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.
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1) 1948: NHS inception and limited data on abuse
In 1948, the NHS was founded, a groundbreaking 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.
6) Breast cancer screening’s impact and link to Domestic Abuse
The launch of the NHS Breast Screening Programme in 1988, led by Dr Julietta Patnick, represented a pivotal moment in women’s healthcare. This programme aimed to detect breast cancer early, thereby increasing survival rates. Between 1988 and 2017, the programme screened over 70 million women, and it is estimated to have saved more than 1,300 lives annually by detecting breast cancer at an early, treatable stage. This data underscores the programme’s significance in women’s health, demonstrating its life-saving potential.
- Unveiling the connection between Domestic Abuse and breast cancer
A study published in 2023 investigated the experiences of women with breast cancer in abusive relationships. It identified three forms of blaming: patients blaming their partners, partners blaming the patients and self-blame. Blame is linked to psychological adjustment to the cancer diagnosis. Patients may search for reasons for their illness, potentially leading to self-blame or blaming others. In couples, cancer was considered a shared burden, and mutual blaming can harm their psychological well-being. The study emphasises the vulnerability of cancer patients, underscoring the significance of a holistic and patient-centred approach. Furthermore, it advocates for additional research into the connection between chronic stress and cancer development, with the aim of informing preventive strategies.
The research team concluded: “Due to the significance of the breasts and their functions in intimate and romantic relationships, providing couple-centred and patient-centred care instead of disease-centred care is necessary in planning intervention programmes for patients with breast cancer, especially those who feel trapped in an abusive relationship”.
7) Women’s health and emotional abuse: Insights from gynaecological services in the NHS
The NHS’s commitment to providing access to gynaecological services has been pivotal in addressing women’s unique healthcare needs. Over the years, the NHS has facilitated millions of gynaecological procedures and treatments. In 2019, for example, there were over 1.2 million attendances for gynaecological outpatient appointments in England alone, illustrating the continuous demand for these services and the healthcare benefits they bring to women.
- Unveiling the connection between emotional abuse and gynaecological symptoms
A 2007 study conducted in a north of England hospital gynaecology outpatient clinic found that 24% of women attending the clinic had experienced emotional abuse. The research included 920 consecutive women with a 90% response rate. Among the fifteen reported symptoms, women who had experienced emotional abuse were significantly more likely to present with concerns about termination of pregnancy, cervical smear abnormalities, cancer worries and urinary incontinence. These women also had a higher number of medical consultations, though the duration of their symptoms did not significantly differ. The study highlighted the variation in the prevalence of emotional abuse across different settings and populations and underscored the importance of routine screening for emotional abuse in clinical settings, as it often remains unnoticed. The connection between various forms of abuse and gynaecological symptoms is thoroughly examined during IRIS and ADViSE training sessions. This equips healthcare professionals participating in these programmes with a comprehensive understanding of how gender-based violence can widely affect women’s reproductive health.
8) Women’s mental health and the impact of Intimate Partner Violence (IPV)
The NHS’s role in addressing women’s mental health issues cannot be understated. In 2022/23, 14.0% of local health spend is being allocated to mental health, including learning disabilities and dementia, an increase from 13.8% in 2021/22, with specific programmes focusing on women’s mental health, including postpartum depression and domestic abuse-related trauma. These services have supported countless women in their mental health journeys, offering counselling, therapy and treatments when needed.
Still, much remains to be done. Launched in 2021, Women’s Aid’s “Deserve to Be Heard” campaign aims to raise awareness about how domestic abuse significantly impacts the mental health of women and children. Their report showed that almost half of women in refuge services felt depressed or had suicidal thoughts due to domestic abuse, underscoring the need for effective mental health support for survivors. However, survivors face several barriers when seeking such support, including professional victim-blaming, mental health stigma, and the manipulation of diagnoses by perpetrators.
