'Women deserve better': a national mixed-methods exploration of the 'silent' health conditions and social issues affecting women and girls in Australia

A total of 2,221 surveys were submitted. Of these, 18 were ineligible as the respondents were aged less than 16 years resulting in 2,203 surveys for analysis. Overall, the sample was broadly representative of the general female Australian population (Table  1 ) and included women and girls who had been treated for, diagnosed with or experienced a range of health conditions and social issues during their lifetime (Supplementary material). Table 1 Survey respondents’ sociodemographic characteristics Sociodemographic characteristic Sample Australian female population Age (mean; range) ( n  = 2165)  16–19 years  20–29 years  30–39 years  40–49 years  50–59 years  60–69 years  70–79 years  80–89 years  90–99 years 50.3 years; 16–93 49 (2.3%) 207 (9.6%) 329 (15.2%) 420 (19.4%) 494 (22.8%) 396 (18.3%) 219 (10.1%) 50 (2.3%) 1 (0.0%) 46 a 5.8% 13.5% 14.8% 12.8% 12% 10.9% 8.2% 3.9% 0.9% Country of birth ( n  = 2176)  Born in Australia 1620 (74.4%) 69.5% b Aboriginal or Torres Strait Islander ( n  = 2174)  Yes 37 (1.7%) 3.8% b Relationship status ( n  = 2179)  Partnered 1499 (68.8%) 56.0% c Highest level of education ( n  = 2177)  Has a post-secondary school qualification 1650 (75.8%) 41.4% Sexual orientation ( n  = 2180)  Heterosexual 1951 (89.5%) 94.8% d Healthcare concession card ( n  = 2172)  Has a concession card 743 (34.2%) 35.0% e Residential location ( n  = 2117)  Lives in a metropolitan area 1553 (70.5%) 72.0% b Geographic location - State ( n  = 2117)  Tasmania  Victoria  New South Wales (includes ACT)  Queensland  Northern Territory  Western Australia  South Australia 62 (2.9%) 668 (31.6%) 574 (27.1%) 374 (17.7%) 9 (0.4%) 240 (11.3%) 190 (9.0%) 2.1% f 25.8% f 32.9% f 20.6% f 0.9% f 10.8% f 6.9% f Occupation  Manager or administrator Professional 194 (8.8%)500 (22.7%) 11.2.7% g 27.8% g  Associate professional 102 (4.6%)  Tradesperson Advanced clerical, sales or service worker 33 (1.5%) 168 (7.6%)  4.4% g 16.8% g  Intermediate clerical, sales or service worker 192 (8.7%)  Intermediate production or transport worker 9 (0.4%) 1.6% g  Elementary clerical, sales or service worker 73 (3.3%)  Labourer or related worker 38 (1.7%) 6.8% g  Self-employed  Student  Retired 127 (5.8%) 136 (6.2%) 512 (23.2%)  No paid job 257 (11.7%) 4.1 g Survey language ( n  = 2203)  English  Arabic  Chinese  Punjabi  Vietnamese 2179 (98.9%) 2 (0.1%) 18 (0.8%) 4 (0.2%) 0 (0.0%) 72% h 1.4% h 3.9% h 0.9% h 1.3% h [ 38 ] Language spoken at home ( n  = 2178)  Speak a language other than English at home 297 (13.6%) 24% i Sources: a ABS, b AIHW, c ABS, d ABS, e Melbourne Institute, f ABS, g ABS, h ABS, i ABS Survey respondents’ sociodemographic characteristics Age (mean; range) ( n  = 2165) 16–19 years 20–29 years 30–39 years 40–49 years 50–59 years 60–69 years 70–79 years 80–89 years 90–99 years 50.3 years; 16–93 49 (2.3%) 207 (9.6%) 329 (15.2%) 420 (19.4%) 494 (22.8%) 396 (18.3%) 219 (10.1%) 50 (2.3%) 1 (0.0%) 46 a 5.8% 13.5% 14.8% 12.8% 12% 10.9% 8.2% 3.9% 0.9% Tasmania Victoria New South Wales (includes ACT) Queensland Northern Territory Western Australia South Australia 62 (2.9%) 668 (31.6%) 574 (27.1%) 374 (17.7%) 9 (0.4%) 240 (11.3%) 190 (9.0%) 2.1% f 25.8% f 32.9% f 20.6% f 0.9% f 10.8% f 6.9% f 33 (1.5%) 168 (7.6%) Self-employed Student Retired 127 (5.8%) 136 (6.2%) 512 (23.2%) English Arabic Chinese Punjabi Vietnamese 2179 (98.9%) 2 (0.1%) 18 (0.8%) 4 (0.2%) 0 (0.0%) 72% h 1.4% h 3.9% h 0.9% h 1.3% h [ 38 ] Sources: a ABS, b AIHW, c ABS, d ABS, e Melbourne Institute, f ABS, g ABS, h ABS, i ABS The respondents reported that the condition/issue they were most concerned about was violence ( n  = 1268, 57.6%). Cancer was perceived by the respondents to be the condition/issue that received the most funding ( n  = 1615, 73.3%) and attention ( n  = 1557, 70.7%). The respondents thought that women and girls needed more information about mental health conditions ( n  = 867, 39.4%) (Table  2 ; Fig.  1 ). Endometriosis ( n  = 1540, 72.9%), depression ( n  = 1397, 66.3%) and homelessness ( n  = 1670, 79.0%) were identified by the respondents as the conditions/issues which needed more funding and support (Table  3 ). Table 2 Survey respondents’ top 5 health conditions/social issues Health condition/social issue Top 5 (total 1–5 rankings) Most concerned about 1. Violence ( n  = 1268, 57.6%) 2. Mental health conditions ( n  = 1183, 53.7%) 3. Homelessness ( n  = 821, 37.3%) 4. Cancer ( n  = 719, 32.6%) 5. Poverty ( n  = 571, 25.9%) Most commonly funded 1. Cancer ( n  = 1615, 73.3%) 2. Cardiovascular disease ( n  = 889, 40.4%) 3. Diabetes ( n  = 830, 37.7%) 4. Mental health conditions ( n  = 799, 36.3%) 5. Drug and alcohol problems ( n  = 758, 34.4%) Gets the most attention 1. Cancer ( n  = 1557, 70.7%) 2. Violence ( n  = 1112, 50.5%) 3. Mental health conditions ( n  = 878, 39.9%) 4. Drug and alcohol problems ( n  = 734, 33.3%) 5. Homelessness ( n  = 557, 25.3%) Need more information about 1. Mental health conditions ( n  = 867, 39.4%) 2. Violence ( n  = 834, 37.9%) 3. Menopause/perimenopause ( n  = 768, 34.9%) 4. Gynaecological cancers ( n  = 612, 27.8%) 5. Endometriosis ( n  = 595, 27.0%) Survey respondents’ top 5 health conditions/social issues 1. Violence ( n  = 1268, 57.6%) 2. Mental health conditions ( n  = 1183, 53.7%) 3. Homelessness ( n  = 821, 37.3%) 4. Cancer ( n  = 719, 32.6%) 5. Poverty ( n  = 571, 25.9%) 1. Cancer ( n  = 1615, 73.3%) 2. Cardiovascular disease ( n  = 889, 40.4%) 3. Diabetes ( n  = 830, 37.7%) 4. Mental health conditions ( n  = 799, 36.3%) 5. Drug and alcohol problems ( n  = 758, 34.4%) 1. Cancer ( n  = 1557, 70.7%) 2. Violence ( n  = 1112, 50.5%) 3. Mental health conditions ( n  = 878, 39.9%) 4. Drug and alcohol problems ( n  = 734, 33.3%) 5. Homelessness ( n  = 557, 25.3%) 1. Mental health conditions ( n  = 867, 39.4%) 2. Violence ( n  = 834, 37.9%) 3. Menopause/perimenopause ( n  = 768, 34.9%) 4. Gynaecological cancers ( n  = 612, 27.8%) 5. Endometriosis ( n  = 595, 27.0%) Fig. 1 Health conditions and social issues the survey respondents were most concerned about, perceived to be most commonly funded and received the most attention, and need more information about Health conditions and social issues the survey respondents were most concerned about, perceived to be most commonly funded and received the most attention, and need more information about Table 3 Survey respondents” top 5 health conditions/social issues which need more funding/support Affect only women/girls Affect women/girls disproportionately Affect women/girls differently Endometriosis ( n  = 1540, 72.9%) Depression ( n  = 1397, 66.3%) Homelessness ( n  = 1670, 79.0%) Ovarian cancer ( n  = 1499, 71.6%) Alzheimer’s Disease ( n  = 1380, 65.7%) Cardiovascular disease ( n  = 1213, 57.2%) Uterine/womb cancer ( n  = 1380, 67.1%) Perinatal depression ( n  = 1322, 62.7%) Body image ( n  = 1164, 55.6%) Peri/menopause ( n  = 1378, 65.9%) Chronic pain ( n  = 1293, 61.5%) Stress ( n  = 1153, 54.6%) Vaginal/vulva cancer ( n  = 1361, 65.5%) Anxiety ( n  = 1269, 60.1%) Palliative care ( n  = 1078, 51.9%) Survey respondents” top 5 health conditions/social issues which need more funding/support Endometriosis ( n  = 1540, 72.9%) Depression ( n  = 1397, 66.3%) Homelessness ( n  = 1670, 79.0%) Ovarian cancer ( n  = 1499, 71.6%) Alzheimer’s Disease ( n  = 1380, 65.7%) Cardiovascular disease ( n  = 1213, 57.2%) Uterine/womb cancer ( n  = 1380, 67.1%) Perinatal depression ( n  = 1322, 62.7%) Body image ( n  = 1164, 55.6%) Peri/menopause ( n  = 1378, 65.9%) Chronic pain ( n  = 1293, 61.5%) Stress ( n  = 1153, 54.6%) Vaginal/vulva cancer ( n  = 1361, 65.5%) Anxiety ( n  = 1269, 60.1%) Palliative care ( n  = 1078, 51.9%) The survey respondents were categorised into three age groups: ‘younger’ (16–39 years), n  = 585, 27.0%; ‘middle’ (40–59 years), n  = 914, 41.5%; and ‘older’ (≥ 60 years), n  = 666, 30.8%. The three age groups were similar in their rankings of the health conditions/social issues. Consistent with the overall sample, all age groups reported that the health condition/social issue they were most concerned was about violence, and cancer was perceived to be the most commonly funded health condition/social issue and the one which received the most attention (Table  4 ). Table 4 Health conditions and social issues ranked #1 – survey respondents by age group Age group Most concerned about Most commonly funded Most attention Need more funding & support Need more information about Only affect women/girls Disproportionately affect Differently affect Younger Violence ( n  = 177, 30.3%) Cancer ( n  = 281, 48.0%) Cancer ( n  = 256, 43.8%) Endometriosis ( n  = 466, 79.7%) Perinatal depression ( n  = 439, 75.0%) Homelessness ( n  = 426, 72.8%) Endometriosis ( n  = 83, 14.2%) Middle Violence ( n  = 263, 28.8%) Cancer ( n  = 502, 54.9%) Cancer ( n  = 442, 48.4%) Peri/menopause ( n  = 690, 75.5%) Depression ( n  = 602, 65.9%) Homelessness ( n  = 695, 76.0%) Peri/menopause ( n  = 144, 15.8%) Older Violence ( n  = 184, 27.6%) Cancer ( n  = 350, 52.6%) Cancer ( n  = 275, 41.3%) Ovarian cancer ( n  = 490, 73.6%) Alzheimer’s disease ( n  = 478, 71.8%) Homelessness ( n  = 533, 80.0%) Violence ( n  = 119, 17.9%) Total sample Violence ( n  = 628, 28.5%) Cancer ( n  = 1139, 51.7%) Cancer ( n  = 981, 44.5%) Endometriosis ( n  = 1540, 72.9%) Depression ( n  = 1397, 66.3%) Homelessness ( n  = 1670, 79.0%) Violence ( n  = 285, 12.9%) Health conditions and social issues ranked #1 – survey respondents by age group Violence ( n  = 177, 30.3%) Cancer ( n  = 281, 48.0%) Cancer ( n  = 256, 43.8%) Endometriosis ( n  = 466, 79.7%) Perinatal depression ( n  = 439, 75.0%) Homelessness ( n  = 426, 72.8%) Endometriosis ( n  = 83, 14.2%) Violence ( n  = 263, 28.8%) Cancer ( n  = 502, 54.9%) Cancer ( n  = 442, 48.4%) Peri/menopause ( n  = 690, 75.5%) Depression ( n  = 602, 65.9%) Homelessness ( n  = 695, 76.0%) Peri/menopause ( n  = 144, 15.8%) Violence ( n  = 184, 27.6%) Cancer ( n  = 350, 52.6%) Cancer ( n  = 275, 41.3%) Ovarian cancer ( n  = 490, 73.6%) Alzheimer’s disease ( n  = 478, 71.8%) Homelessness ( n  = 533, 80.0%) Violence ( n  = 119, 17.9%) Violence ( n  = 628, 28.5%) Cancer ( n  = 1139, 51.7%) Cancer ( n  = 981, 44.5%) Endometriosis ( n  = 1540, 72.9%) Depression ( n  = 1397, 66.3%) Homelessness ( n  = 1670, 79.0%) Violence ( n  = 285, 12.9%) However, the age groups differed in the conditions/issues they perceived to require more funding and support. Younger women tended to report that endometriosis and postnatal depression needed more funding and support whilst most women in the middle age group identified peri/menopause and depression, and those in the older age group perceived ovarian cancer and Alzheimer’s disease to be the most in need (Table  4 ). There were also differences between the age groups in their perceptions of the conditions/issues which women/girls needed more information about. Younger women tended to report that women/girls needed more information about endometriosis, middle age women thought peri/menopause and older women violence (Table  4 ). The survey respondents were categorised according to their geographic location: ‘live in a metropolitan area’ ( n  = 1,553. 70.5%); and ‘live in a regional/rural area’ ( n  = 650, 29.5%). Both groups were consistent with the rankings of the overall sample in terms of the health conditions/social issues they were most concerned about and needed more information about (i.e. violence), and thought was mostly commonly funded (i.e. cancer). However, respondents living in regional/rural areas ranked ovarian cancer as the condition affecting only women and girls which needed more funding and support; whereas respondents living in a metropolitan area and the overall sample identified endometriosis (Table  5 ). Table 5 Health conditions and social issues ranked #1 – survey respondents by geographical location Geographic location Most concerned about Most commonly funded Most attention Need more funding & support Need more information about Only affect women/girls Disproportionately affect Differently affect Live in a metro area ( n  = 1553, 70.5%) Violence ( n  = 440, 28.3%) Cancer ( n  = 839, 54.0%) Cancer ( n  = 699, 45.0%) Endometriosis ( n  = 1107, 71.3%) Depression ( n  = 1005, 64.7%) Homelessness ( n  = 1201, 77.3%) Violence ( n  = 201, 12.9%) Live in a regional/rural area ( n  = 650, 29.5%) Violence ( n  = 188, 28.9%) Cancer ( n  = 300, 46.2%) Cancer ( n  = 282, 43.4%) Ovarian cancer ( n  = 447, 68.8%) Depression ( n  = 392, 60.3%) Homelessness ( n  = 469, 72.2%) Violence ( n  = 84, 12.9%) Total sample ( n  = 2203) Violence ( n  = 628, 28.5%) Cancer ( n  = 1139, 51.7%) Cancer ( n  = 981, 44.5%) Endometriosis ( n  = 1540, 72.9%) Depression ( n  = 1397, 66.3%) Homelessness ( n  = 1670, 79.0%) Violence ( n  = 285, 12.9%) Health conditions and social issues ranked #1 – survey respondents by geographical location Violence ( n  = 440, 28.3%) Cancer ( n  = 839, 54.0%) Cancer ( n  = 699, 45.0%) Endometriosis ( n  = 1107, 71.3%) Depression ( n  = 1005, 64.7%) Homelessness ( n  = 1201, 77.3%) Violence ( n  = 201, 12.9%) Violence ( n  = 188, 28.9%) Cancer ( n  = 300, 46.2%) Cancer ( n  = 282, 43.4%) Ovarian cancer ( n  = 447, 68.8%) Depression ( n  = 392, 60.3%) Homelessness ( n  = 469, 72.2%) Violence ( n  = 84, 12.9%) Violence ( n  = 628, 28.5%) Cancer ( n  = 1139, 51.7%) Cancer ( n  = 981, 44.5%) Endometriosis ( n  = 1540, 72.9%) Depression ( n  = 1397, 66.3%) Homelessness ( n  = 1670, 79.0%) Violence ( n  = 285, 12.9%) Almost a third of the respondents ( n  = 635, 28.8%) provided a free-text comment. Overwhelmingly, the respondents stated that all health conditions and social issues experienced by women and girls needed more support and awareness. I’m tired of woman’s health and wellbeing being overlooked. It’s incredible the amount of women I speak to , look to , and relate to who are dealing with at least one health concern they can’t seem to identify , manage , or receive support for because we simply don’t know enough and are being told that it’s “probably nothing” , or that it will eventually resolve itself. I don’t know a single woman in my life who doesn’t have a least one “silent” health issue , whereby they lack the support and knowledge (from both themselves and professionals) to be able to manage their issue. Why has it taken us all so long to acknowledge that woman’s health DOES matter? (Survey respondent) I’m tired of woman’s health and wellbeing being overlooked. It’s incredible the amount of women I speak to , look to , and relate to who are dealing with at least one health concern they can’t seem to identify , manage , or receive support for because we simply don’t know enough and are being told that it’s “probably nothing” , or that it will eventually resolve itself. I don’t know a single woman in my life who doesn’t have a least one “silent” health issue , whereby they lack the support and knowledge (from both themselves and professionals) to be able to manage their issue. Why has it taken us all so long to acknowledge that woman’s health DOES matter? (Survey respondent) The respondents also discussed a range of conditions and issues in their free-text comments including medical misogyny, violence and healthcare access (Table  6 ), and identified a need for greater awareness and support of women’s and girls’ health including from healthcare providers. Table 6 Survey respondents’ free-text comments by health condition/social issue Health condition/social issue Comments about … Number of comments Medical misogyny • healthcare providers’ dismissal of or lack of knowledge and experience treating women’s health conditions; lack of research about conditions which affect women 72 Violence • intimate partner and domestic violence, coercive control, financial abuse, bullying, sexual