Woman's Hour - AI and IVF, Cousin marriage, Sugarcane documentary, 'Masculine energy'

Episode Date: January 17, 2025

Can AI improve the success rates of women undergoing fertility treatment? Anita Rani discusses the impact of AI on IVF with Dr Cristina Hickman, an embryologist, co-founder of Avenues, and Chair of the Global AI Fertility Society, and Dr Ali Abbara, a Clinician Scientist at Imperial College London, and Consultant in Reproductive Endocrinology at Imperial College Healthcare NHS Trust.The second reading is due today of a private members bill that seeks to ban first-cousin marriage. It’s particularly prevalent among Pakistani and Muslim communities. But what would this mean for women? And how would genetic testing to enforce the ban work? Anita speaks to CEO of Karma Nirvana Natasha Rattu and Emeritus Professor of Health Research at Bradford University Neil Small. The award-winning documentary Sugarcane follows an investigation into the Canadian Indian residential school system, and the attempts of survivors and their descendants to try to understand what happened in them. Emily Kassie is the film's producer and co-director and joins Anita on Woman's Hour. Mark Zuckerberg says companies need to embrace more “masculine energy”. The Meta boss told a podcast that instead of trying to get away from it, corporate culture should celebrate the positive side of things like “aggression”. But what even is ‘masculine energy’? And do we really need more of it? Anita talks to Josh Smith, contributing editor of Glamour magazine, and Becky Hewitt, Chief Executive of culture change company Kin&Co.Presenter: Anita Rani Producer: Laura Northedge

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, I'm Anita Rani and welcome to Woman's Hour from BBC Radio 4. Good morning and welcome to Woman's Hour. Can AI help people get pregnant? Today we'll be talking about whether and how AI can improve IVF success rates. Also, Mark Zuckerberg, the billionaire founder of Facebook, said this. Masculine energy, I think, is good. And obviously, you know, society has plenty of that. But I think corporate culture was really like trying to get away from it. And I do think that

there's just something, it's like, I don't know these all these forms of energy are good. And I think having a culture that like celebrates the aggression a bit more has its own merits that are really positive. So this morning, we're going to be discussing masculinity in the workplace, whatever that may be, what do you think it is? And how does it compare to feminine energy? Is there even such a thing? And what energy do you bring to your workplace? Do you predominantly work in a male or female environment? Do you think there's even a difference? And how has your energy helped or hindered you?

Get in touch in the usual way. The text number is 84844. You can email me via our website. You can also WhatsApp the programme on 03700 100 444. And if you'd like to follow us on social media, it's at BBC Woman's Hour. Also later in the programme, I'll be joined by the director of a powerful and important documentary that explores the harrowing story of historical systemic abuse in Catholic-run schools in Canada, specially set up to educate Indigenous children for such a devastating subject matter, And if you'd like to get in touch, that text number once again.

Your thoughts and opinions on anything you hear on the programme, it's 84844. First, though, earlier this week, the Prime Minister, Keir Starmer, announced the government's Artificial Intelligence Action Plan, promising to turn the UK into an AI superpower. He mentioned how AI is already being used in the health care system to aid stroke victims. Can it also help women going through fertility treatment? In the UK, one in seven couples have difficulty conceiving and over 50,000 patients go through IVF each year. Currently, around 31% of IVF treatments result in a live birth. But can AI improve it? Well, joining me to discuss it is Dr. Christina Hickman, an embryologist,

co-founder of the Fertility Clinic Avenues and the chair of the Global AI Fertility Society, and Dr Ali Abara, a clinical scientist at Imperial College London and consultant in reproductive endocrinology at Imperial College Healthcare NHS Trust. A very good morning to both of you. Welcome to the programme. Christina, I'm going to come to you first. This is a lot for people to get their heads around. So let's start right with the basics. How is AI being used right now within IVF? Tell us the various ways it can be used. So we're actually the first clinic to incorporate AI throughout the journey of the patient. So at the moment that the patient joins us, we can use AI to compare their demographic information

to that of other patients who have had care in the past to help manage their expectations of what are their chances of conceiving and start identifying what is the right journey for them. Then as they're going through the diagnostics, we use AI in the ultrasounds to try and identify and see details that might be missed if only assessed by a human. We then start making decisions as they're going through the IVF journey, if IVF is right for them. And at that point, we need to decide what's the right dose, what's the right protocol. So AI can help us identify, based on all the knowledge of many patients, millions of patients who have had treatment before, what is the right decision for

this particular patient? We then get to the lab. And at this point, we're trying to decide, is it the right time to get to the lab? What we call the trigger. So missing the right time of trigger can compromise the right chances for you. We maximize that by using the AI decisions. Now we see the egg. the egg we can now identify is this egg likely to form a blastocyst or not? Is this egg going to be a viable egg? Is it a good one or not a good one? And then we get to look at the sperm and do the same assessment on each individual sperm. We then bring the two together and creating the embryo. And during the ICSI procedure, we're using AI to support the ICSI process. Then we culture the embryos in the incubator for between five and seven days.

And at this point, we're capturing billions of data points that we're contributing towards making an accurate assessment of, is this going to become a baby or not? So we're also using AI to help support the patient emotionally. We're using AI to capture data so that the embryologist can treat more patients in less time whilst dedicating even more time to the patient for compassionate care. So it's that balance between compassion and technology that brings the best of both worlds for the patient. I'm going to bring in Dr. Ali Abara here as well. How excited should people trying to conceive be by this? Yeah, I think the potential is huge. Yeah. So I think, as we know, AI has really exploded over the last few years, and the models are getting so much better so quickly that in the future, the processing power is just improving so fast that obviously it might well be able to make decisions at a far greater level than what we can at the moment.

