Greater openness about women’s bodies was one of the big themes of postwar feminism. Access to contraception and the right to terminate a pregnancy were crucial stepping stones on a path to liberation from a social order that for centuries constrained women. The right to choose whether to have children is now well established, along with access to education, employment and equal pay (although gender pay and pension gaps remain). But sexism has not gone away. Among the findings of the Independent Medical Devices and Medicines Safety Review set up to investigate vaginal mesh implants is that the UK’s health system has a habit of ignoring women.
One patient likened the search for a doctor who would take seriously her concerns about the implants, which were widely used to treat pelvic organ prolapse and stress urinary incontinence until 2018, to “traipsing through treacle”. A former doctor referred to an “unconscious negative bias” towards middle-aged women in chronic pain. The report described a culture in which “anything and everything” women said about their discomfort was put down to the menopause.
While three-quarters of all NHS staff are female, most senior doctors are male, including 73% of surgeons. As the review points out, some of its findings echo those of the inquiry into the jailed breast surgeon Ian Paterson. While the report says tens of thousands of women were harmed, poor data collection means a precise figure will never be known. The review, which was led by Julia Cumberlege, also examined the use of hormone pregnancy tests and the epilepsy medicine sodium valproate, which was prescribed in the UK for decades without adequate warnings of its known teratogenic (birth defect-causing) effects. Taken together, Lady Cumberlege’s recommendations amount to a significant tightening of health system processes, as well as a critique of its culture.
Loopholes in the testing of devices including mesh must now be closed, as part of the new framework on UK medicines regulation outside the EU. The Medicines and Healthcare Products Regulatory Agency must take on a more proactive role. A “sunshine act” obliging doctors and pharmaceutical companies to declare payments is also overdue. There is a public interest in knowing where financial incentives exist (as they did in the 1990s when the Swedish doctor Ulf Ulmsten published influential research on vaginal mesh). The recommendation of a new patient safety commissioner should also be taken up unless there is some other way of bridging existing gaps. The creation of a new database of patients with mesh implants has started, and compensation must not become mired in delays.
Problems linked to surgical mesh are symptomatic of the wider neglect of reproductive health that has led to a lack of continuity, staff shortages and poor outcomes in maternity services. In future, multidisciplinary teams should be convened when treatment options include non-surgical options. Pelvic floor physiotherapy should be a routine postnatal option, as it is in France.
That health professionals and organisations must get better at listening is not a new idea. In recent years, patient groups and service users have played a key role in opening up discussions about health. In the midst of a pandemic and with the government planning a new NHS reorganisation, the families harmed by vaginal mesh or drugs taken in pregnancy years ago may not look like a priority to ministers. But the government and the health system owe it to the women who fought for this review to act on what it has found out.