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How women with autoimmune conditions are misdiagnosed

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How women with autoimmune conditions are misdiagnosed

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‘Gaslit for years’: How women with autoimmune conditions are misdiagnosed

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Parliamentary debate relating to decriminalising abortion

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Parliamentary debate relating to decriminalising abortion

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E-petition debate relating to decriminalising abortion - Monday 2 June 2025.

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The Petitions Committee has scheduled a debate relating to decriminalising abortion.Tony Vaughan MP has been asked by the Committee to open the debate. The G…

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House of Commons Library briefing on debate on decriminalising abortion 

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House of Commons Library briefing on debate on decriminalising abortion 

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MPs debate decriminalising abortion as opponents warn it would be a radical step

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The issue has come to the fore in recent times with prominent cases such as those of Nicola Packer and Carla Foster.

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BBC report about abortion decriminalisation plans pushed by Labour MP

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BBC report about abortion decriminalisation plans pushed by Labour MP

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Abortion decriminalisation plans pushed by Labour MP

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Tonia Antoniazzi aims to scrap the law that still makes abortion a crime in England and Wales.

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Concerning lack of female-only medical trials in UK

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Concerning lack of female-only medical trials in UK

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‘Concerning’ lack of female-only medical trials in UK, say health experts

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Exclusive: doctors and patients forced to make decisions in ‘vacuum of evidence’ as women under-represented in data

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1 in 4 women have serious reproductive health issue

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1 in 4 women have serious reproductive health issue

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One in four women in England have serious reproductive health issue, survey finds

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Exclusive: Racial disparities highlighted as researchers estimate 10 million women have conditions such as fibroids or endometriosis

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Game changing breast cancer pill to be offered on NHS

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Game changing breast cancer pill to be offered on NHS

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‘Gamechanging’ breast cancer pill to be offered on NHS in England and Wales

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U-turn by medicines watchdog means about 3,000 women with advanced forms of disease could benefit each year

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NHS England " Cervical cancer elimination by 2040 - plan for England

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NHS England " Cervical cancer elimination by 2040 - plan for England

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All Party Parliamentary Group report on addressing women's reproductive health inequalities

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All Party Parliamentary Group report on addressing women's reproductive health inequalities

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APPG on SRH Publishes Landmark Report Addressing Women’s Reproductive Health Inequalities

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The All-Party Parliamentary Group on Sexual and Reproductive Health (APPG on SRH) has released a report highlighting urgent issues related to women’s reproductive healthcare across the UK. The report explores how the system’s design and delivery resu

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Run sessions for schools and workplaces, and provide information about support organisations and charities.

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Find the Right Support
We proudly offer menstrual health sessions for schools and workplaces, shining a light on everything you should have been taught about menstrual health. Busting myths and taboos, Menstrual Health Project (MHP) can run in-person or online sessions for employees and students alike, tailoring the subject content appropriately. Whether you're hoping to gain a better insight into certain menstrual health conditions like adenomyosis and polycystic ovarian syndrome (PCOS), or hear real patient insights, MHP can personalise your session to your organisation's needs. We are passionate about bridging the gap between patient and professional, ensuring patients feel empowered with knowledge backed by our Medical Advisory Board .

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Menstrual Health Sessions & Resources | Workplace & Education

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We offer menstrual health sessions for schools and workplaces, shining a light on everything you should have been taught about menstrual health. Enquire today.

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New pill to transform treatment of endometriosis approved on the NHS

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Endometriosis occurs when cells similar to those in the lining of the womb grow in other parts of the body, such as the pelvis, bladder and bowel.

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Produced by Age UK

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One in four women don't take up first invite for breast screening

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One in four women don't take up first invite for breast screening

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Breast Screening Programme - NHS England Digital

Feb 2025

The NHS this week launched its first ever campaign to encourage women to come forward for breast screening as new figures show nearly 750,000 women didn't take up invites last year.

They show that while uptake had improved to its highest level (70%) since the pandemic, this was still lower than 74.6% recorded in 2019. Two and a half million women were invited to book a check-up in the last year, with 1.75 million attending the screening. This equated to 30 per cent overall not attending, with non-attendance higher in nearly four in ten (37.5%) of women invited for the first time.

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Women in England want at home cervical screening tests

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Women in England want at home cervical screening tests

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Women in England want at home cervical screening tests on the NHS

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Our new research calls for a more personalised approach to cervical screening to help the NHS meet its ambition to eliminate cervical cancer by 2040.

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Heart attacks in women: delays, missed diagnoses and under-treatment

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Heart attacks in women: delays, missed diagnoses and under-treatment

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Heart attacks in women: delays, missed diagnoses and under-treatment

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Find out why women who have heart attacks face poorer care than men, and what we’re doing to change this.

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Underdiagnosed cardiovascular killer of young women

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Underdiagnosed cardiovascular killer of young women

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Verifying you are human. This may take a few seconds.

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Gender Healthcare - HWY priority for 2025

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Gender Healthcare - HWY priority for 2025

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Introduction to women's healthcare starts on page 2.

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The economic case for investing in women's health services

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The economic case for investing in women's health services

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The economic case for investing in women’s health services revealed

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A report by the NHS Confederation, Create Health Foundation and London Economics highlights the economic imperative of investing in women services

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‘Medical misogyny’ is leaving women in unnecessary pain and undiagnosed for years

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‘Medical misogyny’ is leaving women in unnecessary pain and undiagnosed for years

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‘Medical misogyny’ is leaving women in unnecessary pain and undiagnosed for years - Committees - UK Parliament

An inquiry by a cross-party committee of MPs has found that “medical misogyny” is contributing to women being left in pain with undiagnosed reproductive health conditions for years.

The inquiry report out this week includes patient stories shared by Healthwatch Liverpool and also references a submission from Healthwatch Birmingham.

Chair of the Women and Equalities Committee, Labour MP Sarah Owen said: “Women are finding their symptoms dismissed, are waiting years for life changing treatment and in too many cases are being put through trauma-inducing procedures.”

The committee has made a number of recommendations, including:

Better training of medical students and upskilling of GPs

Targets to improve diagnosis times

Action to cut surgery waits, including NHS financial support to help women travel further to be seen earlier

More monitoring and enforcement of trauma-informed practice for procedures such as hysteroscopy, IUD fitting and cervical screening, with patient surveys being used as a key measure

Better promotion and content on women's health on the NHS App and other channels

Free tampons and other products for particular groups such as asylum seekers

Free prescriptions for medication to treat heavy bleeding and other conditions

Better funding and strengthening of the Women’s Health Strategy.

The government has two months to respond to the findings.

Note also that the Healthwatch national report on cervical screening has been referenced in new clinical guidelines published by the Royal College of Nursing on carrying out screening with physically disabled and autistic women. Our report included national polling and in-depth interviews carried out by 10 local Healthwatch.

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Women's health profile - by Humber & North Yorkshire ICB

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Women's health profile - by Humber & North Yorkshire ICB

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‘Why we need to talk about women’s health following pregnancy’

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‘Why we need to talk about women’s health following pregnancy’

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This is not a statistic regarding women in sub-Saharan Africa - but those in the United Kingdom, in 2023.

If this is not worrying enough, in a recent poll, a third of Britons have never heard of the term 'period poverty'. This may in part explain why we find ourselves in this situation.

Yet period poverty is not a new problem. It has been around for several years, but it is only recently that public attention has been given to an issue which should have been addressed and resolved long ago.

Sadly, women's health is often the butt of unhelpful jokes.

Although sometimes subtle, nevertheless these can be a form of abuse. As a result, normal and essential bodily functions and processes have been stigmatised.

You only need to think of the negative comments about the menopause and 'hormonal middle-aged women' to see how girls and women are belittled at times of vulnerability, when understanding and support should be being offered.

Just as the menopause is a normal phenomenon, so too are periods.

Period poverty relates to several problems.

First and foremost is the issue that girls and women suffering period poverty do not have the financial means to purchase sanitary products. They may not be able to afford sanitary products or must choose between these and other essential items.

I use the word essential because it should be a basic human right to manage your period in a clean and dignified manner, without having to decide between this and feeding yourself and your family.

Secondly, girls and women must have access to appropriate places to manage their periods. Toilets in public spaces should always be clean and user friendly. This is often seen as a luxury, but it must become a basic standard.

Finally period poverty encompasses how periods are viewed by society. We need to be comfortable talking about these issues, whether we like it or not.

Our daughters are starting their periods at increasingly young ages, sometimes before they reach secondary school. Discussions need to be had about how this is a normal and natural process, otherwise they are likely to feel embarrassed or worse as a result.

There are multiple consequences of period poverty. If sanitary products cannot be accessed, girls and women may not be able to go about their daily lives while having their period.

They may miss school and work, with significant problems if this is a regular occurrence. Outside of work, they will be unlikely to be able to play sports, pursue hobbies or socialise while on their period.

Many will use sanitary products for longer than recommended or use alternatives such as tissue paper and even cardboard or dirty rags.

Not only is this uncomfortable and degrading, but it is also likely to lead to infection, including urinary tract infections and bacterial vaginosis. It may also affect fertility.

The combination of all the above naturally may contribute to poorer physical and mental health.

Thankfully measures are being taken to redress this issue.

Scotland led the way in 2020, being the first country in the world to offer free sanitary products for all. Closely behind this, in 2022, Northern Ireland made it a necessity to have free products in all schools, colleges and public buildings.

Yet Wales and England still lag, with no legislation in place in either country at the present time.

Since 2019, NHS hospitals have provided free products to patients on request.

Although available through foodbanks and some public toilets, as well as certain supermarkets offering free period product schemes, we need to get to a situation where every menstruating girl and woman can access period products in a free and timely manner, such that no one suffers or must worry about affording these essential items.

Although the 'tampon tax' has been abolished, clearly this has not been enough.

Ideally in public toilets, sanitary products need to be available in the same way as items which are taken for granted, such as toilet paper and soap.

We can only say we have achieved our goal when every girl and woman doesn't have to worry about being able to obtain sanitary products whenever needed, without charge for those who cannot afford them.

Some useful websites

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It is time to talk openly about women's health

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It is time to talk openly about women's health, says Dr Zak

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Women who suffer miscarriage should get paid leave 

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Women who suffer miscarriage should get paid leave 

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UK women who suffer miscarriage should get two weeks’ paid leave, MPs say

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Government urged to introduce universal right of bereavement leave as ‘time to grieve’ early pregnancy loss

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Women are overmedicated, misdiagnosed and left untreated

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Women are overmedicated, misdiagnosed and left untreated

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Women are overmedicated, misdiagnosed and left untreated – there’s one reason why

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Women are overmedicated, misdiagnosed and left untreated – there’s one reason why - IN FOCUS: A new report from the country’s leading cardiovascular experts is shining a light on how the healthcare system is failing women with heart disease. But the rot doesn’t stop there, writes Helen Coffey

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Healthwatch England report on experiences of cervical screening

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Healthwatch England report on experiences of cervical screening

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Healthwatch England's report unpacks women's experiences of cervical screening and sets out recommendations for healthcare leaders.

In 2023, NHS England set a target to eliminate cervical cancer by 2040. It's an admirable but challenging goal, set against declining levels of uptake by women of cervical screening over the past 20 years.

In response, Healthwatch England launched research to investigate why some women are hesitant to go for screening, to make recommendations to policymakers on how to improve uptake and to help meet the elimination goal.

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Our report unpacks women’s experiences of cervical screening and sets our recommendations for healthcare leaders.

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Healthwatch England's position on women's health

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Healthwatch England's position on women's health

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Take a look at our work on women’s health concerns, and what we’re calling for to improve and tackle health inequalities.

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NHS set to revolutionise access to cancer screening

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NHS set to revolutionise access to cancer screening

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The NHS is set to revolutionise access to cancer screening for women in a major drive to boost uptake and save thousands of lives, the head of the NHS has announced.

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The NHS is set to revolutionise access to cancer screening for women in a major drive to boost uptake and save thousands of lives, the head of the NHS has announced.
From next month, the NHS will begin to roll out a new "ping and book" service, alerting the phones of women to remind them they are due or overdue an appointment, with new functionality being developed to enable millions to book screening through the NHS App next year.

The head of the health service, Amanda Pritchard, today set out reforms that will fully digitise screening delivery and help save the NHS over £130m over the next five years, while helping improve uptake by making it easier for women to take up the offer of screening.

Announcing the new drive in a speech at the NHS Providers' annual conference, Amanda Pritchard, NHS chief executive, said: "We're making massive strides with the NHS App, with patients getting more information, convenience and control over their own care, while helping us to work more productively too.

"We are really excited by the potential of technology to revolutionise access to cancer screening for women and help ensure everyone eligible can make the most of these life-saving services at the touch of a button.

"Next month we're starting the rollout of a new 'ping and book' approach for breast and cervical checks through the NHS App, which will replace costs of letters and text messages with pop-ups on your phone and help make it as convenient as possible to book appointments."

Last year alone, NHS breast screening services detected cancers in 18,942 women across England, which otherwise may not have been diagnosed and treated until a later stage.

However despite rising uptake overall last year, the latest annual data (2022/23) shows more than a third of women (35.4%) did not take up the offer of breast screening following an invitation, with 2.18 million eligible women not having had a mammogram in the last three years.

The plans will see invitations for breast screening being sent directly via the NHS App beginning to scale from next month - to be expanded to cervical screening in the Spring 2025 - and from early 2026, the NHS is set to enable millions of women to book breast screening appointments through the App.

Eligible women will first receive a notification through the app to remind them to book an appointment, followed by an email or text message if they don't respond, followed by a letter through the post if neither of the first two reminders have been responded to. NHS cancer screening programmes currently send over 25 million invitations, reminders and results letters to patients by post, costing £14.7 million every year.

Health and Social Care Secretary, Wes Streeting, said: "As a cancer survivor, I know how devastating a diagnosis can be - and how important it is to get the right diagnosis and treatment as quickly as possible.

"If we're going to make the NHS fit for the future, we need to catch cancers earlier so that we can give people the best possible chance of survival. I hugely welcome plans to make it easier for millions of women to book a screening by harnessing the power of the NHS App.

"This is a great example of shifting the NHS from analogue to digital and the benefits of a modern health service, which this government will deliver as part of our 10 Year Health Plan."

Michelle Mitchell, chief executive at Cancer Research UK, said: "Screening programmes are effective tools in spotting cancer early, before symptoms start. Innovations like this could make it easier for people to access screening, and ultimately, increase the number of cancers caught at an early stage. Almost all breast cancer patients and 9 in 10 cervical cancer patients in England will survive their disease for five years or more if the disease is caught at the earliest stage.

"It's important to remember that cancer screening is for people without symptoms though, so if you've noticed any changes that are not normal for you don't wait for your next screening invite, talk to your doctor. It probably won't be cancer, but if it is, spotting it early means that treatment is more likely to be successful."

Athena Lamnisos, CEO at the Eve Appeal, said: "To meet the ambitious but achievable goal of eliminating cervical cancer, we need to encourage everyone eligible to take part in the screening programme. Modernising the invitation system is key to this - letting people know when screening is due and making it simple for them to book an appointment that works for them.

"Making the whole system, from booking through to results, and with easy online links to further information for support and to address any barriers to screening, would make a huge difference for the many groups who don't find cervical screening easy. A digital first approach will be the answer for many, and at Eve we want to make sure that every single case of cervical cancer is prevented that possibly can be."

The move comes following the announcement of a new pilot scheme in Somerset, to see whether 111 online could refer women with 'red flag' symptoms for breast cancer checks without the need to see a GP, as the NHS continues its drive to improve women's health.

Claire Rowney, chief executive at Breast Cancer Now, said: "Breast screening plays a central role in saving more lives from breast cancer. Yet the stark reality is, thousands of women in England are missing having their breast cancer detected each year, and the decline in breast screening uptake in recent years is deeply concerning. This is why urgent changes to the breast screening programme are needed to guarantee women's access both now and for the future.

"Modernising and making the programme more flexible and responsive to people's needs will be key to providing accessible and efficient screening to everyone eligible. This welcome initiative to update IT and digital systems to allow for in-app invites, is a positive first step forward to encourage more women to attend breast screening."

The NHS is working closely with the government on developing a 10-Year Health Plan which will see more innovations and technology to improve care for patients and make the delivery of healthcare more efficient for generations to come - moving the health service from hospital to community, analogue to digital, and from sickness to prevention.

Members of the public, as well as NHS staff and experts have been invited to share their experiences, views and ideas for fixing the NHS via the Change NHS online platform, which will be live until the start of next year, and available via the NHS App.

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NHS England " NHS 'ping and book' screening to help save thousands of women's lives

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The NHS is set to revolutionise access to cancer screening for women in a major drive to boost uptake and save thousands of lives, the head of the NHS has announced. From next month, the NHS will begin to roll out a new "ping and book" service, alerting the phones of women to remind them [...]

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Vast inequalities faced by women in the north of England

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Vast inequalities faced by women in the north of England

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Women in the North of England live shorter lives, work more hours for less pay, are more likely to be an unpaid carer, and more likely to live in poverty than women in other regions of England.

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Report exposes vast inequalities faced by women in the North of England

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Women in the North of England live shorter lives, work more hours for less pay, are more likely to be an unpaid carer, and more likely to live in poverty than women in other regions of England, according to new research co-authored by a University of York academic.

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Specialist menopause care service in York

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Specialist menopause care service in York

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Acomb Garth Community Centre offers a specialist care service for menopause related issues that will be run by specially trained GPs.

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Specially trained GPs with an interest in women's health will be launching the service at Nimbuscare's Acomb Garth Community Care Centre on Monday, March 6.

It will be available to anyone from Nimbuscare's 11 GP member practices in York following a referral from their GP.

The service will be overseen by a consultant in sexual and reproductive health and community gynaecology.

It will initially take place on Monday and Thursday mornings, from 9am to 1pm.

Dr Melanie Fritter, who is leading the service said: "This is a new and much needed menopause service for York patients, we're so pleased to have collaborated across the city to make this possible.

"We have some amazing, well qualified GPs in this field and it's fantastic to be working closely with them to develop this service here in York, and with the Women's Health Strategy published last year, it seems like the perfect time to develop this locality based community service."

The clinic will provide specialist care for patients with more complex menopause related issues, including women who have problems with hormone replacement therapy (HRT), and premature ovarian insufficiency.

York woman Helen Booth, 46, said she welcomes the new service following the support she receieved by York GP Dr Kathy Bill.

Helen suffered from period problems, night sweats and a lack of sleep.

She said: "I was really struggling so I rang the doctors. One evening Dr Bill, who was working as part of the Nimbuscare team, phoned me.

"She was really lovely. There's nothing worse than waking up every morning feeling like you've had no sleep. She was a God-send and the patches and tablets she prescribed for me have made such a massive difference.

"I've shared on social media and talked to friends - we really need this service to help more people like me who are struggling with their symptoms."

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York's first menopause specialist care service to launch

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Specially trained GPs with an interest in women's health will be launching the service at Nimbuscare's Acomb Garth Community Care Centre on Monday, March 6. It will be available to anyone from Nimbuscare's 11 GP member practices in York following a referral from their GP.

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NHS England announces first ever national clinical director for women's health

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NHS England announces first ever national clinical director for women's health

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NHS England » NHS announces first ever national clinical director for women’s health

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The NHS has appointed Dr Sue Mann, a consultant and lead for women’s health in City and Hackney, North East London, as its first ever national clinical director for women’s health

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York and Scarborough Teaching Hospital Gender Pay Gap Report 2023

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York and Scarborough Teaching Hospital Gender Pay Gap Report 2023

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Gender Pay Gap Report 2023 FINAL DOCUMENT @ 17 3 23

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We asked you what you think about women's health 

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We asked you what you think about women's health 

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Humber and North Yorkshire Breastfeeding and Infant Feeding Strategy

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Humber and North Yorkshire Breastfeeding and Infant Feeding Strategy

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This is a draft strategy by Humber and North Yorkshire Health and Care Partnership.

Feedback on the strategy is welcome

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HNY Breastfeeding Strategy DRAFT 200123 _2_ (2) (7) (1)

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Joint Violence Against Women and Girls Strategy: Progress Updates

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Joint Violence Against Women and Girls Strategy: Progress Updates

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York and District MVP Poster 26.04.23 (2)

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Parliamentary and Health Service: Spotlight on maternity care

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Parliamentary and Health Service: Spotlight on maternity care

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Spotlight on maternity care: your stories, your rights | Parliamentary and Health Service Ombudsman (PHSO)

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Lack of research on heart disease in women is risking lives, say experts - The Guardian

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Lack of research on heart disease in women is risking lives, say experts - The Guardian

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Gaps in understanding about how cardiovascular disease affects women are putting lives at risk, say experts, who have called for greater action and investment to improve access, quality and equity in women's heart health.

In a presidential advisory issued by the American Heart Association, leading heart doctors argued that women continued to be underrepresented in research for cardiovascular disease - the number one killer of women in the US and UK - and that greater emphasis needed to be placed on prevention and education. They suggested heart health programmes should begin as early as primary school, to engage girls and empower families to take greater control over their health.

"We are losing ground on key indicators of cardiovascular health among women, including blood pressure control, weight management and diabetes," said Dr Véronique Roger, the advisory committee's corresponding author and a senior investigator at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

According to research funded by the British Heart Foundation, more than 8,000 women died between 2002 and 2013 in England and Wales because they did not receive the same standard of care as men. Inequalities at every stage lead to women being diagnosed late and not getting the prompt treatment and aftercare they need to survive a heart attack.

Roger added there needed to be a cultural shift in how cardiovascular data was presented in research studies, if health equity for women was to be achieved.

"Comparing data from women with data from men inherently positions data from men as the gold standard," said Roger. "For example, the belief that women having a heart attack will present more often with atypical symptoms carries an undertone that women present in the 'wrong way'."

Instead, researchers should focus on recruiting more women to clinical trials, and analyse their data in a more objective way, she said.

The advisory, which was published in the journal Circulation, outlined a roadmap divided into four key areas requiring attention and investment: epidemiology and prevention; awareness; access and delivery of equitable health care; and involvement of health care professionals, researchers and communities.

In particular, women and their doctors should be educated about certain female-specific factors that increase the risk of heart disease, such as starting menstruating before the age of 11; early menopause (before age 40); hormone imbalances that result in irregular ovulation, eg polycystic ovary syndrome (PCOS), or having unpredictable cycles.

Other risk factors include suffering from inflammatory and autoimmune disorders, such as lupus, rheumatoid arthritis and scleroderma, or depression and anxiety - all of which women are disproportionately affected by - and risks related to oral contraceptive use and hormone replacement therapy, or treatment for various cancers that are more prevalent in women, such as breast, uterine or ovarian cancer, some of which may harm the heart.

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Of particular concern is heart health among women considering pregnancy, where high blood pressure or diabetes could increase the risk of pre-term delivery, or delivering a baby that is significantly above or below the average birthweight, with potential long-term consequences for that child's health.

"We recommend cardiologists, primary care physicians and obstetricians and gynaecologists work together to quantify and reduce the risks of cardiovascular disease throughout a woman's life. These interdisciplinary partnerships are crucial to developing and implementing the best approaches that will yield improvements in women's overall health," said Nanette Wenger, an emeritus professor of medicine at Emory University School of Medicine, who chaired the advisory group.

"We need to help women develop a 'lifetime approach' to their health, where they are empowered to proactively manage their heart disease risk in every life stage."

Prof Sir Nilesh Samani, the medical director at the British Heart Foundation, said: "Women are disadvantaged at so many stages in their heart journey - they are underdiagnosed, undertreated and underrepresented in research. There's now an urgent need for more research to close this health gap in cardiovascular diseases seen in women across the UK and globally.

"It's vital that we tackle the fundamental problems - to understand sex-specific risk factors for cardiovascular diseases, to improve participation of women in clinical trials so the evidence generated is equally applicable to them, and to guard against the unconscious biases which lead to women with heart disease receiving worse care than men."

Helen Wilson, the head of research at Heart Research UK, said: "We are in complete agreement with the American Heart Association that research into women's heart health needs more investment to reduce the number of women living with and dying from cardiovascular disease, and to improve their chances of surviving a heart attack."

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Lack of research on heart disease in women is risking lives, say experts

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Gaps in understanding about how cardiovascular disease affects women are putting lives at risk, say experts, who have called for greater action and investment to improve access, quality and equity in women's heart health.