- Unveiling the connection between Intimate Partner Violence, suicidality and self-harm
Published in 2022, the study titled “Intimate Partner Violence, Suicidality, and Self-Harm: Insights from a Probability Sample Survey in England” is based on data from the 2014 Adult Psychiatric Morbidity Survey in England. The research examined the correlation between intimate partner violence (IPV) and self-harm as well as suicidal thoughts. The results highlighted a significant prevalence of IPV, particularly among women, and its strong association with increased rates of self-harm and suicidal ideation. Among individuals who attempted suicide in the past year, a significant proportion had experienced IPV, with the odds of a recent suicide attempt nearly three times higher for those with a history of IPV. These findings underscore the importance of healthcare providers addressing IPV when dealing with individuals in distress or following incidents of self-harm – and emphasise the need for interventions aimed at reducing IPV to protect those at risk of self-harm and suicide.
As evidence-based programmes, both IRIS and ADViSE continually analyse research and data like these to translate it into practical knowledge for healthcare professionals. Our training sessions heavily emphasise the recognition of IPV signs and the associated mental and physical health conditions.
While women make up 51% of the population, historically the health and care system has been designed by men, for men. This ‘male as default’ approach has been seen in research and clinical trials, education and training for healthcare professionals, and the design of healthcare policies and services. This has led to gaps in NHS’s data and evidence base which means that that not enough is known about conditions that only affect women, for example, menopause or endometriosis.
9) Women’s Health Strategy (2022): addressing gender disparities in healthcare
Launched in 2022, this strategy aims to address disparities between women and men within healthcare services offered by the NHS. While women in the UK on average live longer than men, women spend a significantly greater proportion of their lives in ill health and disability when compared with men.
And while women make up 51% of the population, historically the health and care system has been designed by men, for men. This ‘male as default’ approach has been seen in research and clinical trials, education and training for healthcare professionals, and the design of healthcare policies and services. This has led to gaps in NHS’s data and evidence base which means that that not enough is known about conditions that only affect women, for example, menopause or endometriosis.
It also has meant that not enough is known about how conditions that affect both men and women impact them in different ways, for example cardiovascular disease, dementia, or mental health conditions.
• What does the strategy say about Domestic Abuse and Sexual Violence?
The Women’s Health Strategy, shaped in collaboration with domestic abuse specialist services, recognises the health impacts of violence against women and girls. It underscores the goal of strengthening the healthcare system’s role in preventing, identifying and supporting victims and survivors by promoting a trauma-informed approach within healthcare settings. The strategy also highlights the Home Office’s commitment to invest up to £7.5 million in domestic abuse interventions within healthcare settings. This investment is particularly significant as the NHS often serves as the initial point of contact for individuals affected by Violence Against Women and Girls (VAWG), aligning with IRISi’s longstanding advocacy. With the strategy, we anticipate the potential for securing sustainable funding to expand the reach of IRIS and ADViSE programmes across the UK.
10) Diversity and Inclusion in healthcare: NHS initiatives and challenges
The NHS is actively enhancing healthcare inclusivity via its NHS equality, diversity, and inclusion improvement plan, with a focus on ethnic minorities, disabled and LGBTQ+ patients. This involves cultural competency training, data analysis, and customised health promotion. Yet, there is still a lot to be done. Recent data reveal that 27.6% of BAME staff have experienced harassment. Disabled staff also encounter challenges, with 25% reporting bullying. LGBTQ+ colleagues face workplace harassment at a rate of 23.5%. Just as there’s much work needed within the NHS to ensure proper inclusion of minoritised groups, a similar situation arises when healthcare professionals are serving patients from these backgrounds. Organisations specialising in supporting minoritised groups consistently emphasise the urgent need for improvements, citing a notable lack of funding, especially within the healthcare system.
• What do we know about Domestic Abuse and minoritised groups?
Promoting diversity within healthcare teams is vital to ensure the representation and consideration of minority groups in shaping public health policies. This is particularly important because, as highlighted in a Joint Briefing by Imkaan and the End Violence Against Women Coalition (EVAW), Black and Minority Ethnic and migrant women experience higher rates of domestic abuse-related homicide and are 3 times more likely to commit suicide than other women in the UK. They also often face inappropriate responses from statutory and voluntary agencies, influenced by cultural, ethnic and religious stereotypes.
