Engender blog

Invisible in Scotland’s Health System

The recently published Voluntary Health Scotland (IN)VISIBLE research report explores the complex relationship between sex, gender, and health. In this guest blog, report author Sarah Latto reflects on the findings and how we can work together to bring about systemic change.  

A research participant describing her experience of navigating Scotland’s health system as ‘institutional gaslighting’ really cemented the importance of our (IN)VISIBLE project. I also have personal experience of my symptoms and pain being minimised in Scotland’s health system, and this is happening to too many of us, too often.   

Led by evidence and insights from over 50 representatives from Scotland’s third sector, the (IN)VISIBLE research looks at how sex and gender affect the health of all Scotland’s people, not just women. However, the report surfaces clear evidence of misogyny in Scotland’s health system that will be familiar to many Engender members.  

In writing the report, I was keen to ensure that the themes were navigated sensitively and inclusively. As well as engaging with a wide range of health-specific VHS member organisations, I approached third sector organisations that have expertise in gender issues, like Engender, for their insight. I also worked closely with LGBT Health and Wellbeing and Scottish Trans to ensure that an intersectional approach was adopted throughout.  

Physiological Differences 

For women assigned female at birth, physiology – or biology – plays an important role in determining their health. ‘Women’s health’ is often defined by the female reproductive organs and hormones, focusing on conditions like endometriosis, adenomyosis, or menopause. However, assigned females are also more likely to develop certain neurological conditions such as ME or Functional Neurological Disorder, and experience many other health conditions differently to assigned males.  

In fact, assigned females routinely have their symptoms dismissed, are misdiagnosed, or experience treatment delays because these physiological differences are not well understood by health professionals. As one participant stated, ‘women are seen as “little men”’ with treatment ‘based on the “typical” 70kg man’. This creates considerable health inequalities and can have life-threatening consequences for women.  

For trans women, physiological differences lead to more complex inequalities due to the binary nature of our health system. Gender identity healthcare often creates new biological realities that aren’t well understood, and don’t align with dated NHS systems for patient data. For example, a trans woman might be eligible for breast screening as a result of hormone therapy but they may also still require prostate screening. Unfortunately, screening invitations are largely based on binary gender categories, meaning that many trans people have to proactively request screening that is appropriate to them.  

Societal and Systemic Barriers 

Societal gender norms have a significant impact on health outcomes, along with systemic barriers in Scotland’s health infrastructure and workforce. For example, women are more likely to provide, or be expected to provide, primary unpaid caregiving roles. Several sources in the research spoke about the burden on women in heterosexual relationships to provide their partner with a ‘good death’, with some of that pressure appearing to come from health and care workers. This places significant economic pressure on many women, often leading to poorer health outcomes. It also limits their capacity to prioritise their own health, with many unpaid carers ending up ‘missing’ from the health system. 

Intersectional Inequalities 

The impact of gender on health is often compounded when it intersects with other protected characteristics. VHS members shared evidence of ageism, ableism, racism and queer-phobia, often having devastating impacts on the health of women in Scotland. Women with learning disabilities are often infantilised, with some reportedly experiencing pressure to terminate pregnancies. Similarly, migrant women regularly experience discrimination in maternity services, with reports of informed consent not being adequately obtained for procedures including the provision of long-term contraception.  

Bisexual women have a disproportionately high likelihood of reporting poor health outcomes, including depression, self-harm, disordered eating, and abusive relationships. Frustratingly, there is not enough evidence to understand why this is the case – a common theme when it comes to understanding intersectional health inequalities. One research participant stated that:  

‘Not only do we have data gaps, but where we have data, particularly when you’re talking about disaggregated data, it is not statistically significant enough for us to base anything on it.’ 

So, how do we solve this? 

There are six recommendations detailed in the report, all aimed at improving health experiences and outcomes by bringing about systemic change. Health policy and research need to reflect the impact of sex and gender on health, particularly where they intersect with other characteristics.  

The health workforce needs to be better informed on the specific impacts, and we need to invest in dedicated systems and spaces that address common barriers. We need to empower women through public awareness campaigns – only by understanding the ways that sex and gender impact on health will we be able advocate for ourselves.  

Finally, it is clear through this report that third sector organisations like VHS and Engender have a vital role to play in understanding and responding to inequalities. I urge women, and organisations that support and empower women, to read this report, share its core messages, and help us to make the invisible visible.  

Sarah Latto (she/her) has been the Policy and Public Affairs at Voluntary Health Scotland since May 2025. She is passionate about social justice and a proud member of Engender. Voluntary Health Scotland are a movement for health creation, working collaboratively with their 300+ members to reduce health inequalities. 

Research shows record number of women MSPs standing down ahead of election

Ahead of the upcoming Scottish Parliament elections on 7th May, today Engender is publishing our new paper exploring why women MSPs are stepping down, and what we can do to tackle this.

The upcoming elections are a crucial moment to ensure that our next intake of MSPs furthers women’s representation at the highest levels of decision-making, but our research shows that an unprecedented number of women MSPs are not seeking re-election.

Out of 129 MSPs serving in the Scottish Parliament until March 2026, over a third announced that they would not stand for re- election in May 2026. Of the 40 MSPs who stood down, 23 were women (58%). Women made up 45% of the Scottish Parliament in March 2026. With 23 out of a total of 58 women MSPs standing down, this meant that 40% of women MSPs decided not to run again. Nine out of the 23 women who stood down were elected for the first time in 2021 meaning they served only one term in Parliament.

Understanding why women are standing down from elected office is essential in addressing persistent gender inequalities within democratic institutions and to ensuring that women’s perspectives continue to inform the decision-making that impacts their lives. We surveyed the women MSPs who had announced their intention to stand down to find out what factors were motivating their decision.