But obviously, as with all new technologies, it's really important to just confirm the efficacy before we roll these things out. Christina, how's it working? I mean, did you say you're the only clinic using it at the moment? We're the only clinic using the extensive throughout the journey. There are other clinics that might use a couple of tools here and there, but not all of them together. And that's important because when you're making decisions, if you're only looking at the embryo, but you're not taking into context what's happening in the uterus, or you're only looking at the sperm, but you're not taking into account the egg or the embryo development, this siloed information could lead to incorrect decisions for the patients. It's really looking at the holistic approach to the patient that brings that difference,

that brings a better clinical decision-making process. And have the results been different at your clinic consequently? So we've only been licensed for a year. It's a new clinic. The first babies are being born this week actually. So we have about 50 babies or so are on their way very, very soon. We have seen that our success rates are going on their way to being on a 56% live birth rate, but we're still waiting for some of these babies to be born to confirm. So at the moment, we categorize them as ongoing birth rates. And this is twice what we've seen as a national average across the UK. So this is not exactly a randomized control trial that we're comparing to demonstrate this improvement.

But the way that we have validated these technologies is by looking at each of these technologies on their own. To look at them cumulatively is going to take us a bit more time to do these demonstrations. But all our key performance indicators of operations are demonstrating much higher results than we've observed in other clinics before and you've done some research into ai and trigger shots um yes yes sorry both of you have yes i'm sorry yes so no we've just published a paper on looking at exactly which follicles within the ovary are the ones that are most likely to give you an egg. So the follicles are the structure there that support the egg during development. And maybe during a natural cycle, maybe one follicle will develop each month.

But obviously during IVF, we give quite strong, powerful stimulation to the ovaries and you get multiple follicles. And you can, like Dr. Hickman was saying, you can decide when to stop that process and move on to the next process. And so it's really important to figure out which of those follicles are the ones are most likely to give you eggs. And that was the research we've just done. And essentially, if you maximize those follicles, you can improve the number of eggs you get and also the live birth rates. And traditionally, doctors have relied on their own human assessments to make decisions

about the health of the sperm or the egg or the correct drug protocol. And I mean, I know Dr. Hickman gave us good overview, but to you as well, Ali, how can AI help doctors make these decisions? So I suppose it's a bit more objective and scientific. So obviously the protocols are designed for the average person and they will work for most people and then the doctors will intervene to try and personalise that treatment.

So they'll rely on their experience and sometimes intuition and things like that. But obviously AI can allow us to handle that really complex data that's generated during IVF treatment and be quite data-driven in the type of decisions that we can make. So hopefully it should optimise and make it more objective. Do we need to be concerned about the biases within the data that's being used? For sure. So I think one of the benefits of IVF treatment is people,

the data is stored on electronic databases. They can be then combined. And so you can get very large data. So in our study, for example, we had more than 19,000 patients. But of course, if there are biases within that data, it will learn those biases. So that is something that we need to be mindful of. There are statistical techniques to try and account for that and make sure the data is more generalizable and can be applied to different people in the population. And Christina, I guess a big thought about all of this, is AI going to be another expensive add-on that people have to pay for? We know that each cycle already costs over £5,000. Yeah, so at the moment, what I see from AI is that it's one of the first technologies in a while on IVF that might actually be coming to reduce the cost of IVF. At the moment, what we've seen

is that the increase in efficiencies, it reduces operational costs, which can be passed on to the patients. So we've seen that in our clinic at Avenue. So our operational costs are half the operational costs to what is seen in other clinics. So this is something that the AI technology, yes, we have to pay for the technology. As a clinic, we have to pay the providers of technology. And I would like to keep it that way. Because if we have professional companies making AI, we get robust, medically robust AI, which I'd much rather prefer than homegrown AI, which then brings the risks

associated with bias, generalization, hallucination, even ethics concerns on how it's being built. So it is important to highlight that there is good AI, but there's also bad AI. And we do need to have the necessary frameworks in place to ensure that these technologies are introduced in a responsible manner, which is a lot of the work that we're doing both at Avenues and at the AI Fertility Society. statistically only one in three women get pregnant after their first IVF cycle, as I mentioned before, the average success rate is 31%. Will AI be able to increase those odds? Yes, but not in the measure of success that's traditionally used. So the measure of success that's used by the HFEA, for instance, is number of pregnancy per embryo transferred. Now, an example of how AI goes contrary to that is AI might turn around and say, this is a poor quality embryo. It might look nice, but it's got a low chance.

So I would suggest that you transfer two of these because it's got such a low chance. Now, in doing that, you're reducing the definition of success by the HFEA, which is number of embryos. But if you think of it from the definition of success by the HFEA, which is number of embryos. But if you think of it from the perspective of the patient, you're maximizing her chance of having a baby in that cycle with those embryos. You're making personalized decisions down to the level of each embryo.

So we have changed our definition of success, which is getting the patient pregnant within a year of them coming to meet us for the first time. In that way, we might actually choose to put multiple embryos if it's relevant whilst minimizing multiple birth rates, or we might choose to do multiple egg collections within the same cycle. So we're using AI then to value engineer their journey all the way to a baby, irrespective of how many transfers or egg collections are planned for her, because we are creating a personalized plan for her and him, right? So we're looking at that couple and thinking for you, we're going to do one egg collection with multiple transfers. And for the other couple, we're going to do multiple egg collections with one transfer.

