To mark International Women’s Day (Wednesday 8 March), the RCOG and women’s health organisation partners have published the below joint statement on the stigma and shame in women’s health services globally.
Stigma is experienced across many women’s health services by both patients and health providers around the world. The stigma that surrounds women’s health conditions and procedures leads to them frequently being deprioritised within health budgets and services. To ensure all women can access the highest standard of care without fear of judgement or delay, the RCOG, Baby Lifeline, Endometriosis UK, Faculty of Sexual and Reproductive Health, Florence Nightingale Foundation, Group B Strep Support, Jo’s Cervical Cancer Trust, Royal College of Midwives, The Eve Appeal and Wellbeing of Women are committed to tackling stigma within health services, reducing health inequities and supporting the health workforce to provide quality, respectful care to all.
Stigma is a social process through which people are distinguished or labelled based on attributes, illness, disability, or identity. People who experience stigma are often subjected to shaming, stereotyping, discrimination, or pitying. People who are stigmatised for possessing more than one stigmatised characteristic can face particular challenges because of this intersectionality, e.g. women living with HIV and mental illness will experience levels of stigma for each stigmatised status.1
The signatories recognise that stigma and shame perpetuate health inequities by deterring people from seeking care, increasing stress around health concerns and lowering self-esteem, undermining the ability to receive quality care. We also understand that healthcare providers’ experience of stigma contributes to stress, burn-out and attrition.2
As organisations at the forefront of women’s health, we see the negative impact that stigma has on health care delivery and outcomes on a daily basis. Stigma in women’s health can lead to:
- Denial of care, or unequal care for individuals or groups, for example young people being denied comprehensive sexual and reproductive health services.
- Patients or healthcare providers being labelled or stereotyped, for example obese people being framed as lazy or of low intelligence.
- Poor mental and physical health, low self-worth, self-esteem and shame among patients and healthcare providers, for example people experiencing stress incontinence or other gynaecological conditions withdrawing or feeling anxious about engaging in social situations.
- The implementation of policies, guidelines and care pathways that are unsuitable or overly onerous for stigmatised groups or conditions, for example imposing waiting times or the requirement to obtain spousal approval to have an abortion.
We are committed to:
- Lobbying for the repeal of laws that perpetuate stigma, such as restrictive abortion legislation, and engaging with political leaders and policy makers on the impact of stigma in women’s health outcomes.
- Participating in research to identify effective solutions to eliminate stigma in women’s healthcare - and expanding coproduction work with those communities experiencing the greatest stigma, exploring stigma impact and solutions.
- Advocating for health systems to embed solutions that will tackle stigma in strategies, guidance and service design; providing evidence and sharing best practice to support systems to achieve this.
- Promoting workforce diversity to place lived experiences at the heart of our organisations’ plans, priorities, and decision-making.
- Ensuring our publications, guidelines and education programmes include information on stigma, use inclusive language and support the delivery of culturally competent care provision.
List of signatories:
- Baby Lifeline
- Endometriosis UK
- Faculty of Sexual and Reproductive Health
- Florence Nightingale Foundation
- Group B Strep Support
- Jo’s Cervical Cancer Trust
- Royal College of Midwives
- Royal College of Obstetricians & Gynaecologists
- The Eve Appeal
- Wellbeing of Women
References
1. Jackson-Best, F., Edwards, N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 18, 919 (2018). https://doi.org/10.1186/s12889-018-5861-3
2. Birbeck, G.L., Bond, V., Earnshaw, V. et al. Advancing health equity through cross-cutting approaches to health-related stigma. BMC Med 17, 40 (2019). https://doi.org/10.1186/s12916-019-1282-0