what must be done to reform reproductive health, Amber Rudd, Former Minister for Equalities, believes that there are two essential components needed to precipitate major change. The first is more women in Government. “Representation leads to policy. Unless you have women really involved in representation, you’re not likely to get good policy properly considered for their health”, explains Amber. The second is data. We need more representative data sets, not simply data that is based on male groups and touted as relevant to women.
The pandemic has resulted in big changes in how people are able to access contraception and abortion. As such, there is a currently a large question mark over what will happen to these reproductive health policies once the pandemic is over. Amber hopes the pandemic “will mean an important step forward” in supporting women’s access to “good reproductive health support”.
A Population Issue
Reproductive health is about more than contraception. As Dr Sue Mann, Medical Expert in Reproductive Health at Public Health England (PHE) explained, “Reproductive health is everybody’s business. As service providers and policymakers, we need to speak to this and say there isn’t one size fits all.
“We need to be able to take account off all the different stages that women have in their life as they pass through the different ages”, argued Sue. “What a young woman needs and wants at the point when she starts her period or becomes sexually active, is going to be very different from a woman who’s moving into her menopause. But each and every one of them is important. ”
There are vast inequalities in the opportunities different demographics have to access reproductive health support. “We must do more for those who we find it difficult to serve well,” explained Sue, “We need to hear from those populations and make sure that what we provide absolutely reaches their needs. ” Such inequalities have widened during the pandemic and “those who are least able to have their needs met were even more unable to get them met”.
Clare Murphy, Chief Executive at the British Pregnancy Advisory Service (BPAS), discussed how reproductive choice extends far beyond the use of contraception to avoid unwanted pregnancy and access to abortion. It includes “the choices a woman makes in pregnancy, around birth, how she feeds her baby and all the way through to accessing the care and evidence-based information she needs to make decisions in the menopause”.
Emergency abortion legislation enacted during the first wave of pandemic allowed women to take early medical abortion pills at home, following a telephone consultation with a licensed clinician. While Clare celebrated this “revolutionary” change, she highlighted that “it’s a shame that it’s taken a pandemic to achieve something which we have long known would improve women’s access to this fundamental aspect of women’s health care”. One in three women will have an abortion in her lifetime.
The earlier an abortion can be performed, the better it is both for women’s physical and mental health. By improving accessibility and reducing waiting times, this new legislation allows reproductive health services to engage with more women within the earlier gestation period. As the Government consults on whether or not to enshrine this into legislation permanently, the Chief Executive of BPAS argued that this legislation must absolutely remain post-pandemic.
“Trusting women is something which we need to see across the reproductive spectrum”, argued Clare. Current frameworks demonstrate a reluctance to trust women to make decisions for themselves, particularly in the way a “women’s ability to make their own decisions in pregnancy gets policed” explains Clare. For instance, we undertake monoxide testing to objectively test whether a woman is smoking during pregnancy, rather than taking her word at face value. “We don’t apply that to any other field of health care...undermining the trust between a woman and her health care provider is a problem”, she argued.
“We are very good at growing up services around what we think women need and what’s appropriate for them. But we’re not always very good at listening to women’s own voices and perspectives about what matters to them", she explained.
A Self-Care Revolution
When it comes to providing women with reproductive choice, Marie Stopes International (MSI) "trusts women to make the right decisions for themselves", explained Megan Elliott, Vice President and Chief Operating Officer at MSI. Trusting women means investing in listening to women, particularly those "who are likely to be at risk of stigma or exclusion".
For Megan, “Sexual and reproductive health is foundational to gender equality. Equitable access to safe, affordable and quality reproductive healthcare is essential for gender equality”.
Finding innovative, low-cost solutions that put women in charge of their sexual and reproductive healthcare is crucial. 230 million women worldwide want to access contraception but cannot do so. As a result, 35 million women each year make the agonising decision to resort to an unsafe abortion.
Despite these tragic statistics, Megan argued that "that difficult times can always be opportunities for positive change". National lockdowns, restricted movement, a lack of information about services, supply chain disruptions and an overwhelmed health system significantly impacted women’s access to reproductive care.
However, the pandemic has presented an opportunity for a ‘self-care revolution’. The UK implemented solutions for self-care for both medical abortion and emergency contraception. "We’ve proven that this works for women and it works for the health care system", explained Megan, "In our study of over 52,000 women, only 0.02 per cent of cases resulted in serious complications requiring further medical intervention after a medical abortion given with the support of telemedicine. We have less than 5 per cent failure rate. Even more exciting is that 98 per cent of clients reported that their experience was good or very good. So, we were meeting the needs of women as well as being clinically safe."
Megan also called for the UK government to remove unnecessary legal barriers that prevent access, such as the requirement for multiple doctors’ signatures to authorise an abortion. "I want us to remember that the legal status of abortion has no effect on a woman’s need for an abortion. It only dramatically increases her risk of an unsafe abortion", said the Vice President of MSI.
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