Woman's Hour - Abortion laws, Anorexia and bone health, Profile of Greta Thunberg, Susanna Hoffs

Episode Date: June 13, 2023

Is current abortion legislation fit for purpose? It's a question debated this morning following the conviction and sentencing of Carla Foster for inducing an abortion outside the legal time limit using pills at home. Nuala is joined by barrister, Harriet Johnson and Ruth Rawlings from CBR UK, Centre for Bioethical Reform which seeks to challenge views on abortion. Dr Laura Flexer, a GP, emailed Woman’s Hour to ask the programme to talk about bone health, especially that of teenage girls with anorexia. Should young women with eating disorders be given oestrogen to boost bone density? Dr Flexer joins Nuala to talk about her research, along with Professor Sandeep Ranote, an expert clinical media spokesperson for the eating disorders charity BEAT and a consultant paediatric psychiatrist for eating disorders in the NHS. Last Friday climate activist Greta Thunberg took to twitter to mark her final school strike for climate. We wanted to take this opportunity to look back at the impact of Greta’s work so far and cast forward to the future. Guardian climate journalist Fiona Harvey and Climate activist Mikaela Loach join Nuala. Susanna Hoffs is a solo artist and a founding member of the Bangles. Blending ’60s garage rock, harmonies, and jangly guitars, they became a seminal band of the 1980s with a string of hits including ‘Manic Monday’ , ‘Walk Like an Egyptian’ and ‘Eternal Flame.’ She’s since written and recorded for and appeared in the Austin Powers movies. She joins Nuala to discuss her career and her first novel – This Bird Has Flown – described as "part British romcom, part Jane Eyre” – which gives a glimpse inside the music business.Presenter: Nuala McGovern Producer: Lucinda Montefiore Studio Manager: Steve Greenwood

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, this is Nuala McGovern and you're listening to the Woman's Hour podcast. As you were hearing in the news, some are calling for Parliament to debate overhauling abortion rules after a woman was convicted of inducing an abortion outside the legal limit using pills at home. Now, others believe the laws are there to be enforced, and particularly in cases like this, to protect the unborn child. We'll get into the details in a moment. And as always, we want to hear your views.

Do you think the current abortion legislation is fit for purpose? You can text the programme. That number is 84844. On social media, we're at BBC Woman's Hour, or you can email us through our website. If you want to send a WhatsApp message or a voice note, that number is 03700 100 444. So do get your messages in, we'll be discussing it in just a moment. Also today, Susanna Hoffs, the lead singer of the 80s group The Bangles, has written her debut novel, This Bird Has Flown, described as part rom-com, part Jane Eyre, set in the world of music.

I'm looking forward to speaking to her. Also, Greta Thunberg has grown up. The environmental activist has graduated from school and so has participated in her last school strike for climate. But what difference has she made over the past five years? Michaela Loach and Fiona Harvey will be with us. And also, should oestrogen be considered for those with anorexia to prevent osteoporosis in later life? That's all coming up. But let me begin with the question, is the current abortion legislation fit for purpose?

This is a question debated this morning following the conviction and sentencing of Carla Foster for inducing an abortion outside the legal time limit using pills at home. Ms Foster received a sentence of 28 months, 14 of which will be spent in custody and was between 32 and 34 weeks pregnant when she took medication acquired via the Pills by Post scheme, which was introduced during lockdown. Abortion in England and Wales can be permitted up to 24 weeks

and the procedure must be carried out in a clinic after 10 weeks. There are calls, as we're hearing, for some by some for an overhaul of the abortion laws and questions over whether the sentencing is in the public interest. Now, Justice Pepperall, in his sentencing remarks, described this case as one woman's tragic and unlawful decision

to obtain a very late abortion. He acknowledged that abortion is, and I quote, an emotive and often controversial issue, unquote, but a matter for Parliament, not the courts. In July 2021, the Labour MP Diana Johnson tabled an amendment to the Police Crime Sentencing and Courts Bill that would have introduced abortion on demand for any reason up to 28 weeks in England and Wales.

Earlier on the Today programme, she had this to say. We rely on the 1967 Act in certain circumstances to allow abortions to take place. But underlying that and underpinning it is that abortion is a criminal offence unless you comply with the 67 Act. And so it seems to me that when you've got legislation that's over 150 years old and legislation around the Abortion Act, which is over 50 years old, society has moved on, healthcare has moved on. And I think that Parliament has a role now to look at reforming our abortion laws in this country. Do you agree? Or would you be concerned by a regulatory system instead of a criminal system when it comes to

abortion cases. Do you think the current laws are working in a case like this, for example? Well, I'm joined by Barrister Harriet Johnson from Doughty Street Chambers and Ruth Rawlings, CBR UK is her organisation, the Centre for Bioethical Reform, which seeks to challenge views on abortion.

They are anti-abortion, to be clear about that. Harriet, could you see a system that is decriminalised and welcome? I think whenever you have a regulatory system, criminalisation is the end point of regulation. So it's often where we end up. But certainly across Europe, we see other countries where there is regulation. If there's breach of those rules about abortion provision. It's the providers rather than those seeking abortion who are penalised. Now, that in itself has its own problems. It creates access problems. It often results in even more restrictive provision from medical professionals who are themselves anxious about penalties. So there's no clear and easy solution to this, I'm afraid. So let me turn to you, Ruth, and also welcome.

