Woman's Hour - 08/05/2025

Episode Date: May 8, 2025

The programme that offers a female perspective on the world

This BBC podcast is supported by ads outside the UK. Dear daughter, the lesson that I want you to take from this is simple. Choose yourself first. You cannot pour into others from an empty cup. Dear Daughter is the podcast building a handbook to life for daughters everywhere. Our listeners share their life experiences. We've shared so many moments of laughter and tears. Words of wisdom.

Never be afraid to take risks. Education is your greatest weapon. And letters to their daughters. Dear daughter. Dear daughter. Dear daughter from the BBC World Service. Listen now wherever you get your BBC podcasts. Hello, this is Kylie Pentelow and you're listening to the Woman's Hour podcast. Hello and welcome to the programme. Coming up today, a report shows more middle-aged

women are starting businesses than any other demographic. But behind those stats, the reality of actually doing it is not always easy. Many say they aren't taken seriously and find it hard to get financial backing. So we want to hear from you on this. Have you become an entrepreneur in mid-life? How was it? You can text the programme, the number is 84844 on social media, we're at BBC Women's Hour. You can email us through our website too. Or send us a WhatsApp message or a voice note using the number 03700 100444. I'm looking forward to hearing your stories and your thoughts on this. Also coming up, the lack of women-only medical trials and what that means in practice for

the way women's health is treated. Plus on the 80th anniversary of Victory in Europe Day we hear the fascinating, intimate and often practical letters of a wartime couple that have now been turned into a play. And after winning the BBC Short Story Award, the author of a new novel, Gunk, joins me in the studio. The book takes a gritty look at friendship, love and motherhood. But first, there is news today that Weight Watchers has filed for bankruptcy in the US. The company has struggled with debt and fierce competition from weight loss jabs like Azempic and Manjaro. The company has been around for more than 60 years and many of our listeners

will be familiar with the original model, monitoring your food intake by calculating its points and sharing your highs and lows in a community space and later online with other dieters. In 2018, the company was rebranded as WW, claiming it was moving away from weight loss to wellness that works. To discuss this further, Daniel Wolfson is senior business reporter at The Telegraph who covers consumer and leisure industries. Thanks very much for your company Daniel. Can you just start by telling me what's been announced? Sure, good morning. So first up, they've said in the US that they're going to go into bankruptcy and companies do this essentially when they can't repay their

debts and they need to either reorganize their finances, maybe they need to sell some things. But it allows them to continue trading whilst they do this and whilst they come up with a plan. So it's different to a liquidation, which is usually the end of a company. They've said they want to come out of this process, their services are continuing running. But it's never a sign of health when a companies do this. It's a sign that their debts are weighing on them to the point where they need an emergency plan. So for people who don't know what what what is Weight

Watchers? Who are they? So they were founded in the 1960s and they began with this pretty revolutionary approach to dieting whereby you know you would score the foods according to their calories according to their health began with this pretty revolutionary approach to dieting whereby, you know, you would score the foods according to their calories, according to their health rating. So, you know, if I had a burger, that would be a very high score. If I had a salad, that would be a low score, which seems quite intuitive. But at the time, there really was nothing like it. And over the decades that followed, they they expanded across the world. In the UK, they had a big presence and they really picked up in the 80s and the 90s when I guess diet culture

really, really boomed. Sorry, you were going to ask a question. No, I was just going to talk about what happened to them from 78 as well because Heinz became involved, didn't they? Yeah, so they were bought by Heinz and they were owned by Heinz for a long period of time, I think until the late 1990s. Then in 2001, they went public and they've been a public company since then. So what does that involvement from Hinds tell us about that kind of diet culture, that diet food industry? I think for Hinds, they simply saw a massive opportunity. They saw that people were becoming concerned about their weight, you know,

obesity levels, particularly in America were beginning to rise. And I think they saw a brand that had a great wide appeal and they thought, we can take this into the supermarkets, we can use the strength of manufacturing that we already have and really do move it into a new space that it wasn't in before. It was massive, wasn't it? You know, I do remember my mum going to Weight Watchers and, you know, it was like we were saying, it was a kind of community as well for people getting together and trying to lose weight at the same time. Of course, there was that whole element of being weighed as well in those meetings, which seems like a world away now. But there was a rebrand, wasn't there, in 2018?

So there must have been a sense that that wasn't popular anymore. Yeah. So in 2018, they started calling themselves WW, which I'm not sure how convincing that is as a rebrand because it still clearly stands for Weight Watchers. And I think they still had that association, although I'm sure some consultants got very rich from the process. And it was it was wellness that works. What was the sense there do you think about bringing in that wellness brand? I think that speaks to the fact that there's been a big change in mindset in

terms of how people approach food, health and how they're eating you know I mean for a long time, for many decades, I think people who wanted to lose weight or wanted to eat healthier, were very focused on cutting things out, on low fat foods, on low salt foods, on focusing on the things that aren't in the food. Whereas in recent years, as things have evolved, I think people now are much more interested in the good things that are in the food, rather than the stuff that's been cut out that actually tastes very nice. The company's had some big names involved. Oprah Winfrey, I mean, you don't get much bigger than that. She bought 10% of the business in 2015, but then she sold her

shares last year. She disclosed in 2023 that she was using a weight loss jab. What do you think is the significance of that? I think it's massive. I mean, you know, Oprah is a huge, huge influential celebrity in America and indeed around the world. And she justified it on the basis that she wanted to be able to discuss weight loss medications without any perceived conflict of interest because of her involvement with Weight Watchers. But I think markets take these things very seriously and to have a brand ambassador, I guess, such as Oprah step down in such a high-profile way, I think people took that as a real sense of are things going the right way here. Yeah, and the company itself started selling weight loss jobs.

