Mind the gap: how our healthcare system fails women

Women have been underrepresented and underserved in UK healthcare for decades.  Women’s healthcare in the UK lags behind France, Germany, the USA, Australia and New Zealand (2021 Hologic Global Women’s Health Index). Women often struggle to access care, including cancer screening, diagnosis of causes of pain and mental health support.   

Areas of particular concern are pulmonary and cardiovascular disease.Women are more likely to die from coronary heart disease, although men are more likely to have a heart attack. As women present different symptoms than the more well-known male presentations, they go longer without treatment. Early-stage exclusions in medical trials create knowledge gaps that lead to large discrepancies in treatment. 

These blind spots leave plenty of room for burgeoning women’s health research. At Imperial, researchers are studying the sex differences in cardiovascular, pulmonary, reproductive and degenerative diseases to learn more about how women and other groups present differently.  

Some of this research was showcased this May at the Great Exhibition Road Festival, where the ‘Wonder Women’ stand was set up by the Imperial Women’s Health Network. ‘Wonder Women’ shared the wonders of the female body and created conversations about less often discussed topics including female anatomy and the vaginal microbiome.  

The stand was staffed by scientists, midwives and clinicians who shared knowledge and engaged with visitors from all age groups through interactive activities including teaching about the female anatomy using felt structures, microbiome making using slime and beans, and a microbiome memory match game.  

The stall’s celebration of women’s bodies casts light on the ongoing research in women’s health, but change is slow and our healthcare is still in crisis – so what can and should the future look like? 

As a Professor of Neonatal Medicine at Imperial and the current president of the UK Medical Women’s Federation, Neena Modi can help explain the problem. Professor Modi has dedicated much of her career to addressing health inequalities, emphasising how “it’s not just women, there are many other groups” that go underserved in healthcare.   

According to Professor Modi, the added expense of increasing samples sizes for clinical trials disincentivises progress, despite there being multiple ways to include more women in research. For example, enrollment caps can be added to trials, which limit homogeneity in the sample size by shifting the focus to other racial, ethnic and gender groups to ensure diversity and balance. Other means include using social media and women-focused groups to facilitate awareness of clinical trials and improve recruitment.   

Yet risks of pregnancy and hormonal differences are continually perceived as operational, financial and legal challenges, ensuring women are not represented in clinical trials. This missing representation is an early-stage barrier that has trickle-down effects, leading to the poor state of women’s health as conditions aren’t understood from a sex difference perspective. Such deprioritisation is also seen further down the line in wait times, where gynaecology waiting times have tripled over the last decade. It’s no coincidence that wait times increased the fastest for the specialty solely responsible for women’s care, but rather a symptom of continual deprioritisation. 

To tackle these issues, we need a globally synchronised effort. Modi says, “there has to be an international component to it…it’s difficult but it can be done”. The global covid vaccine was an example of what can be achieved under pressure and international effort.  

Research is most successful when it is collaborative across institutions and nations. Yet even during covid vaccine trials, pregnant and lactating women were excluded, which led to many refusing the vaccine. Modi comments that “there was no reason to exclude pregnant and lactating women from those trials…it was a case of they weren’t asking the right questions”.   

But what are the right questions? They’re the ones that seek to include rather than exclude, challenge the paternalistic roots of medical care and rewrite some of the medical assumptions we’ve grown all too familiar with. Until then, women will suffer in a health service not designed for them.  

Image credit: Emma Tegg