News – Beyond care, IRISi reflects on 75 years of NHS’s commitment to women’s health, rights and safety

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In 2023, the National Health Service (NHS) celebrates its 75th anniversary, a significant milestone. At IRISi, we’ve selected this special occasion to focus on the NHS’s significant contributions to women’s health, rights and safety. As we launch our campaign for the 16-days of activism against Gender-Based Violence, we welcome you to explore 16 topics, each underscoring the vital role healthcare settings can play in tackling GBV, exploring where more needs to be done and how IRISi can support this work. Come join us on this impactful journey below.

1) 1948: NHS inception and limited data on abuse

In 1948, the NHS was founded, a ground-breaking initiative that aimed to provide healthcare services for all, regardless of their financial situation. Prior to the NHS, the population faced significant barriers to accessing medical care due to high costs. With its inception, the NHS became the world’s first nationalised healthcare system, covering the entire population of the United Kingdom. In 1949, across England and Wales, the NHS employed a total of 11,735 full-time equivalent hospital doctors, with 3,488 of them being consultants. During the same year, there were 68,013 registered nurses working in hospitals.

  • What do we know about Domestic & Sexual Violence and Abuse (D&SVA) 75 years ago?

Data on Domestic & Sexual Violence and Abuse (D&SVA) in the UK for the 1940s and 50s is limited. During that period, these issues were often underreported, stigmatised and not systematically documented. The social and cultural norms of the time discouraged survivors from coming forward, and there was little public awareness and legal support for victims.

It wasn’t until later decades, particularly in the 1970s and 1980s, that efforts to collect data and raise awareness about D&SVA in the UK gained momentum. Organisations like Women’s Aid, founded in 1974, played a significant role in advocating for survivors and conducting research on these issues.

2) Maternity Services in the NHS era – and the alarming reality of Domestic Abuse during pregnancy

The introduction of maternity services as part of the NHS’s comprehensive healthcare coverage had a profound impact on women’s health. Prior to the NHS, childbirth often came with hefty bills that many women could not afford. Post-NHS, maternity care was provided free of charge, leading to a significant increase in hospital births. In the first year of the NHS, there were approximately 1.5 million births, highlighting the immense demand for and benefits of accessible maternity services. This marked a crucial step toward ensuring safe and affordable childbirth for women throughout the UK.

  • The hidden perils of Domestic Abuse during pregnancy

For many women, domestic abuse begins in pregnancy, while for others it escalates in terms of frequency and severity of violence. According to the Supporting women and babies after domestic abuse toolkit, produced by Women’s Aid, “prevalence suggests that between 20% and 30% of women will experience physical violence at the hands of a partner/ex-partner during pregnancy. About 36% of women report verbal abuse, 14% severe physical violence and approximately 20% of pregnant women reported sexual violence”.

3) Empowering reproductive choices: The NHS, emergency contraception and Domestic Abuse

In 1961, the NHS began providing free contraceptive services, marking a fundamental moment in women’s reproductive rights. The Family Planning Association, now known as the sexual health charity FPA, worked alongside the NHS to make various contraceptive methods readily available to women. By 1967, just six years after the introduction of free contraceptives, 1.7 million women were using birth control pills. This remarkable uptake demonstrates how the NHS played a pivotal role in empowering women to make informed choices about family planning and having agency over their reproductive health. The availability of emergency contraception through the NHS has also been vital in women’s reproductive health. In 2019-2020, over 1.4 million women in England received emergency contraception.

  • Unveiling the connection between Domestic Abuse and emergency contraception

Researchers have been exploring the link between emergency contraception and domestic abuse. One notable example is the study  “Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset“, which reports that women frequently turn to emergency contraception due to concerns about the effectiveness of their regular birth control or following sexual violence, coercion and rape.  Reproductive coercion, involving manipulation and interference with a woman’s reproductive choices, also plays a significant role in this context. This study has had a substantial impact on both IRIS and ADViSE training programmes, leading to the integration of new guidance and protocols based on these insightful findings.

4) Cervical cancer screening programme success and gaps in access for survivors of intimate partner violence (IPV)

The NHS Cervical Screening Programme, initiated in the 1960s, has been a cornerstone in preventing and detecting cervical cancer. With the programme’s implementation, the incidence of cervical cancer decreased dramatically. In 1988, the programme screened over 3 million women, and by 2018, the number had risen to more than 4.4 million. This ongoing initiative has undoubtedly contributed to the reduction of cervical cancer-related deaths, emphasising its importance in safeguarding women’s health.

  • Unveiling the connection between Domestic Abuse and cervical cancer prevention

A 2022 study in the US revealed significant disparities in cervical cancer prevention and screening among survivors of Intimate Partner Violence (IPV). The research focused on how controlling behaviour from partners can influence women’s health decisions, particularly regarding cervical cancer screening. The findings showed that survivors weren’t getting as involved in HPV vaccination and regular smear screening as needed, resulting in a higher incidence of cervical cancer compared to the general population.

Examining 30 women seeking help for IPV, the study delved into their behaviours, knowledge and confidence in getting checked for cervical cancer. It concluded that these survivors require more support in managing their cervical health, underlining the importance of confidence, HPV awareness and feeling empowered in health decision-making. The researchers also suggested a potential link between experiences of violence, empowerment, and taking proactive steps for cervical cancer screening and prevention.

In summary, the study highlighted the urgent need for collaboration between social service providers and healthcare professionals to streamline access to sexual and reproductive healthcare services for survivors. The research team underscored the crucial role of education and information in empowering survivors to make informed choices. They also stressed the need to take into account both controlling behaviour and the severity of violence, aiming to facilitate survivors’ access to sexual and reproductive healthcare services.

5) The 1967 Abortion Act and its impact on women’s reproductive rights

The Abortion Act of 1967 marked a significant turning point in women’s rights in the UK. This legislation legalised abortion under specific circumstances, including risks to the physical or mental health of the mother, foetal abnormalities, or economic and social factors. In the first year after the act was implemented, there were approximately 23,000 legal abortions. This figure highlights the immediate impact of the law in granting women the right to choose. The act has since been instrumental in ensuring women’s reproductive autonomy and access to safe abortion services.

  • Unveiling the connection between Domestic Abuse and abortion

In a study that examined 74 research papers, researchers investigated the link between intimate partner violence (IPV) and termination of pregnancy among women. The data revealed that globally, IPV rates among women undergoing termination ranged from 2.5% to 30% in the past year and from 14% to 40% over their lifetime. The meta-analysis indicated a lifetime IPV prevalence of 24.9% among women seeking termination.

The study found a significant association between IPV and termination, including repeat terminations. For instance, women seeking their third termination were over 2.5 times more likely to have a history of physical or sexual violence compared to those seeking their first. Additionally, women in violent relationships were 3 times more likely to conceal a termination from their partner than those in non-violent relationships.

These findings suggest that IPV is linked to termination of pregnancy, with a potential repetitive cycle of abuse and pregnancy. The researchers recommend that healthcare professionals should be aware of the possibility of IPV among women seeking termination, even if they focus on contraception.

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