Feature

Health for women, and for all

There’s never been a better time to think seriously about a new agenda for women’s health, says Wendy Savage

With more women in the House of Commons than ever before, what better time to think seriously about what needs to done to secure real improvements in women’s health? Action could be taken rapidly on a wide range of issues. I would put the following firmly at the top of the agenda for New Labour’s new ministers.

Sex education should be part of the national curriculum and taught from a feminist perspective so that the number of unwanted teenage pregnancies declines. This would reduce perinatal mortality and improve young women’s chances of completing their education and getting a job in the future. Women (and men too) need to have a much clearer idea about the risks of sexually transmitted diseases for their future fertility. A ‘double dutch’ approach to contraception would reduce the incidence of chlamydial and gonococcal infections, as well as the risk of unplanned pregnancy. There should be a campaign advising women to have their children between the ages of 20-35, and job policies which recognise that this is the best time for women to have children. Delayed childbearing increases the risk of infertility.

In addition, abortion law needs to be changed to allow abortion on request to at least 14 weeks. Ideally, I would like to see abortion decriminalised and treated like any other surgical operation. In the meantime an amendment to the regulations could improve equity of access by ensuring that at least 90 per cent of abortions are paid for by the NHS. In Scotland 95 per cent already are: this should be a long term aim for the rest of the UK.

The Changing Childbirth implementation team has been wound up, without any money set aside to ensure that its targets were achieved by 1998. The new government should set up a reasonably sized pilot project, in an area where GPs have already opted out of maternity care, to investigate the feasibility of independent midwifery practices. The system of maternity payments for GPs is archaic and doesn’t encourage any involvement in the delivery; it should be reviewed. All small maternity unit closures should stop until their future role is clear.

Caesarean section rates continue to rise without good reason. The information collected on caesareans is very limited, so I would want the government to set up a proper monitoring system with much more detailed information available, perhaps based on the US model.

Maternity benefits – ours are the lowest in Europe — must be improved. The anomalies pointed out by the Winterton Committee penalise young mothers and should be corrected. Nursery provision for all children from the age of two should be available, together with more crèche facilities for children under that age. A decent minimum wage will benefit women’s health as they make up a disproportionate number of those in low incomes. Further, caring for others needs to be recognised by such measures as a ‘carer’s wage’ so that more than lip service is paid to the roles that women so often undertake.

Our understanding of the psychological aspects of breast cancer, while improving, is still not adequate. More counsellors and women surgeons are needed. Centralising cancer services may improve prognosis but before changing from the present system we need to have a review of the likely impact of all aspects of care, not simply the crude survival rate.

Although drug addiction is less common than alcohol abuse, it destroys families and we should revert to the medical model of treatment we had in the 1960s, in place of the criminal model which has been so destructive. School health education should be explicit about the dangers of drugs but not overstate the case as far as soft drugs are concerned. I would legalise cannabis, which is widely used, less harmful than alcohol or tobacco, and the use of which could then be regulated (and could even be a nice tax earner).

Depression is a big problem for women, especially the elderly and those isolated at home with young children. I would set up a network of non-smoking ‘cyber juice bars’, to attract young people away from pubs. Older women (and men) could be recruited to staff these and local authorities could reduce the council tax so that the fresh fruit juices would be cheap. This might help with some of the Health of the Nation targets. To get away from the institutional feel of so many council-run enterprises they should be run by private groups, perhaps charities.

More widely, good public transport and a reduction in violent crime (including domestic violence) which would follow a reduction in unemployment would have important benefits for women’s mental and physical health. Although the police are now more understanding towards women who have suffered rape, the law should be changed to allow a woman to speak to the barrister who is prosecuting on her behalf.

The election of 120 women to Parliament is an enormous step forward, and a credit to Labour’s selection policies. In time it will – it must — help to decrease the gender inequality which, despite their greater longevity, underlies so much of women’s poorer health.