We can use AI to cancel a transfer to say it's not worth the time. Let's go straight to another cycle. So overall, the cost to baby across that journey is expected to be lower. And this is what we would like to demonstrate once we're open for a little bit longer. But we're already starting to see that with our preliminary patients. Dr. Burrow, it all sounds great, but there will be some people that it won't help, right? opened for a little bit longer. But we're already starting to see that with our preliminary patients. Dr. Burrow, it all sounds great, but there will be some people that it won't help, right? Their medical problems will be so great that they're never going to have the baby that they want. And this is a reality for a lot of people going through IVF. So we don't want to overplay the

power of AI, do we? Or do we? I don't know. Of course. So obviously, there's going to be biological factors that an AI can't necessarily change. But I suppose the way I would think of AI, do we? Or do we? I don't know. Of course. So obviously, there's going to be biological factors that an AI can't necessarily change. But I suppose the way I would think about it is it's about optimising the potential for each couple. So it's making the best decisions, selecting the best embryos that are available. So you're quite right, you can't change biology, but you can try and optimise things as good as possible. Will we? Yes. Dr. Hitman, yes. It's also a matter of using AI to assess which patients we should advise to stop. And that's the power of the information.

AI itself is not necessarily going to increase your chance of success, but it's going to help you make the right decisions for you. And some of these might mean it's time to help you make the right decisions for you. And some of these might mean it's time to stop care. That's really interesting. Will we see AI helping at every stage of the IVF cycle? Will this become more common? Yes, is my opinion. We're already seeing that in clinical practice. And I would like to see it beyond the fertility care as well. So throughout your reproductive journey, you know, so from the moment you hit puberty all the way to your menopause, how can we plan a reproductive life in advance using the information and start promoting our

fertility health rather than waiting to become infertile and discovering at the point. So how do we nurture that fertility health so that less people need IVF in the future? Fascinating stuff. Thank you both for joining me to talk about that. That's Dr. Christina Hickman and Dr. Ali Abara. 84844 is the number to text. We're going to be discussing masculine energy within the workplace and lots of you getting in touch about this. David says, my name is David. I work in a legal firm with a team of 10 women and me i don't find the balance has any impact on me we stick to respecting experience i do think more should be done to correct the balance of the team but the candidates must have the right character and balance i previously worked in a firm that had a sales arm and the manager tried to encourage male

aggression to drive sales i ended up leaving because of the culture which I found objectionable. I was their highest earner by far bringing in over two million pounds per year. It became toxic and unacceptable. I much prefer working in a respectful environment whether with men or women. I expect clients to be treated with respect so respect has to run through the organisation. Keep your thoughts coming in. 84844 is the number to text. Now, to a powerful and devastating film. Sugarcane follows an investigation into the Canadian residential school system where indigenous children were placed and the attempts of survivors and their descendants to try to understand what happened to them. The schools, of which there were over 100 in Canada, were mostly run by the Catholic Church. They ran from the 1930s right up until the late 1990s.

Indigenous children were separated from their families and were subjected to horrific abuse, including sexual abuse. A Canadian government report from 2015 called the practice cultural genocide. The film focuses on one school in particular, St Joseph's Mission School in British Columbia. Some of the details about what happened at the school may be hard to hear. Well, Emily Cassie is the film's producer and co-director

and joins me now. Emily, welcome to Woman's Hour. I was very moved by this film. The details are harrowing, but there's also such humanity in the way you tell it. But I'd like to start by asking you why you wanted to make this film. Well, thanks so much for having me. It's so great to get to speak to the Woman's Hour about Sugarcane. I'm an investigative journalist and documentary filmmaker. And I've covered conflict and human rights abuses all over

the world, from Rwanda to Afghanistan, trying to understand these questions of why we exact violence on one another and how we survive and what we do in the aftermath. And yet I had never turned my lens on my own country and the horrors that it perpetrated against its first peoples for over 150 years. The last residential school, as you mentioned, closed in 1997, which was my first year of kindergarten, and yet I was taught nothing about it. And so when the news broke, I felt compelled and moved towards the story. There was this news that there were potential unmarked graves on the grounds of one of these schools that became a kind of international news event and sparked searches across the country. And I felt that I felt

compelled to follow one of these searches. And the first thing I did was reach out to an old colleague of mine, Julian Brave Noisecat. We were randomly seated at the desks next to each other as cub reporters in a New York newsroom. And in the years since, he had gone on to become a writer and journalist on Indigenous life in North America. And so I reached out to him and he said, let me give it some thought. And in the meantime,

I went looking for a nation that said they were going to do a search. I found this article in the Williams Lake Tribune about Chief Willie Sellers and the Williams Lake First Nation. And I sent a cold email. The chief called me back that same afternoon. He said, the creator has always had great timing. Just yesterday, our council said, we need someone to document our search. So I spoke to council and I got my gear together, ready to go follow this investigation

on the grounds of St. Joseph's mission. I heard back from Julian two weeks later and I told him that, you know, that's where I would be. And he went silent. And that's when he said, that's, you know, that's crazy. That's the school where my family attended. And I had heard a rumor that my father was born there or nearby. And that's all I've ever known. Yeah so in the documentary you have the the sort of the larger story of what happened in Canada with the schools and then you have this the intimate story of the father and son and the going on a journey to discover what happened to his father extraordinary the coincidence is extraordinary but I think we

need to get an overview and an understanding of what these schools were. Yeah, absolutely. So, you know, for starting in the late 1800s in both Canada and the United States, there was a vision and a program for eliminating what Canada called the Indian problem in the words of one of its architects, and in the words of the architect in the United States, Richard Henry Pratt, was to kill the Indian, save the man. And so based on that assertion, and in Canada, the idea to not leave one Indian left in Canada was the idea.

