Woman's Hour - ADHD and women, Author Claire Lynch, Gaming for good

Episode Date: January 23, 2026

A study led by the University of Oxford shows a 20-fold rise in the proportion of women over 25 using ADHD medication in the UK. The study looked at 5 countries - Belgium, Germany, the Netherlands, Spain and the UK - showing use has more than tripled in 13 years - the UK having the highest relative increase. To unpick this, Anita Rani is joined by Amanda Kirby, former chair of the ADHD foundation and Emeritus Professor of neurodevelopmental disorders at the University of South Wales and Kat Brown, author of It's Not a Bloody Trend, who was diagnosed with ADHD aged 37 and uses medication.The Oscar nominations are out and to celebrate we revisit our recent interviews with nominees, Hamnet director Chloe Zhao and Kate Hudson, who's up for best actress for her film Song Sung Blue. Author Claire Lynch discusses her debut novel, A Family Matter, which recently won the Nero Book Award's prize for debut fiction. Having spent her career teaching literature in universities, the author of non-fiction book Small: On Motherhoods, was inspired by her discovery that 90% of lesbian mothers in 1980s’ divorce cases lost legal custody of their children. The novel alternates between 1982 and the present day and explores love and loss, intimacy and injustice, custody and care.Miscarriage in the early stages of pregnancy is common. But clinical NHS practices for disposal of pregnancy tissue following an early stage miscarriage can sometimes appear to be at odds with some women’s wishes and are not conducive to inclusive care. That’s according to a new study published in Social Science and Medicine and reported in the British Medical Journal. Susie Kilshaw, Professor of Medical Anthropology at University College London, spent nearly two years observing miscarriage care inside one of England’s NHS Foundation Trusts and interviewing women about their experiences. Susie explains how she found that the choices available often didn’t match what women want.Can video games be used for good? From reducing our environmental impact to fundraising for access to education for all, Jude Ower from not-for-profit gaming platform PlanetPlay has spent the last two decades creating initiatives to do just that. Jude has now been named by the Aurora awards as one of ten women to watch, who are shifting the dial in the gaming industry. She joins Anita in the studio.Presenter: Anita Rani Producer: Sarah Jane Griffiths

Hello, I'm Anita Rani and welcome to Woman's Hour from BBC Radio 4. What a lovely way to start the program. Thank you and cheers to you. Good morning. Welcome. On the program today. ADHD, attention, deficits, hyperactivity disorder. New research has found the number of women over the age of 25 on ADHD medication has increased dramatically. We'll be understanding more. We're also going to be discussing a very sensitive issue around miscarriage and what happens to the pregnancy tissue in a clinical setting, what options are offered, if at all, to women going through this trauma?

And we'll get an insight into the world of gaming and how games can be used as a force for good. Plus, author Claire Lynch is here to talk about her debut novel Family Matters. The story is based around the little-known history of the treatment of lesbian mothers in British courts in the 1980s. Around 90% of lesbian mothers in the last year, divorce cases, lost legal custody of their children, tearing families apart. The novel is about a child who we meet as a woman in her 40s who never knew the real reason

she didn't see her mother, a secret kept from her. So maybe this is a story you can relate to, in which case we would very much like to hear from you this morning. Or is there a family secret that you only discovered as an adult? Maybe you're keeping a family secret from others. If you are, why are you and what toll is it taking? Please share your stories with me and remember you can remain anonymous. The text number is 848444.

If you wish to email us, then go to our website. And our WhatsApp number is 0700-100-444. And if you want to follow us on social media, it's at BBC Woman's Hour. That text number once again, though, 84844. Tell me your secrets. First, a study led by the University of Oxford shows a 20-fold rise in the proportion of women over 25 using ADHD medication in the UK. The study looked at five countries, Belgium, Germany, the Netherlands, Spain and the UK,

showing use has more than tripled in 13 years, the UK having the highest relative increase. Although ADHD medication use remained higher among males, the gender gap in treatment narrowed over time and with increasing age. That's what the researchers have said. Well, to unpick what lies behind this increase, I'm joined by Amanda Kirby, former chair of the ADHD Foundation and Emeritus Professor of Neurodevelopment Disorders at the University of South Wales. Also with us is Kat Brown, author of It's Not a Bloody Trend,

who was diagnosed with ADHD age 37 and uses medication. Kat and Amanda, welcome. I'm going to come to you first, Amanda. Why is there such a big rise in women over 25 using ADHD? medication. Well, I think it's the way we've looked at ADHD in women has been historically really underdiagnosed. So currently the prescribing partly reflects a correction of the longstanding misneeds rather than a sudden rise. So we can go, why is this rise? But actually, we weren't diagnosing women to relatively recently. We were looking for male symptoms predominantly.

Awareness has increased. So that's the other bit. So generally awareness across ADHD and other conditions like autism has increased and professionals are being more aware of how do identify, what do I need to do, and referring people, rightly so. The other key thing is many women were previously treated for anxiety and depression. And I always think of the term hysteria. Hysteria was in the diagnostic criteria, which is all about women's wombs, right? Yeah. It comes from until the 1980s. So the knowledge and awareness around ADHD and women is relatively these really recent and we're now looking at the hormone interaction between ADHD and looking

at how it presents differently. Who knew that women had hormones till now? So there's a catch-up going on and I think the UK just presents that we are perhaps ahead of the game in the sense of awareness is good but the services weren't there. So to relatively recently, even 20 years ago, we didn't really have adult services for ADHD particularly until recently. They were predominantly boys and then men. So this is a new conversation. And the research in women is relatively new. There was around ADHD and the menopause.

That was only in 24, 25. Which is amazing when we think how long we've talked about ADHD in the research and the clinical practice. I want to discuss that with you, actually. We'll get to ADHD and women in the menopause and various things. I'm sure there'll be lots of people leaning in to listen to this. But let me bring in cats.