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New digital system to revolutionise maternity care

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New digital system to revolutionise maternity care

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NHS Trusts across the Humber and North Yorkshire Health and Care Partnership, including York and Scarborough Teaching Hospital, are rolling out a new digital system for expectant mums to register their pregnancy and access their care notes.
This will remove the need for a GP appointment to be referred through to the service and ensure that they are seen by a midwife as soon as possible. Women who do not have digital access, will be able to telephone the service to self-refer for their pregnancy care.

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Humber and North Yorkshire Health and Care Partnership

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NHS Trusts across the Humber and North Yorkshire Health and Care Partnership which provide maternity care are rolling out a new digital system for expectant mums to register their pregnancy and access their care notes.

The new system, called BadgerNet, is provided by a company called Clevermed. BadgerNet is a full electronic patient record, which supports clinical and administrative management of the woman's whole maternity journey and replaces the current paper-based records.

NHS Trusts taking part are York and Scarborough Teaching Hospitals NHS Foundation Trust, Hull University Teaching Hospitals NHS Trust and Northern Lincolnshire and Goole NHS Foundation Trust.

With BadgerNet, the way that women access and book into the maternity service will change. Expectant parents will be able to self-refer directly into the service via an online booking form where they will fill in their details, be assigned to a midwife and an appointment will be generated. This will remove the need for women to get an appointment with her GP before being referred through to the service and ensure that she is seen by a midwife as soon as possible. Women who do not have digital access, will be able to telephone the service to self-refer for their pregnancy care.

The service will also launch 'Badger Notes', an online portal and app. Badger Notes replaces the traditional hand-held paper record and allows the parents to have real-time access to their maternity care record, which is updated with information drawn from the hospital maternity records. It is a secure system requiring a log-in, which allows parents-to-be to see updates to their notes in real-time, as well as adding their own information such as birthing plans or preferences and feedback. The portal is connected to the BadgerNet system which will be used by maternity staff to record notes following appointments and consultations.

Records can be easily updated at each maternity visit or appointment, and midwives do not have to 'double enter' data onto paper handheld notes, allowing them more time to focus on delivering the best care.

Women receiving maternity care using traditional paper notes, will be transferred on to the BadgerNet system when they birth their baby. They will be given access to Badger Notes at that point, giving them access to their digital maternity record and that of their baby.

Becky Case, Local Maternity and Neonatal System Programme Lead, Humber, and North Yorkshire, said: "This is positive news for families across our region. The new system is secure and puts control in hands of families and easy access to their notes for the healthcare professionals involved in their care,

"The app is easy to use and so we expect that most parents-to-be will enjoy the benefits almost straightaway. We feel that this portal allows us to enhance our person-centred approach, putting families at the heart of their maternity care throughout the pregnancy and post-natal journey."

More details, including the new link to register a pregnancy, are available at https://humberandnorthyorkshire.org.uk/our-work/maternity/badgernet/.

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New digital record system set to revolutionise maternity care in Humber and North Yorkshire. - Humber and North Yorkshire Health and Care Partnership

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NHS Trusts across the Humber and North Yorkshire Health and Care Partnership which provide maternity care are rolling out a new digital system for expectant mums to register their pregnancy and access their care notes. The new system, called BadgerNet, is provided by a company called Clevermed.

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Many women aren't getting to hospital quickly enough when they have a heart attack - and some don't get the right drugs to help improve their chances of survival.

Dawn had a heart attack but 'powered through' making the Christmas dinner before seeking help - because she put her symptoms down to anxiety and backache.

Her interventional cardiologist in Newcastle-upon-Tyne, Professor Vijay Kunadian, sees many women like her who aren't seen quickly enough or given the right medication to improve their chances of survival. We hear about research which reveals that women are much more likely to die of a heart attack than men because of delays and lack of treatment.

Learning the piano can help to improve the way our brains process audible and visual information - a task we carry out effortlessly when looking and listening as we do things like cross the road safely or chat with friends. Dr Karin Petroni explains how even just a few microseconds in processing speed can make a difference - so she's going to carry on playing drums.

James Gallagher's piano version of Giuseppe Verdi's La donna è mobile/When the saints go marching in (trad) arranged by Nancy Litten/Kenneth Bartels (ABRSM)

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BBC Radio 4 - Inside Health, Women and heart attacks

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Many women aren't getting to hospital quickly enough when they have a heart attack - and some don't get the right drugs to help improve their chances of survival. Dawn had a heart attack but 'powered through' making the Christmas dinner before seeking help - because she put her symptoms down to anxiety and backache.

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£25 million new funding allocated to create new women's health hubs, as part of the Women's Health Strategy for England

New hubs to reduce pressure on secondary care, waiting lists and tackle health inequalities

Women across England will benefit from tailored healthcare and support by new women's health hubs - improving access and quality of care for services for menstrual problems, contraception, pelvic pain, menopause care and more.

A £25 million investment over the next 2 years will accelerate the development of new women's health hubs to benefit women across England and help to ease pressures facing the NHS.

The hub models will be tailored to meet local women's needs. They will focus on delivering services in the community that better fit around women's lives and streamline access to women's health services. Hubs aim to address fragmentation in provision, for example by providing management of contraception and heavy bleeding in one visit, or integrating cervical screening with other aspects of women's health care. At the moment, women often need to attend multiple appointments and go to different places to access these essential services.

As well as improving women's experiences of healthcare, hubs can create longer-term savings for the NHS through improving access to preventative care and reducing pressure on secondary care services.

Health and Social Care Secretary Steve Barclay said:

As we celebrate International Women's Day, it is important we look back on the real progress made on the rollout of our Women's Health Strategy - including making hormone replacement therapy more accessible and supporting women's reproductive health in the workplace.

New funding of £25 million for women's health hubs - which provide tailored services for women including menopause care, menstrual health and contraception - mean more women can get the right support that works around their daily lives.

Minister for Women's Health, Maria Caulfield said:

Women make up 51% of the population and should not be an afterthought in healthcare.

Better access to specialist services is key to tackling health inequalities - the £25 million funding will create new women's health hubs providing specialist care and advice to women across the country.

We are making excellent headway to meet our commitments set out in England's first ever Women's Health Strategy, aiming to boost the health and wellbeing of women and girls.

Early adopter women's health hubs already exist in England including in Liverpool and Manchester. These have been well received by women in their area and are offering a significant increase in appointments for long-acting reversible contraception, alongside other services such as menstrual health, menopause, and pelvic floor care.

Other existing hubs make use of digital models to tackle inequalities in access to care and ensure services are delivered efficiently. These include City and Hackney women's health hub which is leading the way with virtual menopause engagement events and group consultations, with follow up in a physical location hub where needed.

Based on consultation with more than 100,000 people across England, the Women's Health Strategy sets out an ambitious ten-year plan for improving the health and wellbeing of women and girls and reforming how the health and care system listens to them.

As part of this, Professor Dame Lesley Regan was appointed as the Women's Health Ambassador. Her role is instrumental in raising the profile of women's health, increasing awareness of 'taboo' topics, and supporting implementation of the strategy's priorities.

Professor Dame Lesley Regan, Women's Health Ambassador:

As a practicing gynaecologist, I have first-hand experience of how important it is for women to have easy access to the right care when they need it.

Although a woman's health needs change during her life course, most of them are predictable. It is crucial that we provide her with the best information and support at each and every stage of her journey.

Women's health hubs offer us the opportunity to provide holistic care - including contraception, help with period problems, early pregnancy problems, pelvic pain, menopause and cancer screening. Timely access to high quality services will help to build women's confidence in the healthcare system.

Expanding women's health hubs across England is a key commitment in the first ever government-led Women's Health Strategy for England, with an initial aim to see at least one hub in every integrated care system (ICS).

The Department of Health and Social Care is working collaboratively with stakeholders across the health and care system to develop resources to support local creation of women's health hubs, including a best practice guide, possible care pathways for local adoption, case studies and a cost benefit analysis. This will be published in due course.

Expanding women's health hubs is one of ministers' top priorities for the first year of implementing the Women's Health Strategy. The 8 priorities are:

1. Encouraging expansion of women's health hubs to improve women's access to services and to create efficiencies for the NHS

2. Improving information provision on women's health, including improvements to the NHS website and supporting teachers to deliver women's health elements of the relationships and sex curriculum

3. Supporting women's health in the workplace, including through the Health and Wellbeing Fund 2022 to 2025.

4. Pregnancy loss, including through reporting findings of the independent Pregnancy Loss Review and developing the pregnancy loss certificate

5. Fertility, including improving access to NHS fertility treatment for female same-sex couples and assessing the use of non-clinical access criteria locally

6. Improving access to hormone replacement therapy (HRT) by introducing the HRT prescription prepayment certificate in April 2023 and boosting HRT supply

7. Healthy ageing and long-term conditions - with work feeding into the government's forthcoming major conditions strategy.

8. Boosting research and evidence into women's health

NHS chief executive, Amanda Pritchard, said:

For too long, too many women have felt that their pain has been ignored, misunderstood or downplayed when they approach health professionals for help.

The NHS is continuing to find ways to ensure women's health is prioritised, that more focus is placed on their needs, and that access to the care they need is as convenient as possible - whether that's for menstrual problems, menopause or contraception.

So it is fantastic, particularly on a day where we are recognising women, that this new funding will be made available to support the NHS to expand these one stop shops across the country.

They are already making a huge difference where they are up and running and will hopefully go a long way in improving the health and experiences of women.

This comes following last week's announcement that the government has appointed a Department of Work and Pensions Menopause Employment Champion. Helen Tomlinson will work with employers to ensure women affected by the menopause are properly supported in the workplace.

Background information

Find further information on the Women's Health Strategy England.

For ongoing NIHR funded evaluation of women's health hubs see Women's Health Hubs from the University of Birmingham.

For primary care women's health forum case studies, see Women's Health Hub Toolkit case studies (PDF, 137KB).

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£25 million for women's health hub expansion

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£25 million new funding allocated to create new women's health hubs, as part of the Women's Health Strategy for England New hubs to reduce pressure on secondary care, waiting lists and tackle health inequalities Women across England will benefit from tailored healthcare and support by new women's health hubs - improving access and quality of care for services for menstrual problems, contraception, pelvic pain, menopause care and more.

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Women in England will be able to access cheaper hormone replacement therapy (HRT) for menopause through a new prescription prepayment certificate (PPC)

To be rolled out from 1 April 2023, the certificate will help around 400,000 women save hundreds of pounds a year, reducing their HRT costs to less than £20 a year

Better access to HRT will improve the lives of millions of women in England who suffer from negative symptoms of the menopause

From 1 April 2023, women prescribed HRT - the main treatment for menopause symptoms - will have access to a new scheme enabling access to a year's worth of menopause prescription items for the cost of 2 single prescription charges (currently £18.70).

As part of commitments to reduce the cost of HRT for menopausal women, the PPC will be valid for 12 months. It can be used against a list of HRT prescription items, and a patient can use this against an unlimited number of HRT items, such as patches, tablets and topical preparations. There will be no limit to how many times the certificate can be used while it is valid.

Reducing the cost of HRT is just one of the steps being taken by the government to improve access to HRT, alongside continuing work with suppliers to encourage and support them to boost supply to meet growing demand.

The introduction of the certificate delivers one of our year 1 priorities for the Women's Health Strategy for England. Published last summer, the strategy sets out an ambitious new agenda for improving the health and wellbeing of women and girls and to improve how the health and care system listens to women. Menopause was announced as a priority area within the strategy.

Health and Social Care Secretary Steve Barclay said:

This new certificate will make HRT more accessible than ever before - helping around 400,000 women save hundreds of pounds a year.

This is another step in our drive to improve support for millions of women experiencing the menopause, delivering on our Women's Health Strategy.

Minister for Women, Maria Caufield, said:

Around three-quarters of women will experience menopause symptoms, with a quarter experiencing severe symptoms - which can seriously impact their quality of life.

Reducing the cost of HRT is a huge moment for improving women's health in this country, and I am proud to be announcing this momentous step forward.

In our Women's Health Strategy, we made menopause a top priority. By making HRT more accessible, we're delivering on our commitment to women.

Women's Health Ambassador, Dame Lesley Regan, said:

The menopause is an inevitable stage in a woman's life course. As a gynaecologist, I've witnessed first-hand the symptoms that women experience, which can have debilitating impacts on their daily lives.

Making HRT more affordable will have a hugely beneficial impact on the lives of so many women. This prepayment certificate is a major step forward in prioritising the health and wellbeing of women.

Around 15% of women aged 45 to 64 in England are currently prescribed HRT, which has increased rapidly in the last 2 years from around 11% and continues to increase.

The government has accepted the recommendations of the HRT Taskforce, including encouraging and supporting manufacturers to boost supply to meet growing demand and continuing to issue serious shortage protocols ( SSPs) when needed to even out distribution. This involved allowing alternative products to be dispensed when necessary, and reducing the need for the patient to return to their GP.

The department engages with suppliers on a weekly basis, closely monitors the supply of HRT, and regularly meets with individual suppliers, including hosting quarterly roundtables with industry to ensure a continuous supply of HRT.

Women will need to apply for the PPC through the NHS Business Services Authority or in person at a pharmacy registered to sell PPCs. Once it has been granted, it will be available for use immediately on or after 1 April 2023. When collecting HRT products, patients will be able to simply show the digital or paper copy HRT PPC to the pharmacist and complete the exemption declaration on the NHS prescription form.

Dr Ranee Thakar, President of the Royal College of Obstetricians and Gynaecologists, said:

We know that cost can be one of the barriers that women face in accessing treatment to manage their symptoms during menopause, and the introduction of HRT PPCs is a positive step to improve access to HRT. This announcement is an important first step, and we hope that more will be done to address the challenges and inequalities faced in accessing menopause care and treatment.

Dr Janet Barter, President of the Faculty of Sexual and Reproductive Healthcare, said:

We welcome the introduction of HRT PPCs by the Department of Health and Social Care. This is a big step towards improving women's access to menopause treatment in England and reducing inequalities in access to this essential healthcare. Improved access to HRT will improve the lives of millions of women, allowing them to easily take control of their own menopause.

Janet Lindsay, CEO of Wellbeing of Women, said:

HRT is a first line treatment for women who may need help with managing menopause symptoms which can be debilitating. Improving access to HRT, by reducing the prescription costs, is absolutely the right thing to do and will help to empower women during this life stage.

The HRT PPC is in addition to the existing help with prescription charges, including the 3 and 12 month PPCs.

For people who need multiple medicines, the existing PPCs may remain a more cost effective method of paying for prescriptions.

HRT items in scope for the HRT-only PPC (as of 21 February 2023)

Bijuve/Bijuva

(Estradiol 1mg; micronised progesterone 100mg)

Climanor

(Medroxyprogesterone 5mg)

Clinorette

(Estradiol 2mg; norethisterone 1mg)

Elleste Duet

(Estradiol 1mg and 2mg; norethisterone 1mg)

Elleste Duet Conti

(Estradiol 2mg; norethisterone 1mg)

Elleste Solo

(Estradiol 1mg and 2 mg)

Estraderm MX

(Estradiol 25mcg, 50mcg, 75mcg and 100mcg)

Estradot

(Estradiol 25mcg, 37.5mcg, 50mcg, 75mcg and 100mcg)

Estring (90-day preparation)

(Estradiol 7.5mcg/24 hours)

Ethinylestradiol 10mcg

(Ethinylestradiol 10mcg)

Evorel

(Estradiol 25mcg, 50mcg, 75mcg and 100mcg)

Evorel Conti

(Estradiol 50mcg; norethisterone 170mcg)

Evorel Sequi

(Estradiol 50mcg; norethisterone 170mcg)

Femoston

Estradiol 1mg and 2mg; dydrogesterone 10mg)

Femoston Conti

(Estradiol 500mcg and 1mg; dydrogesterone 2.5mg and 5mg)

Femseven

(Estradiol 50mcg, 75mcg)

Femseven Conti

(Estradiol 50mcg; levonorgestrel 7mcg)

FemSeven Sequi

(Estradiol 50mcg; levonorgestrel 10mcg)

Imvaggis

(Estriol 30mcg)

Indivina

(Estradiol 1mg and 2mg; medroxyprogesterone 2.5mg and 5mg)

Kliofem

(Estradiol 2mg; norethisterone 1mg)

Kliovance

(Estradiol 1mg; norethisterone 500mcg)

Lenzetto

(Estradiol 1.53mg)

Mirena

(Levonorgestrel 20mcg/24 hours)

Novofem

(Estradiol 1mg; norethisterone 1mg)

Oestrogel/dose

(Estradiol 0.06%)

Premarin

(Conjugated oestrogen 300mcg, 625mcg and 1.25mg)

Premique low dose

(Conjugated oestrogen 300mcg; medroxyprogesterone 1.5mg)

Progynova

(Estradiol 1mg and 2mg)

Progynova TS

(Estradiol 50mcg and 100mcg)

Sandrena

(Estradiol 500mcg and 1mg)

Tridestra

(Estradiol 2mg; medroxyprogesterone 20mg)

Trisequens

(Estradiol 2mg/2mg/1mg; norethisterone 1mg)

Utrogestan

(Micronised progesterone 100mg and 200mg)

Vagifem

(Estradiol 10mcg)

Vagirux

(Estradiol 10mcg)

Zumenon

(Estradiol 1mg and 2mg)

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Hundreds of thousands of women experiencing menopause symptoms to get cheaper HRT

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Women in England will be able to access cheaper hormone replacement therapy (HRT) for menopause through a new prescription prepayment certificate (PPC) To be rolled out from 1 April 2023, the certificate will help around 400,000 women save hundreds of pounds a year, reducing their HRT costs to less than

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Presented to Parliament by the Secretary of State for Health and Social Care.

30 August 2022

CP 736

ISBN 978-1-5286-3665-0

Note: this is an updated version of the Women's Health Strategy for England. The previous version was laid in July 2022 and withdrawn August 2022.

Ministerial foreword

This country's health and care system belongs to us all, and it must serve us all. However, sadly, 51% of the population faces obstacles when it comes to getting the care they need.

Although women in the UK on average live longer than men, women spend a significantly greater proportion of their lives in ill health and disability when compared with men. Not enough focus is placed on women-specific issues like miscarriage or menopause, and women are under-represented when it comes to important clinical trials. This has meant that not enough is known about conditions that only affect women, or about how conditions that affect both men and women impact them in different ways.

We also know that there are disparities in women's health across the country. Smoking in pregnancy is one example of this. While progress has been made in reducing rates of smoking in pregnancy to 9.6% of deliveries, the headline figure masks significant geographical differences, with prevalence ranging from 1.8% in Kensington to 21.4% in Blackpool.

There are also far too many cases where women's voices have not been listened to - indeed the responses to our call for evidence found 84% of respondents felt that this was the case. One of the most tragic moments in both of our roles was hearing the heart-breaking stories in the Ockenden review, which highlighted shocking failings in maternity care. Here, as in so many cases, women were not listened to; one mother said she felt like a "lone voice in the wind".

This is the government's first Women's Health Strategy for England and shows how we will right these wrongs. It sets out how we will improve the way in which the health and care system listens to women's voices, and boost health outcomes for women and girls. It takes a life course approach, focused on understanding the changing health and care needs of women and girls across their lives, from adolescents and young adults to later life.

We published the call for evidence last year and we are so grateful to everyone who made their voice heard. It's brilliant that we have received almost 100,000 responses from women across the country, and over 400 written submissions from organisations and experts in health and care.

We have used these responses to shape this document and make sure it reflects the voices of women across the country. This is a 10-year strategy that sets out a range of commitments to improve the health of women everywhere, including a plan to transform women's health content on the NHS website, a definition of trauma-informed practice for the health sector and plans to increase female participation in vital research.

It also includes the appointment of Professor Dame Lesley Regan as a Women's Health Ambassador for England, who will shortly be joined by a Deputy Women's Health Ambassador. They will both help us to keep up this momentum and better reach women and girls across the country.

If we get this right and put this landmark strategy in place, then we can lay the foundations for change and end the injustices that have persisted for too long.

- The Rt Hon Steve Barclay MP, Secretary of State for Health and Social Care

- Maria Caulfield MP, Minister of State for Health

Women's Health Ambassador foreword

I am honoured to be taking up the position as the first Women's Health Ambassador for England. Having spent my career working with and caring for women, I see this newly created role as a unique opportunity to 'get it right' for women and girls.

In the 2014 chief medical officer's annual report The health of the 51%: women, we identified the widening disparities for girls and women during their adolescent, reproductive and post-reproductive years. The issues raised then remain relevant today, and in some cases health disparities have widened and been further exaggerated by the pandemic. The Better for Women report published in 2019 by the Royal College of Obstetricians and Gynaecologists highlighted the need to adopt a life course approach, emphasising the importance of preventative health interventions, instead of focussing on the treatment of established disease.

This first Women's Health Strategy for England is the next step on the journey to reset the dial on women's health. The call for evidence, which informs the ambitions of the strategy, reiterates what I hear repeatedly from women: that our healthcare systems are failing them because NHS services are not designed to meet women's day-to-day needs.

All too often it forces women to navigate their way around multiple different health professionals and facilities trying to access basic services to maintain their health and wellbeing. The irony is that their care can easily be provided more conveniently and at significantly lower cost during a single visit to a women's health hub or centre if we adopt a 'one-stop-shop' model.

My initial priorities will be to tackle health issues that affect most women for long periods of their lives, which, if left untreated, can limit a woman's ability to attend school, go to work or undertake their caring responsibilities. Most women will menstruate for nearly 40 years, and most women require reliable contraception (which is also a highly cost-effective intervention) for most of this time to prevent unplanned pregnancies. Contraception is frequently used as a first-line treatment for menstrual problems, but many women meet barriers in accessing the method of their choice due to siloed commissioning.

Miscarriage is a common complication of pregnancy and yet it remains a taboo subject, rarely discussed due to embarrassment, distress and even shame. Almost all women will experience menopause and menopause symptoms can severely impact a woman's quality of life. Although women usually live longer than men, they spend considerably more time in poor health. We must ensure that our goal is to prioritise quality and longevity of life.

I am looking forward to developing a plan for the short, medium and long-term actions we will need to take to improve women's health across the life course. Most importantly, I view this strategy as the beginning, which we can amend and add to our priorities as we gain more experience of implementing the changes needed.

To achieve sustainable change and improvement, it is important to recognise that better health for women extends beyond our health and social care system. Every sector in society has a role to play, and I hope we will persuade many others to collaborate with us and contribute to achieving this goal.

I look forward to working with women, girls, charities, health services, policymakers, the government and the many other partners needed to implement this strategy effectively.

When we get it right for women, everyone in our society benefits.

- Professor Dame Lesley Regan DBE MD DSc FRCOG

1. Introduction

Why do we need a Women's Health Strategy?

While women in the UK on average live longer than men, women spend a significantly greater proportion of their lives in ill health and disability when compared with men. And while women make up 51% of the population, historically the health and care system has been designed by men for men.

This 'male as default' approach has been seen in:

This has led to gaps in our data and evidence base that mean not enough is known about conditions that only affect women - for example, menopause or endometriosis. It has meant that not enough is known about how conditions that affect both men and women impact them in different ways - for example, cardiovascular disease, dementia or mental health conditions. It has also resulted in inefficiencies in how services are delivered - for example, we know that many women have to move from service to service to have their reproductive health needs met, and women can struggle to access basic services such as contraception.

The impact of failing to put women at the heart of health services has been clear to see through the number of recent high-profile independent reports and inquiries. This has included the:

As these independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.

These high-profile incidents were the focus of much national attention and conversation, and have rightly triggered extensive work to improve things for the women and families affected. However, we have heard very clearly that women and girls across the country do not feel well served by the healthcare system as it is.

On 8 March 2021, the government launched a 14-week call for evidence to inform the development of this strategy. The call for evidence had 3 parts:

1. A 'Women's Health - Let's talk about it' public survey, which was open to all individuals aged 16 and over in England.

2. An open invitation for individuals and organisations with expertise in women's health to submit written evidence.

3. A focus group study with women across England, undertaken by the University of York in collaboration with the King's Fund.

We received 110,123 responses of which 97,307 were from individuals who told us that they lived in England and wanted to share their own experiences, the experiences of a female family member, friend or partner, or their reflections as a health or care professional. We also received 436 written responses from organisations and individuals with expertise in women's health.

Through the call for evidence, we heard about women's experiences at every stage of their interactions with the healthcare system - from initial discussion of symptoms to further appointments, discussion of treatment options and follow-up care. Women said they were often not listened to or told that heavy and painful periods are 'normal' or that the woman will 'grow out of them', and many women told us about waiting years before receiving a diagnosis for conditions such as endometriosis. Women also told us about their struggles to access high-quality information on women's health issues, such as advice on accessing the right form of contraception for them. We also heard about the impacts that women's health issues - such as heavy menstrual bleeding, fertility treatment or menopause - can have on women's participation in the workplace and ability to go about their daily lives.