They created a system of schools in the United States. It was 417 schools that began operating in the late 1800s. And in Canada also operated since the late 1800s, a system of 139 schools. And these schools were built to forcibly assimilate Native children into white society by removing them from their homes, not allowing them to see their families, cutting off their hair, beating them for speaking their language, and in many cases, systemically, sexually, and physically abusing them. And many children did not return home from these schools because they died of various causes, from suicide to running away and freezing to death to outbreaks and unfettered checks of diseases and starvation at many of these schools.

And of course, what the film uncovers is something much more menacing and nefarious. Yeah. Can you tell us? So what we discovered in Sugarcane, and this is the first time this is being reported, was a pattern of infanticide at St. Joseph's Mission. So we're talking about babies who were born to students at the school and to young women who were working there

as well, Indigenous girls who were often raped by priests and gave birth at the school. And in some of those cases, the girls were sent away to unwed mothers' homes and the babies were forcibly adopted out into white families. And in other cases, they were forcibly aborted. And then in some cases, the babies were put in the school's incinerator to be burned with the trash. And that, of course, is the story of Julian's father at Archie Noiscat, who was found and saved from the school's incinerator by a night watchman. School follows the investigation of both what happened at the school and what happened to Julian's father. And it's a deeply moving, incredibly powerful,

very difficult, devastating watch. I can't imagine what it must have been like whilst you were filming it and covering the story as you were making the documentary. It was an incredibly profound and painful experience. You know, we lived alongside the community for two and a half years. We shot 160 days. We followed the story of Chief Rick Gilbert, former Chief Rick Gilbert, who, you know, in his very DNA carried a very dark secret, which was that the he was the son of the priest, the principal of the school. And he goes as far as the Vatican to confront the head of the Catholic order that abused him. And he's there for the Pope's apology and

the courage of these survivors who have gone through just unbelievable atrocity that has been passed on through generations. We're talking about six generations of families who this happened to. And you can see the trauma being passed from generation to generation. That's right. These are cycles of abuse and violence,

suicide and addiction that run rampant in indigenous communities as a direct result of these schools. And so though this is a story of the past, it's very much present. You know, we attended many funerals during the making of sugar cane. And in fact, there's actually a man who takes his life on the first Truth and Reconciliation Day, the son of survivors who suffered from the same cycles of addiction and abuse from the schools. Tell us more about the Truth and Reconciliation Days. So Canada, you know, created just a few years ago, the first Truth and Reconciliation Day. Canada

has been far ahead of its southern neighbor in the United States in addressing these issues. There has been some funding in Canada and an apology. There's been an apology from the Pope. And in the United States, and the film was, you know, part of the movement to have President Joe Biden apologize, in which, you know, we were there for and we were able to show the film at the White House. So all of these things are movement towards some idea of, you know, at least acknowledgement of what happened. And at the same time, the church, the governments of both the Canada and the United States have not yet opened their records to indigenous families and survivors so that they can at least know the truth of what happened. Just to follow up with what you were saying, I should also say that acknowledgement

of the wrongs done by the residential school system began in the 1980s and 90s. In 2008, the then Canadian Prime Minister Stephen Harper issued an official statement to former students apologising. The current Prime Minister, Justin Trudeau, who will soon be stepping down, of course, asked Pope Francis to issue an apology in 2017. And as he mentioned there, in 2022, the Pope did apologise for the conduct of some members of the Roman Catholic Church in the Canadian Indian school system and said it amounted to genocide. How do the community feel about religion now? Are they still religious people? Well, you know, it's an interesting question because as the film shows, faith is entwined in the lives of this community. And there are many elders and community members who are very loyal to the Catholic faith,

who pray at night with a rosary in their hand. And we try to represent that really quite honestly in the film that though the church and institution itself perpetrated with knowledge, unbelievable harms that it has yet to pay its part for, there are still community members who remain faithful to the church. And you see that again in the character of Rick Gilbert, who despite being the son of the priest of the school, despite being abused at the school, remains loyal to the Catholic faith. And, you know, when you're

brought up in a school where you have nothing else to hold on to, it makes sense that the faith might provide a refuge when you're separated from just about everything else. And the survivors now, are they still looking for answers? Well, this is one of the first investigations that has uncovered these horrific truths, right? And there were, as I said, 138 other schools in Canada and 417 federally funded schools in the United States. And we still don't know the extent of what happened at all of those schools. And so survivors are still searching for answers, are still searching to find out what happened to their loved ones. Charlene Bellew, who's the lead

investigator in St. Joseph's Missions and a survivor of the schools who's been doing this work for over 30 years, is looking for the remains of her relative who committed suicide at the school. We know from records it's buried somewhere on its grounds. And until she finds him, you know, she won't rest. One of the most moving scenes, so much of it is utterly devastating, harrowing, moving, all of it, is they go into an old school building and they see graffiti from some of the children who went to the school. That's right.