You were diagnosed at 37, Cat. What was your experience of getting a diagnosis? Oh, goodness me. Well, it was firstly just like lots and lots and lots of car crashes sort of through my life up until it got to the point when I literally just looked on Twitter one day and somebody had shared a thread by an ADHD coach asking adults how they'd had that lightbulb moment

about knowing that they had ADHD. And I mean, everybody's, life is fairly specific to themselves, I'd say. But even so, looking through this thread, I was like, it's me, it's me, but hang on, I'm not a middle-aged man. How is this also me? I had given up alcohol the year before, having desperately tried to understand how to manage it and tried endless dry January's and sober octobers and all that sort of stuff. And what I really found was that not having alcohol anymore as a social crutch or anything else like that had shown what I later understood to be my ADHD symptoms and stark relief. I mean, it's not as if I haven't

been near my GP in years either. I'd been treated for depression, anxiety. I'd even been surprised to be diagnosed with an eating disorder, which I didn't realize. I just thought I was greedy and disgusting. And it turned out it was binge eating disorder instead. So I'd had all of these, all of these sort of conditions, but nothing had sort of ever helped me, even though I'd, you know, paid for therapy, I'd had therapy on the NHS. They'd just never helped me understand why it was basically a suicidal upset person. That sort of parallels, but what Amanda was just saying. So how did the medication change things for you? Oh, well, my immediate, happy response was, well, I'm going to be a completely different person and everything will be magic and fine. And I'm,

actually what happened was it took a solid year of working with my psychiatrist because I did originally go and do a TED talk to my GP. I went on to an NHS waiting list, but in the end I couldn't wait. Ha-ha, and spontaneity, what a surprise, and paid to have a private diagnosis through my tax savings. But not every single medication worked instantly. I think there's this imagination that ADHD meds are just one tiny pill. And it's no, God, not at all. I mean, I'm on a what's more like a sort of little scaffolding of things, not necessarily to hold me together, but all interacting in different ways. But what I will say is that the medication coupled with therapy to work on accepting that my life could have been different, but it wasn't, and that's totally fine. Plus also all the other non- ADHD stuff that's happened in my life as well has been just such a huge factor in making me feel much less like a horrendous.

effective robot. Amanda, I'm going to bring you in. I mean, I'm sure you can understand because you've probably heard from so many people and a lot of women about how their ADHD impacts their lives. But what questions, you know, do these figures raise about long-term treatment patterns, care that's needed, tap into what Kat was saying, because, you know, specifically for what the needs of women are? Well, I think the first thing is we need to raise awareness in clinicians, GPs,

GPs are often the first port of call to understand what women's symptoms and signs of ADHD are. And I think that's really important. Kat's experience of having anxiety or depression and, you know, is not uncommon. And in fact, there's good evidence to show that. So that's really important that GPs, if you go there, take women's symptoms seriously, understand what they are, but also understand. And I think your point was just a pill won't sort of solve every ill. And I think that's important.

So getting awareness that Medicaid, is part of intervention and understanding what the interventions are for females because of we know that dopamine interacts with estrogen. So we also know in females that your symptoms of ADHD vary across your cycle. So this is really important that we are going to have to get that information out there to clinicians, but also to individuals to recognise that the diagnosis might be a starting point, but other things might need to happen as well, help with planning an organisation help with managing your emotions. And also like Kat says, getting a diagnosis later, often people feel angry and grief reactions, really, of I wish I'd known if only I had.

And dealing with some of that as well helps people to move on. Can you relate to that, Kat? Oh, hugely. When I first got the diagnosis, I felt almost as though I was walking off into the sunset and nothing would ever be bad again. But, you know, it's life and life carries on, you know, lifing. But it's just made such a huge difference to know. And what is fascinating is I keep getting emails, messages from people, not just my age, I'm now 43, but in the 60s, 70s, 80s even.

Because it's not as if you get to a point in life where you want to stop understanding what makes you tick, not just so that you can operate better, but so that the people around you know how you work. and so that also, sadly, so that you can be less of a burden to other people, I felt like an enormous burden in my life. And something I would say as well is I only discovered a few years ago that rather than having PMS symptoms, if you like,

I've actually got that condition that you were discussing on the show the other day, PMDD, and lots of people anecdotally find that their ADHD meds simply don't work around the time of their period, which is not helpful. I'm also very much in the throes. of perimenopause right now.

I'm sitting here having a lovely hot flash as we speak. I do apologise to anybody watching visually. But it's all tying in with HRT and hormones and ADHD overplay. But again, because it's only been the last 12 years that we've understood about women, ADHD, and even since 2013, that autism and ADHD could be diagnosed comorbidly. So that's another huge sway of potential people who will then be hopefully finding some help through meds. Well, wonderfully, we've got Amanda to kind of answer some of these questions. But by the way, if people are watching you, we are just, well, personally, I'm delighted by your fantastic wallpaper behind you.

And the combination with that amazing shirt you're wearing is very, very good. And so, Amanda, before we do discuss what happens when, you know, when women hit perimenopause and menopause, we can't take for granted that everyone knows what we're talking about. What is it? What is ADHD? So, attention-deafed hyperactivity disorder. the deficit in the disorder are not a great sales tools because it says the things that we're challenged with

and actually it challenges because often people with ADHD find it can hyper focus on things but find it harder to shift focus. In males, there is overlap. I want to make sure we say that. It's not males of this and females of that, classically, but there are overlap. But in attention, so losing focus on the things

which are boring are not so interesting. Procrastinations are getting started to get going, be really difficult. And time estimation, knowing how long something's going to take, that can be quite hard as well. And that can have an impact on your organisation, getting things done, getting things done to time. And hyperactivity that you see in the boys can just be busy brain, this brain that doesn't switch off. And often that has an impact on things like your sleep rhythms as well, so getting to sleep. And that can lead to fatigue as well, so more fatigue as well. So it, You know, people say there's lots of, oh, we've all got a bit of ADHD.

