A d v ic e Pa p er
O ctober 2 0 1 3
Women, work and care; a challenge for the 21st century
In February 2013, the Royal Society of Edinburgh hosted a two-day inter-disciplinary conference on Women’s Reproductive Health Across the Lifecourse. This conference brought together clinicians, policy makers, scientists, social scientists and other stakeholders to consider and debate women’s reproductive health. The purpose of this conference was to consider evidence, from diverse perspectives, relating to reproductive health, and to discuss the wider implications of this for health and social policy generally, and for the medical, clinical and academic workforce of the UK specifically.
Recommendations to the Scottish Government
• A lifecourse approach to women’s healthcare: The Scottish Government should work to develop a lifecourse approach to women’s reproductive and post-reproductive health which raises its visibility as a concern. A gendered approach to policy making: The Scottish Government should commit to taking a gendered approach to policy making, to ensure that policy with relevance for the whole of society is responsive to the experiences of men and women.
Recommendations to the Scottish and UK Governments
• Increased provision for high-quality, flexible and affordable childcare: The Scottish and UK Governments should develop a strategy which is focused on enabling men and women to balance their caring roles with their professional/working lives, and which places the availability and affordability of high quality, flexible childcare for pre-school and school-age children at its centre.
Recommendations to employers and tertiary education providers
• Educational and early career trajectories that are compatible with childbearing: Employers and tertiary education providers should work towards an environment in which childbearing is made compatible with further and higher education, and continued professional development, thus facilitating less constrained reproductive choice. Employers support women and men in their caring roles: Public, private, and third sector employers should work to facilitate an environment in which women and men are supported in their caring roles; and in which women and men feel that the value of their caring roles is recognised.
A d v ic e Pa pe r 1 3 – 11
A challenge for the 21st Century
Women play a vital role in the workforce of the UK, and constitute a larger proportion of that workforce than ever before1. The contribution made by women in all sectors is crucial, not only for women’s own careers and professional development, but also for the economy as a whole. Equality legislation has sought to ensure that women are provided with opportunities in their employment equal to those of men. However, it remains the case that women’s workplace participation has yet to be fully incorporated and supported from a policy perspective. Women experience a unique set of countervailing pressures related to their reproductive health and wellbeing which, until recognised and mitigated by effective policy and practice, will remain invisible.
invisible from a policy perspective. Furthermore, as age at first sex declines, age at first childbirth increases and smaller family size becomes the norm; most women spend thirty or more years of their life trying to avoid unwanted pregnancy. Whilst modern contraception is effective and easy to use, the need for it does impose another burden on women who still have to attend their doctor on a regular basis for contraceptive supplies and follow-up. Because women are now working until later in life, health issues relating to the menopause are also becoming increasingly relevant for women in the workplace. Symptoms (of peri-menopause) impacting upon lifestyle include hot flushes and night sweats; aching joints; urinary problems and mood changes3. For women with severe menopausal symptoms, there may be a significant impact on wellbeing and lifestyle as well as on the risks of serious disease in later life. There is a need for greater recognition of women’s reproductive health across the whole lifecourse and not just in relation to maternal health. There is also a need to focus on the work-place as a site for promoting women’s health and wellbeing.
The policy landscape: what needs to change?
Approaches to women’s healthcare needs
At present, women’s reproductive health is understood primarily in terms of maternal health, with the majority of available support and intervention occurring in a medical setting, at the time when a woman first becomes pregnant or begins trying to become pregnant. As a result, many of the health issues affecting women in the workplace have become invisible. These health issues include menstrual cycle-related problems such as heavy bleeding, endometriosis, and fibroids, which can lead to painful periods and negatively affect quality of life and workplace activity2. The relevance of cycle-related problems for women’s quality of life and workplace activity is becoming increasingly apparent in the UK and other developed nations, due to the fact that women are now typically having fewer pregnancies and more periods. There is a need for a greater medical understanding of cycle-related problems, and more options for the management of these problems by women. At present, the most effective treatments for cycle-related problems are often surgical and irreversible and may have unacceptable consequences for women, especially for those who have yet to start a family. As a result, many women must manage cycle-related problems alongside their working lives and other commitments; this challenge is largely
The Scottish Government should work to develop a lifecourse approach to women’s reproductive and post-reproductive health that raises its visibility as a concern. This should include taking advantage of opportunities for sign-posting early indicators of health risks, and taking mitigating action4. An emphasis on promoting women’s health at work should underpin such an approach.