Yes, they did. they moved into a clinical prescription business that they have in 2023 where they became able to prescribe those jabs for the first time but my personal view is I don't necessarily think jumping on that bandwagon addresses you know the underlying problems with the brand and the demand for it. What's next then? What happens now with Weight Watchers? Does it does it even have a future? So they say that there's going to be no impact on their members. And they they say that they intend to remain a publicly traded

company upon upon the end of this bankruptcy process. And, you know, that that's probably the case, you know, they will still exist. They will just have slightly different, you know, financial structure, and less pressure from their debts. But you know, ultimately, they're still going to have to grapple with the fact that the market is just not moving in their favor. You know, these these drugs have been in you know huge, huge growth in recent years and I'm not sure if I'm not sure whether there's a demand for Weight Watchers to play in them in that way going forward. Okay Daniel Wolfson thank you very much indeed and to add what Daniel was saying there we've got a statement here from Weight Watchers they've said

it will remain fully operational during the process with no impact to members that's according to the chief executive she also told the press that for more than 62 years Weight Watchers has empowered millions of members to make informed healthy choices staying resilient as trends have come and gone the plans have the overwhelming support of our lenders. Or from one business largely used by women to women who are starting up their own business. And a new report out today from HSBC looks at the obstacles and opportunities facing

mid-life female entrepreneurs. Middle-aged women are starting businesses more than any other demographic, peaking between the ages of 45 to 55. But what's it really like to be a female founder in midlife? Well, Eleanor Mills partnered with HSBC to write the report. She set up her own company Noon at 50. And Helen Lord is the co-founder of Rehome, a UK-based business specialising in the resale of used and ex-display kitchens. She started the business when she was in her late 40s and also won the Queen's Award for Enterprise in 2022. Helen and Eleanor, thank you very much for joining me here on Women's

Hour. Thanks for having me. Well, let's start with you, Eleanor. You surveyed over 320 midlife female entrepreneurs are part of this report. So what did they tell you about starting a business later in life? Well what comes across incredibly clearly is the enthusiasm for starting businesses. You know, nearly 70% of women say they want to start a business, but only about 19% of UK businesses are actually run by women. But the big discrepancy here is around funding.

So our report found that 8% of women have got a government grant to help them fund their business, while only 2% have got venture capital funding and only 3% have got a loan from the bank. And 69% have started their business on their own savings or by remortgaging. And so there's a real problem with the ecosystem providing finance to female entrepreneurs. And there's a problem here because actually women entrepreneurs have a 35% higher return on investment, i.e. the capital that's put into their businesses, than men. So actually we're very good at running businesses, but we don't get the money that's required to help us thrive. And the other thing is there's an enormous opportunity in the whole market

of midlife women because we're behind over 75% of all discretionary spending and yet we appear in less than 10% of advertising. So there's a huge gendered ages and peace here going on that market that marketeers don't want to target older women directly and companies don't think about our needs. So there's actually a massive opportunity here for midlife women to not just start businesses which serve everybody but to serve this particular cohort. When I interviewed Cheryl Sandberg a few years ago she said to me that these women, I call them queen-ages, are the most lucrative and underserved cohort in the

whole of the marketing firmament. So there's a massive opportunity here, but too often the people handing out the money are men on the other side of the table and there was a very interesting study done by Harvard Business Review which showed that if you had a man presenting exactly the same presentation about a business as a woman, they were 70% less likely to choose it if it had a woman's name on it. So there's a huge bias here in the system, which is stopping loads of incredible female entrepreneurs, many of whom we profile in this report, from getting the kind of funding and the expansion that they need.

So there's an opportunity here, because this government is all about growth We could add 250 billion to the UK economy if we funded female-owned businesses and help them scale in the same way that men Do but because of a kind of I think a kind of gendered-ageous lag in the system. That's a polite way of putting it Women aren't getting the money that they that they should do in order to for their businesses to thrive Yeah Just to back up what you're saying there, research commissioned by the Invest in Women Task Force and Barclays Bank showed that in 2024 2% of UK equity investment went to all female founder teams. Yeah and that's not kind of taking into account how much harder it is if you're an older woman.

When I set up my company noon.org.uk which is a community of women in midlife and we're really interested in doing everything for women at this point. I was in a lift, I was at a media breakfast and I came downstairs and I was talking with some younger men and they said to me, how amazing that a woman of your age is setting up her own media company. And I thought, well, nobody says that to James Harding, my direct contemporary when I worked at the Times. So there's a real kind of problem in the way that we think about female business founders. And even ones who've been incredibly successful like Trini, she had huge problems getting founded because she was getting funded because she kept going into meetings full of men on

the other side of the table, the investors who just couldn't understand that there was a massive opportunity in older women's skincare. That's Trini Woodall you're talking about. Trini Woodall, yeah, you know, the amazing Trini Woodall. Even she couldn't get funded. She had to sell her clothes. She did a massive auction to get the money and moved out of her house and rented it out to get enough money to start Trini London.