The findings from the call for evidence are summarised throughout this strategy, and the full findings from the public survey and written submissions can be found in full in the call for evidence consultation response. The findings of the focus group study can be found on the University of York PREPARE website.

We are extremely grateful to all the individuals and organisations who responded to our call for evidence, which provides a strong mandate for change and is reflected in this strategy.

The 6-point plan

We have a clear ambition that, within the next 10 years, our Women's Health Strategy for England will have:

boosted health outcomes for all women and girls

radically improved the way in which the health and care system engages and listens to all women and girls

We will achieve this by:

We will bring together everyone across the healthcare system to act as the catalyst for the long-term change we all want to see.

The strategy builds on Our Vision for the Women's Health Strategy for England, which was published in December 2021, and set out our ambitions for improving the health and wellbeing of women and girls in England based on the life course approach, and resetting how the health and care system listens to women.

Recent achievements

Addressing all of this is a significant challenge, but we are not at a standing start. The government has been taking action to begin to address the issues and disparities women face, including:

setting out our approach to reducing waiting times and improving patient experience across all specialty areas, including gynaecology and urogynaecology through the Delivery plan for tackling the COVID-19 backlog of care, published in February 2022, which sets out our approach to driving efficiency and innovation within the system

establishing a Maternity Disparities Taskforce to tackle disparities in outcomes and experiences of care for women and babies by improving access to pre-conception and maternity care for women from ethnic minorities and those living in the most deprived areas

investing £127 million to increase and support the maternity NHS workforce, and to increase neonatal care capacity over the next year. This is on top of £95 million investment into recruitment of an additional 1,200 midwives and 100 consultant obstetricians

establishing the UK Menopause Taskforce to drive forward the work on improving healthcare support for women, raise levels of awareness in the population and among healthcare professionals, encourage workplace support, and consider where further research is needed to address gaps in the evidence base

reducing the cost of - and improving access to - hormone replacement therapy (HRT) by identifying ways to support the HRT supply chain and addressing shortages some women face on a limited number of products, and by reducing the cost of HRT though a new bespoke HRT pre-payment certificate that we will introduce by April 2023

banning virginity testing and hymenoplasty in the UK through the Health and Care Act 2022. Virginity testing and hymenoplasty are forms of violence against women and girls, and such practices will not be tolerated in the UK

enhancing women's reproductive wellbeing in the workplace through the Health and Wellbeing Fund 2022 to 2025. The fund supports voluntary, community and social enterprise organisations to expand and develop projects to support women experiencing reproductive health issues, such as pregnancy loss or menopause, to remain in or return to the workplace

banning the availability of 'Botox' and cosmetic fillers to under-18s for cosmetic purposes and banning adverts for cosmetic surgery that target under-18s

investing £302 million in family hubs and the Start for Life programme, including the creation of a network of family hubs in 75 upper-tier local authorities across England, bespoke parent-infant relationship and perinatal mental health support, and the establishment of breastfeeding support services

providing protections to the millions of people who experience domestic abuse through the Domestic Abuse Act 2021

abolishing the tampon tax, removing VAT from women's sanitary products, and rolling out of free sanitary products in schools, colleges and hospitals

introducing the Online Safety Bill to make the UK the safest place in the world to be online. The bill will restrict exposure to legal but harmful content, such as exposure to self-harm, harassment and eating disorders content

This strategy sets out how we will go further with our 6-point long-term plan for transformational change:

1. Ensuring women's voices are heard - tackling taboos and stigmas, ensuring women are listened to by healthcare professionals, and increasing representation of women at all levels of the health and care system.

2. Improving access to services - ensuring women can access services that meet their reproductive health needs across their lives, and prioritising services for women's conditions such as endometriosis. Ensuring conditions that affect both men and women, such as autism or dementia, consider women's needs by default, and being clear on how conditions affect men and women differently.

3. Addressing disparities in outcomes among women - ensuring that a woman's age, ethnicity, sexuality, disability or where she is from does not impact upon her ability to access services, or the treatment she receives.

4. Better information and education - enabling women and wider society to easily equip themselves with accurate information about women's health, and healthcare professionals to have the initial and ongoing training they need to treat their patients knowledgably and empathetically.

5. Greater understanding of how women's health affects their experience in the workplace - normalising conversations on taboo topics, such as periods and the menopause, to ensure women can remain productive and be supported in the workplace, and highlighting the many examples of good practice by employers.

6. Supporting more research, improving the evidence base and spearheading the drive for better data - addressing the lack of research into women's health conditions, improving the representation of women of all demographics in research, and plugging the data gap and ensuring existing data is broken down by sex.

The strategy goes on to set out our approach to priority areas related to specific conditions or areas of health where the call for evidence highlighted particular issues or opportunities:

The 10-year timeframe of this strategy recognises that achieving our ambitions requires long-term cultural and system changes. There are a number of areas where we can be clear on what change needs to and will happen, and in others more work will need to be done to develop solutions, which will be delivered in the longer term.

Our top commitments

There are a number of immediate steps that we are taking to improve the experience and outcomes for women. These are:

appointing the government's first ever Women's Health Ambassador for England, Professor Dame Lesley Regan, to champion women's voices and take forward a programme of work to support delivery of the Women's Health Strategy, eradicating deep-seated biases and driving forward the system-level changes needed to close the gender health gap

working with the NHS to create a clinical women's health lead in NHS England to provide support to the Women's Health Ambassador, and to work with the Department of Health and Social Care in developing longer-term plans for women's health

encouraging the expansion of women's health hubs around the country and other models of 'one-stop clinics', bringing essential women's services together to support women to maintain good health and create efficiencies for the NHS. We will establish a women's health accreditation mechanism to recognise commissioners and providers who offer services in these ways, and promote best practice across the country

investing in research on women's health issues. Through the National Institute for Health and Care Research (NIHR), we are commissioning a new Policy Research Unit dedicated to reproductive health, subject to receiving high-quality applications. This will undertake research to inform government policy in areas such as menstrual health, gynaecological conditions and menopause

improving the quality of health and health service data collected within NHS services, as well as processes to link data collected across the NHS, the Department of Health and Social Care, and NHS England

the General Medical Council (GMC) will be introducing the Medical Licensing Assessment for the majority of incoming doctors, including all medical students graduating from academic year 2024 to 2025 and onwards. Within this assessment, there are a number of topics relating to women's health. This will encourage a better understanding of women's health among doctors as they start their careers in the UK

improving care for women who experience pregnancy and baby loss, including by introducing a pregnancy loss certificate in England as recommended by the interim update of the independent Pregnancy Loss Review. This voluntary scheme will enable parents who have experienced a loss before 24 weeks of pregnancy to record and receive a certificate to provide recognition of their loss

transforming the NHS website into a world-class, first port of call for women's health information by updating existing content and adding new pages - such as for adenomyosis - where needed, and bringing together third-party new and existing content to create a trusted and comprehensive guide to women's health

Implementing the strategy

We will also continue our engagement directly with women, including through community groups and charities. We saw a huge level of support during the call for evidence and development of the vision and the strategy. The same level of collaboration and partnership will be just as important for realising our ambitions. The Women's Health Ambassador and her deputy will be key to driving this engagement with professional bodies and the wider public.

A delivery plan will be developed to track implementation of the strategy, and the final section '18. Implementation and monitoring progress' sets out our plans for implementing the actions set out in this strategy and for monitoring implementation.

2. Women's health across the life course

The Women's Health Strategy is informed by the life course approach. Unlike a disease-orientated approach, which focuses on interventions for a single condition often at a single life stage, a life course approach focuses on understanding the changing health and care needs of women and girls across their lives.

It aims to identify the critical stages, transitions and settings where there are opportunities to:

This life course approach has already been adopted by the World Health Organization and the Royal College of Obstetricians and Gynaecologists in their report Better for Women.

Our ambition is for women's health policy and services to be based on the life course approach, and for care to be wrapped around the needs of individual women and girls, rather than based around one specific issue or condition.

Women's health across the life course

Text alternative to diagram on women's health across the life course

The diagram shows the women's health and general health needs of women throughout the life course.

The diagram has 3 columns, each representing a life course stage:

1. Adolescents and young adults, from puberty to 24 years of age

2. Middle years, from 25 to 50 years old

3. Later years, from 51 years old onwards

A horizontal bar represents each potential health need and shows how many of the life course stages it predominantly affects. These health needs are:

Women's health needs

HPV vaccination is limited to stage 1 - adolescents and young adults.

Menstrual health is across stages 1 and 2 - adolescents and young adults, and middle years.

Gynaecological conditions is across all 3 stages.

Contraception is across all 3 stages.

Cervical screening is across stages 2 and 3 - middle years and later years.

Gynaecological cancers is across stages 2 and 3 - middle years and later years.

Sexual health and wellbeing is across all 3 stages.

Pregnancy, fertility, pregnancy loss, abortion care and postnatal support is across stages 1 and 2 - adolescents and young adults, and middle years.

Pelvic floor health is across stages 2 and 3 - middle years and later years.

Early menopause and perimenopause is limited to stage 2 - middle years.

Perimenopause and menopause is limited to stage 3 - later years.

General health needs

Healthy behaviours - for example, healthy weight, exercise and smoking - is across all 3 stages.

Mental health is across all 3 stages.

Long-term conditions is across all 3 stages.

Health impacts of violence against women and girls is across all 3 stages.

Osteoporosis and bone health is limited to stage 3 - later years.

Dementia and Alzheimer's is limited to stage 3 - later years.

Thematic priorities across the life course

An arrow contains 5 key themes that the document focuses on, which impact all health needs of women throughout their life course. These themes are:

3. Women's voices

What we've heard

In the call for evidence public survey, 84% of respondents said that there had been instances in which they had not been listened to by healthcare professionals. We heard about women's experiences at every stage of the journey - from initial discussion of symptoms to further appointments, discussion of treatment options and follow-up care.

We heard concerns from women about not being listened to in instances where pain is the main symptom - for example, being told that heavy and painful periods are 'normal' or that the woman will 'grow out of them'. While this was not limited to women's health issues, a significant volume of responses focused on gynaecological symptoms.

The survey and written submissions also highlighted that pregnant women and new mothers often reported negative interactions with healthcare professionals, and do not feel their needs are always listened to, particularly in specific situations such as during childbirth. This reinforces what we have heard through other independent reports and inquiries, including the report of the IMMDS review, the report of the Paterson Inquiry and, more recently, the final report of the Ockenden review.

In the call for evidence, we heard the importance of listening to a more diverse range of women in all aspects of our work, including the development and implementation of healthcare policies and services.

Some written submissions called for more accountability and leadership for women's health at a national and system level - for example, dedicated women's health leads.

We also heard calls for more diverse leadership and representation of women and other under-represented groups at all levels of the health and care system - for example, in leadership positions and on boards - and involvement of women in the development of curricula and training, and in research pathways.

Our 10-year ambitions

Our ambitions are:

women and girls feel listened to and have their concerns taken seriously at every stage of their journey, from initial discussion of symptoms to further appointments, discussion of treatment options and follow-up care. There is an end to taboos and stigmas that reinforce beliefs among women, health and care professionals, and wider society that health problems or painful symptoms - in particular 'hidden pain', which could be a symptom of gynaecological conditions - are normal and something to be endured

women and girls report better experiences of procedures and are well informed about the care they can expect - for example, conversations on pain relief before a hysteroscopy procedure or intrauterine device (IUD) fitting, or being offered a chaperone for intimate examinations. Disparities in experiences of services and procedures are reduced, especially for women from under-served and seldom-heard groups

personalised care and shared decision-making are embedded in all areas of women's health - for example, in management of long-term gynaecological conditions and gynaecological procedures, learning from best practice in maternity care

there is more research into women's experiences of health and care. We have a better understanding of why and how women do not feel listened to, and healthcare professional's perspectives on listening. As a result, we have a better understanding of the most effective solutions

there is increased leadership, accountability and representation of women and women's health expertise in all forums where decisions are made in the health and care system. This includes at national level, system and local level. There is also enhanced representation of women and women's health expertise in:

the commissioning of research

the design of curricula for healthcare professionals

policy making

the commissioning and delivery of services

Actions we are taking

Listening to, and working with, women and girls to implement the strategy

We have appointed Professor Dame Lesley Regan as the Women's Health Ambassador for England. The ambassador will lead a programme of work to support delivery of the Women's Health Strategy. They will focus on:

We will also appoint a Deputy Women's Health Ambassador who will work collaboratively with the ambassador to help increase awareness, and build relationships with community groups and women and girls across the country.

We are working with the ambassador to develop plans for working with women, girls and stakeholders to implement the strategy. A core part of the ambassador's role is to bring in a diverse range of voices, including those of individual women and voluntary sector organisations. This includes reaching groups that were less well represented in the call for evidence.

Representation of women and women's health expertise

NHS England will have a women's health lead. They will provide support to the Women's Health Ambassador, and work with the Department of Health and Social Care in developing longer-term plans for women's health.

We also recommend that integrated care systems ( ICSs) take into account the ambitions and actions set out in this strategy when developing their local plans.

We are also working with NHS England and our other arm's-length bodies ( ALBs) to increase the representation of women from a wide range of backgrounds at senior - including board - level across the health and care system, including within the Department of Health and Social Care as well.

We will support implementation of evidence-based best practice that improves women's experience and outcomes, including shared decision-making and personalised care.

Shared decision-making supports people to make informed decisions in relation to their health and care. Patient decision aids and conversation aids have also been found to improve people's experience of informed decision-making.

Maternity care is leading the way in implementing informed decision-making in women's health, including through digital tools.

NHS Digital is developing a series of tools called iDecide to better support informed decision-making in labour. The NHS England Maternity Transformation Programme is prioritising embedding informed decision-making for all women during pregnancy and childbirth. The final report of the Ockenden review also outlines the importance of personalised maternity care.

Within menopause care, the NHS England Menopause Pathway Improvement Programme is developing decision support tools to help women understand their symptoms better and to inform discussions with healthcare professionals.

We are also committed to increasing the proportion of women with long-term conditions accessing personalised care. Personalised care provides opportunities for improving women's experiences, as personalised care means people have choice and control over the way their care is planned and delivered. We have recently set out our ambition for 4 million people to benefit from personalised care by March 2024, including pregnant women.

We will also work with the ambassador and other key organisations to consider what more we can do to improve women and girls' experiences of services, building on work already underway across the system.

We are also pleased that the Royal College of Obstetricians and Gynaecologists guidelines on outpatient hysteroscopy are being updated, and that the Royal College of Obstetricians and Gynaecologists is producing a good practice paper on pain relief and informed decision-making for outpatient hysteroscopy procedures, which will be published shortly.

In addition, the Royal College of Obstetricians and Gynaecologists has been commissioned by the Getting it Right First Time ( GIRFT) programme to develop consent guidance for 9 gynaecological procedures as part of the High Volume Low Complexity Programme, which is supporting elective recovery and the development of standardised patient pathways across regions.

These are:

1. Outpatient hysteroscopy.

2. Outpatient operative hysteroscopy.

3. Operative hysteroscopy under general or regional anaesthesia.

4. Diagnostic laparoscopy.

5. Laparoscopic sterilisation.

6. Total laparoscopic hysterectomy.

7. Vaginal hysterectomy and repair.

8. Endometrial ablation under general anaesthetic.

9. Outpatient endometrial ablation.

We are pleased that the Faculty of Sexual and Reproductive Healthcare ( FSRH) has published an updated statement on pain associated with IUD insertion,and has consulted on an updated standard on obtaining consent in sexual and reproductive healthcare services.

Research and evidence

In the call for evidence, we heard about women's experiences of not feeling listened to. However, it was not always clear why this occurs or what the best solutions are for improving women's experiences. There is a particular gap in understanding healthcare professional's perspectives on this, as less than 2% of respondents to the public survey were from health and care professionals.

We are furthering our understanding of patient and healthcare professional perspectives by commissioning research in this area through the NIHR, including:

primary research into healthcare professionals' perspectives of listening to women in primary care - with a focus on menstrual and gynaecological symptoms - to better understand the issues, and inform new policies and actions. This follows an initial evidence review that identified very few studies relevant to this topic

a qualitative study of people's experiences of urogynaecology services. This study is examining interactions with clinicians and services covering a range of conditions, including pelvic organ prolapse and incontinence. Findings will be reported in early 2023

In addition, an important part of the ambassador's role will be engaging with healthcare professionals to better understand their perspectives.

4. Information and awareness

What we've heard

Through the call for evidence, we heard of the importance of high-quality information provision - from school education through to support for adults. Overall, family or friends was the main source of health information (74%), followed by Google (71%), other online search engines and blogs (69%), GPs or healthcare professionals (59%), and the NHS (54%).

Respondents to the public survey placed importance on making sure that the relationships, sex and health education ( RSHE) curriculum in schools is taught to both girls and boys, so that boys are also educated on female health conditions, and sexual and reproductive health. Respondents who were teachers reflected they were not always adequately equipped to teach certain topics effectively and would like to see modern teaching tools including webinars.

We also heard calls for more trusted and easier-to-understand information regarding a range of women's health issues such as fertility, the menopause, gynaecological conditions and cancers.

Organisations raised the issue of barriers to accessing information, which are greater for some groups of women and girls due to biases. We heard that information should be made available in a range of formats that are accessible, such as blogs or social media.

Organisations also noted the importance of providing alternative ways for women who may face digital exclusion to access up-to-date information on conditions and treatment options. Organisations also raised the importance of public information campaigns, in partnership with community and voluntary organisations, to provide high-quality and up-to-date information on women's health conditions.

Our 10-year ambitions

Our ambitions are:

Actions we are taking

Education in schools, colleges and universities

The government's introduction in 2020 of compulsory RSHE in all schools was an important milestone in increasing knowledge of female health conditions among both girls and boys. Pupils are now taught about several areas of women's health, including:

When teaching RSHE, schools should seek to avoid segregating lessons, as educating both girls and boys on women's health will help to improve the population's awareness, and reduce stigma and taboos surrounding these topics.

The Department for Education are monitoring RSHE implementation and findings from their research will be published in early 2024. The evaluation will look at how schools have implemented the curriculum, while understanding barriers to implementation. This will inform any further support offers. Alongside this, we will work with the Department for Education to understand women's health topics that teachers feel less confident in teaching, and work to improve provision of high-quality teaching resources.

The Department for Education is also working with stakeholders to produce additional non-statutory guidance covering specific topics mentioned by the Ofsted review into sexual abuse in schools and colleges, including non-consensual making and sharing of images.

It is also important that high-quality information on women's health is provided throughout further and higher education. We will work with stakeholders to consider how information provision in secondary schools, colleges and universities can be improved.

NHS website

In the call for evidence, we heard that the NHS website is a trusted source of health information, with 54% of respondents citing the NHS, including 111 and the NHS website, as a source for health information. We want the NHS website to be the first port of call for women and girls seeking health information, advice and signposting to reliable sources.

As part of this work, we will improve signposting to other reliable sources of information and support, including charities' websites and health apps. NHS Digital will also improve the search function and navigation of women's health content on the NHS website to make it easier for women and girls to find relevant information.

We will also add additional pages on the NHS website to include women's health issues and conditions that are not there currently - for example, adenomyosis, a condition where the inner lining of the uterus grows into the muscle wall of the uterus, and results in painful and heavy menstrual bleeding.

We will work with NHS Digital to better understand the best way to ensure that women and girls get the information they need about their health from the NHS website, including considering whether to establish a central women's health area as suggested in the call for evidence.

Language matters. Concern has been raised about removing language around biological sex and women - for example, referring to 'pregnant people'. Such an approach has the potential for unintended adverse health consequences. The government has been clear that we must not countenance the erasure of women from our public discourse or our legislation. We will work with NHS bodies to ensure that women are properly represented in communications and guidance, and that there is appropriate use of sex-specific language to communicate matters that relate to women's and men's individual health issues, and their different biological needs.

Providing health information through a range of channels and formats

In the call for evidence public survey, we heard that popular sources of information also include online blogs and search engines (69% of respondents), and social media (39% of respondents), particularly for younger respondents to the survey.

In partnership with YouTube, NHS Digital is developing credible, clinically safe health information that will appear as a top search result for UK audiences. This will include priority topics that came out of the call for evidence, including information on less well known gynaecological conditions.

We will work with the Women's Health Ambassador to raise awareness of women's health symptoms and conditions, and tackle taboos that prevent women accessing care. We will partner with key stakeholders, including the voluntary sector and industry, to provide accurate health information and destigmatise women's health conditions.

For example, digital health technologies have an important role in supporting women's access to high-quality health information, and can support women with tracking symptoms, providing advice on self-care and when to seek support from healthcare professionals, ultimately improving health outcomes for women.

This work will also include a focus on reaching under-served populations, including older women and those who are digitally excluded. We will ensure information is provided in non-digital formats across a range of women's health conditions. We will explore how we can capitalise on points of interaction that women have with the healthcare system and wider public services to provide high-quality health information - for example, NHS health checks, postnatal checks with GPs and health visitors, and through family hubs.

We also know that health and care professionals are an important source of health information, cited by 59% of survey respondents. Section '8. Education and training for health and care professionals' sets out our plans to support health and care professionals to provide up-to-date information and advice on women's health.

5. Access to services

What we've heard

In the call for evidence, we heard the importance of women and girls being able to access services that meet all their reproductive health needs from adolescence through to menopause - from the routine (for example, choosing the right contraception for them) to the more specific (for example, specialist endometriosis care). We heard that it can be difficult for women to access the women's health services they need in ways that are convenient to them.

We heard that fragmented commissioning and delivery of sexual and reproductive health services negatively impact women's access to services, in particular access to contraception. Some written responses highlighted barriers to women accessing contraception for non-contraceptive purposes - for example, LARC to treat heavy menstrual bleeding. Many survey responses and written submissions called for more joined-up and holistic provision through one-stop women's health clinics or women's health hubs.

We also heard concerns about geographical variation in access to some services - for example, menopause clinics and NHS-funded fertility treatment. Some responses called for work to ensure national guidelines are fully and consistently implemented.

We heard concerns that the coronavirus (COVID-19) pandemic made it more difficult to access some services such as cervical screening or LARC. We also heard of some positive changes - for example, the offer of virtual or telephone appointments alongside face-to-face appointments.

Our 10-year ambitions

Our ambitions are:

women and girls can access services that meet their needs across the entire span of their life course - from adolescence through the middle and reproductive years to menopause and the post-reproductive era, including for general health conditions and disabilities

there is a system-wide approach to women's reproductive health - as set out in the reproductive health consensus statement - based on reproductive wellbeing and supporting individual choice. This means national and local policies and services are centred on women and girl's needs, and reflect the life course approach, rather than being organised around a specific health issue or the needs of commissioners

women and girls have more of their health needs met at one time and in one place, through the development of local pathways that bring together and improve access to services - for example, into women's health hubs. There are clear pathways between primary, community and secondary care settings delivered, for example, through the expansion of community diagnostic centres and surgical hubs, and women and girls can access secondary care and specialist services for conditions such as endometriosis when needed. Achieving this ambition will require partnership working across all policy, commissioning, and delivery partners

Actions we are taking

Improving access to women's health services and tackling inefficiencies

Driving innovation and collaborative delivery of women's health services will be a key way of:

We have been encouraged to see how women's health hubs and similar models of 'one-stop clinics' are being created around the country, including in Liverpool, Manchester, Sheffield, Hampshire and Hackney, London. These models provide integrated women's health services at primary and community care level, where services are centred on women's needs and reflect the life course approach, rather than being organised by individual condition or issue.

For example, hub models can provide management of contraception and heavy bleeding in one visit, integrate cervical screening with other aspects of women's health care or manage menopause at the same time as contraception provision for women over 40.

Women's Health Hubs in action - Liverpool

Local authority and NHS commissioners have worked together to combine budgets and jointly set up a network of women's health hubs across the city. An initial pilot took place in one primary care network (PCN) in the north of the city, which allowed for testing of different approaches to service provision. This has been followed by a city-wide rollout, with there now being a network of women's health hubs across the city's 10 PCNs.

The hubs are hosted in GP practices and offer a range of NHS and local authority-commissioned services, including:

LARC fitting and removal

cervical screening

psychosexual services

treatment for menopause and heavy menstrual bleeding

A 'hub-and-spoke' model allows for women to access both within their own network, and to venture outside of it. 'Hubs' identified in each of the PCNs are commissioned to deliver the bulk of LARC provision and condition management. 'Spoke' practices still offer basic advice and support, and refer women into the hubs where they can book their LARC appointments. A strategic training group led by Liverpool Women's Hospital and Axess Sexual Health has helped to deliver training in LARC fitting for nurses and GPs working in the hubs.