 
5 Reasons for women MSPs to stand down from elected office (from our survey) 

1. Work/Life balance

2. Length of time spent away from family

3. Demands on time beyond working hours

4. Misogynist abuse (including on social media)

5. Threats to safety 

Women MSPs told us about their difficulty balancing work with caring responsibilities and the parliament’s lack of offering support to the barriers and misogyny women face on top of the busy lifestyle of a politician. These compounding impacts leave women vulnerable, and ultimately contribute to their decision to quit politics altogether.

Using input from women MSPs and building on work from Engender’s Equal Representation project, our paper contains recommendations for political parties, Scottish Government and the Scottish Parliamentary Corporate Body to increase women’s participation and retention, tackle violence against women, misogyny and abuse in politics, balance family life and work, and build long term culture change.

5 Key Recommendations 

1. Ensure there is a Code of Conduct and bespoke policies for all members that prohibit gender-based violence and discrimination, and set out clear and transparent reporting processes.

2. Together with Police Scotland, continue to raise awareness about Operation Ford and increase capacity so that all MSPs are adequately supported in monitoring their social media abuse and violence.

3. Provide access to mental health and wellbeing support for members who have experienced gender-based violence or discrimination.

4. Adapt party structures and ways of working to better accommodate women’s and caregivers’ needs, respecting family and caregiving responsibilities.

5. Agree long-term goals for diverse representation across local council, Holyrood and Westminster elections. Create accompanying strategies to guide work to achieve them. At all levels, foster a culture that takes proactive steps against sexism, racism, classism, ableism, transphobia and other intersecting discrimination.

Read the full paper including all the recommendations for action here.

Holyrood 2026 - Calling on candidates to invest in women

We’re calling on candidates to commit to taking action on three key areas for women if elected – and we need your help!

A decade of austerity policies, the pandemic, and the ongoing cost-of-living crisis have all impacted women disproportionately. Far too many women in Scotland report that their lives are increasingly impacted by financial insecurity, that the disproportionate burden of caring responsibilities they carry continues to go unrecognised and be undervalued, and that their fundamental rights increasingly feel at risk.

We’re calling on candidates to commit to policies that will transform women’s lives by raising 3 of the key asks from our manifesto, which focus on tackling women’s deep financial insecurity head-on. These are realistic steps that political parties can take to ensure that policy and public investment translate into real change for the most marginalised in our communities. 

Gender inequality is not inevitable in Scotland, and the Holyrood 2026 elections on 7th May can be a hopeful moment of change for women in Scotland, but we need parties and candidates to commit to making women’s voices heard.

We’re asking candidates to commit to making Scotland a place where…

1. Women live free from poverty and financial inequality.

We’re calling on candidates to commit to supporting the creation of a ‘Women’s Equality Fund’ designed to provide targeted crisis financial support for marginalised groups of women, with a focus on unpaid carers, women with experience of domestic abuse, women with No Recourse to Public Funds, and disabled women.

2. We value the unpaid care women provide in our communities.

We’re calling on candidates to commit to providing vital financial assistance for unpaid carers, including improving the Carers Support Payment, increasing its value and extending access for young carers, older carers, those in education and employment, and those with multiple caring roles, and to support the introduction of a well-structured pilot scheme of the ‘Minimum Income Guarantee’ by 2029, with a focus on unpaid carers, including carers from a diverse range of ages, employment and education statuses.

3. Women’s participation in the economy is valued and invested in.

We’re calling on canddiates to commit to supporting the designation of childcare and social care as crucial economic growth sectors by recognising and investing in the care economy as key infrastructure, including in Scotland’s National Strategy for Economic Transformation (NSET).

Use the tool at the top of this page to write to your local candidates and ask them to commit to investing in women and transforming our communities.

Building an intersectional feminist future for Scotland

Earlier this month, our membership came together for our Annual General Meeting and to consider our Annual Report 2025, which you can read here.

It gave us a rare opportunity to take stock of our work and what we’ve managed to achieve in the last year. 
 
We’d like to say a huge thank you to our members, followers, and everyone we’ve collaborated with. We’re grateful to the hundreds of women from across Scotland who have responded to our consultations and surveys or who joined our workshops in person. Your support and engagement enrich our work, help us understand the challenges women face, and what the priorities for change need to be - thank you.

It’s been a busy year... 

We’ve worked across issues including women’s:  

• Poverty and the impacts on unpaid carers, single mums, migrant and refugee women. 

• Health, securing phase two of the groundbreaking Women’s Health Plan and a renewed focus on mental health.  

• Reproductive Rights, launching a major partnership campaign on abortion: Lets change the Act.  

• Safety: focusing on how violence against women can be prevented using policy changes across transport, housing and planning.  

• Equal Representation in Politics, Media and Culture, publishing in-depth research on the increasing hostility and pressure women face in these spaces and what government and organisations can do to improve things. 

We’ve engaged with hundreds of women through our research, surveys and events, including in-person workshops across the country. We captured powerful personal testimony and positive feedback:  

“Diverse, respectful, and inclusive workshop space” 
“Felt heard, valued, and respected”
“Really excellent event and well run”
“Amazing, so engaging and freedom for chat”

 
We produced a wide range of briefings, evidence and analysis highlighting 14 vital areas for women’s equality in Scotland today. 

We collaborated directly with 130 different organisations.

We contributed to 22 advisory bodies, sharing our expertise and advocating for change. 

We hosted 28 in-person and online events, conferences and webinars. 

We could not do this without you, thank you.