So there's a huge problem here and an opportunity. Let's bring in Helen here. So Helen, you started your business Re Home in your late 40s, you're now in your late 50s. So what was it like for you becoming an entrepreneur at that point? I mean, first of all, I love the positivity here. And it's great to hear that we're being recognised as a real opportunity to help the UK economy. But my experience has been slightly different to lean into what Eleanor says. We funded our business through retained earnings and that was a decision we made very early on. We saw development of Rehome and we knew the possibilities for it.

But from my perspective, I've always seen being a female entrepreneur and older as a kind of badge of honor and a backstage pass, if you like. And that may be because I come from a sales background and I'm always looking for the better if but but actually feeling that and letting that give me confidence I've got one example I mean we have received funding but we've received it for services so we've worked with an MKTP program, and also a scale up program through Innovate UK. And I have to say, you know, the Badges of Honor and the backstage passes really worked there. And I was able to drive that as part of the narrative and the reason for supporting

our business with it being a sustainable business, and also being headed by an older female. You said retained earnings there, you mean basically the kind of savings? Yeah, we didn't spend anything, so anything we made in the business, any profit, we've we squirreled away basically. Which you know, might be because I'm female and I didn't feel the need to go out and spend lots of money or take lots of money out of the business, you know, might be because I'm female and I didn't feel the need to go out and spend lots of money or take lots of money out of the business. You know, I've been very frugal, I suppose is the best way. But one thing I did do that I thought might be useful is just bring to the table that

we can challenge these decisions. We had an issue where a national organization, a B2C domestic organization, said no to taking Rehome on board and I literally drove it through to the board of directors and had a meeting with them and said this is not acceptable, you know, just because of one nuance or something, you won't accept us. You should be, you should be supporting female entrepreneurs. You should be supporting sustainability and ageism is just not allowed. And, and it worked. And they actually changed their decision. So that would be my main advice. Don't take no as a no. And I think, you know, as women, we don't like no, and we might go off them, but we don't challenge it. And that can be about us potentially being a little bit more risk adverse. But age has given

me that level of determination and perspective where I can actually say, well, actually, I don't like this. I don't think this is right. Well, we've had some comments from our listeners about this and one that reflects what you're just saying there. This person says, I'm 58 and I've just finished five years at university training to be a vet and intend to start my own probably mobile veterinary business. I knew what I wanted to do from a very early age and have finally realized my childhood dream despite being told in school by careers advice to become a secretary. She says, if you want to do something, you've just got to find a way to do it and not listen to people that try to tell you otherwise. Do you think that is something,

Eleanor, that you might hear this, whether it's reality or a voice in your head saying, oh, I can't do this. I can't do this at my age or because I'm a woman or? Well, that's exactly what my organization, noon.org.uk is here to remedy. We're all about women starting new chapters at 50. I've written a book this year called Much More to Come, which is a Times Bestseller,

which is all about becoming the women we always wanted to be in our 50s at midlife. In the 100 year life, 50 is only halfway through. It's lunchtime. We're all going to have to work till we're nearly 70 before we get a pension. And lots of women are also being exited from the corporate world at around 50. So it makes sense to set up a business. It helps you have the lifestyle that you want. For many women, it's what they've always wanted to do. So it's the realization of that incredible ambition. And I love your

correspondence saying she's going back to change as a vet. We see lots of that in our, in what we call our queen ages, and they are, many of them are going back to study or they're doing the things that they really wanted to do, say when they were in their 20s, life got in the way, we've been like raising families, you know, earning a living. And actually at 50, for lots of us, there's an opportunity to go back and find those dreams, to start again. And starting a business is really part of that. And it's really important that there's an ecosystem of funding which allows women to do this. Men are not bootstrapping their businesses on their own savings, they're getting investment allowing them to scale quicker. I mean, I absolutely love what Helen's talking

about but it's really important that we actually allow women to be ambitious, to go for their dreams and we elongate thinking about women's careers and their possibility over 50. This is all about changing the story that we tell as a culture about what women are for as they age and that is a huge huge issue particularly when we're all going to live so much longer. We can't write women off and put them on the scrapheap when they're 50. We have to fund their dreams for entrepreneurship and any other dreams they have to to go back and study or be creative or whatever it is that they want to do. Helen obviously you've been successful in your business but did you

do you think you faced that that people are asking you why you were doing this as a woman of a certain age if you like? Oh that's a good phrase! I'll just like to say I do still think I'm 27. Yeah, yeah. I haven't reset yet. Yeah, it does tend to be more from maybe the other side of your life, i.e. your family, your friends, your friendship groups, etc. do change as you start a business because you know, what you're doing and what they're doing are slightly out of sync. I've

been very fortunate in that both of my closest friends have started their own businesses so I have got a little bit of a network of friends that I can you know download to or go to to ask for advice but starting a business if you don't have that, can be very isolating. So anything that can be done to help support women in a positive manner should be really pushed forward because I think as a group we don't necessarily think it's possible for us. Somebody said to me when I was about 40, other people do this so why can't we? And that was my personal friend and it really resonated with me. But if that person hadn't

have said that to me, I don't think I would have done what I've done. It kind of just switched a light bulb on in my head, you know, the fact that I'm female shouldn't matter. The fact that I'm older shouldn't matter. In fact, it's a badge of honour and it's a backstage pass. Absolutely the experience that you bring from what you've learned. Yeah. Eleanor and Helen, it's been fantastic speaking to you. Thank you so much. As I've been saying, we've got so many comments. I just want to make time to read a couple. As I've been saying, we've got so many comments. I just want to make time to read a couple more here. This person says, I've become an entrepreneur aged 50.