The introduction of a women's health hub model has led to an improvement in access to services, with a growth in the total number of appointments available and an increase in LARC prescribing rates. Liverpool saw a rapid recovery in LARC prescribing and latest data suggests it has a GP LARC rate that is higher than any it has previously recorded, including pre-pandemic.

Liverpool City Council have published a case study of the work in Liverpool to share insight and lessons learnt with other commissioners and providers.

We are supportive of the expansion of women's health hubs and 'one-stop clinics' and strongly encourage local commissioners and providers to consider adopting these models of care, ensuring that existing resources are being used efficiently to deliver high-quality care to women.

We also encourage local commissioners and providers to refer to best practice materials - for example, the Primary Care Women's Health Forum's women's health hub toolkit - to support local commissioners and providers.

To support the expansion of these new models, we have commissioned the NIHR-funded Birmingham, RAND Europe and Cambridge Rapid Evaluation Centre to carry out scoping work for an evaluation of existing women's health hubs. This is expected to conclude in early 2023.

We will work to integrate these learnings into future national policy development and share best practice with local systems to support the development and implementation of new local models across the country.

We will also establish a women's health accreditation mechanism to recognise commissioners and providers who offer services in these ways and promote best practice across the country.

We will also set out our plans for sexual and reproductive health later this year. This will include a focus on encouraging collaboration and improving access to services and treatment, including increasing access and choice for all women who want contraception.

We will also commission a new reproductive health experiences survey every 2 years beginning this year. This will gather data on women's experiences across all areas of reproductive health. This will include areas such as menstrual health, contraception, pregnancy planning and menopause. This follows a pilot survey that was commissioned by PHE in 2021. We will also make the survey tool available to local systems and encourage use of the new survey locally to better understand their population's health needs and experiences, and inform local commissioning of services.

Improving access to NHS services

We are investing record amounts in improving access to NHS services, which will benefit everyone, including women.

We have invested at least £1.5 billion, announced in 2020, to create an additional 50 million general practice appointments by 2024. We are doing this by increasing and diversifying the workforce, enabling a wider range of staff to deliver more capacity and new services. This includes recruiting 26,000 more primary care professionals to deliver appointments, support GPs, and deliver new and enhanced services. These roles will also support the creation of multidisciplinary teams in general practice, delivering better care for those with long-term and complex conditions. We also made an additional £520 million available during the pandemic to improve access and expand general practice capacity during the pandemic.

Within community pharmacy, the progesterone-only contraceptive pill has been available to women to purchase over the counter in pharmacies since 2021 and access to wider oral contraception through pharmacies is currently being piloted.

Women are waiting longer than ever for their care, and gynaecology waiting lists grew significantly during the pandemic. We are committed to reducing waiting times and improving patient experience across all specialty areas, including gynaecology and urogynaecology.

The Delivery plan for tackling the COVID-19 backlog of care, published in February 2022, sets out plans to reduce waiting times and improve patient experience for patients across all specialty areas, including gynaecology and urogynaecology. This includes plans to:

communicate better with patients about treatment options and establish a network for people waiting a long time, including through the My Planned Care patient platform

roll out up to 160 community diagnostic centres across the country to help clear backlogs of people waiting for clinical tests, many for gynaecological pathways - for example, ultrasound scanning, blood tests and hysteroscopy to investigate heavy menstrual bleeding or post-menopausal bleeding

roll out surgical hubs across the country. We are increasing activity through dedicated and protected surgical hubs that conduct planned procedures only. These might exist within a hospital as a distinct unit or ringfenced theatre, or they might have been established on a separate site. Surgical hubs are focusing on providing high-volume low-complexity surgery, as recommended by the Royal College of Surgeons of England

The GIRFT programme will work with the Royal College of Obstetricians and Gynaecologists and others to consider how surgical hubs can work in gynaecology as a specialty.

6. Disparities in health outcomes between women

What we've heard

In the call for evidence, we heard that women's experiences of health and services varied by characteristics such as age, ethnicity, gender identity and disability status. In the public survey, we heard that women with an existing health condition or disability were also less likely to feel comfortable talking to healthcare professionals about some topics - for example, contraception and pregnancy (where 77% felt comfortable vs 82% of respondents who did not have an existing health condition or disability).

In the written submissions, we also heard that some groups of women face additional barriers regarding access to and experience of services, and that there are disparities in health outcomes. For example, organisations also told us that disabled women often find themselves unable to access some in-person services.

We also heard that women in particular groups or settings - such as women experiencing homelessness, refugees, asylum seekers and women in prisons - face additional barriers to accessing healthcare, and have poorer health outcomes compared with women in general.

We heard about disparities in health outcomes between different demographic groups. For example, organisations told us that lesbian and bisexual women can face stigmatisation when accessing healthcare - for example, experiencing discrimination in sexual health clinics and having poorer experiences with fertility services than heterosexual women.

Additionally, although maternal deaths are very rare, there are disparities in this area, with black and Asian women being more likely to die during pregnancy, childbirth and the year following childbirth than white women.

We also heard that there are disparities in access to services and health outcomes that stem from economic and geographical disparities - for example, differences in life expectancy across socioeconomic groups.

Our 10-year ambitions

Our ambitions are:

disparities in access to services, experiences of services and outcomes are tackled. Women with additional risk factors or who face additional barriers have equitable access to services. All women can access health and care services that are free from stigma and discrimination, and their experiences of the healthcare system are supportive, positive and sensitive to additional needs they may have

all women across all demographic groups have access to high-quality health information, and know their health care options and where to seek support. Women are not excluded from information or services that are only provided in a digital form

there is a renewed focus on tackling disparities at a whole-society level in all health programmes - for example, through implementation of the health mission in the Levelling Up the United Kingdom white paper

health and care professionals feel supported and able to handle the complexity of needs that people in inclusion health groups often face, and are enabled to provide the best health and care possible

through more research and engagement, we have a better understanding of health disparities between different groups of women. In developing solutions, policy-makers, commissioners and providers of healthcare services work together to identify opportunities to include diverse women's voices in policy development and service design, and make sure they are heard

Actions we are taking

Tackling health disparities

We know that health disparities are experienced by different groups of women - for example, maternity services for black and Asian women, and fertility access for lesbian, gay and bisexual women. We are tackling these disparities, including through the Maternity Disparities Taskforce, with a focus on women living in the most deprived areas and ethnic minority women.

Women in the most vulnerable and under-served groups may not have engaged, or have been able to engage, with the call for evidence. For example, information about sexual orientation was not collected in our public survey, so we are limited in the conclusions we can draw about the experiences of lesbian, gay and bisexual women from that analysis.

We also know for many vulnerable women, such as those experiencing homelessness or seeking asylum in the UK, digital exclusion is a real challenge and therefore participation in online surveys is unlikely.

We recognise the need to do more to ensure that women at risk of social exclusion are represented and have their voices heard. This engagement and representation are crucial to understanding the health and care needs of women and girls in under-represented groups, which in turn is critical to improving the system to better meet their needs.

We will work with the Women's Health Ambassador and Deputy Women's Health Ambassador to address the gaps in the insight gathered through the call for evidence. We are committed to ensuring that under-represented groups and groups that experience health disparities are listened to in the implementation of this strategy.

The Office for Health Improvement and Disparities ( OHID) was established in October 2021 with a focus on improving the nation's health and supporting the public to live more of life in good health, and tackling health disparities that exist across the country. OHID 's aim is to address health disparities at each life stage, including socioeconomic and geographic disparities as well as the disparities experienced by inclusion health groups, such as people sleeping rough and asylum seekers.

The Core20PLUS5 name refers to the most deprived 20% of the population of England (the Core20), and other population groups identified by local population health data, such as ethnic minority groups and inclusion health groups (the PLUS groups), among whom women may experience particular challenges with access to, or significantly worse outcomes of, care. The NHS has also set out actions and plans to address health disparities within local maternity systems in guidance for maternity systems.

The sections below set out actions we are taking in relation to particular groups of women who face additional barriers. We will work with the Women's Health Ambassador to explore other groups of women to focus on who are not mentioned below, such as women with disabilities.

Women in inclusion health populations

'Inclusion health' is a catch-all term used to describe people who are socially excluded. This term can include a number of groups, for example:

People in inclusion health groups typically experience multiple risk factors for poor health, stigma and discrimination, and are poorly represented in data. These factors result in barriers to accessing healthcare, differences in experience of the health and care system and extremely poor health outcomes, often considerably worse than those of the general population. These can include much lower life expectancies and higher instances of mental health and substance misuse issues.

Women in inclusion health groups often experience severely poor health outcomes. For example, women sleeping rough, on average, die almost 40 years earlier than women in the general population, and Gypsy, Roma and Traveller women are 20 times more likely than the wider population to have experienced the death of a child. It is vital that we address these stark disparities and improve health outcomes for women in these groups.

The government is addressing disparities in healthcare experiences and outcomes for women in inclusion health groups. For example, the National Women's Health and Social Care Review Group, a partnership between NHS England and Her Majesty's Prison and Probation Service, was convened in January 2021 to undertake an 18-month review that will aim to improve the health and wellbeing of women in prison. The review seeks to reduce disparities, improve outcomes for women in prison and upon their release, and ensure equity of access to the full range of high-quality health and social care services for women in prison. The review is being informed by women who are experts by experience at every stage, to ensure their views are heard and feed directly into recommendations for change. The outcomes of the review, including recommendations for implementation, will be reported in summer 2022.

We will continue to work across government, with NHS England and the voluntary sector to raise awareness of the health and care needs of women and girls at risk of social exclusion. For example, we have published the women's health migrant health guide, a free-to-use online resource to support practitioners in caring for patients from overseas, and cross-government work is ongoing to ensure the health and care needs of women seeking asylum are met.

Further work could include best practice guidance to health and care services, such as GPs and pharmacies, to support socially excluded women, including women experiencing homelessness and rough sleeping.

Women who are serving or have served in the armed forces

In the call for evidence, 1% of respondents selected veteran's health as a topic for inclusion in the strategy. The government is committed to making the UK the best place in the world to be a veteran. Within this context, it is important to ensure that the needs of female veterans are considered by default. The government recognises that female members of the armed forces community - those that currently serve or those that have served - can face a unique set of challenges accessing healthcare that are separate from their male counterparts.

In partnership with the Office for Veterans' Affairs and the Ministry of Defence, NHS England has established a multi-agency health improvement group for women who are serving and those that have served. An ambitious work programme is in place to ensure that women receive targeted and appropriate healthcare throughout their serving life and as veterans, based on the health needs of these women, the unique experiences they have had, and the potential physical and mental combat-related injuries they may have incurred.

In addition, the Veterans' Health Innovation Fund 2022 to 2023 will be considering initiatives that help identify or provide solutions to disparities in female veterans' health and healthcare.

Mental health is just as important as physical health, and NHS England has introduced several services to meet the needs of veterans and their families. This includes Op COURAGE: the Veterans Mental Health and Wellbeing Service for veterans. As part of the care and support available through this service, Op COURAGE works with several charities and local organisations to provide help with wider health and wellbeing needs, such as for drug and alcohol addiction.

From April 2023, NHS England will be re-launching an integrated Op COURAGE service that brings together the currently 3 separate veteran mental health services into a single service.

Autistic women and girls

Autism and neurodiversity were chosen by 10% of respondents to the survey to be included in the Women's Health Strategy. It is important that we address the under-identification of autism in women and girls, as well as the additional health and care disparities they may face throughout their lives. The NICE guideline on autistic spectrum disorder in under-19s recommends that, when considering the possibility of autism, healthcare professionals should be aware that autism may be under-recognised in girls leading to under-diagnosis.

In addition, as set out in the National strategy for autistic children, young people and adults, in 2021 to 2022 we invested an additional £13 million of funding to test and improve different diagnostic pathways, which included looking at pathways that could work for women and girls as part of the wider work on improving diagnostic pathways. We are building on this with a further investment of £2.5 million to test and implement the most effective autism diagnosis pathways for children and young people in 2022 to 2023.

We have also invested £1.4 million to trial and develop the Oliver McGowan mandatory training in learning disability and autism. The training is intended to ensure that all health and social care staff have the skills and knowledge to provide safe, compassionate and informed care. It is also an important way in which we can address significant and persistent disparities in health and care outcomes for women with a learning disability and autistic women.

7. Health in the workplace

What we've heard

In the call for evidence public survey, just over 1 in 3 respondents felt comfortable talking about health issues with their workplace (35%) and around 1 in 2 said their current or previous workplace had been supportive with regards to health issues (53%).

Respondents to the public survey called for flexible working arrangements and inclusive working environments that:

allow women to discuss health issues openly

improve managers' and employers' understanding of symptoms

Access to good occupational health services, mental health support, line manager training and workplace adjustments were perceived to be ways to create a working environment that is conducive to managing a health condition or maintaining good health at work - in addition to tackling stigmas and taboos around menstruation, menopause and gynaecological conditions - so that women feel able to speak up and access support.

In the written submissions, organisations recommended employers introduce or improve their workplace provisions and policies to better support women in different situations. This included:

helping women to manage the impact of symptoms of menstrual health problems, conditions such as endometriosis or menopause in the workplace

supporting women and partners undergoing fertility treatment or who have experienced a pregnancy loss

We also heard that the majority of unpaid carers are women, and of the impact that unpaid caring roles can have on health and wellbeing. These can include women who:

Our 10-year ambitions

Our ambitions are:

health conditions and disabilities are no longer a barrier to women's participation or a positive experience in the workplace. Women feel able to speak openly about their health and to be confident that they will be supported by their employer and workplace colleagues, with an end to taboos. This includes for less well known, invisible or undiagnosed conditions where pain may be the primary symptom - for example, heavy menstrual bleeding or endometriosis

women experiencing women's health issues such as period problems, endometriosis, fertility treatment, miscarriage and menopause feel well supported in their workplaces. Women also feel supported for general health conditions and disabilities that may impact women in the workplace such as cardiovascular disease, MSK conditions or mental health problems

through information and awareness, workplace colleagues feel better equipped to support their female colleagues

employers feel well equipped to support their female employees. Employers are encouraged to implement national policy and best practice - for example, a culture of flexible working - and to offer evidence-based workplace support - for example, high-quality occupational health services to support those managing long-term conditions and workplace policies for issues such as menopause. There is greater recognition that there is no 'one-size-fits-all' approach to supporting health in the workplace, and that needs will vary by different workplace settings and relationships

the Civil Service, NHS and social care lead the way in tackling taboos and supporting women's health in the workplace. Within health, both NHS and social care workforces are predominantly female, and it is vital that we can recruit, retain and support our workforces to reach their full potential

employers and colleagues are better informed on the potential impact of caring responsibilities on participation in the workplace and other aspects of carers' lives. Unpaid carers - who are predominantly female - feel better supported to manage work, caring responsibilities and other aspects of their lives

Actions we are taking

Support for women's health issues in the workplace

The theme of the Health and Wellbeing Fund 2022 to 2025 is women's reproductive wellbeing in the workplace.

The Civil Service provides a range of support in the form of workplace adjustments for long-term health conditions and disabilities, including for those conditions specifically experienced by women. The Civil Service recently became one of the largest employers to sign the Wellbeing of Women menopause workplace pledge. This follows the launch of the Civil Service menopause workplace policy in December 2021 to better support staff and ensure we can retain talent.

NHS England has also recently signed the menopause workplace pledge. NHS England is also supporting the NHS workforce through delivery of the 7 areas of the Our NHS People Promise. These themes have come directly from those who work in the NHS and offer significant benefits for women working in the NHS.

The Women's Health Ambassador will also work across government to further raise awareness and tackle taboos surrounding women's health issues in the workplace. This will include working with employers to implement evidence-based workplace policies and other appropriate support - for example, for women experiencing menstrual health problems, and women and partners undergoing fertility treatment or who have experienced pregnancy loss.

Sections '11. Menstrual health and gynaecological conditions' to '17. Healthy ageing and long-term conditions' below set out further actions we are taking in relation to specific health issues and conditions, particularly on workplace support for the menopause.

Support for all health conditions and disabilities

We are improving support for disabled people and people with health conditions in the workplace, which will also benefit women with physical and mental health conditions. This includes investing £1.3 billion to expand or extend employment support for disabled people and people with health conditions to enable them to enter and stay in work, including measures to reduce ill-health related job loss as set out in the government's response to the Health is everyone's business consultation.

Many women experience health conditions that impact their participation in the workplace. Some health conditions are more prevalent in women, such as MSK conditions, and women may come up against more taboos than men when discussing their health at work.

Access to high-quality occupational health services can play an important role to support women to thrive in work. The response to the Health is everyone's business consultation sets out our plans for increasing access to employer-provided occupational health for small-to-medium-sized enterprises and self-employed organisations - to support innovation and build capacity in the occupational health market - and around the guidance needed on how employers can best support people to remain in work.

Flexible working is another key component of the government's work that will benefit women experiencing health conditions or with caring responsibilities. The government recently consulted on ways to make flexible working the default and will respond to the consultation in due course.

The government will launch a new call for evidence looking at the sorts of 'informal' flexibility people may need to help them live their lives in the best way they can - both at work and at home. This will help establish how important this sort of flexibility can be for women and others in managing health conditions at work.

Support for unpaid carers

Through engagement undertaken as part of the People at the Heart of Care white paper, we have heard that unpaid carers value services and support provided for them and the people for whom they care - such as respite and breaks - but that these are not always easy to access. We have committed to investing up to £25 million to work with the sector to kickstart a change in the services provided to support unpaid carers - looking at interventions that support unpaid carers, which could include respite and breaks, peer group and wellbeing support, and new ways to combine these to maximise their impact.

It is also important that carers are supported to provide care as they would wish, and to do so in a way that supports their own health and wellbeing, and other life chances. The government response to the consultation on carer's leave was published in September 2021. This set out that carer's leave will be a 'day one' right, available to all employees who are providing care for a dependant with a long-term care need. Eligible employees will be entitled to one week of unpaid leave a year, which will be available to take flexibly in individual or half days.

8. Education and training for health and care professionals

What we've heard

Through the call for evidence, we heard the need for healthcare professionals to receive better education and training on women's health conditions, and to be better supported to deliver the best health and care possible.

Some respondents to the survey called for better education on women's health conditions and treatment options, in particular the causes of infertility and miscarriage, the menopause and HRT.

As the main access point into health services for many, there was a particular emphasis on education for GPs. Some responses called for compulsory training for GPs on women's health to help create a supportive and informed environment in which women would feel comfortable coming forward to discuss issues. Some respondents to the survey also suggested training to improve how healthcare professionals listen to, communicate with and treat women.

Written submissions also highlighted the importance of providing education, training and guidance to health professionals, with a number of specific suggestions being made. For example, some organisations called for better education and guidance for healthcare professionals, including pharmacists, on providing women with unbiased information on the different types of contraceptives (including emergency contraception) available.

Organisations also called for more education and training for healthcare professionals on:

Our 10-year ambitions

Our ambitions are:

all healthcare professionals are well informed about the importance of women's health and are enabled to provide or direct women towards the best care possible, including information on how to stay well, self-care, and advice on treatment options throughout the life course

undergraduate curricula for all healthcare professionals include teaching and assessment on women's health. Curricula for specialist training - for example general practice, physiotherapists or emergency medicine training - include teaching and assessment on women's health where relevant. This reflects that teams in both primary and secondary are becoming increasingly multidisciplinary and with a broader skills mix

to ensure there are improvements in lifelong learning opportunities for all healthcare professionals to enhance their knowledge and skills in women's health. Continuing professional development activities take different forms across different healthcare professions, and we would like Health Education England, professional bodies and other providers to review their resources to identify where content on women's health could be added, strengthened or distributed more effectively. Healthcare professionals are supported to undertake additional training and continuous professional development

NICE guidelines for women's health issues are developed where they do not currently exist and existing guidelines are updated rapidly in response to new evidence, and guidelines are implemented into practice. Guidelines are presented in an interactive format to support healthcare professionals to provide high-quality and cost-effective care

curricula, further education and training, and NICE guidelines that reflect the diversity of society - for example, by reflecting sex or ethnicity-based differences in symptoms, or response to treatment for general health conditions or disabilities. Where there are clear gaps in the evidence base in these areas, we want to see work to fill these gaps and ensure the findings are effectively communicated to frontline healthcare professionals

Actions we are taking

Improving education and training on women's health

The Women's Health Ambassador will work with regulators, professional group leaders, royal colleges and other stakeholders to improve healthcare professional education and training on women's health.

We will encourage more world-leading best practice, building on good progress already underway. This will have an initial focus on women's health topics such as gynaecological conditions and menopause.

Undergraduate and postgraduate education

Undergraduate medical curricula for people training to be doctors are set by individual medical schools, with the GMC's Outcomes for graduates ensuring that all doctors have the requisite set of skills required to progress into specialty training. The GMC will be introducing the Medical Licensing Assessment for the majority of incoming doctors, including all medical students graduating from academic year 2024 to 2025 and onwards. Within this assessment, there are a number of topics relating to women's health. This will encourage a better understanding of women's health among doctors as they start their careers in the UK.

Similarly, higher education institutions develop the curricula content that enables their nursing, midwifery and allied health professional students to meet the regulators' outcome standards. They cover the skills and approaches a healthcare practitioner must develop in order to ensure accurate and timely diagnoses, and treatment plans for their patients.

For example, pre-registration nurses will participate in specific sessions on women's health, and the standards for midwives include a domain that covers universal care for all women and newborn infants. Many other professions also have women's health content in their curricula or assessment - for example, curricula for diagnostic radiographers and sonographers include content on gynaecology and breast imaging, and, where relevant, obstetric screening and diagnosis. Therapeutic radiography curricula include treatment for breast and gynaecological cancers.

Community pharmacists and their teams are uniquely placed to provide support and expert advice on medicines, as well as wider health advice and support to women at all stages of their lives. We are looking at ways to enable community pharmacies to offer a wider range of services - for example, the progesterone-only contraceptive pill has been available to women to purchase over the counter in pharmacies since 2021, and access to wider oral contraception through pharmacies is currently being piloted, increasing choice for women in the ways in which they can access contraception.

The pharmacy regulator, the General Pharmaceutical Council ( GPhC), has highlighted issues relating to women's health - for example, the key role pharmacy professionals play in safely dispensing sodium valproate, an anti-epileptic medication, given that children born to women who take valproate during pregnancy are at significant risk of birth defects and persistent developmental disorders. In addition, community pharmacists are now able to offer women additional support with their epilepsy medication through the New Medicine Service to provide specific advice when they start a new medicine, which will include responding to their concerns about their wider health needs.

The COVID-19 pandemic highlighted the need for generalist skills among healthcare professionals. Enhanced 'generalism' for doctors in foundation and specialty training is a wraparound professional development offer designed by Health Education England to enhance current specialty training that takes place across the first 5 years of postgraduate medical training. This will help doctors identify where a patient is experiencing multiple health issues and may need the care of more than one specialist.

This work will contribute to women's health where there are health disparities affecting women, or where they have complex multiple long-term conditions.

Further training and lifelong learning

Improvements to curricula and assessment will ensure that the next generation of healthcare professionals are better educated in women's health. However, it is also vital that currently practising health and care professionals are supported to continuously learn and update their knowledge in women's health.

Between 2020 to 2021 and 2022 to 2023, we are investing an additional £210 million funding in learning and development for frontline NHS staff. This investment provides a £1,000 personal development budget for every nurse, midwife and allied health professional working in the NHS to support their continuing professional development, such as upskilling within current roles, training in new specialties or undertaking leadership courses.

Within adult social care, our social care reform package outlined in People at the Heart of Care includes £500 million investment from between 2022 to 2023 and 2024 to 2025 for the social care workforce to have the right training and qualifications, and feel recognised and valued for their skills and commitment. We will work towards this through a new knowledge and skills framework within a career structure that supports learning and development, and helps the workforce to achieve their career goals.

We are also funding tailored training places for different social care professions, along with portable care certificates and a digital skills passport so the workforce can evidence their skills and experience when switching employers.

Many healthcare professionals build knowledge throughout their careers by developing specialist skills. We would like to see further opportunities from professional bodies, Health Education England and the NHS to support the development and recognition of new skills in women's health, such as the development of accessible, multi-professional credentials to recognise skills in women's health to support new models of care.