There's a difference between somebody having in attention and not being able to focus because of lots of things going on in their life or being distracted by social media. And somebody actually, the impairment, you don't get a diagnosis or shouldn't get a diagnosis of ADHD. If it's not impacting, it's not all wonderful. If it was, people would not be going forward to try and gain a diagnosis. You know, so it's about the impact on day to day. But it varies hugely. that's really important. Not everybody looks the same with ADHD and so that's why

interventional support needs to be tailored to you in the context of your life, the age you where you're working. And this increase that we're talking about in medication is set across a backdrop of concern on meeting the demand for adult autism and ADHD diagnosis that Kat just mentioned. And yesterday, Wes Streeting, I'm sure you're aware Amanda, speaking on BBC Radio Oxford, admitted the NHS is falling short on this. He went on to say it was a national issue that he was very worried about, should he be? Well, I think, yes, we've got higher demand. We haven't got the services set up.

We need to look at upstream, so we need to be helping children, young people, adults, in education and employment, in the communities, to ensure that people are getting the needs-led support. So let's have the help while waiting is nothing, right? So while you're waiting, you're not getting anything. So let's look at who's in the greatest need. And at the moment, because of the raise in a WIO,

We're all running to the gates trying to get an assessment. And what it means is if you can't get an assessment, you can't get diagnosed. You'll either go elsewhere like Kat did or you won't. And individuals who are from socioeconomic groups or moving around systems, we need to get left behind. And we see that in the justice system, high rates of ADHD traits, but not being diagnosed because of poverty and other reasons. So needs led upstream, we need to get those systems. So yes, we need to be concerned, but there are solutions. And what do we know? Because it's something that comes upon the program time and time again and the impact of menopause on ADHD symptoms and women's lives. What do we know? Well, first of all, perimenopause, you're suddenly going, your estrogen's going all over the place. And dopamine and estrogen interact with each other

and it's really important for the helping you to focus and concentrate. And at that time, when your estrogen levels are going all over the place and you're having the flushes and night sweats and all the other lovely symptoms that are related, you can get worse concentration, brain fog, increased forgetfulness, heightened emotional reactivity. So it's some of the symptoms on steroids, well, not on steroids, but heightened, right? And I think that, and you see the reduced effectiveness of your coping strategies. Yeah. The other bit is really understanding, if you're on ADHD medication already, it might be that needs to be looked at.

And we are really at very early stages. I'm sort of upset by that in 2026. we're only starting to talk about these things in 24, 25. We need longitudinal studies about what do we treat, how do we treat effectively in this time of life, which really is really important for many, many women who've been missed or misdiagnosed or misunderstood. And yet the numbers are so small as well.

If I may just very briefly, this increase, this 20-fold increase, if you like, is from 0.01% of all over 25s in 2010 to 0.0.0.4.4. 20% in 2023. This is still tiny. Just because, you know, some rather bad faith people are going, oh, people are taking up the NHS's time. Yes, they are because the side effects, the impacts of not being diagnosed are absolutely enormous. And very important. The ramifications of lack of diagnosis or wrong diagnosis cost in society. And as you say rightly, Kat, the relative increase is small. We're still under-diagnosing. There's a huge catch-up. So we do need to do more.

Really interesting conversation. I want to thank you both for joining me to talk about that. Amanda Kirby and Kat Brown, 84844, if you'd like to share your experience of that sparked, something that you want to tell me about. I've had a message here from someone saying I'm a 60-year-old woman and a psychotherapist. I am recently diagnosed combined type ADHD. I think of all the years I labeled myself lazy, uncommitted, disorganized and impulsive. Did you label yourself that or did other people? I don't know. I'm just putting it out there. There is relief. but also a lot of grief at what might have been had I had I been diagnosed and supported earlier. Well, I'm glad you have had your diagnosis now. Thank you for your message, 84844. Now, the nominations for this year's Oscars are out, and as you may have heard, the vampire film Sinners has broken the record for the most Oscar nominations received by a single film with 16, including a best-supporting actress nod for our very own,

were me Musaku for her role as Houdou Priestess Annie. She is incredible in it and the film is brilliant. Hamnett has received eight nominations. Have you seen it yet? You may have caught my recent interview with its director Chloe Zhao, career high for me. She is the only woman

nominated in the Best Director category as well as being in the running for Best Picture and adapted screenplay with Maggie O'Farrel who wrote the book. Well, Chloe has history with the Oscars as only the second woman and first woman of colour to win by Best Director for her film at Nomadland, which won in 2021. When she came into the Woman's Hour studio recently,

I asked her about that experience. When you were a little girl or just even being in film school, you look at that happening on the television. And I usually watch the Oscars with a pint of ice cream, mango sorbet, it was my choice. I used to watch it in my 20s every year. And you don't think it's so far from your reality because I didn't know anybody and I didn't, you know, I was an immigrant.

So then one day you wake up with that nomination and really, I mean, since we're on the conversation of community, I started, again, knowing no one and Sundance Institute, film independent, FP, you know, all these labs welcomed me. I met Ryan Cougalor there, you know, I met David Lowry and Mario Heller and a lot of these filmmakers that are supporting each other right now. And from these institutes, and then the festivals, Ken, Venice, Sundance, you know, telluride. And these festivals have supported me for all my films.

And when you go to these festivals, that's your community right there. So then when you can, in that moment, I go, I guess, I was held. Yeah. Yeah. So you feel really nice. It's extraordinary. So just to remind people, Chloe is only the second woman to have won best director, Oscar, but also the first non-white woman.