assault and harassment, self-harm, impact on women’s health 65 Health care costs/access/equity • especially for population groups such as women living in regional and rural communities, First Nations women, migrant women, women of low socio-economic status, women with a disability(s) 47 Mental health • depression, anxiety, stress, body image, eating disorders, prevalence across all life stages, perinatal mental health, lack of (affordable) services 33 Health information/awareness • need for (further) information and awareness about women’s and girls’ health 29 Perimenopause/menopause • lack of awareness and information (women and healthcare providers) 26 Poverty, loneliness and homelessness • especially for older women and mothers 26 Chronic health conditions • lack of funding, invisible conditions (e.g. autoimmune conditions, chronic fatigue, cardiovascular disease) 23 Reproductive health • fertility, pregnancy, postnatal health (including breastfeeding, prolapse), stillbirth, childlessness, abortion, support 20 Menstruation • period pain, period poverty 19 Endometriosis and PCOS • lack of awareness and research, symptoms/pain, treatment 19 Ageing • invisibility of older women, common health issues, voluntary assisted dying 15 Caring responsibilities • the ‘mental load’, impact of caring responsibilities on women’s health 12 Neurodiversity • lack of funding, difficulties getting diagnosed and accessing treatment 12 Gender • gender gaps in pay, research participation 11 Chronic pain • ‘invisible’ condition 11 Cancer • especially in young women, screening 10 Nutrition and physical activity • lack of education (especially school-based) 9 Sexual health • affordability of contraception (expensive), education (especially school-based), safe sexual relationships 7 Grief • lack of awareness and health impacts 7 Weight stigma/obesity • especially in healthcare settings 5 Dental health • cost of care (expensive) 5 Fibromyalgia • lack of awareness 4 Disability • care for people with a disability, NDIS Drug and alcohol abuse • education, regional areas 4 Survey respondents’ free-text comments by health condition/social issue 50% of the population go through menopause (and peri) but so many of our doctors/GPs only get the very bare minimum of training about menopause and the many & varied symptoms & effects the lack of hormones has on our bodies. (Survey respondent) 50% of the population go through menopause (and peri) but so many of our doctors/GPs only get the very bare minimum of training about menopause and the many & varied symptoms & effects the lack of hormones has on our bodies. (Survey respondent) Chronic health conditions were identified by many respondents as overlooked or ‘silent issues’ and particular conditions such as autoimmune disorders and fibromyalgia were perceived to need further attention and support. Autoimmune diseases are silent & don’t receive much media attention even though they cause so much pain & stress to those who suffer from them. (Survey respondent) Autoimmune diseases are silent & don’t receive much media attention even though they cause so much pain & stress to those who suffer from them. (Survey respondent) The respondents highlighted barriers to accessible, affordable, gender-responsive healthcare and information in their free-text comments especially for women and girls from certain population groups such as those living in regional and rural areas or First Nations women and girls. Regional health care is lacking overall but particularly when it comes to services for women and girls. (Survey respondent) Regional health care is lacking overall but particularly when it comes to services for women and girls. (Survey respondent) The importance of ensuring health information was easily accessible and evidence-based was emphasised by the respondents. It would be useful if the funding and support went towards making information more easily accessible. When I was experiencing these conditions , I found that going to my doctor wasn’t enough to answer my questions and concerns , but often information online was contradictory or hard to find. (Survey respondent) It would be useful if the funding and support went towards making information more easily accessible. When I was experiencing these conditions , I found that going to my doctor wasn’t enough to answer my questions and concerns , but often information online was contradictory or hard to find. (Survey respondent) The respondents also commented that more research is needed about women’s health, and such research should include (more) female participants. More research needs to be done so women can thrive not just survive. (Survey respondent) More research needs to be done so women can thrive not just survive. (Survey respondent) Research on health conditions need to include women as participants as their experience of the same condition is different to men. (Survey respondent) Research on health conditions need to include women as participants as their experience of the same condition is different to men. (Survey respondent) Twenty-three interviews were conducted. The participants included fifteen women’s health/social care organisational leaders, five women’s health/social care providers, five women’s health/social care academics (i.e. researchers employed at a university) and two policy makers (note: some participants held more than one role such as an academic and healthcare provider). The interviews had a mean duration of 27.4 min (range: 10–49). Analysis of the interview transcripts identified three main categories: (1) Health conditions and social issues which need more support; (2) Barriers to healthcare; and (3) Participants’ suggestions about what ‘better’ might look like. The participants perceived that women’s and girls’ health is not just sexual and reproductive health (and breast cancer). One participant (organisational leader) stated that we ‘ need to go beyond the bikini line’ . Several conditions and issues were identified by the participants as needing a better response or further support. These included conditions which only affect women and girls such as endometriosis, peri/menopause and abortion. I think what’s not given a lot of attention , and we’re talking about it more , but it’s not really being given the right sort of attention is certainly perimenopause and menopause and post menopause. (Interview participant #13 – organisational leader) I think what’s not given a lot of attention , and we’re talking about it more , but it’s not really being given the right sort of attention is certainly perimenopause and menopause and post menopause. (Interview participant #13 – organisational leader) Participants also discussed the importance of and need for (further) acknowledgement of and support for conditions and issues which disproportionately affect women and girls in particular body image, eating disorders, body literacy (especially for young women and girls); mental health conditions; and fibromyalgia. I think if you talk to most women about women’s health , they’ll go , ‘oh yeah , it’s menopause and it’s endometriosis and it’s having babies and it’s breast cancer’ … And they might rattle off a couple of other different things , but actually it’s women have more back pain. 70% of migraine sufferers are women , about 80% of fibromyalgia sufferers are women. Autoimmune diseases affect more women. So I think we’ve actually got to really get past this very narrow understanding of women’s health as sexual and reproductive health. (Interview participant #15 – organisational leader) I think if you talk to most women about women’s health , they’ll go , ‘oh yeah , it’s menopause and it’s endometriosis and it’s having babies and it’s breast cancer’ … And they might rattle off a couple of other different things , but actually it’s women have more back pain. 70% of migraine sufferers are women , about 80% of fibromyalgia sufferers are women. Autoimmune diseases affect more