With the first Women’s Health Plan for Wales now launched, what progress has been made for women’s health across the four countries of the UK? Charlotte Glynn reviews what has been achieved, and priorities for 2025 and ahead.

In a year of political change in the UK, how committed are the governments of the four nations to improving women’s health?

Steps seen this year have included the announcement by the NHS of the first ever National Clinical Director for Women’s Health, Dr Sue Mann, to oversee the implementation of the Women’s Health Strategy, and the roll-out of Women’s Health Hubs. This is welcomed, as shocking statistics such as Black women being three times more likely to die during childbirth or in the immediate postnatal period, and Asian women twice as likely to die compared to white women exemplify the need for significant work.

Over 60 organisations came together under the Faculty of Sexual & Reproductive Healthcare to launch the FSRH Hatfield Vision, which highlights health inequalities as unacceptable and preventable and sets ambitious goals to be achieved by 2030.

The FSRH has called on the government to:

• Introduce a dedicated Sexual and Reproductive Health (SRH) Strategy and commit to continuing the Women’s Health Strategy.
• Improve contraception access for all people, in a location of their choosing.
• Ensure education and information about SRH is easily available and accessible, across the life course.
• Tackle SRH disparities faced by Black women and women of colour.
• Ensure Community SRH training posts are fully funded.

So, what commitments have been made to women’s health across the four countries, and how much more action is still needed?

England

The previous UK Government released the Women’s Health Strategy for England in July 2022. The strategy pledged coordinated care for women with the development of Women’s Health hubs, as well as more mental health support for women and improved sexual and reproductive health education in school for all children.

One significant achievement was the introduction of Hormone Replacement Therapy Prepayment Certificates (HRT PPC) on 1 April 2023. This enables women on a variety of types of HRT such as tablets, patches, or topical treatments to pay £19.30 annually and access as much treatment as they need throughout the year. By 4 April 2024, 37,700 people had purchased HRT PPC, saving over £1.13 million. The scheme was reported on by Money Saving Expert and the BBC, contributing to the growing platform for women’s health.

Another step forward has been the NHS Pharmacy Contraception Service that means women can attend their local participating pharmacy for a consultation and subsequent initiation of the oral contraceptive pill. This avoids the need to visit their GP or local sexual health clinic, removing potential barriers to access. This service can be accessed even if not registered with a GP surgery, and as of January 2024,

One of the biggest and most welcomed ambitions has been the expansion of Women’s Health Hubs. A study by the NIHR in 2023 identified 17 Women’s Health Hubs, with 13 in England and 4 in Northern Ireland. Most hubs were evolving and there was no standardised approach, but findings demonstrated an increase in local long-acting reversible contraception (LARC) fitting rates and a reduction in secondary care gynaecology referrals from primary care. However, one issue identified was that access to these services was a ‘postcode lottery’. In March 2023, it was announced there would be a £25 million funding allocation for Women’s Health Hubs.

In January 2024, a £2 million investment was pledged, enabling survivors of domestic abuse to receive a lifeline payment to support them in escaping abuse and rebuilding their lives. Police forces are now following a new approach for the investigation of sexual assault, with 2,000 new officers specially trained in sexual offences by April 2024.

However, a survey conducted by Deloitte via YouGov demonstrates that some significant issues remain when it comes to the women’s health gap in the UK. Overall, working women spend £1.5 billion more than men on healthcare each year, and are consistently spending more in every health category, including fertility, menopause and menstrual health. It was also highlighted that most employees aren’t sure what women’s health support they should expect from their employers. Recommendations include better education for healthcare providers on all areas of the female life course, more research on women and women’s health, and that policymakers need to ensure equitable care across the UK for all women and incentivise research organisations and employers to improve women’s health.

When it comes to abortion care throughout the UK, there is limited scope for treatment at a later gestation in the pregnancy, or if there are medically complicating factors, meaning it is common for women to travel hundreds of miles across the country to obtain abortion treatment. It has also been identified by the British Pregnancy Advisory Service (BPAS) via a recent survey that 57% of women ended their pregnancy partly, or wholly to financial reasons, indicating that the cost of living crisis is impacting decisions women make about their body. Women living in the most deprived areas were twice as likely to have an abortion than women from the least deprived areas.

Overall, there is clearly significant progress, but further work is needed to ensure the most vulnerable and deprived women receive equitable care. Waiting lists for gynaecology are the longest of any specialty, with 89% of healthcare professionals believing these waiting lists are impacting patient’s quality of life.

Wales

The Welsh Government published the Quality Statement for Women and Girls’ Health in July 2022. This outlined some of the health inequalities women and girls experience, including the attribution of symptoms to psychological causes, and the normalisation of pain. It also notes how this will impact the health and social care workforce, which is predominantly made up of women. Commitments made included care for women and girls across the life course, evidence-based support for reproductive choices, and supporting women who have experienced adversity because of previous healthcare (e.g. the use of vaginal mesh). There is also a list of conditions which currently exhibit gender inequality regarding the treatment women receive compared to men, such as asthma, dementia, and mental health conditions.