I know, as I mentioned, you're against abortion, but what would your specific concern be about decriminalisation of the abortion laws for it to be within a regulatory context instead? Hi, thank you for having me on the show. Yes, I mean, we have to take a look at this case in specifics is that the baby in mention was actually 32 weeks, that's eight months old. And, you know, as as we know, that's already outside of the current abortion law. And you just have to have a look at public opinion. Public opinion is not for late term abortions.

These are viable babies. We all know that babies can live outside the womb with help, even from 24 weeks. We're talking about 32 weeks, eight months. People know what an eight month baby looks like. It's, you know, and so this is the case that we're talking about and it's interesting that the abortion lobby and all those that are trying to use this as an opportunity to call for liberalization further liberalization of the abortion law are so out of step with public opinion and they're ignoring this point that the baby

was actually fully viable. It's interesting. The baby could have been viable. Let me just hop in there, Ruth. But as an eight month old baby, we're talking about an eight month pregnancy, of course, not an eight month old baby. And it could be seven. We're still not sure on that.

And I know what you're trying to get across is that you feel that pregnancy was viable and that birth could have been viable but you talk about public opinion but there are questions about public interest this morning and you will have seen this as well Ruth about whether this conviction and sentencing in particular were in the public interest as she was a mother of three one of the children with special needs do you agree with the sentencing in this case? I mean, we don't know the details of the case, so I couldn't comment on the specifics of the case. But we would say, actually, in a nation where there is so much disinformation

about what abortion is, and this disinformation about what abortion is and this is for disinformation is coming from the abortion industry itself they're the ones who should be facing this investigation they are the ones who provided and posted this pill to this woman and you know people who whatever side of the debate they're on whether they're for abortion or against abortion, have raised alarm bells on this, sending these pills by post to women where women don't know how far along they are. So these women are not getting a consultation.

Let's talk about some of these aspects because I know you call it the abortion industry. Other people would call them healthcare providers and that is your characterisation of them. With this also, the pills were intended to be used up until 10 weeks. This woman instead, they say that she was not honest about how far along her pregnancy was. So where's the regulation there? The regulation should be

on the abortion industry for distributing these pills to this woman. I mean, like, it's clearly not working. So let me take your point. It's clearly not working. Let me take your point there.

And it's dangerous. And let me put it back then to Harriet. Ruth believes that the way it is set up at the moment and there is obviously the criminal aspect to it,

which we're talking about, which, of course, led to this sentencing. Ruth feels that the regulation is not there at the moment. What would you say, Harriet? Well, I think, first of all, when we talk about viability

at 24 weeks, we're talking about a 40% chance of survivability at 24 weeks. So we need to be absolutely clear what we're talking about a 40 chance of survivability at 24 weeks so we need to be absolutely clear what we're talking about there is some chance but it is absolutely not categorical that certainly increases as the fetus develops um but we're we're certainly not talking about 100 chance we're about chance without complications so it's important to be factually accurate in this i think this baby was 32 weeks so let's have Harriet speak and then I will come back to you afterwards. Okay thank you. Abortion was decriminalized in 1967 but section 58 of the

1861 law which is what Miss Foster was convicted under which wasn't repealed that still carries a sentence of penal servitude for life which I think shows just how out of date this law is. I think the time is certainly ripe for revisit and ideally reform. But like I said, when we talk about criminalising those providing access to abortion health care, what we are often talking about is then an incentive for those providing health care to women to be more restrictive, to be more conservative in what they're doing and actually narrowing access to really vital health care for women, especially if we look at the circumstances of this case, which is it was happening during that first phase of lockdown, which I think we all remember very vividly how difficult it was

to leave the house, let alone to get access to health care when the infrastructure wasn't in place for things like remote appointments and for telephone appointments or consultations so and the I mean when we talk about criminalizing this woman as Miss Rawlins insists on calling her we're looking I think at a question of interpretation of the law rather than the law itself because the law allows for any sentence up to 24 months to be suspended for up to two years. Now, Miss Foster was sentenced to 28 months. This is a crime without specific sentencing guidelines. So the judge can't really say that his hands were tied by those. He did say, just to be clear, that he felt he did not have sentencing guidelines to follow

in this case. Yeah, no, that's what I mean. So there are some cases where there are formal sentencing guidelines where you follow a chart and it puts you in a category of a range of a specific sentence. Most sentences or most crimes have those sentencing guidelines. Now, because this is such an old offence, one might imagine, we don't have that specific chart, those guidelines. So the judge was left a sentence on the basis of case law, which is looking at other cases and what those sentences have been given. So had less guidance, which in some ways you might say is a little difficult for him, in other ways you might say gives him more flexibility and more freedom. And I think the question that's being asked, especially in this context where there is so much mitigation of the woman in question making this decision in the height of that first lockdown when her personal circumstances are such that she has three children at home, one of whom has specific care needs, as you've said,

why that sentence couldn't have been suspended when if it had been just four months less, it could have been. Yes, but that is all taking place within a criminal framework. I'm interested to hear how this could work outside of a criminal framework, Harriet. Is there examples? Yeah, there are examples across Europe where although abortion is still prohibited after a certain period of time um if an abortion takes place after that period of time then then it's the provider who is um punished whether that's through a criminal system or as is more common through a regulatory system now of course there are many sanctions for medical providers who step outside of their regulatory system which are not criminals so you