New credentials focused on women's health have already been piloted or are in development. These support additional training and regulation in areas of high patient need. For example, Health Education England is developing pelvic health modules, and has commissioned the development of credentials in perinatal mental health and advanced practice mammography. The breast clinician credential has already been developed and piloted for 2 cohorts, and the obstetric physician credential has been developed and delivered. This will standardise and improve training in these areas of women's health, and recognise the work of all healthcare professionals working in these areas.

There are also existing multi-professional credentials in integrated sexual and reproductive health, such as the FSRH Diploma, which is an important component of women's health.

NICE guidelines

NICE provide authoritative, evidence-based guidelines for healthcare professionals on best practice. Guidelines are developed by experts based on a thorough assessment of the available evidence and through extensive engagement with stakeholders. NICE guidelines are often the first port of call for healthcare professionals, and it is vital that they reflect the most up-to-date evidence.

NICE is taking a more co-ordinated approach to guidelines on women's health and is currently updating its guidelines on topics such as the diagnosis and management of menopause, and intrapartum care, and is developing a guideline on familial ovarian cancer.

NICE's updated guideline on antenatal care was published in August 2021, and focuses on women-centred care and informed shared decision-making while aiming to improve the consistency of care across the country.

NICE also recently published its guideline on the prevention and non-surgical management of pelvic floor dysfunction in women aged 12 or over, which includes recommendations on how to raise awareness of the condition.

We need to ensure that NICE guidelines are easily accessible to healthcare professionals. NICE guidelines only make a difference for patients if they are put into practice.

Best practice resources for healthcare professionals

Professional bodies and other organisations have developed evidence-based resources and materials to support healthcare professionals to translate guidance into delivery of care.

The RCGP has developed a women's health toolkit which aims to support practising GPs. This resource is continually updated to ensure GPs have the most up-to-date advice to provide the best care for their patients. Within this, RCGP has worked in partnership with Endometriosis UK to develop a menstrual wellbeing toolkit for GPs and other healthcare professionals.

The Primary Care Women's Health Forum ( PCWHF) also produces training materials to bring guidance into practice for primary care in a range of formats. This covers a range of women's health issues including the menopause, menstrual disorders, vulval and ovarian cancer.

The Royal College of Nursing has also produced a women's health pocket guide for nurses and midwives working with women.

Many charities have resources for healthcare professionals to support them to deliver best practice in prevention, early diagnosis and management. For example, Cancer Research UK have a range of resources for healthcare professionals covering evidence for interventions that increase uptake of screening and resources to help healthcare professionals carry out those activities.

We will work with the Women's Health Ambassador and key stakeholders to promote and improve the accessibility of existing guidelines and evidence-based resources available to healthcare professionals, and to consider where new resources are needed.

Ensuring education, training and guidelines reflect the diversity of society

We will work with education institutions, professional bodies and other stakeholders to consider how evidence on sex-based differences in general health conditions can be included in undergraduate and postgraduate education and training. This is important for tackling disparities between men and women, and ensuring that women receive the best care possible.

However, we know that there are research gaps on how conditions manifest and are experienced differently by men and women, and between different groups of women, meaning that guidelines cannot always account for the diverse experiences of women. NICE guidelines often make recommendations for areas of future research, including if more research is needed into differences between men and women. Section '9. Research and evidence' below sets out our plans for tackling these gaps in research and evidence.

9. Research and evidence

What we've heard

In the call for evidence, we heard that there is limited research into women's health issues and calls for more research into health issues specific to women, such as the menopause, fertility, pregnancy and gynaecological conditions. This included research into causes and treatments of conditions, and into women's experiences of health conditions and health services. Some responses also called for more research into the relationship between women's health issues and other health issues or conditions - for example, the relationship between COVID-19 infection and 'long COVID', and women's health issues such as menstrual cycles and menopause.

Responses to the public survey and written submissions spoke of the importance of ensuring a diverse range of women are represented in clinical trials and studies for both women's health and general health issues or conditions. Some responses reflected that, historically, women have not been represented in all research studies. Examples were given of groups of women who have been less likely to be included in research, such as pregnant women, women from ethnic minorities, and lesbian and bisexual women.

We also heard a desire for more women to be working in senior research roles, and for the outcome of research to be accessible and widely disseminated to diverse women, practitioners, policy-makers and the general public.

Our 10-year ambitions

Our ambitions are:

Actions we are taking

Encouraging high-quality research

High-quality research that represents a range of women and health issues is vital for evidence-based policy-making and clinical decisions.

We are taking action through the NIHR (the nation's largest funder of health and care research, which spends £1 billion from the Department of Health and Social Care budget on research every year) and UKRI (a national funding agency investing nearly £8 billion a year in research and innovation in the UK and internationally, sponsored by the Department for Business, Energy and Industrial Strategy). Within UKRI, the Medical Research Council ( MRC) funds the highest volume of research relevant to women's health. Over the 5-year period 2017 to 2021, MRC spent £96 million on its women's health portfolio.

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. These centred on women's health issues such as miscarriage or menopause, and on women's experiences of general health conditions such as cardiovascular disease or mental health conditions.

Research into women's health

We will work with the NIHR to improve women's health research. We have already launched several research calls, including an NIHR rolling call, which is open for researchers to submit applications that address research recommendations identified in NICE guidance, including those on women's health. We know these are important first steps to encourage more research into women's health conditions.

Through the NIHR, we are commissioning, subject to receiving high-quality applications, a new policy research unit dedicated to reproductive health. This unit will be one of a set of policy research units covering a range of health and care subjects. It will undertake research to inform government policy in areas such as menstrual health and gynaecological conditions, and menopause. The commissioning process will start in summer 2022 and the unit is expected to operate from January 2024. The new unit will complement the existing unit dedicated to pregnancy and neonatal health.

To improve our understanding of research gaps, the NIHR will undertake further analysis of their portfolio and, in the longer term, explore mechanisms across the NIHR to address these gaps. This builds on recent work commissioned by the UK Clinical Research Collaboration, and funded by the NIHR and Wellcome, to evaluate UK pregnancy research needs and priorities.

The NIHR has made significant investments into research on a wide range of women's health conditions, including gynaecological conditions, pregnancy and menopause. This includes a £1.9 million study to develop treatments for postmenopausal women and a £2 million randomised control trial on endometriosis to examine the effectiveness of surgery compared with non-surgical interventions to manage chronic pelvic pain in women. The NIHR has also made large investments across NIHR infrastructure, including Biomedical Research Centres and NIHR Applied Research Centres, with dedicated themes to women's health, including reproductive health, perinatal women's health, and metabolism and endocrinology.

Participation of women in research studies and trials, and understanding sex-based differences

The NIHR equality, diversity and inclusion strategy, which is expected to be published in autumn 2022, will outline next steps in addressing disparities, including widening participation of research for under-served groups, including women.

NHS England is also committed to increasing participation of women and other under-represented groups in research by launching the Find, Recruit and Follow-up activity.

The MRC is currently exploring the development of policy to promote the consideration of sex and other diversity characteristics in the design, conduct and analysis of all human participant studies. Possible measures include, for example:

ensuring that women and men are given equal opportunity to participate where this is appropriate to the research project

ensuring analyses involve a wide range of groups and backgrounds, including those currently under-represented

A related initiative is to promote the inclusion of both sexes in the design of animal studies. Within biomedical research, female animals are under-represented in preclinical studies, including illnesses that disproportionately affect women (for example, stroke, depression and anxiety), and the effect of sex as a variable in basic research is frequently overlooked in single-sex animal and in vitro studies. The MRC has recently launched a new requirement to consider both sexes in experimental design of animal studies.

However, we know there is more that can be done to improve the participation of women in different types of research, and to improve our understanding where there are sex-based differences in health conditions and disabilities that affect both men and women.

As a first step, the Department of Health and Social Care's Chief Scientific Adviser, Professor Lucy Chappell, will lead a roundtable with researchers in autumn 2022 to explore the best ways to tackle the under-representation of women in research, including:

In the long term, we will seek to understand any complex system-wide barriers that may prevent pregnant women from participating in research.

We will also work with the NIHR to understand where there are gaps in our knowledge of sex-based differences in health conditions, symptoms and outcomes.

We, along with the NIHR, have a long-term aim to explore how we can encourage researchers to disaggregate research findings by sex. This will also help us understand sex-based differences in health conditions. As part of this, we will work with research funders to explore how females are included across different types of research, including discovery science and early phase clinical work.

Supporting women in research

The NIHR published its first Diversity Data Report, which set out the initial baseline for promoting equality, diversity and inclusion, and addressing inequalities, forming the benchmark for further reporting and to enable the tracking of progress of the equality, diversity and inclusion actions that are underway.

There are a number of areas that the NIHR identify as needing action, including the number of women applying for career awards, with particular concern that the number of applicants decreases with the seniority of award. There has already been some progress made, including removing any barriers for researchers making applications and, where necessary, introducing new policies and interventions. However, there is more to do.

The NIHR will build on this work in their upcoming equality, diversity and inclusion strategy so that the researcher career development pathway provides support for women at each stage of their journey. This will help ensure that there are enhanced opportunities for women and other groups of researchers who are currently under-represented in some NIHR awards and on panels assessing research applications.

Maximising the impact of research

It is crucial that national policy and clinical practice is informed and updated by robust research, and that women's health research is effectively disseminated to women, practitioners and the public. The NIHR is taking steps to make women's health research as accessible as possible, including proactively sharing with key groups and individuals, such as through evidence summaries on women's health and care and care and decision-making in pregnancy, which draw on NIHR research.

10. Data and digital

What we've heard

In the call for evidence, we heard that, when data is collected, it should be categorised and analysed by demographic characteristics such as ethnicity, age, sex and geography. This is to understand:

Written submissions drew attention to gaps in the quality and granularity of health-related data - in particular, in relation to specific conditions, violence against women and girls, fertility, medicines or medical devices.

The written submissions also raised the subject of 'FemTech', which is a term applied to a category of software, diagnostics, products and services that use technology to focus on women's health. This sector includes:

Respondents also suggested further research into digital technologies that help women understand their own bodies better, and for more work to consider strategies to support the FemTech sector in delivering collaborative innovation within the NHS and improving the personalisation of health advice provided to women in pregnancy.

Our 10-year ambitions

Our ambitions are:

organisations involved in health and care decision-making and service delivery have access to the high-quality data required to understand and tackle disparities in women's access to services, experiences of services and health outcomes

we make better use of data already captured to improve women's health outcomes and reduce disparities between different groups of women - for example, data gathered during pregnancy that can be an indicator of future health risks. This includes making better use of women's voice and experience data - for example, data collected through surveys and patient feedback

gaps in women's health data are better understood, and so we can tackle sex-based data gaps. Existing data sets are improved, and new data sets are established with the aim of improving women's health outcomes, reducing disparities and supporting a life course approach for women's health

health data is collected, categorised and analysed by relevant demographic characteristics such as ethnicity, age, sex, disability and geography. There is consistency in how sex is defined and recorded in health data sets. This allows policy-makers and the health service to better understand gaps in the data, where there are disparities, and for more effective commissioning and delivery of health services

there is greater use of digital health technologies to empower women - such as period tracking or menopause apps - while giving women fair access to clinically safe technologies, whether diagnostic, therapeutic or preventive

there is closer working and collaboration between with the digital health technology sector - especially FemTech - to deliver collaborative innovation within the NHS in areas such as menstrual problems, access to contraception, fertility and pregnancy complications, to plug evidence gaps, and reach a wider audience, particularly women in inclusion health groups

Actions we are taking

Health and care data

System-wide changes are needed to ensure we have high-quality data to improve our understanding of women's health experiences and outcomes. This includes:

The government's strategy Data saves lives: reshaping health and social care with data sets out our plans to unleash the potential of data in health and social care, focusing on improving health outcomes and reducing disparities.

When carrying out this work, it will be critical that the Department of Health and Social Care and NHS England work closely with the Government Statistical Service harmonisation team, based within the Office of National Statistics, who are developing updated harmonised standards for ethnicity data collection across government (as well as long-lasting health conditions data and mental health data). Milestones and timelines for the Government Statistical Service work are set out in the harmonisation team workplan published in February 2022.

We will commission a reproductive health experiences survey every 2 years, beginning this year, to tackle the gap in data collection specifically relating to women's experiences across all areas of reproductive health. This will include areas such as menstrual health, contraception, pregnancy planning and menopause. This will be used to inform future policy development, and support strategy work by improving our ability to monitor changes and disparities in women and girls' access to and experience of reproductive health services.

To support work to develop the delivery plan and implementation framework for this strategy, we will undertake a mapping exercise to identify what data is collected, where there are gaps, and how we can fill those gaps. More detail on implementation is set out in section '18. Implementation and monitoring progress' below.

In the longer term, we will explore how data collection for other areas of women's health can be improved - for example, data on gynaecological conditions such as endometriosis.

Digital health technologies

Digital health technologies, or HealthTech, are crucial tools to getting the women's health agenda right. This is a growth industry, including all areas of health and social care from primary care and triage through to remote treatment and monitoring, self-care and wellness, screening and diagnosis, and community engagement. In 2020, the UK was third in the world for digital health investment - only behind the US and China - and, in 2021, there were just over 4,000 start-ups and scale-ups operating in HealthTech in the UK.

FemTech - technologies that specifically focus on women's health-related topics, such as fertility, period tracking, pelvic health and sexual wellness - is a growing area of digital health. These technologies can empower women to have fair access to clinically safe technologies - whether diagnostic, therapeutic or preventive - to ultimately improve health outcomes for women.

We want to see greater use of digital technologies to empower women by demystifying and simplifying the process for companies to scale and launch their products in the UK.

NHS England is working with NICE and the Medicines and Healthcare products Regulatory Agency ( MHRA) through the Accelerated Access Collaborative to speed up the access to technologies that are proven to be safe and effective by patients.

The NHS Innovation Service builds on the work of HealthTech Connect, bringing organisations together to collaborate around the needs of innovators. There are 10 partner organisations in the new NHS Innovation Service, working together to support innovators to scale their products in the NHS, including NICE, NHS Supply Chain and the 15 academic health science networks operating across the country.

NHS England is also implementing the 5 national commitments from the Digital Clinical Safety Strategy. Accelerating the adoption of digital technologies to record and track implanted medical devices through the continuation of the Scan4Safety programme will improve safety and traceability of devices including those used in women's health.

In 2021 to 2022, NHS England invested £40.8 million across 128 units and trusts, which will help to address the varying levels of digital maturity within trusts across England, and put in place elements of the digital foundations that services require.

Priority areas

In the previous sections, we have set out our approach to the cross-cutting themes of:

women's voices

information and awareness

access to services

disparities in health outcomes between women

health in the workplace

education and training for health and care professionals

research and evidence

data and digital

These are relevant to the health of women and girls across the life course, and are areas where we aspire to make systematic changes that will improve women's health outcomes and experiences in the long term.

Responses to the call for evidence also highlighted issues specific to certain conditions or areas that will require targeted action. Our plans in these priority areas are set out in the sections below.

11. Menstrual health and gynaecological conditions

What we've heard

In the call for evidence public survey, gynaecological conditions were the top topic that respondents picked for inclusion in the strategy, with 63% of respondents selecting this. Menstrual health was the fourth most selected topic, with 47% of respondents selecting this.

Access to information was a key issue, with only 8% of respondents feeling that they had access to enough information on gynaecological conditions, such as endometriosis and fibroids, and only 17% of respondents feeling that they had enough information on menstrual wellbeing.

We heard concerns that women had not been listened to in instances where pain is the main symptom -for example, being told that heavy and painful periods are 'normal' or that the woman will 'grow out of them'. Women also told us about speaking to doctors on multiple occasions over many months or years before receiving a diagnosis for conditions such as endometriosis.

Linked to diagnosis times, many responses called for better education for healthcare professionals and improved service provision. Organisations also raised concerns about the normalisation of symptoms - for example, issues such as incontinence and pelvic organ prolapse being viewed as normal and something to be accepted after childbirth.

Organisations also raised the issue of period poverty and limited access to menstrual products that some girls and women experience, and that access to period products is important for mental wellbeing and sense of dignity. We also heard from organisations about period stigma, which can negatively impact women and girls' participation in education and work.

Gynaecological and urogynaecological conditions

Gynaecological conditions are conditions that affect the female reproduction organs, including, for example:

heavy menstrual bleeding

premenstrual syndrome (PMS)

premenstrual dysphoric disorder (PMDD)

endometriosis

adenomyosis

fibroids

polycystic ovary syndrome (PCOS)

Urogynaecological conditions include:

urinary incontinence

vaginal prolapse

recurrent urinary tract infections

Gynaecological cancers - for example, cervical or ovarian cancer - are included in section '15. Cancers'.

Our 10-year ambitions

Our ambitions are:

girls and boys receive high-quality, evidence-based education on menstrual and gynaecological health from an early age. Across the population, there is increased awareness, and menstrual health and gynaecological conditions are no longer taboo subjects in any aspect of society

women and girls are empowered to stay well throughout their lives, including through self-care. Women and girls have an awareness of the different gynaecological conditions (such as endometriosis and PCOS) and less well-known conditions (such as adenomyosis), and an understanding of what a normal menstrual cycle should look like for them. Women and girls know where, when and how to seek help for menstrual or gynaecological symptoms, and what support and care they can expect

all women and girls can access high-quality, personalised care within primary and community care, including access to contraception for the management of menstrual problems and gynaecological conditions. Where more specialist care is needed, women and girls can access diagnostic and treatment procedures in a timely manner.

women and girls with severe endometriosis experience better care, where diagnosis time is reduced on the journey from initial GP appointment through to final diagnosis

women and girls report improved experiences of care and gynaecological procedures, in particular experiences of pain during procedures such as hysteroscopy and IUD fittings. Disparities in access to care and experiences of care are tackled

healthcare professionals in primary care are well informed and trained in menstrual and gynaecological health, and can offer women and girls evidence-based advice and treatment

NICE guidelines for gynaecological conditions are developed where they do not currently exist and existing guidelines are updated rapidly in response to new evidence, and guidelines are implemented into practice. Guidelines are presented in an interactive format to support healthcare professionals to provide high-quality, cost-effective care

women and girls with menstrual and gynaecological conditions are supported to reach their full potential in education and the workplace. Education institutions and employers are well equipped to support their students or workforce, and are encouraged to implement evidence-based support such as workplace policies

there is more research into menstrual and gynaecological conditions to better understand causes, treatments and impacts on wider health and quality of life

Actions we are taking

Information and awareness

We will work to improve the provision of high-quality information about menstrual health, gynaecological symptoms, conditions and cancers, recognising that, in the call for evidence, these were areas where fewest people felt they had enough information.

The government is fully funding access to free period products in schools and colleges across England for girls and women that need them. Organisations can order period products online from the supplier, PHS. This scheme has been in place since January 2020 and is currently funded until 2025.

The Women's Health Ambassador will also have a crucial role to increase public awareness of menstrual health and gynaecological conditions, including by working in partnership with the voluntary sector and industry. This will include a focus on tackling taboos that contribute to the normalisation of symptoms and can prevent women from seeking help - for example, for very painful periods or incontinence following childbirth.

Improving healthcare advice and support for menstrual health, gynaecological conditions, and urogynaecological conditions

We are working to ensure women and girls can access the healthcare services they need. Section '5. Access to services' above sets out our plans for improving women and girls' access to services.

We recognise the vital role that contraception plays in managing menstrual and gynaecological conditions in addition to pregnancy prevention. We will set out our plans for sexual and reproductive health later this year. This will include a focus on increasing access and choice for all women who want contraception, including LARC.

The Delivery plan for tackling the COVID-19 backlog of care, published in February 2022, sets out plans to reduce waiting times and improve patient experience for patients across all specialty areas, including gynaecology and urogynaecology. This includes plans to:

communicate better with patients about treatment options and establish a network for people waiting a long time, including through the My Planned Care patient platform

roll out up to 160 community diagnostic centres across the country to help clear backlogs of people waiting for clinical tests, many for gynaecological pathways - for example, ultrasound scanning, blood tests and hysteroscopy to investigate heavy menstrual bleeding or post-menopausal bleeding

roll out surgical hubs across the country. We are increasing activity through dedicated and protected surgical hubs, which conduct planned procedures only. These might exist within a hospital as a distinct unit or ringfenced theatre, or they might have been established on a separate site. Surgical hubs are focusing on providing high-volume low-complexity surgery, as recommended by the Royal College of Surgeons of England

NHS England is implementing the national rollout of the GIRFT High Volume Low Complexity Programme. Gynaecology is one of 6 specialties being prioritised through this programme, which supports the establishment of surgical hubs for high-volume procedures, and the development of standardised patient pathways. As part of this work, the Royal College of Obstetricians and Gynaecologists has been commissioned to develop consent guidance for 9 gynaecological procedures. The GIRFT programme will work with the Royal College of Obstetricians and Gynaecologists and others to consider how surgical hubs can work in gynaecology as a specialty.

NHS England is also working to reduce waiting times and improve patient experience within gynaecology services, including:

supporting providers to roll out 'patient-initiated follow up', which gives patients and their carers the flexibility to arrange their follow-up outpatient appointments as and when they need them

developing national guidelines on first outpatient consultations offered through virtual routes where appropriate, which will increase patient choice

For fibroids, NICE 's recommendation of the use of relugolix with estradiol and norethisterone acetate means that women with uterine fibroids will benefit from access to a ground-breaking new oral medicine to improve their symptoms.

NICE also recently published its guideline on the prevention and management of pelvic floor dysfunction in women aged 12 or over, which includes recommendations on how to raise awareness of the condition.

NHS England is also working to improve services for pelvic floor dysfunction. Through the perinatal pelvic health programme, NHS England is working to improve prevention and identification of mild to moderate pelvic floor dysfunction around birth. NHS England is also leading work through the pelvic floor health programme for stress urinary continence and pelvic organ prolapse. This includes work on pelvic floor registry with NHS Digital to track patient outcomes for safer care, improving patient experience of care, and increasing understanding of pelvic floor health.

NHS England has also established a network of specialist centres to provide comprehensive treatment, care and advice for those affected by implanted mesh. There are now 9 specialist centres in operation across England.

Subject to the outcome of the consultation, this change would provide women who use this medicine with a choice in whether they obtain their supplies via prescription or buying from a pharmacy. This would improve access to this type of treatment for some women and increase patient choice.

Research and evidence

Through the NIHR, we have commissioned several research studies into menstrual health and gynaecological conditions, including:

In addition, through UKRI, the MRC has invested in the MRC Centre for Reproductive Health, which aims to understand the causes of reproductive health disorders to design interventional and preventative therapies. The centre advocates for increased awareness of women's health, and works together with patients and healthcare professionals to influence the prioritisation of future research. The centre also co-funds the EXPPECT Centre for Endometriosis which is advancing research into endometriosis and its management.

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. For menstrual health and gynaecological conditions, these areas included:

the impact of menstruation and gynaecological conditions on educational outcomes and attainment, and on workforce participation and sick absence rates

the relationship between COVID-19, 'long COVID' and menstruation

the links between menstruation, gynaecological conditions and mental health symptoms and outcomes

the links between PCOS and metabolic syndrome (a cluster of conditions that increase the risk of heart disease and type 2 diabetes)

the causes of fibroids and why they develop more frequently in women from ethnic minority backgrounds, in particular women of African and Caribbean origin

the ability of FemTech apps to help women understand their hormonal fluctuations and augment existing support

the ways in which service provision can be more sensitive to the additional needs of inclusion health groups, including through community-based participatory research

12. Fertility, pregnancy, pregnancy loss and postnatal support

What we've heard

In the call for evidence public survey, fertility, pregnancy, pregnancy loss and postnatal support was the second most selected topic that respondents picked for inclusion in the Women's Health Strategy, with 55% of respondents selecting this. Responses to the call for evidence covered a wide range of issues, including:

Information was a key theme, with calls for more education for young people on:

Another key issue raised was miscarriage and pregnancy loss. Women who responded to our public survey shared accounts of the devastating impact of pregnancy loss and the variation in the level of support available from healthcare services.

We also heard concerns that postnatal support was often too focused on the health and wellbeing of the baby, sometimes to the exclusion of the mother.

Some written submissions also focused on the ways in which pregnancy provides opportunities to support improvements to women's health - for example, advice on smoking and maintaining a healthy weight.

Many of the written submissions also spoke of the importance of continuing to tackle disparities in maternal and neonatal outcomes.

