Discrimination, inclusion, and exclusion

Women and those with physically female sex reproductive characteristics experience different challenges to biological males. Managing menstrual cycles, contraception, maternity and menopause are unique and require women to navigate healthcare systems, media and advertising influences, community and cultural norms. However, women face frequent discrimination in healthcare, due to their sex, sexual orientation and / or gender identity.

Firstly, there is a bias towards male physiology built into medicine. The vast majority of medical (and other) trials are conducted solely on biological men, as women’s hormones, menstrual cycles and reproductive changes across the life course are seen as ‘too complicated’ to study [17]. Results of clinical trials on men are extrapolated to women and treatments are assumed to have the same effect on women as men [18]. Medical investigations and therapies are designed and administrated based on how diseases manifest in men and may therefore be ineffective in women.

Furthermore, when we investigate health outcomes and experiences of Black, Asian and Minority Ethnic Women we see more inequalities, such as an increased risk of maternal death (almost four times higher for Black women and twice as high for Asian women as their white counterparts [19]. Disparities also exist across sexual orientation, disability, and other protected characteristics. Examples include, Lesbian and Bisexual women have a higher proportion of current smokers (at 31%, compared to heterosexual women who are current smokers is 16%) . Trans and non-binary people experience worse mental health outcomes compared to their lesbian and gay counterparts and more frequently report negative interactions with healthcare professionals [20].  Rates of obesity are higher among disabled adults compared to those not reporting a disability. Additionally, rates of obesity are higher amongst women with a learning disability compared to men with a learning disability, (45% compared to 31% respectively) [21]. Where there is no evidence of an improvement or decline in outcomes, this is because sex-disaggregated data is unavailable.

Women’s healthcare needs change over time, and at all stages, there are opportunities to promote good health, prevent negative outcomes and restore health and wellbeing. Doing this well for women in Torbay means improving all our systems to account for sex, sexuality, gender identity and other protected characteristics in a way that informs and drives addressing health inequalities. By taking this crucial step, we will start to understand the needs of our populations and how we can make a difference across not only healthcare, but also in social care, housing, economic development, and industry.