A similar situation is observed among the LGBTQ+ population in the UK. According to a report by Galop, most LGBT+ survivors have had to cope with their experiences in isolation, unaware of the support available to them. Approximately 61% of LGBT+ survivors did not seek help from services after experiencing abuse from a family member or partner/ex-partner. Even among those who sought support, about 15% did not receive professional assistance despite their efforts to access it.
According to the Outcomes for disabled people in the UK: 2021 report, by the Office for National Statistics (ONS), up to March 2020 approximately 1 in 7 disabled individuals experienced Domestic Abuse, in contrast to 1 in 20 non-disabled individuals. These statistics serve as a stark reminder of the challenges confronting the disabled community. Healthcare professionals are pivotal in recognising and addressing this issue, provided they receive the necessary training and have access to a referral pathway, such as those provided by the IRIS and ADViSE Programmes, which empower them to offer effective support to their patients.
11) Women’s advancement and abuse concerns in the NHS Workforce
In the early days of the NHS, data on female doctors wasn’t collected, but they were a minority, often holding lower-ranking positions. As presented in this article by Dina Balabanova, Associate Professor in Health Systems and Policy, the post-war period saw a baby boom, and while there were no legal restrictions on married women’s employment in the NHS, societal beliefs about women’s roles as housewives were prevalent. Notably, access to contraception and legal abortion became available in the 1960s, as presented before, so, in 1965, women comprised nearly 21% of doctors on the medical register, increasing slightly by 1974 but remaining a minority.
Over time, societal norms shifted, and the number of female doctors increased. As of March 2021, the NHS employed over 1.3 million colleagues, with women constituting 76.7% of the workforce. Women’s roles also evolved, with increased representation in various medical specialities. However, the significant presence of women in the NHS workforce highlights a troubling statistic. Reflecting real-world trends, where women are disproportionately affected by Domestic Abuse and Sexual Violence, this pattern persists within the NHS itself.
• Alarming incidents of abuse within the NHS workforce: a call for action
Various forms of abuse have been documented within the NHS workforce. An investigation unveiled over 20,000 incidents of sexual violence and misconduct by patients towards hospital staff in the five years leading up to 2022. These reports encompassed allegations of rape, sexual assault, harassment, stalking and sexualised comments, highlighting the significant issue of abuse encountered by healthcare professionals. Another survey revealed that almost one in three female NHS surgeons experienced sexual assault, with 11 instances of rape reported among the study participants. The survey also indicated that 29% of female surgeons encountered unwanted physical advances at work, while over 40% received uninvited comments about their bodies, and 38% experienced sexual “banter” in the workplace.
For members of the NHS workforce, Domestic Abuse extends beyond work, impacting both professional and personal lives. The study Healthcare Professionals’ Own Experiences of Domestic Violence and Abuse explores the global prevalence of DVA, revealing a significant lifetime rate among healthcare professionals (31.3%), with women experiencing it at 41.8% versus 14.8% for men.
Consequences include job challenges and barriers to seeking support. The study also suggests a higher abuse prevalence in healthcare professionals than in the general population, emphasising the need for specialised interventions. The ongoing PRESSURE study, a NIHR School for Primary Care Research-funded project, aims to improve policy and practice regarding support for healthcare professionals who have experienced domestic abuse.
In response to these concerns, NHS England introduced a new sexual safety charter, outlining ten commitments for organisations to ensure the safety of their staff. While this is a good start, organisations operating within the Violence Against Women and Girls (VAWG) sector, such as IRISi, firmly believe that there is room for additional policies within the NHS to improve the healthcare system’s response to gender-based violence.
12) Women’s health movement: transforming research and healthcare within the NHS
The women’s health movement in Britain, which emerged during the late 20th century, was a pivotal component of the broader women’s liberation movement. Its primary mission was to address various aspects of women’s health and well-being while advocating for significant societal changes.
A key focus of the movement was women’s reproductive rights, emphasising a woman’s autonomy regarding her body, which included advocating for access to contraception and safe, legal abortion. Additionally, the movement worked to challenge gender stereotypes that influenced women’s healthcare experiences, striving to establish a more equitable healthcare system. It also aimed to improve healthcare services tailored to women’s unique needs, such as gynaecological and reproductive health.