know the most extreme example is being struck off or having extra training and things like that are all available they're all non-criminal sanctions that don't criminalize very often the vulnerable person seeking the abortion but but criminalize or punish often without criminalization in fact the person who is providing the health care and I think in some ways that's a much more appealing option, albeit there are perhaps inevitable consequences with them restricting access. But on this, I suppose the providers did not have that information that this woman was so far along in her pregnancy. And I'm wondering what the sanctions should be or could be if, in fact,

in the UK it was decriminalised. Well, I think then we'd be looking at regulatory sanctions along the lines of sanctions for other medical professionals who step outside of the regulations, whether it's in providing other care or seeking seeking consent for certain things or you know an ordinary regulation of standards of care have ordinary sanctions so things like further training or being struck off at the extreme those are all available and i don't and i i think that's what's being asked for by yeah what about what about that ruth that that's probably is somewhere where you would agree with Harriet. That the providers, in fact, if in fact they provided it

outside of the care, which it should have been, we'd say within a certain amount of weeks, the other cases that she's looking at in places outside of the UK, it's the providers that instead are liable instead of the woman. Indeed, definitely.

I mean, they are the ones who are pushing these, you know, these pills by post. And I think that's part of the reason why they are calling for quote unquote decriminalisation to protect themselves. Because again, you have to look at public opinion.

Public opinion does not want babies at eight months, seven months being ripped apart limb by limb. People know what an eight month baby looks like. And public opinion is not for this. Ruth, I'll come back to a couple of words. One is that pushing, you know, that is a word that you are characterising how you see the current legislation that has been passed in Parliament. That was what was decided during lockdown, but it was to be up to a 10 week limit. So they were totally within their rights to send those pills and for women to ask for them

within those particular terms. I want to read some of the comments that are coming in, though. You do talk about public opinion, but of course, abortion is on the books in this particular way at this time. Let's get a reaction to what people are hearing so far.

This is Sharon in Hampshire. Abortion is totally a personal choice. I believe that everyone has their reasons and should never be judged. I feel total empathy for that lady and her choice has nothing to do with anyone else. Let me see.

The law is there to protect, especially for those who have no voice. We need to discuss the logic of babies in neonatal units born at 36 weeks or less. Those lives have been fought for a while. We are also discussing the possibility of termination up to term for those unborn. No woman should be

undergoing a late termination at home. I suspect this woman had suffered enough without a prison sentence. What about the rights and well-being of the mum's living children? Sending her to prison creates adverse childhood experiences for them all. It's crazy to incarcerate her. Legisl legislation is there

to protect the innocent, says another. This was a viable baby at 32 weeks. Infanticide is illegal. This baby could have survived and been adopted. Sad as this is, the child had a right to life as well. Let me go back to you, Harriet.

I mean, do you believe that in fact there is the political will to decriminalise in the way that Labour MP Diana Johnson was requesting? I think there's definitely the will to have the discussion. And I think the point that Diane makes is absolutely valid, which is it's been 50 years since this this bill was passed um and we absolutely need to be having a conversation where medical technology has advanced so much where women's health care has advanced so much but also where we're still in a state where um women's rights are nowhere near um where they should be if we look at comparable rights with men and adding in of course the fact

that the law that uh carla foster was sentenced under was an 1861 law that viewed for women very much as as chattels and a second class citizens we weren't allowed to vote we weren't allowed to own property in our own rights we weren't allowed to have bank accounts um so to say that that law is is not out of date is i think a little bit farcical i think there's certainly scope for the discussion and of course it's the thing that people feel very strongly about because of course there are you know there are babies born at 32 weeks and who do go on to survive but then also we we need to bear in mind the fact that if we look at the comparative analogy of organ donation we're not allowed to donate the organs of even dead people

without their consent in life even though that could well save the lives of two, three, four people. And we don't require any justification for that. And yet we are certainly Ruth is keen for us to put the lives of living women as secondary to those of the rights of the lives of the unborn. So there's a definite discrepancy in that. And I think it's absolutely time for that conversation. Let me throw that back to you, Ruth, before we go. You do believe at times, though, in abortion, if the life of the mother is at risk, correct? We're saying that, you know, you should never intentionally kill the life of an innocent human being where the intention is to go in and kill another human being

because we know an abortion is only effective if a human being dies. Sometimes, you know, where that baby doesn't die, they're called abortion survivors and there are people walking around today who have survived abortion. So yes, we're talking about the intentional killing of an innocent human being.

Yes, but I was just trying to be clear about where you stand on it. As opposed to, say, something like an ectopic pregnancy where they need to go in and do life-saving treatment. It's important to note that that is not even, it's not the same procedure

as an abortion. OK, Ruth, let me just stop there for a second. If I could just finalise my point, I just feel I haven't had enough time, as much time as my opponent. I feel that we have been discussing the issues back and forth,

but I do have one last question for you. Do you believe, same question as I had to Harry, do you believe that in fact decriminalisation will become the conversation? And do you feel that in fact it may go the way, for example, that Diana Johnson would like it to

and take criminalisation out of the conversation when it comes to abortion laws. We have to look at what that criminalisation, what law we're talking about. And Harriet brought up, you know, the offences against the person at 1861. That is, and just saying it's out of date just because it's old that very law protects me and you it protects us as people from offenses against us from us being killed and then obviously there is a section 58 and 59 which protects the unborn person it recognizes that these are people and throughout history we have known the science of embryology tells us that from that point of fertilization you have a whole unique living human being that's when the

life begins and so we want to see all human beings protected under law right everyone should have the equal rights to life and protected you under law and people can go and see what happens in abortion if they go to abortionreality.com you can see the reality of abortion. We invite you on because we want to have a conversation and I don't want to cut you off or speak over you but I do hope you feel you were heard. Ruth Rawlings from CBRUK

Centre for Bioethical Reform and also Harriet Johnson from Doughty Street Chambers. Thanks to all of you getting in touch. Tristan says this case is a very sad one. One size fits all law. With a one size fits all law is where the law looks

flawed. It's a very difficult debate to be had. You've been listening. It's a very emotive issue as people have strong views on both sides. Our child was born at 35 weeks and is and has grown up beautiful and clever and just incredible. So keep your comments coming. I'll keep reading.

