RCN position on support for women's reproductive health in the workplace

Introduction 

The RCN believes that everyone has a right to access support at work on women’s reproductive health concerns such as fertility care, menstrual health, miscarriage, maternity care and menopause care, to enable them to continue in employment and ensure they maintain their health and wellbeing.

This position statement is for all nurses, midwives, registered nursing associates and health care support workers, including students, working in any health and social care setting in any of the four countries. This includes the NHS and other working environments, such as community settings and the independent and social care sector. It may also be of interest to those working in occupational health, human resources, RCN workplace representatives and those who manage nursing staff.

It is not designed as a treatment guide, and further information on the conditions mentioned can be found in guidance produced by the RCN forums including Making Sense of Women’s Health (RCN, 2021a), and Fertility Preservation (RCN,2021b).

Women’s reproductive health at work

The nursing workforce is predominantly female, with the largest number of nurses in the age group 21-40 (NMC, 2023). Having a predominantly female demographic can represent an employment issue regarding women’s reproductive health concerns at work in relation to staff turnover, sickness absence, performance, and retention.

• 1 in 6 women in a heterosexual relationship will experience fertility issues (WHO, 2023).
• Heavy menstrual bleeding affects 1 in 4 women (Kiran et al, 2018).1 in 4 women will experience a miscarriage (Tommy’s, 2023).
• From January 2014 to March 2020, 66,000 nurses and midwives went on maternity leave at least once (IFS, 2022).
• Conditions such as endometriosis and polycystic ovary syndrome affect 1 in 10 women in the UK, leading to reduced productivity and absence, and forcing some into part-time work or preventing them from working at all (Endometriosis UK 2024, NHS, 2022).
• Those with serious menopausal symptoms take an average of 32 weeks of leave from work, whilst one in six women aged 40-60 report they have considered leaving work due to a lack of support in relation to their menopause symptoms (Department for Work and Pensions, 2023).

There are many conditions such as adenomyosis, fibroids and premature ovarian insufficiency (POI) which can have an adverse impact on working life.

The degree of impact on a woman’s quality of life and the symptoms experienced with regards to reproductive health concerns are very individual. The symptoms can be physical, emotional and psychological, which can lead to vulnerability at work.

When faced with women's reproductive health concerns, many women, including those with female reproductive organs, may consider reducing their work hours or leaving work entirely. For example, heavy periods may require frequent changes of clothing/sanitary products, women may have to inject fertility medication in staff toilets or may struggle to concentrate due to chronic pain.

It is important that all health care professionals and managers understand the health concerns that women may experience and the potential for enduring debilitating symptoms, sometimes for years.

The working environment can also play a part in exacerbating symptoms and causing more distress. Employers have a duty of care to their employees, including providing safe and healthy working conditions, increasing awareness and having robust women’s health friendly policies that include options such as reasonable adjustments when needed. As women age and may work longer due to changes to the state pension, it is fundamental that good health is maintained through their employment and for life in general.

Exposure to hazardous substances, shift work or unsafe working environments can also present risks. Employers have a duty to identify these risks and put measures in place to reduce harm to general and reproductive health.

In addition, it is important to be aware that some treatments such as fertility care may have a financial impact on emotional wellbeing as the ability to access NHS funding for fertility treatment is limited and, in some regions, non-existent (Fertility Network UK, 2023).

One survey by Fertility Network UK (2022) found that 38% of employees undergoing fertility treatment considered leaving their roles, with 90% experiencing anxiety, stress, and depression during this time. Highly skilled women are also working longer, but lack of support in the workplace leads many to leave their roles or reduce their hours.

This position statement is aimed at increasing awareness of women’s reproductive health concerns at work and can be used by all who work within health and social care, including managers, as a resource to find help and provide support for their employees, themselves or colleagues.

It provides a summary of evidenced based resources that relate to work, whilst experiencing reproductive health concerns that include (but are not restricted to) fertility, menstrual health, miscarriage and pregnancy loss and gynaecological health.

The symptoms experienced by some women can affect performance, therefore it is crucial that women receive workplace support if they need it. Line managers should be sensitive about this, as some women may not wish for or need help, and may worry that disclosing that they are trying to conceive or need time off to manage a particular gynaecological condition may cause active discrimination or impact on career progression, so policies need to be sensitive to the needs of all.

This statement does not focus on menopause at work, as this can be found in the RCN’s position statement on menopause and work and further resources on menopause.    

This statement does not cover maternity or postnatal support in the workplace. This is covered in the RCN’s Having a Family Toolkit which outlines the rights of nursing staff as a parent or parent to be, including provisions for those returning to work who wish to continue breastfeeding.

What good looks like and recommendations for best practice

All four UK governments recognise the importance of addressing women's health issues and employers must take greater responsibility for their female employees by implementing policies and processes to ensure they receive the necessary support and improve their working experiences.