So this is in the old barns of St. Joseph's Mission, which has become somewhat decrepit, even though it's a working ranch owned by white ranchers who live nearby. And in the attic of this barn, in the stalls, there are etchings from children dating back as early as 1917, counting down the days until they could go home, writing their names, where they came from. And in some cases, writing messages like, I don't care about Lucy's baby was one of the ones that we found and a number of other kind of harrowing messages. And these were also places where the children were taken to be whipped. They were put up on a poster and brutalized there. But it was also a place where they could hide out and mark that they were there. And this is also the place where Charlene conducts a sort of ceremony on Julian to call on him to help tell the story. And it's so much for the indigenous First Nation community to deal with, to unpack and all the many, many, many generations of immense trauma

that they're having to confront. But what about wider societies? How does Canada feel about its history? Well, despite there being this movement and funding for these investigations to, you know, confront this horrific past, unfortunately, there's a counter movement, there's a large wave of denialism amongst kind of far right and conservative movement that denies the existence of abuse at any of these schools and, you know, denies the experience of survivors. And that is, that movement is growing, unfortunately. And the funding as a new administration comes into play in both Canada and the United States. To look further into these schools, we're not sure what's going

to happen. But it doesn't look good. It doesn't look like the continuation of these efforts will proceed. And that's a shame. There's a bill actually going through Congress right now in the United States, and it passed one house, but we don't know and feel very dubious that it will move forward from here. And what's the reaction to your film been, Emily? You know, we've been blown away by the reaction of survivors, in particular in indigenous communities. We've taken the film across Indian country to reservations from Yellowknife

in the Northwest Territories, through the prairies, Standing Rock in the Dakotas, and Asitka, Alaska. And what has been so moving is to see multiple generations of families and survivors come and see the film together, grandparents with their grandkids and kids, and then for the first time having conversations about what happened. Because for so many years, the truth wasn't just suppressed from society and the government and the church, but also from within families where the pain and the shame was far too great for them to talk about it. And so we have people who have said, you know, for the first time, I've been able to speak to my father about what happened. For the first time, I've been able to forgive my parents for how they treated me.

And that's been profound. And we've also, you know, as I said, been so lucky that the film has reached the highest levels of government in Canada and the US and been part of this broader movement to reclaim what was taken and to rewrite and correct the historical record. Well, we requested a statement from the Canadian Conference of Catholic Bishops, but they were unable to provide one. We did hear from the Canadian government and the minister responsible for Crown Indigenous Relations for Canada, Minister Anna Dangsary, and they said residential schools are undeniably a shameful part of Canada's history. We're working diligently to uncover

and share the truth about these institutions and the harms they have and continue to inflict. He thanks you, Emily, and the others involved with the film for bringing it to wider attention. Thank you so much for joining us this morning to talk to me. Thank you. The film is called Sugarcane.

It's from National Geographic and is now on Disney+. And if you've been affected by anything you've heard today, resources for support can be found on the BBC's Actionline website. 84844 is the number to text. I'm Sarah Trelevan, 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 was faking pregnancies. I started 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. Now, a private member's bill that proposes banning first cousin marriage is due to have its second reading today. It was introduced by the Basildon and Billericay MP Richard Holden, who said the practice of marrying cousins poses a public health risk. Marrying among cousins is a common tradition among lots of communities, including Irish travellers and British Pakistanis,

and it's been legal in Britain for more than 400 years. But it's not just these communities. Royal families across Europe have been marrying their cousins for generations. Prince Albert, Queen Victoria's husband, was her first cousin. Charles Darwin married his cousin, as did Albert Einstein. But there is a darker element to cousin marriage, especially for women, some of whom are forced into cousin marriages by their families. And there's the medical element to consider. Cousins who marry run a much higher risk for their children's health.

Joining me now are Natasha Ratu, CEO of the charity Karma Nirvana, which helps women who are victims of honour-based and domestic abuse, and Neil Small, Emeritus Professor of Health at Bradford University. Neil was a member of the Born in bradford study which has the largest body of evidence on children born to child cousin marriage uh natasha and neil welcome to the program let me come to you first natasha why is there a practice of people marrying their cousins well at carmen nirvana we do sometimes and it's not for every case that we deal with um come across people who are being pressured to marry their cousin and in terms of the experiences that they share as to why this happens it can be that families want to ensure that people do not marry outside of their community their culture etc

and then we also get scenarios where we're dealing with issues from a child protection lens, where it's become apparent that somebody's been promised from birth to marry their cousin. I have to say that that is quite uncommon. And actually, sometimes in experiences, we do come across people who are consenting and making a choice to want to marry their cousin and ultimately do go on to experience abuse that's not actually connected to the fact that they're married to their cousin, but about this wider issue that we're trying to challenge nationally, globally around gender-based violence and violence against women and girls specifically. So we see people who go through it and it is a problem and some people who go through it and it isn't. Do we know how prevalent it is? It's really difficult to quantify because there aren't many data sources if any at all. We do at Carmen Havana capture data if that's shared with us on a call and it's part of the experience of

abuse that somebody is facing but there isn't any national data to specifically say how common or frequently this is happening. Neil, let me bring you in here. What did the Born in Bradford study find out about cousin marriage? Thank you for having me on. Cousin marriage and the recessive genetic disorders that are associated with it is a small part of the Born in Bradford study. It's an important issue because of the particular circumstances of the city of Bradford. In Bradford, when we recruited for the Born in Bradford study, just over half of the babies

