_Hlk7175556
| Table 2.3 Gender differences in mental health | ||
|---|---|---|
| Themes | Women | Men |
| Life experiences | — Over a quarter (26%) of women surveyed in Ireland had experienced physical and/or sexual violence by a partner or non-partner since the age of 15.51 — Caring responsibilities | — Accidents (e.g. at work) — Social isolation — Homelessness — Prison |
| Socio-economic realities | — Poverty — Gender pay gap — Juggling demands of care and work — Backbone of caring services but few in leadership positions | — Full-time employment — Unemployment — Retirement |
| Expressions of mental distress and symptoms | — Depression — Anxiety — Eating disorders (anorexia and bulimia nervosa) — Somatic disorders — Self-harm — Post-traumatic stress disorder — Perinatal mental health — Borderline personality disorder | — Early onset psychosis — Suicide — Substance abuse — Anti-social personality disorder — Behaviour and personality difficulties, including alcohol and drug dependence |
| Pathways into services | — Primary care — Community services — Maternity services | — Emergency Department — Drug/alcohol services — Criminal justice system |
| Treatment needs and responses | — Community-based and informal (e.g. women’s groups) — Gender specific services — Greater risk of victimisation and exploitation | — Activity based (e.g. men’s shed) — Assertive outreach — Early intervention |
| Source: Table adapted from presentation by Dr. Karen Newbigging, Senior Lecturer in Health Policy and Management, University of Birmingham at NWCI ‘Gender and Mental Health’ Roundtable, November 2016. |
51 Fundamental Rights Agency. (2014).Report on violence against women across the EU: abuse at home, work, in public and online. Retrieved from:http://www.cosc.ie/en/COSC/FRA%20EU%20Survey%20on%20Violence%20Against%20Women%20-%20 Full%20report.pdf/Files/FRA%20EU%20Survey%20on%20Violence%20Against%20Women%20-%20Full%20report.pdf
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
Given the gender differences detailed in Table
time, with services currently being developed in
2.3 it is not surprising to find that within the
Limerick, Cork and Galway.
Healthy Ireland survey52 higher levels of female
Research59 shows too that marginalised women
participants (13%) indicated probable mental
(including asylum seekers, homeless women,
health problems in comparison with males (6%).
Traveller and Roma women, LGBTQI+ women and
women with disabilities) are disproportionately
It is the case too that 19% more women than men attempt suicide, while men are four times more likely to die by suicide than women.53,54 Female rates of self-harm in contrast were 21% higher than male rates in 2017.55
impacted by poor mental health. See Table 2.4
for characteristics of gender sensitive services. A
2017 analysis of admissions to Irish psychiatric
units and hospitals found that there was an
equal proportion of male and female admissions
(all), with males having a slightly higher rate of
all admissions, at 353.8 per 100,000 compared
with 349.4 for females. Forty-seven per cent of
Groups atparticular risk of suicidal behaviour
first admissions were female and females also
include middle aged women and women
had a lower rate of first admissions, at 115.1 per
experiencing violence.56
100,000 compared with 133.2 for males60. 43% of
all admissions to general hospital psychiatric
Issues also exist in relation to peri-natal mental
units and psychiatric hospitals/continuing care
health57 and the National Maternity Strategy 2016-
units (53%) were female compared with a 60%
202658 includes a number of actions in relation
admission rate for females to independent/
to mental health supports. The HSE’s Specialist
private and private charitable centres. Similarly,
Perinatal Mental Health Service Model of Care was
females accounted for 56% of first admissions
launched in November 2017 and includes a model
to independent/private and private charitable
for an overall perinatal mental health service
centres. One-third of patient’s resident on 31
clinical pathway. This provides for screening
December 2017 had a diagnosis of schizophrenia,
for mental health problems such as depression,
13% had a diagnosis of depressive disorders, 12%
anxiety, psychosis at the first visit to the
had a diagnosis of organic mental disorders and
maternity service, called the booking visit. The
8% had a diagnosis of mania. Schizophrenia had
project is currently at implementation stage with
the highest rate of hospitalisation, at 16.1 per
full time services available in the Rotunda and
100,000, followed by depressive disorders, at 6.5
National Maternity Hospitals for the first
and organic mental disorders, at 5.7. Females had
52 Ipsos MRBI and Department of Health. (2015). Healthy Ireland Survey 2015 Summary of Findings. Department of Health: Dublin. Retrieved from: https://health.gov.ie/wp-content/uploads/2015/10/Healthy-Ireland-Survey-2015-Summary-of-Findings.pdf
53 Arensman, E., Wall, A., McAuliffe, C., Corcoran, P., Williamson, E., McCarthy, J., Duggan, A., Perry, I., (2013). Second Report of the Suicide Support and Information System. National Suicide Research Foundation 2013. Retrieved from: https://www.nsrf.ie/wpcontent/uploads/reports/SSISReport2013.pdf (accessed 24th March 2019
54 Corcoran, Keeley, O’Sullivan, and Perry. (2004). ‘The incidence and repetition of attempted suicide in Ireland.’ EuropeanJournal of Public Health, 2004 Mar;14(1):19-23.
55 Griffin, E., Dillon, CB., McTernan, N., Arensman, E., Williamson, E., Perry, IJ., Corcoran, P. (2018). National Self-Harm Registry Ireland Annual Report 2017. Cork: National Suicide Research Foundation. Retrieved from: https://www.drugsandalcohol.ie/29774/1/ nsrf-national-self-harm-registry-ireland-2017.pdf
56 Department of Health, Healthy Ireland, National Office of Suicide Prevention, HSE. (2015). Connecting for Life: Ireland’s National Strategy to Reduce Suicide 2015-2020. Retrieved from: https://www.healthpromotion.ie/hp-files/docs/HME00945.pdf
57 Department of Health (2016) The National Maternity Strategy 2016-2026: Creating a Better Future Together. Retrieved from: https:// health.gov.ie/wp-content/uploads/2016/01/Final-version-27.01.16.pdf
58 Ibid.
59 Department of Justice and Equality. (2017). National Traveller and Roma Inclusion Strategy 2017-21. Retrieved from: http://www. justice.ie/en/JELR/National%20Traveller%20and%20Roma%20Inclusion%20Strategy,%202017-2021.pdf/Files/National%20 Traveller%20and%20Roma%20Inclusion%20Strategy,%202017-2021.pdf; Health Service Executive, Glen, BelongTo, TCD. (2016). The LGBTIreland Report: national study of the mental health and wellbeing of lesbian, gay, bisexual, transgender and intersex people in Ireland. Retrieved from: http://belongto.org/wp-content/uploads/2018/05/LGBT-Ireland-Full-Reportpdf.pdf; and Mental Health Reform and Simon Community (2017) Homelessness and Mental Health: Voices of Experience. Retrieved from: https://www. mentalhealthreform.ie/wp-content/uploads/2017/06/Homelessness-and-mental-health-report.pdf
60 Daly, A., & Craig, S. (2018). Activities of Irish Psychiatric Units and Hospitals 2017 Main Findings. HRB Statistics Series 38.
a lower rate of hospitalisation for schizophrenia
2.2.3 Women’s sexual, reproductive and maternal health
than males, at 12 per 100,000 compared with for
20.3 per 100,000 for males. Females also had a
lower rate of hospitalisation for organic mental
2.2.3.1 Women’s sexual health
disorders, at 4.4 compared with 7.1 per 100,000
The majority of the adult population have engaged
for males.
in sexual intercourse at some stage in their
lifetime61,62,63,64,65: 92% of the adult population
Table 2.4 Characteristics of gender sensitive services
report previously having sexual intercourse,
with the vast majority (85%) reporting that their
Prioritise understanding mental distress in the context of women’s lives
most recent sexual contact occurred within
a relationship66,67. The overall median age for
reported initiation of heterosexual sexual activity
Are co-designed with women with lived experience
remained stable at 18 between 2003 and 201068.