And just to remind everyone, Chinese immigrants to America, as a woman, going into the rarefied world of filmmaking, to win an Oscar, it's extraordinary. What does it take? What does it take to do that? Like, how? I mean, of course the work speaks for it. you know, your art is your art and it's extraordinary. But, you know, to get into that world is...

Well, so the women's hour. So, like, I do think as women, we value collaboration. And again, community more, you know, more than what I think sometimes the dominant culture are saying, like you've got to do it on your own. And I have always been, you know, collaborating not just with my crew and cast, but the places I go into. Yeah. You really, you know,

director sounds very kind of singular. But a captain of a ship will tell you, if you want to live. You need a good crew. And they trust you. They trust it, it's trust, right? There is a fine line between being in control and preparing everything

and making sure everything is going to produce like we wanted to be. And then also there's another half of the equation, which is do the work to create the container. So when we actually are in it, then do the work of letting the go and allowing everyone to bring forth what they're bringing forth and trust that sometimes something happens that is so different than what I envisioned. And you have to look at that. I go, there is a message there. And you have to be on said, try to decipher what that. message is and try to follow that because you fight against it, then there's a chance you lose

that extra thing, that mystery that's bigger than you. This is lovely. This is very good, profound life advice. I was going to say to you, what advice would you give to any sort of creative who feels like they're an outsider? How do they get in? Of that. Yeah. Yeah. That is more, you know, because I wasn't given the mainstream opportunity, the first two films, I just had this, people had asked me during that time, and I always said, you know, if you're trying to get to the top floor of a house, and then they're not letting you up, and you can spend a decade of your life trying to climb one flight up, or you can walk out of the house and you see like, whoa, there is a whole undiscovered countries out there. But then you have to humble yourself because you're not going to have the infrastructure of the existence. house. And then can you talk to your ego and go, well, I'm not going to be able to rise up. You know, I'm not going to have all these convenience. I have to cut down the trees.

I have to get people to help. I have to build a foundation. It's going to take time. And you have to weather some bigger storms. But then when it's all finished, is your house. Build your own house. Chloe Zhao, the director of Hamlet talking to me recently. The film star, Jesse Buckley, has also been nominated for Best Actress alongside Rose Byrne. Renato. Rendsfei and Emma Stone, and our recent guest, Kate Hudson, for her performance in the film Song Sung Blue. She told me, when she popped in to have a chat, how she found her voice to sing in the film. So it was a huge part of opening my throat chakra and giving me confidence as a singer. And you've seen her face.

What? And I've seen it. Oh, yes, I have. Your throat chakra. Come on tell me. How did you do that? Well, I just feel like it's been so close. I was so fearful of, like, sharing my voice and mom.

multiple ways, like writing music. I've been writing music my whole life and just opening this part. I was always so timid and afraid to do it. And there's been a lot of people along the way who were really wanted me to get in the studio, wanted me to be singing more. I don't know what it was that was holding me back until I got a little bit older. And then working with Sia and her musicality, her writing, and her songs, which are big, you know, you have to really be. very confident singer to really get her songs right. And she just gave me so much confidence. She had so much belief in me. And I just, she really like unlocked it. Is it significant that it was a woman who did that? Yes. Absolutely. Like a hundred thousand percent

for me, yes. I think people will be surprised to hear you say that you, there was something holding you back. Because you can obviously sing. I bet there's people who've told you this your whole life. And you knew on some level yourself that you can sing. Well, and I had been singing. You know, I sang in nine. I sang in glee. And it's not like my voice. I wasn't able to access certain parts of my voice. It was like the whole embodiment of myself and the belief in myself as a singer, you know, is different.

And Sia really was the one who was like, this is, this is who you are. So once you've felt the belief and you fully embraced it and your throat, chakras opened. It just flew open. Yeah. I'm just thinking about women listening. who will full well, me included, we all have our thing, know the thing that we want to release but something is holding us back. Give us some advice, Kate.

How do we? Well, I don't, it's so different for everybody. I think the thing is, is that it comes at the right time. I think, you know, I think the only advice I would give is to be patient with yourself. You know what I mean? It's like, I think sometimes we're fighting so hard to make something happen, you know? And maybe sometimes you just need to be patient. and be okay with it.

You're not there yet, you know? And I have that with music. Some people go, what took you so long? And I'm like, life. Like, this is exactly where I'm supposed to be and why I'm here now is because everything that I was afraid of and all of the people along the way that empowered me, Cia being one of the biggest ones,

help me be here and, like, open this up for me. And I remember hearing a woman talk about not liking the word empowerment because it means that someone else has to show your power. I thought that was a really interesting thing. I thought about it a lot. I love provocative statements. I'm thinking about it now. And as I thought about it, and I'm all down for everybody's point of view, right?

But like, I don't know where I would be without other women empowering me. I needed it. Maybe some women don't, but I did. And in many ways, whether it be from my mother or from my girlfriends or from colleagues, sometimes you do need a little bit of that push. It doesn't mean your power doesn't exist. It means it just helps you find it, you know, and access it. Kate Hudson there who came in to speak to us at the end of last year about her film,

Song Song, Sung Blue, that she's now been nominated for Best Actress at the Oscars for. Also, a mention of the documentary, beautiful documentary, come see me in the good light about activist and poet Andrea Gibson. Their wife, Megan Fally, came in last year you may remember to speak about this beautiful and extraordinary documentary which I highly recommend and I've been recommending to everybody. So pleased to see that that's had an Oscars nod as well. A few of you have been getting in touch about ADHD. So I'm going to read out a couple of your messages.

8444 is the text number. My workplace brought in an organisation who initiated and how to work with me session. And it was so helpful for me as a woman in my 50s with ADHD and menopause. Our whole team did it. It gave us all an insight into what helps us. And we've started body doubling, changing lighting, buying noise reduction headphones and a fidget treat box. It's taken the shame away and actually help show what makes us most productive. And another message here saying it would be helpful to many if you could mention some of the positives about ADHD people.