Moreover, the movement placed a strong emphasis on research and education related to women’s health conditions and the development of women-centred health education. Its influence played a substantial role in advancing women’s health and shaping healthcare policies and practices in Britain.
- How does the women’s health movement benefit health research in the UK?
The women’s health movement had a profound impact on research in women’s health. The movement raised awareness about gender disparities within the healthcare system, compelling the NHS to address the underrepresentation of women in medical research and healthcare leadership roles. Advocacy for research and education on women’s health led to increased funding and focused studies on women’s health conditions, ultimately resulting in better diagnostic and treatment options. The movement’s influence extended to public opinion and policymakers, driving changes in healthcare policies and practices within the NHS, particularly in addressing issues related to gender bias and discrimination. Additionally, research on violence against women, encompassing domestic violence and sexual assault, emerged as a critical area of study, serving as the foundation for informed policies and support services for victims.
Currently operational in over 50 areas across the UK, the IRIS Programme stands as a tangible outcome of invested health research focusing on women. Originating in academic settings, the model transitioned from concept to reality following a randomised controlled trial conducted from 2007 to 2010, involving urban primary care trusts in London and Bristol. The intervention, comprising training sessions, medical record prompts, and a referral pathway to a domestic violence advocate, yielded significant results published in 2011. The study showcased a noteworthy increase in recorded referrals and identifications of domestic violence in intervention practices compared to control practices, revealing a seven-fold difference in referrals received by domestic violence agencies.
Setting itself apart from conventional approaches, the IRIS model effectively identifies women experiencing violence in primary care, emphasising the importance of healthcare professionals in the response to domestic abuse and the unique role of advocate educators:
“We showed that the IRIS programme increased identification and referral and that clinician behaviour with regards to domestic violence, a major public health and healthcare issue that has largely been ignored in clinical practice, can be changed”.
The legacy of the women’s health movement continues to shape research, healthcare, and policies in the UK, ultimately benefiting the health and well-being of women across the nation. In March 2023, for example, the UK government allocated £25 million to expand women’s health hubs, offering tailored healthcare and support for women across England. Unfortunately, within this budget, there is no allocation planned for further research in Women’s Health or for implementing and sustaining evidence-based interventions that have demonstrated their effectiveness, such as IRISi interventions.
13) The last 5 years in the NHS response to Domestic Abuse – unveiling progress and ongoing challenges
The NHS plays a crucial role in addressing domestic abuse, engaging directly in various ways to support victims and survivors. According to the Department of Health, 80% of women in violent relationships turn to health services for help, often marking their first or only point of contact. Annually, nearly half a million individuals affected by domestic abuse seek assistance from medical professionals.
The Home Office highlighted the substantial economic and social cost of domestic abuse, exceeding £66 billion in England and Wales for the year ending March 2017. The amount surpassed the estimated cost of any other single type of crime, with £2.3 billion allocated specifically to healthcare services.
In March 2017, the Department of Health released “Responding to domestic abuse: A resource for health professionals“, aligning with recommendations from the NICE guideline “Domestic violence and abuse: multi-agency working“. These were just some of the resources launched throughout the years targeting NHS staff and service providers and aiming to assist them in improving their identification and response to potential victims and survivors.
However, a study published in the British Journal of Nursing in July 2020 explored why health professionals were still reluctant in screening women for domestic abuse. The research concluded that a prevalent obstacle was the “lack of training and education” within the healthcare sector. In her document “The Role of Healthcare Services in Addressing Domestic Abuse“, Melissa Macdonald noted that clinicians might avoid engaging in conversations about domestic abuse particularly when they sense a responsibility to “fix” the situation and face a lack of clear referral pathways to specialised support.
- NHS advancements in domestic abuse response: the Impactful role of the IRIS Programme
During discussions about the Domestic Abuse Bill, the INCADVA (Inter-Collegiate and Agency Domestic Violence Abuse) Forum submitted written evidence to express their concerns about the bill’s oversight – emphasising the absence of a call for a coordinated response to domestic abuse within the health system. According to them, the bill overlooked the critical role of the healthcare system in addressing domestic abuse, so they put forth specific actions for the Government to rectify this, including the implementation of:
The IRIS (Identification and Referral to Improve Safety) Programme. IRIS is an evidence-based intervention to improve the general practice response to domestic abuse through training, support to practice teams and having a DA specialist embedded in practices. It is nationally recognised as best practice and has informed NICE guidance.