born in the city were born to parents of Pakistani heritage. And of those parents of Pakistani heritage, when we recruited to the study between 2007 and 2011, 64% were married to a cousin. I think we should get an overview, a quick top line of what the Born in Bradford study is actually, Neil. I've just realised we should probably explain what that was. Right, okay. Well, Born in Bradford's been going since 2007, and it's following up the health of around 13,500 babies born in the city between 2007 and 2011. And its remit is to look at how the circumstances of their birth shape their subsequent health and well-being, including their educational well-being so basically what it's looking at is a city-wide um context in which we're watching these babies go through their infancy through their childhood they're all now in secondary school and saying these are the things that have presented as particular challenges for

them and these are the strengths of the city that have helped them to to grow and to flourish in Bradford in these years. We've concentrated on health in the first instance. We're now very preoccupied with looking at what's happening to children's education, sitting in general at their well-being. And I hope what we're going to be doing is following up these children throughout their childhood to see them go from just before they were born to when they become adults and perhaps have children themselves. Can you explain some of the health risks then that you've discovered for children of cousin marriage? We all carry, all of us, the potential for having one or two damaged genes in our bodies. And when we have a child, the child inherits from mother and father. If the damaged gene is the same in mother and in father, the child is likely to be born with the damaged gene. Now these occur randomly. So recessive

genetic disorders, which are single gene disorders, occur randomly across the population. But cousins share more of their DNA each with the other. About an eighth of the DNA is shared if you're a cousin. So the chance of you inheriting the same damaged gene increases. And what we found specifically in Born in Bradford is that in cousin marriages, about 94 children born to cousins did not have a recessive disorder, but six did have a recessive disorder. 2.6% of people of Pakistani heritage who were not cousins and in 2% of white British mothers who were not cousins as well. So there is a background level of risk, but that level of risk increases if you're a cousin and it increases so that we see six in every hundred having a recessive genetic disorder. Natasha let me bring you back in here as it is women's hour what would a what would a first cousin marriage ban mean for women in particular? Well in terms of the there are

proposals to ban cousin marriage and I think it's important to highlight that Carmen of Arna and the women's sector more generally were not made aware of this prior to this bill proposal being introduced. And I think on the basis of that, not necessarily have the desired effects of supporting people affected by violence against women and girls. From a health perspective it's quite different but from a abuse perspective it's going to potentially prevent people from feeling able to come forward and speak because already people within these communities do feel marginalised. And then to bring in legislation that bans it but doesn't seek to engage with them, doesn't seek to support them necessarily, is going to be quite counterintuitive to tackling the issues around the abuse element to this issue. I also read that a ban might not actually stop the practice, it would just drive it

more underground and therefore there'd be less legal protection for women. Absolutely, it would drive it underground. And you might also find that people may be less inclined to register marriages if they are cousin marriages. So they may have a religious marriage, for example, which isn't registered. And what that then means are, and this is what we do see in unregistered marriages, is that women tend to have less legal support or if they then try to separate from that marriage, it's a lot more difficult for them to do so without that legal framework that you have with a registered marriage. So actually, we think that it could potentially put women and girls at more danger. Yeah. Neil, the independent MP Iqbal Mohammed says that genetic testing would be a better way to keep an eye on this.

How would that work exactly and would it? Can I just say I absolutely agree with everything Natasha said. And I think some of the points she's made about discouraging people accessing services apply to health services as well. On genetic testing, we're doing much they're at and to give them the opportunity then to make some sort of informed decision about whether they wanted to go ahead and get married and indeed if they wanted to get married if they then wanted to have children. If you've got the same damaged gene you've got a one in four chance that your child will be born with the recessive genetic disorder so it's a big decision for people to make. The capacity to do that is not widespread.

The idea of a ban on cousin marriage, I guess, which would incorporate the potential to test people to see if they are cousins, the resources for that might be better targeted at communities with high prevalence or likely high prevalence of cousin marriage, where couples could be tested to identify if there was a risk, enhanced risk of recessive disorder and allow them to make those choices themselves. But I also very much agree that the voice of those people most affected have not been heard very much in this debate so far. And the debate would be much enriched were that to be the case. Thank you both for joining me to discuss that Professor Neil Small and Natasha Rattu. Thank you 84844. We are going to be talking about masculine energy or feminine energy in the workplace and lots of you are getting in touch with your thoughts on this. I'm a female in my early 30s who consistently throughout my career

has been referred to as the bubbly positive one and this is an image I try to project at all times, whether working or not. I think you can be the best version of yourself and inspire your colleagues with your attitude and achievements, whether male or female. Has Mark Zuckerberg considered the term fighting talk? I think this has far more desirable connotations than aggression, which reminds me of a testosterone-charged ball in a field.

It has its place, but not in an office environment for me. Love the show. Thanks, Elizabeth. Nice to have you listening, Elizabeth, in London. Now, Dame Joan Plowright, the acting legend and one of Britain's most esteemed stars of stage and screen, has died at the age of 95. Her family announced this morning that she passed away peacefully yesterday, surrounded by her loved ones. Dame Joan had a career that spanned more than 60 years.