women. So I think we’ve actually got to really get past this very narrow understanding of women’s health as sexual and reproductive health. (Interview participant #15 – organisational leader) Health conditions and social issues which affect women and girls differently to men and boys were also discussed by the participants including violence against women, cardiovascular disease and dementia. Domestic violence is an interesting one , because it’s , obviously , you know , it’s a priority area. There’s a huge , there’s a lot of investment in it , it has huge impacts , but I would almost say there’s not enough investment at the same time , because the stats aren’t changing. (Interview participant #3 – organisational leader) Domestic violence is an interesting one , because it’s , obviously , you know , it’s a priority area. There’s a huge , there’s a lot of investment in it , it has huge impacts , but I would almost say there’s not enough investment at the same time , because the stats aren’t changing. (Interview participant #3 – organisational leader) The participants identified several ‘silent’ conditions and issues which needed support including head injuries experienced by women as a result of domestic violence, mental health support and cancer screening for women and girls with different sexual orientations, and bowel cancer in young women. A specific health impact of domestic violence is head injuries , repeated head injuries. … Now , if a football player gets a head injury , life stops until they’re well , and they don’t go home to nothing. They have repeated visits to neurologists. They have all this stuff. … We have a brain bank of rugby players , and no one is looking at the head injury impact [of women who have experienced domestic violence]. … Because it is repetitive , it is invisible , because no one outside the community knows that. … domestic violence you’ve got all the other injuries that happen , but I think head injuries are having the most impact. … we’re not looking at this long term injury. … Yeah I mean a rugby player at 45 with a brain disorder is a tragedy , but a woman at 30 with a brain injury is invisible. (Interview participant #4 – healthcare provider and organisational leader) A specific health impact of domestic violence is head injuries , repeated head injuries. … Now , if a football player gets a head injury , life stops until they’re well , and they don’t go home to nothing. They have repeated visits to neurologists. They have all this stuff. … We have a brain bank of rugby players , and no one is looking at the head injury impact [of women who have experienced domestic violence]. … Because it is repetitive , it is invisible , because no one outside the community knows that. … domestic violence you’ve got all the other injuries that happen , but I think head injuries are having the most impact. … we’re not looking at this long term injury. … Yeah I mean a rugby player at 45 with a brain disorder is a tragedy , but a woman at 30 with a brain injury is invisible. (Interview participant #4 – healthcare provider and organisational leader) The participants discussed barriers they believed women and girls often experienced accessing high quality, timely, acceptable, affordable, gender-responsive health care. Women and girls from certain population groups such as First Nations women and girls, those who live in regional and rural areas, migrant or refugee women, younger women and teenage girls, and women with different sexual orientations were identified as being more likely to experience barriers to healthcare. I really do think that young girls and young women who have mental health issues or intellectual disabilities , physical disabilities. I think for those women and girls , accessing health can be very , very daunting. Women who come from a non-English speaking background , Aboriginal Torres Strait Islander women , I think , you know , there’s sort of those specific groups that we always tend to recognise that , you know , healthcare is not equitable , and their ability to navigate the healthcare system is significantly reduced compared with a white , middle aged or a white privileged woman who can sort of work out more easily what services are available and what she can access. And is able to advocate for herself. (Interview participant #10 – academic and healthcare provider) I really do think that young girls and young women who have mental health issues or intellectual disabilities , physical disabilities. I think for those women and girls , accessing health can be very , very daunting. Women who come from a non-English speaking background , Aboriginal Torres Strait Islander women , I think , you know , there’s sort of those specific groups that we always tend to recognise that , you know , healthcare is not equitable , and their ability to navigate the healthcare system is significantly reduced compared with a white , middle aged or a white privileged woman who can sort of work out more easily what services are available and what she can access. And is able to advocate for herself. (Interview participant #10 – academic and healthcare provider) The participants highlighted that ‘ women deserve better’ and offered suggestions at individual (i.e. women and girls) and structural/system (i.e. healthcare providers, services and policy) levels and for research and prevention. Increasing women’s/girls’, healthcare providers’ and community awareness of and education about the conditions and issues experienced by women and girls was perceived to be important by the participants in addressing inequities and ‘silent’ issues. I think it’s about knowledge of all the different health problems , often you don’t know what you don’t know. (Interview participant #1- organisational leader) I think it’s about knowledge of all the different health problems , often you don’t know what you don’t know. (Interview participant #1- organisational leader) Similar to the survey respondents, the interview participants also emphasised the importance of ensuring equity so that all women and girls are able to access high quality, timely, affordable, and gender-responsive health and social care. Acknowledgement of the intersectionality (i.e. different aspects) of women’s and girls’ lives and taking a life course approach (i.e. acknowledging the (cumulative) impact and influence of different stages of a woman’s life) was also considered by the participants to be important in ensuring women and girls are able to live healthy lives and access care. Health equality across the board , and yes , you know , lowering barriers to access for vulnerable populations. (Interview participant #3 – organisational leader) Racism and sexism , and the way those intersect in terms of being able to get care , like , regardless of what kind of issue you’re facing that will basically always affect the way you’re able to respond … or whether you’re treated with the kind of respect you think you deserve. (Interview participant #8 – organisational leader) Health equality across the board , and yes , you know , lowering barriers to access for vulnerable populations. (Interview participant #3 – organisational leader) Racism and sexism , and the way those intersect in terms of being able to get care , like , regardless of what kind of issue you’re facing that will basically always affect the way you’re able to respond … or whether you’re treated with the kind of respect you think you deserve. (Interview participant #8 – organisational leader) The inclusion of women and girls particularly those with lived experience of a particular condition or issue in research and the design and implementation of any response, intervention or program was also discussed by the participants as important in furthering understanding and ensuring the conditions/issues women consider important are investigated and addressed. I think , you know , really empowering women , women’s voices need to be heard in