Leading women’s health specialist, Dr Anne Connolly is no doubt one of the leading voices on tackling iniquities in women’s health: she has received an MBE for services to Women’s health in the 2021 Queens Birthday Honours list, is a founding member and Chair of the Primary Care Women’s Health Care Forum (WHCF) where she established the campaign #rockmymenopause (www.rockmymenopuase.co.uk) to breakdown taboos for women to talk about and live with the menopause, she is women’s health champion for the Royal College of General Practitioners and has recently been selected to feature in #WorldWomansHour – one of just 60 global ‘Leadhers’ selected by the World Woman’s Foundation to do so. But there is nowhere Anne sees the real-world impact of these iniquities more than in her work as a GP at Bevan.
Bevan is an inclusion health practice providing primary care and wellbeing to people who typically experience social barriers to accessing such services. These include people experiencing homelessness, sex working women, refugees, and asylum seekers.
“There are many inequalities women experience because of pregnancy, period or menopausal problems. But there is also an iniquity within the iniquity for those women we care for at Bevan who are socially excluded already and then experience even further barriers or even trauma because of their experiences as women” Dr Anne Connolly, MBE
You only need to look at statistics to find support for these statements. Consider that refugee and asylum-seeking women comprise just 0.5% of the population but account for 14% of all maternal deaths in the UK (Helping refugees and asylum seekers to find healthcare – Refugee Council).
“In addition to poverty and other issues that all refugees may face, women refugees have an added layer of oppression from gender discrimination.” (UNHCR – The Global Report)
Or consider that whilst generally women tend to live longer than men, the reverse is true for homeless women. 43 is the average age of death for women experiencing homelessness compared to 47 for men. In the general population it is 74 for men and 80 for women. (About Homelessness | Crisis UK)
Take Fatima, a Bevan patient who is seeking asylum in the UK. At home in The Gambia Fatima experienced forced marriage, domestic violence, sexual exploitation and was subject to Female Genital Mutilation (FGM). Fatima’s traumatic experiences have had significant impact on both her physical and mental health.
Another Bevan patient, Jess, became addicted to heroin as a young woman under the influence of an older and controlling partner, became a sex worker and found herself dependant on her partner, who became physically and emotionally abusive, for a roof over her head.
Whilst Fatima and Jess are from hugely different backgrounds, their stories are both ones that have seen them face even greater hardship because of gender related iniquities faced by women around the world.
Bevan are a GP practice who take a holistic approach to the care and rehabilitation of their patients. They will only take on patients from socially excluded groups, those who typically face barriers to registering with a GP for example. Many people believe you need an address or an NHS number to register with a GP but this is not the case and Bevan staff are trained to understand the rights of those experiencing homelessness or asylum seeking. Bevan also have translators on hand and are at the forefront of developing a range of resources to help those newly arrived in the UK to understand their rights to NHS care.
Bevan also understand that people experiencing homelessness can find themselves trapped in a cycle of addiction and mental health issues that can make escaping homelessness so hard (Health of Homelessness | The BMJ) and so they treat the whole person, not just their medical needs. Their team of social prescribers will link patients into the social or wellbeing services they may need to rebuild their lives. For those who need it, Bevan will provide one to one trauma informed psychotherapy sessions while Bevan’s Wellbeing centre offers a range of classes to help patients have a quality of life that gets and keeps them on track, classes include yoga, pottery, help with job applications.
In addition, Bevan pioneers projects like SHIPs – a digital inclusion project which aims to address digital barriers to accessing healthcare, (something which was exacerbated by the swift shift to remote and digital during the pandemic). Starting Well is another, it seeks to address inequities in access to preconception care and so help optimise the physical, social, and mental wellbeing of women prior to or after conception with the ambition of improving pregnancy outcomes and giving children the best start in life. Both projects also provide opportunities for patients to volunteer which helps to equip them with transferable skills and rebuild their lives.
Both Fatima and Jess now volunteer as peer advocates on the SHIPs project – a model built by Groundswell (Homeless Health Peer Advocacy (HHPA) – Groundswell) which means they use their lived experience to help others. Supported by Bevan and through their own resilience and tenacity, Fatima and Jess are well on track to rebuild their lives and their futures’ look bright:
“My aim is to advocate for women who are at risk of or have experienced FGM. I experienced FGM and it has caused so much pain and suffering – all in silence – and I want to encourage people to talk about it and how damaging it is. I feel I must find a platform to change people’s attitudes. It would make me so happy to do this work, it is everything I want to achieve in life. I have thought about the steps I will take to do this. I am looking into applying to go back to university. I feel supported now.”
Fatima, Bevan Patient“I used to be full of fear, but through the help of good people I began to believe in myself again. I am volunteering and I am writing poetry pretty much every day now. It helps me make sense of what I’ve been through, and I want to tell my story to take away the taboo and to help others who find themselves in my situation know that they can get out of it. That they can rebuild their lives.”
Jess, Bevan Patient