_Hlk531695944

162 Watson, D. and Parsons, S. (2005) Domestic Abuse of Women and Men in Ireland: Report on the National Study of Domestic Abuse. Dublin: National Crime Council and ESRI.

163 Women’s Aid. (2018). Femicide Watch 2017. Republic of Ireland. Retrieved from: https://www.womensaid.ie/download/pdf/ womens_aid_femicide_watch_2017.pdf

164 McGee H., Garavan, R., deBarra, M., Byrne J., Conroy R. (2002). The SAVI Report. Sexual Abuse and Violence in Ireland. A national study of Irish experiences, beliefs and attitudes concerning sexual violence.

165 Marmot Review. (2010). Fair Society, Healthy Lives- Strategic review of health Inequalities in England post 2010.

Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan

Table 2.11 Some key social determinants of health
Social Determinant	Impact
Gender	In addition to biological differences, fundamental social differences exist in the way women and men are treated and the assets and resilience they possess. In all societies, these gender relations affect health to varying degrees
Income and income distribution	Income provides direct and rapid access to the range of health services as well as indirect access to education, food, housing, recreational activities, and other societal resources (including private health insurance).
Education	Educational disadvantage can limit access to employment, raising the risk of poverty and its adverse impact on health.
Unemployment and job security	Unemployment has been found166,167,168 to damage both physical and mental health. It can also trigger other problems that have negative impacts including marital breakdown (it increases the risk by 70%) and problem drinking. A direct correlation has also been found in an Irish context between unemployment and increased risk of suicide for men in particular (NSRF, 2008).
Housing	According to the WHO (2011) the health effects of poor-quality housing environments include the following: — 2-12% pop. effected by radon will develop lung cancer — 6-15% people using solid fuels will be affected by chronic obstructive pulmonary disease, acute lower respiratory infections and lung cancer.
Location	Prevalence rates for diseases such as diabetes, cancer, migraine/severe headaches and depression have been found to be lower in living environments with green space within a one-kilometre radius, with mental health thought to be particularly affected by the amount of local green space169.
Food Insecurity	Food poverty (which refers to the inability to acquire or eat an adequate quality or sufficient quantity of food in socially acceptable ways) clearly contributes to health inequalities.
Source: Walsh, K (2014) Health Inequalities in Ireland in a Cancer Context (unpublished paper for the Irish Cancer Society)

166 Watkin, S. (1985). ‘Recession and Health - a Literature Review’. Health Policy Implications of Unemployment. World Health Organization Regional Office for Europe, Copenhagen.

167 Morrell, S., Taylor, R., Quine, S., Kerr, C., & Western, J. (1994). ‘A Cohort Study of Unemployment as a Cause of Psychological Disturbance in Australian Youth’. Social Science and Medicine. 38.11:1553-1564.

168 Barnes M., Mansour A., Tomaszewski, W., & Oroyemi, P. (2009). Social Impacts of Recession: The Impact of Job Loss and Job Insecurity on Social Disadvantage. The Social Exclusion Task Force: Cabinet Office UK.

169 Maas, J., Verheij, R.A, de Vries, S, Spreeuwenberg, P., Schellevis, F.G. & Groenewegen, P. P. (2009) ‘Morbidity is related to a green living environment.’ Journal of Epidemiology and Community Health. 63: 967–97.

Social determinants (including gender and

—Those in more deprived areas are also more —

socio-economic status) contribute to health

likely to smoke and binge drink, while women

inequalities because their effects on health are

living in more deprived areas are more likely

not distributed equally across society. They can

than those in affluent areas to continue

influence health both directly and indirectly.

smoking and binge drinking into their 50s172;

They also operate at different levels. Structural

and

issues, such as socioeconomic policies or income

—High stress levels stress can also be linked to —

inequality, are often termed ‘upstream’ factors.

the impact of poverty, financial strain, social

While ‘downstream’/lifestyle factors like smoking

exclusion, discrimination or inequality, as can

or stress operate at an individual level – and can

behavioural factors such as cigarette use173;

be influenced by upstream factors. It is the case

or poor diet (a healthy diet being difficult to

therefore that efforts to address inequalities in

achieve on a low income).

health must address the distribution of the social

See Figure 2.5 for an illustration of the health

determinants of health. It requires going beyond

issues and social determinants affecting women

the immediate causes of disease and placing

across the life course.

a stronger focus on upstream factors, or the

fundamental ‘causes of causes’ (WHO, 2008).