Research has found that early sexual initiation
Enable all dimensions of the problems experienced to be addressed
(at or below 16) is associated with an increased
risk of crisis pregnancy, STIs and higher partner
Address sexual abuse, domestic violence, body image concerns, reproductive and life stage elements of health and wellbeing
numbers69. In terms of partner numbers, half of
women in Ireland (51%) and almost one-third
(29%) of Irish men report one lifetime sexual
Are sensitive to the diversity of women’s needs, experiences and backgrounds including race, sexuality and disability
partner. Six percent of heterosexual women and
one-quarter of heterosexual men in Ireland report
having ten or more lifetime sexual partners.
Enable women to make choices about their care and treatment
Figure from page 27
Empower women to develop skills for addressing their difficulties
Promote self-advocacy and advocacy for women who need support to voice their views
Value women’s strengths and potential for recovery
Source: Abel K M., Newbigging, K. (2018). Addressing unmet needs in women’s health. British Medical Association. Retrieved from: https://www.bma.org.uk/collective-voice/ policy-and-research/public-and-population-health/ womens-health
61 Layte, R., McGee, H., Quail, A., Rundle, K., Cousins, G., Donnelly, C., Mulcahy, F. and Conroy, R. (2006). The Irish Study of Sexual Health and Relationships: Main Report. Crisis Pregnancy Agency and the Department of Health and Children: Dublin.
62 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24. HSE Crisis Pregnancy Programme: Dublin.
63 Rundle, K., Leigh, C., McGee, H. and Layte, R., (2004). Irish Contraception and Crisis Pregnancy Study: A Survey of the General Population. Crisis Pregnancy Agency: Dublin.
64 Ipsos MRBI and Department of Health. (2016). Healthy Ireland Survey 2016 Summary of Findings. Department of Health: Dublin. Retrieved from: https://health.gov.ie/wp-content/uploads/2016/10/Healthy-Ireland-Survey-2016-Summary-Findings.pdf
65 Ipsos MRBI and Department of Health. (2015). Healthy Ireland Survey 2015 Summary of Findings.
66 Ipsos MRBI and Department of Health. (2016). Healthy Ireland Survey 2016 Summary of Findings.
67 Ipsos MRBI and Department of Health. (2015). Healthy Ireland Survey 2015 Summary of Findings.
68 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
69 Rundle, K., Layte, R. and McGee, H. (2008). Irish Study of Sexual Health and Relationships Sub-Report 1: Learning About Sex and First Sexual Experiences. Crisis Pregnancy Agency and Department of Health and Children: Dublin.
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
Young People (aged 15-24)
Over-50s
Early sexual initiation, at aged 16 years or
While reported frequency of sexual activity declines with increasing age, the longitudinal study on ageing in Ireland finds that the majority (59%) of the Irish population over-50 report sexual activity within the previous 12 months72.
younger, is more likely to be reported by younger
adults, with the proportion remaining relatively
stable for men at 39% in 2003 and 37% in 2010 but
increasing for women from 21% to 26% over the
same period.70
The Growing Up in Ireland71 study found that
among the 17/18-year olds cohort 33% reported
they were having sexual intercourse, while 40%
This sexual activity is strongly linked to
reported having oral sex. 17-18-year-old females
relationship status (married or cohabiting) as well
were more likely than males to report having
as being positively associated with self-reported
had sexual intercourse with one person (55%
good health, higher quality of life and positive
compared to 48%) and less likely to have had
perceptions of ageing. Older people report a lower
four or more sexual partners (14% compared
median number of lifetime partners than their
to 23%). Females also reported feeling less
younger counterparts, as well as lower levels of
pressured (either a little or a lot) to have sex when
overlapping sexual partners73.
compared to male respondents (13% compared
to 22%). Females were however more likely to
Migrant Women
fear losing a partner if they did not have sex with
A 2010 ICCP (Irish Contraception and Crisis
them when compared to males (8% versus 3%).
Pregnancy) study found that migrant women’s
The study found a higher level of sexual activity
(from Poland and Nigeria, and aged 18 to 34
among young people from socially disadvantaged
years) sexual behaviour generally mirrored that
backgrounds.
of the indigenous population, with the vast
majority reporting experience of sex74. In contrast
Figure from page 28
a qualitative study of the views of Chinese,
Polish and Muslim women in Ireland found that,
although these migrant women shared many
perspectives with Irish women in how they feel
about sex, fertility and motherhood, some specific
attitudes linked to cultural differences were
different. For example, some migrant women
believed that their culture prevented them from
talking openly about sex and sexual health and
that sexual behaviour can affect a young woman’s
reputation and that of her wider community75.
There is a dearth of information relating to sexual
behaviour among sex workers, women with
disabilities or prisoners.
70 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
71 Growing Up in Ireland Study Team (2016) Key Findings: Child Cohort at 17/18 years No. 4 Risky Health Behaviours and Sexual Activity. ESRI/TCD/DCYA: Dublin. Retrieved from:https://www.esri.ie/system/files/media/file-uploads/2016-11/SUSTAT59.pdf
72 Orr, J., McGarrigle, C. and Kenny, R. (2017). The Irish Longitudinal Study on Ageing in Sexual Activity in the Over 50s Population in Ireland. Trinity College, Dublin: Dublin.
73 Layte, R., McGee, H., Quail, A., Rundle, K., Cousins, G., Donnelly, C., Mulcahy, F. and Conroy, R. (2006). The Irish Study of Sexual Health and Relationships: Main Report.
74 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
75 Conlon, C., O’Connor, J. and Ní Chatháin, S. (2012). Attitudes to Fertility, Sexual Health and Motherhood Amongst a Sample of Non-Irish National Minority Ethnic Women Living in Ireland, Crisis Pregnancy Programme Report No. 25. HSE Crisis Pregnancy Programme: Dublin.
Women aged 25 to 34 are most likely to have had a test, with 44% having had a STI/STD test during their lifetime, and 39% having had a HIV test during their lifetime, this increase among women may be due in part to the antenatal screening programme for HIV.
STIs and HIV
Data on notifiable infections is reported annually
by the Health Protection Surveillance Centre
(HPSC) and is gender disaggregated. Statutory
notifications of STIs have been increasing steadily
since the mid-1990s, with a notable 10% increase
between 2015 and 201676. HIV notifications have
also increased in recent years77. These increases
may reflect an increase in testing rates. There
are differences in the distribution of certain STI
Routine opt-out antenatal screening for syphilis,
notifications by sex, with a female predominance
hepatitis B and HIV is recommended for all women
for chlamydia, genital herpes simplex and
booking antenatal care. National antenatal HIV
trichomoniasis notifications. In 2017, there were
screening began in 1999. In 2016 the HIV test
1,780 notifications of chlamydia infection among
uptake rate was 99.8% and the overall prevalence
females aged 20-24 compared to 1,217 among
of newly diagnosed HIV was 0.2%.
males 20-24. Surveillance data indicates that
STIs are concentrated within two specific groups:
2.2.3.2 Women’s reproductive health
young people and men who have sex with men
(MSM). Most notifications of STIs in 2016 were
Reproductive health affects both women and
among young people, with 70% of all notified STIs
men, but it is women who carry the burden of
identified in the under-30s.
reproductive ill health, linked to their biological
status, but also because of a wider social, economic
STI and HIV Testing
and political disadvantage. On a more positive
note, the increased medical surveillance of women
A nationally representative survey in 2006 found
during their reproductive years (including the
that 1.8% of women and 3.4% of men reported
use of hormonal contraceptives) means women’s
having ever been diagnosed with an STI; the
chronic illnesses tend to get picked up earlier,
proportions were highest among those aged 25
with increased metabolic pressure that pregnancy
to 34, with rates of 4.8% for males and 3.6% for
puts on one’s body means that a tendency to
females78. A 2010 nationally representative survey
chronic disease, may be picked up in pregnancy
found that 14% of those who reported ever having
before it becomes entrenched. For example, blood
an STI screen had had an STI diagnosis79. Factors
pressure screening during pregnancy, or before the
associated with a greater likelihood of reporting an
prescribing of hormonal contraception, is likely to
STI diagnosis were early sexual initiation and non-
identify problems early; similarly, identification
use of contraception at first sexual intercourse.
of gestational diabetes during pregnancy may
point to a higher risk of type 2 diabetes later in life.
