CMO calls for measures to improve women's health

A new report by the Chief Medical Officer Dame Sally Davies makes a series of recommendations to improve women's health in the UK.

Leading academics from across King's Health Partners contributed to a number of chapters in the report, focusing on health measures to improve reproductive success and pregnancy outcomes, prenatal screening, postnatal care, perinatal mental health and the experience of menopause.

Professor Lucilla Poston, Head of the Division of Women's Health at King's College London, contributed to a chapter of the report which highlighted the importance of health in adolescents and young people in mitigating the risk of disease in the next generation. Most young people make no preparation for parenthood and are unware of the need optimise preconceptional health especially in relation to modifiable risk factors such as obesity, poor diet and smoking. Professor Poston said 'the report has highlighted an urgent need for restructuring of health care for adolescents and women planning pregnancy'.

Professor Andrew Shennan, Professor of Obstetrics at King's College London and Consultant Obstetrician at Guy's and St Thomas' NHS Foundation Trust, was part of the group advising on prenatal screening, and reviewed the chapter which highlighted the high clinical and other costs related to poor outcomes around pregnancy, along with the need to develop tests to identify those in need of care. The group identified areas requiring further resource, particularly research, which included fetal growth restriction, preterm birth, gestational diabetes, and the mechanisms of complicated births. Many of the 7,000 babies that currently die in pregnancy could potentially be saved by identifying those at risk.

Professor Debra Bick, Florence Nightingale Faculty of Nursing & Midwifery at King's College London was lead author of the chapter addressing missed opportunities for postnatal care, where current health guidance does not address interventions to reduce the risk to women's future health of poor pregnancy or postnatal outcomes.

Professor Bick said: 'Postnatal contacts should offer opportunities to identify and implement effective care to reduce maternal morbidity and promote longer-term physical and mental health, including outcomes of subsequent pregnancies and family health. Current service provision and content is not utilising these opportunities and revision is urgently needed.'

Professor Louise Howard, Professor in Women's Mental Health from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and Consultant Perinatal Psychiatrist at South London and Maudsley NHS Foundation Trust, was lead author of the chapter on perinatal mental health. This chapter highlights the need to address barriers to implementation of NICE guidance on antenatal and postnatal mental health care through more comprehensive training of staff and better integration of physical and mental health care. The inequity in access to specialist perinatal mental health services in different regions across England is also highlighted.

Professor Howard said: 'Mental health problems are more common than physical health problems in pregnancy and the postnatal period, but commissioners of maternity and postnatal care focus on physical health, with very limited access to perinatal mental health services in some parts of the UK. I hope this report, and the work currently being carried out by NHS England, will lead to improvements in access to care for the full range of perinatal mental health problems - mild to severe – and thus improve outcomes for women and their families.'

A chapter co-authored by Professor Myra Hunter, Emeritus Professor of Clinical Health Psychology at the IoPPN, considers psychosocial factors that influence women's experience of menopause. The report suggests strategies to improve quality of life, for example increasing awareness amongst managers and offering practical support in the workplace.

Professor Hunter commented: 'The menopause should be considered in a psychosocial and cultural context. We recommend the provision of evidence-based and balanced information, both before and during the menopause, to counter overly negative expectations and stereotypes and to promote health and wellbeing. For women who have troublesome symptoms, non-medical approaches, such as cognitive behavioural therapy, can also be effective.'