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Health of Women: Achieving Gender Equality in Treatments, Services and Outcomes

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Health of Women: Achieving Gender Equality in Treatments, Services and Outcomes Beijing + 25: the fifth review of the implementation of the Beijing Platform for Action in the EU Member States Area C — Health of women: achieving gender equality in treatments, services and outcomes Introduction The European Pillar of Social Rights states that gender equal- services. For example, while the EU has done work to increase ity is a concern and establishes access to timely, affordable the access of girls and women living outside the EU to sexual and good-quality healthcare as a social right. However, in the and reproductive health services (e.g. within the EU Gender EU, health is a significant area of inequality between women Action Plan 2016-2020), there has been limited action to pro- and men. Gender differences in health are not only biolog- mote access to such services within the EU. To date, impor- ical but also strongly shaped by the interaction of econom- tant unmet mental health needs of women and men persist, ic, political and cultural factors. Increased recognition of the and access to sexual and reproductive health services varies impact of social factors on health and well-being is reflected greatly between the Member States. in the Directive on Work-life Balance for Parents and Carers Looking broadly at medical research, this area has historically (2019), which highlights the positive health impacts of an im- shown limited gender sensitivity. An important step forward proved work–life balance. Furthermore, the Third EU Health in this respect is the Clinical Trials Regulation of the European Programme, 2014-2020, has funded projects that recognise Commission (2014), which requires the consideration of gen- the impact of gender on health, even if it does not explicitly der in clinical trials, even though this has yet to be implement- incorporate a gender perspective. ed. It should help address concerns about drugs being mainly Gender stereotypes and socioeconomic inequalities continue tested on men, and thus possibly ignoring adverse side ef- to impact on access use of preventative and curative health fects that are more common among or exclusive to women. © Chiara Luxardo Chiara © European Institute Beijing + 25: for Gender Equality the fifth review of the implementation of the Beijing Platform for Action in the EU Member States Consideration of gender in treatment and care is lacking Broadly speaking, women enjoy longer lives than men, ment; those from certain migrant and ethnic backgrounds; but spend less of them in (self-reported) good health (Fig- older women and women with disabilities; and LGBTQI* peo- ures 1 and 2). This broad comparison rests on a number of ple. For example, both women and men with low education health-related differences among men and women, which levels are more likely to develop diabetes, but women with result from particular combinations of certain biological and low education levels have higher death rates from diabetes social factors. than men from similar backgrounds, partly due to lower lev- For example, the mental health needs of women and men els of care. differ: there is a greater prevalence of depression and anx- This is linked to challenges related to the low representa- iety disorders among women and of externalising mental tion of women subjects in clinical research, gender-blind or health disorders (such as drug and alcohol abuse) among biased medical research and healthcare services, and gen- men. This is partly explained by social factors: higher prev- dered use of healthcare services. For example, women’s alence of depression among women is linked to low socio- health needs are overlooked in cases of non-communicable economic status as a predictor of depression. The burden of diseases (NCDs) such as cardiovascular disease, despite this combining employment and family demands appears espe- being the main cause of death for women in the WHO Euro- cially harmful for women’s mental health. Intimate partner vi- pean Region. Conversely, men’s health needs are often pre- olence also significantly affects the mental health of women. Men are less likely to seek out help related to mental health sented in terms of NCDs, with little attention paid to their because of gendered behavioural norms, which has been sexual, reproductive, family and mental health needs. linked to higher suicide rates among them. Insufficient gender sensitivity in medical research and health- As women and men are not homogeneous groups, their care is perhaps not very surprising, given the under-rep- health opportunities and risks vary according to social, eco- resentation of women in health governance, decision-mak- nomic, environmental and cultural influences throughout ing and certain occupations. Although women are now well their lifetime. This is likely to add to health vulnerabilities and represented among medical students and doctors, they are problems with healthcare access for certain groups, includ- less well represented among senior