The Gender Health Gap, with Sarah Graham - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump. Busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about - incontinence, prolapse, pelvic pain. Problems that affect millions of women, one-in-three. I'm one of them. I have a prolapse, my pelvic organs fell out of place after the birth of my second child. And if you had told me back then that I would be speaking about this stuff out loud, I would have told you to give your head a wobble.

Helen

Hi, it's the final episode of season three, I can't believe I'm saying it, and what a season it's been. Inspiring stories from more brave women, incredible advice on things like menopause, on surgery, on running. Tons of food for thought around why the taboo around pelvic floor problems exist in the first place, how humour can help, why it's a feminist issue. And of course, that time I took a recording device to a pessary appointment. Yes, I did. And it's almost like the more we talk about it, the more I feel like there is to say.

So I am planning to return after a break and there are some exciting things happening in the meantime, so make sure you find me on social media, if you haven't already.

Today's episode is sponsored by Modibodi, the go to brand for any of life's leaks. There's a range of products, not just for periods, but for bladder leaks, postpartum bleeding and leaky boobs, as well as reusable nappies for babies, helping to support you through different stages of life. And the new ultra range for incontinence is the most absorbent, yet it can hold 250 millilitres of liquid. No pads, no disposables, just undies. The Modibodi sent me a pair and they are lovely to look at and they're very, very soft. And as you know, I mean, I have been using Modibodi for three years now for periods and I haven't looked back. So if you fancy trying them, you can use the code WMDJ15 for 15% off your first order, excluding sale items, bundles, gift cards and maxi 24 hours. Thanks to Modibodi for all your support.

Episode ten, then. It's one I've been thinking about for a while now, you know how, I don’t know if this makes sense, but you know how lots of people say if men had pelvic floor problems, it would have been sorted by now? And I used to think, yeah, well, it's easy to say that, but is it really fair? And what do we mean by that, exactly? And then over the last couple of years, I started hearing more about the gender health gap and it's a bit like something sort of clicked, so I wanted to explore it. And it's fascinating to me this, and I think it's important if we want things to change, if we want to end the stigma, make it easier for women to advocate for themselves to get the treatment they deserve.

There's obviously a UK focus to this, but it's relevant everywhere. Sarah Graham is a freelance health journalist. She is the founder of a hysterical women blog which looks at inequalities in women's health, and she's writing a book on the gender health gap, which is due out in 2023. She's, she's also a new mum, so I'm especially grateful to her for finding the time to answer all my questions the other day, starting with what exactly do we mean when we talk about the gender health gap?

Sarah

So I guess in kind of the simplest terms, the gender health gap is a way of looking at and talking about the health inequalities that exist between men and women. And obviously, you know, like with a lot of these things, there are other factors that come into that. So class, and race, and sexuality, age, all of these, kind of, things also have an impact. But, essentially it's looking at the way that men and women are treated differently by healthcare professionals, by the medical community, and the various different inequalities in terms of the knowledge that we have, the research that exists when it comes to various different health conditions.

Helen

So give me some examples of where we might see the gender health gap, because this is one of those things where, until I heard the expression, I hadn't really considered how that might apply to pelvic floor problems for women after childbirth. And after I did hear it, I was like, aha, now I see, now I see what's going on here. So give me some examples of where the gender health gap can be evident.

Sarah

Yeah, absolutely. I think there are loads of different examples. And what kind of got me interested in this is that I was writing about lots, and lots of different health conditions and you know I hadn't necessarily, kind of connected the dots, like you say, but actually started seeing patterns coming up.

So I guess the, kind of, big picture is, although we know that women have a longer life expectancy than men, they actually spend more of their lives in sort of ill health and there are loads, and loads of different examples.

So women not being taken seriously when they're in pain, being offered antidepressants or anti anxiety medication instead of pain relief, it's the fact that women are more likely than men to die of a heart attack because the care that they receive isn't as good, they're more likely to be misdiagnosed in the context of your work, it's things like that sort of attitude that childbirth injuries are just kind of part and parcel of being a mum, you know, that actually is something we should just accept and put up with and suck it up, rather than a medical problem that has solutions.

So I think there are loads of different examples. And where I became really interested in this, in my work, was the fact that it's not just stuff to do with wombs and vaginas. It happens across everything, heart attack care, mental health care, you see it in the menopause, you see it in things like endometriosis and PCOS (Polycystic Ovary Syndrome).