The exact pathways from social determinants to

health inequalities are not yet fully understood.

What is clear is the way in which socio-economic

or material factors such as government social

spending and the distribution of income and other

resources in society influence the social and built

environment, which in turn influence and interact

with the health and well-being of the individuals

and communities who live and work in these

places.

As this interaction feeds into psychosocial factors

such as stress, isolation, social relationships and

social support as well as behavioural and lifestyle

factors, such as smoking, diet and exercise.

Ultimately, all these factors are inter-related and

influence health as follows:

—Women in more deprived areas are less likely —

to rate their health as good or very good170,171;

—Women in more deprived areas are more likely —

to have a long-term health problem;

170 Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings, p. 23.

171 The gap between the self-rated health of women from deprived and from affluent areas emerges from the 35 to 44 age group onwards. This gap is widest among those aged 55 to 74.

172 Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings

173 Graham, H. (2009). ‘Introduction: the challenge of health inequalities.’ Understanding Health Inequalities, 2nd edition. Maidenhead: Open University Press.

Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan

Figure from page 46

Figure from page 46

Preconceptual Early childhood Adolescent Women influences and development prenatal development

Puberty and social role transitions

Figure from page 46

Psychological distress Self-harm Eating disorders Teenage pregnancy Unprotected or unwanted sex

affecting women across the life course

Figure 2.5 Health issues and social determinants

Figure from page 47

Young Adult Women Middle-aged Women

End of childbearing years onset of peri-menopause and menopause

Completing education, initiating permanent employment and starting a family

Figure from page 47

Psychological distress Anxiety Depression Menopause Vitamin D deficiency Breast cancer Cervical cancer

Psychological distress Maternal depression Infertility Gestational diabeties Vitamin D deficiency Chlamydia infection Polycystic ovarian syndrome Breast cancert mortality

Steel, et al. (2013) Women’s health in NSW – a life course approach: a rapid review. (p5)174

174 Steel, A., Frawley, J., Dobson, A., Jackson, C., Lucke, J., Tooth, L., Brown, W., Byle, J., Mishra, G. (2013) Women’s health in NSW – a life course approach: a rapid review. University of Queensland, Centre of Research Excellence in Women’s Mental Health in the 21st Century. Retrieved from: https://www.saxinstitute.org.au/wp-content/uploads/Womens-health-in-NSW2.pdf

Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan

2.6.2 Structural inequalities

2.7 Priority groups of women

The structural inequalities women face, which

Being part of a socially or economically

have the potential of negatively impact on their

disadvantaged group may mean there are barriers

health, include the fact that women are more

to healthcare access, including lack of affordable

likely to:

health services, or access to female doctors.

Discrimination and prejudice such as racism, and

—Be poor175; —

homophobia may also prevent women accessing

—Parent alone176; —

health services. Women from deprived areas and

marginalised social groups in particular are likely

—Be the main provider of unpaid care work177; —

to experience multiple disadvantages within the

—Be in precarious employment earning low —

health service.

wages178; and

2.7.1 Traveller and Roma women

—Be at risk of domestic or sexual violence. —

Traveller and Roma women experience stark

Income (and a lack of it) is important both for

health inequalities due to structural inequalities

itself and for the access it provides to other social

linked to the social determinants of health,

determinants of health such as education, food,

including poor accommodation conditions,

housing, recreational activities, and other societal

poverty, illiteracy and discrimination181. See Table

resources (including private health insurance).

2.12 for details.

Women in less well-off socio-economic groups

have consistently been shown to be at the greatest

Traveller women have identified significant

disadvantage with regard to many aspects of

barriers to health services, including:

health. The majority of those with a medical card

discrimination and racism (both at individual and

are women, who have primary or no education,

institutional levels); lack of trust with healthcare

are not employed, and are more likely to rate

providers; lack of culturally-appropriate service

health as lower than other groups. In contrast

provision; and limited engagement from

those with private health insurance are more

service providers with Travellers and Traveller

likely men, who have education, who are in the

organisations.

workforce, and rate their health as excellent or

very good179. The variation among individuals and

Roma women also experience significant

groups due to income is often referred to as the

structural barriers to accessing primary health

‘social gradient.’ This gradient is more obvious

care due to lack of sufficient income, high cost

in some locations than others, with health

of health care and lack of interpretation and

progressively better the higher the socioeconomic

translation services.The Primary Health Care

position of people and communities. In more

Traveller Projects, which have been so effective

affluent counties for example where high levels

at increasing access to health information and

of overall population health exist, the average

services for the Traveller community, are staffed

can mask significant health differentials between

by a predominantly female workforce who receive

those on low and high incomes.180.

less than the minimum wage and have precarious

working conditions.