Later in 2022 Women’s Health in Wales was published; a summary of concerns relating to women’s health following a listening exercise, and recommendations for improvement. It is noted that there are some projects which are well underway and will continue, such as the period poverty campaign, the All Party Parliamentary Group on Menopause, and the establishment of the Women’s Health Wales Coalition. Next steps included the establishment of a substantive Women’s Health Network, develop actions, key deliverables and measurable outcomes in priority areas, and audit and undertake capacity modelling of the conditions most suffered by women and girls outside of gynaecology conditions.

Towards the end of 2023, the Women’s Health Wales Coalition received an update from the newly convened Welsh Government Women’s Health Policy team, reporting that the Women’s Health Network was in the process of being set up. The first Women’s Health Plan for Wales was launched on 9 December 2024, setting out a 10-year vision to improve health services for women. It embraces a life-course, prevention-based model of healthcare, and showcases eight priority areas:

• Menstrual health
• Endometriosis and adenomyosis
• Contraception, post-natal contraception and abortion care
• Preconception health
• Pelvic Health and incontinence
• Menopause
• Violence against women and girls
• Ageing well and long-term conditions across the life course.

The plan displays clearly set out short, medium and long-term goals for each area. Innovations such as Endometriosis Cymru are also included that contains practical resources for both patients and healthcare professionals affected by endometriosis. There is a strong focus on collaboration and networking, which will hopefully lead to successful outcomes.

Scotland

The Women’s Health Plan for Scotland was published in August 2021, reporting the formation of the Women’s Health Group (WHG), made up of organisations and individuals with specialist knowledge and expertise in the area of women’s health. Five subgroups were established:

• Sexual health, contraception, abortion, pre-pregnancy care
• Menopause and menstrual health, including endometriosis
• Heart health
• Gender and health
• Lived experience.

Good communication and access to information were a focal point for the work, as 12% of adults in Scotland don’t have access to the internet, and that number increases to 21% of adults who live in social housing. It was also highlighted the challenges many women struggle with when they are required to attend appointments. 61% of the 1.1 million unpaid carers in Scotland are women, therefore fitting appointments around work and caring commitments is difficult; these difficulties increase for women with a history of trauma, or those who have a disability.

Abortion statistics follow the same trend in Scotland as the rest of the UK, as in 2020 the abortion rate was 2.2 times higher in the most deprived areas of Scotland, versus in the least deprived areas. Significant gaps were identified regarding young people and their access to sexual health care and contraception. In one survey, almost 50% of young people did not know where to access free condoms in their local area, and in one study, 1 in 3 sexually active young people struggled to access an appointment for contraception or STI testing. Scottish women have reported feeling unprepared for the menopause, with around 400,000 women in Scotland being of menopausal age.

Plans to improve Women’s health in Scotland include:

• A central platform for information on Women’s Health on NHS Inform
• Seek lived experience of Scottish women
• Promote the use of telemedical services to ensure easier access to healthcare
• Improved access to sexual health, contraception, abortion and pregnancy care for all women

No mention is made of how those who struggle to access information through digital means will be supported, to ensure equity.

Two years after the above plan was released, the British Medical Association (BMA) reported little progress had been made, although it was acknowledged that a national Women’s Health Champion has been appointed, along with a Women’s Health Lead for nearly every NHS board.

Northern Ireland

Following a debate in NI parliament in February 2024, it was announced that a Women’s Health Action Plan is being developed by the Department of Health. This will encompass collaboration between different areas in the department, as well as the acknowledgement that greater public awareness in this area is critical. This was followed in March 2024 by the initiation of a public listening exercise, involving surveys and focus groups to gather women’s opinions of the current healthcare they receive in NI, and how this can be improved.

The Primary Care Women’s Health Forum had completed a case study in 2023 on the GP training pathway in Northern Ireland, enabling GPs to train in certain areas of gynaecology such as long acting reversible contraception (LARC), and the management of uncomplication heavy menstrual bleeding (HMB). This will reduce the referrals made into secondary care, and therefore have a positive impact on waiting lists.

In November 2024 the NI government released a public listening exercise in the form of an anonymous survey, to gather women in NI’s views on women’s health. Around the same time, Dame Lesley Regan, the Women’s Health Ambassador for England, advised it is essential that Women’s Health hubs are introduced in NI. There is still significant work to be done, however hopefully there will be more movement on the Women’s Health Action Plan in the coming months.

Future priorities

With a recent change of government now is the time for politicians to show their commitment to the issue of women’s health and build on the work started by the previous government. The RCOG has detailed the key areas they feel need to be prioritised, including:

• Gynaecology waiting lists
• Continued roll-out of Women’s Health Hubs
• Enhanced maternity care
• Tackling racial inequality
• Retention of staff in obstetrics and gynaecology.

The Labour Party’s 2024 manifesto made minimal mentions around commitment to women’s health but did say: ‘Never again will women’s health be neglected. Labour will prioritise women’s health as we reform the NHS’.

Charlotte Glynn is vice-chair for the RCN Women’s Health Forum committee, lead nurse at the British Pregnancy Advisory Service, and a specialist nurse in sexual health and contraception.