I now run a home help service for older people in my local community. Having seen how hard it is to find reliable companion care for older people. Having suffered from workplace bullying, I make sure that everyone who works for me has a good work-life balance and feels appreciated. We're largely middle aged women supporting women, older women. And this one from Flora. Flora says, I make greeting cards and decorate them with plastic collected on beach cleans to help spread awareness on plastic pollution in an engaging way. I also run beach cleanups with corporates and schools to get others involved too. I find my aspects of running a business hard. My main problem, she says, is confidence of can I really do this?

Can I grow this? Flora says, I'm trying really hard this year to lean more into being honest about all this to hopefully get more support and confidence to carry on. Thank you so much for all your comments. Do keep them coming in. You can message us around 84844 on social media. Thanks so much for all your comments, keep them coming in. Commemorations have been taking place all week to mark the 80th anniversary of Victory in Europe Day. On this day, the nation experienced a moment of collective euphoria. Huge crowds

took to the streets to sing, dance and rejoice after nearly six years of war. But it was also a moment of great sadness and reflection. For members of the armed forces, the importance of receiving mail during the war was said to be second only to food. And now in a new play that brings to life the compelling correspondence between a young wartime couple. Dear Lol, a wartime marriage in letters is the work of Guardian journalist and author Rosanna Greenstreet and her husband Matthew Fay. It tells the story of Matthew's grandparents. Journalist Gerard Gerr Fay and his wife Alice or Lol, they were writing virtually every day and their correspondence over four years gives a really fascinating insight into

just how one couple survived and it offers a deeply personal and refreshing and honest window into marriage, motherhood, separation and survival. Delighted to say that Rosanna joins me in the studio now. Thanks very much for coming in Rosanna. Thank you for having me. Really interesting letters. I've read some of them. How did you find them? Well, they emerged during a house move. My parents-in-law were moving just before Covid and this sturdy cardboard box appeared and it was either going into the skip or it was coming home

with us. So we took the letters, we began to look at them and there were thousands all jumbled up, mostly undated and it seemed too big a task at that point. A couple of years later, so probably 2023 beginning of, our daughter was at university, We had a space whereby we could spread the letters out and begin to see the correspondence and the story that was unfolding over four years. It must have been amazing to read those letters for the first time. They were like, it was like a treasure trove. There was obviously all the make do and mend the fashion stuff, but, and the food, the rationing, but

there was so much more. There was sex, contraception, pregnancy, childbirth, weaning, stuff that you don't really read about generally in wartime memoirs. Let's hear a clip, shall we? This is Daisy Waterstone as Lol and Charlie Hamlet as Jerk. This is kind of them talking about contraceptives. Let's have a listen. Edward has brought her a wonderful arrangement. You screw a pump onto a tube of jelly and fill the pump, then pump the stuff into the lady and it deals with the sperm chemically. Five bob. Also she has some tablets which you just slip in. They only last 40 minutes though and the jelly lasts several hours.

Olive says she doesn't want to have her eye on the clock. She's very concerned about whether these methods will mess the best sheets, so she tries them by herself to see. She said, if I had known about these things before I might have been tempted by curiosity once or twice in my life. I was rather thrilled, thinking what fun it would be for us. Do you agree? When you are busy glamorising for my leave, don't get it too fixed in your mind that

I should be home in time for Christmas. The chances are less than 50-50, so I'm quite likely not to come until January. When I do though, I think Oliver and Edward's contraception would be a very good idea." It's really interesting hearing it. It is very personal though. I mean, this is your husband's grandparents that's talking about. Was there an element of you that was thinking, this is a bit personal, to share with the world?

I think that's when my journalistic side took over and I realised that it was such good stuff, such good material and it just puts a totally new spin on what we imagine a wartime marriage was actually like. It was very modern. They were very, you know, they shared duties with the children. When he was home, he was very involved and when she writes in her depression quite often that she's so unhappy, she's lonely, she's worried about the children, when she writes to him about her worries she says, you know, do you mind me bothering you with all this stuff? And he says no, absolutely, because if I was home they would be my worries too. They wrote a lot didn't they? They did they wrote about five or six times a week

so if you think that's a good 12 letters a week from June 40 for over four years. Why do you think that was so important from both sides? It was that literally their only means of communication. There was the very odd phone call but that was it. So at one point she's living with relatives, she's living with relatives in very cramped conditions, she's very unhappy and she's desperate to camp follow, she's desperate to go with him and be somewhere in digs nearby where he's stationed and she sends desperate to camp follow. She's desperate to go with him and be somewhere in digs nearby where he's stationed. And she sends all these SOS letters. And of course,

because there's a time delay, very often he's not getting the letters. He's out on learning to be a soldier, he's out on exercise. So there's a time delay and the letters get more and more desperate. Meanwhile, he is receiving some of them, but she's not getting the responses. Sometimes they send telegrams and wires. Yeah, it must have been frustrating if you're writing that letter and you're looking for an answer and then you're not getting it, but might be getting another letter. Let's hear another section. We were talking about the kind of, they talk about the mundane things in life, don't they? Let's have a listen to this one. Life is assuming it's rice pudding aspect again, now that you have gone and the excitement is over.