84844. Now, I want to move on to my next guest who's sitting opposite me in bright pink this morning in the Woman's Hour studio, Susanna Hoffs,

founding member of the Bangles and a solo artist. During her college years, Susanna was stirred by punk rock and new wave movements, transformed by seeing the last ever Sex Pistols show and the Patti Smith group at Winterland. She started a band with Dave Roback, the collaboration dubbed The Unconscious. And then she went on, of course, to co-fan the Bangles, blending 60s garage rock, beautiful harmonies, jangly guitars.

And they became a seminal band of the 1980s with a string of hits. How does it feel hearing those songs? It feels great. Welcome, welcome, welcome. I haven't heard them strung together like that in a long time. It feels good. I have to say, I've met you before. Oh. I met you in 1986 when you were supporting Queen at the Lane Castle.

Oh, really? You know, I didn't actually go to see Queen. I went to see you Queen at Slane Castle. Oh, really? You know, I didn't actually go to see Queen. I went to see you. Really? Oh, my gosh. That is one of the most magical days in tonight that I've ever experienced in my life. So it's like 80,000 people for people who don't know Slane Castle outside Dublin. I was listening to an RTE report about it. It was like Susanna Hoffs, who leads an all-female band, which was a big deal.

Yeah, I mean, well, we thought it was a lot of fun. I mean, I'd always been enchanted by music. It was like a spell being cast on me whenever songs would come out of the radio growing up in Los Angeles. And from then on, yeah, I just wanted to pursue some kind of life in the arts. My mom was a painter and sculptor and my dad a psychoanalyst. So something about growing up in that household had an effect. And you're right. When I was at university up in Berkeley, California, I did have an opportunity to see a lot of music in San Francisco, like the Patti Smith group and the Sex Pistols. And I thought, I'm going, I want to do this. And I don't that I would hand drawn flyers that I'd made. And then I did advertise myself in a kind of throwaway paper where you could buy a couch, a used couch or a used car or find potentially a bandmate. And that's how I got to meet the

Peterson sisters, guitarist and drummer from the Bengals. And it just kind of went from there. And wow, what a wild ride. And I kept thinking of you and the 80s as I was reading your first novel, which is This Bird Has Flown, of course, also hearkening back to the Beatles song Norwegian Wood. You know, the Beatles are in the news today talking about using AI. We can talk about that later. Bangles might want to use AI to recreate some things. But with this novel, it's a little bit of romance, a little bit of rock and roll. It has music, fate, redemption, love. And it's got this protagonist, Jane Start, who sings and plays guitar.

She starts in Las Vegas. She has been a one hit wonder, unlike you. But tell us a little bit about her and why you decided to write about her. You've talked about your career in music, but now you're here. Well, yeah, I thought when I, it had been a lifelong dream to write a novel. And it just took a moment where I'd co-written a screenplay only to find out that it was stuck on a shelf in development hell. And my older son Jackson suggested, you know, he said, Mom, you've always wanted to write a novel. Why don't you? And I took a beat and I said, yeah, why don't I? So that was all I needed. And then he gave me another prompt to open my computer, look at a blank screen and just start. And so the following day I did that and I forced my and so I wrote a couple of pages and I forced myself to gather even my parents to come to the house to be witnesses to this launching in on this novel. But it just went from there.

I just had the, it was so transporting to be in the world of fictional characters that I love whose voices would just, they would just start talking to me and I just had to bottle what they were saying. And of course I had to craft the story of this one hit wonder who kind of goes on a journey to kind of find redemption in all ways in her life, including love, because she has been sort of dumped and thrown over for another woman. And there you have it.

So it gave me a lot of predicaments to deal with. Susanna Hoss would never have been thrown over like Jane Starrett, though. You know, there are grown men that swoon when I mention your name. Oh, well, I did have my, I did have a series of ill-fated romances in the 80s to pull from. But then I met my husband on a blind date in 1991. And we're still together 30 years later. All of us here with the two boys in London.

Oh, that's so great. Because the novel, it starts in Las Vegas, but she, Jane goes first class on a flight. I won't give away all the details, but she does meet an Oxford professor. Tom Hardy is his name, something of maybe a Mr. Darcy. There's so much of England. Have you spent a lot of time here? There's so many references to it as well. attended a charity event down the block from where I grew up. And there's newsreel footage of all the kids in the neighborhood. I'm somewhere in the mix, kind of gathering outside the home where the Beatles were. And my mom had all the Beatles records. And I think that sound, the sort of look,

feel and sound of swinging London of the 60ss that, you know, entranced me. And somehow, without even knowing it, I, as the story of This Bird Has Flown kind of evolved in my imagination, I just decided that she should meet a British man on a plane randomly, and then wind up spending a lot of time in England, in Oxford particularly. Yeah, because there's all those references. I saw you were written up in the local Oxford paper, actually, about the book.

