A recent report from the Work Foundation is appealing for an end to stigma surrounding women’s health issues at work, in particular reproductive and gynaecological conditions. Jenna Kerns, one of the authors, rounds up key lessons for employers.
The Work Foundation’s recent report, ‘More than ‘Women’s Issues’ – women’s reproductive and gynaecological health and work’ revealed that under-recognised chronic gynaecological and reproductive health conditions are holding back women’s productivity and could be damaging their career and earning potential.
The report highlights that common women’s health conditions, such as endometriosis or infertility, having a long-term condition during pregnancy, and the experience of the menopause are still considered taboo and are under-recognised in the workplace.
Endometriosis, a chronic condition that affects one in ten women of reproductive age in the UK, is the second most common gynaecological condition. It occurs when cells similar to those lining the uterus grow elsewhere in the body and can cause symptoms such as excessively painful periods, chronic pelvis pain and fatigue. There is no cure and symptoms get worse with age. The symptoms can also lead to poor mental health.
Women with endometriosis can also be reluctant to disclose their conditions to employers due to concerns around stigma and a lack of understanding. There are significant implications for work; a 2011 study conducted across 10 countries found women with endometriosis experienced reduced work performance, losing on average of almost 11 hours of work each week.
This was mainly due to reduced effectiveness in work. The costs of this lost productivity were considerable – on average costing almost €6,300 [euros] per person each year. A lack of support can also lead to women losing their jobs – particularly if they are in physical roles, such as in the armed forces.
The Work Foundation is calling for perceived taboos around women’s gynaecological and reproductive health to be shattered. We argue women need to be empowered to get support through greater recognition of conditions and ensuring parity alongside other workplace health issues.
We also call for dialogue among employers, policy makers and health professionals, and for severe endometriosis to be included as a disability in the Equality Act 2010 as a chronic, debilitating disease.
However, the report has identified steps that can be taken by HR professionals, line managers and occupational health practitioners to ameliorate the negative impact of these conditions on work. The following recommendations are suggested to support women in the workplace with these health conditions, while also reducing the financial impact to both the employer and the employee.
Good practice to support women’s health issues at work
For endometriosis, we found that making small adjustments to work – particularly in the form of flexible working, allowing home working, and allowing extra breaks – was often crucial for women’s retention, providing women with some time and space in which to manage their symptoms around their workload.
As seen with other long-term conditions, the importance of having a supportive line manager who understands that time off might be required is essential.
Self-management was also found to be important in terms of managing symptoms at work, for example peer support, healthy eating, exercise, massage and acupuncture, so occupational health practitioners and HR should be providing guidance on how to access these resources.
We also looked at women’s health and wellbeing during infertility treatment. This is a situation on which there is a considerable divergence in views. While some recognise this as treatment for a health condition, others may see it as a ‘lifestyle’ choice.
The stress of infertility can manifest in mental health conditions, with one study finding 90% of infertile women regularly experiencing feelings of depression. The stress associated with infertility has a negative effect on employment outcomes.
Stress is the most common cause of long-term sickness absence and the second most common cause of short term absence, and the risks to work are often higher when experiencing competing pressures and stresses both in and out of work.
Research indicated that a large majority of women who experience infertility found it to affect their performance at work.
Women who received support from their employers during infertility treatment, such as a fertility leave policy, reported higher rates of disclosure, lower levels of distress and less suicidal feelings.
Good practice included employers who provided specific support, for example offering paid time off for fertility treatment for both partners, along with options to swap shifts to fit appointment schedules and the option for additional unpaid leave.
Flexible working and additional sickness absence days offered by employers, as part of a comprehensive approach to employee health and wellbeing and an inclusive flexible working policy, were also found to be good practice. For example, working through lunch in order to attend appointments, rather than having to take the entire day off.
A lack of line management awareness of this issue was also a huge barrier to effective management. We suggest that good quality information is available to management and employees so that work does not worsen what is already a stressful time and that the impact on and risks to work are minimised.
Being pregnant is often in itself a stressful time, often with implications for health and well-being. Having certain pre-existing health conditions, such as heart conditions, obesity, diabetes and mental illness, increase these health risks.