175 EAPN (No Date). Consistent Poverty Rates. Retrieved from: http://www.eapn.ie/eapn/training/consistent-poverty-rates

176 CSO. (2017, 27 July). ‘Census 2016 Results: Profile 4 Households and Families - Number of families increases to 1,218,370’. [Press Release]. Retrieved from: https://www.cso.ie/en/csolatestnews/pressreleases/2017pressreleases/pressstatementcensus2016resultsprofile4- householdsandfamilies/

177 CSO. (2017). Census 2016 Profile 9 - Health, Disability and Carers. Retrieved from: https://www.cso.ie/en/csolatestnews/ presspages/2017/census2016profile9-healthdisabilityandcarers/

178 National Women’s Council of Ireland. (2019). Women and Employment. Retrieved from: https://www.nwci.ie/discover/what_we_ do/womens_economic_independence/women_and_employment

179 Department of Health. (2016). Health in Ireland Key Trends 2016.

180 Mikkonen, J. and Raphael, D. (2010) ‘Social Determinants of Health: The Canadian Facts.’ York University School of Health Policy and Management, Toronto. Retrieved from: http:/thecanadianfacts.org.

181 Department of Justice and Equality. (2017). National Traveller and Roma Inclusion Strategy 2017-21.

Table 2.12 Traveller and Roma women’s health
Life expectancy	Traveller women’s life expectancy is ten years lower than for women in the general population182. Traveller women have a life expectancy of 70.1 compared to the national average of 81.6. According to the ESRI183 there is a steeper increase in poor health with age for Travellers, particularly in the 34-64 age range, than in the general community.
Mental health	Traveller women experience mental health difficulties at higher rates than women in the general population.184 The suicide rate for Traveller women is five times higher than women in the general population.185 63% of Traveller women disclosed that their mental health was not good for one or more days in the last 30 days; this was compared to 20% of female medical cardholders.186 60% of Roma women report more than 14 days of the previous month when their mental health was not good187.
Infant mortality	Infant mortality is 3.6 times higher among Travellers than among the general population188.
Violence against women	Domestic violence is an issue within the Traveller community, as it is in the general population. Traveller women account for the largest group in admissions to domestic violence refuges, with 49% of refuge admissions being Travellers and 57% of Traveller women recorded as repeat admissions.189
Health access and screening	31.5% of Roma women do not have a GP. 44.6% of Roma women don’t have a medical card (often due to problems proving where they live). 84% of Roma women have experienced discrimination in health services, compared to 53% of Roma men.190
Imprisonment	Minority groups are often over-represented in prison. Reasons proposed for overrepresentation include socio-economic factors, alcohol and other drug misuse and mental health problems191. Traveller women are at least 18 times more likely to be imprisoned than women in the general population.192
Traveller Women as Healthcare Providers	The All Ireland Traveller Health Study highlighted that 83% of Travellers received their public health information through the work of Primary Health Care Traveller Projects (PHCTP) and Traveller organisations, principally from Traveller women who have been trained as health advocates and who liaise with health professionals.193

182 Pavee Point (2017) Shadow Report to CEDAW Committee. Retrieved from: http://www.paveepoint.ie/wpcontent/uploads/2015/04/ Pavee-Point-NTWF-2017-Joint-Shadow-Report-to-CEDAW-Committee-19012017.pdf

183 Watson, D., Kenny, O., McGinnity, F.(2017) A Social Portrait of Travellers in Ireland. Dublin: ESRI. Retrieved from: https://www.esri. ie/system/files?file=media/file-uploads/2017-01/RS56.pdf

184 Pavee Point Presentation ‘Our Geels: Mental Health and Suicide’. Presentation to the World Congress on Women’s Mental Health, Dublin March 2017. Retrieved from: http://www.paveepoint.ie/wp-content/uploads/2015/04/PP_MissieMaryBrigidCollins_ WCWMH.pdf

