Scotland’s Women’s health crisis was predicted

The crisis in women's healthcare cannot be explained by NHS pressures alone. When the same warnings are repeated year after year, poor outcomes stop looking like isolated failures and start looking like the consequences of political neglect.

I’m back again, with yet another piece on misogyny. In my last article on this topic, I made clear that misogyny has evolved beyond its original definition of hatred. Today, the word is used to describe something much broader: systems, institutions, cultural norms and patterns of behaviour that shape women’s lives in ways that are often invisible until you start looking for them.

One of the clearest examples of this is healthcare.

At this point, someone will inevitably object that this is not misogyny at all. The NHS is struggling. Waiting lists are long. Staff are exhausted. Everyone is finding it harder to access care. There is truth in that. But the collapse of a system and the biases within it are not competing explanations. They are interacting ones. A struggling health service affects everyone. The question is whether some groups experience that failure in particular ways. Women’s healthcare provides a compelling case that they do.

The statistics are now so well known that they barely raise eyebrows. Women wait longer for a diagnosis. Women’s pain is more likely to be dismissed. Conditions that primarily affect women receive less research funding and less public attention. The first study to test the absorbency of period products using actual blood was only published in 2023. Before that, manufacturers generally used saline solution.

On its own, that sounds absurd. But it is also illustrative. Women’s experiences have historically been treated as niche, specialised or secondary concerns rather than a central part of healthcare provision. The result is not usually dramatic acts of discrimination. Instead, it is a thousand small assumptions, omissions and delays that accumulate over time. That is why I find discussions about misogyny so frustrating. People often imagine it as an individual attitude. A sexist remark. A discriminatory employer. A man who dislikes women.

Those things exist. But focusing exclusively on individual prejudice can obscure something much larger: institutional neglect. When a problem repeatedly affects women across multiple services, over multiple decades, despite repeated warnings from experts, we should stop asking whether individual people hold sexist views and start asking whether the system itself is functioning properly.

Recent developments in Scotland offer a case study in exactly that. This week, The Herald revealed that NHS Greater Glasgow and Clyde recorded 736 serious adverse events in maternity and neonatal services between 2019 and 2025. More than 400 involved a death. Others resulted in major injuries requiring surgical intervention or intensive care.

The figures themselves are alarming. But what struck me most was not the headline number. I twas the recurring causes identified in the reviews. Training failures. Communication breakdowns. Poor record keeping. Staffing pressures. Inconsistent escalation procedures. Lack of senior oversight. These are not new problems. In fact, they are remarkably familiar.

For months, the Royal College of Midwives has been warning about workforce shortages, rising workloads and a lack of investment in maternity services. Last year, a BBC Disclosure investigation highlighted many of the same concerns. Before that, the Royal College of Midwives’ own reports pointed towards staff shortages, inadequate training opportunities and increasing pressures on already stretched services.

What makes this particularly troubling is the nature of the service in question. Childbirth remains one of the most dangerous things most human beings will ever experience. Pregnancy and labour place extraordinary demands on the body and have been major causes of death and disability for women. Modern medicine has transformed those risks, but it has not eliminated them. That is precisely why maternity services require such careful staffing, training and oversight. When systems begin to fail, maternity care is often one of the first places where the consequences become visible.

The question, therefore, is not how these issues emerged. The question is why we continue to act surprised when the consequences arrive. There is a tendency within politics to treat every scandal as an isolated event. A failure here. A mistake here. A few bad decisions. A few unfortunate outcomes. But eventually the pattern becomes impossible to ignore.

When professional bodies repeatedly identify the same risks, when staff repeatedly raise the same concerns and when inspections repeatedly uncover the same deficiencies, poor outcomes stop looking like isolated incidents and start looking like predictable outcomes. That is not simply a healthcare problem. It is a governance problem.

This is why the recent controversy surrounding the removal of a dedicated Women’s Health Minister is so revealing. The response from medical organisations was swift. Thirty-five organisations, including the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, warned that removing explicit ministerial responsibility risked reducing accountability and slowing progress on women’s health.