I can take rice pudding, of course, as long as I get trifle occasionally. I'm glad your tough week is over. But I know you've got three equally tough at battle drill school looming. What a life. You playing war at one end of the country and me going daft with loneliness at the other. Sometimes life just doesn't seem worth living. It's all so futile. Steve is so naughty that he's just an irritation. As a baby I'm just thankful she's so well and good but Marron Paz is a most unhappy house and the devil is I see no prospect of

getting anywhere else to live. There's a nice doctor's bill to pay by the way. One baby, one chill, one measle. Nearly every child in Royton seems to have or have had measles. Citizen Kane is on in Rochdale next week, so shall try go. Also the flashing stream. Might go twice and forget my troubles. I like that. She's talking as if almost she's in the room, isn't she? Yes.

You know, we've got that medical bill to pay and the child's poorly and, you know, it's kind of updating. But there are some interesting, slightly more intimate moments. There's one where she discusses underwear. Yes. Tell us about that. Yes. So at one point she says, I've got the idea of getting a really glamorous housecoat so that when the children are in bed, I can slip it on over my undies. And Gerard is very taken with this idea.

I should be, yes. He responds and says, I thoroughly approve of the housecoat idea. It'll be a great labor saving device, not that I object to the labor. What made you think, you know, I want to take these to the stage? Because you have published some of them, haven't you? We have. We've published the first six months last year for the anniversary of D-Day. Gerard fought at D-Day. And then this year, today, we're bringing out 41-42. And I just felt that the detail was so important to get out from a historical point of view

that we're self-publishing them at at the moment so they're on Amazon and then obviously the play that became that took on a whole that was a that's another whole story so the play came about because we saw the Hamlet's fabulous production Laurie Lee production last year which has an on stage orchestra with two actors reading Laurie Lee's last year, which has an on-stage orchestra with two actors reading Laurie Lee's work. I thought it would be an amazing vehicle for the letters. So I wrote to Judy Reeves, who's the producer, and she went for the idea. And it's now happening at Wilton's at the end of the month, and it's also going to tour. So it's going on to Hereford

Cathedral in September, on September the 27th, and it's going to be at Winchester Theatre Royal on November the 9th, and more dates to follow. So it's coming on a pace. And what will it be like when you finally see it on stage? Oh my god, I'll probably cry because it's been such a long time. Yeah. It's been years, years. Oh, it's been lovely talking to you about it. So Dear Lola, Wartime Marriage and Letters, as we were hearing their premieres at Wilton's Music Hall in London, that's 30th of May. Rosanna,

thank you so much for your time here on Women's Hour. And just to let you know, you'll be able to follow the BBC's live coverage of today's VE Day service of Thanksgiving on 5 Live and on BBC One all this morning. There'll also be a live concert from Horse Guards Parade this evening. That's from 8 till 10 p.m. which you can catch on BBC One and on the iPlayer. I just want to bring you some more of your comments on starting a business in midlife. This one here says, I'm a holistic massage therapist and 64 years old this year currently launching my mobile holistic massage studio, converted horse trailer to take bliss and tranquility to the equestrian community. Another one here saying, it's nice to hear women

talking about running successful businesses, but at the age of 44, all the successful women entrepreneurs I know have started our businesses out of necessity, needing to be around for children and caring responsibilities rather than it being a lifetime dream. Very good point there. And this one from Sarah in Sheffield who says, I started setting up my business four years ago. It provides parent-friendly guides to help them support their children's development and ensure a smooth school start. I feel sure that if I was a man, I'd have been taken much more seriously by head teachers and CEOs of academies and I'm certain it would have taken off quicker.

It's very frustrating, Sarah says. Getting funding is very difficult to reflecting what we were talking about. Sarah says, I'm self-funding and caught in a vacuum. Thanks very much for your comments. So we do have lots of them so I'll try and read some before the end of the program. a handbook to life for daughters everywhere. Our listeners share their life experiences. We've shared so many moments of laughter and tears. Words of wisdom. Never be afraid to take risks. Education is your greatest weapon.

And letters to their daughters. Dear daughter. Dear daughter. Dear daughter from the BBC World Service. Listen now wherever you get your BBC podcasts. Now health experts are calling for more UK clinical trials to focus on finding new treatments for women as what has been described as concerning new data from the Medicines and Healthcare Products Regulatory Agency or the MHRA has been published.

The evidence shows that while the UK is a hub for pioneering research in this area, details of thousands of studies reveal that women are severely underrepresented with 67% more male-only studies than female-only studies. Professor Anna David, consultant obstetrician and gynaecologist and the director of the EGA Institute for Women's Health at UCL in London said the findings help explain why some women are not getting the care they need. And to explain those concerns that have been flagged by this report, Professor Anna joins me now. Welcome to Women's Hour. Thank you very much for inviting me. Very glad to be here.