185 Ibid.

186 All Ireland Traveller Health Study Team. (2010). Our Geels, All Ireland Traveller Health Study.

187 Pavee Point (2017) Shadow Report to CEDAW Committee.

188 Department of Justice and Equality. (2017). National Traveller and Roma Inclusion Strategy 2017-21.

189 Pavee Point & Traveller Women’s Forum (2017) Irish Traveller and Roma Women Joint Shadow Report: A Response to Ireland’s Consolidated Sixth & Seventh Periodic Report to the UN Committee on the Elimination of Discrimination Against Women. http://www.paveepoint.ie/wp-content/uploads/2015/04/Pavee-Point-NTWF-2017-Joint-Shadow-Report-to- CEDAWCommittee-19012017.pdf

190 Pavee Point (2017) Shadow Report to CEDAW Committee.

191 All Ireland Traveller Health Study Team. (2010). Our Geels, All Ireland Traveller Health Study.

192 Ibid.

193 Ibid.

Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan

who are homeless. A 2010 review for the HSE198

2.7.2 Women who are homeless

of this supported accommodation found that the

There has been a feminisation of homelessness

women using the services attached most value

in Ireland during the current housing crisis.

to having a safe and affordable home, access to

In August 2018 women made up 42% 194 of the

affordable childcare, transport so they could

national adult homeless population (rising to 44%

access education, training and employment, and a

in Dublin). This increase has been attributed to

society that did not judge them as ‘bad mothers’.

the rising numbers in family homelessness, the

majority of which are lone parent, female-headed

Table 2.13 A definition of complex needs

households.195 Women often enter homelessness

Complex needs as where a person who is homeless present with three or more of the following:

with a history of domestic violence, trauma,

and/or time spent in hospital, prison or other

institutional settings. For many of these women

Mental health problems

it is a temporary never-to-be-repeated situation,

Problematic use of various substances

the minority are however not so lucky and can

Personality disorders

get trapped in homelessness, cycling between

services196.

Offending behaviours

Vulnerability because of age

An Irish study in 2015, Homelessness,

Borderline learning difficulties

An Unhealthy State197, reported that almost 50% of women experiencing homelessness classified their health as ‘poor’ or ‘fair’ and 90% had at least one diagnosed mental or physical health problem.

Disability

Physical health problems

Challenging behaviours

Source: All Party Parliamentary Group on Complex Needs and Dual Diagnosis. (2014). Complex Needs and Dual Diagnosis Factsheet.199

These overlapping needs in relation to health, life

The concept of complex multiple needs is often

skills and housing can exacerbate one another,

used to describe the situation where an individual

while meeting the breadth and complexity of

(in this case a woman) who is homeless will

these needs is clearly a challenge.

present to services with more than one serious

problem. See Table 2.13 for a definition of complex

needs.

In certain circumstances, a crisis pregnancy can

contribute to women becoming homeless. The

HSE Sexual Health & Crisis Pregnancy Programme

has provided grant assistance for the provision of

supported accommodation services for pregnant

women, or lone mothers with young children

194 Department of Housing, Planning and Local Government. (August 2018). Homelessness Report August 2018. Retrieved from: https:// www.housing.gov.ie/sites/default/files/publications/files/homeless_report_-_august_2018.pdf

195 Mayock, P & Bretherton, J. (2017). Women’s Homelessness in Europe. Palgrave: MacMillan

196 Walsh, K (2015) Women and Homelessness – A Resource Guide. Simon Communities of Ireland.

197 O’Reilly, F., Barror, S., Hannigan, A., Scriver, S., Ruane, L., MacFarlane, A., O’Carroll, A. (2015) Homelessness: An Unhealthy State - Health status, risk behaviours and service utilisation among homeless people in two Irish cities. Dublin: Partnership for Health Equity. Retrieved from: https://www.drugsandalcohol.ie/24541/1/Homelessness.pdf

198 Lennon, L., O’Connor, H., OCS Consulting.(2010) 2010 Review of Supported Accommodation Services for Women During and After Pregnancy. Dublin: HSE Crisis Pregnancy Programme. Retrieved from: https://www.sexualwellbeing.ie/for-professionals/ research/research-reports/2010-review-of-supported-accommodation-services-for-women-during-and-after-pregnancy1.pdf

199 All Party Parliamentary Group on Complex Needs and Dual Diagnosis. (2014). Complex Needs and Dual Diagnosis Factsheet. Retrieved from: https://www.turning-point.co.uk/_cache_1d62/content/appg_factsheet_1_-_june_2014-5090910000019641. pdf

