The new Labour government is busy looking for ways to depart from the Conservativesâ legacy. One target may well be the 2022 womenâs health strategy for England, an underfunded package of insufficient medical offerings that sidestepped important questions about inclusivity and narrowly constrained womenâs health to conditions affecting the uterus, ovaries and breasts. As if women donât have other body parts that go wrong. It is tempting to see the strategy as a smokescreen for how badly the Tories have let women down: widening gender pay disparities, leaving half a million people stuck on gynaecology waiting lists, prompting fear about maternity failings, burdening women with childcare constraints and excluding them from political decision-making.
In Sick of It, Sophie Harman expertly shows that failings at home are mirrored and magnified across the globe. For all the talk about the importance of womenâs health, âno country has broken a trade deal, a special relationship or sanctioned countriesâ over the wellbeing of women and girls. A professor of international politics specialising in global health, Harman is perfectly placed to explain the forces that shape womenâs health, from Kenya and Sierra Leone to Washington and Geneva. Harman highlights the misapprehension that womenâs health is a âneutral scientific space free from politicsâ, where leaders follow the data and deliver what works. Instead, womenâs health is often used as mere âdiplomatic brandingâ. Sick of It exposes how women are exploited as recipients of aid and medical treatment, as healthcare workers and unpaid carers, and as female leaders outnumbered by men.
Womenâs health is a currency of power and influence. In Rwanda, over the last 25 years, Harman describes how Kagameâs government publicly prioritised maternal outcomes to âhealthwashâ atrocities of oppression and killing. Success stories such as an 85% reduction in maternal mortality, huge improvements in HIV care and world-leading immunisation against HPV attracted global business, foreign aid and complicity from world leaders. Using womenâs health as flattering lighting in Rwanda was too readily condoned because the outcome improved some womenâs lives. But as Harman reminds us, authoritarian governments tend to âration who does or does not get access to healthâ, exercising its services âby fear not trustâ.
Meanwhile, as the largest provider of aid, the US offers assistance with strings attached. Since Ronald Reagan, Republican governments have imposed a âglobal gag ruleâ that dictates no foreign organisation can receive money for family planning and reproductive health if they also offer or discuss abortions. US support becomes contingent on women dying from illegal terminations, unwanted pregnancies and complications of childbirth. This coercion worsens a precarious situation as ânearly half the women in the world have no, or very restricted, access to abortionâ. As Harman concludes, âwomen donât have to die because America sneezes its politics into the worldâ. But with every rightwing US government, they do.
Even when money flows, foreign agendas distort the true health needs of recipient countries. Not all women are seen as equal. âSaving mothersâ is a popular womenâs health slogan that has mobilised billions of dollars. Mothers arenât supported for their own sake, though, says Harman, but rather because they look after young and old. As global philanthropist Melinda French Gates put it: âIf you invest in women, they invest in everyone else.â Just as there is a stereotype of virtuous recipients of aid, there is also a cliche of virtuous healthcare delivery: by underpaid or even unpaid local women carrying their communities as âboth the fixers and shit-catchers in global healthâ. Harman emphasises that no health policy would succeed without this invisible workforce. And even among those who are paid, abuse is an inevitable occupational hazard. From Uganda to the UK, clinicians and female employees at every stage of healthcare delivery are at risk, to the point where âviolence against health workers needs to be seen for what it is: gender-based violenceâ.
Reading Harmanâs powerful narration and detailed analysis of case after case of womenâs dispossession cannot but leave you angry. As Ebola spread, women were sexually abused and exploited by the World Health Organization and Oxfam health workers who were meant to be there to help. Before October 2023, pregnant Palestinian women were dying because of understaffed and underfunded hospitals in Gaza and the West Bank. Forced to use Israeli facilities, women died at checkpoints waiting to get to them. Harman forcefully condemns the alleged targeted bombing of Palestinian maternity hospitals over the last nine months as not just âcollateral damageâ of war, but a direct attack on Palestineâs future. Global health charities continue to operate without a âcharter of patient rightsâ, which means photographs of vulnerable women taken in moments of desperation can be bought as stock images. To increase charitable donations, female victims are then expected to share their stories with just the âright amount of trauma and redemptionâ to prompt western women to reach deep in their pockets.
Harman delivers this devastating diagnosis with a powerful prescription for change. I cheered along with her central message that women must be believed and that society needs to be ready to hear their testimony. When sceptics ask: âBut what about the men?â Harman underlines that this filibustering should be challenged as a deliberate attempt to distract women. Expertise on gender, such as Harmanâs own, needs to be threaded through global health work rather than belatedly added as a rubber stamp. While being careful with our own health data, women should insist on data collection that sincerely tries to understand sex and gender dynamics in places where the world often chooses to look away â whether thatâs the stark racial inequities in medical care or impaired quality of life from disability.
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I also wanted to agree with Harmanâs stance that we should ânever advocate for womanâs health as a means to something elseâ because that is to âdevalue the lives and health of womenâ, but this gave me pause, as a clinician, academic and a patient. What happens in the meantime between the chaos of global womenâs health as it is and what it could be? Should all philanthropy that comes with provisos be rejected? Should funding from companies that enjoy the PR boost of helping women as well as their bottom line be criticised? Harman too quickly minimises the work of âcounting the women who sat on panels, authored publications and participated in clinical trialsâ.
And there is value in the 2022 womenâs health strategy, despite its many shortcomings, it remains one of the most substantial offerings on the issue in this country for generations. It has improved lives, opened access to contraception and menopause support, to menstrual education and to sexual and reproductive healthcare. For Labour to discard this imperfect piece of work, contaminated as it might be by agendas of the past, would be foolish. Women will be best served by leaders who are prepared to improve what already exists, to fail again and fail better.
Kate Womersley is a doctor and academic specialising in psychiatry. Her work at Imperial College London focuses on sex and gender equity in biomedical research