Pitiful history of women’s health: No strategy, no sense, no wonder it’s a shambles

Our pesky wombs which leak and sag, our tendency to shred and tear, the irritating way we fall pregnant without really meaning to! Our ovaries emptying themselves of eggs, our bones growing lucent and shattering when we fall. We are made to feel that we place a heavy burden on the public purse, overloading a health system already at breaking point looking after citizens with real illnesses

‘Being born a woman is my awful tragedy…’ Sylvia Plath

It is hard not to sometimes feel that being a woman in New Zealand is an “awful tragedy”.

A recent email from the National Screening Unit informed me that September is cervical screening awareness month. The message contained a long and detailed update on the work being done to address the vast backlog of overdue cervical smears, now estimated at over 50,000, and included information on the launch of a cheery campaign – Hey, Let’s Catch up!

HPV screening is now due to start on 1 July 2023 and the NSU update was keen to tell me of sector engagement, implementation phases, equity lenses and data migration.

I had to scroll through several pages to find the informa­tion I was looking for, buried in the FAQ section. Surely a red flag if it even needs to be asked of a screening programme: will people need to pay for the new self-tests?

The answer: “The model approved by Government does not provide for HPV testing to be free…the health provider will set any costs for visits to their practice.”

HPV screening threatens to become yet another of the gender-specific health taxes with which women are burdened throughout their lives. The cost, of course, will present a barrier to access – the whole point of introducing this new test is to address current barriers to screening.

There is a tendency for New Zealand to pat itself on the back for having a female prime minister, as if this equates to there being no gender gap in New Zealand. Nothing to see here. In fact, the recent World Economic Forum Global Gender Gap Report produced earlier this year, presents a more nuanced view. Overall, New Zealand is rated 4th out of 156 countries for gender parities across a range of parameters, mainly because of high ranking in educational attainment and political empowerment (as well as having a female prime minister, New Zealand currently has its highest ever number of female MPs).

However, New Zealand is at 106 for the gendered gap between men and women for health and survival, below countries such as Tunisia, Tajikistan, Iraq and Nigeria. This is unacceptable.

New Zealand is proud to be a signatory to the UN sustainable development goals, which include measures of women’s sexual and reproductive health and rights, and set targets that address human rights-based dimensions. It is not overstating the point to describe the state of women’s health in New Zealand as a human rights issue.

Our current approach to women’s health is contradicto­ry, fragmented and tokenistic. Numerous initiatives appear with fanfare, only to fade into obscurity when it becomes obvious that no one has seen the bigger picture and joined the dots.

For instance, abortion was removed from the Crimes Act in 2020, ostensibly to make it easier to access as part of basic healthcare in community settings. This is not yet the case, and no training or funding for abortion is currently available in primary care. All funding still sits with the hospitals and the newly established consortium DECIDE, a collaboration between Family Planning and a private company, Magma Healthcare.

Where it is available, abortion is free to access but contraception is not. There is no universe in which this makes sense. In some areas, contraception is free if taken up immediately post-delivery; if you would rather go home and talk to your GP about your options, you have missed your funded window and must pay. And who remembers the last National Government’s policy of shaming beneficiaries and their children, offering them free appointments at their local branch of WINZ where they could access funding for long-acting contraception, therefore making sure they did not further burden the taxpayer with more children?

This policy, scrapped by the Labour Government, was described as “stigmatising”. It has been replaced by contraception funding policies which differ between regions and which discriminate based on parameters such as ethnicity and the number of children a woman already has; in some areas a woman must answer invasive questions about drug or alcohol use or previous abortions in order to be eligible for funding.

This is a source of great moral injury for many GPs, myself included.

A further tax is imposed during pregnancy. Antenatal care is sort of free and sort of not, as in many areas a copayment for antenatal ultrasound scans must be made. Some regions cover this payment, some do not.

ACC is still determining what will be covered with regard to “birth trauma”. Women are not entitled to access ACC-funded pelvic physiotherapy in the community after a difficult birth, and must endure up to two years on a public waiting list.

Babies have a six-week check at which time they are examined by their GP and have their first immunisations; their mothers are entitled to no such funded check.

No one knows who is ultimately responsible for these policy decisions.

Our pesky wombs which leak and sag, our tendency to shred and tear, the irritating way we fall pregnant without really meaning to! Our ovaries emptying themselves of eggs, our bones growing lucent and shattering when we fall. We are made to feel that we place a heavy burden on the public purse, overloading a health system already at breaking point looking after citizens with real illnesses.

The promise of a Women’s Health Strategy was a last-minute addition to the Pae Ora (Healthy Futures) Bill after many months of strenuous lobbying and petitions.

In the three years prior to this, no fewer than 45 petitions had been presented to Parliament calling for action on different aspects of women’s health. Some of these were successful, but single-issue advocacy can never replace a big-picture view and strategic thinking. And equally, strategy does not necessarily result in action. The question is, does Te Whatu Ora – Health New Zealand have this big-picture view, and does it have the teams in place to implement the developing strategy?

Orna McGinn is an Auckland-based specialist GP and chair of the New Zealand Women in Medicine Charitable Trust