2.7.3 Migrant women

Table 2.14 Health recommendations in the McMahon report
1	The HSE initiative to exempt residents from prescription charges, which the Working Group welcomes, be implemented as soon as possible.
2	A health promotion initiative be targeted at residents of Direct Provision centres to inform them about access to breast screening, cervical checks, and bowel and diabetic screening services free of charge.
3	Immediately undertake a review of services for persons in the system experiencing a crisis pregnancy, with a view to a protocol being agreed to guide State agencies and NGOs supporting such persons. Particular attention should be paid to addressing the needs of the individual in the context of the legislative framework. Issues relating to travel documents, financial assistance, confdi entiality, and access to information and support services should be addressed.
4	The RIA Sexual and Gender-based Violence Policy be rolled out as soon as possible and accompanied by an awareness-raising and training plan.
5	An initiative be put in place to facilitate access by persons in the system to information and services concerning sexual and reproductive health and family planning.
6	An adequately trained and resourced interpreting service be put in place where demand exists. Interpreters dealing with persons in the system should be sensitivity trained, especially when interpreting the disclosure of needs, experiences and values of vulnerable groups. General Practitioners should be encouraged to ofef r interpreting services to this client group.
7	All centre staff should be provided with mental health awareness training by the HSE or designated NGOs. This training should cater for recognition of mental health issues and assist staff in alerting appropriate services, while ensuring the safety and wellbeing of the individual and all those who work and live in the centre.
8	Sensitivity training on issues that impact on vulnerable groups should be provided to all relevant Direct Provision staf.f
9	Information leafel ts, posters, talks and confdi ential contact details be provided in every centre and kept up to date to target vulnerable groups and promote dignity. Issues to be identifei d include e.g. FGM, torture, HIV, mental health, LGBT, disability, religion, domestic violence, human trafficking, exploitation, prostitution and older people’s needs.
10	Residents be able to access appropriate transport provision or financial assistance to ensure attendance at medical appointments and safe return to the centre.
11	The HSE National Operational Plan to include an account of progress on the implementation of the health-related recommendations made by the Working Group that are adopted by Government.
Source: MacMahon, B et al (2015) Working Group to Report to Government on Improvements to the Protection Process, including Direct Provision and Supports to Asylum Seekers

Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan

The double discrimination experienced by women

2.7.4 Women with disabilities

as a result of their gender and ethnicity has an

Almost 50% of women with disabilities in Ireland

impact on all aspects of their lives, including on

are at risk of poverty or social exclusion.205 Labour

health200. Immigration status is an important

participation rates for people with disabilities are

factor in determining use of health services in

extremely low, with only three out of 10 adults

Ireland. Undocumented migrants, those seeking

with a disability of a working age having a job.206

asylum and those who have refugee status often

Women with disabilities are less likely to be

experience poor access to health services.201

employed, with family caring responsibilities a

key reason for their lower rates of employment.207

Exclusion from health services means that undocumented women face delayed access to screening, treatment and care, limited access to contraception and heightened levels of discrimination and gender-based violence, all of which damages women’s health and perpetuates health inequities.202

Women with disabilities have lower uptake of

health promotion and health screening services

than women in general.

Rates of screening for both cervical and breast cancer are lower among women with disabilities than the general population and especially low for women

with severe and profound intellectual disability.208

Reception and Integration Agency figures for

October 2018203 show 6,405 people resident in

Direct Provision, of which 2,626 were female (of

According to Inclusion Ireland209, women with

all ages). The 2015 McMahon report on Direct

disabilities experience inequality in accessing

Provision and the Protection Process204 made a

sexual health services and in their right to enjoy

series of eleven recommendations in relation to

relationships on an equal basis with others.

enhancing access to health services and support

Due to a legacy of institutionalisation and

for those living in Direct Provision. See Table 2.14

segregation, women and girls have been deprived

for details.

of information and education on sexuality and

family planning. Internationally,

200 Health Service Executive. (2007). Intercultural Health Strategy. Retrieved from: https://www.hse.ie/eng/services/publications/ socialinclusion/national-intercultural-health-strategy-2007---2012.pdf

201 AkiDwa, Dorus Luimni and HSE. (2012). Migrant Women’s Awareness, Experiences and Perceptions of Health Services in Limerick. Retrieved from: http://dorasluimni.org/wp-content/uploads/2017/07/healthmapping.pdf