This means medical support during pregnancy will be even more important. However, we know that one in 10 mothers report their employer discouraged them from attending antenatal appointments.
The additional time needed to attend medical appointments, or to manage the additional strain of an illness exacerbated by pregnancy, can mean that women with pre-existing health conditions may need to take more time off work. Extra leave could lead to employers gaining a negative impression of their pregnant workers, but we suggest that employers need to give additional entitlement for paid leave for antenatal appointments to retain and support their pregnant workers.
The Royal College of Nursing (RCN)’s guidance has examples of good practice, highlighting the need for risk assessments and reasonable adjustments. Midwives and occupational health nurses have a key role in using this guidance and supporting working pregnant women with disabilities.
We also suggest developing strategies to manage mobility, physical and psychological hazards, which can be crucial to keeping women in work.
In the case of the menopause – experienced by half the working age population – efforts should be made in organisations to provide appropriate support for women who are experiencing this natural transition.
For many, this is an ongoing condition – with symptoms often experienced for between four to eight years. Employers and managers need to be more aware of what the menopause means for their female employees, and how they can better support them, to reduce any negative impact it has on work, and on the women who are experiencing it.
There are four areas which an organisation should think about in improving support for employees experiencing the menopause, which include improving awareness among managers about the menopause as a possible occupational health issue.
There is limited awareness of the implications of the menopause at work and what it means from an occupational health perspective, so improving managerial awareness about the menopause and its challenges can help to normalise support and reduce stigma.
Allowing flexible working hours can also be an effective tool to minimise the effect of menopausal symptoms. We also urge improving access to information and sources of support at work.
More information about the menopause may help and empower employers to raise this sometimes difficult topic with managers, as well as informing them as to what they can do in terms of self-management.
Finally, paying attention to workplace temperature and ventilation is important in terms of minimising the effect of hot flushes and sweats. Making efforts to provide a ventilated environment can reduce some of the distress associated with these common symptoms.
So what action can employers take?
Employers should improve recognition of women’s reproductive and gynaecological health in workplace policy and processes. We found that this is necessary to both provide assurances to women that they can raise their symptoms with managers/employers, and to provide managers/employers with tools to support them.
We encourage employers to review their polices and processes around sickness absence, maternity leave, flexible working, health and safety and occupational health provision to ensure that these health conditions are being accounted for and women are not unduly disadvantaged in work.
In particular, employers should ensure that women’s reproductive and gynaecological health issues are recognised and understood by HR and occupational health providers/practitioners in risk assessments, as per the Health and Safety Act, particularly in relation to menopause and in line management training alongside other health-related training.
We also suggest that managers should be aware that such conditions may be eligible for support under the Equality Act 2010 and provisions of the Health and Safety Act.
These health conditions should also be recognised in decisions around flexible working requests for self-management of symptoms and in sickness absence policies and processes. Such issues, including menopause, could be eligible for sickness absence and care should be taken to ensure that sickness absence and performance systems do not unfairly treat women in this context.
Additional annual leave or compassionate leave may be appropriate in some circumstances. Managers could also be flexible in their working policies of reasonable adjustments decisions and remain sensitive to requests, e.g. breaks, workplace temperature control, time off/leave, working from home, or even to reduce working hours temporarily..
There are clear issues surrounding disclosure in the workplace and fears around stigma, particularly where there is a male line manager who may be entirely unfamiliar with the conditions. Employers could also provide a pathway for female staff to access confidential work support.
Non-disclosure of health conditions may lead to incidents being mismanaged or women not seeking support for their health condition, when with adjustments, they might be more productive or even be able to remain in work.
Employers could consider assigning a staff member (e.g. in HR or occupational health) as a gender-specific representative in the organisation providing guidance on sensitive issues, or acting as a go-between or supportive presence for meeting with line managers.
We urge that these issues are brought more out in the open and discussed. Life, and business performance outcomes, can be much better for women suffering from these conditions if open dialogue in this space continues and accommodations are made in the workplace.
Additionally, with more acceptance of these issues, more training for line managers to understand the impacts on work, and also better understanding among women themselves, we can help make more positive outcomes for all.
Jenna Kerns is research and policy assistant at The Work Foundation. The research team for the report also comprised of Karen Steadman and Cicely Dudley.