The Healthy Ireland Survey 201880 found that 21%
This tends to result in action being taken earlier
of its survey respondents have had a HIV test and
and may be a contributory factor to higher female
22% have had a STI/STD test during their lifetime.
life expectancy. Key elements of reproductive
health for women include access to affordable and
accessible contraception, maternity entitlements,
the ongoing development of women-centred
maternity care, family formation (including the
regulation and public provision of assisted human
76 Health Protection Surveillance Centre. (2017). Sexually Transmitted Infections (STIs) in Ireland, 2016. HPSC: Dublin.
77 Health Protection Surveillance Centre. (2017). HIV in Ireland, 2016. HPSC: Dublin.
78 McGee, H., Rundle, K., Donnelly, C. and Layte, R. (2008). The Irish Study of Sexual Health and Relationships Sub Report 2: Sexual Health Challenges and Related Service Provision. CrisisPregnancy Agency and the Department of Health and Children: Dublin.
79 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
80 Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings.
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
reproduction), and prevention of infertility. There
is also a need for the provision of menopause
reproductive health82
services. In its work, Public Health England has
identified six pillars of reproductive health. See
Figure 2.2 A three-pronged approach to
Table 2.5 for details.
Contraception
Table 2.5 Six pillars of reproductive health
Preconception
Abortion
— Positive Approach: The opportunity for reproductive —
Period poverty
Unintended pregnancy
health and access to reproductive healthcare, to be
Menstrual difficulties
Pregnancy planning
free from stigma and embarrassment.
Incontinence
Fertility
Inequalities
— Knowledge and resilience: The ability to make —
informed choices and exercise freedom of
Sexual pleasure
expression in all aspects of reproductive health.
Violence & coercion
— Free from violence and coercion: The ability to —
FGM
form enjoyable relationships whilst not fearing
Prevention of infective reproductive sequelae eg infertility & cervical cancer
or experiencing any form of power imbalance or
intimidation.
— Proportionate universalism: The ability to optimise —
reproductive health, and social and psychological
Pregnancy Related
well-being through support and care that is
Sexual Health Related
proportionate to need.
Non Pregnancy Related
— User-centered: The ability to participate effectively —
and at every level in decisions that affect
reproductive lives.
2.2.3.3 Women’s maternal health (before and after pregnancy)
— Wider determinants: The opportunity to experience —
good reproductive health free from the wider
factors (such as education and social deprivation)
The TCD Maternal health And Maternal Morbidity
that directly and indirectly impact on reproductive
in Ireland (MAMMI) study has found that serious
well-being, and the ability to access reproductive
aspects of women’s health during and after
healthcare when needed.
pregnancy remain almost completely hidden for
various reasons (e.g. this could include sciatica or
Source: Public Health England (2018) A consensus statement: reproductive health is a public health issue.
hiatus hernia towards the end of pregnancy that
doesn’t entirely resolve subsequently). They go
While a lot of effort goes into improving
on to report that most of conditions identified are
healthcare for women and their babies during the
preventable or treatable, yet women are not being
crucial period of pregnancy and childbirth, the
asked about them during the first three months
greater proportion of women’s lives exists outside
postpartum, a time at which they are in regular
these events. Reproductive wellbeing for the
contact with healthcare professionals. See Table
non-pregnant woman is also important with the
2.6 for details.
non-pregnancy related aspects of reproductive
health often overlooked (e.g. heavy menstrual
bleeding, infertility and menopause), compared
with the short and intense healthcare needs of a
pregnancy. For this Mann and Stephenson (2018)81
in their work outline a three-pronged approach to
reproductive health. See Figure 2.2 for details.
81 Mann, S. & Stephenson, J. (2018). Reproductive health and wellbeing - addressing unmet needs. British Medical Association. Retrieved from: https://bma.org.uk
82 Ibid.
| Table 2.6 Health problems during and after pregnancy83 | ||
|---|---|---|
| Health Problem | Prevalence at 3 months postpartum | Number of GPs who did NOT ask mother directly about the problem or condition |
| Pelvic Girdle Pain | One in three | Almost two thirds |
| Sexual Health Problems | Half experienced painful sex, one quarter had not resumed having sex | Eight out of ten |
| Anxiety | 28% (self-reported) experienced some anxiety, and 12% experienced anxiety occasionally or often | Half |
| Depression | 18% experienced depression at some time since giving birth | Half |
| Leaking urine | Almost 60% of women leaked some amount of urine since giving birth | Three quarters |
| Anal incontinence | 12% | Three quarters |
| Source: Begley, C., Daly, D., Clarke, M., (2013). The Silent Morbidities: Early Results of the MAMMI study. Trinity College Dublin, Queen’s University Belfast, Health Research Board. Retrieved from: http://www.mammi.ie/downloads/findings/3.pdf |
Crisis pregnancy in Ireland
Crisis pregnancy is defined in Irish legislation
as ‘a pregnancy which is neither planned nor desired
by the woman concerned and which represents a
personal crisis for her’. This definition is understood
to include the experiences of women for whom
a planned pregnancy develops into a crisis over
time due to a change in circumstances84. The
reasons why a pregnancy is considered a crisis can
in some cases be linked to the age of the woman
involved and the point in her life at which she
becomes pregnant. Research has found that a
woman who becomes pregnant unexpectedly must
consider how that pregnancy will impact on other
dimensions of her life, including her personal
relationships, job, education, health and financial
situation. The most common reason given for a
pregnancy being a crisis is that the pregnancy
was not planned85. Research during the recent
recession found that employment and financial
factors featured more strongly for women
experiencing a crisis pregnancy, which reflected
the impact that the socio-economic environment
can have on a woman’s personal circumstances86.
Medical complications during pregnancy are also
an important reason for considering a pregnancy
a crisis87.
83 Begley, C., Daly, D., Clarke, M., (2013). The Silent Morbidities: Early Results of the MAMMI study. Trinity College Dublin, Queen’s University Belfast, Health Research Board. Retrieved from: http://www.mammi.ie/downloads/findings/3.pdf
84 Irish Statute Book (2001) Crisis Pregnancy Agency (Establishment) Order, S.I. No. 446/2001. Ireland.
85 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
86 Ibid.
87 Russell, H., Watson, D. and Banks, J. (2001). Pregnancy at Work: A National Survey. SHCPP: Dublin. Retrieved from: https://www. ihrec.ie/download/pdf/pregnancy_at_work_a_national_survey.pdf
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
Prevalence of crisis pregnancy
Teenage pregnancy
Approximately one in three women (35%) and
Not all teenage pregnancies are interpreted as
one in five men (21%) surveyed in 2010 with
a crisis by the young people involved. However,
experience of pregnancy reported having
traditionally, the teenage birth rate and abortion
experienced a crisis pregnancy88. The proportion
rate were used as indicators of crisis pregnancy.
has increased for women (28%) and remained
The teenage birth rate, as defined by the number
stable since 2003 for men (22%)89. In 2010, over
of births to females aged under-20 in relation
65% of women and men with experience of crisis
to females aged 15 to 19 per 1,000 population,
pregnancy reported that they were in a steady
declined in Ireland from 20 births per 1,000 in
relationship, cohabiting, engaged or married at
2001 to 7.8 births per 1,000 in 2016. There was a
the time a crisis pregnancy occurred90.
total of 1,098 births to teenagers in 2016 compared
with 3,087 in 2001, representing a 64% decrease in
Groups identified as being at a particularly high
the number of births to teenagers over the 15-year
risk for experiencing a crisis pregnancy include:
period96.