Yeah, I know. They're delighted. And I just played the kite festival in Oxfordshire. How was that? It was amazing. It was amazing to commune with people who love books and music. And at the end, somebody kind of came over to me with a guitar and I was like, okay. So I played a few songs as well. It was really, really fun. Because you are also,

as I mentioned, you've got also an album of covers coming out. It's called The Deep End. But I've heard that described as a feminist version of the Rolling Stones under my thumb. Yes, that was the intent. I love the Beatles and also the Rolling Stones. And one day I'm on my walk where all my creativity seems to be sparked when I'm on a walk listening to music. And I listened to those lyrics and I went, wait a minute.

This is time for a reinvention. What if we flip the gender? It's great. But the thing I was when I was listening to some of your covers and also reading the book, I was like, how does this woman get the time to be so creative and put it all out there at the same time? Well, I just carved time for it, I just carved time for it. I just made time for it. And, you know, there was an opportunity to be touring with the Bengals, but I'd done so much of that, decades of it.

And I just thought, I have this one chance. My son gave me the prompt to write that novel I'd always wanted to write and I just made the space for it. Let me turn wanted to write. And I just made the space for it. Let me turn back to Jane. She doesn't want to be a world touring stadium playing artist. She would be happier as a close to home folk singer. Is that something you identify with?

I see you on TikTok as well. You often have your guitar. Yeah. And obviously you've released this album of covers. Where are you most happy? I am quite happy now, you know, not having to feel the pressure to wear a miniskirt and lots of makeup and, you know, to just be more my of music with other people who love music and do it in a more simple way, just, you know, with a guitar and singing. And, yeah, I don't know. It's feeling comfortable and authentic to do it that way now. What did it feel like as well, thinking back into that world of music, what it was like?

We mentioned the stadium gigs at the beginning. Lane Castle gig was one of the greatest, watching Freddie Mercury, as I said, and the band from the side of the stage. But it was quite compressed, the 80s, for me. It was so fast-moving. And when you're in a band, it's like it's its own family. I had the two sisters in the band, myself, and the bass player. And it was just, it was a bit of a pressure cooker. And there was,

there was a lot of, yeah, I don't know, it was wonderful. But reflecting back on it, it's not necessarily, I like writing novels. Let's just pivot to that. I really love being home writing novels. So my next question is, will there be a follow up? Oh, yes. I've already just broken the ice on the next one. Have you? Yeah. Was the family invited around to see the beginning of it again? I have not read that first page to anyone. I've written about just the just broken the

ice the first few pages because I just I been, I've been nervous to do it. I felt the pressure. Is Jane back again? Yeah. Jane is back. Yeah. Okay. So we're going to follow Jane's start

and see where she goes next. I have to say, I've really enjoyed it and it's got wonderful reviews so far as well. Best of luck with it. Thank you. Susanna Hoffs,

of course, off the bangles, but also author, her debut novel, which I feel is probably going to be turned into film. Oh, that's all right. Yeah, I've already written

the screenplay. Yeah, Universal's picked it up. Yeah, I could see it. I could totally see it as I was reading it. Oh, good. Susanna Hoffs, thanks so much for coming

into Woman's Hour. Thank you. Now, I want to move on to bone health. How much do you think you know about your bones and the health of your bones? Well, an NHS GP

and Woman's Hour listener, Dr Laura Flexer, emailed the programme to ask to talk about that, bone health, and especially that of teenage girls with anorexia. According to her research,

young women with the eating disorder can lose bone mass, a problem that can persist even long after they've addressed anorexia, and which can lead in the long term to osteoporosis. So Dr. Flexer asks, should teens be offered oestrogen as a preventive measure? I'm joined on Zoom by Professor Sandeep Ranaut, expert clinical media spokesperson for the eating disorders charity BEAT,

who's a consultant paediatric psychiatrist for eating disorders in the NHS. And also Dr Flexer is with me here in studio, who co-wrote the paper Eating Disorders and Bone Health, a Missed Opportunity? And it is being presented at the RCOG World Conference this week.

Laura, you're a GP who specialises in the menopause. So why did you want to look at teenagers and bone health? And welcome. Hi, hi Nuala. Thanks so much for having me on today to talk about such an important issue. So as a GP who does a lot of menopause, I spend a lot of time talking and thinking about bone health. And through that have come to the realisation that awareness of bone health and the importance of it is generally quite low, even amongst some healthcare professionals. And when osteoporosis and osteoporosis being a condition where the bones are thin and weaker and break more easily with little impact. You know, this is a largely preventable condition that has really devastating consequences for the patient, for their loved ones, for their carers. And with awareness of the risk factors

of osteoporosis and, you know, awareness of the need to take care of our bones, we really can reduce the impact of this devastating condition in society. And, you know, I think that the way that we look at bone health around the menopause in terms of oestrogen is how we came on to write our paper looking at girls with anorexia and the impact on bone health at that stage of life as well. So in your paper, it says the typical age of onset of anorexia is 15 years. And on average, it takes an anorexic patient five to six years from diagnosis to recovery. So what can happen to bones in that time? So bones are really fascinating.

