Written Evidence from Holland & Barrett [WRH0027]

Executive summary

●       Holland & Barrett has over 50 years of experience supporting women with their health and wellness needs. Our team members are qualified to guide on a range of reproductive health issues, such as menopause, menstruation, fertility, endometriosis, PCOS and baby loss.

●       The women we support often tell us they feel dissatisfied and unheard by their healthcare providers. This is why we are so focused on amplifying women’s health needs on our platforms.

●       Our direct customer research and insights generated from our leading digital women’s health platform, Parla, show that ethnic minority women face substantial barriers to accessing the healthcare they need. 

●       For example, in a recent study, we found that 51% of women aged 40+ from black, Asian and minority ethnic backgrounds say that the conversation about menopause in public and in the media is mainly focused on the experience of white women.

●       This is the reason we recently launched our ‘Every Menopause Matters’ campaign, which seeks to address this diversity gap by providing women of every background with safe, inclusive spaces to discuss their experiences with menopause and receive support. We are also ensuring that menopause support services are available in multiple languages in our most diverse communities.

●       Holland and Barrett are also supporting communities through our “Women’s Health Community Fund” set up in partnership with the Wellbeing of Women charity - which will fund women’s health initiatives led by grassroots organisations.

●       In 2022, the team at Parla published their ‘Women’s Health in the Workplace’ white paper, which demonstrates the economic impact of failing to support women adequately with their reproductive health challenges. It shows how taboo, fear of job loss, lack of flexibility and support create significant barriers to women thriving in the workplace.

●       The research also illustrates the devastating impact that reproductive health challenges can have on women’s mental well-being.

●       In addition, the white paper highlights that employers have a central role to play in providing both resources and flexible working practices to enable women to remain in the workplace at various reproductive life milestones.

Overview

Holland & Barrett are delighted to have the opportunity to respond to the Women and Equalities Committee inquiry into ‘Women’s Reproductive Health’. This is a timely and important inquiry, which we hope will shine a spotlight on the barriers faced by women, from a wide range of backgrounds, when it comes to accessing the information and support that they need for reproductive health conditions.

Holland & Barrett support women with their health and wellness goals across every life stage from menstruation to fertility and menopause. We are focused on delivering more evidence-backed and tailored solutions that are accessible through high-quality digital tools, platforms, communities and on the high street. We have unique and extensive insights, backed by over 50 years of experience in supporting women with their health needs, which we believe can provide a valuable perspective on what public policy in this area should consider.

In this submission, we draw on the extensive work of our in-house Data and Insights team, and in particular, the research carried out by our women’s health experts working on our leading women’s digital health platform, Parla, which we acquired in April 2022.

Two areas we have focused on in our submission are the inequalities that prevent women from black and ethnic minority backgrounds from accessing the care they need (drawing on research we commissioned from YouGov), as well as the barriers faced by women in the workplace when they encounter reproductive health challenges, which are leading causes of women leaving the workforce.

We hope the content of this submission will help to inform the Committee’s work and we would be very happy to meet with the Committee members to discuss this in further detail, should that be of interest.

About Holland & Barrett

Holland & Barrett is the UK’s leading wellness retailer and one of the largest in Europe, with a retail footprint of more than 800 stores in the UK and Ireland, alongside our rapidly expanding e-commerce business. Established in 1870, we have been trusted for wellness for over 145 years.

Holland & Barrett plays a key part in the transformation of how we view health and wellness in the UK, as we seek to move from a reactive to a more preventative approach. Our mission is to make health and wellness a way of life for everyone.

We have an aim to help everyone add six more quality years to their life. We also want to help absorb some of the extensive demand for healthcare services (particularly on primary care) through our growing testing and soon-to-be-launched over-the-counter medication services. Our long-standing history in the wellness space, backed by our own research, data and insights, has equipped us with the knowledge and in-depth understanding of the barriers that our customers face in accessing support for their complex health and wellbeing needs.

By seeking to make health and well-being accessible to everyone with a growing range of digital tools, products and services, we occupy an increasingly critical space in the healthcare value chain, delivered both on the high street and virtually.

