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CMO calls for better training to identify violence against women

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More attention should be given to tackling violence against women, along with rising levels of female obesity and continence “taboos”, the chief medical officer has said in her annual report.

Professor Dame Sally Davies, CMO for England, targeted the health of women in her latest annual report, making recommendations on a wide range of issues.

“We need to ensure the awareness of healthcare workers and their access to appropriate training”

Sally Davies

All clinical staff should be better trained to recognise and respond to violence against women, she said in the report titled Health of the 51%: women.

She warned that violence against women was “prevalent at levels which make any ideals of ours as a civilised society difficult to reconcile with the reality”. It impacted on both the mental and physical health of women and also their children, she stated.

She highlighted official crime figures from 2013-14 showing that 2.2% of women aged 16-59 had experienced some form of sexual assault in the last year and 8.5% of women had experienced domestic abuse.

Particular groups of women, such as sex workers and migrants, were more at risk of physical and sexual violence than the general population.

The CMO noted a survey of asylum seekers detained at Yarl’s Wood immigration centre in Bedfordshire, which found three quarters reported having been raped prior to seeking asylum and nearly half reported experiencing torture.

Dame Sally said: “To address the needs of women affected by violence, we need to ensure the awareness of healthcare workers and their access to appropriate training.

“Safe disclosures by women, with clear pathways for referral, are essential to protect women and their children from further harm,” she said. “These must be underpinned by an understanding that violence against women is a determinant of mental and physical health.

“Education on violence against women needs to start at the undergraduate level so that healthcare workers consider it amongst the determinants of health,” she noted.

Sally Davies

Sally Davies

Sally Davies

She added: “Educational materials should also be available for postgraduate healthcare professionals to continue their learning as they practise.

In her report, she recommended that the Nursing and Midwifery Council and other professional regulators ensure that violence against women was “given due prominence” undergraduate training.

She also recommended that Health Education England develop e-learning modules – such as its existing set for female genital mutilation – be developed for sexual violence and “honour”-based violence, and made freely available to all regulated healthcare professionals.

In addition, the report encouraged women “not to suffer in silence” about problems such as incontinence or the menopause.

It noted that urinary and faecal incontinence affected more than five million women in the UK and, along with prolapse, costs the NHS more than £200m a year.

Dame Sally said: “We need to challenge taboos around the menopause and incontinence to make sure embarrassment is never a barrier to better health.

“Public awareness is needed to empower women to access self-help resources and treatment pathways,” she added.

Another key theme of the report – picked up on by the national media – was obesity.

It highlighted that obesity was one of the biggest risks to women’s health, affecting all aspects of a woman’s life from birth, family planning, pregnancy and right through to menopause and later life.

In England, 56% of women aged 35 to 44 and 62% of women aged 45 to 54 were classified as overweight or obese in 2013.

Dame Sally said the growing obesity problem was so serious that the government needed to make tackling obesity in the whole population a national priority.

She said: “We need to address the educational and environmental factors that cause obesity and empower women and their families to live healthier lives.”

“We need to challenge taboos around the menopause and incontinence”

Sally Davies

As obese women have an increased chance of miscarriage and premature birth, the report also highlighted planning for pregnancy as an important missed opportunity to give women health messages to improve their mental and physical health and that of their children.

Dame Sally said she wanted to end the myth that women should eat for two when pregnant and asked all women to work with healthcare professionals to make “positive changes” when planning to get pregnant and to stay healthy throughout their pregnancy.

The CMO’s report also examined women’s cancers, particularly ovarian cancer.

It noted that ovarian cancer was the second most common gynaecological cancer and the most lethal, with five-year survival rates of around only 36%.

The report called for a national audit of ovarian cancer to improve outcomes for the disease and highlighted the benefits of better surgery. Operating times of over three hours are more successful in removing the cancer cells, compared to shorter operating times.

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