this space to really get , you know , an equitable health system. (Interview participant #16 - organisational leader) In order to change [healthcare] guidelines and change the understanding of health provision , we need evidence and evidence base and , and in order to have an evidence base , we need to actually include women in trials. (Interview participant #12 – healthcare provider) I think , you know , really empowering women , women’s voices need to be heard in this space to really get , you know , an equitable health system. (Interview participant #16 - organisational leader) In order to change [healthcare] guidelines and change the understanding of health provision , we need evidence and evidence base and , and in order to have an evidence base , we need to actually include women in trials. (Interview participant #12 – healthcare provider) Approximately one in five ( n  = 716,733, 19.8%) of the identified peer-reviewed research articles published about health conditions and social issues affecting women and girls was focused on their sexual and reproductive health (Table  7 ). Table 7 Desktop review – published literature about health conditions and social issues affecting women and girls (2020–2024) Health condition/social issue Search results ( n ) Medline PsycInfo MJA ANZJPH HPJA ASW Total % (Total) Sexual and reproductive health  Pregnancy 195,890 15,142 266 64 92 56 211,510  Prenatal/antenatal care 75,332 7,547 128 31 33 15 83,086  Postnatal health and support 37,234 7,737 41 10 20 140 45,182  Menstruation (e.g. heavy, irregular, painful periods, PMT) 10,150 1,236 28 7 8 43 11,472  Menopause/perimenopause 14,069 1,129 49 5 13 21 15,286  Endometriosis 7,289 193 12 1 1 1 7,497  PCOS 6,524 189 14 1 4 1 6,733  STIs - including HPV & HIV 48,078 5,878 12 1 1 0 53,970  Contraception (e.g. access, awareness, method) 10,684 1,778 59 10 10 5 12,546  Breastfeeding 12,474 1,478 42 4 32 2 14,032  Abortion 12,576 1,039 58 15 8 4 13,700  Stillbirth 4,928 233 37 9 4 2 5,213  Miscarriage 11,445 318 32 8 4 5 11,812  Pre-eclampsia 12,339 243 26 2 2 0 12,612  Infertility/fertility 27,277 1,799 68 15 17 7 29,183  IVF 6,686 142 13 0 1 1 6,843  Egg freezing 138 37 0 0 2 0 177  Assisted reproductive treatment 3,677 168 1 0 1 0 3,847  Uterine fibroids 3,285 27 0 0 0 0 3,312  Female genitals 35,899 1,837 291 13 9 42 38,091  Adenomyosis 1,168 6 0 0 0 0 1,174  Urinary tract infections (UTIs) 5,538 84 7 2 0 0 5,631  Hysterectomy 8,137 109 11 2 2 0 8,261  Maternal health 91,086 17,267 373 107 185 94 10,9112  Vaginal secretions 994 17 2 0 0 0 1,013  Ovarian cyst 1,091 12 0 0 0 0 1,103  Pelvic organ prolapse 3,055 48 0 0 0 0 3,103  Yeast infections/BV 1,213 17 2 0 0 0 1,232   TOTAL: Sexual and reproductive health 648 , 256 65 , 710 1 , 572 307 449 439 716 , 733 19.8% Chronic health conditions  Diabetes (including gestational diabetes) 81,503 3,073 237 70 132 12 85,027  Asthma 12,020 500 60 13 23 2 12,618  Cardiovascular/Heart disease 93,248 3,559 263 67 124 6 97,267  Stroke 43,831 1,774 121 15 35 9 45,785  Chronic Kidney disease 24,047 302 66 11 10 2 24,438  Arthritis (including rheumatoid) 17,352 825 50 10 17 1 18,255  Hypertension/high blood pressure 52,743 1,792 144 35 1 8 54,723  Epilepsy 12,526 1,679 35 1 6 2 14,249  Migraine/headaches 12,445 1,084 73 9 13 4 13,628  Hay fever/Allergies 13,580 223 57 0 19 3 13,882  Back problems/pain 7,033 485 19 3 10 1 7,551  Osteoporosis 10,812 186 20 2 10 0 11,030  Incontinence/pelvic floor 6,910 258 14 0 2 4 7,188  fibromyalgia 1,595 376 5 1 0 0 1,977  Lupus 7,658 108 12 0 0 0 7,778  Multiple sclerosis 8,272 622 12 0 0 1 8,907  Chronic pain/women’s pain 7,866 1934 15 3 2 3 9,823  Anaemia 32,377 600 52 8 2 1 33,040  Chronic obstructive pulmonary disease (COPD) 6,945 186 32 9 0 0 7,172  Irritable bowel syndrome (IBS) 1,563 122 4 0 0 0 1,689  Dementia/Alzheimer’s 24,948 6,896 72 8 26 8 31,958  Cystic fibrosis 2,701 51 19 0 3 0 2,774  Muscular dystrophy 1,071 46 1 0 0 0 1,118  Motor neurone disease 63 3 1 0 0 0 67  Obesity 61,427 5,374 116 64 3 9 66,993  Autoimmune diseases 16,799 445 37 4 3 0 17,288   TOTAL: Chronic health conditions 561 , 335 32 , 503 1 , 537 333 441 76 596 , 225 16.5% Mental health conditions  Depression (including pregnancy & postnatal) 71,261 37,935 137 55 125 40 109,553  Anxiety (including pregnancy & postnatal) 48,551 27,032 528 160 209 107 76,587  Eating disorders (e.g. anorexia nervosa, bulimia) 7,192 4,883 19 3 12 3 12,112  PTSD 6,653 5,239 21 9 8 8 11,938  Bipolar disorder 4,092 2,068 18 7 2 2 6,189  Stress 78,202 27,019 235 133 323 202 106,114  Suicide 12,479 6,968 99 39 28 25 19,638  ADHD 5,349 2,763 406 223 3 178 8,922  Neurodiversity (e.g. autism) 10,999 4,657 15 0 0 8 15,679   TOTAL: Mental health conditions 244 , 778 118 , 564 1 , 478 629 710 573 366 , 732 10.2% Cancer  Breast 69,839 2,440 79 16 20 6 72,400  Cervical 15,853 639 30 6 16 0 16,544  Skin 10,584 161 58 17 16 8 10,844  Vaginal/vulva 734 12 1 0 0 0 747  Ovarian 15,767 174 13 1 2 0 15,957  Uterine/Womb 6,718 58 8 2 3 0 6,789  Lung 18,837 224 23 5 1 2 19,092  Bowel/colorectal 14,348 300 24 11 8 0 14,691  Brain 6,885 78 14 0 0 1 6,978  Pancreatic 7,424 28 13 3 0 0 7,468  Lymphoma 15,573 97 19 3 0 1 15,693   TOTAL: Cancer 182 , 562 4 , 211 282 64 66 18 187 , 203 5.2% Other health conditions  Ageing 6,738 1,348 750 260 447 175 9,718  Brain injury 8,737 1,427 8 2 0 0 10,174  Hip fracture 3,741 95 0 0 0 0 3,836  Hepatitis 14,179 359 50 12 8 0 14,608  Tuberculosis 9,667 115 50 4 1 0 9,837   TOTAL: Other health conditions 43 , 062 3 , 344 858 278 456 175 48 , 173 1.3% Health behaviours  Smoking/vaping 41,129 5,834 182 93 128 8 47,374  Alcohol 35,037 11,297 158 109 141 75 46,817  Substance use 334,633 26,730 276 82 97 165 361,983  Physical activity 58,514 9,848 1,038 289 6 253 69,948  Nutrition/diet/vegetarianism 96,088 6,920 161 77 5 185 103,436  Oral health 7,663 401 19 23 38 18 8,162   TOTAL: Health behaviours 573 , 064 61 , 030 1 , 834 673 415 704 637 , 720 17.7% Other health matters  COVID-19 76,946 11,539 292 73 139 54 89,043  Antibiotics 23,385 219 87 9 4 140 23,844  Vaccination 33,016 1,336 183 53 52 5 34,645  Gut health 3,564 146 4 0 0 0 3,714  Health care 127,484 20,809 1,037 293 248 71 149,942  Health care access 1,368 894 22 6 20 0 2,310  Health disparities 8,165 3,161 0 0 0 0 11,326  Health technology 2,078 646 4 1 10 1 2,740  Indigenous health 327 46 112 75 96 68 724  Infectious diseases 14,065 503 28 291 10 0 14,897  Injury 81,524 5,630 406 145 200 164 88,069  Women’s health policy 7,381 917 104 56 56 7 8,521  Women’s bodies 7,425 1,926 964 224 389 207 11,135  Wellness 2,209 877 1,038 293 495 253 5,165  Sleeping difficulties/insomnia 32,007 8,212 94 28 88 48 40,477   TOTAL: Other health matters 420 , 944 56 , 861 4 , 375 1 , 547 1 , 807 1 , 018 486 , 552 13.5% Social issues  Disability - physical 1,129 293 2 0 5 3 1,432  Disability - intellectual 19,599 6,324 10 4 7 14 25,958  Family violence 2,791 2,878 35 22 25 100 5,851  Intimate partner violence 5,893 4,902 11 10 12 12 10,840  Sexual violence (e.g. rape, sexual assault) 4,078 3,802 19 14 13 27 7,953  Child abuse/neglect/trauma 5,520 4,624 25 4 3 31 10,207  Harassment/discrimination 34,389 10,826 109 57 105 125 45,611  Racism 3,059 2,263 65 41 47 53 5,528  Homelessness 2,329 1,029 26 25 28 51 3,488  Child marriage 493 297 0 0 0 2 792  Poverty 9,131 2,794 316 159 291 127 12,818  Socioeconomic status 19,449 6,603 21 73 79 19 26,244  Social connection/support 18,985 11,751 22 25 102 38 30,923  Dating/relationships 170,621 52,088 397 223 392 219 223,940  Employment 16,815 6,450 112 111 201 194 23,883  Parental/maternity leave 550 236 16 2 3 1 808  Caring responsibilities 1,211 1,155 8 5 21 17 2,417  Elder 31,869 3,844 39 47 70 143 36,012  Food insecurity 10,390 985 20 11 26 4 11,436  Gender & sexual identity 7,613 5,071 10 3 17 11 12,725  LGBTQIA+ 10,342 6,259 96 43 112 79 16,931  Immigrant/refugee 9,559 4,740 59 38 79 43 14,518  Women’s sport 18,101 4,039 52 48 155 18 22,413  Pornography 