doctors and professors, ing women with lower income and/or educational attain- or in executive health sector positions overall. Figure 1. Healthy life years at birth by gender, EU-28 Figure 2. Healthy life years at birth as a percentage of total life expectancy by gender, EU-28 5 5 2 2 80.3 64 78.9 63.3 80 78.6 76.8 76 63 5 73.9 73.9 5 61.8 2 5 2 70 61 61.4 61.4 60 5 2013 2014 2015 2016 2013 2014 2015 2016 en en en en Source: EU-SILC hlth_hlye Source: EU-SILC hlth_hlye NB: 2013, estimated; 2015, break in the series; 2017, data not available. NB: 2013, estimated; 2015, break in the series; 2017, data not available. Beijing + 25: European Institute the fifth review of the implementation of the Beijing Platform for Action in the EU Member States for Gender Equality Threats to sexual and reproductive health services Under international law, Member States in the EU are re- women with disabilities and Roma women have been violat- quired to provide access to safe and high-quality sexual and ed through forced sterilisation. reproductive healthcare. This is not only a legal obligation, Many women lack, or have limited access to, necessary pre- but also a crucial element of safeguarding the wider health natal and maternal healthcare. Currently, some 500 000 and well-being of women. women in the EU lack access to health services during preg- In practice, however, access to sexual and reproductive nancy. For instance, nearly half of pregnant refugees and health services varies significantly by Member State. This is migrants in Europe may not have access to antenatal care, due to differences in service availability and affordability, leg- which helps explain higher risks of maternal mortality among islation, and cultural and religious factors. Since 2013, a wor- migrant women in Europe; the increased risk is 25 times rying trend of retrogressive policy and legislative proposals greater in some countries. Roma women experience greater has been seen in several Member States, threatening the risks of maternal mortality than non-Roma women in the EU, sexual and reproductive rights of women. Although these and face access issues. proposals have mostly been rejected, in some cases they Around 10 % of married women in Europe continue to report have led to tangible restrictions, such as introducing new unmet need for contraception — given the focus on only preconditions for women to access legal abortion services or married women, this figure may well be a (significant) un- allowing conscientious objections by gynaecologists to per- derestimate. Unmet contraceptive needs particularly affect form abortions. The sexual and reproductive health needs vulnerable groups, including adolescents, those with a low of certain groups of women, such as women with disabilities, income, those living in rural areas, people with HIV, refugees often remain unmet, while in some countries the rights of and migrants. Recommendations for action To make EU health policy more gender sensitive, it is impor- ences of women and men. Desirable measures include ap- tant to systematically mainstream gender into key EU health propriate training for healthcare professionals on gender strategies. It would also be good to highlight the importance and health, ensuring access to medicines and services that of mental and physical health (and its gendered aspects) in reflect gendered health needs (e.g. prenatal and maternity key EU employment and social policy strategies. services, hormonal contraception and abortion) and provid- Robust implementation of gender sensitive measures at EU ing sex and relationship education to young people. Target- level, such as effective monitoring and enforcement of the ed initiatives to increase the access of vulnerable groups to EU Clinical Trial Regulation, would strengthen the gender healthcare services would be welcome, including provision of sensitivity of medical research and healthcare. These meas- multilingual information on the availability of healthcare ser- ures would be well complemented by efforts to strengthen vices (e.g. through asylum reception centres) and ensuring the representation of women in health governance, deci- that interpreters accompany migrants to healthcare appoint- sion-making and certain occupations (e.g. senior doctors or ments where they may face language barriers. Finally, Mem- professors). ber States are recommended to strengthen the collaboration Member States are recommended to develop gender-sen- between health and other ministries, including employment, sitive health policies, and to design medical research and social affairs and finance, to address work, care and fiscal health services that address the impact of both sex (biolog- conditions that have a negative impact on women’s health ical factors) and gender (social factors) on the health differ- over the life course. Beijing + 25: European Institute the fifth review of the implementation of the Beijing Platform for Action in the EU Member States for Gender Equality Further information Beyond the developments presented here, a number of other pensions and are at higher risk of social isolation, poverty, challenges persist.
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