Women's Health Plan - phase two 2026 to 2029: equality impact assessment

Key Findings

Age

The focus groups heard from women of all ages to inform development of these actions. Girls aged 12 onwards to women up to their 90s were engaged with through targeted focus groups facilitated by the Young Women’s Movement and Age Scotland, as these young girls and older women are less often represented.

We know that:

• 12 is the average age at which a woman has her first period^[1].
• The average age at which a woman will reach menopause is 51^[2].
• In Scotland, 359,313 women are of menopausal age, between 45 to 54 years.^[3]
• In Scotland, life expectancy for women is 80.8, compared to 76.8 for men.^[4]
• The number of older people in the UK workforce has reached record levels in recent years, making it essential for employers to retain the skills and experience of this demographic to stay competitive and mitigate skills and labour shortages.^[5] In Scotland, over a third (33.38%) of the female workforce is over 50.^[6]
• The number of people aged 50 and older who suffer hip fractures has increased by just over 25% between 2017 and 2023. More than twice as many women are admitted into hospitals for hip fractures than men.^[7]
• Women account for the majority of hip fracture patients in Scotland.^[8] In 2023 the Scottish Hip Fracture Audit (SHFA) found that socio-economically deprived patients suffer hip fractures 5.6 years earlier than the least deprived patients, which may impact overall life expectancy.^[9]

Phase Two includes a greater focus on the needs of older women. This includes actions to support women’s pelvic floor health, brain health, bone health and how we optimise future health to ensure women enjoy more years of healthy life. We know women are more likely than men to experience osteoporosis and dementia and therefore need specific support and information to manage their health and wellbeing in their later years.

In addition through our lived experience engagement, girls and young women consistently asked for more support and education to understand their health, particularly menstrual health. A specific action has been included in Phase Two in response to this. We will review, update and promote the Women’s Health content on RSHP.scot to help girls and young women better understand their health, and know where and how to access help and support as well as developing new, more detailed educational resources on menstrual health and periods, to augment the RSHP.scot offer.

Disability

There is limited data available regarding disabled women in Scotland and understanding of disabled women’s experiences is limited, particularly women with a learning disability.

We do know that:

• Disabled women in the UK make up 20% of women of reproductive age^[10]
• On average, the life expectancy of women with a learning disability is 23 years shorter than for women in the general population^[11].

In the 2023 Scottish Government commissioned report titled ‘Women's experiences of discrimination and the impact on health’, a focus group participant described how structural discrimination affects her access to women’s health services. She spoke of being unable to get onto the table for a smear test, with “lack of thought” about her access to such appointments. This participant no longer attends women’s health appointments because of the ableism she experienced. The specific needs of disabled women will be a consideration in the implementation of this Plan, particularly regarding access to cervical screening and gynaecology service transformation.

Through our lived experience engagement women told us they would like more support to live well and optimise their health for the future. We know the prevalence of disability is strongly correlated with age, increasing from 11% among children to 23% for working-age adults and 45% for adults over State Pension age across the UK.^[12]d. Specific actions have been included within the Plan to support women throughout the life course, for example: NHS Boards will maximise the use of women’s health ‘touchpoints’ – for example smear tests - to promote future health, staying well and preventative options to women by building on existing work to deliver holistic women’s health care.

Sex

Women and girls experience various health needs and risks during their lives which are not the same as those of men. This may relate to starting and managing periods, choosing contraception, accessing abortion services, planning for pregnancy, managing pelvic floor health, managing menopause symptoms and the manifestation of chronic conditions such as heart disease. We know women are more likely than men to experience osteoporosis and dementia, and therefore need specific support and information to manage their health and wellbeing in their later years.

Sex-based disparities are evident across Scotland’s health and social data. Women make up 51.4% of the population.

The ‘Review of the Data Landscape^[13]’ notes that:

• Women have a higher healthy life expectancy than men but because they live longer, they spend more time in poor health compared with their male counterparts.
• Women are consistently experiencing a greater burden of mental health issues than men.
• Anxiety amongst young women is more than double that of their male counterparts.
• Alzheimer’s disease and dementia are the leading causes of death in women and breast cancer is the most common cancer for women.
• Women are more likely to be living with chronic pain compared with men.
• Women are less likely to be physically active than men and almost two thirds of adult women are overweight or obese.
• Women in Scotland lose 11,574 years of health due to falls, compared to 10,925 for men^[14].