She only stopped in 2014 when her increasing blindness made her retire. She was nominated for an Oscar and two BAFTA awards and won a Tony. Her personal life was no less dramatic. When she met Lawrence Olivier in the 1950s, they were both married to other people and there was heavy press coverage of their affair and subsequent marriage. In 2001, Dame Jones spoke to Jenny Murray on Woman's Hour about her memoir, And That's Not All,

and she told us about what it was like when she first joined the English stage company at the Royal Court in London in the 1950s. I mean, it was an extraordinary meeting place, the Royal Court, in those years. It wasn't only actors, directors, authors. It was people in the music world and dress designers. All that kind of generation looked upon the Royal Court as a kind of meeting place. It was a symbol of rebellion in a way and all the young writers and actors who were there with me, Alan Bates, Albert Finney, were A from

the provinces, B they were kind of rebelling against a Western theatre which you know was personified by people people in cricket flannels and flowers. It turned the class system completely upside down. The what? It turned the whole class system completely upside down. How did you begin? What convinced you that you wanted to be an actress? Your mother, I think, was always involved in this kind of thing, wasn't she?

My mother was a leading amateur actress at home in the Players' Society. And when I made my first success in London, I remember going down the high street into Gunthorpe and people stopping me to say, well, of course we're not surprised. I mean, you should have seen your mother as Elizabeth Barrett Browning. She played this part in The Barretts of Wimpole Street and was extraordinary.

And I remember we had to have Flush, the Spaniel, which Elizabeth Barrett Browning always had, in the house for three months before she even started rehearsals. So my mother was a method actress before it had even been thought of. Dame Joan Plowright, who has died at the age of 95. Now, Mark Zuckerberg says companies need to embrace more masculine energy and that corporate culture has become culturally neutered. The boss of Meta was speaking on the Joe Rogan podcast and added that instead of trying to get away from masculinity

corporate culture should embrace the positive side. So what even is masculine energy and what impact could comments like Mark Zuckerberg's have on women in the workplace? Well, joining me in the studio are Becky Hewitt, the chief exec of Kin & Co, who work with companies to improve their workplace culture, and Josh Smith, a contributing editor of Glamour magazine, which it's fair to say is a pretty female dominated environment, I should imagine, Josh. It is. I mean, I've just written an article about this as the perspective of someone who's only ever worked in female dominated spaces. And I can see the sheer positives that come from embracing femininity in the workplace. I've never really had to deal with toxic masculinity inside the workplace. I've had to deal with it outside

of work, you know, growing up being bullied for gay, that you get, you are definitely at the receiving end of a lot of toxicity and of male aggression. So working in a space full of women, I felt like I was accepted, I was seen, I was included, and that went for everyone. And I feel like we need to be embracing more of that energy, rather than masculine aggression. Well, you are embraced at Women's Hour. Thank you so much. I'm so thrilled to be embracing more of that energy rather than masculine aggression. Well, you are embraced at Woman's Hour. Thank you so much. I'm so thrilled to be here. What does he even mean by masculine energy, though, Becky? It's really hard to know. And when I was thinking about this, I was thinking actually any gendered language and stereotyping of this kind is just it's deeply harmful for everybody. I think the first problem is it implies there's some kind of gendered hierarchy, you know, a set of behaviours, sort of typically traditionally male around being strong, dominant, that belong to men, and somehow women don't embody and don't

have access to. And I think that stereotyping really feeds into all the challenges that we know about the glass ceiling and women's representation in roles. And I think the second problem is that it implies there is a set of strengths and preferences and experiences that are somehow universal to all women. Whereas, of course, we actually know that, you know, women have a whole beautiful spectrum of different characteristics and different strengths, areas of power. And of course, they're very different depending on whether you're a woman of colour, a disabled woman, an LGBTQ plus woman, you know, this isn't a universal thing, we are all different.

And those differences absolutely need to be celebrated. Yeah, you were so moved, like you just said, you wrote about it, because you were so moved by what he said, because actually, what is masculine energy? You know, for you, what does it mean? It means toxicity. That's what he said because actually what is masculine energy you know for you what does it mean it means toxicity that's what he was saying yeah that that's for me what it felt like when he said that it was like let's embrace toxicity and i feel like at this juncture in our lives we don't need more toxicity we don't need more aggression we need more allyship towards every single community and i think what's so weird about what he said is it kind of neglects the fact

that the patriarchy that we've lived in for so long has actually damaged so many people. It's not just women, but it's also men who suffer at the hands of patriarchy and aggression as well. I know that I've experienced that myself. So I feel like at this juncture, especially when we've got, you know,

a rise in violence against women and young girls, have less less female ceos than we do steves in the top 100 companies we need to be saying to people strong fact yes strong fact we need to be embracing female energy and to change the tide of what's going on aggression's not going to get us forward no but but here's because obviously we've all spent a bit of time thinking about this one. What's to say that a bit of aggression isn't feminine energy? Yeah. And this is right. And I and I feel one of the challenges, you know, as a female CEO who has had to take on a lot of leadership roles. Actually, there are some really important kind of powerful qualities you need as a woman leader. You know, you need to be able to speak truth to power.