Educational and career trajectories
Contemporary educational and career trajectories still follow a traditional linear pathway, with periods of continuous formal education and training being followed by gradual professional progression. For women pursuing tertiary education followed by professional careers, the period of education and early career training often lasts into the late twenties or early thirties. Career and financial security is unlikely to be reached until a woman is in her mid to late thirties, meaning that more women are now delaying pregnancy decisions and childbearing until their thirties and early forties.
1 According to a 2011 report by the UK Government ‘Women on boards’, women now form 51% of the UK population and 46% of the economically active workforce; https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/31480/11-745-women-on-boards.pdf 2 Women’s Reproductive Health Across the Lifecourse – implications for public policy, Royal Society of Edinburgh, ISBN: 9780 902198 96 8 3 Women’s Reproductive Health Across the Lifecourse – Implications for Public Policy, Royal Society of Edinburgh, 2013 4 A lifecourse approach to women’s healthcare is endorsed by the RCOG in their expert advisory group report High Quality Women’s Healthcare: a proposal for change, and by the MRC lifecourse epidemiology unit.
A d v ic e Pa pe r 1 3 – 11
Although this might be understood as a matter of active choice, such reproductive decisions are made in the context of specific constraints that limit available options. It is taking longer for women, especially those pursuing careers, to reach a stage of security typically deemed necessary for starting a family (being in a settled relationship and a homeowner). The economic recession and the associated negative impact upon housing, employment, income, public spending on childcare, and mobility are likely to have exacerbated this. An alternative trajectory towards earlier childbearing requires greater societal support, facilitating further and higher education and job prospects in the context of raising a family. This should include a shift away from linear career trajectories, whereby solid periods of education, training and work occur in consecutive blocks, and childbearing only seems feasible once a certain level of seniority is reached. An alternative approach with greater focus on life-long learning and continued training should be adopted. Greater flexibility to map periods of study and training around periods of childbearing and child rearing should also be actively promoted, for men and for women. women’s participation in the workplace is still disproportionately constituted by part-time work, as compared with men. Interruptions to linear career trajectories experienced by women as a result of maternity leave or periods of part-time working mean that they are less likely to progress to the highest paid positions within their chosen careers. As a result, the gender pay gap remains intractable. Inequity of access to longer maternity leave and affordable childcare mean that some women are more negatively affected than others by their caring roles. Women in higher paid and managerial positions are likely to have access to better maternity packages. They are also more likely to take advantage of formal childcare, meaning their workforce participation is less heavily penalised by motherhood than that of women who cannot afford this option. Working men and women need to be enabled to manage their caring roles – be this as parents or as carers for elderly relatives – alongside their working lives. There is a need for much greater availability of flexible and less than full-time working packages, so that working men and women can balance their dual roles as carers and professionals/workers. This needs to occur alongside a greater societal recognition of the importance of caring roles for society as a whole, especially given the demographic pressure of an ageing population that the UK currently faces. Workplace ethos should recognise the tensions and intersections between people’s professional, civic and family commitments, and working men and women should not feel under pressure to minimise the importance of their caring roles in order to appear committed and professional. Both men and women in the workplace should feel confident about taking up flexible and less than full-time working packages, without the fear that this will unduly hinder their career progression.
Employers and tertiary education providers should work towards an environment in which childbearing and child rearing is made compatible with further and higher education, and continued professional development, thus facilitating less constrained reproductive choice. • Place greater emphasis on part-time/flexible study, to allow men and women to manage study and early career training around periods of child rearing; • Ensure tertiary educational institutions are ‘family friendly’ towards students, with appropriate facilities and support.