451 571 1 0 3 2 1,028  Body image/self-esteem 7,901 6,535 20 11 80 19 14,566  Gender pay gap 82 85 1 1 0 2 171  Women’s human rights 1,590 838 5 3 4 5 2,445  Financial literacy 81 112 0 0 4 1 198  CALD 678 629 35 35 87 48 1,512   TOTAL: Social issues 414 , 699 152 , 023 1 , 532 1 , 015 1 , 971 1 , 408 572 , 648 15.9% Total 3,088,700 494,246 13,468 4,846 6,315 4,411 3,611,986 Desktop review – published literature about health conditions and social issues affecting women and girls (2020–2024) Of the over AUD3.5 billion of research funding allocated in 2023–2024, only 3.3% supported women’s health related research (Table  8 ). Of this, more than half (56.1%) was allocated to research about health conditions which only affect women (i.e. reproductive health including pregnancy, gynaecological cancers) while those which affect women disproportionately or differently to men (i.e. chronic kidney disease, depression, violence) received the least funding (25.7% and 18.3% respectively) (Table  9 ). Table 8 Australian research funding 2023–2024 Funding body Total Funding Women’s health funding Proportion allocated to women’s health NHMRC AUD 1,559,608,709 AUD 78,403,369 5.0% MRFF AUD 1,122,439,618 AUD 33,691,641 3.0% ARC AUD 821,092,628 AUD 4,525,305 0.6% Total AUD 3,503,140,955 AUD 116,620,316 3.3% The ARC does not specifically fund health and medical research, only when it is related to economic, social, environmental and cultural benefit Australian research funding 2023–2024 The ARC does not specifically fund health and medical research, only when it is related to economic, social, environmental and cultural benefit Table 9 Australian research funding 2023–2024 by condition/issue Affects women Health condition/social issue Proportion of total funding Funding Disproportionately Stillbirth 1.5% AUD 1,779,242 Disproportionately Multiple sclerosis 2.4% AUD 2,769,655 Disproportionately Incontinence/pelvic floor 2.4% AUD 2,767,312 Disproportionately Breast 14.1% AUD 16,439,400 Disproportionately Injuries 3.5% AUD 4,089,921 Disproportionately Social connection/support 0.4% AUD 483,379 Disproportionately Depression (including pregnancy and postnatal) 1.4% AUD 1,594,207 Total: Disproportionately 25.7% AUD 29,923,116 Only Pregnancy 24.8% AUD 28,977,937 Only Endometriosis 2.0% AUD 2,312,749 Only PCOS 3.7% AUD 4,280,851 Only Breastfeeding 4.1% AUD 4,757,993 Only Pre-eclampsia 4.1% AUD 4,776,224 Only Cervical 3.8% AUD 4,472,722 Only Ovarian 4.2% AUD 4,910,498 Only Uterine/womb 3.3% AUD 3,820,905 Only Gynaecological cancers 6.1% AUD 7,099,619 Total: Only 56.1% AUD 65,409,498 Differently Infertility/fertility 1.9% AUD 2,169,655 Differently Diabetes (including gestational diabetes) 2.5% AUD 2,938,386 Differently Asthma 1.7% AUD 1,994,723 Differently Cardiovascular/Heart disease (including stroke) 2.3% AUD 2,627,836 Differently Chronic Kidney disease 0.1% AUD 140,663 Differently Smoking/vaping 1.8% AUD 2,146,367 Differently Physical activity 4.4% AUD 5,103,994 Differently Obesity 0.1% AUD 101,729 Differently Violence (including sexual violence and intimate partner violence) 3.5% AUD 4,064,349 Total: Differently 18.3% AUD 21,287,702 Total AUD 116,620,316 Australian research funding 2023–2024 by condition/issue Of the 20,000 media items published in November 2024, over a third ( n  = 7,389, 36.9%) were about women’s health and wellbeing. Of these, most were about abortion, violence, breast cancer, endometriosis and alcohol. Of the conditions that only affect women, endometriosis received the most mentions; abortion had the most mentions for conditions which affect women disproportionately; and violence for those which affect women differently (Table  10 ). Several chronic health conditions and cancers affecting women including polycystic ovary syndrome (PCOS), fibromyalgia and vaginal cancer received no or few (< 5) media mentions. A similar proportion of media items related to girls’ health and wellbeing ( n  = 6,448, 32.2%). Most were about violence ( n  = 1,936, 30.0%), mental health ( n  = 1,214, 18.8%), body image/appearance ( n  = 513, 8.0%) and chronic pain ( n  = 227, 3.5%). Most articles about women’s and girls’ health published in The Conversation ( n  = 136) focused on their reproductive health ( n  = 102; 75.0%). Table 10 Top 5 media mentions – women’s health (Meltwater - November 2024; n  = 7389) Overall Affect women only Affect women disproportionately Affect women differently Abortion ( n  = 2296; 31.1%) Endometriosis ( n  = 348, 4.7%) Abortion ( n  = 2296; 31.1%) Violence/abuse ( n  = 1652; 13.5%) Violence/abuse ( n  = 1652; 13.5%) Pregnancy ( n  = 139, 1.4%) Breast cancer ( n  = 704; 9.5%) Alcohol ( n  = 273, 3.7%) Breast cancer ( n  = 704; 9.5%) Menopause ( n  = 119, 1.6%) Blood pressure ( n  = 126, 1.7%) Diabetes ( n  = 259, 3.5%) Endometriosis ( n  = 348, 4.7%) Cervical cancer ( n  = 82, 1.1%) Anxiety ( n  = 103, 1.4%) Ageing ( n  = 163, 2.2%) Alcohol ( n  = 273, 3.7%) Ovarian cancer ( n  = 8. 0.1%) Depression ( n  = 100, 1.4%) Heart disease ( n  = 98, 1.0%) Top 5 media mentions – women’s health (Meltwater - November 2024; n  = 7389) Abortion ( n  = 2296; 31.1%) Endometriosis ( n  = 348, 4.7%) Abortion ( n  = 2296; 31.1%) Violence/abuse ( n  = 1652; 13.5%) Violence/abuse ( n  = 1652; 13.5%) Pregnancy ( n  = 139, 1.4%) Breast cancer ( n  = 704; 9.5%) Alcohol ( n  = 273, 3.7%) Breast cancer ( n  = 704; 9.5%) Menopause ( n  = 119, 1.6%) Blood pressure ( n  = 126, 1.7%) Diabetes ( n  = 259, 3.5%) Endometriosis ( n  = 348, 4.7%) Cervical cancer ( n  = 82, 1.1%) Anxiety ( n  = 103, 1.4%) Ageing ( n  = 163, 2.2%) Alcohol ( n  = 273, 3.7%) Ovarian cancer ( n  = 8. 0.1%) Depression ( n  = 100, 1.4%) Heart disease ( n  = 98, 1.0%) Comparison of the desktop review, survey and interview data identified consistent findings about the existing focus on women’s reproductive health and the lack of awareness and support for many health conditions and social issues which only, disproportionately or differently affect women and girls. Several conditions and issues were highlighted as requiring further awareness and support including those which affect women and girls only such as endometriosis, peri/menopause and abortion; and those which affect them differently and/or disproportionately to men and boys such as violence, mental health problems and chronic health conditions (Table  11 ). Table 11 Health conditions and social issues which need more funding and support Health condition/social issue Survey Interviews Desktop review Prevalence (Australian women) Affect women/girls only Endometriosis √ √ 14% a Menstruation √ Peri/menopause √ √ Abortion √ √ 33% b Affect women/girls differently &/or disproportionately Violence (especially health effects of intimate partner violence) √ √ 27% c Mental health (including depression , eating disorders) √ √ 45% d Fibromyalgia √ √ √ 5% e Cardiovascular disease √ √ √ 4.8% f Body image/literacy √ √ Medical misogyny √ √ Health care costs/access √ √ Source: a AIHW;,  b RWH,  c AIHW,  d AIHW,  e Better Health Channel,  f AIHW Health conditions and social issues which need more funding and support Source: a AIHW;,  b RWH,  c AIHW,  d AIHW,  e Better Health Channel,  f AIHW