Gynaecology waiting lists in Scotland have grown by 193% since the pandemic began in February 2020^[15]. Gynaecology is the only single-sex specialty. With approximately 10% of women and girls of reproductive age worldwide affected by endometriosis, it represents a significant global public health concern.^[16]

A 2024 report published by the NHS Confederation identified that the economic cost of absenteeism due to gynaecological conditions is estimated to be nearly £11 billion per annum. It found that for every £1 of investment in obstetrics and gynaecology services per woman in England, there is an estimated return on investment of £11.314. The report found that if an additional £1 per woman in England were invested in these services, the economy could benefit from an additional £319 million in total gross value added (GVA). While this report focussed on NHS services in England, Northern Ireland and Wales, findings from the report are pertinent to the situation in Scotland^[17].

Women are disproportionately impacted by caring responsibilities. In 2023–24, 73% of all carers were female, and 80% of working-age carers were women.^[18] Women typically begin caregiving responsibilities at age 45, 12 years earlier than men. Women are also more likely to be victims of domestic abuse, with 83% of incidents involving a female victim and male perpetrator.^[19]

The primary purpose of the Women’s Health Plan, and Phase Two, is to reduce health inequalities for women and girls in Scotland.

Gender Reassignment

There is limited evidence on the experiences of transgender people in Scotland. Many surveys and data sources do not include questions on a person's trans status or provide a non-binary response to the sex/gender question.

We recognise that there are specific barriers faced by trans, intersex and non-binary people in accessing health services.

Transgender and non-binary individuals in Scotland face substantial health and social inequalities. Discrimination and negative experiences with healthcare providers are prevalent. Over half of non-binary people reported that their GP did not understand their needs, and 40% of trans people described negative or harmful encounters in medical settings, including being ignored or subjected to inappropriate questions.^[20] These barriers often lead to avoidance of essential healthcare and reports indicate that these delays lead to severe mental health issues, including heightened anxiety and depression.^[21]

The Women’s Health Plan makes clear that some transgender men, non-binary people, and intersex people or people with variations in sex characteristics may also experience menstrual cycles, pregnancy, endometriosis and the menopause and require access to gynaecology and reproductive health services.

Healthcare services should be inclusive and responsive to the individual and clinical needs of all.

Pregnancy and Maternity

There were 44,383 maternities (a pregnancy ending in a live or stillbirth) recorded in Scotland in 2025 compared to 44,714 in 2022/23. The known upward trend in maternal age continued. In around a quarter of maternities, women were aged 35 years or older^[22].

The Scottish Government remains committed to continuous improvement in maternity services to ensure that all women and their babies receive the best possible care. There are a number of pieces of work in this area, focused on continuous improvement in experiences and outcomes for women, their babies and their families.

Specifically, the Women’s Health Plan adopts a life course approach, emphasising the importance of identifying opportunities to prevent disease and promote health at key stages of life from pre-pregnancy through pregnancy. Pregnancy is a key opportunity to support women and improve health.

Phase Two includes specific actions to support improvement in preconception health.

Sexual Orientation

Public Health Scotland reports that there is evidence that lesbian, gay, bisexual, transgender and intersex (LGBTI) people are particularly at risk of negative sexual health outcomes such as STIs and unintended pregnancies. There is also evidence of low uptake of, or late access to services, and that stigma and discrimination is experienced by LGBTI people in Scotland^[23].

Race Scotland's population is becoming increasingly ethnically diverse. In the 2022 Census, 87.1% of the population identified as white, while 12.9% were from a minority ethnic background. This represents a significant increase in ethnic diversity, doubling from 4% in 2011.^[24] Despite this, within the social care system, approximately 98% of people receiving social care in 2022-2023 were of white ethnicity. ^[25]

Health inequalities between different ethnic groups exist. Ethnic minority populations experience higher rates of conditions such as diabetes and cardiovascular disease and were disproportionately affected by COVID-19 mortality. ^[26]

A study on the burden of poor reproductive health found that 10.5% of women reported polycystic ovary syndrome, with 8.8% reporting endometriosis. Participants from minority ethnic groups were more likely to report heavy and/or very painful periods^[27]. It is estimated that, by the age of 50 years, 80% of Black women and nearly 70% for white women will have had fibroids^[28].