Women’s Health

Sonia Kumar Excerpts

Thursday 27th February 2025 Westminster Hall

[Sonia Kumar (Dudley) (Lab)]

It is a pleasure to serve under your chairmanship, Dr Huq. I congratulate my hon. Friend the Member for Hastings and Rye (Helena Dollimore) on securing this important debate. Today, I want to talk about the stigma and embarrassment in relation to women’s incontinence: stress incontinence, urinary or faecal incontinence, and double incontinence. It affects so many aspects of women’s lives: where they go out, how much time they spend out, their relationships and their sleep patterns. And of course there are the effects on their mental and physical health.

Working as an NHS physiotherapist, I spoke to women about their incontinence when I did back screening, and I heard over and over again that women felt an overwhelming sense of shame—the fear of the smell, the sense of being dirty and the feeling of always having to check their pad to make sure that it is in place and has not leaked down their leg. It is estimated that a third of women in the UK are living with urinary incontinence. That means someone in this room will have those symptoms. A third of women suffer from a pelvic floor disorder after childbirth, including urinary incontinence and pelvic organ prolapse, but only 17% of women actually seek help. I would recommend to any woman who is suffering that she seek professional help from her GP or specialist. What we do not talk about for both faecal and urinary incontinence is the psychological problems, low self-esteem, anxiety, depression, sexual problems, social isolation, physical problems, skin breakdowns, and the falls when having to get to the toilet as quickly as possible.

At the moment, we also know there is an economic case that is also very compelling. Research shows that every £1 spent on women’s health services will return up to £13 back into our emergency services by reducing women going to A&E and GP appointments.

So what do I, as a clinician, propose? As a physiotherapist, of course I propose physiotherapy. Physiotherapy is the first line of intervention preventing mild to moderate incontinence and prolapse. It is therefore essential that we have women’s health physiotherapists in hubs locally as they are rolled out. We should also take a multifaceted approach to urinary and faecal incontinence, where women’s mental health, physical health, lifestyle—their caffeine and dietary intake—and the incontinence all get addressed. We should also make sure that, when people need the most help, referrals to secondary care or a surgeon are optimal.

We also need to get the first line of treatment for incontinence on to our high streets, making it more accessible for women to get self-referrals as quickly as possible. We should not have a barrier to speaking to a healthcare professional or a GP; women should be able to go into a high street pharmacist and say, “I’ve got incontinence. What can be done to help?” I welcome the Government’s steps for women’s health hubs, but we need to go further by making sure that there is a national campaign so that women know that those hubs exist.

I say to the women listening to this Westminster Hall debate: you are not alone and there is no shame. As a nation, we cannot allow women to feel shame or embarrassment about this topic any longer. Incontinence is common, so will my hon. Members join me in my mission to break the silence, end the stigma and eliminate the anxiety around incontinence?

--- Later in debate ---

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

May I, too, welcome the Minister? Gosh, what a debate to come into—it is such a wide-ranging field. I am so glad that she has been ably supported by the hon. Member for Hastings and Rye (Helena Dollimore) who put in a fantastic effort and managed to cover so many topics.

When I came to look at this debate, I thought about the best way I could try to touch on many of the topics. I thought a physiological view might be quite useful, starting with birth. Earlier this week, we had a debate on maternity services. The point is this: there is an explicit risk in pregnancy and birth, but we should do all we can to mitigate those risks. We know from the last 10 years that the maternal mortality gap has reduced from five times to two times, but much more can still be done. I am pleased that we heard that the Government are working through getting the Ockenden recommendations in place.

That leads me on to talk about postpartum depression, breastfeeding, and supporting recovery post-caesarean section delivery or episiotomy. We have heard about infertility and miscarriage. We have not even mentioned looking after a newborn. These are tough things to go through.

Young girls have to deal with body image, which is a personal hobby horse of mine. We heard about eating disorders. In 2023, we saw an investment of £4 million into new research, but there is still much more to do. Of course, that leads us to cosmetic surgery and when we need to regulate there. There is the issue of menarche and managing periods, not only from the contraceptive angle, but what to do when they are too heavy, too painful, irregular or do not happen at all. All these things require time, dedication and compassion to find out what works for that individual and what can be done to support, inform and empower that woman.

Returning to medical problems, Members have spoken eloquently about incontinence, as well as polycystic ovary disease and endometriosis, which are really common problems that are hard to diagnose and even harder to treat. I hope that the roll-out of 161 community diagnostic centres, which the new Government commit to carrying on with, make a giant leap forward in allowing women to get the diagnosis they need.

There is, of course, screening. We talked about breast screening, but cervical screening has not been mentioned. Screening is so important, and I urge every woman to consider it. What about the successful roll-out of the HPV vaccine, over a decade ago, to dramatically reduce cervical cancer? From 2019, it has also been offered to boys to help reduce that further. We need support for both lobular and ductal breast cancer. We have not really mentioned ovarian cancer and how difficult it is to pick up, often happening far too late.