Whilst we have become best known as the ‘go-to’ retailer on the high street for wellness, we are especially proud of our commitment to and focus on women’s health where we have a particularly strong focus on reproductive health. Women and their well-being have always been at the heart of our business, and for more than 50 years we have provided trusted support on wide-ranging and complex women’s health conditions including menopause, peri and post-natal pregnancies, and menstruation. This is typified by our latest campaign, ‘Every Menopause Matters’, which we provide detail of in this submission as an example of best practice.

A leader in women’s reproductive health

We support women with their health needs and challenges, providing a safe, non-judgmental space to ask questions and discuss personal experiences. We know that many women’s experiences in seeking to access reproductive healthcare have left them feeling dissatisfied and unheard by their local healthcare services. This is why Holland & Barrett has undergone significant work to amplify women’s health on our platform:

●       Working closely alongside the Menopause Mandate to provide a free menopause advice line, where women can speak to a qualified menopause nurse.

●       Through product innovation, delivering more tailored health and wellness support that is accessible to all through innovative digital tools and platforms. One of the main ways we do this is through Parla, the leading digital women’s health platform we acquired in April 2022, which offers holistic wellbeing care for a range of common but challenging conditions including endometriosis, PCOS and pregnancy loss.

●       Through our endometriosis community events hosted in-store, where we partner with leading endometriosis charities to hold panel discussions on topics such as nutrition and fertility (the most recent event in our Marble Arch store had over 60 attendees, who had travelled from all over the UK and beyond).

●       In our ‘Pause & Listen’ rooms, where women can talk to qualified health advisors about their menopause experience in 18 locations around the UK.

●       By ensuring that we are equipped to provide support to under-served communities and help address inequalities in accessing menopause care. We will do this through our soon-to-launch trained qualified advisor services which will be available in multiple languages in stores across our most diverse communities.

●       As a result of many of these efforts we have been shortlisted by GenM as a company leading social change for Menopause

●       By harnessing the data and insights we receive from our customers, to better identify, and address, the barriers that women face, we continue to support their health journey throughout the course of their life.

Response to inquiry terms of reference

What constitutes healthy periods and reproductive health?

At Holland & Barrett, we believe it is important to support women through every reproductive life stage – from menstruation to fertility through to menopause - and to ensure there is the right education, awareness and support mechanisms in place for women at all stages of the life cycle. We also believe that having healthy periods and reproductive health is not only about regular cycles or uncomplicated pregnancies - it’s about understanding how your menstrual health impacts your mental health and overall quality of life too.

Through our extensive work, some of the main reproductive health challenges that we currently see impacting women include:

Periods

●       For women with healthy periods, their menstrual cycle can still affect their working life on a monthly basis. However, for the millions of women affected by issues such as endometriosis and PCOS - the impact on their life and work can be even greater.

●       Findings from Parla[1] show that 23% of women reported taking time off work due to period-related health issues, while on average, endometriosis causes individuals to miss 10 hours of school or work per week due to painful periods.

Fertility

●       As many as one in seven couples will face infertility, and this number is constantly increasing.

●       Three-quarters of women who have undergone fertility treatment say their emotional well-being has been affected while over a third of women (36%) considered leaving their job during fertility treatment.

Pregnancy Loss

●       Though often a taboo or under-discussed topic, pregnancy loss is incredibly common, affecting one in five pregnancies, with many women experiencing this grief before they have even disclosed their pregnancy to friends, family and colleagues.

●       This means women don’t receive the support they need during this challenging time, with 78% of women reporting that they needed emotional health support after pregnancy loss but were unable to access it.

Post-Partum

●       Post-birth support for mothers in the UK tends to focus on medical appointments to discuss contraception, scar healing and baby health checks. While these areas are clearly important, there tends to be little focus on maternal mental health and physical rehabilitation.

●       As many as 70% of new and expectant mums say they experience poor mental health during or after pregnancy.

Menopause

●       We believe that menopause remains one of society’s lingering taboos, despite it affecting the lives of 15.5 million women in the UK.

●       Our research suggests that 61% of women do not talk about menopause and an estimated 14 million days of work are lost a year due to menopause symptoms

What are women’s experiences of being diagnosed with, undergoing procedures and being treated for gynaecological or urogynaecological conditions?

