Women’s equality in the UK – A health check

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12.16 12.17 12.18 also face barriers getting childcare to attend appointments. 32 BMER women are less likely to receive appropriate and useful information about services and experience less continuity of care as a result. 33 Another barrier to accessing care is some health professionals’ lack of cultural competence and effective engagement in terms of responding to the health needs of BMER communities. For example, a lack of competence can include making cultural assumptions or being over sensitive about culture which can lead to professionals not knowing how to intervene appropriately or not intervening at all. Women may also find it difficult to disclose some health problems, for example those associated with female genital mutilation (FGM) , due to fears of being judged and embarrassment. 34 (See Appendix: 33) The health consequences of forced marriage have also not been adequately addressed. Women and girls may experience self-harm, panic attacks, depression, psychosis and trauma and where there are gaps in responses this can result in an exacerbation of perceived or hidden mental health needs and issues. Health professionals have been identified as being less engaged with forced marriage yet should play a key role in identifying girls at risk. The recently published review of multi-agency guidelines found that “health services do not engage or work proactively to ensure staff are able to identify cases of forced marriage”. 35 (See Appendix: 29) Recommendations: • Healthcare professional communication training should include cultural awareness skills and diversity issues including better signposting to services for women from BME groups. Statutory and voluntary sector service providers should also consult with women from BME groups regarding future service developments • Through work with its voluntary sector Strategic Partners, the Department of Health should ensure that any inequalities and barriers that women experience in accessing healthcare should be monitored and reviewed to include good and bad practice. The data should then be communicated to local Health and Wellbeing Boards to encourage shared learning and promote good practice Asylum seeking women and women with irregular status For some years mainstream research and policy has recognised ethnicity as a key element of social inequality, and there have been increasing (and welcome) interventions to address ethnic inequalities in most areas of social policy including health. However, changes in patterns of immigration and immigration policies have created many different types of migrants who have differing health needs and differing entitlements to access healthcare that are not simply reducible to their ethnicity. 36 32. ‘Engaging and Influencing the New Health Landscape; An event for the women’s voluntary and community sector in Bristol’, Friday 20th March 2012 http://www.whec.org.uk/wordpress/wp-content/uploads/downloads/2012/05/Report-from-WHEC-Bristol-event-30- March-2012.pdf see also Women’s Health and Equality Consortium (2011) Why women’s health? WHEC: London http://www.whec.org.uk/ wordpress/wp-content/uploads/downloads/2011/11/WhyWomensHealth11.pdf 33. Bharj, K et al. (2008) Addressing ethnic inequalities in maternity service experiences and outcomes: Responding to women’s needs and preferences. Race Equality Foundation: London http://www.raceequalityfoundation.org.uk/publications/downloads/addressing-ethnicinequalities-maternity-service-experiences-and-outcomes-res 34. FORWARD (2009) FGM is Always with Us: Experiences, Perceptions and Beliefs of Women Affected by Female Genital Mutilation in London. FORWARD: London http://www.forwarduk.org.uk/news/news/563 35. Forced Marriage Unit (2012) Report on the Implementation of the Multi-Agency Statutory Guidance for Dealing with Forced Marriage (2008). Foreign and Commonwealth Office and Home Office: London https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/136371/Guidance_for_dealing_with_forced_marriage_A4_v1.6_WEB.PDF 36. Maternity Action (2012) Guidance for Commissioning Health Services for Vulnerable Migrant Women. WHEC: London http://www. maternityaction.org.uk/sitebuildercontent/sitebuilderfiles/guidancecommissioninghealthservvulnmigrantwomen2012.pdf 114 Women’s equality in the UK: CEDAW shadow report 2013
12.19 12.20 12.21 12.22 Barriers to accessing care for irregular migrants and those with uncertain immigration status (including visa overstayers, 37 refused asylum seekers, victims of trafficking and women on dependant visas escaping domestic violence) are common. According to current rules governing access to healthcare these categories are not entitled to some services, for instance free hospital care, except for emergency care or treatment for HIV. Such restrictions on access mean that there is currently a stratification of rights to healthcare in the UK. 38 There is evidence of poor antenatal care and pregnancy outcomes (asylum seeker and refugee women make up only 0.03% of the population but 12% of all maternal deaths 39 ) and low uptake of preventative healthcare measures concerning breast and cervical cancer. 40 Research has shown that compared to white women born in the UK, BME women born outside the UK had poorer information provision and were less likely to be treated with respect by staff. 41 The UKBA policy of dispersal to cities across the UK on the basis of accommodation availability also impacts on the continuity of care for pregnant asylum seekers. It may increase health risks and undermines the NHS’ strategic focus on improving health outcomes for women and babies. 42 (See Article 9 and Appendix: 7 for further information) Lesbian and bisexual women’s health Lesbian and bisexual (LB) women report high levels of dissatisfaction with the health system and discrimination by healthcare professionals. They face barriers to accessing breast screening and have higher rates of breast cancer. 43 They also face barriers to appropriate sexual health services and being open about their sexual orientation with GPs. 44 LB women have higher incidents of alcohol use and report higher rates of depression, anxiety, as well as self-harm, eating disorders, suicide and suicidal thoughts. 45 There is a continued lack of appropriate health services and discrimination in existing services for LB women. In the first instance it is difficult to find out if LB women are subject to any greater risk of particular health conditions in comparison to other groups because the information is not collected or collated centrally. There is also a need to identify and target specific health measures for LB women in order to ensure improved physical and mental health in the longer term. 46 Stonewall found that only 2% of LB women had attended a service tailored towards their needs. Staff are also often not trained adequately which can lead to confusion, stress and discrimination. 