So let's start by clarifying them what what clinical trials actually are. And why are they key in in that development of treatment? Yeah, so clinical trials essentially take a drug or a device that's not been used before in humans, and they test out and find out if they're a safe and secondly effective and there are various different phases of clinical trials so for a one to four so a phase one trial would be a first in human trial and commonly um healthy volunteers take part and

the report actually showed that men were more likely to be taking part as healthy volunteers and for that I think we have to be incredibly thankful. And then phase two you often then look more rather than just safety you look at effectiveness and whether those trials those drugs are working. Phase three you often have a randomized controlled trial so you have women are or men are randomized to having either the drug or no drugs so a placebo or control. And then you work out how effective it is, and then you license the drug, and then phase four is what's called post-marketing surveillance, where effectively you look at

what happens to people taking the drug after it's licensed for use and it's used commonly in the population. And that's often when we find out information about drugs that are being taken by pregnant women or women who are breastfeeding. And so that data comes in really in a bit of a vacuum. We don't have a lot of information. It's not properly set up but it's a really important part of monitoring the effectiveness and safety of drugs. It's worth pointing out that women aren't underrepresented in trials overall with 90% of both sexes being included in most trials. But we're talking about the male-only trials

were actually twice as common as female-only studies. Why do you think that is then? Well I think it's partly because obviously when you're testing out a new drug, you want to start off in a population that is less at risk. So you know about one in five women of reproductive age are either trying to get pregnant, are pregnant or are breastfeeding and because of concerns about potential harms of a new drug, you know thinking about the effect that thalidomide had, women very commonly are excluded from trials of drugs that are first inhuman, quite rightly, because we don't know what the effect might be. But then of course we do need to move on to make sure that women are taking part in these drugs

trials and I think that's where we have the problem. Because it was only 7%, sorry, male only was 6% and female only was 3.7%. So there is a big discrepancy. So what impact then does that have? I guess leads to a lack of information, doesn't it? And then what happens for the way that women are treated? Well, I think what happens is that, you know, if there are new drugs coming onto the market, and we were talking earlier about Azempik and these trials about weight loss,

it means that people who perhaps have lost weight and might be taking this drug and they get pregnant and they don't know what effect that is gonna have on their baby. And there is some evidence to show that in animal studies that it might have a potential harmful effect. So what happens is people who are perhaps ill, they might have a potential harmful effect. So what happens is people who are perhaps ill, they might have a kidney transplant,

and then they're taking immune rejection drugs, or they lose a lot of weight, and then they are more likely to get pregnant, they'll be fitter in that pregnancy. They then go and talk to their clinician, and they say, well, what is the risk to the baby? And we don't really have any evidence. So women and clinicians are having to make decisions about whether to carry on taking these drugs in a

vacuum of evidence and I think that's really not on, it's just unethical to do that. It's occurring, you know, women are effectively being treated a little bit like guinea pigs taking part in testing out these drugs and so we find out the effect after the drugs been licensed for use. There might be some concern if people are listening and thinking about weight loss drugs as we've mentioned them. What's the guidance on weight loss drugs during pregnancy? So at the moment we don't have any evidence about weight loss drugs in pregnancy. The guidance suggests that you should stop taking the drug, probably have

a washout period of at least about two or three months before you get pregnant and that's what the evidence suggests. But I think, you know, we need to find out more about what's going on and so really asking women to take part in trials of drugs is really, really important and it's quite difficult for companies to do that because they might think that it's an increased risk. And actually to get insurance for a trial of a drug that might be used in pregnancy or might be used in breastfeeding is very, very difficult. It's hugely expensive.

So there's a barrier to actually getting women, asking women to take part in drugs trials. Is that essentially because of risk? Risk to the baby and risk to the mother? It is very much so and also because people are companies are not mandated to think about whether to test out the drugs in pregnancy or women of reproductive age. It's really had a lot of movement in terms of drugs for child health so there is this thing called a pediatric investigational program which means that companies should think about the potential effect or usefulness or safety of a drug in children when they're

developing a drug. And I think we need to think more creatively about whether companies should be encouraged to do that for women of reproductive age. So how has this solved then? Because there does feel like there are some issues obviously about testing on particularly on pregnant women, but more generally, how do we get this figure more even so that there is a similar amount of male-only trials and female-only trials? Well, I think one of the things to do is to raise the awareness, which is why it's great to talk about it. I only look after women who are pregnant or are thinking of getting pregnant. And actually, if you ask women,

would they take part in a trial? They very often say, yes, we had a huge uptake for COVID vaccine trials when we tested them out a few years ago at UCLH. And women were delighted to take part. Overwhelmingly, they responded to a call. So I think we have to say, yes, we need to think about it. Sometimes we need to make it easier for women to take part in trials.

