Women's Health Strategy: Hestia's Consultation Response

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About Hestia

At Hestia we support adults and children in times of crisis. We deliver services across London and the surrounding regions, as well as campaign and advocate nationally on the issues that affect the people we work with.

This includes victims of modern slavery, women and children who have experienced domestic abuse, young care leavers and older people. From giving someone a home, to helping them to get the right mental health support, we support people at the moment of crisis and enable them to build a life beyond a crisis.

We are proud to be the home of the UK SAYS NO MORE campaign, bringing together a diverse coalition of individuals, charities, businesses and public sector organisations to campaign for an end to domestic abuse and sexual violence. UK SAYS NO MORE launched Safe Spaces in over 5,600 pharmacies and banks across the UK to provide victims of domestic abuse to seek specialist support and advice. Hestia also developed the Bright Sky domestic abuse app in partnership with Vodafone.

Executive summary

Hestia is the largest provider of modern slavery support and one of the largest providers of domestic abuse and mental health support in London and the South East. In 2020, we supported 15,238 adults and children to a life beyond crisis. Of this number, over 7,100 were women.

Hestia welcomes the Government’s commitment to the introduction of a Women’s Health Strategy. At Hestia, we recognise the importance of providing person-centred support to enable recovery, and this includes responding appropriately to the differing needs of men and women. The experiences of the women we support differ greatly from that of the men who use our services. For example, 65% of the women supported by our modern slavery response team experienced sexual exploitation as part of their experience, compared to just 6% of the men we support.

Education and awareness is also a vital element of improving women’s health across the country. Many women are not aware of the support available for issues that could be drastically affecting their health. Hestia research, for example, shows that almost two-thirds (63%) of women did not know domestic abuse refuges existed before being referred to one. [1]

Our 50 years of experience in supporting adults and children in crisis has taught us that the people who use our services are the experts in their own lives. Their views, experiences and hopes for the future guide the support that we provide them. We are pleased to see the Government will be adopting a similar approach, ensuring women’s voices are at the heart of their own care.

Hestia’s experience in supporting women with varying support needs has also taught us that many health and support needs are interconnected, with one often enhancing or impacting the other. Women who have endured domestic abuse, for example, are often at much higher risk of experiencing significant mental health support needs, or suicidal ideation, than women who have not. Women who have experienced modern slavery often face greater challenges with both their physical and mental health. If the Women’s Health Strategy is to be effective in improving the health and well-being of women across the country, a holistic approach is the way forward.

Over the past 15 months, we have seen just how vulnerable our health is. The pandemic has affected us all, but women have been disproportionately affected in numerous ways, from the reduction in accessible cervical cancer screenings, to the increase in the number of women trapped at home with an abusive partner.

There has never been a greater need for a strategy that focuses specifically on women and their health and care needs. We urge the Government to ensure the strategy listens to women of all backgrounds and experiences, so that all women are able to recover from this national crisis, and no woman has to experience health inequality unnecessarily.

Ensuring the health and care system understands and is responsive to women’s health and care needs across the life course

Victims of modern slavery

As one of the leading providers of support for victims of modern slavery, Hestia has identified a key gap in support for female survivors who are pregnant. A report published by Hestia in early 2018 identified that of the 671 women we supported the previous year, 1 in 4 of them were pregnant when they arrived with us. [2]

We know that pregnancy can be a time of intense vulnerability for many women. For female victims of modern slavery, this vulnerability is exacerbated by the trauma they have experienced. A number of the women who came to Hestia were pregnant as a result of sexual exploitation. Their experiences result in severe health needs long after they have been freed and there are several barriers that prevent them from accessing the health support they need.

Mental health

The number of women who report feelings of suicidal ideation or poor mental health when they are first referred to Hestia’s modern slavery service is exceedingly high. For many women, pregnancy prevented this. However, one in three women continued to have suicidal thoughts throughout their pregnancy and several continued to self-harm. [3]

There are several factors that can be attributed to this high level of suicidality and ill mental health besides the trauma of exploitation itself. Our report identified that 16% of the women referred to Hestia had slept rough while pregnant, and all relied on food banks for their basic needs. Around 80% reported being estranged from their families and reported feelings of intense isolation. [4]

As it stands, mental health support for female, pregnant survivors of modern slavery falls short. Specialist services lack availability, with 90% of the pregnant victims we supported waiting several months to access the mental health support they needed. To ensure these women and their children can recover properly, the NHS must provide priority perinatal mental health support to pregnant victims of modern slavery. [5]

Physical health

Pregnant victims of modern slavery face significant barriers in accessing support for their physical health, too. Perhaps most troubling, we found that nearly 2 in 3 women received no antenatal care until the third trimester of their pregnancy [6]. One woman received her first antenatal appointment so late that she went into labour during her first scan.