—Young adults (18–25): The average age for —
Causes of crisis pregnancy
experiencing a crisis pregnancy is 24 for women
and 23 for men – this finding has remained
Causes of crisis pregnancy include the non-use of
stable over time; 44% of pregnancies among
contraception, with almost half of the women who
women aged 18 to 25 are perceived by the
reported experiencing a crisis pregnancy indicating
individuals involved as a crisis91.
that contraception was not used at the time of
conception. The main reasons given for the none
—Young people who have first sex before the age —
use of contraception, were that ‘sex was not planned’
of 17: These young people are less likely to
(32%), that they ‘took a chance’ (30%), or that ‘alcohol
use contraception and are 70% more likely to
and drugs were used at the time of conception’ (20%)97.
experience a crisis pregnancy and three times
Other reasons for crisis pregnancy were: the ‘failure
more likely to experience abortion later in
of contraception’, with31% of women and 40% of
life92.
men not knowing why contraception had failed98;
—Older, married women (over the period 2003 and —
problems with condom use (19% of women and
201093,94): This may be related to the financial
15% of men) and contraceptive pill failure (20% of
crisis in the intervening years. A crisis
women and 12% of men).
pregnancy in this age group is more likely to
be due to the fact that the woman sees her
family as complete or has given birth recently.
Research finds contraception use is becoming
less consistent for both women and men in
this age group95.
88 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
89 Ibid.
90 Ibid.
91 Ibid
92 Rundle, K., Layte, R. and McGee, H. (2008). Irish Study of Sexual Health and Relationships Sub-Report 1: Learning About Sex and First Sexual Experiences.
93 Ibid.
94 Bourke, A., Kelleher, C., Boduszek, D. and Morgan, K. (2015). Factors Associated with Crisis Pregnancies in Ireland: Findings from Three Nationally Representative Sexual Health Surveys. ReproductiveHealth. 12: 14.
95 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
96 Health Service Executive. (2017, 31 May). 64% Decrease in the Number of Births to Teenagers over 15 Year Period. [Press Release]. Retrieved from: https://www.sexualwellbeing.ie/about/media/press-releases/decrease-teen-births-2016.pdf
97 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
98 Ibid.
Crisis pregnancy responses
Abortion services
Parenting is by far the most common outcome for
Until2019, abortion was illegal in Ireland under
women who experience a crisis pregnancy.
almost all circumstances. Yet, abortion was still
a service accessed by Irish women, with women
Research finds that when asked about their most recent crisis pregnancy, just under three-quarters of women chose to parent; among men, 66% chose to parent99.
travelling from Ireland to other countries to
access services and in more recent years, women
ordering abortion pills online to take at home.
Prior to 2019,the thirteenth and fourteenth
amendments to the Constitution Act 1992
protected the provision of information on all
options available to a woman experiencing a crisis
Adoption while it was once a common response
pregnancy, including abortion services outside the
for women experiencing a crisis pregnancy in
state, and protected an individual’s right to travel
Ireland this is no longer the case, with the number
outside Ireland to avail of abortion services103,104.
of babies placed for adoption having decreased
Women travelling to another jurisdiction for an
significantly in recent decades and continuing
abortion tend to choose England, Wales or the
to fall on an annual basis. Research has found
Netherlands to access abortion services. Research
that just 1% of women and men chose adoption
found that the majority of women travelling from
following their most recent crisis pregnancy100.
Ireland for an abortion travelled to England or
Thirty children were placed for non-family
Wales. In 2016, 3,265 women gave Irish addresses
adoptions in 2016, compared with 88 in 2004, 99
at UK abortion services, representing a rate of
in 2002 and 1,005 in 1976101.Abortion is another
3.2 per 1,000 women105. There has been a gradual
possible crisis pregnancy response with 24% of
decline in women availing of abortion services
women and 32% of men with experience of crisis
in the UK since 2001, when there were 6,673
pregnancy reporting that their most recent crisis
abortions to women giving Irish addresses in UK
pregnancy had ended in an abortion102.
abortion clinics, representing a rate of 7.5 per
1,000 women.The Netherlands has emerged as
the only other jurisdiction to which women from
Ireland have travelled to for abortion procedures
in any significant numbers. The Ministry of
Health in the Netherlands has collated data
on women providing Irish addresses in Dutch
abortion clinics since 2010. In 2015, 34 women
were recorded to have provided Irish addresses in
abortion clinics in the Netherlands106. The figures
have significantly declined since their peak in
2006, when the number was 461.
99 Ibid.
100 Ibid.
101 The Adoption Authority of Ireland. (2017). The Adoption Authority of Ireland Annual Report 2016. The Adoption Authority Ireland: Dublin.
102 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
103 Irish Statute Book (1992) Thirteenth Amendment of the Constitution Act 1992. Ireland.
104 Irish Statute Book (1992) Fourteenth Amendment of the Constitution Act 1992. Ireland
105 Department of Health (UK). (2017). Abortion Statistics, England and Wales: 2016 Summary Information from the Abortion Notifications Returned to the Chief Medical Officers of England and Wales.Department of Health: London.
106 Ministerie van Volksgezondheid, (2017) ‘Welzijn en Sport, Netherlands, Women Providing Irish Addresses in Dutch Abortion Clinics Since 2010’. Personal communication to M. O’Brien by email, 30 January 2017.
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
The legal restrictions on abortion
—If there is risk to life or health in any —
disproportionately impacted on women who
emergency
were already marginalised and disadvantaged:
—Any condition likely to lead to the death —
those with little or no income, women with care
of the foetus
responsibilities, minors in state care, women
with disabilities, women with a pre-existing
To comply with the certification requirements of
illness, women experiencing domestic or sexual
the law, there must be at least three days between a
violence, asylum seekers and women who were
woman’s first consultation and having the abortion.
undocumented. The need to travel also precluded
Abortions over 12 weeks of pregnancy in the case
doctors in Ireland providing proper care – or even
of risk to life or health or likely death of the foetus
referrals – for their patients. This meant that
must be certified by two clinicians. A HSE review
women with pre-existing health problems who
process is available for the pregnant person in cases
required abortion had to travel without important
where the clinician(s) does not certify the abortion.
medical records.
