Healthcare and feminism
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In the last decade, it has become common for politicians to don t-shirts claiming that they are what feminists look like. The bra-burning of the 1960s had faded into a fashion statement, but what about the politics of it?
I remember being introduced to feminism by my mother, who told me that if I thought that women should be paid the same as men for the same job, I was a feminist. Back then, office culture in many places dictated that women could aspire to be the personal assistant to the chief executive officer (CEO), not the CEO, and to wear skirts by diktat, not trousers. Babies were career suicide, and working part-time once you’d had them (the hours of which, in medicine, would be counted as full time in any case) was viewed by many to indicate a lack of seriousness in aspiration. Female consultants were rare – and still are in many specialties.
Women are different from men: as a sex class, we are smaller, weaker and can be made pregnant by force. It was not until 1991 that rape within marriage was made illegal.1 The crime survey for England and Wales 2020 found that 7.1% of women reported sexual assault, by rape or penetration from the age of 16 years, including attempts.2 UN Women UK surveyed women who said that 97% of women aged between 16 and 24 years had been sexually harassed, with all but 4% not reporting these as they felt ‘it would not change anything’.3
In the 1970s, rape crisis centres started to form, by women and for women.4 Generally low-budget affairs, they offered peer support and counselling for survivors of sexual violence. Given that it is men who overwhelmingly sexually assault women, this single-sex facility was a straightforward offer: refuge. Traumatised women need to feel safe. This does not, of course, mean that all men are rapists or are a threat. Rather, it means that the shared experience of womanhood, and then understanding the fact that women are more physically vulnerable than men, removes a huge burden of uncertainty in the ability to trust an environment and restore dignity. The Equality and Human Rights Commission commissioned a report in 2012, and interviews with women using crisis centres found that they overwhelmingly wanted women-only services, citing safety, empathy and solidarity.5
A recent investigation by the BMJ is telling: sexual violence happens, dreadfully, in the National Health Service (NHS) – a place that is meant to keep you safe. Police recorded 180 cases of rape of children aged under 16 years on NHS premises between 2017 and 2022. A total of 35,000 sexual safety incidents (which covers a wide variety of sexual aggression, from verbal harassment to bodily harm) were reported in the NHS in England in the 5 years from 2017 – and this is likely an underestimate. Twenty percent of the time, the incidents were related to patients abusing other patients.6
But women-only spaces have been increasingly threatened by the inclusion, in many services, of anyone who ‘self-identifies’ as a woman. We have known for decades that sex offenders actively seek ways to access vulnerable people, whether to exercise emotional power or do physical harm. It does not take a genius to work out the threat if men, convicted of sexual crimes, decide to identify as women, whether for their own sexual gratification, and access to what should be women-only spaces and the women within them. Several criminal cases exemplifying this problem have now attracted public attention. Yet the NHS response, even where rape was alleged, has been to initially deny that it was possible, given that the assailant self-identified as woman.7 This kind of denialism – of not believing women by design – is not new, but it is a new iteration. Everyone, regardless of their sex – and regardless of their gender identity – deserves safe care. That also means respecting women’s boundaries.
Author’s note
Margaret McCartney is a Director of Beira’s Place, a women-only sexual assault and rape support centre, Edinburgh. Her full DOI is at whopaysthisdoctor.org.
Ethics approval
Not applicable.
Competing Interests
None declared.
Funding
None declared.
Declarations
Guarantor
MC.
Provenance
Commissioned; editorial review.
References
1. The Law Commission. Criminal law: rape within marriage. 12 January 1992. See https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/228746/0167.pdf (last checked 22 June 2023).
2. Office for National Statistics. Nature of sexual assault by rape or penetration, England and Wales: year ending March 2020. See www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/natureofsexualassaultbyrapeorpenetrationenglandandwales/yearendingmarch2020 (last checked 22 June 2023).
3. Open Access Government. Research finds that 97% of women in the UK have been sexually harassed. 7 October 2022. See www.openaccessgovernment.org/97-of-women-in-the-uk/105940/ (last checked 22 June 2023).
4. British Library. Campaigns and protests of the Women’s Liberation Movement. 8 March 2013. See www.bl.uk/sisterhood/articles/campaigns-and-protests-of-the-womens-liberation-movement (last checked 22 June 2023).
5. Hirst A, Rinne S. Equality and Human Rights Commission Research report 86. The impact of changes in commissioning in and funding of women-only services. See www.equalityhumanrights.com/sites/default/files/research-report-86-the-impact-of-changes-in-commissioning-and-funding-on-women-only-services.pdf (last checked 22 June 2023).
6. Torjesen I, Waters A. Medical colleges and unions call for inquiry over “shocking” levels of sexual assault in the NHS. BMJ 2023: 381: 1105.
7. Health and Care Bill. Amendment 172. Volume 820. 16 March 2022 Hansard. See https://hansard.parliament.uk/Lords/2022-03-16/debates/84C9B6AA-0214-4CEF-A41D-302373BDC190/HealthAndCareBill#contribution-B907C955-8932-460A-A6F4-E8009D6915FA16/3/22 (last checked 22 June 2023).
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