In Her Head is a Herald campaign for better health services. Health reporter Emma Russell women's investigates what's wrong with our system and talks to wāhine who have been made to feel their serious illness is a figment of their imagination or "just part of being a woman". Today:
In Her Head: Women's health strategies in NZ behind other countries
Wāhine have been made to feel their serious illness is a figment of their imagination or "just part of being a woman". Graphic / Paul Slater
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The announcement came after more than a decade of governments – led by both National and Labour - ignoring pleas from advocates to better our women's health services.
Advocates and experts working in the sector say progress in four countries, often regarded as benchmarks for our health system, shows New Zealand has a long way to go.
Scotland
Scotland's Women's Health Minister Marree Todd last year said she wanted her country to become a "world leader" in addressing women's health inequalities.
Todd introduced a plan, last year, with recommendations for better endometriosis diagnosis and treatment, and specialist menopause services.
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The strategy would drive wider change across health and social care services because "when women and girls are supported to lead healthy lives and fulfil their potential the whole of society benefits," Todd told the BBC in August.
"The reality is we live in a man's world and when we look at systems of all sorts around the world we see inequality for women ... we have listened to what women are telling us and we are determined to correct that."
Scotland's plan, which was drafted with input from the real-life experiences of women, sets out 66 actions.
They include:
• Appointing a women's health lead in every NHS board.
• Establishing a women's health research fund and providing a central platform for information on NHS Inform.
• Commissioning endometriosis research to develop better treatment, management and find a cure.
• Developing a menopause and menstrual health workplace policy and promoting it across the public, private and third sector.
England/UK
In the UK, specialised endometriosis centres started to be set up in 2006. Now, the UK Government is committing to getting the diagnosis of endometriosis down to one year by 2030. In New Zealand, it takes on average 8.7 years.
The UK Government is also working its own women's health strategy for England.
"There is strong evidence of the need for greater focus on women's health and to recognise and act on the inequalities," UK Department of Health and Social Care officials state on its website.
They said on average women in the UK spent a quarter of their lives in ill health and disability compared with about one fifth for men.
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"We want to understand more about issues that only affect women (for example, gynaecological conditions or menstrual health), and also issues that affect both men and women but may be more prevalent in women, or affect men and women differently."
Australia
In 2019, Australian Minister for Health and Aged Care Greg Hunt said in his Government's National Women's Health Strategy 2020-2030; "Recognising and responding to differences in health outcomes - between women and men and between different groups of women and girls within our population, must be an ongoing focus of our efforts."
Hunt said enabling women and girls to have access to support for their particular health needs would help to improve the health of Australia's nation.
"It recognises that women have both general population and specific health needs."
In March, Australia Prime Minister Scott Morrison announced A$16.4 million (NZ$18.1m) towards establishing specialised endometriosis and pelvic pain clinics in every state and territory to improve diagnosis, care and treatment for over 800,000 Australian women with the disease. A endometriosis research programme has also been set up in Australia.
Canada
In Canada, a women's health strategy was established in 1999 to show commitment to the obligations set out in the United Nations World Conference on Women Action for Equality, Development and Peace 1995. It promised to create health systems which "accord women and men equal treatment".
Canada's Women's Health Strategy requires that gender considerations are integrated into all policies and programmes through the application of GBA (gender-based analysis) in the formulation and evaluation of all government policies.
Back in New Zealand
The most recent attempt for change in New Zealand began more than a year ago, in April 2021.
Advocacy group The Gender Justice Collective (GJC) handed in a 2873-signature petition that was backed by specialists, academics and women across the country asking for a gender lens to be applied to all policies relating to health.
That turned into a submission to Parliament's health select committee, a cross-party group of MPs whose role it is to examine public proposals and consider bills relating to health, before sending recommendations to health ministers.
Specialists and advocates of women's health argued there was no better time than now to introduce the strategy amid the country's massive health system restructure - trading in the DHBs for a national body.
In the GJC submission, Dr Anna-Marie Van der Merwe, an obstetrician and gynaecologist at Counties Manukau DHB, asked policy makers to seize the moment; "There is a real opportunity with the restructuring of the New Zealand health system to ensure cohesive, evidence-based care is delivered to all women."
The GJC report said: "There are many health issues which are unique to women, wāhine, non-binary, trans and intersex people. And yet, the health system continues to rely on data from studies done on men as if they apply to women also."
"Without an overarching, strategic approach for women's health, these negative outcomes will only continue," the group warned.
The GJC's proposed strategy included changes to improve treatment of endometriosis, birth care, gynaecological cancers, and to create better access to maternal mental health and contraception.
The group suggested to the interim Health NZ board:
• A nationwide survey to find out what women, non-binary, intersex and trans people need from the health system.
• The establishment of specific women's health teams in each of the new proposed localities under the health reforms.
• A dedicated policy team for Women's Health within the Ministry of Health, which would be directly accountable to the Minister of Health.
• A national website focused on equitable patient access to contraception and abortion service information and providers.
• At least $6 million (or $2.60 per woman) allocated in this month's Budget to implement the women's health strategy.
Last month the select committee recommended a women's health strategy, and the Government agreed.
Associate Minister of Health Ayesha Verrall said she expected work to begin this year.
The National Party's position is more cautious. Health spokesman Shane Reti told the Herald late last year his party supported "a strategy that sits amongst other strategies". He said National's focus would be on improving care for cancers, including ovarian, fallopian tube, uterine, cervix and vaginal cancer.
GJC co-founder Angela Meyer says she's thrilled at the Government's change of heart but it will need to be followed up with specific plans and money, as neglect of women's health has grown worse in the Covid pandemic.
"I was talking to [a doctor during lockdown] who said they were seeing women presenting at A&E with bleeding because they weren't able to get IUDs changed or fitted probably. It's a s*** show."
"There's total frustration from specialists saying 'why are you not listening to us?' because they're the ones on the front line advocating for this."
Meyer said women were disproportionately affected by Covid, through higher numbers of job losses and stress.
"The situation is so dire that politicians are nervous to rip the Band-Aid off, but it's only going to get worse so you might as well get the Band-Aid off now and actually start healing it."
In the past year alone, there were at least 14 separate petitions to Parliament requesting action on specific health conditions unique to women. These included better access to maternity care, improvements in treating ovarian cancer, a clinical pathway for endometriosis, action on preventing traumatic birth injuries and a ban on surgical mesh.
Meyer says addressing these conditions individually will not be effective because only a coordinated strategy can tackle the root of the problem.
"We don't as a country have a really good understanding of what women's health needs are, so we are not able to create solid policy decisions and deliver on those...if we are always at the bottom of the cliff that's not a way to ultimately improve the health of half the nation."
Follow women's personal stories of poor healthcare in our interactive grid below. Click on a face to go to the full story.