The abortion service is provided by the HSE as
Research about the experiences of women who have taken an abortion pill in Ireland found that 94.7% say they successfully ended their pregnancy without surgical intervention.
a free service for those who normally live in the
Republic of Ireland. It is provided through GPs
or family planning services which have signed
up to provide the service, and in maternity units
and hospitals. Women from Northern Ireland
can access this service but must pay for their
care. In May 2019 the SHCPP commissioned a
research piece which will generate qualitative
The study reported on 1,000 women from Ireland
data to develop an in-depth understanding of
who reported taking an abortion pill and who
the experiences of women who have accessed
followed up with the online service. Many
unplanned pregnancy support services and
women reported being afraid to tell a healthcare
abortion services since the Regulation of
professional that they have taken the abortion
Termination of Pregnancy Act 2018 was
pill for fear of a negative reaction or that they will
implemented on January 1st 2019.
be reported to the authorities107. Women who did
seek follow-up medical care reported a variety
Abortions can be provided medically (taking
of experiences with healthcare professionals in
medication to end the pregnancy) or surgically
Ireland, including encountering hostile attitudes
(a procedure to remove the pregnancy from the
and being provided with inadequate information108.
womb by a doctor using a suction method). For
abortions in early pregnancy, medical abortions
Following the removal of the 8th Amendment to
up to nine weeks of pregnancy generally take
the Constitution and the enactment of the Health
place with a doctor in the community; while
(Regulation of the Termination of Pregnancy)
medical abortions between nine and 12 weeks
Act 2018, abortion services have been provided
take place in a hospital setting. Hospitals will
in Ireland since 1st January 2019. Abortion is now
also provide for circumstances where there is a
available in certain circumstances109:
risk to life or health of the pregnant person, or
where there is a condition likely to lead to the
—In early pregnancy, up to 12 weeks —
death of the foetus before or shortly after birth.
—If there is a risk to life or health of the —
pregnant woman
107 Aiken, A., Digol, I., Trussell, J. and Gomperts, R. (2017) ‘Self Reported Outcomes and Adverse Events After Medical Abortion Through Online Telemedicine: Population Based Study in the Republic of Ireland and Northern Ireland.’ BMJ Research.
108 Aiken, A. (2017). ‘Oireachtas Debate: International Developments in the Provision of Health Care Services in the Area of Termination of Pregnancies’. Lyndon B Johnson School of Public Affairs and World Health Organization. Houses of the Oireachtas: Dublin.
109 Health Service Executive. (2018). Your guide to medical abortion. Retrieved from: https://www2.hse.ie/file-library/unplannedpregnancy/guide-to-medical-abortion.pdf
Information, support and counselling for women
Figure from page 35
experiencing an unplanned pregnancy are
provided by the HSE’s My Options service on 1800
828 010 or on myoptions.ie. If a person decides
to have a termination, ‘My Options’ will provide
details of the doctors (with the consent of the
doctors) providing termination of pregnancy
services in their locality. ‘My Options’ provides
signposting, referrals as appropriate and
information for any pregnancy related queries.
This includes supporting those who opt to
continue their pregnancy and for people who will
not meet legislative requirements in Ireland but
may need support to travel abroad for abortion
services.
Research about the experiences of women who
have taken an abortion pill in Ireland finds that
94.7% say they successfully ended their pregnancy
without surgical intervention. The study reports
on 1,000 women from the island of Ireland who
reported taking an abortion pill and who followed
up with the online service. Ninety-three women
reported experiencing a symptom for which they
were advised by the online service to seek medical
advice and 87 followed up on this advice. Seven
women reported receiving a blood transfusion and
26 reported receiving antibiotics. The author of
the report concludes that fear of the consequences
of taking an abortion pill can discourage women
from accessing medical services following the
taking of an abortion pill. Many women report
being afraid to tell a healthcare professional that
they have taken the abortion pill for fear of a
negative reaction or that they will be reported to
the authorities110. Women who did seek follow-up
medical care reported a variety of experiences
with healthcare professionals in Ireland, including
encountering hostile attitudes and being provided
with inadequate information111.
110 Aiken, A., Digol, I., Trussell, J. and Gomperts, R. (2017) ‘Self Reported Outcomes and Adverse Events After Medical Abortion Through Online Telemedicine: Population Based Study in the Republic of Ireland and Northern Ireland.’
111 Aiken, A. (2017). ‘Oireachtas Debate: International Developments in the Provision of Health Care Services in the Area of Termination of Pregnancies’.
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
2.3 Women’s health in Ireland at different life stages
Women’s health needs and risks vary depending on their life stage. Table 2.7 summarises some the key
health needs and risks for women at various stages.
| Table 2.7 Women’s key health needs and risks at different life stages | |
|---|---|
| Health behaviours and chronic disease | |
| Young Women (Approx. 12-24 years) | — Women aged under-25 are more likely to smoke than men of the same age: 21% and 18% respectively112 — The drinking behaviour of young women – and the fact that it replicates that of young men more closely than that among older groups of the population – warrants particular attention, given the increased health risks of drinking at this level113. |
| Adulthood (Approx. 25-49 years) | — The rate of binge drinking at least once a week among Irish women aged 18 and over was 6.8% in 2014, the highest rate in the EU and more than double the EU average rate of 2.6%.114 |
| Healthy Ageing (Approx. 50-65 years) | — Women make up a greater proportion of deaths from cardiovascular disease, yet rates of hospitalisation from men with heart disease and heart attacks are nearly double that of women115. — Breast cancer is the most common cancer for women, accounting for 30% of all cancer diagnoses. Lung cancer is the second most prevalent cancer for women at 11%. Lung cancer is the leading cause of cancer death for women116. — Irish respiratory death rates are high by comparison with the EU15 average, especially for women117. — 1 in 2 women over 50 will develop a fracture due to osteoporosis in their lifetime118. |
| Older Women Approx. 65 years + | — Although women have a higher life expectancy than men, women spend many more years than men living with age related ill-health and disability.119 — Traveller women have a life expectancy more than 10 years lower than the general population.120 |
112 Ipsos MRBI and Department of Health. (2016). Healthy Ireland Survey 2016 Summary of Findings.
113 Ipsos MRBI and Department of Health. (2017). Healthy Ireland Survey 2017 Summary of Findings.
114 CSO. (2016). Women and Men in Ireland 2016. Retrieved from: https://www.cso.ie/en/releasesandpublications/ ep/p-wamii/womenandmeninireland2016/health/ and http://www.cso.ie/en/releasesandpublications/ep/p-wamii/ womenandmeninireland2016/introduction/
115 Women’s Health Council. (2002). Women and Cardiovascular Health. Department of Health. Retrieved from: http://health.gov.ie/ wp-content/uploads/2014/03/women_cardiovascular.pdf
116 National Cancer Registry Ireland. (2017). Cancer in Ireland 1994-2016 - With Estimates For 2015-2017: Annual Report Of the National Cancer Registry. Retrieved from: https://www.ncri.ie/sites/ncri/files/pubs/NCRReport_2017_summary.pdf
117 Jennings, S.M. (2014). Preventing chronic disease: defining the problem – Report from the Prevention of Chronic DiseasesProgramme.
