NWC calls on Government to deliver much needed systemic change through Women’s Health Action Plan

Published: Monday, November 29, 2021

‘The entire system is set up for coping, not thriving… to access supports you have to be barely coping’ – disabled woman

‘Going in my early 20s and saying to a doctor sex is painful and them saying it’s just the way you are built, nothing we can do for you’ – disabled woman

‘As the mother, and as the woman, you are expected to advocate and push and put yourself under unbearable amounts of stress and pressure the whole time trying to advocate for what you know your child needs’ – woman is disadvantaged community

‘I was forced to have a mental health check because I was seen as this absolutely crazy mother… they [abusive partners] they turn the whole system against you’ – survivor of domestic abuse

“It’s very difficult for us to open up about our problems, doctors are different, sometimes I had a good experience, but there were times I wouldn’t ask a question because the moment they see you they treat you different and speak to you differently” – woman of minority ethnicity

Quotes of women who participated in Radical Listening Workshops with NWC

Launching its new report today ‘Improving the Healthcare Outcomes and Experiences of the Healthcare System  for Marginalised Women’,  the National Women’s Council (NWC) calls on the Government to deliver much needed  reform through the forthcoming Women’s Health Action Plan to ensure marginalised women receive timely and adequate healthcare.

The report today is part of the ‘Radical Listening Exercise’ commissioned by the Department of Health to hear the experiences of marginalised women and their interactions with the health services.  The report builds on previous evidence[1] which shows there are multiple groups of women in Ireland who have distinct healthcare needs but who face barriers to accessing good care. The report is based on focus groups with 50 women who identified as disabled, of minority ethnicity, as a survivor of domestic abuse or from a disadvantaged area.  

Developed in partnership with Community Work Ireland, the report is part of NWC’s work with the Department of Health Women’s Health Taskforce to improve women’s health outcomes and experiences of healthcare.

Although some women spoke positively about the care and support they received, and the specific circumstances of participants varied, experience of inaccessible services, dismissive attitudes of healthcare providers and a lack of cohesive supports were repeated concerns raised:

• Across all groups, women voiced frustration at the lack of being listened to and taken seriously in healthcare interactions.
• Lack of accessibility was a key issue in terms of built environment and universal design but also in terms of supports available to enable women to be listened to and taken seriously in shared decision making, for example translation services (e.g. sign language) and the availability of accessible, simple information.
• Women spoke enthusiastically about the accessibility of community support delivered by local organisations and this was often presented as an antidote to the complex network of broader services that women must navigate.

Participants spoke frankly about the numerous and multifaceted barriers that undermined their health outcomes, including the absence of comprehensive health and sexuality education in schools, childcare challenges and challenges linked to family courts and child protection services, Direct Provision, and legal aid and medical card thresholds.

Speaking upon the launch of the report, Orla O’Connor, Director of the National Women’s Council said:

“Our report highlights the importance of listening to women and their experiences of health services. In their own words, women have detailed how poor experiences of healthcare erode trust in the system and in many cases, cause women to withdraw from vital care. These experiences included a lack of join-up in services and failures to take health concerns of women seriously. One simple example of this is how the physical design of facilities in hospitals resulted in some disabled women being unable to access mammograms and cervical smear tests - one woman did not have a cervical smear test in over 11 years due to the trauma of a previous experience.  Women have also highlighted the positive experiences of primary healthcare and the benefits of community based supports”

Rachel Doyle, Joint National Co-Ordinator at Community Work Ireland and workshop facilitator said:

“This process has highlighted once more the health inequalities and high levels of exclusion, isolation and disempowerment faced by so many women across a wide range of communities throughout Ireland.  Addressing these concerns requires strong community development support, strengthening and building women’s voices and harnessing their experiences towards the development of a health care system that is accessible, affordable and meets the needs of all women as a basic human right.”

Alana Ryan, Women’s Health Coordinator, NWC and report author said,

“To tackle unconscious bias and create a culture of care which listens to women and recognises them as experts by experience, we need to revisit the training and support package given to professionals. It’s clear from the stories’ women shared that more must be done to bridge the gap between service users and providers to ensure the diversity of women’s needs are being fully met. It’s why at NWC, we are calling for an enhanced unconscious bias and gender sensitivity training package which is co-designed and delivered with women, as well as greater awareness and education on how to recognise signs of domestic abuse or coercive control.”

Based on the findings of the report, NWC calls on the Government to prioritise the following:

• Provide mandatory gender-sensitivity and unconscious bias training for health and social care professionals to create a culture of care which listens to women and takes their concerns seriously
• Champion community-based care and community development support through sustained investment in local services for health promotion and early intervention that meet the diverse needs of women
• Ensure all healthcare services are accessible and inclusive, for example, through considering the built environment, providing interpretation and translations services, as well as plain language information and support on diagnosis and the next steps for recovery

See the full version of the report ‘Improving the Health Outcomes and Experiences of the Healthcare System for Marginalised Women’ 

NWC would like to thank the HSE Health and Wellbeing department for providing the funding which enabled us to undertake this research project and the Women’s Health Taskforce for commissioning this research.