Critics have framed this debate as a symbolic issue. I think that misses the point entirely. The importance of a dedicated minister is not primarily symbolic. It is practical. Accountability matters. When services are struggling as badly as they are now, someone should be responsible for answering questions. Someone should be responsible for driving improvement. Someone should be responsible for ensuring that commitments made on paper are translated into reality. Starting this new government off with the election of a new dedicated Women’s Health Minister symbolises priority.

“When professional bodies repeatedly identify the same risks, when staff repeatedly raise the same concerns and when inspections repeatedly uncover the same deficiencies, poor outcomes stop looking like isolated incidents and start looking like predictable outcomes”

The danger is not that women’s health disappears overnight. The danger is that responsibility becomes diffuse. Everyone supports improving women’s health in principle, but nobody owns the problem in practice. Scotland does not lack plans. In fact, we have quite a lot of them. The recently published Phase Two of the Women’s Health Plan contains many sensible ambitions. Improving menopause care. Reducing inequalities. Expanding access to gynaecology services. Earlier intervention. Better information. Better pathways.

These are worthwhile goals. But Scotland’s challenge is increasingly not the production of strategies. It is implementation. The gap between what government documents promise and what women experience is often enormous. Take gynaecology waiting times. Between 2018 and 2025, the number of women waiting longer than the target time for treatment increased dramatically. Tens of thousands of women remain stuck on waiting lists.

Or take contraception. For months, I have been trying to book an appointment for a fitting. No appointments available. Different areas. Different times. The answer remains the same. Likewise, attempts to access sexual health services frequently lead to unavailable appointments or unavailable home testing kits. None of this makes headlines. No public inquiry is launched because someone spends months refreshing an online booking system.

But this is how systemic problems are often experienced. Not through dramatic failures, but through endless friction. A phone call that goes unanswered. A referral that takes months. A clinic with no appointments. A service that technically exists but is practically inaccessible. Alongside difficulties accessing contraception, I have suffered recurring bartholian cysts, an intensely painful condition that makes walking difficult, if not impossible.

Yet accessing treatment often requires navigating a system that expects you to be mobile enough to reach a GP appointment before you can access hospital care, while simultaneously being unwell enough to justify intervention. Go too early, and you are told to go home. Go too late, well, that’s impossible, as you’re unable to get out of bed. Over time, you learn how to navigate the system rather than trust it. That is not how healthcare is supposed to function.

The cumulative effect is that women spend enormous amounts of time navigating barriers to care that should not exist in a wealthy country. And that is before we even consider conditions that remain poorly understood, underdiagnosed or routinely dismissed.

The irony is that we know how to talk about structural inequality in almost every other context. We recognise that housing outcomes are shaped by systems. Same with educational outcomes. And poverty. Yet when it comes to women’s healthcare, there remains a temptation to treat failure as unfortunate anomalies rather than evidence of deeper institutional weaknesses. The reality is that healthcare does not exist separately from the society that creates it.

If women’s experiences have historically been undervalued, then healthcare systems will inevitably reflect some of those biases. If women’s health has historically received less political attention, then services will inevitably feel the consequences. If governments repeatedly delay action despite warnings, then inequalities become embedded rather than resolved.

None of this requires conspiracy. It requires only neglect. And neglect is often far more politically significant than hostility. The uncomfortable truth is that most of the people responsible for these systems genuinely want better outcomes. Most healthcare staff work extraordinarily hard under difficult circumstances. Most politicians would say they support improving women’s health. But the problem is that good intentions do not create capacity. They do not train staff, reduce waiting lists, provide appointments, or prevent adverse outcomes.

Only sustained political attention, investment, and accountability can do that. Which brings us back to misogyny. If misogyny is understood purely as individual prejudice, then much of what is happening in women’s healthcare appears disconnected from it. But if misogyny also describes systems that consistently fail to prioritise women’s experiences, needs and outcomes, then the picture looks rather different.

We are repeatedly told that these failures are the result of the pressure on the NHS. That is undoubtedly true. But pressure alone cannot explain why so many of the warnings have been known for years, why so many of the same recommendations keep appearing, or why conditions that predominantly affect women remain so frequently overlooked. The NHS crisis did not create those problems. It exposed them.

The issue is not whether anyone hates women. The issue is whether our institutions are built to serve them properly. And at the moment, the evidence suggests that answer is still far less certain than it should be.