They aren't fixed, solid structures, as you would think. They're actually constantly changing over time. So they're constantly being what we call remodeled. So cells that build up bone and cells that break down bone. And it's the balance between these two processes that determines whether or not we gain bone or lose bone at that particular point in time. Really interestingly, we actually get an entirely new skeleton every 10 years, which is extraordinary. And there are lots of factors at play in the way our bones are remodeled. But for women, a really important factor is our oestrogen, which is why doing lots of menopause work, I spend a lot of time talking about bone health. Because, of course, at the menopause with a reduction in oestrogen, unfortunately, women go through a period of rapid bone loss

around that time. So it's very important to be aware of your bone health around the menopause. But actually, oestrogen is an important factor in bone health and other stages of life. And for adolescent girls, we go through a phase of rapid bone accrual, so bone gain in our late teens into early 20s. So that time people could be affected. Exactly. And that is a really crucial stage for bone development. But what you're talking about is raising the question about oestrogen. Why could it be or how could it be used as a treatment or a preventative measure?

What would it do? Because there may be alarm bells if people just hear that sentence. Sure. So anorexia is a devastating condition whereby low body mass causes the body to go into sort of a conservation mode where some biological processes are shut down. And one of those is the hormonal axis that stimulates the ovary to produce oestrogen. So in girls with severe anorexia, where their periods stop, this becomes a low oestrogen state. And as you've just mentioned, Nuala, average age of onset is about 15. Recovery can take years and years. And so if you think about the importance of oestrogen in that really crucial bone development stage for these teenage girls and young women in their 20s, that low oestrogen in that really crucial bone development stage for these teenage girls and young women in

their 20s, that low oestrogen insult on the bone and that crucial stage of bone development can have long lasting impact on bone density for the rest of their lives and hugely increase the risk of osteoporosis. And the statistics around osteoporosis are truly shocking. This would be intradermal if I've understood.rogen through the skin during their recovery process for anorexia, we can actually protect their bones from the impact of having low oestrogen during this time. And we went on to look at how bone health is managed locally where we work. I say we because the paper was written with some lovely colleagues. And we discovered that actually this is not common practice either in primary care where of course lots of girls with anorexia are managed by their GP, but also not in the eating disorder services, which is in contrast to other areas of the country. Well, let me turn to Sandeep there. Laura's mentioned there isn't, she's surprised there's not more general take up or interest from eating disorder charities like this. Why do you think

that's the case? Do you think maybe just not aware? Multifactorial, like all things. But first of all, I want to say so much, but I want to start by saying Laura and her colleagues, absolutely brilliant paper. So pleased that it's going to be presented this week because anything to do with mental illness, I think we need to keep that spotlight shone on. But the fact that you've chosen eating disorders is crucial and bone health within eating disorders is often, although it's talked about, isn't necessarily where the focus lies of both training, research and funding. So I think what Laura's doing is brilliant from that primary care lens but not just primary care obviously she's a specialist around hormone replacement therapy 10 or 15 years ago were we talking about menopause in the way that we are now so one of the things I talk about is I'm so pleased, I'm so glad the consideration of anything that is going

to help an illness that is hugely complicated, still actually poorly understood in terms of etiology and causes, where we've made huge advances in our understanding genetics, neurophysiology, neuroanatomy, but we're still not there. So what I am really keen to do is better research. We're years and years under resourced research in this area, better training. And I think Laura brings that out in Laura and her colleagues bring that out massively in her paper. And that's not just for doctors in primary and secondary care. That's for health care professionals. We, again, have made progress, but not enough. And training, research and funding. So your question about are we doing and considering in specialist services, and if we're not, why not?

We are, but probably not enough. So it depends on the configuration of your services in terms of the skill mix. In our services, for instance, we work very much in collaboration with our paediatric endocrinologists. I think it's got to be a multidisciplinary decision, really important, and using the evidence-based frameworks. So where we can and where our framework allows us to, we absolutely should be having those conversations

to help families and young people make informed decisions. And I'm wondering about that, Sandeep, though, because we've talked about anorexia a lot in this programme. And even I spoke to Hadley Freeman not so long ago, and there was so much emphasis on survival, to be quite honest, you know, for somebody to make it through day to day. And I don't think there was perhaps always, correct me if I'm wrong, but that more long term thinking about the potential physical impacts of anorexia. Would that be fair, Sandeep? So, yeah, I think it's a fair comment.

It's changing. And with greater awareness, COVID also has shone a massive spotlight, particularly in this age group. Post lockdown in this country, we saw up to a threefold increase in presentations with anorexia. Laura makes also a really good point. You know, it's delivery method, skin, transdermal versus oral. What dose, what duration and what cohort of young people do we have the best evidence? I'm wondering, Sandeep, and I know you're not an oestrogen

expert, I want to be clear about that. Yeah. But many people will immediately think there must be negatives of young women taking oestrogen. What would that be as far as you know? Well, and you're right, I'm not the hormone replacement or endocrinologist on the team. And that's why it's really important to work as a team with young people and families and seek that advice. And also colleagues in primary care have specialisms. So, again, it's about having primary care physicians around the table making those decisions. It's weighing up like everything risks and benefits so i think again laura and her colleagues outline this is where we've not necessarily got the evidence for oral but for transdermal this might be a breakthrough in terms of then having those

discussions so that people can make informed decisions about um people will be worried about breast cancer risk about um endometrial risk what other things can we do how can we weigh up this because don't forget the important thing also here is laura's pointed out a three-time three it increases your risk three times of osteoporosis you know fractures as long-term incapacity and also anorexia carries the highest mortality rate. Yes, well you go ahead indeed when it comes as well to eating disorders. Let me turn back to you Laura though because people will be concerned and people might be thinking HRT, hang on I usually need to take progesterone

with my oestrogen and stuff like that. But this is oestrogen only and what would some of the negative potentials be? So actually, it's not oestrogen only. So it's given as HRTs, it's given as cyclical HRT with a progesterone cyclically. So that person... As well, okay. Yep, yep, yep.