Public, private and third sector employers should work to facilitate an environment in which women and men are supported in their caring roles; and in which women and men feel that the value of their caring roles is recognised. • Provide greater flexibility around working hours, including more part-time and flexible roles, and more opportunities for remote working; • Provide support, such as refresher courses, to reintegrate men and women returning to work after maternity/paternity leave and other career breaks.
Work place policy and practice
Equality legislation designed to remove gender inequalities negatively affecting women’s access to work does not always translate into effective workplace policy and practice. Women continue to take greater responsibility for domestic work and caring roles than men, whether they are simultaneously engaged in work or not. This is particularly the case in relation to childcare, but also applies to the care of elderly relatives. As a result of pressures to balance caring roles with professional life,
A d v ic e Pa pe r 1 3 – 11
The Scottish Government recognises that affordable, high-quality pre-school and school-age childcare would make it easier for some women to return to work, as do recommendations made in the RSE’s report on Women in STEM5. The increased provision of early years childcare introduced by the Children and Young Peoples Bill6 is a positive step. However greater provision for school-age children is still needed, to enable parents to balance their professional and parenting roles. with regard to when they have a family, and of what size, and the ability of women and men to participate in the workplace at the level they want to, are just some of the societal issues which can be affected by policy relating to women’s reproductive health. Whether women and men are constrained or enabled in these areas depends upon the policies and practices in place. Women’s health policy needs to reflect and respond to this range of medical and social experiences that affect women throughout their lives. For this to happen, women’s experiences need to feed into and inform policy decisions. Policy making needs to have a gendered lens to ensure that the experiences of women, at work and at home, gain visibility in policy development, implementation and practice. This must occur alongside recognition of the fact that policy relating to women’s reproductive health – including childcare and workplace policy – has significance for the whole of society, at every level. Policy relating to these areas therefore needs to be understood as policy with relevance for the whole of society, not just for women.
The Scottish and UK Governments should develop a strategy which is focused on enabling men and women to balance their caring roles with their professional/working lives, and which places the availability and affordability of high quality, flexible childcare for pre-school and school-age children at its centre.
Conclusion – a gendered lens, not ‘women’s policy’
The complexity of women’s experiences throughout their lives was demonstrated at the two day conference on Women’s Reproductive Health Across the Lifecourse, and is detailed in the report of the event7. A key message from this conference was that women’s reproductive health and wellbeing is impacted upon by a range of medical and social factors, and has far-reaching relevance for society as a whole. The ability of women and men to participate in their caring roles, the options available to women and men
The Scottish Government should commit to taking a gendered approach to policy making, to ensure that policy with relevance for the whole of society is responsive to the experiences of men and women. An expert body similar to the Women’s Budget Group should be established to cover health policy.
5 Tapping all our Talents - Women in science, technology, engineering and mathematics: a strategy for Scotland, Royal Society of Edinburgh publication, April 2011 6 The Children and Young People Bill, introduced to the Scottish Parliament on 17 April 2013, will increase the amount and flexibility of free childcare, from 475 hours a year to a minimum of 600 hours a year for all 3 and 4 year olds, and 2 year olds who are, or have been at any time since turning 2, looked after or subject to a kinship care order. 7 Women’s reproductive health across the lifecourse – implications for public policy, Royal Society of Edinburgh, 2013
Additional Information and References
Related RSE report: Women’s Reproductive Health Across the Lifecourse – Implications for Public Policy, Royal Society of Edinburgh, October 2013, ISBN: 9780 9021 9896 8 For any further information please contact the RSE’s Policy Advice Officer, Elizabeth Hemsley (Email: firstname.lastname@example.org)
The Royal Society of Edinburgh (RSE) is Scotland’s National Academy. It is an independent body with a multidisciplinary fellowship of men and women of international standing which makes it uniquely placed to offer informed, independent comment on matters of national interest.
The Royal Society of Edinburgh, Scotland’s National Academy, is Scottish Charity No. SC000470