So for example, provide support if they've got children, childcare, you might need to ask two women to one man to take part. You need to broaden the sort of criteria for getting into trials. So there's lots of things that you can do and evidence shows that you can increase the number of women who take part in clinical trials. Do you think this has also anything to do with attitude, that women's health, you know, menopause for example, isn't as important as some men's health issues? I'm talking about a perception there, not my view of course. No, I mean, I think there is this perception that it wasn't important. And that's the same for us women as well. So I think that the women's health strategy,

the call for investment in women's health that came out and a hundred thousand women answered that call about what's important. And that really unearthed this whole issue that, it takes seven years to get a diagnosis of endometriosis where you get the lining of the womb embedding in the pelvis and it causes huge problems. And of course women of menopause, as your earlier speaker said,

you know 50 is only lunchtime from our sort of life course, lifetime. Menopausal women are having to stop work because they can't cope with the symptoms. We need more investment in drugs for menopause as well. So it's not just about pregnancy reproductive health, it's also about the 50 to 100 that we're all going to be living later. Absolutely okay. Professor Anna David, thank you very much for your thoughts there. And we did have a statement from the MHRA who said about the analysis, while it underscores the UK's role as a leader in pioneering research, it also reveals a clear need to improve diversity in trials, particularly the inclusion of women. They go on to say that they're committed to driving more inclusive

and representative research across the life sciences sector. Just to mention as well that on tomorrow's programme, we'll be delving further into medical misogyny, talking to writer and broadcaster Naga Munchetti about her own experience and research in this area. Now my next guest is the writer Sabba Sams whose debut novel Gunk has just been published. Sabba won the BBC's short story award in 2022, but now she's moved into longer fiction. Now her novel is about Jules, who works in a nightclub alongside her ex. Jules makes friends with a younger woman, a fellow bar worker who becomes pregnant with, you've guessed it, Jules' ex and has the baby. Then for one reason or another, I'm not going to spoil the book for you, Jules is left to care

for that baby. There's lots to get into here with alternative families, age gap relationships. But first, we're going to start with witnessing a birth. Sabah, thanks very much for joining me in the Woman's Hour Studio. Thank you so much. You've got a reading for us. It does mention the process of birth in detail, I should point out. If you're happy to read it, can you go ahead? Sure. Thank you. Yeah, I'm just reading from kind of the middle of the birth scene, which is one of the final scenes in the

book. The midwife announced that she could see the baby's head. And I stepped down to look at his damp wrinkled scalp, the fine hair soaked with blood, streaked with a white paste that I cannot now resist describing as gunk, and then I returned to Nim's face and I kissed her salty forehead. I was crying and she was crying and nothing mattered then apart from the baby's safe arrival. In that sense it was the plainest moment I've ever experienced in my life. When he came he was a blue squirm soaking wet, the umbilical cord a long plasticky rope. He opened his mouth and screamed that he was alive. The midwife placed him on Nim and he turned

his scrunched up face into her skin and right then the two of them looked so separate to me and that separateness was miraculous and tragic at once." It's really powerful and I found it quite emotional when I read it. You're a mother of three. I am, yes. The birth scene was actually the first scene I wrote of the whole book. Really? I had been pregnant and given birth once and I hadn't ever read a good birth scene. And I thought, well, okay, I'll write one. And I sat down and I wrote it from the perspective of the character giving birth. And it was impossible. It fell apart at the seams. I saw why I hadn't read a good birth scene because, you know, my character who was giving birth, Nim, she was on a different

planet. There was no narrative, there was no character development. It was impossible to write something that made any kind of sense. And the reason I wanted to write a birth scene is because I wanted to force my readers to witness a birth. And then I realized that I needed a witness within the book. I needed someone to witness Nim's birth, another character, and explain the the birth through their eyes and that was how I could write a birth scene that made sense and that's when Jules the other character came in to be my witness. Was it important for you that it was honest then if you said you hadn't read a good birth scene were they too romantic in the birth?

The other birth scenes I've read. You know what? I just hadn't, I don't think I had read any, like really any. I had read lots of accounts of birth when I was pregnant, true accounts, which was so helpful for me. But I'm obviously love fiction and I had found them so difficult to find. And yeah, I wanted it to feel real and to feel true. And I really did write from my experience of giving birth. Like the birth in the book is very close to my first labour with my first son. There's a lot of complicated feelings around motherhood in the book. Tell me about what you're trying

to say or what you're exploring with that sense of motherhood. I wanted to write a book that just kind of broke open the definition of motherhood. You know, we think of motherhood as biological ties, as social convention, that there are mothers and there are not mothers. And I'm just interested in this idea that perhaps we could all mother each other. Perhaps mothers still need mothering even after they become mothers. Perhaps it's not linked to gender. So I just wanted to write a book that allowed everyone in the book the kind of capacity to mother and be mothered. So I had these two women, one of whom is pregnant and not particularly connected to the baby,

and the other woman has always wanted a baby and has thought about motherhood her whole life and can't have children. And I was just interested also in sharing the load, you know, because mothering is hard. So why not split it between people too? So you have in this book someone who's pregnant and gives birth and then the other one who kind of takes on the baby for the newborn stage, which is obviously incredibly intense, especially having just given birth. I did my first event for the book tour last week and I forgot what I was saying on stage, just complete fog, like mid-sentence.

Couldn't remember the question, couldn't remember my answer. And I spoke to my mum afterwards about it. I was just like, oh my God, it was mortifying. I'm going to have to go out and talk about this book. And I can't. I have a five month old baby and I can't remember anything. And I'm exhausted. And she was just like, Sabra, it's postpartum brain fog. And I realized that this is what gunk's about.