Orla O’Connor concluded,

“Through our partnership with the Women’s Health Taskforce and the Department of Health, women’s voices are informing the systemic changes needed in our healthcare system. The forthcoming Women’s Health Action Plan is an important milestone on our journey toward a healthcare system that meets the needs of all women, and provides care that is human rights based and person centred. Through the Action Plan, we have a unique opportunity to progress our vision of an inclusive and enabling healthcare system that promotes both the health of current service users and the health of future generations of women and girls. It’s vital that we seize this essential opportunity and ensure that policy and practice is responsive to the needs of the most marginalised.”

ENDS

For more information or to organise an interview with the National Women’s Council, please contact Sarah Clarkin, Communications Coordinator, 085 8619088, or Vicky Masterson, Digital Campaigns and Communication Officer, 087 1000385

Notes to Editor:

Context

In 2019, Department of Health established the Women’s Health Taskforce to improve women’s health outcomes and experiences of healthcare, including a social media analysis and a series of radical listening workshops and one-to-one interviews

In June 2021, the National Women’s Council (NWC) and Community Work Ireland (CWI) conducted four workshops over Zoom in with a total of 50 women taking part from both urban and rural areas

These targeted workshops were organised to provide space to discuss the conditions needed to promote positive health and wellbeing, and to identify what the key enablers and barriers are for accessing high-quality and needs-based healthcare

This work was commissioned to support the development of the Women’s Health Action Plan, the outcome of the work of the Women’s Health Taskforce.
The publication of the Women’s Health Action plan is currently being developed and is due imminently[2]

Research methodology

Participation was based on self-identification with the theme of the workshop and a radical listening approach was deployed to ensure that women could share openly.
Building on the evidence gathered to date, this project was concerned with two key questions: 1) What is the experience of the Irish healthcare system for diverse groups of marginalised women and what are the key barriers to accessing person-centred and appropriate care? 2) What would an enabling and inclusive healthcare system look like?
Based on the evidence review, we held four workshops with:

• Disabled Women
• Women of Minority Ethnicity
• Women Living in Socially and Economically Disadvantaged Communities
• Women Survivors of Violence and Abuse

Participation in the workshops was self-selective and open to anyone who identified as a woman over the age of 18 with direct experience of the workshop themes. Each of the four workshops had 9-19 women participants, with 50 women taking part in total.

CWI led the recruitment of participants using its connections to national and local organisations, as well as by contacting organisations in the NWC membership network following indication of interest

Summary of NWC Recommendations:

• View women as equal partners
• Introduce gender-sensitivity and unconscious bias training, beginning in undergraduate curriculums and continuing across professional development. This should be co-designed with a diverse cohort of women, including those who are experts by experience on different health conditions.
• Ensure that training emphasises that clinical best-practice and shared decision-making go hand-in-hand and equips professionals with the skills and knowledge necessary to support meaningful service-user input
• Champion community-based care and community development support
• Invest in local, accessible supports for health promotion and early intervention; including through additional funding for the Traveller Primary Healthcare Projects, community resource centres and local domestic abuse services.
• Improve GPs’ knowledge of local support services to ensure more women are made aware of and connected to relevant services within their communities.
• Examine the viability of introducing peer-led primary health care for migrant communities and those living in socio-economically disadvantaged areas, designed and implemented with women from these communities.
• Enhance pathways between community and specialist care to ensure that where additional support is needed, there is a smooth referral process.
• Explore feasibility of international models of good practice in primary care such as the UK’s Identification and Referral to Improve Safety intervention to improve support for women subjected to domestic abuse and ensure access to timely and appropriate healthcare.
• Promote accessibility and inclusion
• Champion universal design planning and ensure that all services are provided to disabled women as they would their able-bodied peers.
• Enhance access to interpretation and translation services for Irish Sign Language and foreign languages.
• Provide clear and accessible information on the care pathway in a variety of forms to enable service-user engagement.
• Improve diversity and representation across all tiers of the health and social care workforce and ensure that women from marginalised backgrounds can develop their careers and progress to senior levels.
• Collaborate across Government
• Recognise that the common universal drivers of marginalisation, including poverty, deprivation, racism, gender-based violence, social exclusion, ableism, family hardships, and trauma are cross-Government issues.
• Identify areas of current social policy that have a particular adverse impact and proactively engage across Departments by adopting a ‘health in all policies’ approach.
• Use the forthcoming third National Strategy for Domestic, Sexual and Gender-based Violence to tackle the epidemic of violence against women by adopting a public health approach to abuse prevention. The Strategy should be clear that violence against women is preventable, and outline coordinated cross-departmental actions to address the risk factors that increase the likelihood that harm will occur.
• Develop a holistic and intersectional approach between the Department of Health and Department of Justice to protect the safety and mental and physical health of survivors of domestic abuse

[1] Women’s Health in Ireland - Evidence Base for the development of the Women’s Health Action Plan https://www.nwci.ie/learn/publication/womens_health_in_ireland_evidence_base

[2] https://merrionstreet.ie/en/news-room/news/minister_for_health_publishes_report_of_womens_voices_on_womens_health_in_ireland.171271.shortcut.html