Rural women face health inequalities caused by their gender and geography - and they've had enough

“I try not to do the whole sexist thing because at the end of the day men are still having to go down to Inverness for prostate cancer care. But I do wonder whether, if one in 10 men had testicles exploding once a month, there wouldn’t be a dedicated centre for them before now,” Rebecca Wymer, vice-chair of the North Highland Women’s Wellbeing Hub, muses.

Her droll response to a question about whether women’s health needs are not considered a priority speaks to her personal history of battling with the health service. Wymer began treatment for stage two endometriosis last year after spending more than 10 years fighting for it.

She tells Holyrood: “I ended up just living with it. They put me on a huge amount of nerve blockers which I became addicted to, and they just kept upping and upping and upping the medication with no basis. In the end I went into the GP and said I want off all of this stuff. I want a clean slate. I want to know what we’re dealing with here. So, I came off everything and the endometriosis symptoms were so clear.”

She ended up back at the gynaecology department at Raigmore Hospital in Inverness – more than a hundred miles from her home in John O’Groats – for appointments and scans and procedures, all to no avail. “I’ve never been so dismissed”, she says.

The standard of care that we’re receiving, just because of where we live, is so much worse

Ultimately, she paid for a private appointment in Glasgow. The cost of that appointment plus fuel and accommodation was in excess of £1,000 – but it was here she finally received a diagnosis and underwent her first surgery. Since then, she has had two more. “My latest operation was in Raigmore, but it felt like a breeze compared to coming back from Glasgow. Even so, it was a long road home.”

Part of the problem is because the care she needs are not available locally. Maternity and women’s health services at Caithness General Hospital were downgraded in 2016 on safety grounds and they have never been restored. Wymer is one of many women who must travel to Inverness for care – often in huge amounts of pain and discomfort. It also comes with a financial cost.

“What’s happening is that people are avoiding going to consultations that are incredibly important,” says Wymer. “They’ve waited for years for these appointments, but because they’re in Inverness they then have to get annual leave, childcare, pay for accommodation, pay for fuel. If the public transport times don’t tie up, they have to move their appointment and quite often they lose it.

“We’ve got actual physical symptoms getting so much worse, including fertility, because things are being left for so long. The standard of care that we’re receiving, just because of where we live, is so much worse.”

She has now lodged a petition with the Scottish Parliament calling for an in-depth review of women’s health services in the region. The Scottish Government has taken notice.

Rebecca Wymer (left) with Claire Clark and Kirsteen Campbell, who set up the Women’s Wellbeing Hub

Health secretary Humza Yousaf last month travelled to Caithness to meet Wymer and others who have expressed concerns. Speaking afterwards, Yousaf said: “I have every sympathy with the position of the women I met with today and will do everything we can to help.”

Wymer says she is “cautiously optimistic” that the government is listening. “But over the last couple of years, I have worked with a lot of politicians. There’s a big difference between saying you’ll do something and actually doing it. The Women’s Health Plan is a perfect example of that. It was such an amazing document – and so far nothing has come from it.”

The Women’s Health Plan was launched by the Scottish Government a year ago, fulfilling a manifesto commitment made by the SNP. That pledge was a result of rising concern about the women’s health gap – whereby access to healthcare and health outcomes are worse for women than men. The gap exists in healthcare services from dementia care (women receive worse medical treatment) to A&E departments (women are less likely to be given painkillers).

At the launch of the plan, women’s health minister Maree Todd said it would “ensure all our health and social care services meet the needs of all women, everywhere.”

Despite this, what was missing from the plan was any mention of the word ‘rural’. In fact, the only acknowledgement of an intersection between women’s health inequalities and rural life was in a brief section by Dr Alison Scott, a sexual health consultant, who noted: “There are other groups of women too who may struggle to access healthcare, for example those living in geographically remote areas”.

Providing healthcare in rural areas naturally does come with its challenges, from catering for smaller populations while balancing costs to recruitment issues.

We absolutely think that if this was a man’s health issue, the problem would have been fixed by now

Staff shortages have been blamed for the downgrade of maternity services at Dr Gray’s Hospital in Elgin. Speaking at the time, NHS Grampian’s manager for women and children’s services, Sue Swift, said: “This is not a change we wanted to make but, in the end, it was the only option given the low staff numbers.”

What was only meant to be a temporary downgrade has persisted and four years on, Moray women are still without a local, consultant-led maternity unit. Around three quarters of women from the county who give birth are sent over 60 miles away to Aberdeen.

Marj Adams, of the KeepMUM campaign to restore the unit at Dr Gray’s, has warned this is “a tragedy waiting to happen”. She got involved in the original campaign for a maternity ward for the region back in the 80s, after coming dangerously close to losing her own daughter, Amy.

