Women’s Reproductive Health across the Lifecourse – Implications for Public Policy Report of a Conference organised by The Royal Society of Edinburgh 27–28 February 2013 Contents Acknowledgements………………………………………………..4 Conference Programme…………………………………………..6 Executive Summary……………………………………………….9 Key Messages…………………………………………………....10 Overview…………………………………………………………..12 Day 1………………………………………………………………15 Day 2………………………………………………………………31 Chair & Speaker Biographies…………………………………..49 Rapporteurs: Emma Doyle Sarah Elizabeth Jeavons Emily Ross © The Royal Society of Edinburgh: October 2013 ISBN: 978 0 902198 96 8 Requests to reproduce all or part of this document should be submitted to: The Royal Society of Edinburgh 22-26 George Street EDINBURGH EH2 2PQ Tel: 0044 (0)131 240 5000 www.royalsoced.org.uk Opinions expressed in this report do not necessarily represent the view of The Royal Society of Edinburgh, nor its Fellows. 3 The Royal Society of Edinburgh wishes to acknowledge the support of HRA Pharma; Pfizer; The Edinburgh Family Planning Trust; PregLem (educational grant); School of Clinical Sciences, School of Molecular, Genetic and Population Health Sciences, Centre for Research on Families and Relationships, University of Edinburgh 4 and thanks the Organising Committee: Professor Alice Brown CBE FRSE (Then) General Secretary, The Royal Society of Edinburgh Professor John Coggins OBE FRSE Chairman, RSE Scotland Foundation Professor Hilary Critchley FRSE FMedSci Professor of Reproductive Medicine Professor Sarah Cunningham-Burley AcSS Professor of Medical and Family Sociology, University of Edinburgh Professor Anna Glasier OBE Honorary Professor, University of Edinburgh Professor Neva Haites OBE FRSE Vice-Principal for Development, University of Aberdeen 5 Conference Programme Day 1 – Wednesday 27 February 10.00 Registration with tea/coffee 10.30 Welcome Professor Sir Ian Diamond FBA FRSE Principal and Vice-Chancellor, University of Aberdeen 10.35 Introductory Session – Reproductive Health: Women, Work and Care Chair: Professor David Baird CBE FRSE Emeritus Professor of Reproductive Endocrinology, University of Edinburgh Raising issues: recent trends and implications for policy Professor Sarah Cunningham-Burley AcSS Professor of Medical and Family Sociology, University of Edinburgh 11.00 Life expectancy and reproduction Professor Tom Kirkwood CBE Director of Newcastle Initiative on Changing Age (NICA), Newcastle University 11.30 Work and health: contemporary issues and future prospects Professor Linda McKie Professor of Sociology, Durham University 12.00 Panel Discussion Participants: Speakers and Chair from morning session 12.30 Lunch 13.30 Session 1 – Family Formation Chair: Dr Catherine Calderwood Medical adviser for maternity and women’s health, Scottish Government Debate: When should a woman have a baby? Who benefits from women ‘delaying’ childbearing? Professor Susan Bewley Professor of Complex Obstetrics, King’s College London Fertility decisions are complicated and contextual Professor Sarah Cunningham-Burley Professor of Medical and Family Sociology, University of Edinburgh 6 14.30 Presentations with questions and answers: Combining work and family – perspectives from experience Professor Susan Wray Department of Molecular and Cellular Physiology, University of Liverpool Does policy and legislation meet women’s needs? Clare Simpson Project Manager, Parenting across Scotland An employer’s perspective Dr Stewart Irvine Director of Medicine, NHS, Education for Scotland 15.30 Tea / coffee 16.00 Panel Discussion – Policy implications of afternoon session Chair: Professor Alice Brown CBE FRSE (Then) General Secretary, Royal Society of Edinburgh Participants: Speakers and Chair from afternoon session, plus: Dr Marion Slater Co Chair, Trainees and Members’ Committee, Royal College of Physicians, Edinburgh 17.00 Concluding remarks Professor Sir Ian Diamond FBA FRSE Day 2 – Thursday 28 February 09.00 Arrival with tea/coffee 09.30 Session 2 – The Reproductive Years Chair: Professor Iain Cameron Dean of the Faculty of Medicine, University of Southampton Presentations with questions and answers: Epidemiological evidence and socio-economic costs of reproductive problems in UK Professor Siladitya Bhattacharya Professor of Reproductive Medicine, University of Aberdeen Menstruation and cycle-related problems Professor Hilary Critchley FRSE Professor of Reproductive Medicine, University of Edinburgh 7 The maternal body in the workplace: a focus on breastfeeding experience and practices Dr Caroline Gatrell Director of Doctoral Programmes, Senior Lecturer, Department of Management Learning and Leadership, Lancaster University 11.00 Tea/coffee 11.30 Sex and health Professor Kaye Wellings Head of SEHR and Professor of Sexual & Reproductive