An exploratory mixed-methods study using a triangulation approach [ 26 ]: national survey of women and girls; interviews with subject matter experts; and desktop review of Australian peer-reviewed research literature, grant funding and media content. We report the study according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting observational studies [ 27 ]. Women and girls aged 16 years and over living in Australia who could write and speak English or one of four community languages (Arabic, Chinese, Punjabi and Vietnamese) were recruited via email and social media (Supplementary material) from various sources including organisations affiliated with the research team. A sample size of approximately 2,400 was determined to ensure equitable representation of women and girls, and based on a population of approximately 10,632,840 women and girls (16 years and older) in Australia [ 28 ], 95% confidence interval and 2% margin of error. Female subject matter experts including women’s health and social care practitioners, organisational leaders, policy makers and researchers were identified and recruited from various sources including publicly available organisational websites and organisations affiliated with the research team including health services, universities, government departments and non-government organisations located in Australia. A sample size of 20–25 experts was considered to provide sufficient information power for descriptions of different perspectives about the health conditions and social issues currently affecting women and girls in Australia and contribute new knowledge [ 29 ]. People who self-identified as a woman or girl aged ≥ 16 years living in Australia were eligible to participate in the study and invited to complete a brief study-specific, anonymous, self‐administered online survey (hosted on Qualtrics [ 30 ]). The survey (Supporting information) was informed by the existing literature, study objectives and the researchers who have extensive experience designing women’s health surveys. The survey assessed respondents’ sociodemographic and health characteristics; and perceptions of health conditions and social issues currently affecting women and girls in Australia. The respondents were asked to identify and rank the top five health conditions/social issues from a list in the survey they were most concerned about, and perceived to be the most commonly funded, received the most attention, needed more funding and support, and women/girls needed more information about. The list of health conditions/social issues was based on conditions and issues identified in other Australian health surveys such as the Australian Longitudinal Study on Women’s Health [ 31 ], the Victorian Women’s Health Survey [ 32 ] and the Australian Bureau of Statistics’ National Health Survey [ 33 ], and Australian health condition prevalence data [ 7 , 34 ]. Space was included at the end of the survey for respondents to provide free-text comments. The survey was conducted between February – March 2025. Experts were identified by the research team and invited by email to participate in an interview. An interview guide (Supporting information) was used to prompt and initiate discussion about participants’ perceptions of the health conditions and social issues currently affecting women and girls in Australia and of these, which required (further) support. Interviews were held online (Zoom/Teams) at a mutually convenient time, recorded and transcribed verbatim, and conducted in February – March 2025. Contemporary information about health conditions and social issues affecting women and girls in Australia was reviewed: Peer-reviewed research literature published in the last five years (2020–2024) were sourced from academic databases (i.e. Ovid MEDLINE, APA PsycInfo) and Australian journals (i.e. Medical Journal of Australia (MJA), Australian and New Zealand Journal of Public Health (ANZJPH), Health Promotion Journal of Australia (HPJA) and Australian Social Work (ASW)). The search terms are outlined in the Supplementary Material. Appraisal of the allocation of research funding in 2023–2024 by key Australian funding agencies (e.g., National Health Medical Research Council (NHMRC), Australian Research Council (ARC), Medical Research Future Fund (MRFF)); and. Examination of media items focused on women and girls’ health issues from Meltwater’s media monitoring platform (the first 20,000 Australian print, radio, TV and online news/media items published in November 2024) and The Conversation (Australian articles published between 2022–2024) using the search terms ‘woman’/’women’/’girl’ and ‘health’. The title, key phrases, opening text and ‘hit sentence’ of each identified media item were then searched for health conditions and social issues which affect women/girls only, and disproportionately and differently to men/boys. Peer-reviewed research literature published in the last five years (2020–2024) were sourced from academic databases (i.e. Ovid MEDLINE, APA PsycInfo) and Australian journals (i.e. Medical Journal of Australia (MJA), Australian and New Zealand Journal of Public Health (ANZJPH), Health Promotion Journal of Australia (HPJA) and Australian Social Work (ASW)). The search terms are outlined in the Supplementary Material. Appraisal of the allocation of research funding in 2023–2024 by key Australian funding agencies (e.g., National Health Medical Research Council (NHMRC), Australian Research Council (ARC), Medical Research Future Fund (MRFF)); and. Examination of media items focused on women and girls’ health issues from Meltwater’s media monitoring platform (the first 20,000 Australian print, radio, TV and online news/media items published in November 2024) and The Conversation (Australian articles published between 2022–2024) using the search terms ‘woman’/’women’/’girl’ and ‘health’. The title, key phrases, opening text and ‘hit sentence’ of each identified media item were then searched for health conditions and social issues which affect women/girls only, and disproportionately and differently to men/boys. The qualitative (interviews; desktop review) and quantitative (survey) data were analysed separately. Using a triangulation approach [ 26 , 35 ], the data were then integrated to address the study’s objectives and overall conclusions drawn. Descriptive statistics were used to summarise and describe the survey data. Quantitative data analysis was conducted using IBM SPSS Statistics. The health conditions/social issues the survey respondents were most concerned about, and perceived to be the most commonly funded, received the most attention, needed more funding and support, and women/girls needed more information about were also examined in terms of the respondents’ sociodemographic characteristics, namely age and geographic location. Age was categorised into three groups: ‘younger’ (16–39 years); ‘middle’ (40–59 years); and ‘older’ (≥ 60 years). Geographic location was categorised into two groups based on respondents’ residential postcode: ‘live in a metropolitan area’ and ‘live in a regional/rural area’. Content analysis [ 36 ] was used to analyse the survey free-text comments, interview transcripts and desktop review findings. Both inductive and deductive content analysis were used. The survey free-text comments and interview transcripts were coded based on pre-defined content categories (e.g. the topics outlined in the interview guide) as well as categories which emerged from the data, and the frequency of particular health conditions/social issues were identified. For the desktop review, health conditions and social issues were coded against a list of prevalent conditions/issues and those investigated in other Australian studies of women’s health (e.g. the Australian Longitudinal Study on Women’s Health [ 37 ]). Other conditions/issues were added to the list as they were identified during the analysis process and how often each particular condition/issue appeared within a data set (e.g. research funding, published literature, media) was calculated. Members of the research team conducted the analysis and interpretations discussed until consensus was reached. Participant quotes have been included to highlight the findings. The research was performed in accordance with the Declaration of Helsinki. The project was approved by the Monash University Human Research Ethics Committee (Project ID: 45483; 19 December 2024). Participation in the study was voluntary. Completion of the anonymous survey was taken as implied consent to participate in this component of the study which was approved by the ethics committee. Verbal recorded consent was taken as informed voluntary consent to participate in the interview component of the study.

