Social changes over the last century have given women access to many professional opportunities. However, COVID shone a harsh light on deeply ingrained gender disparities. While COVID lockdowns were hard for everyone, they placed a particularly heavy burden on working women who bore the brunt of homeschooling children and caring for elderly relatives on top of their usual responsibilities. Deloitte reports that women are now facing alarmingly high levels of burnout.
The pandemic’s disproportionate effect on women
Attending to one’s health involves a commitment of time and, often, money. Both are in increasingly short supply thanks to the pandemic.
The Australian Medical Association (AMA) notes that 80% of front-line healthcare workers tasked with managing the pandemic were women and that, ‘As pandemic-related work responsibilities increased, women were more likely to manage increased childcare and schooling obligations, coupled with disproportionate household responsibilities, even among dual-earning couples.’
That has a knock-on impact. The Jean Hailes’ Women’s Health Survey 2020 Snapshot found that 1 in 3 women aged 25-44 did not have enough time to attend health check appointments. When they did try to prioritise their health, 1 in 4 women could not get an appointment when they needed one.
Then there’s the affordability of care. Australia has a hybrid health system, sitting somewhere between the UK and US models with both public and private providers. Some services are free while others require payment.
The cost of living is rising in Australia, affecting family budgets in everything from housing costs to grocery shopping. Australia’s National Research Organisation for Women’s Safety surveyed 10,000 Australian women between February and April 2021 and found that 31% had lost their job, had to take a pay cut or reduce their hours in the first 12 months of the pandemic. As a result, women reported a number of financial difficulties, including having to go without necessary medical or dental treatment.
These pressures caused a groundswell of discontent that is thought to have influenced the outcome of the 2022 federal election. Annabel Crabb observes,
When COVID hit, who was simultaneously the most likely to lose paid work and the most likely to take on more unpaid work? Women.
Who was more likely to work in the low-paid sectors of whom Australia asked so much in the pandemic – aged care workers, cleaners, teachers? Women.
Who did the lion’s share of supervising children in lockdown, caring for elderly relatives, and coping with the explosion of anxiety and despair among adolescents? Metrics abound to confirm that it was women, again.
Dianne Hill, CEO of Women’s Health Victoria, does not believe things have improved much since the lockdowns ended.
Women have continued to experience barriers accessing services in some ways similar to during lockdown – services still having staff shortages due to COVID and women themselves having difficulty finding the time to look after their healthcare needs.
Now the recently released 2021 Census data shows a significant disparity between women’s and men’s self-reported mental health status. In the response to the first-ever question about chronic conditions in the Census, 352,354 women stated that they had a mental health condition including depression and anxiety compared to only 218,595 men.
This was no surprise to Women’s Health Victoria. Dianne Hill states that,
Now more than ever we need more and better services that can support women’s mental health and wellbeing using a gender lens including trauma-informed and trauma recovery services.
So, where to now? Which health services are women struggling to access? And how can healthcare planners create the capacity to improve women’s access to timely care?
Timely access to care for women’s health needs
Effective medical treatment relies, among other things, on timely access to care. Delayed diagnosis and treatment are often linked to poorer health outcomes. That’s a sobering thought given that some hospitals have had to suspend elective surgery once again due to a spike in both COVID-19 and influenza cases during the winter of 2022.
Breast and cervical cancer screening and treatment
In 2021, Cancer Australia published a report analysing the pandemic’s impact on cancer-related medical services and procedures in 2020. The report examined 14 cancer types, including many of particular relevance to women such as breast, uterine, cervical, vaginal and vulval cancers alongside colorectal, lung, skin, stomach, kidney, liver and pancreatic cancer. The only one not relevant to women was prostate cancer.
The report found that there was an 8% drop in cancer-related diagnostic procedures in 2020 – 163,595 fewer services recorded. Those figures are for 2020 only and do not take into account the 2021 lockdowns in Victoria, NSW and the ACT. As Professor Dorothy Keefe, the CEO of Cancer Australia states,
Any potential delays in diagnoses and treatment in response to these reductions in services may lead to more cancers being diagnosed at a later stage and poorer outcomes for some patients.
Once a suspicious breast lump is found, the wait for biopsy or excision is relatively short. The Australian Institute of Health and Welfare (AIHW) reports that, of the 25 most common surgeries, the shortest median waiting time (16 days) is for breast lump excision or biopsy.
The bad news here will be the hidden waiting list – those patients who would normally be identified early in their disease course through routine screening but who missed that opportunity due to the pandemic.
In April 2018, approximately 74,000 mammograms were carried out, compared to a national total of just 1,100 in April 2020. The six months from January to June 2020 saw around 145,000 fewer screening mammograms performed than compared to the same period in 2018. As restrictions eased, the number of mammograms increased, with about 12,000 more than usual performed from July to September 2020 compared to the same reporting period in 2018.