Extraordinary problem solvers empathetic. They bring energy and enthusiasm to groups which is contagious. They're super creative and often great linguists because they can hold more than one thing in their minds at once. Emphasizing these with young people especially can mitigate some of their feelings of not being good enough. What a lovely message. Thank you so much.

No, thank you and keep them coming in. 84844 is the text number. Now to a very sensitive topic and you may find some of the discussion and terminology distressing. miscarriage in the early stages of pregnancy is common, but clinical NHS practices for the disposal of pregnancy tissue after an early stage miscarriage can sometimes appear to be at odds with women's wishes and not conducive to inclusive care.

That's according to a new study published in social science and medicine and reported in the British Medical Journal. The study's author Susie Killshaw is a professor of medical anthropology at University College London and spent nearly two years observing miscarriage care inside one of England's NHS Foundation Trusts, interviewing women about their experience. Current national guidance in clinical settings says women should be offered three options after a miscarriage, cremation, burial or incineration.

But this study found that the choices available often don't match what women want. Well, Susie is here to tell us more welcome to Women's Hour. Thank you for having me. What, first of all, motivated you to look at this specifically? Yeah, absolutely. So I am a medical anthropologist, and my previous work was on something quite different. It was, I was quite interested in emergent and contested illnesses, and I worked on masculinity and men.

But about 15 years ago, my research trajectory really changed after I had my own experience of miscarriage. And when I had that experience, I felt, that it really shook me. It really, I was really devastated. And I became very interested in the fact that it seemed like something that's such a common women's health experience globally. I didn't know very much about it. I knew lots about how to get pregnant.

I knew lots about how to get pregnant. I knew vaguely what miscarriage was, but I just didn't know how complicated it was. And at the time of my miscarriage, there was quite a lot of silence. and around it. So I realized that this might be something really interesting anthropologically. So I started thinking about it and then I had two subsequent miscarriages and that really sort of piqued my interest. So I began a 15-year research trajectory looking at women's experience of miscarriage in different

cultural settings. For this particular project, which is a welcome funded project, it's very much informed by my previous research. So when I conducted a comparative project between women's experience in Qatar, so Katari Women's Experience, and also looked at women's experience in the UK, there was some interest. So things started coming up about what happened after a miscarriage, whether people had memorialization practices, whether they might bury at home.

But in the UK, there was a lot of uncertainty. There was a lot of sort of people weren't really sure what they should do. So I realized that this was something quite interesting. to look at. And what's the time frame? Were you looking at miscarriage in a certain period of the pregnancy? Absolutely. So my current project, it was from 22 weeks below gestation, but really the majority, so all but one of my participants had an early miscarriage, so in or around the 12-week gestation period. And what were women telling you?

Yeah, so I should say that one thing that women sort of unanimously told me was that they received really excellent care. They consistently said that they were very happy with the care that they received, that they received very sensitive, very caring care from the NHS Trust where I worked, and that came up again and again and again. But the one thing that women again consistently said, and they used the term jarring, unexpected, was around discussions and the discussions and options and options around pregnancy remains disposal. So they said that that was really at odds with otherwise really excellent care. So this just came up again and again. So as an anthropologist, we often just follow what our participants are talking about. So that's what I did.

So what disposal options was the trust offering? What's out there? Genuinely, something that I'd not known about. So for me, even preparing for this interview. And it was a lot actually even just preparing for it as someone who has gone for a miscarriage myself. And I've spoken about it publicly, which is why I'm bringing it up. It was just fascinating. So, you know, what and how many women actually have miscarriage?

in a clinical setting. Most women have them, you know, at home or, you know, just wherever. So. So I think what you're saying, my participants very much said as well, they hadn't really thought about this before they went into the clinic. So they consistently said that they, it was unexpected. They hadn't even thought about it. So they were really surprised and really shocked and some quite distressed about having to have this discussion, particularly having to have this discussion so close to search. management of miscarriage where they were kind of focused on having the surgical procedure. So they often say that it was jarring. They were kind of shook by it. And what women were, so the option, sorry, that you were asking. So at the trust where I worked, they offered hospital disposal, which was burial, communal burial, or the person could make private arrangements. And those private arrangements would either be through a funeral director or the

person, the woman could take that material or those remains home. So the trust where I worked was fairly typical in the fact that there was a discussion, that there was what they called a kind of consent procedure. I've written separately about why we shouldn't really call it a consent procedure. So the women would have to sign a form to say which option they chose. And the trust, again, was very typical in terms of the process. Slightly atypical in the burial was the hospital disposal management option. Most NHS trusts, most NHS clinics use communal cremation. So that tends to be the most common form of hospital disposal. But as I said, my trust was very typical in that there were options and that the person had to, the woman had to sign her name and that they could take it home

if they wish to. And also what is quite typical of the trust where I worked is, that sensitive incineration or incineration was not offered. And that's very typical of most NHS practices. And I know the reactions from the women that you spoke to varied. Some felt that being offered a burial was almost too ceremonial. Yes. So what I found, as you mentioned... And this is early miscarriage.

Early miscarriage, yeah. That there was huge variation. And I think that really points... My research over the past 15 years has really highlighted the diversity and contingency of experiences and reactions to miscarriage. and that it's really, really important that we don't make assumptions about how someone might feel because someone absolutely might be bereaved and they need to be supported in that.

And that bereavement may focus on the fetal body or the pregnancy remains as a kind of fulcrum of that loss. And absolutely, they should be offered ceremonial disposal. But for some people, some women, they might be bereaved, but they might not be that worried about what happens to the pregnancy. They may be thinking of it as tissue, for example. and they may not want to engage with that element of care. For other women, we have to remember that they may not see it as baby loss, and they may be ambivalent.