IRIS is now included as best practice in the statutory guidance that accompanies the Domestic Abuse Act 2021 and features in “Domestic Abuse and General Practice”, a rapid read guide for all general practices developed by NHS England. IRISi’s flagship programme, IRIS is currently operational in more than 50 areas across the UK, having been recommended in a number of national guidelines. Through this model, over 30,000 patients, the majority women, were identified during consultations with clinicians in their general practice up to March 2022. These clinicians participated in IRIS to learn how to recognise signs of Domestic Abuse, respond appropriately and effectively and subsequently refer patients to the IRIS advocate educator within their area.
Born in an academic setting, this cost-effective model has proven its success in the real world since its implementation in 2010. A 2022 study, “The Social Value of Improving the Primary Care Response to Domestic Violence and Abuse: A Mixed Methods Social Return on Investment Analysis of the IRIS Programme” affirms its impact, concluding that, for every pound invested in the IRIS Programme, a monetary return of £16.79 and a social return of £10.71 are expected.
In the year ending March 2022, 93% of IRIS service users reported a reduction in their visits to see a GP or Practice Nurse. One woman shared her experience, stating, “This has been a liberating journey, from wondering what I had experienced after talking with my doctor, to fully understanding the type of abuse that I had been experiencing for YEARS!! This has been the best service”. The national report from IRISi for the same year highlighted most clinical staff expressing satisfaction with the IRIS training. A clinician emphasised, “This training is brilliant. We have plenty of women who suffered from domestic abuse but were neglected for some clinicians didn’t know the signs. From now on we need to be vigilant and to be aware of any issues”.
14) Addressing gaps: SARCs, sexual violence, and the urgent call for holistic support
Sexual Assault Referral Centres (SARCs) are specialised healthcare facilities offering comprehensive care to victims and survivors of sexual violence within the NHS across the UK. Providing services such as forensic examinations, crisis intervention, counselling, and ongoing support, these unities play a crucial role in aiding victims of sexual assault or rape. The inaugural Sexual Assault Referral Centre, The Haven, was established in Paddington, London, in 2000, and today there are over 40 SARCs across England, Wales and Scotland.
These centres have expanded nationally, delivering specialised services. However, a 2022 study revealed concerning trends: 56% of sexual assault survivors did not seek help, with fear of being believed to be a significant barrier (46%). Additionally, 44% were unsure where to seek help, and 72% were unaware of NHS support. This underscores the imperative need to raise awareness about SARCs, available 24/7 regardless of when the incident occurred.
• Understanding Sexual Assault in the UK
Rape Crisis reports a staggering statistic that 1 in 4 women in the UK has experienced rape or sexual assault as an adult, totalling 6.54 million women. Police records indicate 68,109 recorded rapes between July 2022 and June 2023, with charges brought in only 2.2% (1,498) of cases during that 12-month period. Shockingly, half of rapes against women are perpetrated by their current or former partners, and six in seven are committed by someone known to the victim.
The MESARCH project is evaluating SARCs in England, aiming to understand the benefits and costs for individuals who have experienced sexual assault. The research examines SARCs’ work, addressing gaps in knowledge about long-term support and survivors’ experiences. Early findings indicate a higher proportion of female survivors accessing SARCs, potential underrepresentation of ethnically diverse survivors, and differences in perpetrator types compared to the general population.
An accompanying infographic highlighted key findings about SARCs service users, revealing a significant gender imbalance, with nine out of 10 users over 18 being women, and indicates an under-representation of male victims. The data also shows that a substantial proportion of individuals have a history of self-harm, emphasising the depth of trauma. Mental health challenges are prevalent, with 42% of adults and 22% of children disclosing their experiences. Additionally, the infographic indicates the involvement of domestic abuse in the assault for 13% of adults and 5% of children. Lastly, substance use in assaults is disclosed by 16% of adults and 7% of children, adding a layer of complexity to these traumatic events.