118 Osteoporosis Ireland. (2018). About Osteoporosis. Retrieved from: http://www.irishosteoporosis.ie/?/about_osteoporosis/
119 Department of Health. (2016). Health in Ireland Key Trends 2016. Retrievedfrom:https://health.gov.ie/wp-content/uploads/2016/12/ Health-in-Ireland-Key-Trends-2016.pdf
120 All Ireland Traveller Health Study Team. (2010). Our Geels, All Ireland Traveller Health Study. UCD
| Mental health and well being | |
|---|---|
| Women undertake the majority of unpaid care work in Ireland. In 2016, 98% of those looking after the home/ family were women.121 | |
| Young Women (Approx. 12-24 years) | — Young women (15-24 years) were the group with the highest percentage of negative mental health (17%)122. — Adolescent girls and young women report a higher degree of mental health distress than boys and young men. A higher percentage (24%) also engages in self-harm compared to males (16%)123. — One in every 131 girls (15-19 years) presented to hospital in 2016 as a consequence of self-harm124 . |
| Adulthood (Approx. 25-49 years) | — 16% of pregnant women in Ireland are at probable risk of depression during their pregnancy. With the second highest birth rate in Europe, this means that each year over 11,000 pregnant women could be experiencing, or at risk of depression125. — 62.7% of Traveller women disclosed that their mental health was not good enough for one or more days in the last 30 days; this was compared to 19.9% of General Medical Services (GMS) female cardholders126. |
| Healthy Ageing (Approx. 50-65 years) | Caring responsibilities can have a negative impact on mental and physical health, leading to exhaustion, depression, injury and greater vulnerability to illness. Women (aged 50-69) within the ‘sandwich generation’ make an important contribution to supporting two generations, their children and their parents, and this has an impact on their self-reported physical and mental health. The ageing population and the increasing demands on the middle generation for both financial and informal care may lead to an increasing negative impact on women’s health. |
| Older Women Approx. 65 years + | — The incidence of dementia is substantially higher amongst women than men in Ireland (lifetime risk of one in six, compared with nearly one in eleven for men).127 — Rates of depression have been consistently shown to be higher in older women than in older men128. |
121 CSO. (2016). Women and Men in Ireland 2016.
122 Ipsos MRBI and Department of Health. (2016). Healthy Ireland Survey 2016 Summary of Findings.
123 Dooley, B., Fitzgerald, A., (2012) My World Survey: National Survey of Youth Mental Health in Ireland. UCD School of Psychology and Headstrong. Retrieved at: https://www.jigsaw.ie/content/images/News__Events_/Research/MWS_Full_Report_PDF.pdf
124 Griffin, E., Dillon, CB., Arensman, E., Corcoran O., Williamson, E., Perry, IJ. (2017). National Self-Harm Registry Ireland Annual Report 2016. Cork: National Suicide Research Foundation. Retrieved from: https://www.nsrf.ie/wp-content/uploads/reports/ NSRF%20National%20Self-Harm%20Registry%20Ireland%202016.pdf
125 Kennedy, Y. (2016, 3 November) Rates of depression are high amongst pregnant women in Ireland. [Press Release]. Retrieved from: https://www.tcd.ie/news_events/articles/rates-of-depression-are-high-amongst-pregnant-women-in-ireland/7341
126 All Ireland Traveller Health Study Team. (2010). Our Geels, All Ireland Traveller Health Study. UCD
127 Gantly, D. (2016) ‘ASI highlights double impact of dementia on women’. Irish Medical Times. Retrieved from: https://www.imt.ie/ news/asi-highlights-double-impact-of-dementia-on-women-10-03-2016/
128 O’Regan, C., Cronin, H., and Kenny, R.A. (2016) Mental Health and Cognitive Function. TILDA: Irish Longitudinal Study on Ageing. Retrieved from: http://tilda.tcd.ie/publications/reports/pdf/w1-key-findings-report/Chapter6.pdf
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
| Reproductive and sexual health | |
|---|---|
| Young Women (Approx. 12-24 years) | — 2010 Irish Contraception and Crisis Pregnancy Study identified the cost of contraception as a significant access barrier for young people129. Women’s access to contraceptives can be hindered by the cost of the GP visit and prescription costs. — A recent survey of 1,100 Irish girls aged 12-19 years found that nearly half (50%) of girls aged 12-19 years have experienced issues around affordability of sanitary products130. |
| Adulthood (Approx. 25-49 years) | — In 2016, there were 63,897 births in Ireland, a rate of 13.7 per 1000 population, the highest birth rate in Europe131. — Some mothers experience health problems, sometimes caused by pregnancy or an event that happens during or after the baby’s birth. Some common health problems include; incontinence, pregnancy-related pelvic girdle pain (PPGP), perinatal depression, and postpartum sexual health issues132. — 24% of Roma women had not accessed health services while pregnant and their first point of access was to give birth133. — More than a third of women (23,000) attending antenatal services in Ireland in 2016, did not receive a foetal anomaly ultrasound134. — 81,093 women of reproductive age (15-49), live with disabilities in Ireland135. Women with disabilities using maternity services report issues with accessibility, related to the location and models of care, difficulties in transport and moving around the physical environment136. — 16% of pregnant women attending maternity services across Ireland are at probable risk of depression during their pregnancy137. |
| Healthy Ageing (Approx. 50-65 years) | — There is a higher incidence of cervical cancer in more deprived populations, with age-standardised rates about 120% higher in the most deprived compared with the least deprived fifth of the Irish population.138 — During menopause women can experience hot flushes, anxiety, depression, memory problems, and sexual dysfunction.139 |
| Older Women Approx. 65 years + | Up to three times as many women than men are affected by urinary incontinence, which has a negative impact on mood, quality of life, and social participation140. |
129 McBride, O., Morgan, K. and McGee, H., (2012). Irish Contraception and Crisis Pregnancy Study 2010: A Survey of the General Population, Crisis Pregnancy Programme Report 24.
130 Plan International. (2018). We Need to Talk. Period: Lifting the Barriers to Girls’ Education. Retrieved from: https://www.plan.ie/weneed-to-talk-period/
131 CSO. (2016). Vital Statistics, Yearly summary. Retrieved from: https://www.cso.ie/en/releasesandpublications/ep/p-vsys/ vitalstatisticsyearlysummary2016/
132 Begley, C., et al (2013). The Silent Morbidities: Early Results of the MAMMI study.
133 Pavee Point. (2018). Roma in Ireland, a National Needs Assessment. Retrieved from: http://www.paveepoint.ie/wp-content/ uploads/2015/04/RNA-PDF.pdf
134 Kenny, L. (2017) Institute of Obstetricians and Gynaecologists evidence to Oireachtas, Joint Committee on Health. 16th February 2017. National Maternity Strategy: Discussion (Resumed).
135 CSO. (2011). Persons with a Disability. Retrieved from: https://www.cso.ie/px/pxeirestat/Statire/SelectVarVal/Define. asp?maintable=CD801&PLanguage=0
136 National Disability Authority. (2009). Women with Disabilities: Barriers and Facilitators to Accessing Services During Pregnancy, Childbirth and Early Motherhood. University of Dublin, Trinity College Dublin, School of Nursing and Midwifery. Retrieved from: https://nursing-midwifery.tcd.ie/assets/publications/pdf/nda-literature-review.pdf
137 Kennedy, Y. (2016, 3 November) Rates of depression are high amongst pregnant women in Ireland [Press Release]. REDEEM Research Group, TCD and National Obstetrics Services. Retrieved from: https://www.tcd.ie/news_events/articles/rates-of-depressionare-high-amongst-pregnant-women-in-ireland/
138 National Cancer Registry Ireland. (2016). Cancer inequalities in Ireland by deprivation, urban/rural status and age: a National Cancer Registry report. National Cancer Registry.Retrieved from: https://www.ncri.ie/sites/ncri/files/pubs/cancer-inequality-reportsummary-2016.pdf
139 Marie Keating Foundation. (2018). Information on Menopause. Retrieved from: http://www.mariekeating.ie/cancer-information/ brca/the-menopause-hrt/
140 McGarrigle,C., Donoghue, O., Scarlett, S.,and Kenny, R.A. (2016). Health and Wellbeing: Active Ageing for Older Adults in Ireland Evidence. The Irish Longitudinal Study on Ageing. Retrieved from: https://tilda.tcd.ie/publications/reports/pdf/w3-key-findingsreport/TILDA%20Wave%203%20Key%20Findings%20report.pdf
Female smoking rates are highest among those
2.4 Women’s lifestyle behaviours
aged 25-34. Women more likely to smoke in
disadvantaged areas than in affluent areas.
