The Government Council has shown its unfavorable opinion to the Bill relating to the fight against discrimination due to menopause, presented by the Mixed Parliamentary Group-Adelante Andalucía, given that The Ministry of Health and Consumer Affairs finalizes a Strategy for Sexual Health and Reproductive Health of Andalusia that includes specific attention to the climacteric of women; In addition, the service portfolio of the Andalusian Health Service also provides for menopause care. Likewise, the Ministry of Social Inclusion, Youth, Families and Equality has the necessary resources to act against any discrimination that may occur at this stage of a woman’s life, as at any other.
The Sexual Health and Reproductive Health Strategy aims to identify the main challenges for improving sexual health and reproductive health in Andalusia.a vital sphere of great relevance, and implement measures that optimize, as we say, the quality and warmth of the approach to this matter, not only from the prevention of risks and attention to needs and problems, but also from the promotion and encouragement of empowerment population for the implementation of healthy lifestyles.
The guiding principles that permeate this Strategy are equity and universal access, sexual and reproductive rights, ethical principles, a salutogenic and multidimensional approach to health, inclusion of diversity and the entire life cycle, a focus on social and gender determinants, evidence scientific, as well as the humanization of care. In addition, incorporates the gender perspective in order to eradicate violence and reduce inequalities in access to health and to attention resources, linked to differences in socialization and evaluation based on sex.
Its main lines of action are defined according to some key elements, such as the separation of the areas of sexual health and reproductive health as a fundamental requirement to respond to the complete needs of the Andalusian population; the understanding of sexual health and reproductive health in a holistic sense that contemplates the areas of promotion, prevention and health care, allowing the efforts of public health policies to be directed to foster positive personal relationships, in addition to preventing risks and treating diseases; the importance of research and improvement of professional knowledge to offer health care with high quality standards. Thus, the strategy has five strategic lines: promotion of sexual health; prevention and attention to sexual health; reproductive health promotion; prevention and care for reproductive health; and, finally, professional development, research and innovation in sexual and reproductive health.
Between the concrete actions linked to the climacteric established by the strategy, highlights the implementation of activities in health centers to promote healthy sexuality free of violence, aimed at different age groups and at different moments of the life cycle (pregnancy, puerperium, menopause, etc.).
On the other hand, the SAS Primary Care Services Portfolio already offers a set of scientific-technical activities that are carried out at the first level of care, establishing and unifying criteria that guarantee the quality of the services referred to climacteric care. Specifically, it includes prevention, detection and care for women’s problems in the climacteric, ranging from information to women about changes in the climacteric; promote healthy habits (diet, physical exercise, etc.); assessment of health status and risk factors; to the information and registration system in digital health history.
These services are implemented by the basic Primary Care teams of each user, specifically Family and Community Medicine and Nursing professionals, who carry out the diagnostic assessment and clinical management of climacteric and its own complicationsgiving a response from their level of care or referring, in specific cases, to the hospital level of care, at the discretion of the optional assessment of their reference doctor.
In the field of Hospital Care, the SAS deploys a wide range of specialized services in Obstetrics and Gynecology in its hospital centers distributed throughout the autonomous community. These centers are fundamental pillars to ensure comprehensive medical care for women during all stages of their lives, including menopause and postmenopause.
Likewise, the Government Council opposes the consideration contained in the Proposal of Law on the need to “implement an Integrated Care Process (IAP) to care for women during the climacteric stage” while considering menopause as a problem health could mean medicalizing a natural period for women. Nevertheless, When the symptoms in specific cases require it, the health services intervene appropriately and offer this care to women.. In fact, there is more and more critical scientific literature that suggests that the stages that a person goes through throughout their life, such as adolescence or the climacteric, should not be excessively medicalized.
Thus, it recommends addressing specific situations that may arise during menopause (hot flashes, increased cardiovascular risk, hormonal changes with an impact on quality of life, mood, genitourinary problems, etc.) but advises against medicalizing this stage of life making a differentiated route through these units for the entire female population, because excessive medical intervention can be counterproductive and favor precisely the discrimination due to menopause that we want to combat.
Regarding the proposal of the Bill to create specific climacteric consultations in Primary Care and Hospital Care, attended by at least one medical professional and a midwife, it is recalled that these health activities are currently carried out by professionals. Primary Care health workers according to their capacity. Furthermore, practically all the actions contemplated in the Bill are being carried out at a scientific-technical level of care by the professionals of the Andalusian public health system, as is the case with Integrated Care Processes Cervix and Breast Cancerpathological processes that have a higher incidence in climacteric women, as well as the creation of specific consultations for pathologies in Gynecology Services of regional hospitals.
In the case of midwives, Andalusia has promoted this figure since 2019 with 413 more professionals, which means an increase of 45%, going from the 923 in 2018 to the current 1,336. Midwives provide comprehensive care to women at all stages of life, emphasizing from adolescence to menopause, which is when the most consultations occur. In this sense, the midwife is a fundamental pillar in the public health system of Andalusia, contributing to the well-being of women and newborns. Likewise, it is important to highlight that her work also covers emotional aspects in women’s lives, educational and preventive health.
Finally, the Andalusian Government recalls that specialized health training programs depend on the Ministry, therefore, any proposal to modify this procedure, such as the one included in the bill, must follow the procedures established by the State.
Finally, although the symptoms of menopause can disrupt the personal and professional lives of women, when a woman suffers discrimination at this stage, as at any other stage of her life, the actions and services existing in the Board of Andalusia, specifically those developed by the Ministry of Social Inclusion, Youth, Family and Equality, in such a way that they are specifically aimed at solving this situation of discrimination.
