Ageing women’s workplace wellbeing: A global political imperative

Women live around five years longer than men, reaching an average age of 83.6 years compared to 78.3 years (Organization for Economic Cooperation and Development, [OECD], 2022). Coupled with a trend of women staying longer in the workforce over the last few decades, particularly in the UK, this creates a global political imperative to better understand the role of gender in work in order to sustain workforces.

According to the UK Parliamentary and Health Service Ombudsman, policies that extend working lives have been developed alongside pension increases to protect public finances – resulting in laws enacted in 1995, updated in 2007 and then amended in 2010, in response to women playing an increasingly equal role to men in the economy. It was suggested the changes would enhance the future pension entitlement of many women.

However, there were failings in how these changes were communicated to the public, according to the Parliamentary and Health Service Ombudsman, and the impact of the changes has affected women disproportionately. Most importantly it does not seem to have considered gender-based health and structural inequalities and therefore could be argued to be discriminatory. For example, across Europe, both work stress and inequality have been shown to affect women disproportionately throughout the life course, negatively impacting wellbeing, cognition and health in older women (Miller et al., 2022).

Women's labour force participation reached record levels at 66 per cent in 2022, and the largest increases were seen in the 55-64 year old age group (OECD, 2023), which also had the highest sickness absence of age groups in the UK, with stress as the leading cause (OECD, 2022). This trend is seen across Europe with women more likely to spend more time later life in ill health and with a disability than men, despite the gender paradox of women living longer (OECD, 2022).

There also is a significant gender pay gap (12 per cent across the European Union), which increases with age and stands at an average of 26 per cent across OECD countries (OECD, 2022). Structural inequalities are evident in the gendered social roles women tend to occupy, i.e. the 5 C's of catering, cleaning, caring, clerical and cashiering. This means women are over-represented in lower skilled, lower paid and more insecure roles (OECD, 2023). In addition, women take on more caring responsibilities (Tomczyk et al., 2021) and are more likely than men to engage in caregiving for grandchildren while working, which can create role overload and potentially cancel out the positive benefits of working.

In the United Kingdom, women are more likely to extend their working life and political movements have gained momentum in direct opposition to the pension changes affecting women (Women Against State Pension Inequality, WASPI, 2023). A growing Working Older Women's (WOW) network of stakeholders, including over 70 academic researchers representing over 20 countries, has come together recently, to address the growing need to focus on ageing women's workplace wellbeing. We (Clare and Emma) are the founder and leader of this network and a founding member respectively.

WOW are interested in both defining and conceptualising when women are classed as 'older', and reducing the gap between research, policy, politics, and practice through an approach of evidence-based discourse and change. The network involves researchers and stakeholders with an interest in supporting women's workplace wellbeing across the life course, with a focus on women aged 40 and over due to the age of onset of the perimenopause (although the EU defines 'older workers as aged 50 years old and over or 55 years old and over). Let's turn to that focus now.

Women's health and wellbeing in the workplace

Throughout their working lives, women experience several occasions where their health and wellbeing are negatively affected, and the Covid-19 pandemic has exacerbated health and gender inequalities (Guerrina et al., 2021). Over the life course, many women experience various physical symptoms, in relation to acute or chronic conditions, or factors which impact their mental wellbeing, such as workplace pressures or caring responsibilities (Gupta & Srivastava, 2020). Those of working age may also have premenstrual syndrome, fibroids, and conditions such as endometriosis, all of which can impact significantly an individual's ability whilst at work (Sang et al., 2021). Many women before and/or during menstruation also experience dysmenorrhea (painful periods), which can result in stomach cramps, back pain, headaches, nausea, and bloating, which often negatively impact well-being, resulting in the need for time off work (National Institute for Clinical Excellence, 2018). Others experience fatigue, psychological symptoms, such as low mood, loss of confidence, anxiety, irritability, and describe feeling unable to carry out daily activities (Schoep et al., 2019).

In recent years, much attention has focused upon the concept of menstrual leave policies (King, 2021), whilst recent qualitative research highlights the perceived stigma surrounding menstruation and emphasises the lack of public health and occupational health research focusing on the menstrual cycle (Sang et al., 2021). Such policies are deemed to be progressive, focusing upon women's needs and rights in the workplace and offering flexible working and periods of absence tailored to the individual, which can be paid or unpaid (King, 2021). These policies have generated mixed views in the United States of America, with some perceiving them as supportive of women's health and wellbeing at work, whilst others deem them unfair, with women receiving additional leave compared to their male counterparts (Barnack-Tavkaris et al., 2019).

It is estimated 13 million people are perimenopausal or menopausal in the UK (National Health Service, 2022) and 63 per cent of women who are menopausal report increasing stress, with the majority experiencing multiple negative work outcomes, including lowered ability to concentrate and be patient with customers and clients (Chartered Institute of Personnel and Development, 2019). Geographical and ethnic differences in menopause related symptoms are also experienced (Monteleone et al., 2018). Thus it is important to take individual differences into account when considering the most appropriate support workplaces can provide.

