Woman's Hour - DIY fertility tests, Sudan conflict, Rebuilding my life

Episode Date: September 4, 2023

A BBC investigation has found that at least five women have died after family courts allowed fathers accused of abuse to apply for contact with their children. Some took their own lives, and one had a heart attack outside a court. Nuala McGovern is joined by Dr Elizabeth Dalgarno who led the research in to this. We often talk to women about the immediate impact of traumatic life-changing events. But what happens after the dust has settled? This week on Woman’s Hour, we are inviting you to listen to three women’s experiences of picking up the pieces. Claire Russell lost her partner Mark to suicide in 2018, and miscarried their baby a few weeks later. Claire tells Nuala about how she began to recover. Since the conflict in Sudan erupted again in April, there have been reports of the increased use of sexual violence against women and girls. More than four million women and girls are at risk of sexual violence across Sudan, according to the World Health Organization. Nuala speaks to CNN’s Nima Elbagir and to Duaa Tariq who is in Khartoum.How reliable is DIY fertility testing in helping you plan for a baby? A recent report in the British Medical Journal has found that some DIY tests that were sold in the UK to measure oestrogen levels may have given misleading results. The report's author, Emma Wilkinson, joins Nuala alongside Dr Ippokratis Sarris, Consultant in Reproductive Medicine and Director of King’s Fertility. Have you ever been in a 'situationship'? It's sort of a relationship but you're not exclusive. It's the subject of the debut novel of Taylor-Dior Rumble. The Situationship is published by Merky Books and it's been termed the label's first Rom-Com. Taylor-Dior joins Nuala in the studio. Presenter: Nuala McGovern Producer: Emma Pearce

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

BBC Sounds. Music, radio, podcasts. Hello, this is Nuala McGovern and you're listening to the Woman's Hour podcast. Hello and welcome to Woman's Hour. I hope you had a nice weekend. Did you hang out with a significant other or are you more in a situationship? I'll shorthand the situationship by calling it a non-defined romantic relationship, but we will learn more about it from Taylor Dior Rumble, who has just published a

rom-com with that title. But I did notice a lot of chatter and headlines over the weekend about public marriage proposals and the cases for and against it. Is it romantic or a cringe fest? Well, you've probably seen one online,

maybe at a graduation or on a billboard. But is it something you've been part of? Maybe something you planned? Maybe something you've witnessed? Well, elaborate proposal planning is apparently a business now. And yes, some blame social media for the broadcasting of what was traditionally a private moment. I want to hear your stories and your opinions.

You can text the programme. The number is 84844. On social media, we're at BBC Woman's Hour. Or you can email us through our website. 03700100444 is our number if you want to send us a voice note or indeed a WhatsApp message. So we'll get into that. But also today, at-home fertility tests. Can you trust them? We'll discuss that. We also have a new series on how to survive a devastating life event. What does it take to get through those

first hours, days, weeks and years when you're dealing with a new reality and also a rise in sexual violence in Sudan following the conflict which erupted there in April will be in Khartoum. But let me begin. You might have heard earlier this morning in the news, a BBC investigation has found that at least five women have died after family courts allowed fathers accused of abuse to apply for contact with their children. Some took their own life. One had a heart attack outside the court. And a separate study has found that 75 children in England were forced into contact with fathers who had previously been reported for abuse. Well, in the England-wide study,

this was carried out by the University of Manchester and revealed for the first time by the BBC, in some of the cases, the fathers were convicted paedophiles. All the fathers in the study had responded in court to allegations of abuse with a disputed concept which is known as parental alienation, in which they claimed, the fathers, that the mothers had turned the child against them without good reason. Dr. Elizabeth Delgarno is a lecturer in healthcare sciences at the University of Manchester and carried out that study and joins me now.

You're very welcome. Can you tell me about that research that you were carrying out? Hi, Nuala. Yeah, thank you for having me today. So the study involved interviewing 45 mothers who had been subjected to domestic abuse previously. All of the mothers reported that their children had also been abused by the children's other parent, namely fathers, fathers and what was reported to us was that in 39 of those cases the mothers were accused of parental alienation and for the remaining cases the mothers were either pathologized in another way for example they were called bipolar or hysterical or crazy. I still have you there, Elizabeth, do I? Yes, yes, sorry.