Menopause

We have conducted extensive customer research[2] to help shape our future direction and how we can broaden the support we offer women experiencing (peri)menopause. This includes turning products and wellbeing advice into personalised solutions including testing, services, access to experts and personalised lifestyle advice. These findings provide a useful overview of women’s current experiences in accessing diagnosis and treatment for menopause.

It found:

●       28% of the UK female population have been experiencing (peri)menopause in the last 12 months.

●       91% of those experiencing (peri)menopause are taking action to address their symptoms.

●       For the 9% not addressing their menopause symptoms, lack of severity, lack of trust in solutions and uncertainty about where to start or their diagnosis are also key barriers.

●       54% of women agree that menopause has had a negative impact on their personal lives, and 42% believe that it has had a negative impact on their work lives.

●       Despite the impact of menopause, many feel the topic remains largely undiscussed - 71% of women experiencing menopause, call for more media conversations about the topic, and 63% are angry at the stigma attached to menopause.

●       83% of those surveyed adapted their lifestyles in response to menopause.

●       78% used product solutions (including vitamins and herbal products).

●       46% used an app or service.

●       69% of women experiencing (peri)menopause told us they would prefer to manage their symptoms without HRT.

Menstrual Well-being

Conditions connected to menstrual health, like endometriosis, affect 1 in 10 women, yet in the UK it takes an average of around 8 years to be diagnosed.  Our research has also found that:

●       75.2% of endometriosis patients reported being misdiagnosed with another physical or mental health condition.

●       62% of women would put off going to a doctor with symptoms of endometriosis because they don't think they would be taken seriously.

●       Delayed diagnosis of endometriosis is the leading cause of further health complications which may result in full hysterectomy and early menopause.

●       Fertility preservation is not often discussed with those suffering from endometriosis despite more than 30% of patients struggling with fertility.

●       Around 70% of women, worldwide, who are living with PCOS are yet to be formally and correctly diagnosed.

●       Majority of women who have PCOS and Endometriosis have been prescribed the contraceptive pill rather than being provided with a holistic health and lifestyle solution to address their symptoms.

What disparities exist in the treatment and diagnosis of gynaecological or urogynaecological conditions?

Holland & Barrett’s research has shown that women from black and ethnic minority backgrounds encounter substantial and intricate obstacles when seeking treatment for their menopause symptoms, meaning that they may not receive sufficient support from their healthcare providers. These can include a lack of non-English language healthcare advice and a failure of healthcare professionals to understand the specific symptoms of menopause faced by some ethnic minority women.

For example, new research we commissioned and conducted by YouGov[3] shows 51% of women from black, Asian and minority ethnic backgrounds agree that the current conversation is mainly focused on the experience of white women. A quarter of women (26%) from minority ethnic communities (in any menopausal period or unsure of their status), say they find it difficult to access menopause support and advice. 31% of those who’d stopped seeking support, said being able to speak to a female healthcare professional of the same ethnicity as them would have made a difference to their menopause experience.

The research also found that 30% of those in any menopausal period sought menopause support and advice from their GP/healthcare professional/menopause specific support nurse in the first instance, however, a third of this group (33%) said that the support given was not helpful.

This is the reason we recently launched our “Every Menopause Matters” campaign, which is dedicated to addressing the menopause community care gap by providing women of colour and ethnic minority backgrounds with safe, inclusive spaces to seek advice and discuss their experiences with menopause. In practice, this means:

●       As a trusted advisor on women’s health, we want to guarantee that our guidance and assistance continue to cater to the diverse customers that we serve across the UK. In response, we are introducing a series of fresh initiatives and expanding our existing services so that our customers have a positive experience when they visit Holland & Barrett.

●       We have become the first retailer to launch a free, multi-language menopause online consultation service – starting with Hindi, Urdu, Gujarati and Punjabi. This will ensure that we are best equipped to address the inequalities in accessing menopause care from our customers’ first interaction with us.

●       We have launched the Women’s Health Community Fund in partnership with leading women’s health charity Wellbeing of Women. This community fund aims to provide resources to underserved communities to improve awareness, education and support on menopause – empowering communities to take control of their health.

