Dr Aaliya Goyal is a General Practitioner in Birmingham. She works within a majority South Asian population. She is a Deprivation Health Fellow and has worked with the migrant and refugee community. Dr Goyal has roles across multiple respected medical organisations including the Royal College of General Practitioners and Health Education England. Dr Goyal’s personal viewpoints have been published in internationally renowned online medical journals. In an exclusive interview with Asian Voice, she spoke about health inequalities among South Asian women.
What according to you, are the major talking points when it comes to inequality among South Asian women?
There are lots of talking points when it comes to inequality among South Asian women. Generally speaking, South Asian women may not talk openly about health concerns due to fear of being judged by their family or community. There can be a stigma attached to, for example, mental health or sexual health issues so women may not seek help until a late stage, if at all. The uptake of cervical cancer screening (“smears”) is often low among South Asian women for many reasons including fear, shame, embarrassment, or lack of understanding of its importance. There can be barriers to healthy lifestyle changes for some South Asian women, either through language barriers impacting on education, women prioritising caring for the family over self-care, being unable to have regular physical exercise due to safety fears or difficulty meeting family/religious requirements (women only venues etc). It can be challenging and unacceptable to prepare traditional food in a different way to make it healthier. There are lots of factors that can exacerbate inequalities including the risk of developing obesity and diabetes. When South Asian women do seek help, they sometimes struggle to feel heard or to be taken seriously by some health professionals. Dr Rageshri Dhairyawan recently used the phrase “testimonial injustice” in an article in the Lancet. This is when a person’s voice is dismissed due to the listener holding some bias against them. It is often reported by diverse women and can mean that they are not believed because they are not seen as credible narrators. So, women may not get the help they need until later compared to a non-Asian woman, which can lead to poorer outcomes in health.
As GP what are your primary observations when meeting women of South Asian origin who come to seek help from you?
When I meet women of South Asian origin face to face, there is a sense of connection between us. South Asian women can be more willing to share their concerns with someone who reflects a similar background to them. I can understand some of the pressures and challenges faced by South Asian women, in terms of family and community expectations, norms and attitudes. This means that it can be easier to build rapport and trust. Gaining trust is a privilege I can use to get to the heart of the issue compared to a doctor who may have less cultural understanding. I sometimes find that at the start of the conversation, women are frustrated because they have tried to seek help on multiple occasions and felt they were not being heard. So, all that is needed is to listen, validate their concerns and let them know that they are not alone.
As per your assessment, what can be done at a community level to be able to reduce health inequalities amongst our women?
The coronavirus pandemic has shown us how important it is to engage communities to help spread key messages and combat misinformation. We can apply the same principles to reducing health inequalities among our women. We can seek trusted female and male role models and influential community or faith leaders to educate our communities to seek early support and medical help for our women. They can help destigmatise mental health, sexual health, and cancer screening for example. We can organise engagement events to listen to the concerns of the communities and work together to find acceptable solutions to tackling these concerns. We can help to educate families, by producing easy to understand the information in a variety of languages for people to access either through written documents or short videos. We can bring screening into community spaces such as blood pressure and diabetes checks to make it as easy as possible for people to get assessed at an early stage. We can help with group consultations of people facing similar challenges to provide peer support and empower women to make their health a priority. We can signpost to community groups for peer support as well, in addition to the support we give.
Do you think that the Asian community is educated and informed enough to tackle issues like infertility, polycystic ovarian syndrome, menopause, Osteoporosis, heart conditions and mental health in women?
There are lots of issues that affect all women. In South Asian communities, health information may come from elders in the community and may not match the advice from a healthcare professional. It is important to access trusted websites such as the NHS website and seek help from healthcare professionals in the community whether that is pharmacists, nurses, health visitors or General Practitioners. There are also community groups that produce information in written and video form as well as trusted and respected faith-based medical organisations.
If you were to give three pieces of advice, which the community can adhere to while empowering its women to deal with health issues, what would they be?
Family and community support is vital to empowering women to deal with health issues so be supportive, listen and encourage. Take a community approach, women’s health is important to everyone so educate everyone together. Invite trusted speakers into community spaces. Verify the medical information that you receive before sharing it. Incorrect information can be circulated through short videos and messages on social media such as Facebook and WhatsApp. Community members have a duty not to spread these messages further as they can have a negative impact and lead to harm.
At what age and stage do females need to start keeping a tab on their health, whether they have a healthy body?
Education on good health should start from childhood. Parents play an important role in encouraging girls to learn about healthy eating and exercise to foster good habits. Sometimes there can be a difference between traditional views of health and medical views of health especially when it comes to weight. Body positivity is incredibly important. Females should not be judged on their physical appearance. Comments around weight can be internalised causing considerable distress. Parents should also ensure open and non-judgemental two-way communication so that girls grow up in an environment where they feel comfortable to discuss concerns.
What role do men play in the early diagnosis of health concerns that women complain of?
Men play an important role in advocating for all women, including their mothers, wives, sisters, and daughters. Men should also be educated in women’s health issues as issues that affect women affect everyone. We need men to support women by listening to them, believing them and empowering women to go for screening or get the help they need. It is important for men to keep the channels of communication open with women to give women their voice. Women can choose how they would like to be helped and men should be respectful of the choices that women make. I see men as supporters and facilitators and many men are.
(The views expressed here are Dr Goyal’s and not representative of the organisations she works for.)