This study investigated the health conditions and social issues affecting women and girls in Australia which are not well-understood, discussed or funded. The use of a triangulation approach including different data collection methods and types enabled a more comprehensive investigation than has previously been conducted, and provided original and consistent insights about the key and broad range of conditions and issues affecting women and girls. The findings suggest the existing focus on women’s reproductive health has resulted in a lack of awareness and support for many conditions and issues which only, disproportionately or differently affect women and girls. The ‘silence’ around many of these conditions and issues has resulted in discrepancies and adverse consequences for women’s and girls’ health and social care, access, outcomes, and research participation. The current paucity of research, grant funding and public discourse about many health conditions and social issues affecting women and girls was highlighted in this study. Similar to the perceptions of the participants, the desktop review revealed that the vast majority of published research literature, grant funding and media has focused on women’s reproductive health. Conditions that affect women and girls disproportionately to or differently than men and boys have received little attention. Others have also identified that articles published in health and medical journals are mostly focused on women’s reproductive health [ 39 ]. As this study identified, only a small proportion of research funding in Australia is allocated to women’s health and wellbeing. Analysis of funding data from other high-income countries such as the United States, Canada and the United Kingdom also indicates a gender disparity with similar low levels of funding for women’s health (11%; 8%; 7% respectively) and more for health conditions that primarily affect men [ 17 , 40 – 42 ] even when those conditions have a relatively low burden of disease [ 43 ]. There are also gender inequities in research participation by type of health condition [ 44 ] with women often underrepresented in studies about certain conditions such as cardiology and nephrology [ 16 ]; and rarely included as participants in proportions which are equivalent to the prevalence or burden of disease [ 39 , 44 , 45 ]. The existing focus on women’s reproductive health and the limited research and funding of conditions and issues that disproportionately or differently affect women and girls may reflect traditional societal and institutional (including health systems, healthcare provider education and research funders) gender norms and assumptions which typically perceive women’s health to be synonymous with reproductive health [ 25 , 39 , 46 , 47 ]. The lack of acknowledgement and understanding of the broad spectrum of health conditions and social issues affecting women throughout their life underrepresents women’s health burden [ 1 , 17 ] and their unique health needs [ 48 ]. It also has an adverse impact on the evidence available to inform clinical guidelines and practice, and women’s health care and outcomes [ 15 , 41 , 42 ]. Population subgroup differences were found in the health conditions and social issues perceived to require more funding and support and those which women and girls need more information about. Women’s health needs, risk factors and outcomes tend to vary across the different stages of their lives [ 49 ]. The differences between younger and older women identified in this study tended to reflect the health conditions and social issues which are more prevalent at their respective life stages such as endometriosis for younger women, peri/menopause for middle aged women and Alzheimer’s Disease for older women. The findings highlight the importance of a life course approach to women’s health which acknowledges and responds to the pertinent and diverse health conditions/social issues experienced by women at different stages of their life; the cumulative impact of different factors across different life stages on women’s health; and the need to expand the focus of health policy makers, healthcare providers and researchers beyond women’s reproductive health so that women can receive the health care and support needed at every stage of their life [ 50 , 51 ]. Women’s health may be influenced by a range of social, economic, cultural, and geographic factors [ 49 ]. As identified by the participants in this study, women living in regional and rural areas of Australia tend to have poorer health outcomes than women living in metropolitan areas often due to difficulties accessing healthcare. Others have also identified that women living in regional and rural areas often experience individual, institutional and structural barriers to healthcare [ 52 – 54 ]. The findings of this study indicate that increased availability of affordable, acceptable, appropriate, gender-responsive, local care which meets women’s unique and diverse needs could assist in addressing some of the health inequities experienced by women in these settings and improve their health outcomes. Consistent findings from the survey, interviews and desktop review components of this study highlight the need for increased focus and support of the many health conditions and social issues which only (e.g. endometriosis and peri/menopause), disproportionately (e.g. fibromyalgia and mental health conditions) or differently (e.g. violence) affect women and girls. The findings of this study indicate that addressing health inequities for women and girls requires (further) education for healthcare providers and women and girls about these conditions [ 7 , 32 ]; the integration of an equity and life course approach into health and social care policy and practice [ 50 ]; co-design and inclusion of women in research [ 25 ], and gender-equitable research funding to support understanding of and provide evidence about the range of conditions and issues which affect women and girls especially those they perceive to be most important [ 39 , 50 ]; and consideration of sex and gender differences in clinical guidelines so women and girls can receive high quality, gender-responsive health and social care [ 17 , 23 , 24 , 32 , 55 ]. It was not possible to accurately determine the number of women and girls who received the link to the survey and therefore, a response rate. As is common with this type of data collection, the survey sample included a higher proportion of respondents with post-secondary school qualifications and English language proficiency skills compared to the general female Australian population. Girls aged less than 16 years were not invited to complete the survey. Accordingly, the survey findings may not be generalisable to all women and girls in Australia. Future research should consider the use of targeted recruitment and media/awareness campaigns to ensure samples which include a diverse range of women and girls particularly those who are students, unemployed or not in professional occupations. Selection bias may have occurred as many interview participants represented organisations or had expertise about a specific health condition or social issue; and women and girls with lived experience of a condition or issue may have been more likely to complete the survey. People who self-identified as a woman or girl were eligible to complete the survey. The survey did not specifically ask respondents about their gender identity (nor sex recorded at birth) and therefore, it was not possible to conduct sub-group analyses by gender identity. Further research is needed about the perspectives and experiences of people with a range of gender identities including transgender or non-binary. Due to pragmatic reasons including study time constraints, it was only possible to search two databases for peer-reviewed research literature as part of the desktop review. It is acknowledged that the use of other databases such as those focused on the social sciences may have resulted in more and/or different results. The analysis of research funding allocated by key Australian funding agencies in 2023–2024 included the Australian Research Council (ARC). Although the ARC does not specifically fund medical research (i.e. research about the causes, treatment, and prevention of human diseases) [ 56 ], it does fund research in other disciplines. This may include studies that aim to understand the normal human life cycle, and/or traits and behaviour such as health conditions and social issues relevant to women and girls (e.g. violence or loneliness).

Many health conditions and social issues which only, disproportionately or differently affect women and girls have not received the focus and support required for them to live healthy lives. Individual and system level responses are required to ensure gender health equity including increased awareness and education for women, girls and healthcare providers; co-designed research, programs and interventions with women and girls themselves; further research which aims to increase understanding of gender differences; and improved access to high quality, affordable, gender-responsive health care.

Sex and gender influence health and social care access, use, experiences, treatment and outcomes [ 1 – 6 ]. Although women in countries such as Australia and the United States constitute over half the population [ 7 , 8 ], have a longer life expectancy [ 9 , 10 ] and are more likely to utilise health and social care services than men [ 11 ], there are discrepancies in their care and outcomes [ 11 ] and research representation [ 2 , 12 ]. Women are more likely than men to be misdiagnosed or dismissed due to their symptom presentation [ 13 , 14 ], be diagnosed and receive treatment later [ 15 ], and have multimorbidity [ 11 ]. They are also less likely to receive the care required and participate in health research [ 5 , 16 ]. Health conditions and social issues experienced by women include those which affect them only (i.e. female sex-specific conditions such as endometriosis or menopause), differently (i.e. have different symptoms or a higher disease burden such as cardiovascular disease or violence) or disproportionately (i.e. have a higher prevalence such as fibromyalgia or depression) to men [ 17 , 18 ]. Despite this, consideration of women’s health and wellbeing is often focused on their reproductive health [ 19 ]. As a result, many conditions and issues experienced by women are not well understood, routinely studied, recognised or addressed. The historical ‘one size fits all’ approach to health is based on data collected predominately by and about men, tends to generalise research findings and care to both men and women, and reflects patriarchal and gendered notions and structures of health which often include assumptions about women’s bodies and health and limited recognition of their unique health needs [ 15 , 20 , 21 ]. Such an approach has resulted in a lack of knowledge about women’s health and wellbeing and gender disparities in care and outcomes [ 3 , 4 , 13 , 16 , 17 , 19 , 22 – 25 ]. Little is known about the health conditions and social issues affecting women and girls from their perspectives and those of female experts including women’s health and social care practitioners, organisational leaders, policy makers and researchers as well as their perceptions of the conditions/issues which are most important and require (more) funding and support. There is also little consideration of the proportion of published literature, research funding and media focused on the health and wellbeing of women and girls and the conditions/issues which are predominately researched, funded and discussed. Few studies have utilised or collected data from multiple sources to generate evidence and consensus about the ‘silent’ or overlooked health conditions and social issues affecting women and girls in Australia. The aims of this study were to identify and understand: (1) the health conditions and social issues that only, disproportionately or differently affect women and girls in Australia; (2) of these, which need support and funding; and (3) what women, girls and female experts perceive ‘better’ would look like in relation to women’s and girls’ health and wellbeing.

Supplementary Material 1. Supplementary Material 1. Supplementary Material 2. Supplementary Material 2. Supplementary Material 3. Supplementary Material 3.