The women paying the pandemic penalty
From missed cancer screenings to having to give birth alone, coronavirus has had a huge knock-on effect. Laurel Ives reports
Amy Van Wyk had been complaining of symptoms for two years before she was finally diagnosed with ovarian cancer in 2018. By the time it was confirmed, the cancer had spread to such an extent that doctors said it could never be cured. But there was more trauma to come.
In March this year Amy, 38, had just completed a round of chemotherapy and a separate drug treatment when Boris Johnson addressed the nation to announce a national lockdown.
Her forthcoming appointment with her consultant was abruptly cancelled, and the future of her treatment plan thrown into doubt.
“I was due to meet with a surgeon to discuss whether surgery might be possible, and a consultant to talk about a drug treatment plan, both of which were changed to a telephone call because of coronavirus,” says Amy, who is married and lives in Surrey. The prospect of surgery was shelved, and Amy was told to monitor her symptoms and be in touch if anything worsened.
Without access to any of her usual support sessions, and isolated from her friends due to shielding, Amy felt lost and bewildered. “When you have cancer you build up a rapport with your team, they comfort you in extremely emotional times. I’ve had hugs from doctors and nurses who’ve consoled me in my darkest moments. Suddenly to have that taken away just added to what was already a very stressful time.”
We’ve already seen how the pandemic has had a disproportionate affect on women – they have been more likely to be furloughed or made redundant than men, and recent data showed women took on the bulk of parenting and domestic duties during lockdown regardless of whether they were working or not, resulting in higher levels of psychological distress.
But women’s health has also been badly hit. Last week we learnt that more than a million women have missed vital breast screenings due to the halt in services during the first wave of the pandemic.
The charity Breast Cancer Now calculates that around 8,600 women will now have undetected breast cancer. Screenings have resumed, but patients face lengthy waits due to the backlog and social distancing measures. There has been a similar story around smear tests, which were stopped in Scotland, Northern Ireland and Wales during lockdown, with only limited availability in England. As a result, around 900,000 fewer cervical screens were done between March and August this year.
There are signs that the pressure placed on women by the lockdown, for example around childcare, is causing them to neglect their own health. Historically, women have been better than men at attending screenings and going to the doctor if they have symptoms. But findings by the Estée Lauder Companies’ Breast Cancer Campaign, released last week, show that the shutdown of health services and loss of social networks means
women are now less likely to visit a GP or talk to a friend or relative if they notice a change in their breasts.
There are also concerns over ovarian cancer, known as a “silent killer” because the symptoms are often vague or non-existent. Target Ovarian Cancer reports that women are avoiding seeing their GPS with symptoms because of fears over catching the virus, or being a burden to the health service. A survey by the charity found more than half of women had been unable to access treatment and, in particular, surgery.
Amy Van Wyk’s cancer is stable, but she fears for the future. “There’s talk of a further six months of restrictions, so what will happen when I need further treatment? I’m also worried that research into rare diseases like mine will be suspended. Yes, we need a vaccine, but we can’t forget that there are other deadly diseases out there.”
Another area of women’s health that has been badly affected is maternity
care. Restrictions on hospital visitors have meant thousands of women have gone through labour – as well as enduring stillbirths and miscarriages – alone. Many have reported patchy antenatal care, traumatic births and inconsistent postnatal care.
Natalie Redd, 31, had her baby in April this year and still suffers psychologically from the experience.
“After 24 hours of labour, I was transferred to an operating theatre for a potential caesarean,” says Natalie, an occupational therapist from London.
“They were able to deliver my baby by forceps, but 15 minutes later my partner was asked to leave. I’d lost a lot of blood and was totally out of it. The next thing I knew my baby was transferred to intensive care, and I had no idea why. I was put in a maternity ward, all the curtains were drawn around the beds and you weren’t supposed to mix with anyone. The midwives were in full PPE. They checked my blood pressure and asked if I was OK, but weren’t able to stay and comfort me.
“I spent the first night after the most shocking experience of my life totally alone, with no baby and no partner. Nobody should have to go through that.
“Two of my friends’ partners were allowed to stay with them after birth. The inconsistency of the rules just felt so unfair.”
Mothers are now allowed to have birth partners with them throughout labour as long as they do not show any symptoms of coronavirus, but Dr Jan Smith, the clinical lead at Make Birth Better and a psychologist working in birth trauma, says NHS trusts are interpreting the guidance in different ways. Recent data showed only 23 per cent of trusts were allowing partners to attend throughout labour – and women are still having to face miscarriages and terminations alone.
“We know that birth trauma can be passed on intergenerationally, and maybe if their partners had been
‘Yes, we need a Covid vaccine but there are other deadly diseases out there’
present these women might have been able to make sense of it,” says Dr Smith. “We need to balance the risk of Covid infection against that of the long-term mental health of the mother and whole family. It’s about valuing women in society.”
Reductions in maternity services are proving to have other, tragic consequences. In July, Asma Khalil, an obstetrician at St George’s, University of London, reported a nearly fourfold increase in the incidence of stillbirths at the trust between February and mid-june.
Kate Mulley, at the stillbirth and neonatal death charity Sands, is also hearing anecdotal reports of an increase in midterm miscarriages. “Some women told us they reported worries about changes in foetal movement and bleeding, but were told not to go to the hospital because of coronavirus,” she says.
Meanwhile, restrictions and stress are having a detrimental effect on women’s health and wellbeing in general. Last week a study by the University of Glasgow found that rates of binge drinking rose among women from 8 to 14 per cent during the peak of lockdown. Women are also taking less exercise, with new figures from Sport England showing that only a quarter are regularly active after six months of restrictions.
As Covid’s second wave begins and further lockdowns loom, many experts fear that the consequences for women’s health could continue long into the future.