Amy was born in a small cottage hospital in Huntly, about halfway between Elgin and Aberdeen, after an aborted attempt to blue-light Adams to the Royal Infirmary. She recalls: “I was in the back of the ambulance on my own with a huge black bag, which apparently was a delivery pack, and I shouted to the driver and midwife, ‘I think the baby’s coming.’ They went into a layby, the midwife examined me and then it was all panic. I heard the ambulance driver on the radio phone saying we need a doctor urgently... We had a potential tragedy because the cord was round Amy’s neck twice. That had prevented her from being born in the ambulance, it held her back, but equally that could have suffocated her, and also was a danger to me.”

Marj Adams flanked by daughters Kirsty Watson (left) and Amy Fraser

Adams joined the campaign to have a consultant-led service in Elgin after that and in the summer of 1995, the new ward opened. But she has always felt that the health board was never fully behind it. She says: “They were told to build it and bring all the necessary infrastructure to Elgin – they did it with reluctance. And over the years, they looked for ways to change it… We weren’t surprised [when the unit was downgraded] because they couldn’t get junior doctors to support the consultant obstetricians. We believe that if they had carried out proper forward planning, they would have managed all of that. It was the inevitable result of their attitude to Moray.”

Following sustained pressure from KeepMUM and others, the Scottish Government commissioned a review. A report was published in December and the health secretary confirmed in March that Dr Gray’s maternity unit would be fully restored. Following the statement, NHS Grampian said it would “work in partnership” to “make progress with these recommendations on a phased basis.”

But Adams is still concerned about the lack of detail to get there, and she worries an interim plan to have some Moray women sent to Raigmore Hospital to deliver instead will “inevitably kick [it] into the long grass”. “We haven’t yet seen the details, so that’s the position we’re in. We’re in limbo now,” she adds.

Like Wymer, Adams questions whether the delay is because of a failure to prioritise services for women. “We absolutely think that if this was a man’s health issue, the problem would have been fixed by now. But women and their babies are low priority.”

The government has however reiterated its support for having local services for women. A spokesperson said: “We expect all boards to provide maternity services that are delivered as close to home as possible. Clearly the key priority is that the care provided to mothers and babies is as safe as possible.”

They also pointed to the Best Start North review, commissioned by Highland, Grampian and the island health boards, to look at resources, constraints and challenges for maternity and neonatal services. It was briefly paused during the pandemic but has now resumed.

The thought of something terrible happening before anything changes is horrible

But the north of Scotland is not the only area facing problems. Down in the south-west, the Galloway Community Hospital birthing centre has been closed since 2018. Like in Moray, that was due to staffing issues.

Claire Fleming, whose children were all born in Dumfries – 60 miles away from her home in Glenluce – says women in the area are “terrified” of what could happen. “I feel as though it is going to take a catastrophe before [the health board] do something about it. We have been pointing out to them the dangers in this situation and they seem to be ignoring us. The thought of something terrible happening before anything changes is horrible,” she says.

Fleming has had four pregnancies and says her experience over the last decade maps the decline in maternity services. Her first pregnancy was with Abbey, who was sadly stillborn. Despite the heart-breaking end to that pregnancy, when she had to drive herself to the hospital in Dumfries to deliver Abbey, she says the service until then had been “really good”. She explains: “Had everything been straight forward, I’d have been able to have my baby in Stranraer. I felt like I knew my midwife, there was lots of midwives, everything was done in Stranraer apart from your 20-week scan, which was absolutely fine.”

By the time Molly came along in 2015, she felt that service had got worse and she faced difficulties in seeing her midwife. Then in 2019, when pregnant with James, she was forced to travel to Dumfries for every appointment. “Now I’m talking five-minute appointments. I had gestational diabetes and I had to go down for appointments, and I’m not even joking when I say I would walk in the door and it would be, ‘how are you? You’re fine, see you later.’ And you had to travel all the way down there, I was having to do that twice a week at some points because they weren’t able to tie your scans in with your other appointments. There was a lot of travelling.”

By the time her youngest Andrew was born last year, the service had improved slightly in that it was possible to get scans locally. “It’s a step in the right direction, but everything else was down in Dumfries. I didn’t meet my midwife or my consultant. Nothing. You were just forced to get on.”

NHS Dumfries and Galloway confirmed this summer that it will conduct a local service review. A statement from the board said: “Dumfries and Galloway Integration Joint Board will consider the remit of this and consult with Scottish Government colleagues regarding external input to the process and any proposed timelines.”

But Fleming is worried the board isn’t taking the issue seriously enough. “It comes across that they have no interest. They’re looking as if on paper that they’re taking in public opinion and really wanting to make a change, but just keep cancelling on us… It does definitely feel as though because it’s women’s services, and there is a service of sorts available, that’s enough for us.”

As for Wymer’s petition, MSPs voted to refer it to Holyrood’s health committee for further consideration as part of its health inequalities inquiry. Until then, Wymer warns: “We’re not going to stop, we’ll just keep hassling until something changes.”