So we wouldn't be able to give oestrogen only to a woman with a womb. You know, I think really one of the really important points here is looking to the ahead in that person's life when they hopefully do recover from anorexia to just, you know, underline the devastating consequences of osteoporosis. across a few GP practices locally. And the women who had had a certain type of scan called the DEXA scan to look at their bones were by and large women who had recovered from anorexia and had a normal body mass for many, many years, but still had developed osteoporosis from having had an eating disorder in their adolescence. And the, you know, the impact of that really is huge. So in a woman over 50, their risk of dying following a hip fracture is actually the same as their risk of dying from breast cancer.

And yet we talk so much about breast cancer. And understandably, that's an enormous risk for women. But we don't talk about osteoporosis. Hip fractures are particularly devastating. And following a hip fracture, 20 to 25% will die within the first year. And up to half of these people will never live independently again. So the morbidity and mortality

that ensues from osteoporosis is massive. I know when we've spoken about anorexia previously on the programme, so many people got in touch that had gone through it or perhaps had a loved one that was going through it or went through it. What can they do now? So in terms of if you are struggling with anorexia.

Well, we could talk about that very briefly, perhaps. Should they go to their GP? And so the really important thing I want to I wanted to come and talk about today is awareness, is to ask that question. Go and say to your healthcare professional, to your GP, probably your first port of call, or if you're under the eating disorder service, and say, can you help me to talk about my bone health? Are you thinking about my bone health? Do I need a DEXA scan? Which is a bone scan. Which is a special bone scan to look at my bone health. I've heard that there's something that I might be able to have that could protect my bones during my period of recovery from anorexia that will reduce my risk of osteoporosis later on in my life.

What else can I do for my bone health? And I think that's the first step is to ask the question. I have one more question for you and then I will let you go. For people who have gone through anorexia, maybe when they were younger, maybe they're not, maybe they're perimenopause, wherever they are in their life cycle now, is there anything that can be done for them? There's loads that you can do to help your bones and things like making sure you've got adequate vitamin D, good calcium intake, weight-bearing exercise but not too much are all really important things for bone health. I think if you have got a significant risk factor such as anorexia in your adolescence

and you've now recovered again go to your GP tell them you have this big risk factor please can I have a scan to look at my bones and then to be able to have a risk-benefit discussion about a treatment that is right for them at that stage in their life, depending on where they are and what age they are. Dr. Laura Flexer, thanks so much for emailing the programme. Thank you so much for having me. It's been a wonderful experience to come on and raise awareness. Yeah, no, fascinating. No doubt people will have lots of questions as well. And also to Professor Sandeep Ranaut, you're both so welcome. And thank you for spending some time with us here on Woman's Hour.

Now, let me move on to my next guests. Last Friday, you might have seen climate activist Greta Thunberg, who's graduating this week to Twitter to mark her final school strike for climate and to reflect on the movement she began five years ago in 2018. Seems longer. Since then, Ms. Thunberg has inspired millions of children around the globe to join the Fridays for the Future movement, addressed world leaders at the UN, the Climate Action Summit, and became a household name for her activism.

Let's listen to a little of her in 2019 at the UN Climate Action Summit in New York. This is all wrong. I shouldn't be up here. I should be back in school on the other side of the ocean. Yet you all come to us young people for hope. How dare you? You have stolen my dreams and my childhood with your empty words. And yet I'm one of the lucky ones. People are suffering. People are dying. Entire ecosystems are collapsing. We are in the beginning of a mass extinction, and all you can talk about

is money and fairy tales of eternal economic growth. How dare you? Greta concluded her Twitter post. You might have seen this after she finished on Friday. The fight has only just begun and promises she'll still be protesting on Fridays, just not the school ones, I guess. And it seems like a good moment. Let's look back at the impact

of the past five years of Greta's work and also what she might do for the future. We have in studio with us the Guardian climate journalist Fiona Harvey. Welcome Fiona and climate activist Michaela Loach back with us. Hello Michaela. Well, what about that Fiona? What do you think? How much did she really achieve

in these past five years? How would you characterise it? A huge amount. I mean she's been absolutely iconic. She's really galvanised the discussion around climate change. She has spoken truth to power. She's gone to these UN meetings. She's said very striking things, no holds barred, to these middle-aged men in suits who've been sitting around talking about the climate for 30 years without doing very much. She has been an absolute force to be reckoned with and what she's done has been amazing. Michaela, you know Greta personally. We've met at a few different events. Yes, and of course,

so you were a part of one of those young people as well. Were you inspired by her? I think I definitely was inspired by Greta. I think, I mean, almost any young person who's come up in climate recently. But I think I was also inspired by so many other activists who maybe don't get as much of a spotlight. Well, that's something I want to talk about with you

because she does have the spotlight. Yeah. And some are wondering whether it should all be focused on her. How do you understand her role in the spotlight and whether it's been a help or a hindrance for the movement over the past five years? I think she's been an incredible leader of our movement. I'm really grateful for all the work that she's done.

And I think she's carried that with so much grace. But at the same time, I think it's important for us to recognise that she was chosen by the media to be the face of the climate movement over kind of indigenous youth who've been chaining themselves to pipelines for generations. People like Esneda Saavedra Respeto, who is an indigenous climate leader, who since she was 13 years old, she's in her 40s now, has been taking action, has been challenging corporate interests of companies like Glencore in Colombia. And so I think it's important to recognise who gets the spotlight. And maybe it's because some people seem less challenging to corporate interests or to the systems at play.

