2020 WPUK submission Labour Party Policy Forum: health & social care

This is the submission we made to the 2020 Labour Party Policy Forum on health and social care.

We welcome the opportunity to contribute to Labour’s national policy forum consultation.

About us

Woman’s Place UK (WPUK) is a grassroots feminist campaign which was formed by a group of women in the labour and trade union movement to uphold women’s sex-based rights and protections in the UK. Since September 2017, we have held 27 public meetings across the UK which have been attended  by over 5,000 people.

Initially, our aim was to enable a diverse range of women’s voices to be heard on the UK and Scottish Government’s proposed reforms to the Gender Recognition Act 2004. However, we are increasingly concerned with upholding and advancing women’s sex-based rights. We have recently published a draft manifesto[1] for women.

As architects of landmark UK legislation on sex discrimination, previous Labour governments can lay claim to a strong track record on tackling the structural inequalities faced by women. We would like to see Labour acting as a catalyst to reinvigorate debate and discussion about how to uphold and advance women’s sex-based rights.

We particularly welcomed the commitment in Labour’s 2017 manifesto[2] to “gender audit all policy and legislation for its impact on women before implementation” (p.109).

We support the 2019 Labour manifesto commitment to challenge the discrimination and oppression women face. It is essential Labour does not roll back on women’s rights, in particular, the commitments to:

• Ensure that the single-sex-based exemptions contained in the Equality Act 2010 are understood and fully enforced in service provision.
• End mixed-sex wards.

Background

A decade of Tory-led austerity has hollowed out our public services and women, in particular working class women, have borne the brunt of this. Women are over-represented in public sector employment, which has been subject to year-on-year budget cuts. More women are engaged in precarious forms of employment. Funding for services that they rely upon – such as Sure Start and domestic violence refuges – has been subjected to annual local authority budget cuts. And it is women who so often plug the care gap when these services are diminished or disappear altogether.

We are concerned about the absence of any class-based analysis in the public debate about persistent discrimination faced by women on the ground of their sex. It is impossible to assess and tackle the structural inequalities suffered by women if we cannot recognise women as the oppressed sex. It is against this backdrop that we wish to raise a number of concerns about the challenges facing women in our communities.

Equality Act 2010

The Equality Act (EA) 2010 is the legal cornerstone of women’s existing rights to fair treatment, and to privacy and dignity in services provided to them. Passed by a Labour government, the foremother of the EA was the Sex Discrimination Act (SDA) 1975. The Act defined a woman as a female of any age, a definition carried forward to the Equality Act 2010. The fundamental belief underlying the SDA was that the physical and social consequences of being born and living with a female body are so significant that women deserve specific protections in law, including the right in certain circumstances to single-sex services and spaces.  The SDA stated clearly that it was concerned with discrimination against a woman “on the ground of her sex”.

However, in recent years, the exemptions provided for under the EA 2010 – and indeed the very definition of what it means to be a woman – have come under pressure. Governments and public authorities are increasingly shifting their focus to capturing data and planning services on the basis of ‘gender identity’ rather than sex. We believe that this shift, left unchecked, will have grave consequences for women’s sex-based rights as enshrined, primarily, in the Equality Act. Below we consider the implications of this conceptual shift on women in our communities.

Health and social care

Addressing women’s healthcare needs

WPUK’s draft manifesto calls for the funding of research and national collection of data on women’s medical needs, and the provision of woman-centred healthcare.

In her book Invisible Woman, Caroline Criado Perez critiques the systematic bias of a world that has been designed around the needs of men. She cites several examples where this bias has adverse consequences for women’s health. For instance, women are 50% more like to be misdiagnosed, and more likely to die than a man if they have a heart attack. She also highlights clinical trials that exclude women. One clinical trial excluded women on the basis that they have periods which would impact the findings.

Criado Perez makes a powerful case for tackling this bias through the use of sex disaggregated data. We strongly support the need for sex-disaggregated data and are extremely concerned about the shift by public authorities to collect data on ‘self-identified gender’ rather than sex.

In WPUK’s evidence[3] to the Scottish Parliament on the Census (Amendment) (Scotland) Bill, we emphasised the importance of collecting robust data on sex. We are therefore clear that the 2021 Census must retain a binary sex question based on a clear definition of sex, not least so that public bodies can fulfil their obligations as part of the Public Sector Equality Duty.

Without a clear picture of the number of men and women in the population, we cannot properly plan health services for our communities. Nor can we collect reliable data that enables statisticians to chart the incidences of and plan healthcare responses to diseases that affect women. Collecting sex-disaggregated data is also a requirement[4] of CEDAW signatories (General Recommendation 9).

Single sex wards

A driving force behind the establishment of WPUK was the recognition that women still need and want women-only spaces and services, for reasons of safety, privacy and dignity.

The NHS in England and Wales is notionally committed to the elimination of mixed sex wards. However, the elevation of ‘gender identity’ over sex in NHS documents[5] means that this commitment rings hollow, as NHS providers now permit individuals to be accommodated on hospital wards based on their ‘self-identified gender’, not their sex. The incidence of sexual assaults on mixed sex wards is well-documented[6].

Right to request female healthcare worker

A survey[7] of 2,000 women undertaken by Women and Girls Scotland sought to quantify the potential for women’s self-exclusion from spaces and services that were opened up to men who identify as women. Many respondents highlighted their reluctance to use such spaces and services, and some indicated that they were already self-excluding on this basis.

The same report highlighted that the two largest NHS Boards in Scotland confirmed to the report’s authors that they could not guarantee that a woman’s request for a female healthcare provider would be honoured, due to the fact that the provisions of the Gender Recognition Act 2004 prevented the disclosure of someone’s transgender status.

Women must be able to request a female healthcare provider and expect that that request will be honoured. We cannot risk women self-excluding from essential healthcare services.

WPUK manifesto demands on health and social care:

• Free access for all women, including women in Northern Ireland and migrant women, to NHS services, including maternity care and abortion services; the right to bodily autonomy
• Fund research and national collection of sex-specific data on women’s medical needs and the provision of woman centred healthcare
• Implement the NHS strategy of elimination of mixed sex accommodation in hospitals
• Commit to uphold the right to request a female clinician, carer or support worker and to have that request respected.
• Female-only services for those with sex-specific conditions, mental health, drug and alcohol problems
• Challenge the bias in design and research which is based on a male standard to ensure that the sex-based needs and health and safety of women are properly addressed.

Woman’s Place UK

June 2020

[1] https://womansplaceuk.org/2019/05/20/this-is-what-we-want-the-wpuk-manifesto/

[2] https://labour.org.uk/wp-content/uploads/2017/10/labour-manifesto-2017.pdf

[3] https://womansplaceuk.org/wpuk-submission-to-scottish-census-consultation/

[4] https://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htm?fbclid=IwAR3lQYxyXUHbVdk5i4lhxAIEPZTVdozLZ-yRO8aCu7nsMnJ5NZJjzHJLu3w

[5] https://medium.com/@anneharperwright/sex-gender-the-nhs-1e8f4e6363a6

[6] https://academic.oup.com/shm/article/31/4/732/5166746

[7] https://wgscotland.org.uk/reports/