While SARCs provide crucial immediate support following a sexual assault, research reveals the enduring and damaging effects on women’s mental and physical health. Both IRIS and ADVISE programmes acknowledge the persistent, seemingly unrelated symptoms experienced by survivors and train clinicians to recognise and respond to these thus improving patient care. However, depending on factors such as how comfortable or not they feel during consultations or the duration since the assault, survivors may not disclose these experiences unless prompted by their clinician. Asking is the initial step, but it’s not enough. A well-established referral pathway is essential, ensuring that victims and survivors have the opportunity, at any point in their journey, to access the support needed for recovery.
15) Milestones in menopause healthcare: a journey through NHS services
In the earlier years of the NHS, menopause was not explicitly recognised as a specific health issue. However, as awareness grew regarding the physical and emotional challenges associated with menopause, healthcare professionals began to address it more systematically. During the 1990s and onwards, the NHS developed services and resources to provide support and information to women navigating menopause. This included the creation of informational materials, online resources, and helplines to address questions and concerns related to menopause.
In the 2000s and onwards, the NHS took significant steps in developing guidelines and training programmes for healthcare professionals. This aimed to enhance their understanding and ability to address the needs of women experiencing menopause. Education for doctors, nurses and other healthcare providers became crucial in covering topics such as menopausal symptoms, hormonal changes and available treatment options.
Around the year 2002, Hormone Replacement Therapy (HRT) became a focal point of discussion and research within the NHS. Guidelines were established to help healthcare professionals make informed decisions about prescribing HRT. Starting in the 2010s and continuing onwards, the NHS has placed a strong emphasis on lifestyle factors in managing menopausal symptoms. Advice on diet, exercise and overall well-being has been integrated into the guidance provided to women, promoting a holistic approach to navigating this life stage.
From the 2010s onwards, the NHS has incorporated menopausal healthcare into general women’s health services. This ensures that women receive comprehensive care addressing their needs at every life stage, marking a significant milestone in the healthcare approach to menopause.
The research article “Vision for Menopause Care in the UK” also highlighted the pivotal role of the 2015 NICE guideline in transforming menopause care. This guideline, backed by thorough expert analysis, ensures that Healthcare Providers can offer women evidence-based information for informed decision-making about treatment options.
However, challenges persist due to budget constraints in the Department of Health and Social Care and a lack of prioritisation for mid-life women’s health. This has resulted in a noticeable absence of comprehensive UK-wide menopause services, emphasising the need for increased attention and resources for the well-being of women during this life stage.
- Is there a connection between menopause and domestic abuse?
According to the “‘Stuck in the Middle with You“‘ project, research on mid-life women facing domestic abuse in the UK is quite limited. Despite a concerning statistic that 38% of women killed by their partner or ex-partner are aged 36-55, comprehensive studies are lacking. This project, a groundbreaking initiative by Against Violence and Abuse (AVA) in partnership with IRISi and conducted from 2020 to 2021, was the first of its kind in the UK to explore the link between menopause and domestic abuse and it found evidence that “women experiencing domestic abuse in mid and later life may face similar rates of domestic abuse but substantially more barriers to accessing specialist services than younger women”.
Guidance was developed through this initiative to provide advice and recommendations for general practice staff and clinicians to identify and address possible signs of DA in women experiencing menopause. The “Menopause and Domestic Abuse: Brief Guidance for Staff and Clinicians in General Practice” was informed by focus groups of women who have experienced violence and abuse, and underscored the potential link between domestic abuse and worsening menopause symptoms. Key actions for healthcare professionals include integrating domestic abuse inquiries into menopause-related appointments, addressing barriers to disclosure, utilising follow-up appointments for support, and providing appropriate referrals to specialist services. The guidance also highlights the impact of menopause on relationships and suggests proactive steps for healthcare teams, such as training, improved staff support, and consideration of women’s lived experiences – all incorporated into IRISi’s interventions.
16) Trailblazers in women’s health: pioneering figures in the history of the NHS
These women have left a lasting legacy within the NHS, shaping its history and impact on healthcare in the United Kingdom.