They may be relieved as one of my participants was relieved when she had a miscarriage. So you could see how these sort of practices would just not be relevant or in keeping with the way that they understood their miscarriage. What's the national guidance? So the national guidance that my, the hospital trust where I was working was following the national guidance. So in 2015, the HTA, the human tissue authority issued guidance around pregnancy, which they call remains disposal. And they say that women should be offered options and that these options should be documented. Those options in the 2015 guidance were burial cremation and then they said sensitive incineration in some circumstances. So because of that wording, most, and, NHS trust. There's huge variation in terms of what different trusts do, different NHS settings do, but many sort of took that as thinking that incineration was inappropriate. And there was a real bias in thinking that incineration was inappropriate. And would you like to see the guidance

made mandatory for consistency? Yeah, that's a really good question. So they did just recently revised the guidance. So the HTA guidance was revised in September 2004. The RCN, the Royal College of Nursing, also revised their guidance. So they've made it much clearer that those three options, and also taking home are absolutely appropriate and should be offered. I definitely think that we should have more consistency because what I see quite often when I interview someone is that if they've been offered something and their friend or family member has been offered something else,

that can really cause upset. So I think we do need to move towards consistency. However, I do think that sometimes certain options aren't available. So the trust where I work, it's not that they didn't want to offer cremation. they worked quite hard to offer cremation but they couldn't find a crematorium that would work with them to do this and there's legal reasons around that which I won't go into

it's a bit complicated but I am pleased to say that the trust where I work has now found a crematorium that will work with them so they are now working to offer that Susie thank you so much for coming in to speak about this really important to have this conversation thank you Susie Killshaw and of course if you've been affected by anything you've heard

in this morning's conversation or anything else in the program you can find help and support on the BBC Action Line website. And we have a statement from NHS England. A spokesperson said, our thoughts are with every woman and their families who has lost a baby. It can have a profound emotional impact, whatever stage of pregnancy they're at, and they deserve to be treated with dignity.

We're supporting all NHS organisations to ensure they handle these situations with sensitivity, with arrangements in place so that an individual's wishes are dealt with in a respectful and lawful way. This includes developing a baby loss kit, including appropriate containers where remains may be stored following a miscarriage at home, and we are helping to introduce measures,

so all A&Es and early pregnancy units have appropriate storage facilities available at all time. The text number 84844. Now, Claire Lynch has spent her career teaching literature in universities, but her debut novel, A Family Matter, recently won the Nero Book Awards Prize for debut fiction. A mother following her heart, a father with the law on his side and a child caught in the middle. The novel alternates between 1982 and the present day and explores love and loss, intimacy and justice, custody and care. Claire, welcome to Women's Hour. Thank you. Congratulations. Thanks. I'm not surprised it won. It's brilliant. Couldn't put it down. So as I've just said, it's set in two time periods, 1982, 2022. Can you give us an outline? Yeah, I think that's about

Right to be honest. To me, anyway, it's a novel about a father, Heron, and his daughter Maggie. And the thing about them is it's a family where it's just been the two of them. They're very close. And the mother is kind of a missing piece of the jigsaw. Maggie's been told a version of where her mother's been. And as we go back to 1982, we sort of see Dawn's story and fill in the truth, really, the full truth. The reason that she's been missing all this time is not quite what Heron's told her. Yeah, big family secrets. Yes. Can you tell, I mean, you can reveal what? You can reveal. I don't think it's a spoiler to reveal because, I mean, the sort of true story that's at the core of this fictional family's experience, which you mentioned at the top of the show, is this idea which I had no idea about myself until I sort of stumbled across it, really.

It's these custody cases that happened in the UK, late 70s, 80s, even into the early 90s. So the number of women who were married, had children, but then met and fell in love with another woman, which happens. of course. And then were involved in custody cases and lost custody of their own children. How did you come across the history? I came across it, I suppose, in a way that I'm slightly embarrassed in the sense that I had a vague idea that, you know, I probably knew that life for lesbian mothers in the 80s wasn't all, you know, rainbows and unicorns. And then when I met mothers from that generation, they would sort of say to me, you know,

it's great to hear what your experience is like now, but it was different for us then. but they wouldn't quite tell me the full story, I felt. And then when I started to look into it, started to read the transcripts from the court cases, started to read the newspaper reports from the time and realized that it was a real, you know, the kind of practicalities were there was this incompatibility. You know, you could be a mother.

And the moral judgment. Exactly, the moral judgment of society. And the sort of the weaponisation of shame, right? So you could be one thing, but you couldn't be both. And so the sort of use of that, yeah, that kind of pressure put upon families to say the best thing to do in this situation is to remove the source of embarrassment and shame to take this mother away from the family. And, you know, the intention was, in the best case scenario, the child would be very young and they would forget. And the family could kind of sort of reform around the scar, if you like, and carry on as if that woman had never been there. And the mother is Dawn.

She's a young mother. and we meet her at a jumble sale. Describe who she is for us. I think she's very young, as you say. She's 23 when we meet her. And she's done everything that people expect of her. She's met someone who's nice and got married, and she's got the house and the baby.

And she's trying to do what is the sort of normal thing, is kind of the word, I think. She's trying to do the right thing. But she hasn't really had a chance to know who she is or how she wants to live. So this jumble sale is this kind of moment where she meets someone, you know, And it's just a moment of like, oh, hang on, life could just be slightly different.

Here's an opportunity to think about that. We sort of want her to have that different life. We do. I think so. Come on, Dawn. Live your true life. Live your truth, Dawn. And then you remember, oh no, it's the 1980s.

I mean, the way you develop the story is just, like I said, it couldn't put it down until I got to the bit where she's in court, trying to get custody of her child. And that point, I did have to put the book down and walk around and let off some steam and come back to it. And these are, I'm going to get you to read a bit. actually. These are scenes taken from actual transcripts from court cases of the time. Yeah, exactly. So the job for me was to sort of, I could find out what had been said in court.