Working through life, there is the menopause and the impact it can have on women: confusion, depression, anxiety and sexual dysfunction. It is still not well understood. The last Government, along with many from across the House, campaigned for better understanding to create a supportive environment. This is still developing, and long may it do so. Choice is hard too. Non-HRT or HRT? There are pros and cons. Of course, we had difficulties with shortages during the pandemic. Linked to the menopause, and not mentioned today, is the risk in old age of osteoporosis and fractures. That is critical. We know that women are significantly more affected by that than men, and prevention is much better than dealing with a broken hip or a broken wrist. I could go on.

Women’s health was rightly a priority under the last Government, which had almost 100,000 responses to their call for evidence to deal with the gender health gap. The last Government published the country’s first women’s health strategy in 2022, and expanded specialist women’s health hubs across England to improve access and quality of care for services such as menstrual problems, contraception, pelvic pain and menopause. They improved access to hormone replacement therapy and addressed barriers to health services faced by women who suffered from trauma from things like domestic abuse. Further still, the Government appointed Dame Lesley Regan as the first women’s health ambassador to step up efforts to improve women’s health, and Helen Tomlinson as a cross-Government menopause ambassador to find out the experiences of women employed in different sectors.

Turning to the issues here and now, I have some questions for the Minister, and some context. The Royal College of Obstetricians and Gynaecologists wrote to me on 29 January, just before the announcement by the Labour Government, with the following:

“We express our deep concern about the speculation of the Government’s decision to remove the target for all ICBs to set up and run a women’s health hub in the planning guidance”.

It went on to say:

“Removing the target may well lead to women’s health hubs being closed down, and a worrying rollback on the progress made in improving women’s health services for your constituents. It is self-defeating for the UK Government to close women’s health hubs when they are a clear success story for reducing waiting lists and moving care closer to home—they should instead be given ringfenced funding and expanded.”

I know the Minister cares deeply about improving women’s health, but it is hard not to see this is as a potential row back.

My first question is: what commitment can the Government give, in the light of dropping these targets, that women’s health remains a priority? Secondly, to help demonstrate this commitment, would the Government consider the call by the Royal College of Obstetricians and Gynaecologists for sustained investment in expanding women’s health hubs? Considering what we have heard today from the hon. Members for Walthamstow (Ms Creasy) and for Luton North (Sarah Owen), would the Department make a request in the spring statement and spending review to see that this would be the case? If not, why not?

I have spoken in the past in this Chamber about learning from previous work, so my third question is, how many times have the Government met with the women’s health ambassador since the general election? Can the Minister set out how this role would work alongside the Government’s new menopause ambassador? I hope that in asking these kinds of questions, it will kickstart the system into looking at how we can improve women’s health.

In the short time I have left, it would be remiss of me not to pick up on some of the key issues at the moment: osteoporosis, menopause, workforce and waiting lists. There has been some concern about the Labour Government’s commitment to their own promise of universal fracture liaison services by 2030. The Royal Osteoporosis Society has said:

“We all want to believe that Ministers will honour their promise, but people with osteoporosis tell us their faith is waning. It doesn’t need to be like this—we appeal to Wes Streeting to restore trust and confidence in the specific, measurable pledge that he campaigned on, and for which many people voted.”

[Sonia Kumar]

Will the hon. Member give way?

[Dr Evans]

I am really sorry; I am tight on time. Question No. 4 is, could the Minister kindly clarify, confirm and commit to that promise? If not, why not?

On the menopause, when the women’s strategy was announced in 2022, the then shadow Health Secretary—now the current Health Secretary—said:

“I challenge the Secretary of State to go further than the proposal he outlined to train incoming medical students and incoming doctors. What plans do the Government have for clinicians who are already practising? We need to upskill the existing workforce, not just the incoming workforce. However, let us be clear: informing clinicians is no good if we do not also improve access to hormone replacement therapy, so where is the action in the strategy to end the postcode lottery for treatment?” —[Official Report, 20 July 2022; Vol. 718, c. 977.]

As we are now eight months into the Labour Government, question No. 5 is, when will the strategy document he talked about be produced and presented to the House? Has he made an assessment since July 2024 of HRT medication access in terms of locality?

Turning to workforce, we know that the demand for women’s services is outstripping the supply of generalist and specialist support. The Royal College of Obstetricians and Gynaecologists has highlighted ongoing problems with maternity workforce staffing and agreed that the NHS long-term workforce plan was a good first step on the way to properly staffed maternity services. Therefore, question No. 6 is this: we know that the Government will be looking at a refresh of the plan this summer, so will the Minister give an undertaking today that women’s health will be a priority in both primary and secondary care? Will she update the House on the obstetrics workforce planning tool, which the DHSC commissioned to help maternity units calculate staffing requirements, and when it will be rolled out across the country?

Given that time is tight, I will close by saying that I have heard it said that a healthy woman means a healthy family, a healthy community and a healthier world. That is hard to dispute that; it is now for the House to deliver it.