Health and social care services, and decisions over how they are run, have a major impact on women.
This is not only as service users with particular needs and experiences, but as the majority of both older people and unpaid carers in Scotland. Women in Scotland enjoy comparatively good health and access to healthcare by global standards.
However, women and girls have greater health and social care needs than men over their lives and various equality issues compromise women’s health and wellbeing.
Women’s reproductive rights are currently undermined as a result of legal restrictions and service delivery issues that see abortion regulated differently from all other routine healthcare and impede equality of access.
Reproductive rights remain unrealized for many women, and routine healthcare for women including menstruation and maternity support can be stigmatized.
By 2030 Scotland’s health institutions, practitioners and policies recognise gender as a factor in health inequalities.
Scottish Government and health boards should:
Women and girls face signiﬁcant barriers to good mental and physical health. Historic lack of funding for, or professional focus on, health issues that disproportionately affect women, or affect women differently to men, can mean that these issues are not equally accommodated for in health services or awareness-raising initiatives. Both health professionals and patients report anecdotal evidence of women’s health problems being dismissed, underestimated and diagnosed late. Intersecting equality issues in particular have a major bearing on health outcomes for women in Scotland, and gender is the most signiﬁcant factor that interacts with income inequality to compound health problems. Women facing multiple discrimination also experience signiﬁcantly greater health inequalities. For example: highly gendered health outcomes exist within certain minority ethnic communities; the physical and mental health of transgender women is put at risk by out-of-date protocols and lack of knowledge amongst healthcare professionals; and lesbian and bisexual women experience higher rates of breast cancer.
Systemic gender inequality also has an enormous impact on health. Domestic abuse is a high risk factor for depression, substance abuse, and numerous physical disorders. Carers, around 60 percent of whom are women in Scotland, are twice as likely to suffer from ill health. Mental health is a highly gendered issue, with depression twice as prevalent amongst women, and low-income women in particular.
Scottish Government and COSLA’s ‘Equally Well’ framework identiﬁes some of these issues, but gender concerns are not reﬂected in its recommendations, other than with regards to domestic abuse, and other overarching strategy frameworks including NHS Health Scotland’s framework for reducing health inequalities from 2017-2022, are gender-blind. All of this points to the need for a more strategic approach to women’s health in Scotland and for a focus on systematically applying a gender lens within health policy as well as in developing interventions designed to bring about speciﬁc health outcomes.
By 2030 all women in Scotland have free access to sanitary products, high quality maternity care and informed, easy access to family planning.
The Scottish Government and health boards should:
Women’s reproductive and maternal health is a core part of women’s health needs, but both the concerns expressed, and pain suffered, by women relating to this area are often dismissed. For example, recent reports suggest that women are suffering from injuries during birth, and neither prevention processes nor post-natal support needs are being adequately addressed. Similarly, it is only relatively recently that the chronic pain associated with endometriosis has stopped being dismissed purely as ‘period pain’. Unlike other medications with a similar risk proﬁle, some forms of contraception cannot be obtained over the counter, suggesting that women are less able to make choices in relation to this speciﬁc type of healthcare.
This lack of equality when it comes to issues of reproductive health is more pronounced where women face additional discriminations. Teenage mothers are more likely to suffer from post-natal depression and other mental health problems than older mothers, and are more likely to delay seeking maternity care, and women from deprived areas often don’t receive the same quality of maternity care. There is also a low uptake of cervical screening among young working class women. Low-income women are increasingly struggling to purchase adequate sanitary products, leading to a risk of health complications in addition to some girls missing school.
Disabled women in Scotland report particular discrimination in accessing reproductive health services, facing barriers in accessing birth control and family planning and in having control over care and treatment. Disabled young women and girls are less likely to be given sex and relationships education in schools, leaving them both more vulnerable to exploitation and lacking in sufﬁcient information to make informed choices.
Despite this evidence of need, A Fairer Scotland for Disabled People, Scotland’s key delivery plan on disability equality, contains minimal references to girls and women and makes no reference to reproductive or maternity rights.
By 2030 abortion has been removed from the criminal justice system and women in Scotland have equal access to abortion up to the legal 24 week gestational threshold.
The Scottish Government and health boards should:
Women’s reproductive rights incorporate the right to bodily autonomy and integrity, to reproductive choice and healthcare and to legal, safe abortion. Access to safe abortion is fundamental to women’s economic and social rights, employment, education and access to resources, and therefore to gender equality. Abortion is vital, routine healthcare that around one in three women will experience in her lifetime. It is one of the safest and most frequent medical procedures used by women across the world, but laws and policies do not yet reﬂect this reality.
In the UK, women’s right to choose is still predicated on the legal authority of two doctors, without which both women and health practitioners are subject to prosecution under the 1967 abortion act. With the devolution of abortion law as part of the Scotland act 2016, however, Scotland now has the opportunity to develop a Scottish approach to women’s reproductive rights. This would incorporate improved, modernised and standardised service provision underpinned by a progressive devolved legal framework. Along with other women’s and human rights organisations, we are calling for the decriminalisation of abortion. Abortion law in Scotland should be removed from the criminal justice system and provision should be regulated in line with all other healthcare. Such a change to the legal framing of abortion should reﬂect international best practice and be developed following engagement with women, practitioners, and human rights and gender advocates in Scotland.
As a matter of priority, the Scottish Government should also address a number of issues that would improve Scotland’s current abortion care services. At present, women have to travel to England for abortion between 16-20 weeks gestation, despite the legal threshold of 24 weeks, and access across regional health boards is inconsistent. A national framework should be established to standardise and monitor access to abortion, regardless of geography, ﬁnancial status, or any other equality characteristic.
Devolution refers to the transfer of powers and competencies to a lower level of government, for example transferring powers from Westminster to Holyrood. Powers which lie at Westminster are referred to as ‘reserved’.
Decriminalise means to remove something from the criminal justice system, and cease to treat it as illegal or a criminal offence.
Gender-blind projects, programmes, policies and attitudes do not take into account the different social, cultural, economic and political roles and needs or women/girls and men/boys. They therefore maintain the status quo and will not help transform the unequal structure of gender relations.
Gender-disaggregated data is numerical or non-numerical information which has been broken down by gender.
Health outcomes refer to the changes in health of an individual, group or population which come from planned interventions.
Reproductive rights refer to the rights of individuals to reproductive health and to decide whether to reproduce.
Sex and relationship education is part of the ‘health and wellbeing’ area of the curriculum in Scottish schools.
The Public Sector Equality Duty requires public authorities to take a proactive and organised approach to tackling institutional discrimination, and aims to mainstream equality into public bodies.
Universal access refers to the opportunity for anyone to access a service or product, regardless of their background.