So I think it's important for us to realise that there are other people who maybe weren't chosen as well. What about that, Fiona? I think it's absolutely right that we do need to have more voices on this. And we need to have voices from all over the world, from indigenous people, as you say, and the global south. But also that Greta suited the media. I'm paraphrasing you, Michaela.

Greta came along at an important time and she's a very striking person. You know, she's got real charisma and the way that she speaks, she really, she's unflappable. She sticks to the facts, you know, and she speaks so clearly and forcefully. She really is a fantastic spokesperson

what do you think Michaela concrete change that she achieved I mean getting climate as a thing that's talked about so often and everywhere and and the thousands if not millions of actually young people who've been mobilized into this movement all over the world and I think that's been a huge huge win in the fact that we now talk about climate as like a climate emergency, I think a lot of that came from a spark that was lit and that she was part of. I think that also came from the fact that when she was kind of put into the public eye, that was around a similar time when one of the big IPCC reports came out, this big report on the climate crisis and the science.

So I think she's done a huge amount to mobilise young people around the world and to show also that no one is too small to make a difference, which is something that she talks about. Because it was a solo protest where she started. What about Fiona, some of the people she butted heads with? I mean, even of late, really, I suppose, recently Donald Trump, for example, or if we talk about Andrew Tate. What do you think that does for her,

for the movement? Well, it's great because, you know, she really took no nonsense from Donald Trump. She showed him up for what he was. And similarly with Andrew Tate, she really took him on. And that's really good that that's happening. I don't think that Greta is overshadowing anyone or preventing other voices from coming forward. Quite the opposite. She's been very keen to nurture other voices, to make sure that other people are heard from all around the world. So she's used her fame, her time in the spotlight,

to really bring other people forward. Do you think this will be the end of her time in the spotlight, Michaela? I definitely don't think so. And I think I also want to touch on the fact that I don't think any of this has been Greta's fault in any way. I think she's done an incredible job. But I do think there is, if I ever do an interview with a journalist, I always get asked, are you the new Greta? You know, I've seen so many headlines, the Bolivian Greta Thunberg. Yeah, exactly. And I think it is like somewhat frustrating, I think, for activists who, and not just for myself, but for many people who in their own respect, like do incredible work, or even, for example, how like Vanessa Nakate, the Ugandan activist was cut out of a photo where Greta was in that photo as well but as the only black activist in that photo she was cut out of it so I think that there is something to be said about how the media have used almost Greta to eclipse some other work but

I don't think that's Greta's fault at all and I think that she has done and she continues to try to learn more and more and we have to also remember that she was a child when she was given the spotlight. Well what about that I mean a young girl as well this is woman's hour that was thrust into that spotlight. I can't even imagine how stressful that must have been and I think that I think also something to do with her being a young woman is why maybe some of these men have found her so threatening in some ways because she's a young woman a young neurodiverse woman who speaks like a truth to power in such a powerful way I think that that has made some kind of the masculinity a bit fragile with maybe some of these big powerful leaders.

Fiona, you've been covering her. What do you think she'll do next? Well, whatever she does, it will be earth shattering and world changing, I hope, because we need action on the climate right now. We can see what's happening around the world. Climate change is happening in front of our eyes. We need to be taking action. And there is so much that we can do. We are not helpless in the face of climate change. And we actually could do a lot to make our world a great deal safer if we phased out fossil fuels. And I think that what I also want to say that I want people to really recognise that you don't have to be perfect. You don't have to be a hero. I think sometimes these kind of heroes or these exceptional individuals

can make us feel a bit disempowered of our own impact that we can have. The fact that actually, even all the changes that we've seen happen since Greta's been put in the spotlight, a lot of that change was because of millions of ordinary but wonderful people who've done so much work

that is kind of invisibilised behind the scenes. So I think we also need to kind of interrogate our importance we put on much work that is kind of invisibilised behind the scenes so I think we also need to kind of interrogate our like importance we put on individualism or these kind of hero narratives

and I think that Greta is an incredible person but also all of you listening are incredible too and you can do many great things as well And you don't have to be Greta Michaela Loach

and Fiona Harvey thank you both so much Tomorrow we'll talk about receiving £1,600 a month with no strings attached and no means testing it's universal basic income I'll talk about receiving £1,600 a month with no strings attached and no means testing. It's universal basic income. I'll talk about that.

I hope you join me on tomorrow's Woman's Hour. That's all for today's Woman's Hour. Join us again next time. Hello, my name's Michelle D'Souza. And I'm Laura Smith. And we have a new podcast from BBC Radio 4. Bang On It is a weekly podcast where we curate, recommend, cherry pick through the week

and just go, have a look at that. Basically. We're going highbrow, we're going lowbrow, right? We're doing the legs. We're doing the hard yards so you don't have to. Oh, I like that. Listen, like all podcasts, we're talking about stuff we've done,

whether you should bother doing it, but really we're waxing lyrical and... Trying to make that paper, baby. The economy's in the pan. Subscribe to Bang On It on BBC Sounds. I'm Sarah Treleaven, and for over a year, I've been working on

one of the most complex stories I've ever covered. There was somebody out there who's faking pregnancies. I started like warning everybody. Every doula that I know. It was fake. No pregnancy. Andancies. I start, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig,

the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story. Settle in. Available now.