202 World Health Organisation. (2016). Migrant women’s health issues: addressing barriers to access health care for migrant women with irregular status. Retrieved from: http://www.euro.who.int/__data/assets/pdf_file/0017/330092/6-Migrant-womens-healthissues-irregular-status.pdf?ua=1

203 Reception and Integration Agency Department of Justice and Equality. (2018). Monthly Report October 2018. Department of Justice and Equality. Retrieved from: http://www.ria.gov.ie/en/RIA/October%202018%20monthly%20report%20updated%20.pdf/Files/ October%202018%20monthly%20report%20updated%20.pdf

204 Department of Justice and Equality (2015, 30 June). Government publishes Working Group report on Direct Provision and the Protection Process. [Press Release]. Retrieved from: http://www.justice.ie/en/JELR/Pages/PR15000389

205 European Institute for Gender Equality. (2016). Poverty, gender and intersecting inequalities in the EU Review of the implementation of Area A: Women and Poverty of the Beijing Platform for Action. Brussels: EIGE

206 CSO. (2011). Persons with a Disability. Retrieved from: https://www.cso.ie/px/pxeirestat/Statire/SelectVarVal/Define. asp?maintable=CD801&PLanguage=0

207 Watson, D. & Nolan, B. (2011). The Social Portrait of People with Disabilities in Ireland 2011. A report by the Department of Social Protection and the ESRI. Dublin: DSP.

208 Burke, E., McCallion, E., McCarron, M. (Eds.) (2014). Advancing years, Different challenges: Wave 2 IDS-TILDA: findings on the ageing of people with an intellectual disability: an intellectual disability supplement to the Irish Longitudinal Study on Ageing. Dublin: Trinity College Dublin. Retrieved from: https://www.tcd.ie/tcaid/assets/pdf/Wave_2_Report_October_2014.pdf

209 Inclusion Ireland. (2015). Submission to the Department of Justice and Equality - On a new National Women’s Strategy 2017-2020. Retrieved from: http://www.inclusionireland.ie/sites/default/files/attach/basic-page/1110/submission-womens-strategy.pdf

a systematic review of evidence by the WHO210

2.7.6 LGBTQI+ women

shows that children and adults with disabilities

Principles213 and standards214 exist in relation

are more likely to experience violence than their

to the provision of health care and supports for

non-disabled peers and those with intellectual

LGBTQI+ (lesbian, gay, bisexual, transgender,

disabilities are most at risk.

queer and intersex) individuals. Notwithstanding,

LGBTQI+ women experience barriers in accessing

2.7.5 Women who are carers

health and social services due to a lack of

There were 70,459 people in receipt of caring-

understanding of their specific needs and a lack

related social welfare payments in 2016211, while

of targeted service promotion. Furthermore,

significantly higher number of individuals

research has also demonstrated that LGBTQI+

identified themselves as carers with Census 2016

people are less likely to engage with health

(see Appendix 1 Table A.20 for details). Women

interventions and screening programmes if it is

undertake the majority of unpaid care work.212

not explicit that they are welcome to access the

Caring responsibilities can have a negative

service.215

impact on mental and physical health, leading

to exhaustion, depression, injury and greater

There is also a broad issue of access to health

vulnerability to illness generally. Families are

services for the LGBTQI+ community. These

heavily reliant on grandparents for childcare. A

barriers generally occur due to the consequences

similar proportion of women and men provide

of a complex interaction of environmental,

care but women do so for significantly longer

social, cultural and political factors. Research

hours.

into the causes of health barriers inequalities for

LGBTQI+ people identified a number of causes

including: heteronormativity216; hetero-sexism217;

minority stress218;219; victimisation220; institutional

discrimination221; and stigma222;223. Challenges

and difficulties identified224 for LGBTQI+ groups

210 Hughes K., Bellis M., Jones L, Wood S, Bates G, Eckley L, McCoy E, Mikton C, Shakespeare T, Officer A. (2012). ‘Prevalence and risk of violence against adults. Prevalence and risk of violence against children with disabilities: a systematic review and metaanalysis of observational studies.’ The Lancet. 379(9826):1621-9. Retrieved from: https://www.thelancet.com/journals/lancet/ article/PIIS0140-6736(11)61851-5/fulltext