Lifestyle behaviours, including smoking, diet and
Smoking rates among women aged 55-64 are
physical activity can have a significant impact on
almost four times higher in more disadvantaged
a woman’s health.
areas than in more affluent areas143, see Table 2.8
2.4.1 Smoking prevalence141
for details. Non-manual/skilled workers (21%)
are more likely to smoke than those categorised
Smoking rates are dropping in both females
as professional/managerial & technical workers
and males. The overall population incidence
(11%). Women (10%) are more likely than men
has decreased from 23% in 2015 to 20% in 2018,
(2%) to have made an attempt to quit smoking due
moreover, the decrease from the 1980s, when rates
to advice from a health professional. The most
were around 35%, is very significant. According
tobacco-dependent population sub-group have
to the most recent Healthy Ireland surveys the
been identified as single people aged 35-54, who
rates are 17% for women and 22% for men (this
are engaged in home duties and who left school
compared with rates of 21% women and 24% of
without a Leaving Certificate144.
men in 2015). Notwithstanding these reductions,
a lot of work still needs to be done in order to
| Table 2.8 Percentage of women who smoke (by age and deprivation) | |||||||
|---|---|---|---|---|---|---|---|
| Age | 15- 24 | 25- 34 | 35- 44 | 45- 54 | 55- 64 | 65- 74 | 75+ |
| Women in Deprived areas | 21 | 30 | 27 | 29 | 31 | 13 | 12 |
| Women in Afufl ent areas | 15 | 22 | 13 | 9 | 8 | 8 | 4 |
| Source: Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings. p.24 |
achieve the national goal of a tobacco free society
(i.e. smoking rates of <5%) and to reduce the
damage smoking can do, both to women’s health
and specifically in pregnancy. Within the National
Strategy for Women and Girls there are a number of
specific actions designed to address smoking rates
in women and girls generally (Action 2.14) and
to address female smoking and drinking levels
in the context of the National Maternity Strategy142
(Actions 2.15-2.16).
2.4.2 Consumption of alcohol145
Figure from page 39
Women generally drink less, and drink
significantly less frequently than men (72% of
women drank compared with 78% men in the
last 12 months and of that 48% of women and
62% of men drink at least once a week). Older
drinkers are more likely to drink more frequently,
while female binge drinking drops sharply with
age (compared with male binge drinking). Binge
drinking is defined as six or more standard
drinks on a drinking occasion. Women from more
disadvantaged areas are more likely to binge drink
on a typical drinking occasion than those from
more affluent areas, see Table 2.9 for details.
141 Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings.
142 Department of Health (2016) The National Maternity Strategy 2016-2026: Creating a Better Future Together.
143 Ibid.
144 Ibid, p.24-5.
145 Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings.
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
| Table 2.9 Percentage of women who binge drink (by age and deprivation) | |||||||
|---|---|---|---|---|---|---|---|
| Age | 15- 24 | 25- 34 | 35- 44 | 45- 54 | 55- 64 | 65- 74 | 75+ |
| Women in Deprived areas | 25 | 37 | 18 | 18 | 5 | 8 | 2 |
| Women in Affluent areas | 21 | 20 | 9 | 9 | 8 | 1 | <0.5 |
| Source: Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings. p.25 |
2.4.4 Diet and nutrition150
Diet can have an impact upon the risk of chronic
disease, including cancers and cardiovascular
disease. The prevalence of diets rich in fat and
excess sugars, and low in fibre and fresh fruit
and vegetables combined with inactive lifestyles,
have resulted in greater prevalence of obesity in
many countries. The number of people who are
obese and overweight is increasing in both sexes
in Ireland151.
Using the Metabolic Risk Classification of waist
Particular concerns for women and girls in relation to alcohol consumption include: the breast cancer risks in relation to underage drinking for young girls; alcohol as a risk factor for breast cancer for women146; and the risk of Foetal Alcohol Syndrome and recommendations in relation to alcohol free pregnancy147.
measurements, 45% of women were found to have
a substantially increased level of risk of premature
death due to obesity compared with men (27%).
Almost a third (30%) of young people in Ireland
were found to be overweight or obese, with 27%
of young women overweight and 9% of young
women categorised as obese. The proportion of
women consuming at least one type of unhealthy
food is highest among women aged 75 and over
(42%). People in more disadvantaged areas have
higher levels of consumption (36%) of at least one
2.4.3 Drug misuse148
or more unhealthy foods a day compared with
Illicit drug use has become more common in
32% of people in more affluent areas. Women
the adult population in Ireland. Cannabis is the
(6%) are less likely than men (11%) to drink sugar
most commonly used drug followed by MDMA/
sweetened drinks at least once a day. Women are
ecstasy and cocaine. Illicit drug use is more
more likely (43%) than men (30%) to consume
common among males and younger age groups.
five or more portions of fruit and vegetables
Figures from a Northern Ireland study show
a day. Consumption of fruit and vegetables is
that approximately three in ten adults report
lower among those aged 75 and older (25%) and
use of illicit drugs in 2014-2015, while one in
those aged between 15 and 24 (27%). Women are
eight females between 15 and 24 reported having
also at risk of developing gestational diabetes in
used an illegal drug in the previous 12 months
pregnancy and developing Type 2 diabetes in the
(compared with one in four males)149.
following 5-10 years.
146 Guerra Guerrero, V., Fazzi Baez, A., Cofré González, C.G., Miño González, C.G. (2017). ‘Modifiable risk factors for breast cancer: an obligation for health professionals.’ Rev Panam Salud Publica. 41:e80. Retrieved from: http://iris.paho.org/xmlui/ handle/123456789/34054
147 Department of Health (2016) The National Maternity Strategy 2016-2026: Creating a Better Future Together.
148 European Monitoring Centre for Drugs and Drug Addiction (2018) Ireland Drug Report 2018. Retrieved from: http://www.emcdda. europa.eu/system/files/publications/11313/ireland-cdr-2018-with-numbers.pdf
149 NACDA, Department of Health, Ipsos. (2017). Prevalence of Drug use and Gambling in Ireland and Drug Use in Northern Ireland. Retrieved from: https://health.gov.ie/wp-content/uploads/2016/11/Bulletin-1.pdf
150 Ipsos MRBI and Department of Health. (2018). Healthy Ireland Survey 2018 Summary of Findings. Department of Health: Dublin. Retrieved from: https://health.gov.ie/wp-content/uploads/2018/10/Healthy-Ireland-Survey-2018.pdf
151 Morgan, K., McGee, H., Watson, D., Perry, I., Barry, M. (2008) SLAN 2007: Survey of Lifestyle, Attitudes & Nutrition in Ireland: Main Report. Dublin: Department of Health and Children. Retrieved from: https://epubs.rcsi.ie/cgi/viewcontent. cgi?article=1002&context=psycholrep
who participate in recreational walking by age.
2.4.5 Folic acid
Those with higher levels of education are more
At present, Ireland has the highest rate of babies
likely to go for regular walks than those with lower
born with spina bifida in the EU. Taking a daily
levels of education.152
folic acid supplement can potentially prevent two
thirds of Neural Tube Defects (NTDs) such as spina
bifida from occurring. It is therefore recommended
in recreational walking by age
that all women of childbearing age (who are
sexually active and who could become pregnant
100
Figure 2.3 Percentage of women who participate
- even if taking contraception - as approximately
50% of pregnancies are unplanned) take a 400μg
80
daily folic acid supplement daily.
60
According to the Healthy Ireland Survey 2016 ‘fewer than 1 in 10 (9%) of women take a folic acid supplement’ with just ‘18% of women aged 25 to 34 taking a folic acid supplement and just 5% of those younger taking the supplement’ (p 19).
