Women’s Health Outcomes

Baroness Jenkin of Kennington Excerpts

Thursday 8th July 2021 Lords Chamber

Moved by

[Baroness Jenkin of Kennington]

That this House takes note of the steps taken to improve women’s health outcomes.

[Baroness Jenkin of Kennington (Con)]

My Lords, it is an honour to be introducing this debate on a topic so close to the hearts and other more intimate body parts of 51% of the population—and some men too, of course.

In my International Women’s Day speech this year, I departed from my usual topics of either women in Parliament or the reality of women’s and girls’ lives in the developing world to talk about women’s health. This change was a result of the Government’s very welcome launch of the first ever consultation and call for evidence to improve the health and well-being of women in England, designed to use women’s voices and experiences to write a new women’s health strategy. For the first time in years, I pondered a woman’s life cycle in terms of health, and I am grateful for the chance to expand on those thoughts today. What I found then, and again now, brought home to me all too graphically the experience of millions of women at different stages of their lives.

Let us start with puberty. It is a confusing time for any child but it is especially so for girls, who are entering puberty about a year earlier than they did back in the 1970s according to global data of 30 studies on breast development. Studies also show that early menstrual bleeding, the last clinical sign of puberty for girls, is associated with a higher risk of obesity, type 2 diabetes, heart disease and allergies. During this period—excuse the pun—I thank journalist Emma Barnett for her book, Period: It’s About Bloody Time, which asks why we are so uncomfortable talking about, and clam up about, menstruation—girls have their first introduction to expensive sanitary products, starting for many period poverty, which affects their school attendance. Estimates vary, but around one in five women of childbearing age suffers from painful, irregular or heavy periods, many to a truly debilitating extent.

Endometriosis manifests itself around this time as well. It is a long-term condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. The main symptoms are back and stomach pain, increased period pain, pain during or after sex, pain when peeing or during a bowel movement, feeling sick, constipation, diarrhoea, blood in pee and difficulty getting pregnant. There is a seven-year wait to get diagnosed, with 40% of women needing 10 or more GP appointments before being referred to a specialist.

At this age, social media pressure and social contagion start to have an impact on teenagers’ body image, including anorexia and self-harming. Since 2016, there has been a 45% increase in labiaplasty operations, a female genital cosmetic procedure flippantly referred to as “designer vaginas”. This coincides with a time when vulnerable girls are groomed on the internet and the effects of porn not only are felt on their mental health but lead to this irreversible surgical procedure.

I turn to STIs and birth control. Syphilis and gonorrhoea have almost doubled in the past five years in school-age girls. While chlamydia is decreasing thanks to the screening programme, it remains a problem because of the irreparable damage to girls’ fertility and chronic pelvic inflammatory disease. Avoiding pregnancy is still largely seen as a girl’s responsibility. Boys should be taught that using a sheath not only prevents unwanted pregnancies but also reduces STDs for girls.

I now move to the stage of planned pregnancies and hoped-for motherhood. One in four pregnancies ends in miscarriage, and these women feel let down. There is insensitivity and a lack of empathy in healthcare and arrogance among healthcare professionals, mainly male doctors, who will not and do not listen to patients. My friend had six miscarriages and finally visited a male Harley Street IVF doctor, who put her on a standard protocol for getting pregnant despite her arguing vociferously that getting pregnant clearly was not her problem. She got pregnant again and endured another avoidable miscarriage because she was not listened to. She then went to a female consultant and had a live birth on the first round of tailored treatment.

Antenatal care is inconsistent. Every woman should have the option of the same midwife throughout, up to their delivery. I wish my noble friend on the Front Bench today—she is probably very uncomfortable in her last two weeks—luck and an easy, quick birth, although I am afraid that there is no such thing as a pain-free birth. I also wish her access to the pain control that she wants and, ideally, no episiotomy. I am afraid that nothing can prepare her or other new mothers for the post-birth challenges of getting her body back to a reasonable condition, breastfeeding, disrupted sleep and so called “baby blues”, possibly followed by postnatal depression, which affects between 10% and 20% of women.

I come to motherhood next. In the vast majority of cases, women are the lead parent, combining most child- care with work, usually at a greater career cost than the father. This in turn leads to tension at home and often a relationship breakdown, leaving the mother as the major childcare provider, which in turn leads to increased mental health issues—I think other colleagues will talk about this—or the use of drugs or alcohol as crutches, which I think the noble Lord, Lord Brooke, may raise.

I turn to the eventual emptying of the nest, which is another time of stress in a relationship and often comes at the same time as caring for elderly parents. This is close to my heart because last year we lost my mother, whom we lived with, aged 96.

I now move on to the menopause, which is a “big one”. Some 34 years ago, I ran the Amarant Trust, a menopause charity funding ground-breaking research into HRT with the team at King’s College Hospital, which also ran our self-referring clinic. Women attended in droves, largely because of hostile, and in some cases misogynistic, GPs. I was pregnant at that time so my own hormones were in turmoil, although not lacking in oestrogen and the myriad of miserable symptoms that so many women experience at that time. I can still remember the distress that so many patients suffered in silence and how debilitated they were by the onslaught of flushes, sweats, sleeplessness, vaginal dryness, discomfort during sex and problems with memory and concentration.