And then the novel is me thinking, okay, but what was said at the kitchen table or what was said, you know, falling asleep at night? What happens beyond that? But the stuff in the court case, I thought, as I read it, I couldn't actually, I couldn't make it worse, to be honest. So I brought things from real court cases and put them together because it was, these were the things. that women reported from their own cases, the things that stayed with them for their whole lives. You know, if someone had said this to you in court, how would you ever forget it? You wouldn't. Yeah.

So tell us where we're picking up from. Okay. So I'm going to read this bit, which is the court case. This is the barrister speaking. And it's acknowledged, it's very clear that what he's trying to do is embarrass her. What he's doing here is talking rather than about her ability to mother or how much she loves her daughter. He just wants to talk about her sex life to make it seem that who she is in complete. compatible with being a mother.

James Paul opens the folder on his desk and brings out the list of questions he knows will catch the judge's ear. Mrs Barnes, he begins, will you please explain a practical matter to the court? Dawn nods. When you and your lover have, and here he pauses, make speech marks in the air with his bent fingers around sex. What appliances do you use? Dawn blushes at the question and she does not understand it. Appliances? He goes on, do you, Mrs. Barnes, make love in front of his,

your child? Do you make a noise when you have sex with that woman? Has your child heard you? When Dawn looks at her lap, her hands clinging on to one another and says, what do you mean? Or of course not. Mr. James Paul simplifies another question and another. Kissing then or holding hands. Has that little girl seen her mother kiss another woman on the lips? You must answer, Mrs. Barnes, the judge says. You must answer. Shocking. And it's horrendous. And you feel it. When I was reading it, I felt it, you know, the shaming of her. And you've spoken to women who've lived through it and had their children taken away.

What stories did you hear? Well, when I was writing the book, I was gathering things from handbooks that people had written at the time. Women had written to each other in a way as a kind of guide. But it's more since the books come out. So now I get messages from women from the UK, from America, Germany, Italy,

who say, you know, they recognised this was their experience or something similar. and I think it's a tough experience actually to kind of go back there and to think about it. But the most wonderful thing is that they also tell me what their lives have become since. Or how their children and their grandchildren are thriving. And, you know, there's this kind of hope in how distant that kind of past seems, however close it is to us, and what these women's lives have become anyway. How do you view the father in the story, Heron, and his decision to do this?

And not just Heron, it's everybody around. him, his mother, the community, everybody shunned. Yeah. I mean, I can't condone what he does, but I also really understand why he does it. I think there's a sort of sympathy there, I hope, with, you know, it's very hard to be the person who does the different thing from everyone else. He does what he's advised to do by lawyers, by, you know, social workers. He does what seems the right thing. So I've got a lot of sympathy for him.

What he has to do is 40 years later work out. How do you make peace with something you've done? that maybe now with the benefit of retrospect, maybe you would have done something differently. And then what happens when his 40-something-year-old daughter, who has two children of her own, learns the truth? Exactly, exactly. That's what family secrets are all about, aren't they?

You know, over the layers of generations, what do you do with that then when it's kind of evolved into something else when you've got to face your grandchildren with that truth too? Well, it is a brilliant book, so I want to congratulate you. debut novel, I mean, talk about, you know, of what a start. Thank you for coming in and I'll be interested to when you next come on hear what other stories you've heard from people. Best of luck with the book. It's called A Family Matter by Claire Lynch and it's out now and I'm going to reveal some of your family secrets because people are getting in touch.

And 844-844 is the text number. I'm in my 40s and just before the COVID lockdown my dad told me he'd been married before he married my mum and I had an older half-sister. My dad had been diagnosed with dementia which progressed quickly during COVID. so I was never able to ask why this had been kept a secret, but I've met my sister and her family and we're now close. We lost so much time. But you've met her now, which I'm pleased for you about. Another message here from Andrea saying,

I found out I had a half-brother when I was 65. I found out by accident when my aunt, who's 90, mentioned it in a passing conversation. That little boy your mum had. I was so shocked that I researched this through a local mother and baby home and found it to be true. it's left me profoundly shocked and feeling as though I really never knew or understood my mother. Keep your thoughts coming in.

Also, we have a statement from the Ministry of Justice about what we've just been talking about. The government is committed to a fair justice system for everyone. The legal framework has changed significantly over the years. And since the Children Act 1989, the court's primary consideration must be the welfare of that child and what will be in their best interests. It's, you think these things didn't happen in your lifetime, but they very much did. And that's always something to get your head around as well. Now, on to my next guest and the subject of gaming.

My next guest has spent the past two decades working in the industry, finding ways to use video games for good. Earlier this week at a games industry conference, Jude Ower was named one of 10 women to watch by the Aurora Awards. Jude's the author of Gaming for Good and is currently the chief strategy officer at Planet Play, a not-for-profit gaming platform, which has engaged millions of gamers to raise more than $4 million

for long-term environmental projects like reforestation, renewable energy and water conservation. Welcome to Women's Hour, Jude. Thanks for having me. First of all, congratulations. Thank you. Tell us what this award means.

Yeah, it's brilliant. So the award is about impact beyond gaming. Yeah, and it was just such an honour to win it because there's amazing people doing great things in the industry to kind of, take the industry beyond entertainment. Yeah, so it represents all the great work that's happening to leverage the power of gaming for good.

You're going to have to lift the lid on it and explain it to us because many of our listeners people maybe don't game or maybe the people around them do, and we know lots of women do game. Why do you think, does gaming have a bad reputation? It does. I think it's misunderstood. You know, typically we see kind of negative stories or, you know, it's the, only 2% of games are adult content

and they tend to be the ones that are seen the most. But actually, there's 3.6 billion people that play games. 50% of gamers are women. And the majority of gamers are on mobile. And games are, you know, if you think about when we grow up, we play and we learn through play. And that's what games essentially do. They enable us to learn, to connect, to socialise,

They open up worlds for people in terms of accessibility. You know, there's an amazing organisation called Special Effect who they basically modify controllers for those with disabilities. So there's a billion people on the planet with a disability and this can transform someone's lives. So there's lots of ways that games can be good. It's just it's not spoken about in such a public forum, so it's great to be able to talk about it today.