Our 10-year ambitions

Our ambitions are:

girls and boys receive high-quality, evidence-based education from an early age on fertility, contraception and pregnancy planning, maternity care and pregnancy loss. These issues are no longer taboo subjects in any part of society

For fertility, contraception and preconception:

women are supported through high-quality information and education to make informed decisions about their reproductive health, including if and when to have a child. All women who want contraception are able to access their preferred type of contraception in a convenient way. Women and their partners are supported to optimise their health and wellbeing prior to conception to improve pregnancy outcomes and give their child the best start in life

over the life of this strategy, we will work with NHS England to address the current geographical variation in access to NHS-funded fertility services across England. Female same-sex couples are able to access NHS-funded fertility services in a more equitable way. There is an end to non-clinical eligibility criteria, through an assessment of current criteria and updated commissioning guidance. There is improved evidence-based information about privately funded fertility treatment 'add-ons' so patients are better able to make informed choices

For pregnancy and maternity care:

the NHS is the best place in the world to give birth through personalised, individualised, and high-quality care. Women are treated as equal partners in the planning of their care throughout pregnancy, labour and the postnatal period. Their personalised care and support plans are dynamic and responsive to changes in their clinical needs and choices, and women are supported to make informed decisions during labour

disparities in outcomes and experiences of care for mothers and babies are reduced, and all women receive equitable maternity care that is responsive to their individual needs and choices

all women with significant medical conditions that pre-date or arise in pregnancy will receive timely specialist care and advice before, during and after pregnancy

NHS maternity services will be aspirational workplaces in which multidisciplinary teams work in safe environments and cultures of mutual respect where continuous learning for improvement is the norm

For pregnancy loss:

there are improvements in care pathways for women and their partners who experience pregnancy loss - to support them through bereavement and through future pregnancies, especially if they have experienced multiple early pregnancy losses. Every woman and their partner who needs it should have access to bereavement support and it is our ambition that every maternity service should have a bereavement specialist midwife

Actions we are taking

Contraception

Women, on average, will require contraception for 30 to 40 years of their lives and it is vital that women can access the full range of contraceptive methods in a convenient way.

Contraception plays a vital role in supporting women and partners to fulfil their pregnancy intentions, including the prevention of pregnancy, timing of pregnancy and spacing of pregnancies. Contraception also has an important wider role in women's lives - for example, managing symptoms of menstrual problems, gynaecological conditions and perimenopause. Through management of gynaecological conditions, contraception also supports women and girls to reach their full potential in education or the workplace.

Contraception also has a strong economic case. PHE previously developed a tool that estimates for every £1 invested in publicly funded contraception, the public sector will get a £9 return on investment ( ROI).

Information about contraception after childbirth should be offered in the antenatal period to support informed decision-making. This enables women to plan any subsequent pregnancy and reduce short inter-pregnancy intervals, which are associated with poorer pregnancy outcomes.

We are encouraged to see examples of local areas providing contraception in maternity settings, and encourage local commissioners and providers to consider implementing this service.

Postnatal contraception in action - north-west London

Women in England wanting to access contraception after giving birth can face barriers in accessing this service, including maternity services often not being commissioned to provide contraception and the need to arrange an appointment with a GP or sexual health service.

A study with women in North West London who had just given birth found that 33% of pregnancies were unplanned, 51% of women had not planned future contraception and yet 42% wanted to take home contraception after the birth of their child. In follow-up surveys, over half of women were using no contraception after 7 months. Regional data showed 5% had a second birth within a year, and 3% were estimated to have become pregnant and had a termination within a year.

In North West London, a regional collaboration across maternity services, sexual health, local authorities and commissioners came together in 2020 to introduce a contraception offer within maternity services. The new service model offers contraception counselling and information to all women during antenatal care, and women are offered a choice of contraception, compatible with breastfeeding, before they leave maternity services.

Central to this model has been training all midwives and obstetricians to provide contraception counselling, and a core group in each trust to fit contraceptive implants and coils. Staff were trained in sexual health clinics using new curricula developed by the FSRH for maternity staff, with funding from local charities and the ICS.

Initial follow-up of a cohort over a year shows 28% of women took contraception home, with the progesterone-only pill and contraceptive implant being the most popular options. Those who went home with contraceptive implants had high levels of continued use at one year. 97% of women were satisfied with this service.

Evaluation of contraception provision and access is being undertaken through a regional quality improvement project. The effect on unplanned pregnancy and spacing of births will be evaluated with service-level activity monitoring data to calculate cost savings to the ICS.

Fertility care

We recognise this is an important issue for anyone struggling to have children, and we are clear that patients' access to NHS fertility treatment should only be based on clinical factors. We are committed to ensuring the system offers effective care and support for women across the country - regardless of sexual orientation or other non-clinical factors - and transparency over what patients can expect from the NHS.

To support this, we will remove non-clinical access criteria to fertility treatment, such as one partner having a child from a previous relationship, to create more equality in access to fertility services.

We are also committed to greater transparency of the provision of IVF services across the country and will therefore explore mechanisms to publish data nationally on provision and availability of IVF.

The HFEA will also continue to work with royal colleges and professional groups to consider how best to improve understanding among healthcare professionals about infertility, so that referrals to treatment services are quicker and easier for women.

We will consider whether any change to regulatory powers is necessary to cover fertility treatment add-ons, in light of the HFEA's report following their current stakeholder dialogue about priorities for reform of the Human Fertilisation and Embryology Act 2008, which is due at the end of 2022.

Maternity care

The NHS England Maternity Transformation Programme is delivering the Better Births vision for maternity services across England, which is:

Through the work of the NHS England Maternity Transformation Programme and the NHS Long Term Plan, we have made good progress towards reducing stillbirths and neonatal deaths. Since 2010, there has been a 25% reduction in the stillbirth rate, 36% reduction in the neonatal mortality rate and 17% reduction in maternal mortality.

Despite the reductions in stillbirth, neonatal mortality and maternal mortality rates seen since 2010, MBRRACE-UK surveillance reports show us that women and babies of black or Asian ethnicity or those living in the most deprived areas are more likely to die from causes linked to pregnancy and birth, compared with women living in the least deprived areas. To address these disparities, local maternity systems received £6.8 million of funding in 2021 to 2022 to co-produce and implement their equity and equality action plans, including the implementation of continuity of carer for black, Asian and mixed ethnic groups, and those living in the most deprived areas.

The NHS has also set out actions and plans to address health disparities within local maternity systems in guidance for local maternity systems. This outlines that all maternity systems should consider the impact of women's language during the antenatal risk assessment process, and should refer to the interpretation and translation services to support women.

The Maternity Disparities Taskforce is tackling disparities in outcomes and experiences of care for mothers and babies by improving access to effective pre-conception and maternity care for women from ethnic minorities and those living in the most deprived areas. This taskforce is also addressing the wider social determinants that are linked to poorer outcomes, such as low income and housing, and health behaviours, such as smoking, drinking and obesity in pregnancy.

Reports and investigations into maternity services have underlined the importance of listening to women and their families, and providing safe, personalised care for all women.

The final report of the Ockenden review contains 66 local actions for learning for Shrewsbury and Telford NHS Hospitals Trust, 15 immediate and essential actions for the maternity system and 3 key asks for the Secretary of State for Health and Social Care.

In March 2022, we announced an additional £127 million for maternity services across England, investing in our NHS workforce and improving neonatal care. This is on top of £95 million investment this year, which included increasing the establishment of midwifery roles by 1,200 and obstetric consultant roles by 100.

Personalised maternity care

We will prioritise personalised maternity care so that women are empowered to make purposeful choices during pregnancy and childbirth. Personalised maternity care is central to our ambition to make the NHS the best place in the world to give birth.

Personalised maternity care means care is centred on the woman, her baby and her family, and is based around her needs and decisions, where there has been genuine choice informed by unbiased, evidence-based information. The final report of the Ockenden review also outlines the importance of personalised maternity care and listening to women with their voices heard.

Several programmes of work are supporting the expansion of personalised maternity care and ensuring women's voices are at the heart of maternity care, including:

1. The roll-out of midwifery continuity of carer, prioritising those most likely to experience health disparities. Midwifery continuity of carer facilitates personalised care and supports planning based on informed decision-making. The final report of the Ockenden review includes an action that midwifery continuity of carer should only continue where staffing meets safe minimum requirements on all shifts. NHS England has issued guidance to inform NHS trusts of this process.

2. 15 maternal medicine networks are being established across England to reduce rates of maternal mortality. The maternal medicine networks are responsible for ensuring that all women in the network's area with significant medical problems will receive timely specialist care and advice before, during and after pregnancy. This includes better co-ordination with primary and emergency care. A joint NHS England, integrated care board and Ministry of Defence maternal medicine network has also been established as a pathfinder to ensure women who are serving in the armed forces have personalised and continuity of care.

3. As part of NHS England's iDecide project, which has been co-designed by women and healthcare professionals, NHS Digital is developing a series of decision-making tools to better support informed decisions in labour by supporting women and their families to record their wishes and consent.

4. We provided £5 million in 2021 to 2022 to the Avoiding Brain Injury in Childbirth Collaboration, which includes the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and the Healthcare Improvement Studies Institute at the University of Cambridge. The collaboration is working to build consensus on a new approach for improved identification, escalation and action on foetal deterioration in labour, and a new protocol for complications that can arise with positioning of the baby at caesarean section, specifically when the foetal head becomes impacted in a woman's pelvis. We are currently developing a final pilot programme for 2022 to 2023 to develop and test a delivery model for training of the trainers, and for site-level training, ahead of implementation, of a national improvement programme across maternity services in England.

Support for new mothers and parents

The 1,001 days from conception to age 2 are crucial for development and impact a child's health for the rest of their life. It is also essential that we support mothers and new parents during this significant stage of life. As part of the government's commitment to supporting families and levelling up communities across the country, we recently announced £302 million investment in family hubs and the Start for Life programme.

The package includes £82 million to create a network of family hubs in 75 upper-tier local authorities across England, £100 million for bespoke parent-infant relationship and perinatal mental health support, and £50 million to establish breastfeeding support services.

The investment in breastfeeding support services will help ensure that all mothers can meet their breastfeeding goals. The public health benefits of breastfeeding for child and maternal health are significant and well established, with potential benefits including reduced risk of infections (such as gastrointestinal and respiratory tract infections), childhood obesity and maternal breast cancer.

Different mothers and babies will have different needs, so this investment will increase the range of advice and specialist support that is available, ensure support is available face to face, over the phone and digitally (including at antisocial hours), and reach families where they are - whether that's at home, in family hubs or in hospital settings.

Section '14. Mental health and wellbeing' below sets out our actions on perinatal mental health.

We are working closely with the Department for Education to evaluate the impact of the £302 million investment in family hubs and Start for Life services on key outcomes for babies and families, including outcomes related to:

We have included the 6 to 8-week postnatal check in the GP contract since 2020 to 2021, and provided £12 million to support implementation. This is a separate appointment to the 6 to 8-week baby check, which focuses on the mother's physical and mental health, and general wellbeing.

The appointment uses open questioning and provides an important opportunity to identify women with postnatal mental or physical - including pelvic health - concerns and to begin conversations about family planning or the ongoing management of emerging issues like diabetes and hypertension.

Miscarriage and pregnancy loss

The pathway sets out 9 bereavement care standards, which include:

Every NHS trust in England has expressed an interest with SANDs in joining the National Bereavement Care Pathway programme and around 65% of trusts are now members. We encourage all trusts to become members of the pathway and adopt the bereavement care standards.

Parents whose babies are stillborn (born without signs of life after 24 weeks' gestation) must legally register the stillbirth and a certificate of registration of stillbirth is issued to the parents.

When a pregnancy ends before 24 weeks' gestation, there is no formal process for parents to legally register their baby. Some bereaved parents find this to be distressing, although some parents may find it equally distressing if they were required to legally register the loss when they did not wish to do so.

The Pregnancy Loss Review has examined the impact on families of not being able to formally register a baby loss, and whether it would be beneficial to introduce a registration or certification of loss scheme to recognise what has happened and help parents who are grieving.

An interim update from the review leads, Samantha Collinge and Zoe Clark-Coates MBE, recommended that the government should introduce a voluntary scheme to enable parents who have experienced a pre-24 weeks pregnancy loss to record and receive a certificate to provide recognition of their baby loss. The purpose of recording and of issuing a certificate is to provide comfort and support by validating a loss. The certificate will not be a legal document, but will be an important acknowledgement of a life lost. The government has accepted this recommendation and we will introduce a pregnancy loss certificate in England.

The final report of the Pregnancy Loss Review is expected to be published later this year, and the government will consider the report's additional recommendations.

We will also give further consideration to the recommendations in the Lancet series on miscarriage. We await the publication of the Royal College of Obstetricians and Gynaecologists' updated guideline on recurrent miscarriage, which was out for consultation last year. We will encourage NHS services to implement the new guideline once finalised.

As part of the Signs of Life project, clinical guidance has been developed that aims to support healthcare professionals in the assessment and documentation of signs of life in extremely pre-term births, and increase the consistency of the registration of births and deaths, and reduce the confusion and distress experienced by parents.

We will continue to work across government to assess what more could be done to support bereaved families. We will also work across government and the voluntary sector to consider how we can strengthen workplace support for women and partners affected by pregnancy loss and stillbirth.

Abortion services

Under the Abortion Act 1967, women have access to safe, legal and regulated abortion services.

The wellbeing and safety of women and girls accessing abortion services has been, and will continue to be, our first and foremost priority.

We will set out our plans for sexual and reproductive health later this year, including ensuring women can continue to access robust and high-quality abortion services.

Medicines in pregnancy

Improving the safety of medicines in pregnancy and ensuring that women have high-quality, accessible information to support informed decisions about their healthcare remains a priority.

The NICE guideline on antenatal care, which was updated last year, recommends that healthcare professionals ask women about current and recent medicines at the first antenatal appointment, and that a referral is made to an obstetrician or other relevant doctor if there are any medical concerns or if review of current long-term medicines is needed.

Sodium valproate is a drug that is authorised to treat epilepsy and bipolar disorder. It is also a known teratogenic medicine, which means that, if taken during pregnancy, it can have harmful effects on the foetus and increase the risk of a child being born with physical birth defects and neurodevelopmental disorders. However, for some women, sodium valproate may be the only effective treatment for their epilepsy or bipolar disorder.

We are working to ensure that sodium valproate is only used where clinically appropriate, and to improve patient safety for women and girls for whom there is no alternative medicine. Since 2018, sodium valproate must not be used by any woman or girl able to have children unless she has a Pregnancy Prevention Programme in place. This is designed to make sure patients are fully aware of the risks and the need to avoid becoming pregnant. It includes the use of highly effective contraception for people for whom pregnancy is a possibility and completion of a signed risk acknowledgement form when their treatment is reviewed by a specialist, which must take place at least annually.

NHS England and the MHRA have a programme in place to ensure that sodium valproate is used safely and only prescribed where clinically appropriate. This covers a broad range of areas, including:

The government will shortly publish the results of a 6-week consultation on original pack dispensing and supply of medicines containing sodium valproate that we carried out in partnership with the MHRA. This included a proposal that medicines containing sodium valproate must be dispensed in the original manufacturer's packaging, which would ensure that women and girls - and particularly those of child-bearing age - always receive patient information about taking the medicine while pregnant.

Research and evidence

Through the NIHR, we have commissioned research into maternal and neonatal health, focusing on the safety of maternity services for women and babies, including:

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. For fertility, pregnancy, pregnancy loss and postnatal support, these areas included:

the efficacy of practice models, such as continuity of carer

the causes of miscarriage

the effectiveness of tools to monitor a baby's health in utero, and understand how infant deaths could be prevented

how the prenatal and postnatal environment influences infant development and parent-infant bonding

the effectiveness of AI technologies to help predict which pregnancies will develop life-threatening foetal growth restriction

the evidence on IVF add-on treatments

any long-term impacts of receiving COVID-19 vaccines during pregnancy

13. Menopause

What we've heard

In the call for evidence public survey, menopause was the third most selected topic that respondents picked for inclusion in the Women's Health Strategy, with 48% of respondents selecting this.

We heard the importance of women being provided with information about the menopause before they experience it, so they recognise symptoms and know how to seek support. In the public survey, only 9% of respondents said they have enough information about the menopause and less than 2 in 3 (64%) of respondents felt comfortable talking to healthcare professionals about the menopause.

Many respondents reported finding it difficult to access appropriate menopause care. This was reported as being due to a lack of recognition of symptoms from both women and healthcare professionals, with some written submissions noting that symptoms of the menopause can be confused with other conditions, such as women sometimes being prescribed antidepressants rather than menopause treatments.

We also heard about a reluctance among some healthcare professionals to prescribe HRT for menopause symptoms, with some written responses concerned that current clinical guidelines focus too heavily on risks and not on the benefits of HRT. Through written submissions, organisations called for better training for healthcare professionals.

Support for menopause in the workplace was also an important theme, with many respondents and organisations describing a lack of support at work and a feeling that the menopause is a 'taboo' subject that cannot be talked about openly, which made management of symptoms even more difficult. Some organisations also outlined how this can contribute to productivity and retention issues if women reduce hours or leave the workforce. These could increase over time as the number of women aged 50 and over participating in employment increases.

Our 10-year ambitions

Our ambitions are:

everyone - girls and boys - is well informed about the menopause from an early age. Awareness across the whole population of the menopause is increased and the menopause is no longer a taboo subject in any part of society

women going through the perimenopause and menopause can recognise symptoms and know their options, including self-care and where to seek support

women can access high-quality, personalised menopause care within primary care and, if needed, specialist care in a timely manner, and disparities in access to menopause treatment are reduced. Women are able to access the full range of treatment options, including contraception for the management of menopause symptoms. All menopausal women for whom HRT is suitable are able to access HRT and at a reduced cost

women and girls experiencing early menopause - whether naturally or as a side effect of medical treatment - can access specialist and personalised support, including support for mental health, fertility and bone health

healthcare professionals in primary care are well informed about the menopause, and able to offer women evidence-based advice and treatment options, including HRT and alternatives

other healthcare professionals - for example cardiologists or neurologists - have a basic understanding of menopause, including awareness of symptoms and future health risks associated with menopause, and can signpost women to appropriate support

women are supported to remain in the workplace and employers are well equipped to support their workforce during the menopause. Employers are encouraged to implement evidence-based workplace support for the menopause, including introducing workplace menopause policies

there is increased research into the menopause, including different treatment options and impacts of menopause or menopause treatment on future health risks

Actions we are taking

The UK Menopause Taskforce

It is vital that we take a holistic approach to menopause. For that reason, we established the UK Menopause Taskforce in February 2022. The taskforce is improving holistic support for the menopause across the UK through its focus on 4 key areas:

To support these efforts and maximise the taskforce's impact, the Women's Health Ambassador is a member of the taskforce.

Information and awareness for women, girls and wider society

It is important that girls and boys are educated about the menopause from an early age, and that there is awareness among the whole population to help break down taboos and stigmas.

The inclusion of menopause in the RSHE curriculum in schools is an important step in educating the next generation on the menopause.

The menopause page on the NHS website has recently been updated to include the most up-to-date, evidence-based information on menopause. This includes:

Improving healthcare advice and support

The NHS Menopause Pathway Improvement Programme is working to improve clinical care for menopause in England. This programme launched in 2021 and brings together NHS England, the Department of Health and Social Care, menopause specialists and other key stakeholders.

Within this work, there is a focus on ensuring that care pathways and resources are accessible to and support those from different backgrounds and experiences. An engagement group with public and patient involvement is being established to support this work.

Education and training for healthcare professionals is another important part of this programme. NHS England is working with Wellbeing of Women to develop an awareness-raising package among key healthcare professionals - for example, those who carry out health checks, pharmacists, general consultations and so on - to ensure more women are advised to seek support earlier in their menopause.

The government is also reducing the cost of HRT prescriptions. We will introduce a new bespoke HRT pre-payment certificate ( PPC) by April 2023. People who hold an HRT PPC will be able to access as many NHS prescriptions for HRT medicines licensed for treatment of the menopause as they need for an annual cost of just 2 single item prescription charges (currently £18.70).

The Director General of the Vaccine Taskforce, Madelaine McTernan, was appointed in April 2022 to identify ways to support the HRT supply chain and address shortages some women face on a limited number of products. Actions taken to date have improved the position, and we will take forward her recommendations for ongoing work to engage with the sector to minimise both short-term supply shocks and longer-term supply issues.

The MHRA recently held a public consultation on the reclassification of Gina 10 microgram vaginal tablets, a vaginal oestrogen product used to treat vaginal atrophy in postmenopausal women, meaning women in the UK could access this treatment at a pharmacy without requiring a prescription. Following analysis of consultation responses, the MHRA has announced that Gina 10 microgram vaginal tablets will be reclassified and women in the UK will be able to access Gina 10 microgram vaginal tablets without requiring a prescription for the first time. This change will provide women who use this medicine with a choice in whether they obtain their supplies via prescription or buying from a pharmacy. This would improve access to this type of treatment for some women and increase patient choice.

The MHRA is also reviewing the evidence on blood clot risks with different HRT combinations and routes of administration, and whether the relevant product information -the summary of product characteristics for prescribers and patient information leaflet - needs to be updated.

Workplace support

We are working across government to improve workplace support so that the menopause does not negatively impact women's experiences at work and to better support employers. Women over the age of 50 represent the fastest-growing segment of the workforce and it is vital that we, and business, work to retain this talent.

Within the healthcare system, the NHS Menopause Improvement Programme is developing a model of workforce support that champions staff wellbeing so that women can remain and thrive in the workforce through and beyond their menopause. This will include national menopause guidance for the workplace, developed in partnership with menopause and workforce experts, that will be pioneered in the NHS and then shared with other sectors.

Within the Civil Service, we launched a menopause workplace policy in December 2021 to better support staff and ensure we can retain talent. The Civil Service recently became the largest employer to sign the Wellbeing of Women Menopause Workplace Pledge, which is a public commitment to making our organisation a supportive and understanding place for employees going through the menopause. We hope the demonstration of this commitment through signing the pledge will encourage other employers to do the same.

Many organisations have introduced workplace policies and other forms of support, such as menopause champions, training for employees and line managers, and signposting employees to occupational health services. Flexible working and other adjustments such as changes to temperature, ventilation or lighting can also help women manage the impact of menopause symptoms in the workplace.

Organisations such as the Chartered Institute of Personnel and Development and the Advisory, Conciliation and Arbitration Service have produced resources to support employers and employees, and we encourage businesses to implement evidence-based support.

The recently published government response to the independent, government-commissioned report into menopause in the workplace will commit to working with employer groups and other stakeholders to consider what more we can do to improve support, and tackle taboos and stigmas in the workplace.

This will include launching an employer-led, government-backed, communications campaign on menopause in the workplace. The UK Menopause Taskforce will support this work with employers to develop and deliver this campaign.

The response will also set out that we will look to incorporate menopause awareness into the health pillar of the government's ' Mid-life MOT ', a free online support tool to encourage people in their 40s to 60s to plan ahead in the key areas of work, wellbeing and money.

Research and evidence

Through the NIHR we have commissioned research into menopause, including a £2.2 million randomised control trial looking at the effectiveness of different hormone treatments for women with premature ovarian insufficiency.

As part of its thematic focus on research, evidence and data, the June meeting of the UK Menopause Taskforce considered the evidence base on the menopause and where there are evidence gaps. The taskforce has identified some priorities for menopause research, which will feed into a menopause research prioritisation exercise that the NIHR will commission. This prioritisation exercise will also consider research recommendations from a range of experts such as NICE, including NICE's recent recommendation for further research into testosterone as a treatment for menopause symptoms.

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. For menopause, these areas included:

the wider benefits of using HRT in relation to osteoporosis and cardiovascular disease, and the impact of how early this is prescribed in the menopause cycle

the impact of COVID-19 and 'long COVID' on menopausal women

the reasons women from certain groups, including those from lower socioeconomic backgrounds, are more likely to experience early menopause

the relationship between early menopause and developing Alzheimer's disease

14. Mental health and wellbeing

What we've heard

In the call for evidence survey, mental health was in the top 5 topics selected by respondents for inclusion in the Women's Health Strategy (selected by 39% of respondents) and this was consistent across every age group.

Overall, 65% of respondents felt, or were perceived to feel, comfortable talking to friends about mental health conditions. This dropped to 52% of respondents feeling comfortable talking to family members. Only 34% of respondents said that they, or the woman they had in mind, had access to enough information on mental health conditions - however, this varied by age and health status.