47 Specifically tailored health services are needed to meet LB women’s needs 37. International migrants who remain resident in a country after their legal permission to stay (‘leave to remain’) has expired. 38. Jayaweera, H. (2011) Briefings: Health of Migrants in the UK: What do we know? The Migration Observatory at the University of Oxford http:// migrationobservatory.ox.ac.uk/briefings/health-migrants-uk-what-do-we-know 39. Lewis, G. (2007) Saving mothers lives: Reviewing maternal deaths to make motherhood safer 2003-2005. The seventh report on confidential enquires into maternal deaths in the UK. The Confidential Enquiry into maternal and child health (CEMACH): London http:// www.publichealth.hscni.net/sites/default/files/Saving%20Mothers%27%20Lives%202003-05%20.pdf 40. Aspinall, P. and Watters, C. (2010) Research Report 52: Refugees and asylum seekers: A review from an equality and human rights perspective. EHRC: Manchester http://www.equalityhumanrights.com/uploaded_files/research/refugees_and_asylum_seekers_research_ report.pdf 41. Redshaw, M. and Heikilla, K. (2010) Delivered with care: A national survey of women’s experiences of maternity care in 2010. National Perinatal Epidemiology Unit https://www.npeu.ox.ac.uk/files/downloads/reports/Maternity-Survey-Report-2010.pdf 42. Department of Health (2010) NHS Outcomes Framework for 2011/12. https://www.gov.uk/government/publications/nhs-outcomesframework-2011-to-2012 43. Breast Cancer Care (2011) Breast Cancer and inequalities: A review of the evidence http://www.breastcancercare.org.uk/campaigningvolunteering/policy/breast-cancer-inequalities 44. Hunt, R. and Dr. Fish, J. (2008) Prescription for Change: Lesbian and bisexual women’s health check. Stonewall: London http://www. stonewall.org.uk/documents/prescription_for_change.pdf 45. Hunt, R. and Dr. Fish, J. (2008) Prescription for Change: Lesbian and bisexual women’s health check. Stonewall: London http://www. stonewall.org.uk/documents/prescription_for_change.pdf 46. Women’s Resource Centre (2010) In All Our Colours: Lesbian, bisexual and trans women’s services in the UK. WRC: London http:// thewomensresourcecentre.org.uk/wp-content/uploads/IAOC.pdf 47. Women’s Resource Centre (2010) In All Our Colours: Lesbian, bisexual and trans women’s services in the UK. Briefing 10: LBT women and health. WRC: London Women’s equality in the UK: CEDAW shadow report 2013 115
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Women’s equality in the UK - A he
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Women’s equality in the UK - A he
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Appendices (online only) Appendix 1
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• the continued discrimination ag
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• Develop a common model of analy
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Article 9 - Nationality: One third
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investment in social infrastructure
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and increase the marginalisation of
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have been no prosecutions in Englan
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1 2 3 4 5 Introduction This is a Un
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10 11 12 13 housing crisis, a ‘lo
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1.1 1.2 1.3 Article 1 - Overarching
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1.7 1.8 1.9 1.10 1.11 1.12 Women’
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1.17 1.18 1.19 Young women We are a
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2.4 2.5 2.6 2.7 consult to “remov
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2.12 2.13 discrimination”. Howeve
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2.17 2.18 2.19 2.20 2.21 worsen gen
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2.26 2.27 2.28 2.29 CEDAW and the l
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3.7 3.8 3.9 3.10 would “increase
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3.15 3.16 3.17 and accountable EHRC
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3.22 3.23 3.24 report is was partic
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classes, migrants, and Gypsy, Trave
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the institutional discrimination an
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5.5 5.6 5.7 Case study: 8 Sandra li
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5.12 5.13 5.14 issue. A more approp
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6.1 6.2 6.3 6.4 Article 6 - Exploit
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6.9 6.10 6.11 to the protection and
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6.15 6.16 6.17 6.18 Office’s own
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6.24 6.25 6.26 women and increase t
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6.31 6.32 6.33 6.34 infrequent lap
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7.1 7.2 Article 7 - Political and p
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16.21 16.22 frequently women’s ac
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Recommendations: • Parents with c
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19.6 19.7 19.8 as well as for our c
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19.13 19.14 19.15 19.16 The Governm
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19.22 19.23 19.24 19.25 VAWG is a c
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19.30 19.31 19.32 19.33 DV is still
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19.38 19.39 19.40 perpetrators thro
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19.43 19.44 19.45 Support for victi
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19.49 19.50 19.51 19.52 Recommendat
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19.57 19.58 19.59 19.60 BMER VAWG p
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19.62 19.63 19.64 19.65 VAWG in hea
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19.70 19.71 19.72 Invisibility of s
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19.77 19.78 19.79 A number of repor
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19.85 19.86 means more provision. T
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Annex 1: The Devolved Administratio
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to 41.8% of rural men. 16 Rural are
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Annex 2: The UK’s relationship wi
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Annex 3: UK reservations and declar
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ESA - Employment and Support Allowa
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Annex 5: Acknowledgements Many than
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Women’s Resource Centre is suppor
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