• Dame Josephine Barnes:
Pioneering obstetrician and gynaecologist, Dame Josephine Barnes, significantly contributed to women’s health in the UK, particularly in advancing family planning and contraception.
• Professor Dame Lesley Regan:
Renowned obstetrician and gynaecologist, Professor Lesley Regan, is a strong advocate for women’s reproductive health and fertility. Appointed as the government’s first Women’s Health Ambassador for England in June 2022.
• Dame Jane Dacre:
Physician and academic, Dame Jane Dacre, has been a proponent of women’s representation and equality in the medical profession, contributing to medical education and healthcare leadership.
• Professor Dame Lesley Fallowfield:
Clinical psychologist, Professor Dame Lesley Fallowfield, is known for her research on the psychological aspects of breast cancer and women’s health, enhancing understanding of emotional well-being during medical challenges.
• Professor Louise Howard:
Professor Louise Howard is a prominent figure in the field of women’s mental health. As a psychiatrist, her work focuses on understanding and addressing mental health issues affecting women, making significant contributions to the intersection of mental health and women’s well-being.
• Professor Marianne Hester:
Professor Marianne Hester is a distinguished academic and healthcare professional specializing in domestic violence and abuse. As a sociologist and researcher, she has made significant contributions to understanding and addressing domestic abuse, including its impact on health. Her work includes research, advocacy, and the development of policies and interventions to support those affected by domestic violence.
IRISi: pioneering interventions for a comprehensive healthcare response to Gender-Based Violence
Within the realm of gender-based violence (GBV), all topics covered here find a dedicated focus in the groundbreaking interventions developed and implemented by IRISi. Established in 2017, IRISi is a social enterprise working to enhance the healthcare response to GBV. In collaboration with partners, we craft pioneering evidence-based interventions, offer expert advice and provide consultancy services in the field of Domestic Abuse (DA), tailored to diverse healthcare settings.
IRIS: impacting general practices
A collaborative effort between primary care and third-sector domestic abuse specialist services, IRIS is our flagship programme, and it provides ongoing training, education and consultancy for clinical and administrative staff. Key areas of focus include practitioner care pathways and an enhanced referral process to connect patients with a named specialist in a local DA service.
Evaluated in a randomised controlled trial, IRIS is designed on a survivor-centred model and significantly increases the healthcare response to DA. It guarantees that every patient identified and referred receives comprehensive support tailored to their individual needs. Ongoing evidence demonstrates a continuous increase in referrals from general practice for patients affected by DA, underscoring the critical need for sustained funding to maintain these positive outcomes.
Nationally recognised and evidence-based, the IRIS programme presents a cost-effective intervention for Integrated Care Boards (ICBs) and other commissioning bodies. Its positive impact extends beyond healthcare awareness, improving the safety, quality of life and well-being of survivors.
ADViSE: Extending success to sexual health clinics
Building on the success of IRIS, the ADViSE programme extends its reach to sexual health clinics, empowering clinicians to identify and respond to patients affected by Domestic & Sexual Violence and Abuse (D&SVA). This evidence-based programme establishes a streamlined referral pathway to a named specialist in local frontline services.
Aligned with the demographics typically served by sexual health clinics, ADViSE facilitates the identification of a more extensive and diverse range of patient groups. It provides visibility and support for individuals from minority groups, addressing a crucial gap in care.
Similar to IRIS, the programme strengthens local networks, increases safety, and boosts staff confidence in responding to D&SVA. Given that women affected by Domestic Abuse are three times more likely to face gynaecological and sexual health problems, ADViSE addresses this gap by successfully training sexual health practitioners to identify, respond and refer effectively.
IRISi’s programmes are fundamentally aimed at destigmatising and reducing the underreporting of Domestic Abuse and Sexual Violence in healthcare settings. We firmly assert that these settings and the professionals working in them are pivotal in reshaping social and cultural norms to empower survivors to speak out and know that they will be heard, believed and offered a route into specialist support. Our mission extends beyond intervention; we are committed to heightening public awareness and advocating for support to ensure the rights and well-being of victims are prioritised.