So it really does kind of span the whole of health care in lots, and lots of different ways, some more obvious than others. And the more I talk about it, the more I kind of hear from women who sometimes, it's just the really sort of insidious things that you just think nothing of at the time, but like a GP, that's a little bit dismissive when you go to them with something that actually is having quite a big impact on your life and they seem to not take it very seriously, all the way through to the much, much bigger things. Like women being more likely to die from a heart attack, like women not getting the care that they need for really serious, potentially life threatening issues.

So, yeah, it's massive. And I think once you're aware of it, once you start talking about it and looking for it, you see it everywhere. That certainly has been the case for me.

Helen

That's exactly it, before I had heard that expression, I knew there was something going on with pelvic floor stuff. I was like, why aren't people getting good enough care? Why are people sort of on these long waiting lists? Why are we not even going to the doctors about it? Well, maybe that's on us, because we don't talk about it, maybe that's kind of our fault.

And I sort of internalised this idea of like, well, yeah, it is normal when you have a baby, we should just put up with it and get on with it. And it's only really in the last couple of years that I've been thinking, like, hang on, no, that's not how it should be, that's not how it is. And the way you described people's pain being dismissed, people going to the GP, and even if it is just slightly that attitude of indifference, that's exactly what it is. And all of that adds up, doesn't it, to something that really says everything about how women's quality of life is viewed often by not all, of course not all, but some medical professionals.

It's like, what is an acceptable quality of life for us to be living? And where should people be helping us to get to? It's a hard question to answer, in a way.

Sarah

Absolutely.

And I think, like you say, a lot of it is internal, even before you go to the GP. There's such a sort of stigma and taboo around these issues. But, I think women have really internalised these messages that it's not something we talk about, it's not something that you need to trouble the doctor with, it's something that you just have to deal with on your own and put up with.

So I think it's not entirely on the medical professionals themselves. I think that's where it gets so kind of tricky and so complex, is that there are so many different aspects to it from so many different angles. And a lot of it does start with us being too embarrassed, or too ashamed, or too traumatised and not wanting to kind of put ourselves out there.

That's almost, kind of, the first step. And so if when you do take that step, you then have a dismissive GP, that's, kind of, the second barrier on that path. So there are all these different barriers that can come up at different stages, whether that's things like really long waiting lists to see a specialist because the service isn't prioritised, there's not enough funding, there aren't enough specialists. Kind of, every step of the journey there are these barriers, whether they're internal or external.

Helen

And you're so right about that thing of seeing it everywhere as well. I came across a report the other day and I don't know if you've seen this, but it was from the Royal College of Obstetricians and Gynaecologists that came out about a month or two ago and it was talking about we're in list for Gynaecology and how over Covid they've gone up by like 60%. And you might say well, waiting lists across the board have gone up for all specialties, but not by as much as they have for Gynaecology. And the head of the Royal College was making the point in this article that this was about gender and it was about giving women's health low priority. And I was like, here's someone who really knows this stuff going, this is like the only medical specialism that's unique to women and look what's happened to the waiting list that has gone to the bottom of the pile.

So it's like something like half a million women on this waiting list for Gynaecology now and tens of thousands of them are going to wait for more than a year to get that treatment. It's really frustrating, to say the least.

Sarah

So frustrating. And I think often it's really easy to get frustrated with GP’s because they're the kind of the ones right in front of us, they're the ones that we see that kind of, act as like, the gatekeepers. But, I think often it is just as frustrating for GP’s who don't have services to refer on to, or there's a massive waiting list, so they have to try and just muddle through. And I'm not saying that that's the case for all GP’s. I think there are some GP attitudes that I come across that are just appalling. But, I think for a lot of GP’s it is really frustrating that they really want to help their patients, but they just can't because these issues go all the way to the top.

It's which services commissioners prioritise when it comes to funding. It's which services there's a kind of political will to invest in. So it really does go all the way to the top and trickles right down to the patient.

Helen

Yeah.

And then some of that, I guess, is down to, I think you mentioned, a lack of research. So the other eye opening thing for me was Caroline Criado-Perez's book, Invisible Women and just kind of highlighting the fact that such low investment in research into women's health and partly because women are seen as too complicated to research because of periods, because of hormones.

Sarah

Yeah, our hormones make everything complicated right.

Helen

Yeah, that's exactly why you need to be researching it.

Sarah

Yeah, no, absolutely and again, that's something that, that you see a lot with conditions that primarily affect women.

So Endometriosis is a really good example. It's the one that everyone always talks about, but it's also you see it in things like MECFS (Myalgic Encephalomyelitis, Chronic Fatigue Syndrome), which isn't anything gynae related. Chronic fatigue. It's a really complex condition, but yeah, it's sort of best known for the, kind of, chronic fatigue and various different post viral symptoms that go with it. For some people, it can be really debilitating, but because it mostly affects women, most of the people who affected are women, the research funding just isn't there. There's so much that we just don't know about it. And even the guidance that GP’s are given to follow has been based on bad evidence.