Mental health was a common example used when respondents were asked to give an example of an area in which they felt that they had not been listened to by a healthcare professional. We heard from respondents that mental health should be given equal consideration to physical health, and that a focus should be given to disparities to access and experiences of mental healthcare - particularly for women from ethnic minority backgrounds and women who have faced problems with addiction and homelessness.

Responses also highlighted the impact of domestic abuse and violence against women and girls on the mental health of women across the life course.

Some organisations also flagged that perinatal and postnatal mental health needed more attention and support from healthcare professionals.

Many respondents flagged that they would like to see improved access to mental health services, and that they had particularly struggled to access mental health services and support during the pandemic.

More specifically, respondents highlighted that better mental health support in the workplace would help them, or had helped them, to reach their full potential.

Our 10-year ambitions

Our ambitions are:

preventing the onset of mental health conditions wherever possible, addressing disparities in outcomes, and ensuring equitable and timely access to specialist support for those who are struggling with their mental health. Our plans must take account of differential experiences of women if we are to successfully reduce disparities in mental health outcomes

everyone is empowered to take action to protect and promote better mental health and wellbeing through improved mental health 'literacy' within the general population. This includes gendered dimensions to mental health literacy, such as improving the visibility of how mental ill health can stem from and interact with health conditions typically experienced by women across their life course

there is improved awareness of the effects of alcohol misuse on mental health. As part of this, we are developing the first UK-wide clinical guidelines on managing alcohol misuse, which we expect will be published this year

there is a broader and deeper understanding of the causes of differential mental health outcomes between men and women to ensure national and local partners are equipped to develop tailored plans and interventions that meet the needs of different population groups. This includes conditions with higher rates of prevalence in women, such as eating disorders, and more common mental health conditions such as anxiety and depression

there is better tailored research, information and services that support all women and girls across their life course with their mental health

Actions we are taking

Improving mental health and wellbeing

We recently held a mental health and wellbeing call for evidence seeking views on:

We are currently analysing responses to the call for evidence and will set out our plans in due course.

We are committed to our ambitious plans to expand and transform NHS mental health services backed by £2.3 billion more in real terms each year by 2023 to 2024 - with a planned update to the NHS Long Term Plan later this year considering the impact of the pandemic on the delivery of wider NHS commitments to transform mental health services.

We are working with many different stakeholders to set out a shared vision for change, which that can be 'made real' in each local area through the establishment of ICSs as set out in the Health and Care Act 2022, to transform lives and livelihoods and level up the country.

This will build upon the significant work to date to improve outcomes in mental health, including the work of the Women's Mental Health Taskforce, Five Year Forward View for Mental Health, NHS Long Term Plan and COVID-19 mental health and wellbeing recovery action plan.

We set up the Women's Mental Health Taskforce in response to evidence of deteriorating mental health among women and poor outcomes experienced by some women in mental health services. The Mental Health Taskforce report found that there are a number of women's health factors that contribute to adverse outcome for women's mental health, including those stemming early in life from lack of confidence or self-esteem, body image issues, or bullying.

Work is underway by organisations including NHS England to:

As well as this, our once-in-a-generation proposed reforms to the Mental Health Act 1983 will give patients greater choice and autonomy over their care and treatment, and help address racial disparities in detention rates.

Women are one of our priority groups when promoting our flagship health and wellbeing resource Better Health: Every Mind Matters, given the higher prevalence rates of mental health issues reported. Over the coming months, we will be developing tailored content for the platform to support issues affecting women's mental health that have been raised through this consultation, such as menopause.

We have developed a whole-system approach to mental health and wellbeing, and we are co-ordinating action across different departments to tackle risk and protective factors that impact mental health, including those identified in the Women's Mental Health Taskforce report.

Our COVID-19 mental health and wellbeing recovery action plan included funding for local authority programmes, including those targeted at parents, victims of domestic abuse and more generally creating spaces that provide mental health and wellbeing support for women.

A cross-government ministerial group has been created to oversee progress on the recovery action plan, and ensure that future work on mental health and wellbeing across government reflects the need to tackle risk factors and promote protective factors. For further information on what the government is doing now to support the nation's mental health and wellbeing, you can read the mental health and wellbeing discussion paper.

Young women and girls

It is crucial that we meet the mental health and wellbeing needs of young women and girls. Young women and girls are reporting increasing levels of 'probable mental disorders' and self-harm.

The compulsory RSHE curriculum in schools teaches pupils about mental health and factors that may affect wellbeing. This includes learning about:

the early signs of mental wellbeing concerns, including common types of mental ill health (for example, anxiety and depression)

the impact of unhealthy comparison with others online, including through setting unrealistic expectations for body image and how to be a discerning consumer of information online

Poor body image can lead to anxiety, depression and eating disorders. Over half of 15-year-old girls think their body is not about the 'right size', which is clearly an issue. These subjects will also support pupils by promoting pupils' self-control and ability to self-regulate, as well as strategies for doing so.

To support the RSHE curriculum, we have also produced lesson plans and resources covering body image in a digital world.

All state schools will have the opportunity to train a senior mental health lead by 2025 in how to lead a 'whole school' approach to promoting positive mental health and wellbeing.

We are committed to improving access to eating disorder services. Eating disorders can affect people of all ages, ethnicities and backgrounds. However, eating disorder charity, Beat, estimate from the most recent prevalence data that approximately 75% of those affected by an eating disorder are female.

Last year we published our COVID-19 mental health and wellbeing recovery action plan, backed by a one-off targeted investment of £500 million for 2021 to 2022. As part of this, we invested £79 million extra to significantly expand children's mental health services.

This enabled around 22,500 more children and young people to access community health services, 2,000 more to access eating disorder services, and a faster growth in the number of mental health support teams in schools and colleges to over 500 by 2024. £110 million of the extra £500 million was invested to support the expansion of adult community mental health services, including for eating disorders.

We have also acted to protect under-18s from the effects of non-surgical cosmetic procedures. In October 2021, the government passed the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021, which prohibits the availability of 'Botox' and cosmetic fillers (commonly known as 'dermal fillers') to under-18s for cosmetic purposes. The procedures will still be available to people under 18 but only in cases where the treatment has been approved by a doctor. Their administration may then only be carried out by an 'approved person' (doctor, dentist, pharmacist or nurse).

Adverts for cosmetic surgery that target under-18s have now been banned. The new rules from the Committee of Advertising Practice cover both surgical and non-surgical interventions and will bar ads on all media - ranging from social media sites like Facebook, TikTok and Instagram to billboards and posters, newspapers, magazines and radio as well as social influencer marketing - that are aimed at under-18s or likely to have a particular appeal to that age group.

Also, the government acknowledges the possible link between digitally altered body images and mental health, including the potential harms such a link may cause. The government will consider further proposals to tackle body image issues related to digitally altered images, such as mandatory kite marks, as part of the Online Advertising Programme and our future plans for mental health.

The government's priority will be ensuring that any intervention is evidence-based and makes a real and positive difference, and will set out its approach in due course.

Perinatal mental health

We are committed to addressing perinatal mental health problems. Perinatal mental health problems are those that occur during pregnancy or in the first year following the birth of a child. The NHS Long Term Plan extends this to the first 2 years, in line with the cross-government ambition for women and children focusing on the 1,001 critical days from conception to age 2.

As part of the government's commitment to supporting families and levelling up communities across the country, we recently announced £302 million investment in family hubs and the Start for Life programme.

The package includes £100 million for bespoke parent-infant relationship and perinatal mental health support. This investment will help nurture parent-infant relationships and improve perinatal mental health support for women with mild to moderate mental health difficulties

We are increasing provision of specialist community perinatal mental health services, which provide care and treatment for women with moderate to severe or complex mental health needs, and support the developing relationship between mother and baby. They also offer women with mental health needs advice for planning a pregnancy.

The Long Term Plan commits to at least 66,000 women with moderate to severe or complex perinatal mental health needs having access to specialist community care, and rolling out maternal mental health services. These will integrate maternity, reproductive health and psychological therapy for women experiencing moderate to severe or complex mental health needs directly arising from trauma or loss.

Substance misuse and mental wellbeing

Responses to the call for evidence highlighted the need for better access and join-up of substance misuse treatment with other health services, particularly mental health, domestic abuse, and maternity and perinatal services.

We are raising awareness of the risks of drinking alcohol. Women can access information and advice to help consume less alcohol via the 'Better Health' campaign which includes online tools such as the Drinks Tracker app and the 'How Are You' health quiz. The Start for Life website provides information for pregnant women, to support them in reducing the risks of alcohol-related harm.

Through the 10-year drug strategy, published in 2021, we are making the largest ever single increase in drug and alcohol treatment and recovery funding, with £780 million of additional investment over 3 years, between 2022 to 2025. Of this, £532 million will be invested to rebuild local authority commissioned substance misuse treatment services in England.

This will benefit people seeking treatment for alcohol misuse, as alcohol and drug services are commissioned together. This is in addition to the money local authorities already spend on substance misuse services from the public health grant.

The drug strategy committed to ensuring better integration of services, to make sure that people's physical and mental health needs are addressed, to reduce harm and support recovery. Work in this area will benefit women affected by substance misuse (including alcohol), as many of the physical and mental co-morbidities seen commonly among those affected by drug misuse are also common among those with alcohol-related co-morbidities. Ongoing work on ICSs is also aimed at achieving better joined-up care for those with a substance misuse problem, including women.

The drug strategy also committed to rebuilding the professional workforce of the substance misuse treatment sector. As part of this, we are developing workforce standards, including an expectation that the workforce is trained to have the breadth of skills to respond to the clinical complexities and co-morbidities, including different mental health conditions, substance misuse and homelessness.

We are developing the first UK-wide clinical guidelines on managing alcohol misuse. They provide guidance on women-specific needs, including pregnancy and parental alcohol use, domestic abuse, and physical and mental health comorbidities.

Research and evidence

Through the NIHR, we have commissioned a £7.3 million policy research unit dedicated to mental health policy research, based at University College London. This is researching a number of high-priority areas including the impact of the COVID-19 pandemic on mental healthcare, screen time and young people's mental health, and the Mental Health Act review.

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. For mental health and wellbeing, these areas included:

What we've heard

In the call for evidence public survey, gynaecological cancers - such as "womb (uterus), ovarian, cervical, vulval, and vaginal cancers" - were the seventh most popular topic selected for inclusion in the strategy (30%).

Overall, only 14% of respondents felt they had enough information on gynaecological cancers, and this drops to 5% of respondents aged 16 to 17, and 7% of respondents aged 18 to 19 and 20 to 25.

Some respondents said they were not able to access screening services in a timely manner during the pandemic or experienced poor interactions with healthcare professionals while undergoing a smear test.

Responses to the written submissions also focused on information and awareness as an important theme. For example, organisations emphasised the need to raise public awareness of:

We also heard from organisations about barriers to securing a diagnosis such as symptoms being dismissed or confused with gynaecological conditions, irritable bowel syndrome ( IBS), or mental ill health.

We also heard the importance of better understanding and tackling disparities in access to services and cancer outcomes.

Our 10-year ambitions

Our ambitions are:

women and girls are better educated on cancers from a young age, aware of their risk factors and symptoms for various cancers and know how to maintain good health to reduce these risks. For example, this includes women knowing how to be breast aware, women with a family history of the BRCA gene being aware of early screening offers, and all women and girls seeking advice from a health professional if they experience symptoms that aren't normal for them

we achieve 90% uptake for both human papillomavirus (HPV) doses for the routine adolescent vaccination programme offered to children in year 8, with the ambition of reaching a future where, due to a combination of HPV vaccination and cervical screening, almost no-one develops cervical cancer

uptake of national vaccination and screening programmes is increased to reduce future cases of cancer and maximise early diagnosis. This will be supported by the digital transformation of screening programmes and better access to data on protected characteristics, as well as through greater accessibility and flexibility in accessing screening services

there is continued commitment to improvements in early diagnosis of and survival from cancer as set out in the NHS Long Term Plan - 75% of people with cancer will be diagnosed at stages 1 and 2 by 2028, up from 55%, and that 55,000 more people each year will survive their cancer for at least 5 years after diagnosis. There is also increased use of non-specific symptom pathways, which offer a single point of access to a diagnostic pathway for all patients with symptoms that could indicate a range of cancers

all patients have access to the most appropriate treatments and everyone with a cancer diagnosis gets the personalised support they need before, during and after treatment, and beyond. This includes people undergoing cancer treatment being routinely offered treatment to preserve fertility in line with NICE guidelines and ensuring no local time limits should be applied to reconstructive surgery

research enables us to better understand the causes, identification of and treatments - including side effects of treatment - for poorly understood cancers to reduce risk, improve early diagnosis, and subsequent health outcomes and quality of life

Actions we are taking

Awareness raising

Raising awareness is vitally important, as is the experience of women when they do come forward to seek help, including a clear route to diagnosis for people with non-specific symptoms who may still be at risk of being diagnosed with cancer. Public campaigns play a crucial role in driving earlier diagnosis by increasing awareness of symptoms that could indicate cancer and encouraging people to come forward when they experience them.

We are currently evaluating the results of a major new campaign earlier this year to increase the number of those eligible attending their cervical screening in England. The Help Us Help You - Cervical Screening Saves Lives campaign urged individuals not to ignore their cervical screening invite and, if they missed their last one, to book an appointment with their GP practice or sexual health clinic now. We will continue to use learning from our campaigns to inform future awareness-raising approaches.

The Women's Health Ambassador will have a role in raising awareness of women's health issues including greater awareness of cancer symptoms and encouraging people to attend screening, in alignment with any campaigns that we or the NHS have planned.

Vaccinations

Cervical cancer - HPV vaccination

HPV is recognised as a necessary cause of cervical cancer and high-risk human papillomavirus DNA is found in over 99% of all cervical cancers. HPV is also causally associated with less common cancers, including cancer of the vulva, vagina and anus, as well as some head and neck cancers.

Vaccination against HPV protects against these cancers, and the UK aims to achieve a standard of 90% uptake for both HPV doses for the routine adolescent programme offered to children in year 8, aligned with the World Health Organization target. In the 2020 to 2021 academic year, HPV vaccine coverage increased significantly in relation to the previous year.

Since then, millions of doses of HPV vaccine have been given to young women in this country and over 80% of women aged 15 to 24 at the present time have received the vaccine. Early evidence on the impact of the national HPV immunisation programme has shown a reduction in high-risk HPV infections, genital warts and pre-cancerous lesions among vaccinated cohorts.

Herd protection among unvaccinated groups is also now emerging globally, including in the UK. In addition, a study published in the Lancet in 2021 identified that women who were offered the HPV vaccination between the ages of 12 and 13 years were found to have cervical cancer rates 87% lower than in previous generations. The study also shows the potential for HPV vaccination, when combined with cervical screening, to reduce cervical cancer to the point where almost no-one develops it.

Screening and diagnostics

Cervical screening

We are piloting research into the accuracy and acceptability of an HPV self-sampling test so women can undertake screening for cervical cancer in the comfort of their own home. The research is in its early stages and is being piloted in women who have delayed or turned down a healthcare professional-taken sample.

The findings from this evaluation will be used to inform any recommendation made by the UK National Screening Committee. Self-sampling could lead to an increase in uptake as it will reduce some of the barriers that prevent people from attending for screening, including:

We are ensuring that transgender men and non-binary people with female reproductive organs are aware of cancer symptoms that may impact them, as well as receiving screening invites, and being able to access screening services for cervical and breast cancer screening.

Targeted and stratified screening

Targeted and stratified screening is a tool alongside our national population screening programmes, which will create more personalised, predictive and targeted programmes. We are reforming the UK National Screening Committee so that it can make recommendations on targeted and stratified screening alongside population-level programmes. These recommendations will provide the footing for screening to be targeted at groups of women who have been identified at an increased risk compared with the general population.

This would mean the type of screening test and frequency of testing would be based on individual risk. In the future, both these strategies will allow the NHS to provide more personalised screening programmes, based on predictive analysis of individual risk factors, potentially leading to better outcomes. This will benefit some women - for example, groups of women with a family history of cancer (having a variant of the BRCA gene can greatly increases a woman's chance of developing breast cancer and ovarian cancer). It is important that women are aware of screening options.

The NHS is already using targeted case-finding to prioritise people at the highest risk of certain cancer types for surveillance and other testing, supporting earlier diagnosis. Lynch syndrome and BRCA testing are examples of where this approach is being used.

Recovery of screening and diagnostic services

NHS England has made a significant investment in screening via elective recovery funding, and in diagnostic services more generally to build resilience and capacity, including new models of care. This includes a £38 million investment in breast screening and a £21 million capital investment to improve capacity for mammography screening.

We are also announcing further investment of £10 million in the breast screening programme. Through this, we will provide 25 new mobile breast screening units to be targeted at areas with the greatest challenges of uptake and coverage. This will:

provide extra capacity for services to recover from the impact of the pandemic

boost uptake of screening in areas where attendance is low

tackle health disparities

contribute towards higher early diagnosis rates in line with the NHS Long Term Plan

We are using the lessons learnt from the pandemic to transform the way we deliver screening services and make them more accessible to under-served communities. For example, some appointments can now be held over the phone or via video call rather than face-to-face meetings, and active follow-up is taking place with women who do not book or attend appointments.

Faster diagnosis

The NHS is setting up non-specific symptom pathways to provide a new route to diagnosis for patients who do not fit clearly into a single 'urgent cancer' referral pathway, but who are nonetheless at risk of being diagnosed with cancer.

A best practice timed pathway for gynaecological cancers has been developed and is scheduled for publication shortly, which will help to shorten diagnosis pathways and improve people's experiences of care.

Non-specific symptom pathways will also support the NHS to meet the new Faster Diagnosis Standard, which was introduced from October 2021 and aims to ensure that patients who are referred from general practice or a screening service have a definitive diagnosis or ruling out of cancer within 28 days.

Care and treatment

Improving treatment outcomes

Ensuring that all patients have access to the best treatments is a strategic priority for the NHS.

NHS England has recently commissioned 5 new national clinical audits, via the Healthcare Quality Improvement Partnership, to help increase consistency in access to treatment and improve outcomes.

These are in addition to the 5 existing national clinical audits for cancer. The new audits include a specific audit on ovarian cancer and one on metastatic breast cancer. The latter will form part of a single integrated programme alongside an audit of primary breast cancer in women and men of all ages, building on success and learning from the National Audit of Breast Cancer in Older Patients.

Support and follow up

It is vital that everyone living with a cancer diagnosis gets the personalised support they need before and during their treatment, and beyond. The NHS is committed to ensuring that every patient with cancer gets a personalised plan based on an assessment of their clinical and other needs.

In addition, the NHS is supporting patients to take greater ownership of their follow-up care through the rollout of personalised stratified follow-up pathways, which provide a rapid route back into the system if they notice any worrying changes or need to seek help. The pathways are being implemented across all Cancer Alliances for breast, colorectal and prostate cancers, and are being extended to additional cancer types, including womb cancer.

Breast health

We are working to improve breast health among women, as well as improving prevention, diagnosis, treatment and support for women with breast cancer. About 1 in 8 women are diagnosed with breast cancer during their lifetime.

NHS England is working to ensure women can access the best treatments possible for breast cancer. All completed NICE appraisals of breast cancer medicines since March 2018 have recommended the use of the medicines, which are now routinely available for clinicians to use in the treatment of NHS patients. NICE has recently published final draft guidance that recommends pembrolizumab in combination with chemotherapy as another immunotherapy option for people with triple negative breast cancer that has spread to other parts of the body.

Women who have had a mastectomy as part of their breast cancer treatment can choose to have a breast reconstruction. NHS England has asked Cancer Alliances to work with their local systems so that, wherever possible, surgery is now happening with immediate breast reconstruction, and to seek opportunities to provide reconstruction for those women who have not yet had the procedure following previous breast surgery during the pandemic.

The NHS Cancer Programme has made it clear to systems that no local time limits should be applied to reconstructive surgery, and certainly not where that reconstructive surgery has been delayed as a result of the pandemic.

Future plans

We recently held a cancer call for evidence seeking views on future priorities for cancer over the next 10 years. The call for evidence sought views across a number of areas including:

We are currently analysing responses to the call for evidence and will respond in due course.

Research and evidence

Through the NIHR, we have commissioned research into cancers, including:

a £5 million policy research unit dedicated to cancer awareness, screening and early diagnosis, based at Queen Mary University of London. This is researching high-priority areas including identification of risk factors for late stage or emergency presentation of cancer, barriers of participation in cancer screening, and investigation of potential early markers of cancer and new screening tests.

a study to understand barriers to early diagnosis of womb cancer and an assessment of the accuracy of non-invasive detection tools for womb cancer

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. For cancers, these areas included:

the impact of interventions on reaching women from deprived communities, and with protected characteristics such as ethnicity and disability status

disaggregating data by cancer type, as opposed to pooling all gynaecological cancers together given their varying diagnostic and treatment pathways, and by other characteristics such as ethnicity and sexual orientation

research to better understand the genetic causes of cancers in ethnic minority women, especially those of South Asian origin

research and clinical trials to develop better diagnostic tests and treatments - for example, for ovarian cancer and secondary breast cancer

ensuring trials look at how treatment will impact overall quality of life, as well as how effective it is in combatting the cancer

research and longitudinal data collection on cancer in non-symptomatic women

16. Health impacts of violence against women and girls

What we've heard

In the call for evidence public survey, the health impacts of violence against women and girls was the eighth most selected topic that respondents picked for inclusion in the Women's Health Strategy (30%). It also featured in the top 5 topics selected by respondents aged 16 to 29 and from the mixed or multiple ethnic group.

In the public survey, only 9% of respondents said they had enough information about specialist services such as sexual assault referral centres and female genital mutilation ( FGM) clinics.

Responses from organisations and experts highlighted that some groups of women are at higher risk of experiencing certain forms of violence and abuse than others - for example, disabled women experience higher rates of domestic abuse than non-disabled women, and lesbian and bisexual women are more likely to have experienced abuse than heterosexual women.

Responses highlighted that the health impacts of violence and abuse, including domestic abuse, are wide ranging and extensive, and can have long-term impacts on women and girl's physical and mental health.

Submissions from organisations also noted:

the particular need for healthcare professionals to be able to understand and spot the signs of domestic abuse in order to support women and girls

the specific needs of victims, including having access to trauma-informed services

how employers can do more to support victims of abuse - both in and out of the workplace

Our 10-year ambitions

Our ambitions are:

women and girls who are victims of violence and abuse are supported by the healthcare system and in the workplace, and the healthcare system takes an increased role in prevention, early identification and provision of support for victims. There is a wider acknowledgement and understanding that violence and abuse is a public health issue, as well as a criminal justice issue

there is greater awareness among the general population of healthcare services that can provide specialist treatment and support for victims of sexual violence and FGM, such as sexual assault referral centres and FGM clinics

the health and care system prioritises the prevention and reduction of violence against women and girls, and has an increased role in prevention, early intervention (including through identification of perpetrators), and supporting victims of violence and abuse. This includes targeted interventions to support those groups of women that are disproportionately affected by violence against women and girls, including victims of domestic abuse and violence

NHS services and staff are able to support victims of violence and abuse, and are well equipped with the knowledge and skills to identify and respond to victims and perpetrators. Health and care workers understand the impact of trauma and have the tools available to engage in trauma-informed practice

NHS and social care staff who are victims of violence against women and girls are better supported in the workplace, and are aware of how to access any support they may need. Health employers and colleagues feel well equipped to support fellow staff, and to implement evidence-based policies and other support

learnings and recommendations from the Domestic homicide review that relate to health organisations are taken forward, and embedded into the healthcare system at a national and local level

robust research is carried out to understand the immediate and long-term physical and mental implications of violence against women and girls, as well as the ways to prevent violence and abuse against women and girls

Actions we are taking

Tackling violence against women and girls is a top priority for the government, and we must have a zero-tolerance approach across all of society, including the healthcare system.

Supporting victims

As part of the government's Tackling violence against women and girls strategy, we committed to working with new ICSs, including work identifying potential perpetrators and supporting victims.

We committed to working with NHS England to review and build on their workforce policies to ensure safe, effective processes are in place to support staff affected by violence against women and girls, and other forms of violence and abuse, and that staff understand how these issues affect them as individuals and how to access any support they may need.

We also committed to exploring how victim support services for victims of sexual violence and domestic abuse can be enhanced. As a result, the Health and Care Act 2022 requires the joint forward plan for an integrated care board and its partners to set out any steps it proposes to take to address the particular needs of victims of abuse (including domestic abuse and sexual abuse, whether of children or adults).