In addition, many female victims of modern slavery have health problems as a direct result of their exploitation, such as sexually transmitted diseases, FGM, drug and alcohol abuse and other diseases including cancer and Cardiovascular disease.

One survivor told us: “I have asthma and I couldn’t afford medication. I struggled when I was pregnant. I felt like I couldn’t breathe and worried I’d harm my baby. My advocate helped me get the HC2 form so I could have my medication for free. I wish I’d known from the start.”

Our research found that almost all of the pregnant women who were supported by Hestia were not registered with a GP. This was due to several barriers, including lack of documentation and language barriers. In addition, many women feel unable to endure examinations due to the sexual violence they experienced during exploitation. One woman felt her only option was to terminate her pregnancy in order to avoid physical examination.

Without the appropriate physical health support or maternity care plan, these women face challenges with their health throughout pregnancy and this potentially impacts the health of the baby too.

As the Women’s Health Strategy is formed, there must be collaboration with the National Referral Mechanism (NRM) to ensure additional support is provided for pregnant victims of modern slavery to overcome these health barriers.

Improving the quality and accessibility of information and education on women’s health 

Victims of domestic abuse

As one of the leading providers of domestic abuse support in London, Hestia is aware of the devastating impact that domestic abuse can have on women’s health.  A new survey of women supported by Hestia, revealed that of 33 respondents, 91 per cent felt that domestic abuse had negatively impacted either their physical or mental health or both.[7]

During the Covid-19 pandemic, the detrimental impact of domestic abuse has been under a spotlight. Early on in the crisis, Hestia became acutely aware of the role communities and businesses can play in providing information to help women to flee domestic abuse and ultimately benefit their health.

In May 2020, Hestia and our UK SAYS NO MORE campaign launched Safe Spaces in Boots pharmacies across the UK, providing somewhere for victims of domestic abuse to go to access specialist support. A year on, Safe Spaces are available in more than 6,000 pharmacies and bank branches across the UK and have been used by victims hundreds of times.

However, almost a quarter (22%) of 72 respondents to Hestia’s survey stated that they felt unable to speak to a health professional about their experience of domestic abuse. Of the women who did feel able to speak to a health professional about their experiences, most spoke to their GP. The survey indicated that only 24% had spoken to a midwife about their experience, 15% had spoken to their dentists and none had spoken to their pharmacist.[8]

There are significant opportunities for organisations within communities and within health authorities, such as dentists and pharmacies, to provide what can be life-saving information.

One user of a safe space in a pharmacy told us:

"A Safe Space saved my life. I had been experiencing coercive control for five years of a 10 year relationship. During lockdown and shielding due to my complex medical needs, the abuse escalated to aggression and violence, leading to a fear for my life.

I knew that I needed to get out of the house at the very least but had nowhere to go. My medical conditions mean I take around 23 medications, and as my village pharmacy couldn’t source one of my medications I turned to the Boots online ordering system, and I saw a reference to Safe Spaces. I realised that this was exactly what I needed to access - urgently."

The Government has taken a firm stance against domestic abuse throughout the pandemic, rolling out the Ask for ANI scheme in pharmacies to compliment the Safe Spaces scheme. This commitment to a community response must be expanded post pandemic, so that victims are able to access information and resources on domestic abuse easily and safely whatever their situation.

Following the success of physical Safe Spaces, Hestia partnered with the Royal Mail Group to provide Online Safe Spaces, a portal of information and resources about domestic abuse that can be installed on company websites. Online Safe Spaces, which don’t show up on users’ browsing history, are available on websites including Royal Mail, Post Office, Thames Water and Network Rail. As of March 2021, there are almost 1,500 visits to Online Safe Spaces every day.

In addition, downloads of our domestic abuse support app Bright Sky increased from 22,010 in 2019 to 29,236 in 2020. The app, launched in 2016, provides information and advice to anyone experiencing domestic abuse or those concerned about someone they know.