Cultural context: a mixed picture of gender equity

Cultural norms and values permeate perceptions of gendered ageing and work-related expectations, and can lead to varying attitudes towards women in different societies. Across Europe the picture is mixed across many policy domains. For example, Germany, France and United Kingdom have higher gender pension gaps than the average according to the OECD (2022). In parallel, women in Finland, Hungary and Denmark have lower gender pension gaps than the average, but other data for the picture of employment and well-being by gender vary across different countries.

Turning to experiences of the menopause specifically, these have been shown to differ by country. The word for the menopause in Japan 'konenki', means transformation and renewal. In the UK, the discourse is biomedical, with the menopause presented as an 'invariant biological transformation' (Lock & Kaufert, 2001) that brings decline and loss (de Salis et al., 2018). Stigmatisation of the menopause is linked with body dissatisfaction, self-objectification, and appearance-related ageing anxiety (Nazapour, 2021). Nevertheless, as de Salis et al. (2018) highlight, for some women 'ageing can bring freedom, self-awareness, growth, reflection, and reassessment of role' and, thus, the menopause may be perceived differently.  

A meta-analysis of studies across 24 countries, identified the average age of natural menopause as 48.78, with those in Europe, Australia and America typically having a later onset in comparison to individuals in Africa and the Middle East (Schoenaker et al., 2014). Disparities in onset may occur due to genetic differences, reproductive, environmental, and lifestyle factors, such as occupation, diet, engagement in exercise, and smoking (Sapre & Thakur, 2014). Similarly, a recent systematic review highlighted occupational exposure to pesticides, having a high-pressured role, and repetitive work, as determining factors for menopause onset and symptom severity (Martelli et al., 2021).

Although still lacking, there has been a rise in empirical research focusing on the menopause and women's workplace wellbeing, with governments and employers working together to consider how best to support older female workers, as well as an increase in media attention (Jack et al., 2021). Despite undoubted progress, support provided in relation to the perimenopause and menopause varies, dependent upon employer and geographical location (Dennis & Hobson, 2023). In recent years, positive steps have been taken in some European countries, especially within large public and private sector organisations. This has encompassed workplace policies and guidance surrounding the menopause, training sessions for managers, and modifying workspaces to meet individual needs, although these aspects have predominantly benefited those working in professional roles (Jack et al., 2021). Yet many women feel the menopause is still not openly discussed or addressed in the workplace, with cultural issues also relevant (Atkinson et al., 2021).

Similar to menstrual leave policies, a global debate surrounds the effectiveness of workplace menopause policies. The European Menopause and Andropause Society argue such policies strive for greater inclusivity, diminish stigma, and create better working conditions (Rees et al., 2021). However, others suggest specific policies create negative attitudes towards older female workers, as they imply all individuals experience difficult symptoms, which cannot be managed without workplace adjustment (Carter et al., 2021).

The gap between legislation and practice

In the UK, there are two key Acts to which employers should adhere to with regards to the menopause and women's health and well-being across the life course – the Equality Act (2010) and the Health and Safety at Work Act (1974). Interestingly, the menopause is not deemed as a protected characteristic within the Equality Act (2010). However, if an employee is disadvantaged or treated unfairly due to their menopausal symptoms, this could be considered discriminatory, as the Act covers issues associated with age, disability, and sex. In addition, the Health and Safety at Work Act (2010) aims to ensure employers consider and support health, safety, and welfare in the workplace. However, in practice, recent research exploring implementation of the Well Women Strategy in the NHS Northern Care Alliance found 55 per cent of women surveyed did not know their legal entitlements surrounding workplace health (Wilkinson et al., 2023). This research also highlighted a need for managers to be supported in helping address women's health issues with sensitivity and appropriate language, as well as building confidence in addressing concerns by developing policies and fulfilling legal obligations.

There is a clear gap between legislation, policy and practice, which could be reduced with enhanced political focus, effectively responding to and working with political movements led by women such as WASPI. In addition, it would be beneficial to create and enhance legislation and policy to protect women's workplace health and well-being. In this way, the needs of women across the life course could be actively protected and supported in the workplace.

The gender pay gap and the gender paradox – whereby, women live longer, but spend more time in ill health and disability compared to men – emphasise there is a clear need for policy to look after and understand the health and well-being needs of women, who are the fastest growing group in terms of labour force participation due to necessity. We also need to explore intersectionality – our identity is formed from several social categories, and 'lookism' around women's self-presentation and bodies has been shown to combine with ageism. Psychology has a clear role to play in understanding such factors in order to sustain equitable and healthy societies that are redeveloped with women at the heart.

Dr Clare Edge is a Lecturer in Psychology at the University of Salford and is the founder and leader of a European network of researchers exploring older women's workplace wellbeing, that involves over 20 countries and 70 researchers and stakeholders.

Dr Emma Swift is a chartered psychologist with extensive expertise in Health Psychology, chronic health conditions, and wellbeing. She is currently a Lecturer in Psychology at the University of Salford.

This article was commissioned as part of our forthcoming May edition, themed around Being Political in Divisive Times. Guest editors are Kesi Mahendran, Sandra Obradovic, Sue Nieland and Ashley Weinberg.

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