Health Research, London School of Hygiene and Tropical Medicine Fertility regulation – changing policy to improve access Professor Anna Glasier Honorary Professor, University of Edinburgh and London School of Hygiene and Medicine 12.30 Lunch 13.30 Session 3 – Post-Reproductive Years Chair: Professor Jonathan Seckl FMedSci, FRSE Vice-Principal (Planning, Resources and Research Policy) The Queen’s Medical Research Institute, University of Edinburgh Presentations with questions and answers: A lifecourse approach to women’s health and ageing Professor Rebecca Hardy Professor of Epidemiology and Medical Statistics, University College London and Programme Leader, MRC Unit for Lifelong Health and Ageing The menopausal transition: its effect on lifestyle and health Professor Anna Glasier OBE Honorary Professor, University of Edinburgh and London School of Hygiene and Medicine 15.00 Tea / coffee 15.30 Panel discussion - Overall policy implications Chair: Professor Neva Haites OBE FRSE Vice-Principal for Development, University of Aberdeen Participants: Chairs from Day 1 and Day 2 of the Conference 16.30 Closing remarks Professor Alice Brown CBE FRSE 16.45 Close of meeting 8 Executive Summary This two-day conference explored an important public policy topic requiring both medical and social scientific evidence. The research presented during the conference emphasised the need to focus on the social context in which women’s reproductive health decisions are made, as well as taking into account the biological constraints and possibilities that influence such decisions. Speakers therefore demonstrated that a multidisciplinary approach to women’s reproductive health is required. Speakers highlighted that the medical technologies available to women and their partners are developing rapidly, and that changing social expectations of men’s and women’s roles in society, as well as an increase in life expectancy, have changed the context in which women’s reproductive decision making occurs. However, as several presenters stressed, the time points at which a woman’s fertility is optimal, and when fertility begins to decline, have remained static. Though IVF is often lauded as a ‘cure all’ for couples who delay childbearing, the risks of over-reliance upon IVF to treat infertility were highlighted by several speakers. The importance of a lifecourse approach to women’s reproductive health was recognised in this conference, with presentations focusing on women’s working lives, as well as on the reproductive health of older women. Talks exploring women’s reproductive health during childbearing years included those discussing how women balance a career with family life and the barriers they face; for example, factors deterring women from breastfeeding or from expressing milk in the workplace. The personal and economic costs of menstruation and cycle-related problems were also considered, along with the complex and contextual nature of women’s reproductive decisions. The reproductive health of women in later life was explored in presentations discussing the effect of the menopause on lifestyle and wellbeing, and the sexual health of older people. It was noted that the issue of women’s reproductive health is neglected both in research funding and in public policy, despite there being many areas in which progress could be made. This may be remedied by a more holistic approach to women’s reproductive health, as opposed to the issue being spread across sexual health, maternal and child health, and obstetrics and gynaecology. Areas for potential changes to policy and legislation include improving the education of young people about reproductive health as relevant across the lifecourse, including the realities of infertility. This may include the use of social media, and could help to encourage a culture where these issues are talked about, rather than seen as taboo. The need for a move away from masculinist work practices, towards a culture in which women and men can balance their employment and family life more easily, was also highlighted. Other areas for potential policy change include the availability of oral contraceptives, and a call for public health approaches to the sexual health of older people. 9 Key Messages from the Conference Women’s reproductive health is an important policy issue Women’s reproductive health has implications for social and economic policy. However, the conference highlighted the relative invisibility of some of the issues raised in terms of public policy debates. There is a need to raise the visibility of women's reproductive health as something relevant across the lifecourse, and to support health-promoting workplaces. Women’s reproductive wellbeing has implications for Scotland’s economy Reproductive health