You need to be able to take tough decisions. You need to be able to take risks. You need to believe passionately in change. Now, those are really important characteristics that women need access to, but they're not aggression. They are about kind of feeling power and agency in your role. And that is femininity. Absolutely. So Becky, you coach lots of women in business so what do you think the consequences of these types of comments are yeah and i think the really important thing to acknowledge about this is how dangerous statements like this are from powerful people and we just think about the corporate tone that zuckerberg is setting and what he's giving

permission to exactly and also as josh's interpretation of its toxicity actually it probably it's much more than that isn't it but instantly that's what it triggers it that's what it makes you think yeah and i you know i i coach women and i've spoken to several of them this week and they are head in hands angry and frightened about what this will mean you know these are women who've experienced harassment, discrimination, difficulty getting in role, getting senior roles, they've really had to work hard, and they are so frightened of going back, you know, what is going to be allowed now, in terms of comments, in terms of stereotyping, you know, in terms of giving them roles that are less valued. And all of that now becomes possible. And some of that is really dangerous. I mean, there is recent research from the big financial regulator from the FCA,

which shows that cases of harassment in the city have risen by 75% in the last three years. And over those instances, a quarter of them are bullying and harassment. So it is already not a safe place to work in the UK particularly in the city and if the tone is set now like this and it becomes more dangerous that is a really worrying thing what's the conversation been like at Glamour well it's been interesting about the messages that I've actually got from people afterwards after the article and one of the things that's so interesting about it for me is I wrote the article and I have my own podcast reign where each week I'm joined by 70 guests we talk about empowerment and a lot of the things that's so interesting about it for me is I wrote the article and I have my own podcast reign where each week I'm joined by 70 guests and we talk about empowerment and a lot

of the issues we talk about are actually about creating safe spaces for women and how we need more allyship for that and then a man had commented underneath my youtube video being like this interviewer FFS what happened to real men and I was like this just proves everything that I was thinking and writing in this article. Because actually, what he's saying is it's giving permission for a rhetoric around what masculinity is, what it means. It's giving permission to people who feel disenfranchised with their situation. It gives them permission to go out there and start being more aggressive, or it gives them permission to use rhetoric that they shouldn't be using. And's really damaging not just for women but i think it's damaging for minority communities i

think it's damaging for men as well like no one thrives in a in an aggressive environment today like no one thrives in that environment at all we thrive in environments where we create inclusion and i've written a book last year called great chat which was all about communication at no point did i say in that book that aggression was going to make you a better communicator I so agree with that if we think about what what is aggression what behaviors are it's basically a dysregulated behavior yeah can I throw something in there can is there a place where if we are going to talk about this in the binary because I think we're all in agreement that kind of men and women are a bit of everything we all have masculine energy we all have feminine energy but if we are going

to talk about that can there be positives to a bit of masculine energy speaking as someone who was described as a tomboy as a kid that was the description given to me not by myself by other people because presumably I just had more sort of masculine energy about me um I don't know so is there any positives to be had so i think there are positives in perhaps traits that we might have said were more masculine so i think all those things around you know energy around focus around drive about caring about making change about speaking up about setting the tone around inclusion you know all of those things which might traditionally

have been seen as masculine energy are positive, but I think they don't just belong to men. No, because some of the most driven, organised, capable, brilliant women I know are women, like some of the most brilliant people. And some of the most compassionate, caring, empathetic people I know are men. They need to be able to claim that space too

and not to be excluded from it. We've got loads of messages coming in about this I'm going to read a few out so for generations aggressive masculine energy has prevailed for a brief period feminine energy has been permitted to emerge but it appears that we're going backwards now and it makes me feel fearful for my granddaughters to what you were saying Josh that's from Linda. William says it is complete nonsense to say that there is a masculine and feminine, if I can get the word out, feminine energy. There are traditional Western masculine behavior models, aggression, overconfidence, self-promotion and so on. As a man who is really quite bad at those and who's worked in masculine environment, I'm fairly sure they are great for personal advancement, but not that useful for getting things done. Roberts says retired now, but was the manager of a large prison wing in an even bigger male

prison. Female officers were introduced and blended in quite well but when challenged I used humor to set an equilibrium. It worked so well and he says he's happily married to one of the female officers now for 20 years. And Marie from Winchester says having worked in technology most of my career more recently the defense sector it is a mainly male atmosphere what gets compromised while so much masculine energy and particularly when it comes to from the top is communication caring and collaboration you need to make yourself vulnerable to gain real trust the masculine environment promotes masking vulnerability to what you were both saying so um becky um what are the ingredients to a healthy and successful workplace very quickly from both of you yeah so super quickly I think the first thing is balance you know we absolutely need drive

passion for change and results but it has to be balanced with humanity compassion a sense of common purpose of creating belonging of building trust and empowerment so we need both of these things together I think the key is creating safe spaces. I think every workspace should feel like a safe space for people where they can prosper, grow and thrive. And that always makes you more productive too, if you can be authentically yourself. And as a lone male voice in a predominantly female work environment, good?

I love it. Of course you do. I love it. Right answer. Thank you both for joining me to talk about that, Josh Smith and Becky Hewitt. And thanks to all of you who got in touch with the programme. Do join me tomorrow for more Weekend Woman's Hour.

That's all for today's Woman's Hour. Join us again next time. Hello, this is Danny Robbins. Three years ago, I was told one of the scariest stories we have ever had on Uncanny. The entire room erupts. There are things flying around all over the place. In 1973, a young climber called Phil spent the most terrifying night of his life

in an abandoned house in the Scottish Highlands. We're absolutely terrified and we hear this thing going around the building. Now we are going back there with Phil, returning to Louisbelt 50 years on to confront whatever he experienced there. There it is, Phil. Yeah, that's it, alright. Poking up over the hill like a grim spectre. How are you feeling?

Are you okay? Nervous. Yeah? Yeah. Subscribe to Uncanny on BBC Sounds. I'm Sarah Trelevan, 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 was faking pregnancies. I started, like, warning everybody. Every doula that I know.

It was fake. No pregnancy. And the deeper I dig, the more 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.