Yeah, really important. And you founded a gaming for good company PlayMob in 2011. What was the aim of that? So the aim of that was to connect entertainment games, so games that we play every day to real world impact. And it was really kind of inspired by, so back then social gaming was starting to become a thing on Facebook,

Farmville. People may recognise Farmville. But Farmville actually was the trigger point for me because during 2011, the Haiti earthquake happened. Yeah. And the studio got behind raising money for the victims. And so in the game, you play the game for free, you buy an item inside the game, a percentage of money will then go to real world projects.

So they sold a seed, a virtual seed that you can plant on your virtual farm. And they gave a percentage of that money to the victims of the earthquake. And they raised millions of dollars in just a matter of days. But the players are so engaged. It's so powerful. And they raised a lot of money, but the players were super engaged. They were playing for longer. They were talking about it with their friends.

And yeah, the real thought was about imagine every single game could create impact. Imagine some of the problems we can solve in the world through gaming. So that's one example of when you set up your company PlayMob in 2011. But the environmental footprint of the industry is also a big focus for you. Microsoft has estimated that the average modern gaming console emits around 72 kilograms of carbon dioxide emissions every year. Then you've got the manufacturing process, excess packaging. and in 20204, your company was acquired by Planet Play. That's where you currently work.

And you co-founded the Playing for the Planet Alliance with the UN Environment Program. Tell us more. Very impressive. Obviously, we know that. That's why you're here to tell us about this. But yeah, give us, tell us more. Yeah, so the reason for focusing on the environment was, so I met someone called Sam Barrett from UN Environment.

And we looked at the UN Sustainable Development Goals. So there's 17 goals, which basically, lay out a plan for how to make the world a fairer place by 2030. And if you put the goals into a pyramid, the environment was at the very bottom. It basically impact all the other goals. And so when I set up, play more, we were looking at lots of different impact. But when I realised the environment was the one that we really needed to hone down on, we thought, let's try and rally the industry together to take action.

As well as looking at our carbon footprint and being on the front foot to look at how we reduce this, in terms of the energy production of making games, playing games and packaging. You know, how can we bring the industry together to learn from each other? And that's where the alliance was born. But also it was, you know, there's now 3.6 billion people playing games. How can we mobilize them to, you know, change behaviour, raise money or even, you know, speak their minds so that we could change policy? So that was really the, you know, why the alliance was created. And how can you do that?

Do you need more women working in the industry? That would be great. Do you think that would make a difference? Is it significant that you're a woman who's leading this? There's, I mean, there's more women now in the industry than there was before. I can't remember the exact stats, but it's getting better, but it could be better. In terms of women leadership, yeah, it needs improvement. And that could help.

But, yeah, I mean, so many women play games, so it would be great to get more women into the industry. Tell us about your green game jams. What are those? Yeah, so the green game jam, that was actually. from the that was an idea that came from the plane for the Planet Alliance

and the Green Game Jam is studios like to do something together and when you can do something together you can create real impact and so the jam is a jam is typically studios get together and they make a game quickly

but this is the biggest entertainment games you've got like Pokemon Go Hayday Angry Birds you know all these games that are big and have got big audiences so they come together to think about an environmental theme

whether it be forests or food and they put the theme into their game and they all launch on World Environment Day which is the 5th of June so the point of this is using entertainment games to reach mass audiences to raise money to raise awareness but doing it around a moment in time

where it makes a bigger impact and what about a practical tip Jude for some of our gaming listeners who want to reduce their impact on the planet what tips could you suggest well power off your devices rather than go on standby. So that's an easy one you can do at home.

But also, you know, look out for the games that are doing something green. You know, there are a lot. And the app stores are getting behind this as well. So, you know, around Earth Day, around World Environment Day, you will see kind of editorial on games that are green. So you can, you know, play games that are either given back or raising awareness. But yeah, it's really thinking about your energy consumption, but also supporting the games that are helping to protect the planet too.

Absolutely fascinating. Thank you so much for coming in and congratulations once again. I'm winning the awards. Jude Oa. And if you're interested in hearing more on this topic, you can listen back to our Women and Gaming. Women in Game series in full on BBC Sounds. Just Search Women's Hour, Women and Gaming. I'm going to end with a couple of your messages. Just about the conversation we were having. I'm one of those lesbian women divorced in the early 80s. Luckily enough, I ended up with joint custody, but my sexual orientation was front and center of the whole whole. thing. Thank you for highlighting this forgotten issue and that's from Tina. And another one here long after losing my parents and brother, I discovered that my father was not my brother's father. He must have known this as he was in the army during World War II whilst my brother was conceived and came home to find my mother pregnant. No one in my immediate family ever spoke about it. When I made the discovery, I told my sister who refused to believe it. Family secrets. We'll be talking about lots more on Woman's Hour tomorrow. Join me then. That's all for today's Woman's Hour. Join us again next time.

I'm Paul Kenyon, and for Radio 4 and the History Podcast, this is two Nottingham lads. When the invasion happened, it was completely hell on earth with the sounds. The sad thing about war is people lose their empathy and their humanity. I want to know how two men from Nottingham ended up on opposite sides in the war in Ukraine, and what became of them after a chilling encounter in a prison in the war. Dunyetsk. Out of all the places in the world where I meet someone from Nottingham, it's in captivity on two sides of the conflict. It's a story about how and why you pick a side in a war that's not your own. You can listen to two Nottingham lads first on BBC Sounds.