40
20
0
16–19
20-24 25–34 35–44 45–54 55–64 65+
2015 2017
2.4.6 Physical exercise (including participation in sports)
Source: Irish Sports Monitor 2017 (p.27)
43% of the population regularly participate in
Nationally, the participation rates of teens and
sport153 – either actively or socially – at the
young women in sport are much lower than that
same level as in 2015. 4.5% less women than men
of men and boys. This compares with women of
participate in sport but the gender difference is
over 45 who are more likely to participate in sport
decreasing (the difference was 15.7% in 2007).
than men over 45 (ISM 2017). The percentage of
Younger women are more likely to play sport
women and men who are classified as highly active
than older women, with an increasing number of
(meeting the national physical activity guidelines
women aged 35 and over participating between
of half an hour per day of moderate to vigorous
2015 and 2017. See Table 2.10 for details of the 10
physical activity) shows a similar pattern, with
most popular sports that women participate in
younger men outperforming women up to age
and Figure 2.4 for details of levels of women’s
25, but the reverse gender gap opens up after age
participation in sport by age.
35, with women outperforming men. This would
suggest that possible areas of enhanced gender
related focus for physical activity, of relevance
to the WHAP, would be teenage girls and young
women.
Nationally, recreational walking is the most popular
form of physical activity with almost 2.5 million
(66.2%) people walking for recreation each week.
Females are more likely than males to take regular
walks for recreation (71.1% and 61.2% respectively).
See Figure 2.3 for details of the percentage of women
152 Ipsos MRBI. (2018). Irish Sports Monitor: Annual Report 2017. Retrieved from: https://www.sportireland.ie/Research/Irish%20 Sports%20Monitor%202017%20-%20Half%20Year%20Report/Irish%20Sports%20Monitor%202017.pdf
153 Sport is defined in the Sport Ireland Act “All forms of physical activity which, through casual or regular participation aim at expressing or improving physical fitness and mental well-being and at forming social relationships.”
Women’s Health in Ireland — Evidence Base for the development of the Women’s Health Action Plan
| Table 2.10 Changes in women’s % participation rates in various sporting activities (2017 v 2015) | ||
|---|---|---|
| Sport/activity | 2017 | 2015 |
| Exercise | 13.5 | 12.9 |
| Swimming | 9.8 | 8.6 |
| Running | 5.5 | 6.9 |
| Dancing | 4.3 | 4.2 |
| Yoga | 3.4 | 2.4 |
| Cycling | 3.0 | 3.3 |
| Pilates | 2.2 | 1.9 |
| Weights | 1.3 | 1.4 |
| Gaelic Football | 1.2 | 0.8 |
| Golf | 1.2 | 0.9 |
| Camogie | 0.6 | 0.5 |
| Soccer | 0.5 | 1.2 |
| Source: Ipsos MRBI. (2018). Irish Sports Monitor: Annual Report 2017. Retrieved from: https://www.sportireland.ie/Research/ Irish%20Sports%20Monitor%202017%20-%20Half%20Year%20 Report/Irish%20Sports%20Monitor%202017.pdf p18 |
2.5 Violence against women
‘Violence against women is an umbrella term used to describe any act of genderbased violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women. As well as domestic violence and abuse, it also includes (but is not limited to) rape and sexual abuse, crimes against women, and based on notions of ‘honour’, forced marriage, forced prostitution and trafficking, female genital mutilation (FGM) and sexual harassment’154(p 15).
Health problems that have been linked to violence
against women include depression, emotional
distress and suicidality, as well as injuries,
pain and long-term health conditions.155 Health
problems for women linked to sexual violence
include sexually transmitted infections or
diseases, vaginal bleeding, urinary tract infection,
miscarriage and neonatal death.156 Mental health
by age
impacts of rape include suicidality, flashbacks,
100
Figure 2.4 Women’s participation in sport
anxiety, depression and panic attacks.157
80
Understanding the exact scale of violence against
women is difficult due to systemic underreporting
60
and definitional issues. What is known is that
young women and girls are more likely than boys
to experience sexual abuse, physical abuse or
40
neglect.158
20
0
16–19
20-24 25–34 35–44 45–54 55–64 65+
2015 2017
Source: Irish Sports Monitor 2017 (p.18)
154 Westmarland, N., & Bows, H., (2018). ‘Tackling violence against women - meeting unmet needs. In BMA (2018) Addressing unmet needs in women’s health’. Journal of Interpersonal Violence. 28(17).
155 World Health Organisation. (2012). Intimate partner violence. Retrieved from: http://apps.who.int/iris/bitstream/10665/77432/1/ WHO_RHR_12.36_eng.pdf
156 Ibid.
157 Westmarland, N., & Bows, H., (2018). ‘Tackling violence against women - meeting unmet needs’. In BMA (2018) Addressing unmet needs in women’s health’. Journal of Interpersonal Violence. 28(17): 3265-3282.
158 Women’s Health and Equality Consortium. (2011). Whywomen’s health? Retrieved from: https://www.whec.org.uk/wpcontent/ uploads/downloads/2011/11/WhyWomensHealth11.pdf
What research exists in an Irish context suggests that almost 50% of women in Ireland have experienced a least one form of sexual harassment, while one in four (equivalent to 400,000 Irish women) has experienced physical and/or sexual violence since the age of 15.159
The type of health supports needed to support
women who have/who are experiencing violence
depends on the recency of the violence and abuse,
with different responses needed for someone who
is at immediate risk or who has sustained life
threatening injuries compared with someone who
has experienced years of abuse as a child or adult.
To date, more attention has been directed to acute
needs rather than chronic conditions. Responding
to the complex acute needs arising from violence
requires a multi-disciplinary and multi-agency
Almost half (47%) of those who disclosed
approach. Responding to non-recent/historic
experiences of sexual violence in the 2002
violence and abuse is only in its infancy. The issue
Sexual Abuse and Violence in Ireland (SAVI) study160
of violence against older women appears to have
reported that they had never previously disclosed
been subsumed under the category of elder abuse,
that abuse to others161. Physical and/or sexual
which can be perpetrated inside or outside the
violence also occur between family members and
family.
between same sex couples. Official national data
identified that one in seven women in Ireland
compared to one in 16 men experience severe
2.6 Women, health and disadvantage
domestic violence, with women more than twice
as likely as men to have experienced severe
physical abuse and seven times more likely to
The 2010 Marmot Review165 into health inequalities
have experienced sexual abuse than men.162 In
in England found systematic gender differences in a
contrast, Women’s Aid suggest that that up to
range of health outcomes. So, although women live
one in four women are subjected to domestic
longer than men, they spend a greater proportion of
violence, while annually an average of 10 women
their life in poor health and are ‘more likely to come
die violently in Ireland (with one in every two
into contact with health services – mainly in their
femicide victims killed by a current or former
reproductive years’.
male intimate partner)163.
2.6.1 Key social determinants of health
Worryingly, just one in five Irish victims of
physical or sexual abuse have been found to report
There is an incontrovertible relationship between
this abuse to legal and medical services and/or An
poverty, social inclusion and health inequalities.
Gárda Síochána, while just the one in ten women
Gender and income (or the lack of it) is key social
avail of services such as victims support or
determinants of health. See Table 2.11 for details.
refuges suggesting that there are a lot of women
who have been subject to domestic/gender-based
violence who have unmet needs for assistance.
The health care system is often the route through
which victims seek to access supports164 .
159 Fundamental Rights Agency. (2014).Report on violence against women across the EU: abuse at home, work, in public and online.
160 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. Dublin: Liffey Press.
161 Ibid.
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