Supporting women's reproductive health at work is essential for fostering a healthy and inclusive workplace. Outlined below are some practices that positively contribute to women's health at work in the health and social care environment:

Promoting health and wellbeing

Health awareness programmes: implementing awareness programs addressing various aspects of women's health through workshops, seminars, (both in person or online) e.g. café/informal get togethers.

Well-woman clinics: establishing well-woman clinics or health check-ups (with drop in opportunities) to address specific health concerns and promote preventive care, as well as providing rapid access to in-house services (where available).

Health and wellbeing policies and pledges: actively supporting workplace pledges and implementing policies that explicitly support women's health and wellbeing, encompassing comprehensive health and wellness strategies.

Mental health support: offering safe and confidential mental health support through facilitated or self-help sessions, acknowledging the importance of mental wellbeing in the workplace.

Supportive spaces: creating women's health cafes or safe spaces where employees can discuss health concerns, share experiences and build support networks.

Resource libraries: establishing and maintaining resource libraries with books, articles and materials dedicated to women's health to provide employees with accessible information and support. Access to online support as well as physical resources, such as apps.

Management support 

Communication training: enhanced communication skills training for managers to foster a better understanding of women's reproductive health and encourage open dialogues. An example of this is Channel 4 who have a number of women’ reproductive health friendly policies.

Managerial education: conducting education sessions for managers to equip them with the knowledge and skills needed to support women's reproductive health needs in the workplace.

Open communication: encouraging open communication between employees and managers about health concerns, fostering a culture that values, respects and supports the diverse health needs of women in the workplace.

Sickness absence and performance reviews: when carrying out sickness reviews, appraisals or one-to-one meetings, managers should consider whether the absence or changes in performance may be related to underlying reproductive health conditions and provide appropriate support such as seeking advice from occupational health.

Health, safety and welfare at work

Access to welfare facilities at work: ensuring ease of access to appropriate and hygienic rest and sanitary facilities and free sanitary products, including for women working in community settings, where access to toilets and rest spaces may be less available.

Risk assessments: ensure that risk assessments are carried out to identify any risk to reproductive health of women at work, including new and expectant mothers.

Equality

Reasonable adjustments: going beyond the minimum requirements under equality and disability laws and support women who are experiencing difficulties at work due to their health condition by making adjustments to working environment or working hours (see section below of flexible working).

Equality impact assessment: workplace polices should be equality impact assessed and monitored, particularly those relating to performance, capacity and sickness absence.

Supportive policies and practices 

Flexible working policies: flexible working arrangements also play a crucial role in supporting women's health in the workplace; however, this needs to be balanced and managed alongside the needs of the service, and may involve some negotiation and support from colleagues. Women have additional and different health needs which will fluctuate over the course of their working lives.

Examples of flexibility to better address women's health needs include:

• flexible hours: offering flexible working hours allows women to adapt their schedules to better manage health-related appointments, family responsibilities, or personal well-being.
• remote work options: providing opportunities for remote working enables women to create a work environment that aligns with their health needs, especially during times of illness or when facing specific health challenges.
• compressed workweeks: offering compressed workweeks (e.g., working longer hours on fewer days) can provide women with extended periods of time for rest or personal commitments.
  flexible meeting policies: implementing flexible meeting policies, such as providing options for virtual attendance or adjusting meeting times, to accommodate women's diverse needs and schedules.

By incorporating flexible working practices and supportive policies, workplaces can create a more accommodating environment, acknowledging and addressing the unique health challenges that women may face. This not only enhances the well-being of employees but also contributes to a more inclusive and resilient workplace culture.

Supportive leave policies: ensuring that leave policies are supportive and understanding of women's health concerns, including the availability of sick leave or other health-related time off. An example of this is Birmingham’s Women and Children Hospital. Employers can and should consider offering additional paid time off for medical appointments.

Sickness absence policies: sickness absence policies should be supportive of the needs of women experiencing difficulties at work due to an underlying reproductive health problem which can sometimes fluctuate and cause unpredictable absence. Delays in treatment and diagnosis can also lead to increased absence from work.

Uniform policies: Uniform policies should consider the needs of women at work and allow flexibility for women experiencing issues such as bloating or heavy menstrual bleeding.

Conclusion

Women's experiences with reproductive health concerns are diverse, and the associated symptoms can be distressing, affecting both personal and professional aspects of life. Supporting women of reproductive age in maintaining their health is crucial. Within the nursing workforce, a significant portion of staff are likely to face at least one women's health concern during their lifespan, impacting both their quality of life and work.

This statement aims to guide and support staff, employers, and managers in managing symptoms, addressing concerns and promoting the physical and emotional wellbeing of individuals dealing with reproductive health issues. Encouraging open workplace discussions can normalise women's health, whilst fostering best practices in managing and supporting individuals wherever they work.