As well as the opportunity to provide more information and resources on domestic abuse in community settings, there is evidently a demand for digital domestic abuse information, advice and resources. By committing to provide more domestic abuse information and resources via digital platforms, the Women’s Health Strategy can ensure more women have access to the support they need wherever they are.

Understanding and responding to the impacts of COVID-19 on women’s health

Hestia has become aware of the significant impact of the Covid-19 pandemic on women’s health, particularly for women who have experienced domestic abuse.

A survey of women who used Hestia’s domestic abuse services during the pandemic found that, of 36 respondents, 50% felt the pandemic had a negative impact on their mental or physical health, or both.[10]

It is concerning that of 33 women, 42% said the pandemic had prevented them from accessing healthcare services.[11]

While domestic abuse can often have a detrimental impact on women’s mental health, Hestia has observed a dramatic increase in this risk during the pandemic and subsequent lockdowns. At the beginning of 2021, Hestia conducted a rapid study to determine the link between the pandemic and the prevalence of suicidal ideation for women currently living in Hestia’s domestic abuse refuges. It found that between July and September 2020, four out of every 100 women were contemplating or planning to take their own life, a worrying rise on one in every 100 women during the same period in 2019.[12]

For women who have experienced coercive or controlling behaviour at the hands of their perpetrator, being told to stay indoors throughout the pandemic has been a retraumatising experience.

“There is thread of repeating and reactivating trauma through all the things that are happening for women in lockdown – being trapped inside, being restricted, even more than other people, for women in a refuge.” Domestic Abuse Refuge Worker

Other women told us that the pandemic prevented them from securing move-on accommodation, stopping them from rebuilding their lives and causing their mental health to deteriorate.

The limited availability of services, health or otherwise, throughout the pandemic has caused some of the decline in mental health seen in our domestic abuse services. Some told us that they struggled with isolation because of the lack of face-to-face support available during the pandemic, while one woman said that the closure of child contact centres prevented her from seeing her children, leading to suicidal ideation.

One woman told us that “she felt very suicidal at the start of lockdown” and made direct comments about the negative effects of self-isolation close to her most severe suicide attempt when she was self-isolating: “I find it very difficult having to self-isolate as it has really made my mental health deteriorate.”

There is an existing link between domestic abuse and ill mental health, with one study indicating that women who experience domestic abuse are three times more likely to develop mental illness.[13] A 2018 study revealed that, of 3,500 women who had experienced domestic abuse, almost 1 in 4 had felt suicidal at one time or another.[14] The pandemic has only exacerbated this.

It is critical that both domestic abuse and mental health remain a top priority as the nation begins to recover from this crisis. However, the approach must be collaborative between the domestic abuse and mental health sectors, ensuring greater collaboration and minimising the risk of further ill mental health for those who have already experienced profound trauma.

Conclusion

Hestia believes that experiences such as domestic abuse and modern slavery have a severely adverse effect on women’s physical and mental health. We welcome the introduction of the Women’s Health Strategy, but it is vital that the strategy recognises how these experiences may be detrimental for women’s health and showcases commitment to improving pathways between health services and services supporting women who have experienced other trauma. It is also necessary for the strategy to explore both digital and community-based solutions to the lack of awareness and education around factors that dramatically impact women’s health, such as domestic abuse. By connecting theses dots, the strategy can ensure that women face fewer barriers in seeking the support they need to improve both their physical and mental health.

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[1] Hestia (2016) From Victim to Survivor: Domestic abuse in 21st Century London report

[2] Hestia (2018) Underground Lives: Pregnancy & Modern Slavery

[3] Ibid.

[4] Ibid.

[5] Ibid.

[6] Ibid

[7] Independent survey conducted by Hestia in May 2021, featuring 72 women currently living in a Hestia domestic abuse refuge.

[8] Ibid.

[9] Online Safe Spaces: Quarterly Report March 2021

[10] Independent survey conducted by Hestia in May 2021, featuring 72 women currently living in a Hestia domestic abuse refuge.

[11] Ibid.

[12] Hestia 2021. Suicide attempts and ideation in domestic abuse refuges report

[13] The BMJ 2019. Women who experience domestic abuse are three times as likely to develop mental illness

[14] The University of Warwick 2018. Domestic abuse and suicide: exploring the links with Refuge’s client base and work force

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