A couple of years ago, I attended a round table with the then Women’s Health Minister and campaigners. I was astonished to find that the situation for menopausal women is no better than it was all those years ago when I was actively involved. Indeed, 23% of women who visit their GPs with symptoms are prescribed antidepressants instead of HRT. I was one of the lucky ones—I sailed through—but those suffering symptoms should of course be given the informed option of taking HRT, a transformational drug that makes life worth living again for so many women. I give a big shout-out to James Timpson, who wrote in last weekend’s Times of the need to

“stop the menopause hijacking careers”.

One newish MP told me that, before she was prescribed HRT, she thought that she would have to give up her job as an MP because it was impossible for her to do it properly. I am delighted to be a founder member of the new APPG for the menopause and look forward to its forthcoming inquiry.

In between all this, we have a miserable list of prolapses, cystitis and thrush. Although I have been comparatively lucky in my own health journey, the latter two caused hours of itching and discomfort, including of course painful sex. This is not always easy to discuss with a partner.

Then we have the female cancers. Cancer Research’s most recent figures, from 2015 to 2017, report about 75,000 new cases of breast, cervical, uterine and ovarian cancers. The Government’s sustained good work with the introduction of HPV vaccination is very welcome. Since then, infections of HPV in 16 to 18 year-old women have reduced by 86% in England. Considering that around 80% of all cervical cancers are caused by HPV, we hope for big reductions in that cancer in the years to come, but let us keep the pressure on for improving the treatment and life expectancy of women suffering these diseases.

I turn to the final countdown, once we have passed the period of caring for aging parents and the move towards osteoporosis, leading to life-changing fractures caused by brittle bones, and then finally dementia.

Even with the generous 12 minutes that I have today, I can only touch the surface of women’s health issues. I pay credit to Health Ministers for taking our problems seriously and, in particular, to Nadine Dorries for driving this agenda, and whose own personal challenge with having an IUD fitted 36 years ago—which in the end she failed because of the intensity of the pain—was laid bare in the Daily Mail earlier this week. Many women are unable even to have a cervical smear because of the agony, but they now feel emboldened to speak out because of other women talking publicly, including the campaigner Caroline Criado Perez.

I am not alone among women in wondering whether, if these debilitating conditions afflicted men, better treatments would have been found by now. Less than 2.5% of publicly funded research is dedicated solely to reproductive health, despite the fact that one in three women in the UK will suffer from a reproductive or gynaecological health problem. There is five times more research into erectile dysfunction, affecting 19% of men, than into premenstrual syndrome, which apparently affects 90% of women.

Women are underrepresented in clinical trials even though biological differences between males and females can affect how medication works. The general assumption is that women do not differ from men except where their reproductive organs are concerned, and data obtained from clinical research involving men is simply extrapolated to women. This has important implications for health and healthcare. I understand that over 100,000 women have responded to the Government’s consultation and that they are currently unpacking the data. On behalf of women everywhere, I thank the Government for the initiative and for the forthcoming sexual and reproductive health strategy.

Noble Lords may not be aware that instances of domestic abuse increase by 26% when England play football and by 38% if they lose. So those who may not be looking forward to Sunday’s game will be especially welcoming the actions that the Government are taking on violence against women and girls.

I look forward to hearing from my noble friend the Minister about how these initiatives will improve life for millions of women who are suffering in at least some of the ways that I have described today.

--- Later in debate ---

[Baroness Jenkin of Kennington (Con)]

My Lords, I thank all noble Lords who have participated in this debate and used such a wide variety of their experience to educate us and to plead their different causes—particularly the seven male noble Lords who have supported us. I rather like the idea of it being the seven ages of woman; I will stick with that one. I particularly thank my noble friend the Minister, not only for his comprehensive reply to us today but for his deeply moving description of his and his mother’s experiences. I challenge anyone not to have a lump in their throat hearing this very moving story. He has always been a great supporter of women and of the causes I have supported, and I am extremely grateful to him for that.

I will touch on a couple of the topics we have discussed; they have all been run through by other noble Lords. Like the noble Baroness, Lady Ritchie, I have participated in a clinical trial; it happened to be about endometriosis. I have no idea whether the drug we were testing is currently on the market, but it was a very long time ago so the answer is probably not yet. One of the lessons Covid has perhaps taught us is that clinical trials can be sped through and happen more quickly than we originally thought. I am very glad that other noble Lords raised this as an issue.

A number of noble Lords talked about mental health. The fact that so many people talked about it made us aware of what a big issue it is. Although the noble Baroness, Lady Cumberlege, is not with us today, I suspect that a large number of people—probably more people than are listening to this debate—heard her on the radio this morning. I was very struck by the dignity of the victims: the mother of one victim spoke particularly eloquently and with such dignity about her experience.

A number of noble Lords talked about Sir Michael Marmot and his work on inequality. It is a massive wake-up call for all of us, and the theme of inequality is so clear in the work that he does. It is tempting to think that this debate has been a rather miserable litany of bad experiences, but I think it was my noble friend Lady Bottomley who said—as the Minister has just said—that there have been massive improvements in so many areas. We must not forget that.

I return to the point I mentioned at the beginning. I changed my usual topic of International Women’s Day, but the noble Baroness, Lady Nicholson, raised the hideous plight of so many women across the world. We must remember to count our blessings that we live in such a wonderful country, where we have access to healthcare that is so much better than in so many places across the world.

I will end by again wishing my noble friend Lady Penn good luck. With her typical efficiency, she is actually due on the day we rise, two weeks today—and with her typical efficiency, she will probably have the baby on that day or the day after.

I know the Government are serious about this agenda, and they know that we will be watching them.

Motion agreed.