So the guidelines on MECFS treatments were just recently revised to remove a treatment called Graded Exercise Therapy, which had been in the guidelines for a very long time, but which patients for years have been saying, actually, this does more harm than good. And when they've gone back and they've reviewed it and they've looked at the evidence, they've gone, actually, yeah, this does seem like it could be harmful. There's no evidence that actually it helps people, or that evidence is not good quality enough that we can be recommending this. So stuff like that, lack of research, it really does impact on patients' lives.

Helen

Where has all this come from? What's the history to this gender health gap? It feels like well, I certainly feel like I'm only just waking up to it, but obviously it's been baked into the system from the start, right?

Sarah

Yeah, absolutely. I mean, I think, like I say, it's a really complex problem, and it goes back to sort of thousands and thousands of years of sexism and living in a patriarchal society where you have systems that were set up by men, for men, that are run by men, for men. And so almost kind of as far back as you can even imagine, men's bodies have been seen as the default.

There have been all these, kind of, attitudes that still, I think, to some extent exist about women's bodies, like you were saying about hormones making us too complicated to study.

This whole idea of hysteria that women are, kind of, just governed by our wombs, by our hormones, that we're irrational, and we can't be trusted to tell the truth about our own experiences, because we might be exaggerating, or we're too led by our emotions, rather than being able to sort of objectively report things.

So I think a lot of it comes from those attitudes to women as a whole. And if you look at things like reproductive rights, obviously fairly closely linked actually to postnatal issues, just this idea that women can't be trusted is really kind of inherent in the system. At the same time, then, you've also got, as we've said, this kind of male dominated medical and research fields where the focus has been on men, it's been on men's bodies and conditions that affect men. And so the conditions that mostly affect women are neglected.

There isn't as much research, we don't know as much about how women are affected by gender neutral issues. We don't know as much about the conditions that affect women more than men. So you've got kind of a bit of a double whammy, really, of sort of conscious and unconscious bias that has existed since forever, that I think we've made some progress, but there is still a lot, particularly of the kind of unconscious bias that people don't necessarily realise they have internalised and then also those big gaps in medical research and knowledge. So they really kind of go together to make it very difficult for women in health care.

Helen

Why do you think it does feel like we're suddenly waking up to this? I mean, obviously some people will have been talking about it for years, but certainly we're seeing more about, I guess about menopause, more about endometriosis. Like you say, more people are getting a little bit more up in arms about getting, demanding the right treatment for these things. Where do you think that's come from?

Sarah

Absolutely. I mean, I really feel that it has been building over the last few years and a lot of my work has been following that. And actually the book that I'm writing at the moment is very, kind of, focused on that sort of real, kind of, grassroots movement of ordinary women, ordinary people talking about their experiences, whether that's podcasters like you, or bloggers, or writers, or just people with an Instagram account putting posts about their experiences.

I think we've seen a real kind of movement build in the last few years around all sorts of different issues. And I think the more that those, kind of, separate movements, so there's been a bit of a menopause movement, there's been a bit of a pelvic floor movement, there's been a real big endometriosis movement and all these, kind of, things have sort of come together and people have started, I think, like me in my work, putting the dots together and going, oh, okay, so that woman's experience of the menopause is linked to that woman's experience of having a prolapse, which is linked to that woman's experience of having endometriosis. And there are all these sort of patterns that people are starting to notice and go hang on this doesn't seem right.

A few years ago, I started a blog called Hysterical Women, which was very much based on bringing all of those things together, linking them. Because, one of the things that I'd, kind of, noticed was I was talking to loads of women who had very different health issues, very different conditions, or symptoms, or concerns, but the attitudes they were experiencing and the barriers that they were kind of bumping up against were the same. And so I started Hysterical Women, kind of, to make the point that all of these different women were having very similar experiences, regardless of what the health issue was. And what I found most fascinating, and quite moving actually, was the number of women who said to me, oh, my God, I thought this was just me. I thought it was just me.

All these women who, like we said, they've internalised this shame and this stigma and they're going, my GP had told me so many times that there was nothing wrong with me, that I thought I must just be going mad. And that's really heartbreaking, actually. But, I think that what we have seen over the last few years is enough of those stories to kind of build that momentum and for women to start realising, it's not just me, I'm not just losing my mind. These things are all connected and there are lots of complicated reasons behind them. And it's not necessarily that my GP is a misogynist who doesn't want to help, but that there's this massive problem that is blocking so many of us from accessing the care we really deserve.