●       4,000 Holland & Barrett colleagues have received extended training so that they can better discuss menopause symptoms and guide on solutions. This is in addition to the specialised training our staff undergo to understand and help our customers.

What barriers exist in the treatment and diagnosis of gynaecological or urogynaecological conditions?

The barriers impacting working women

Holland & Barrett, through our leading digital women’s health platform, Parla, is particularly focused on the barriers faced by women in the workplace when they encounter reproductive health challenges.  Ensuring women have access to the healthcare they need throughout their life is not only a moral and health issue but an economic one too.

This is a key point that the team at Parla call out in their ‘Women’s Health in the Workplace’ white paper, which found that 14 million working days are lost every year due to symptoms of the menopause, while 1 in 10 working women said they had left their job due to symptoms of the menopause. The white paper also highlights how whilst 23% of women take time off for period-related health issues, 80% of them would be too embarrassed to give that as a reason for absence. Until we break the culture of taboo and inaction around women’s reproductive health concerns, we risk losing incredible female talent from the workforce with all the economic and social consequences that this brings.

Access to treatment remains a major barrier for many women in taking control of their reproductive health whilst also balancing a career. Taking time off work to travel to and attend appointments is a concern for many working women, and many are turning to more convenient, online solutions (c.60% of ‘telehealth’ users are female).

Research compiled for the white paper found that only 40% of women said that they could access the services they needed in a convenient location, while less than a quarter (24%) of women said they could access services at a convenient time.

This is why we are clear that improving flexibility is an important step to ensure working women can access diagnosis and treatment for a range of reproductive health conditions.

Flexibility and paid leave is also an important factor in supporting the emotional and physical well-being of women experiencing reproductive health issues. The mental health impact of these challenges should not be underestimated. 78% of people who experience pregnancy loss say that their emotional well-being was their biggest issue. 74% of women with PCOS say it impacts their mental health and 53% of women moving through menopause report feelings of depression. Most shockingly, 42% of people going through a tough fertility journey say they experience suicidal thoughts. 

However, all too often women are forced to show up to work in their darkest moments, due to a lack of flexibility and paid leave. Only 8.7% of women have been offered paid leave following early pregnancy loss and a further 49% were not told about pregnancy-protected leave for late miscarriages. Many people going through fertility struggles are leaving the workforce due to a lack of flexibility and support, with 36% of women considering leaving their job during treatment.

On the positive side of the ledger, there are many companies who are already leading the way in enabling women to access the support and treatment they may need. Kellogg’s for example provides three blocks of paid leave each year for workers going through fertility treatment, while also providing access to a private space to administer treatment if necessary. Online fashion retailer ASOS allows staff to work flexibly and to take time off at short notice when going through the menopause. Staff are also able to access paid leave in cases of pregnancy loss and abortion.

Holland and Barrett is not only dedicated to improving the well-being of their customers but their staff too. Last year they signed up to the Pregnancy Loss Pledge and now provide their managers with specialist training on how to discuss pregnancy loss with their teams, as well as other sensitive health topics including fertility, menstrual health and menopause. They have also been certified as a “Menopause Friendly Employer” by Wellbeing of Women and is a finalist for “The Menopause Friendly Employer Award 2023” by Best Trained Workforce. Employees of all genders can access mental and physical health support as part of their benefits package, which has been curated based on feedback from staff about their well-being needs.

Education and access to information also remain a key barrier and it is clear that we are still dealing with a huge knowledge gap when it comes to issues surrounding reproductive health and the treatment available. Parla’s research found that only 17% of women feel that they have enough information on menstrual wellbeing, while less than one in ten feels that they have sufficient information about the menopause.

We believe that employers have a vital role to play alongside the wider healthcare system in helping to not only provide information and support for women being impacted by reproductive health conditions but also to raise awareness amongst their wider teams.  

They may do this by providing ‘one-stop-shops’ for holistic and personalised advice through all life stages, organising support groups for staff and providing education and training for managers. When employers are able to offer this support alongside flexibility, they demonstrate that they are not only willing to give employees the time and space to deal with reproductive health issues but the tools and resources to effectively manage them.

September 2023