We know that violence against women and girls disproportionally impacts some groups of women and, to combat this, NHS England will appoint a national clinical lead and a dedicated team to lead a programme on domestic and sexual abuse this year. We will also work with NHS England and other partners across the healthcare system to improve support for health and care staff affected by violence against women and girls.

NHS England is piloting health-led approaches to violence reduction with ICSs, focused on tackling broad issues such as:

By March 2023, we will be able to start assessing whether these health-led approaches are effective in improving outcomes for people who have experienced or who are at risk of violence.

We will publish a definition of trauma-informed practice for use in the health and social care sector, and will work to encourage its adoption. Trauma-informed practice means being sensitive to the trauma that service users may have experienced and actively seeking to prevent re-traumatisation. This can help to address some of the barriers those affected by trauma can experience when accessing the care and services they need. Publishing the definition will provide the health and social care sector with a consistent foundation on which to build trauma-informed practice into their services and systems. This is the first step towards improving the evidence base to better understand the impact of trauma-informed practice.

The call for evidence identified that awareness was very low of NHS services for victims of violence or abuse, such as sexual assault referral centres and FGM clinics. In February 2022, the NHS launched a 3-month campaign to raise awareness of sexual assault referral centres and will raise awareness of FGM among healthcare professionals who are involved in women's health screening services, so they know:

how to identify FGM

how to provide a sensitive service

where to refer women for expert services

We will work with the Women's Health Ambassador to consider what more we can do to raise awareness of existing support and work on trauma-informed practice.

The Ministry of Defence will launch a campaign based on the principles of the sexual assault referral centre campaign tailored to serving personnel, and families and staff. It will include a clear referral pathway for armed forces-serving personnel, veterans and their families into NHS sexual assault services.

In the Tackling Domestic Abuse Plan, the Home Office committed to investing up to £7.5 million into domestic abuse interventions in healthcare settings. This is important as the NHS is often the first point of contact for women who have experienced violence against women and girls. We have also committed to work with the NHS National Safeguarding Steering Group to embed meaningful learning and action with the healthcare system from recommendations in the domestic homicide reviews at a national and local level.

The Domestic Abuse Act 2021 will transform our response to victims and ensure perpetrators are brought to justice. It introduced a wide-ranging statutory definition of domestic abuse that incorporates a range of abuses beyond physical violence, including coercive or controlling behaviour, emotional and economic abuse. The Home Office has now published statutory guidance on domestic abuse to support the implementation of the definition.

Domestic abuse is an important public health issue that contributes to suicide. It is not just victims of abuse that appear to be at higher risk of suicide, but also children and young people who witness domestic abuse and are victims in their own right, and perpetrators themselves. We will look at the role that family hubs might play in supporting women and children affected by domestic abuse.

Parental substance misuse and conflict

We know there is a complex interrelationship between substance misuse and domestic abuse, though it is never an excuse or justification for perpetrating this heinous crime. Building on the perpetrator pillar of the Tackling Domestic Abuse Plan, we will work alongside the Home Office to ensure the health system continues to play an important role in the prevention, identification and support for victims and perpetrators of violence against women and girls.

Parental conflict is understood as conflicts that occur between parents or carers that are frequent, intense and poorly resolved, and can have negative impacts on children's welfare. Parental conflict is different from domestic abuse because there is not an imbalance of power, neither parent seeks to control the other, and neither parent is fearful of the other. Evidence suggests that, where parental substance misuse and parental conflict is not addressed, it can result in intergenerational patterns of harmful behaviours, including substance misuse and domestic abuse.

To improve outcomes for families affected by parental substance misuse and parental conflict, along with the Department for Work and Pensions, we have invested £7.2 million between 2018 to 2022 in the Children of Alcohol Dependent Parents programme. The programme contributes to meeting the health and social needs of women, and supporting the prevention of perpetrator behaviour. This is achieved by;

All local authorities can invest their funding from the 10-year drug strategy into interventions aimed at children and families over the next 3 years.

We will support work across government to share and embed learning from the independent national evaluation of the programme. We will also launch a national online resource hub, which will provide a single point of access for resources that have been developed through the programme, to support local authorities to develop services for families affected by parental substance misuse. We are also looking at the role that family hubs can play in supporting parents and families in accessing support and treatment for substance misuse.

Virginity testing and hymenoplasty

Virginity testing and hymenoplasty are both forms of violence against women and girls, and are harmful practices that stem from dangerous misconceptions about a woman's sexuality. Such practices will not be tolerated in the UK and we have banned them through the Health and Care Act 2022.

We have developed safeguarding guidance for agencies and those working on the frontline that will sit alongside the legislation. Banning these practices will only go so far in beginning to tackle the harmful misbeliefs that surround a woman's virginity, and we are developing an awareness-raising programme with the Department for Education, the Home Office and other key stakeholders.

We will consult later this year on the need for protection orders for virginity testing and hymenoplasty.

Research, evidence and data

The NIHR has launched a research call to understand what interventions prevent male violence against women and girls, and what are the resulting health impacts. This will help us understand what works to prevent male violence against women and girls, which will support us in tackling the root causes of violence against women and girls.

The government, through UKRI, has funded the Violence, Abuse and Mental Health Network, which aims to understand, prevent and reduce the impact of violence and abuse on mental health. The network is looking at women's mental health, and differences between men and women in experiences of multiple traumas and mental health problems.

The National Drug Treatment Monitoring System data helps drug and alcohol treatment demonstrate the outcomes it achieves. The new data items introduced in April 2022 will record information where domestic abuse victimisation or perpetration has been identified, and help to monitor where appropriate action and support is offered, both to the victims of domestic abuse and to perpetrators.

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. For the health impacts of violence against women and girls, these areas included:

the impact of health disparities and violence against women and girls across the life course

data collection on sex-based violence and links across the patient journey

17. Healthy ageing and long-term conditions

What we've heard

In the call for evidence public survey, healthy ageing was the ninth most popular topic for consideration in the strategy (23%). Many respondents also called for the strategy to cover specific long-term conditions including neurodiversity (10%), MSK conditions (8%), heart disease and stroke (7%), and neurological conditions (7%).

In the written submissions, organisations raised concerns that the healthcare system doesn't focus enough on older women's healthcare needs and experiences. We heard about the importance of health promotion activities and there was a desire to keep women more informed about how to ensure better physical health into older age.

In the call for evidence, we heard examples of general health conditions for which respondents and organisations thought that the services could be improved, including:

MSK conditions such as osteoporosis

heart disease and stroke

diabetes

dementia

vitamin deficiencies

neurodiversity

Some of these conditions can present differently in women compared with men, meaning women can face additional barriers to referral and diagnosis in these areas - particularly as diagnostic tests are often based on research largely done on male samples. Both members of the public and organisations suggested further research and improved data collection on health conditions that may affect men and women differently. This was seen as important for better diagnosis and treatment to help women manage their conditions.

Long-term conditions

Long-term conditions - or chronic conditions - are conditions for which there is currently no cure, and which are managed with drugs and other treatment. These include conditions such as:

cardiovascular disease

diabetes

arthritis

osteoporosis

Our 10-year ambitions

Our ambitions are:

women's healthy life expectancy is improved, and the gap between the most and least-deprived areas is closed. Disparities among different groups of women are reduced, with the ambition that everyone has 5 extra years of healthy life expectancy by 2035

women are better supported to maintain good health throughout their lives, and have the information and support they need to make healthier choices. Women are well informed on potential health risks in later life including long term conditions, as well as women's health issues such as breast cancer and menopause

healthcare strategies, policies and programmes for long-term health conditions and disabilities consider any women-specific issues by default, and take a life course approach to women's health, considering wider determinants of health

healthcare professionals are well informed, via undergraduate and postgraduate education and further training, about differences between women and men in risk factors, presentation and treatment for long-term health conditions and disabilities

there is increased participation of women in research into long-term conditions and disabilities, and research into sex-based differences in general health conditions. There is routine disaggregation of health data by sex and other demographic characteristics

women have improved experiences and outcomes with MSK conditions that disproportionately affect women, such as osteoporosis and fragility fractures. There will be a greater focus on identifying those at particular risk, and on both primary and secondary prevention, thereby addressing the treatment 'gap' that exists currently

women are well informed about cardiovascular risk factors and how to maintain cardiovascular health across the life course. Women with cardiovascular disease have improved care and outcomes aligned with the NHS Long Term Plan ambitions for enhanced diagnostic support in the community, better personalised planning and increasing access to cardiac rehabilitation

greater numbers of women are participating in dementia research, in addition to other previously under-represented groups. There is improved awareness of dementia risk factors and experiences of care for all people with dementia including women

Actions we are taking

Maintaining good health

We are working to narrow the gap in healthy life expectancy between local areas where it is highest and lowest by 2030, and to increase healthy life expectancy overall. The Levelling up the United Kingdom white paper reaffirms the government's existing commitment for 5 extra years of healthy life by 2035.

We will work with the Women's Health Ambassador to raise awareness of risk factors for long-term conditions and cancers, and the links with women's health issues across the life course. For example, we know that women with PCOS are at higher risk of developing type 2 diabetes and cardiovascular disease, and that alcohol consumption and obesity are risk factors for breast cancer.

We are already taking action in a number of these areas to support women to maintain their health across the life course.

Physical activity

It is important that we address differences in physical activity across the life course between men and women, and between groups of women, as this helps guard against bone density loss, which lowers the risk of fractures and osteoporosis, and can also reduce the rate of decline in mobility, strength, dexterity and cognition.

We provide free apps to promote physical activity such as Couch to 5K and Active 10. There have been over 5 million downloads of the Couch to 5K app, and more women than men download these apps. The Sport England This Girl Can campaign has also inspired millions of women to take action, return to or increase their levels of physical activity.

Women will be a target group in a £3 million national 'reconditioning programme'. The programme has been established to support older people to build up strength and resume some of the activities they used to do before the COVID-19 pandemic. The programme will be trialled locally through local authorities and ICSs. This work will reduce falls and health and social care need among the older adult population, and improve our understanding of which interventions are most effective.

The Health Promotion Taskforce has also been established to drive a cross-government effort to improve the nation's health. The taskforce will identify opportunities to take action across government to improve health and reduce health disparities.

Obesity

In 2019, 67% of men and 62% of women were classed as overweight or obese. However, obesity (including morbid obesity) was more common in women (29%) than men (26%).

We are implementing initiatives to support people living with excess weight and obesity to lose weight and maintain healthier lifestyles.

The adult weight management services grant invested £30.5 million in local authorities in England who accepted the grant to provide additional behavioural weight management services in 2021 to 2022.

The NHS Weight Loss Plan app works to support users to start healthier eating habits, be more active and start losing weight, and tends to have more women users than men.

Smoking

In 2019, the government set the bold ambition for England to be smoke-free by 2030 - reducing smoking rates to 5% or less.

On 9 June 2022, Dr Javed Khan OBE published his independent review on smoke-free 2030, providing the government with a wide range of recommendations for how we can achieve this ambition. The government will now carefully consider the recommendations set out in this review.

Smoking during pregnancy increases the risk of stillbirth, miscarriage and sudden infant death, while babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. Smoking in pregnancy remains prevalent, as 9.6% of mothers were smokers at the time of delivery in 2020 to 2021. While progress has been made, this figure masks significant disparities, with prevalence ranging from 1.8% in Kensington to 21.4% in Blackpool. We are working closely with NHS England on the Long Term Plan commitment to embed stop smoking services within maternity services.

Dementia

It is estimated that 65% of people living with dementia are women. According to ONS data, in 2020 the leading cause of death for females in England was dementia and Alzheimer's disease.

It is important that we understand the risk factors for dementia. While there is no certain way to prevent all types of dementia, there is good evidence that a healthy lifestyle can help reduce the risk of developing dementia.

It is also important that we consider the impact of sex, geography and ethnicity on dementia risk factors, diagnosis and research.

Long-term conditions

Prevention is not always possible, so early diagnosis and appropriate management of long-term conditions is key to ensuring good outcomes.

Musculoskeletal conditions

We are addressing both the prevalence and disparities in MSK conditions such as osteoarthritis, back pain, inflammatory arthritis and osteoporosis. MSK conditions are more common in women, affecting 35% of women and 28% of men, and prevalence is higher in areas experiencing higher levels of deprivation.

Supporting women to be active, maintain a healthy weight and not smoke will help to keep muscles and bones healthy. Vitamin D is needed to keep muscles and bones healthy, and maintaining a good vitamin D status throughout life may help to reduce the risk of MSK conditions. We recently held a vitamin D call for evidence to seek views on how to improve the vitamin D status of the population in England and reduce disparities.

To help ensure that women at risk of fragility fracture receive appropriate care to help live healthier lives for longer, the quality and outcomes framework will continue to incentivise general practices to improve the quality care of care they provide to patients. This is done by requiring the GP to maintain a register of those with a confirmed diagnosis of osteoporosis and a fragility fracture in the age groups 50 to 75 and 75 and over.

NICE recently recommended the first new osteoporosis drug treatment of its kind for over a decade, romosozumab, which has been shown to be effective in preventing fractures in postmenopausal women with severe osteoporosis - those who had had a major osteoporotic fracture in the last 24 months. This is set to potentially benefit thousands of women.

Cardiovascular disease

We are working to reduce the incidence of cardiovascular disease ( CVD) and to ensure women do not delay accessing care.

The NHS Long Term Plan sets out the ambition to prevent 150,000 heart attacks, strokes and cases of dementia. CVD is a condition that impacts both men and women, but is not always perceived to be a condition that also affects women, and where there has been less research on the sex-based differences on presentation, diagnosis and treatment. NHS campaigns such as Help Us Help You target female audiences to ensure women do not delay accessing care.

The 2021 NHS Health Check Programme review found that the programme is achieving its objectives and that women are more likely than men to attend a check, but it could go further to improve its impact. We are implementing recommendations from the review and supporting local areas to recover this service, after it was largely suspended due to the COVID-19 pandemic.

In addition, the NHS community pharmacy blood pressure checks service, introduced in October 2021, creates wider access to blood pressure monitoring closer to home in an informal environment that some women may find easier to access.

Diabetes

We want to better understand how diabetes affects men and women differently. While diabetes is more prevalent in men than women, there are specific risks during pregnancy, including pre-eclampsia and caesarean section in mothers, and congenital anomaly and neonatal intensive care admission in infants. To address this, NHS England is offering continuous glucose monitoring to pregnant women with type 1 diabetes.

Research and evidence

We recognise there is a gap in our systematic understanding of where there are disparities between men and women in general health conditions and disabilities that are not specific to women - for example, MSK conditions or dementia - and how these interact with other demographic characteristics. The previous section '9. Research and evidence' sets out our plans for addressing gaps in research and evidence.

We will also look for ways to encourage research into those areas identified through the call for evidence written submissions analysis as suggested areas for further research. For healthy ageing and long-term conditions, these areas included:

women's lifelong health needs and risks, in childbearing years and as they age

the efficacy of workplace adaptations that support women, with particular consideration for long-term conditions

the causes and management of MSK conditions

coronary heart disease in women

the impact of menstruation and menopause on multiple sclerosis

18. Implementation and monitoring progress

This strategy sets out our ambitions for improving the health and wellbeing of women and girls in England over the next 10 years, and the actions we are taking now.

Implementation

We are incredibly grateful for the support that we have received from a huge range of individuals and organisations during the call for evidence, and the development of the vision and strategy. This same spirit of collaboration will be just as important throughout implementation.

The Department of Health and Social Care and our ALBs, other government departments and agencies, commissioners and providers of health and care services, professional bodies, research institutions, employers, industry, the voluntary sector and every individual - including men and boys - all have a role to play in helping us realise our ambition to improve the health of women and girls in England.

For many areas, central government will not be the delivery body or may not be able to reach some groups of women and girls as effectively as others can. We are committed to working in partnership with others so that delivery happens at the right level and is led by the right organisations or people.

The Women's Health Ambassador and the Deputy Women's Health Ambassador will lead engagement with women and other key stakeholders, including regional engagement with system leaders. This will begin to address gaps in insight from the call for evidence by hearing from healthcare professionals and groups of women whose voices were not as well represented in the call for evidence. This will also help us to identify where we can work collaboratively with stakeholders - such as the voluntary sector, industry and others - to deliver the ambitions and actions set out in the strategy.

We will continue to engage over the life of the strategy to ensure that our policy development and programmes of work remain informed by insight from women's experiences.

We will also continue to use the findings from the call for evidence to inform current and future work through the strategy to improve women's health and reduce disparities.

Monitoring progress

To ensure we can monitor the effectiveness of this work, we will develop a delivery plan for the commitments set out in this strategy.

The delivery plan will be underpinned by an implementation framework.

Implementation framework

The implementation framework will set out our:

Text alternative to implementation framework diagram

The diagram shows a flow chart setting out:

1. Ambition - what do we want to achieve?

2. Targets - what is the specific goal or goals? How will we measure if we have achieved these?

3. Actions and policies - what actions will we take to meet our short and long-term targets?

4. Trajectories and milestones - what path do we need to be on, and what milestones need to be achieved by who and by when?

5. Review and evaluation -- how will we capture knowledge and implement lessons learnt as we progress?

This framework will enable us to:

To support work to develop this framework and our delivery plan, we will first undertake a data-mapping exercise to identify what data we collect that can be used to monitor success and where there are gaps.

Governance

The implementation of this strategy will be overseen by a cross-government delivery board reporting to ministers at the Department of Health and Social Care.

Reporting on progress

Much of the change we want to see will take place over the long term and may also be subject to new funding opportunities.

We also need the Women's Health Ambassador to have enough time to reach the many groups of women and girls and other key stakeholders to understand their issues, and to develop partnerships to deliver change. Equally, we also want to maintain momentum.

The government will therefore aim to publish a report on progress in delivering our commitments and the outcomes achieved in 3 years.

Longer-term plans

The specific actions to which we are committing in this document represent significant progress, and lay the foundations for sustained improvements in the health of women and girls. In many cases, they will take time to show progress and will not in themselves deliver all of our ambitions.

Our intention is therefore for the strategy to not just be a moment in time. We have made our ambitions long term in nature and would like to see them delivered over the course of the next decade. This will require investment and concerted action over the life of the 10-year strategy.

In other areas, we need to first work to fill gaps in the evidence - for example, improving our understanding of where there are the greatest disparities between men and women for general health conditions - so that we can target future action to where it will have the most impact.

Through the engagement led by the Women's Health Ambassador, we may also identify additional priority areas for action.

We will therefore continue to invest in new programmes of work to improve women's health throughout the life of the strategy as new funding opportunities arise. This will enable us to build on the actions that we have set out in this document.

Glossary

This glossary contains a brief definition of key terms and acronyms referenced in the strategy, including medical conditions and treatments, which some readers may be less familiar with. The definitions are correct at time of publication.

Breast cancer

Breast cancer is the most common type of cancer in the UK. Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer.

Hymenoplasty

Hymenoplasty is a surgical intervention that involves reconstructing the hymen. It is usually performed with the aim of ensuring the women bleeds when she next has sexual intercourse. Hymenoplasty is a harmful practice that stems from dangerous misconceptions about a woman's sexuality and was banned in the UK through the Health and Care Act 2022.

Expert panel on hymenoplasty and Health and Care Act 2022

Menopause

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally. The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's ovaries stop releasing eggs and then the woman's oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51.

Menstruation

See definition for periods.

See definition for periods.

Obesity

The term 'obese' describes a person who's very overweight, with a lot of body fat. It's a common problem in the UK that's estimated to affect around 1 in every 4 adults. It's very important to take steps to tackle obesity because, as well as causing obvious physical changes, it can lead to a number of serious and potentially life-threatening conditions.

Polycystic Ovary Syndrome (PCOS)

PCOS is a common condition that affects how a woman's ovaries work. PCOS cannot be cured, but the symptoms can be managed. To be diagnosed with PCOS, women have 2 out of the 3 main features which are: irregular periods, excess androgen - high levels of 'male' hormones in the body, and a polycystic appearance of the ovaries - where ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs.

Premature ovarian insufficiency (POI)

POI occurs in women under the age of 40, when their ovaries no longer produce normal amounts of oestrogen and therefore may not produce eggs. This means that their periods stop (or become irregular) and they may experience symptoms of the menopause.

Relationships, sex and health education (RSHE)

It is a statutory requirement for schools in England to teach relationships or relationships and sex education ( RSE) and health education - sometimes abbreviated as ' RSHE '.

PSHE Association and Relationships and sex education (RSE) and health education statutory guidance

Virginity testing

Virginity testing is the examination of the female genitalia, with or without consent, for the purpose, or purported purpose, of determining virginity. Virginity testing is a harmful practice that stems from dangerous misconceptions about a woman's sexuality and was banned in the UK through the Health and Care Act 2022.

Health and Care Bill: banning virginity testing and Health and Care Act 2022

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Presented to Parliament by the Secretary of State for Health and Social Care. 30 August 2022 CP 736 ISBN 978-1-5286-3665-0 Note: this is an updated version of the Women's Health Strategy for England. The previous version was laid in July 2022 and withdrawn August 2022.

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Specially trained GPs with an interest in women's health will be launching the service at Nimbuscare's Acomb Garth Community Care Centre on Monday, March 6.

It will be available to anyone from Nimbuscare's 11 GP member practices in York following a referral from their GP.

The service will be overseen by a consultant in sexual and reproductive health and community gynaecology.

It will initially take place on Monday and Thursday mornings, from 9am to 1pm.

Dr Melanie Fritter, who is leading the service said: "This is a new and much needed menopause service for York patients, we're so pleased to have collaborated across the city to make this possible.

"We have some amazing, well qualified GPs in this field and it's fantastic to be working closely with them to develop this service here in York, and with the Women's Health Strategy published last year, it seems like the perfect time to develop this locality based community service."

The clinic will provide specialist care for patients with more complex menopause related issues, including women who have problems with hormone replacement therapy (HRT), and premature ovarian insufficiency.

York woman Helen Booth, 46, said she welcomes the new service following the support she receieved by York GP Dr Kathy Bill.

Helen suffered from period problems, night sweats and a lack of sleep.

She said: "I was really struggling so I rang the doctors. One evening Dr Bill, who was working as part of the Nimbuscare team, phoned me.

"She was really lovely. There's nothing worse than waking up every morning feeling like you've had no sleep. She was a God-send and the patches and tablets she prescribed for me have made such a massive difference.

"I've shared on social media and talked to friends - we really need this service to help more people like me who are struggling with their symptoms."

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York's first menopause specialist care service to launch

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Specially trained GPs with an interest in women's health will be launching the service at Nimbuscare's Acomb Garth Community Care Centre on Monday, March 6. It will be available to anyone from Nimbuscare's 11 GP member practices in York following a referral from their GP.

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Read the results of our survey looking at the experiences of people receiving maternity services.

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There are five gynaecological cancers - womb, ovarian, cervical, vulval and vaginal - but awareness levels of these cancers is very low.

Each year in the UK, over 22,000 women are diagnosed with a gynaecological cancer. This means 60 people receive this life-changing news each and every day. Sadly, 21 of these women die a day from their gynaecological cancer.

That's far too many mothers, wives, daughters, partners and friends in our opinion, and at The Eve Appeal we're determined to change this. Part of our mission is to ensure that everyone is aware of what to look out for, because recognising gynaecological cancer symptoms can mean an earlier diagnosis and a better outcome.

To find out more about each of the five gynaecological cancers please see our dedicated pages below.

Research shows that surveillance of women at high risk of ovarian cancer would provide benefit.

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Gynaecological Cancers | Symptoms of cancer in women | The Eve Appeal

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There are five gynaecological cancers - womb, ovarian, cervical, vulval and vaginal - but awareness levels of these cancers is very low. Each year in the UK, over 22,000 women are diagnosed with a gynaecological cancer. This means 60 people receive this life-changing news each and every day.

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Healthwatch England: Women are disproportionally affected by costs of living 

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Healthwatch England: Women are disproportionally affected by costs of living 

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The findings also suggest women are disproportionally affected by spiralling costs compared to men and more have taken action to cut back on:

Heating, which 42% of women have not turned on when they usually would, compared to 33% of men;

Food, which 27% of women say they have bought less of, because of the increased cost, compared to 20% of men; and

Energy costs in general, with 33% of women saying they have turned off or avoided using essential appliances to save energy costs, compared to 25% of men.

Cost of living: People are increasingly avoiding NHS appointments and prescriptions | Healthwatch

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Cost of living: People are increasingly avoiding NHS appointments and prescriptions

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Our new data shows a worrying increase in the number of people avoiding vital care. We’re calling for urgent action from government and health and care services to ensure rising costs are not a barrier to healthcare.