Helen

Yeah, you're spot on. And I've noticed exactly the same thing with the podcast and the Instagram comments and messages that come back, 99% of them are, ‘I've felt so alone, and now I don't’. And just even that can help someone feel a lot better. It maybe empowers them to go and advocate for themselves, go back to the doctor, to go back and get the help, because they know that there's a community of people in the same boat.

So we are sort of waking up to it. And it's not just, like you say, it's sort of grown out of these grassroots voices, perhaps, but now also, governments are taking note. My eyes nearly popped out of my head last year when I heard the Health Secretary then, Matt Hancock, talking about, we have this healthcare system designed by men, for men, and we don't know enough about conditions that only affect women. I have to say that was, like, really reassuring to hear that coming from government and Scotland as well, that I think they're making sort of plans around these things. So the authorities are waking up to it, aren't they?

Sarah

Yeah, definitely. It very much feels like all the hard work that activists and campaigners have been doing is very much putting these issues on the agenda. We've got to a point, I think, in some ways, we're still very much in that kind of awareness raising stage. But, I think we've got to the point now where there are enough voices and those voices are loud enough that they can't be ignored anymore, right? Because, that's been the problem for thousands of years, is women being ignored and dismissed and told, oh no, it's just you go away. But, there are enough of us now saying we're not going to shut up, we're not going to go away, that government is having to, kind of, take notice.

So I think, again, with the medical community, we're seeing more and more doctors, midwives, nurses, kind of, engaging with these issues, waking up to problems that exist within their industry and sort of thinking, are there ways in which I'm complicit in this? Are there things I could do more to challenge my own biases, to reflect on my practice?

So I think it has been really powerful from that perspective. I'm very keen to see what will come out of the consultation that the Department of Health put out last year. I think it's great that there's lots of stuff that seems to be happening. In the last few years, we've had all party parliamentary groups set up to talk about things like the Menopause and Endometriosis and we've had reports into Vaginal Mesh and all the various different maternity scandals.

There's a lot of stuff that seems to be happening. And I think what I would really like is just to see the government put their money where their mouth is a little bit and say, okay, we've talked about the issues, we've put out all these reports that say this is what the problem is, this is what women's experiences are, but, this is what we're actually going to do about it. And to see some more sort of concrete actions put in place, whether that's committing to invest in research, whether it's sort of training and getting all of the different medical Royal Colleges involved, looking at things that are from the top down, how can we improve services? How can we make sure that commissioners are prioritising women's health? How can we make sure that the GP’s on the ground know everything they need to know to help their female patients?

Helen

There's a long way to go, isn't there? I mean, how hopeful are you that we'll see any sort of significant change in the next, I don't know, let's say in our lifetime, let's give it that.

Sarah

I think it's really tricky because it is so deeply ingrained and there's no, like, one thing that would fix the whole problem. It's not like we can wake up tomorrow and go, okay, we're going to do X and that will solve everything. No amount of money, and research ,and training. And as brilliant as all of that stuff is, it all has to kind of come together. And it's still going to take a really long time to sort of shift the culture and change attitudes, to disseminate all of that new information. And it's going to take a really long time.

I think I'm fairly hopeful that things are going in the right direction. I think already we are seeing small changes and even just things like celebrities, like Davina McCall going on telly and talking about menopause and HRT is a really big deal. And that empowers women to be able to go to their doctors, but also it empowers their GP’s to go, oh, maybe I don't know enough about this. Maybe I've been too sort of taken in by the research from 20 years ago that kind of exaggerated the risks. Maybe I need to relook at my own knowledge and my own understanding and see if what I'm telling patients is actually the most up to date information.

So I think I do feel hopeful that there are small changes happening at kind of an individual level, but also at a kind of broader social level. Whether we're going to see massive, huge scale, everything completely overhauled and transformed in our lifetime, I don't know.

Helen

Let's say yes.

Sarah

Let's be optimistic and say yes. I'm really interested to see what will come out of the government's women's health strategy, because I think how much they're prepared to actually commit to solid, tangible changes will set the tone and set the pace for how much change we're likely to see. I really do think it has to come from the top.

There's only so much, and there are brilliant GP’s who are campaigning and raising awareness and going on telly talking about these issues. But it has to come from the top if we're going to change the whole system. It can't just rely on individual doctors and patients to do all of the work.

Helen

And this is why we need to keep up these conversations. Thanks again to Sarah Graham, who's on Instagram. She is @sarahgraham,that's all one word, then the number seven, and then the word writer @sarahgraham7writer.

I'll put links to the Historical Women blog and some of the things we talked about in the show notes, and that's about it for now.

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