That leaves a large number of women who did not receive a screening mammogram in 2020. As the AIHW notes,
COVID restrictions also appear to have affected the uptake of breast ultrasound, mammography, breast MRI and colonoscopy…The full impact of the COVID pandemic on cancer diagnosis and treatment will not be known for several years.
Estimating COVID’s impact on cervical screening is more difficult as 2020 was also the first year impacted by the change from 2-yearly to 5-yearly screening. The number of tests fell significantly from approximately 70,000 in w/c 30 March 2018 to around 10,000 in w/c 30 March 2020. How much of that is due to program changes and how much is due to COVID remains to be seen.
Early cervical cancer can often be treated by hysterectomy, which involves removing the uterus and cervix, and occasionally the fallopian tubes and ovaries. A hysterectomy may be used to treat endometrial, cervical, ovarian and uterine cancers. It is telling, then, that the number of hysterectomies dropped during COVID. Nearly 11,500 women were admitted for a hysterectomy in 2016-17 while just 8,730 women had one in 2019-20, rising only slightly to 9,650 in 2020-21.
Endometriosis diagnosis and treatment
Endometriosis is a chronic, progressive condition in which cells similar to those that line the uterus are found around the pelvic and reproductive organs. Thought to affect 10% of women of reproductive age, endometriosis is painful and debilitating and can reduce a woman’s fertility.
A laparoscopy is a surgical procedure that can diagnose and treat endometriosis. Waiting times for this procedure are growing in Australia’s public hospitals.
In 2019-20, the median waiting time for laparoscopy was 64 days. That rose to 79 days in 2020-21.
In 2019-20, 2.5% of patients waited more than a year for their procedure. In 2020-21, that had more than tripled with 8.1% waiting more than 365 days.
Kasharna Fyfe is one of those women. Her GP first referred her to the hospital in 2019. In February 2022, she had still not been given a date for her procedure. That delayed care means she spends several days a month in bed with crippling pain and worries about her chances of falling pregnant when it’s time to start a family.
Indeed, 1 in 3 women using assisted reproductive technology has endometriosis. About two-thirds of those women knew they had the condition before they started reproductive treatment. However, the remaining women (34%) started fertility treatment with undiagnosed endometriosis, unaware of why they were struggling to get pregnant. Sadly, those women are 33% less likely to have a baby. It’s no wonder that women with endometriosis have higher levels of depression, anxiety and stress than both the general population and people with other common chronic conditions.
Not just a COVID problem
The AMA has described these lengthening waits for elective surgery as ‘the continuation of a worrying trend’.
In its ‘Clear the logjam’ campaign, the AMA decried the state of public hospitals stating that,
A lack of government funding is resulting in public hospitals that are in logjam – with ambulances ramping, emergency departments at capacity, and long waits for essential surgery. There are just not enough beds or staff to deal with the demand.
This isn’t just a COVID problem. And it isn’t new. The performance of our public hospitals has been declining for several years and after years of continued neglect, they are now at breaking point.
Flexible solutions to improve access to care
Women’s health needs may create higher demand for surgery and other services for some time to come, as the impact of delayed screening tests and suspended procedures continues to be felt. It also seems that Australia may be experiencing a COVID-induced baby boom. And those babies have to be delivered somewhere.
Beds and staff are the two big obstacles to increasing capacity, according to the AMA.
One of the most effective ways to ease waiting list pressures so that more women can be treated is to create additional onsite capacity using mobile and modular Healthcare Spaces.
Mobile and modular healthcare facilities can be used to augment the existing hospital estate, with rapidly installed solutions in place in just a few months, creating additional surgical capacity. These can also be used to create additional maternity capacity as the Wilhelmina Hospital in Assen did. The fully equipped delivery room was seamlessly linked to the main hospital and 125 babies were born there throughout the duration of the contract, relieving strains on existing maternity services.
The Victorian government’s COVID catch-up plan includes the creation of Rapid Access Hubs across metropolitan public hospitals to streamline surgical theatres, equipment and staffing.
This builds on the UK’s response to COVID. Surgical hubs were introduced to address the growing waiting lists for elective care, which had been steadily building before 2020 and then skyrocketed when elective surgery was suspended. These standalone surgical hubs have formed a crucial part of healthcare planning in an era of increased infection control. Standalone surgical hubs enable the separation of confirmed COVID-negative elective surgery patients from emergency admissions (who may be COVID-positive) through the creation of green pathways. This model allows for the continuation of elective surgery while reducing the risk of patients contracting COVID.
If you would like to explore how Q-bital Healthcare Solutions could help improve capacity for women’s health needs, please contact the Q-bital Australia team.