It's about sharing so that these moments can be softened or potentially avoided. Yeah, absolutely. I think that's interesting. People talk about this baby brain, like it's a kind of a joke, but it's real. It's real. And I had been pretending it's not real. And you know, I have perimenopausal brain, I think, as well. So, you know, it hits us at all walks of life. You had your first child young by today's standards. What was that like, you know, finding out you were pregnant and facing that reality

of being a younger mother? Yeah, so I got pregnant at 22 on the coil and I decided to keep the baby, I think, through just this combination of naivety and brazenness, and also this innate kind of knowing somehow. I just felt like I just knew I wanted to, and I felt like I had to. And everyone in my life was just like, what do you mean? You're 22, and you're at uni. But I went through with it and I think Gunk comes out of that experience too because I actually, I live in a nuclear family. I live with my partner and we have three sons now. And because we're young, we

have so many people in our life who feel like family. Well, they are in the traditional sense of the word. I have my mom and my grandma and my sister who are all, you know, we have like generations to help us because we're in our twenties. And then I also, we also have loads of friends who don't have kids who are so there. And they have these relationships with our children that are undefinable. There is no word for like your parents friend, you know, you can't really call them an auntie or uncle, but it's really such a special relationship and they are so helpful. Yeah, so that is, I think, what Gunk came out of to this idea of family being bigger than what we think of it as.

Yeah, and what family means for different people is very different, isn't it? We've got to talk about the title. Why is it called Gunk? It's called Gunk because it's set in a kind of grotty student nightclub which Jules runs with her ex-husband Leon. And it's this very like kind of visceral, grim place full of students who kind of come from rich families and are spending their parents' money on partying and also discussing like left-wing politics and the smoking area. It feels like a real place to me that I've been many times.

Yeah, me too. And it felt, the word gunk just felt right as a title, as a name for that club. And then, and I knew it had bodily connotations, you know, I knew it was kind of a gross word and I knew I had this birth scene. It was like I say, the first thing I wrote. But it wasn't until like deep into my second draft of the book. So I'd written the birth scene, I'd written about gunk, the nightclub, and my friend said, oh, the gunk that a new baby comes out covered in, referring to vernix, you know, the white

waxy stuff that a newborn comes out covered in. Perfect description for it. Yeah. And then that line I just read out about not being able to resist describing it as gunk when the baby's born, because she's worked in this nightclub for years that's called gunk and then here is like the gunk of life. And I just wanted, you know, I wanted to write a book about mess and I think it makes many things messy.

It makes motherhood messy. It makes relationships messy. Bodies feel messy and gunk felt like that word. We mentioned that you won the BBC National Short Story Award in 2022. Your collection, Sen Nudes, your poem, Blue Forever, won the award. So how different was it moving from those short stories to a novel? Was that your intention or had you just intended to write that birth scene? I had signed a two-book deal to write a novel. I'd written Send Nudes and then I'd got a book deal off of it and there was this untitled novel looming over me. I didn't have an idea and I didn't feel that I knew how to write one.

I had kind of told everyone that I could, and then it came to it and I just thought, oh, like, can I pull this off? So I started with the birth scene, and then I think Jules came out of that, you know, this idea of the witness. And then I wonder about this term long short story which feels, it feels like something that people don't want to admit that they're writing or don't want to admit that they're reading. You know, there's this idea that a novel is a novel and a short story is a short story and you like must do one or the other. But when I think about my process of writing the novel, I think I will accept that it's a long short story.

I sat down to write a short story and I just kept going. And I met issues with pacing later and I had to kind of go in and work out the form towards the end. After I had written my long short story, I kind of, you know, went in and fixed it. But I would do that with a short story too. And I think, again, it's mess. It's this form that doesn't fit in a box. Yeah, that was my process with it. So you just mentioned you signed a two-week deal. Does that mean there's another on the way? I am not writing right now.

As you can imagine, with all my kids and my book tour. But I would love to write another book, I'm sure I will. I think the second book feels like a real moment because I think I feel like a real writer now, you know. The first book felt like a fluke, and the second book, it still felt like a fluke, but it does feel like if I've written two books, I could probably write another one. Absolutely. I mean, I can just say, having read your book, you are certainly a real writer. I really enjoyed it. I think it's a very interesting book, very insightful. So, yeah, I look forward to hearing what you do next.

Sabah Sams, thank you so much for coming in. Thank you so much for having me. Just to mention Gunk is out now. Now, tomorrow, as I mentioned, Anita will have journalist Naga Manchetti joining her. We'll be here to talk about her new book, All About Women's Health. And as the wedding season begins, we'll be here to talk about her new book, all about women's health and as the wedding season begins we'll be discussing what happens if you change your mind, why do women cancel their weddings and what's the best way to go about it. That's tomorrow at 10 o'clock here on Women's Hour. Thank you very much for listening. That's all for today's Women's Hour. Join us again next time.

This is Dr Chris and Dr Zand here and we are dropping in to let you know about our new BBC Women's Hour. Join us again next time. Chris, the massive information out there can be contradictory, it can be overwhelming and Chris and I get confused too. That's right, we get seduced by the marketing, the hype, the trends, so we want to be your guides through it. And I think it's fair to say, Zond, we are going to be getting personal. We're absolutely going to be getting personal, Chris. What I want to do is bring in my own health dilemmas in the hope that we can help you with yours. Listen and subscribe to What's Up Docs on BBC Sounds. not pour into others from an empty cup. Dear Daughter is the podcast building a handbook to life for daughters everywhere. Our listeners share their life experiences. We've shared so many moments of laughter and tears. Words of wisdom.

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