Yeah, no, there's just a little pause in the line for a moment. So let's talk about the term that you mentioned there, parental alienation. I've mentioned in my introduction that it is a disputed context. But you say some of the fathers responded to allegations of abuse with this concept of parental alienation. You've even said it's a handy tool for abusers. Explain the issue. That's right. So it's essentially a pseudo concept. It's been denounced by the United Nations, the World Health Organization, the American Psychiatric Association. It's been rejected globally. It's even been prohibited in many countries. And the problem is, once it is raised, it becomes the focus of the courts and a tsunami of unregulated experts are brought into proceedings to essentially diagnose children and women with parental alienation. This pseudo concept is absolutely killing women. You call it a pseudo concept, but surely there must be cases that come before the courts where fathers, you talk about in the main,

have been alienated by mothers, no? So I would never use the term alienation because it's so powerful. It's a silver bullet and it's catastrophic and it makes's a silver bullet, and it's catastrophic. And it makes the focus around the mother and victim blaming of the mother and the child. Can parents manipulate a child to reject another parent? Of course they can. We would describe that as coercive control. Coercive control is an established framework. it situates in the domestic abuse act and statutory guidance the coercive control statutory guidance which both rejected the term parental

alienation and both refer to child manipulation as coercive control so that is the term that we should be using so would you like the term parental alienation abolished? Absolutely. It should be prohibited. It has no credible scientific evidence underpinning it at all. What about this, though? England's Children and Family Court Advisory and Support Services, CAFCAS, which advises courts about children's best interests, referred to parental alienation in guidance as recently as 2021, but now adopts the term alienating behaviours. It told the BBC its advisers should first consider if factors such as domestic abuse means the child's refusal

to see a parent is justified. And the BBC has learned the government is investigating whether further action is needed on the term alienation since the BBC made the Ministry of Justice aware of the investigation. They say they've issued new draft guidelines for consultations on handling parental alienation claims, I'm using that term again, in domestic abuse cases. But some experts say they don't go far

enough. What do you say? Yeah, the issue again, as I've just highlighted, is that CAFCAS are a governmental organisation. And they are referring to alienating behaviours despite it being rejected from the government's own Domestic Abuse Act and statutory guidance. So we have two governmental outputs here, organisations who are using completely different frameworks. The other issue is that we've been told and multiple people have reported that CAFCAS do not investigate domestic abuse. They do not effectively investigate coercive control.

And in fact, we found out only last week from a Freedom of Information request that CAFCAS are breaching their own policies. They are sending victims of abuse to co-parenting courses. Now, that is victim blaming. Their policies stipulate that they should not be doing that. And I don't have a representative from CAFCAS here and they probably would dispute how you are characterising it. But that is your point, as you put it across.

I do want to know, though, since this story has been reported on the BBC this morning, I understand you've received quite a lot of correspondence. I have. I've awoken to an inbox full of emails from mothers I've never spoken to before telling me this has happened to me. I reported abuse, presented criminal convictions, evidence of abuse from GPs,

multiple health professionals to the family courts, was accused of parental alienation and I've lost custody of my child to the abuser. So we are essentially seeing state-sanctioned abuse and Anula, there is far too much money. Sorry, finish your point, yes. Yeah, there's far too much money involved in the family court one mother told me she's she's lost a hundred thousand pounds to uh barristers solicitors um to unregulated experts who the government which are coming in and i understand that's part of your argument as well that you do not want unregulated experts coming in and arguing really the case for

parental alienation that is one get rid of the term number two what would your other in our last 30 seconds what would your other point be that you would like to see introduced in the courts we need emergency measures right now to prohibit any transfer of residents where parental alienation is alleged and domestic abuse is alleged. And we need government to act urgently to change the law, to remove the presumption of contact where there's abuse. And we need to regulate all professionals working with families. Thank you for coming on. That is Dr. Elizabeth Del Garno. You can watch Mums on the Run, Failed by the Family Court on the BBC iPlayer. I do have a message from somebody who's remaining anonymous saying, I went through the family courts four years ago. It was the most traumatising event of my life. My children's father was abusive and he used the family court system to continue the power and abuse over me. Please continue to raise this very important matter. Now, let me move on.

Actually talking about life changing events and traumatic events. We do talk about them, but we want to focus today on what happens immediately after that. Perhaps when the dust is beginning to settle. How do you go about rebuilding your life? Well, this week on Women's Hour, we're inviting you to listen to three women's experiences of picking up the pieces after a life changing event, a terrible loss. Joining me today is Clare Russell. Clare lost her fiance Mark to suicide in 2018 and they miscarried their baby a few weeks later. She's since set up an organisation that encourages businesses to

support the mental health of their employees. But we really want to find out how did she begin to recover? Welcome, Clare. Good morning. Welcome. It's so good to have you here. And I outlined what you went through, and I'm so sorry that you had that experience five years ago. With that immediate aftermath, because you're here in front of me now and you're surviving, what do you remember of that time, of how things began to coalesce to kind of bring you forward yeah I mean those first sort of days and weeks after losing Mark are I guess you know they're they're something of a blur but when I when I think back to that time what really kind of stands out for me is from a really early point, I, there was a kind of realization that, okay, I need to find a way through this, I need to, I guess, find a sense of purpose in it. And I think that that was the

thing that I really held on very, very firmly to. Do you, that's so interesting. So you had a conscious thought about the purpose to be able to find some kind of sense of purpose in each of those experiences. So absolutely, you know, it was, it was a really conscious choice to seek that, you know, to find a way through. And did the purpose come to you immediately? Kind of it did yes I mean I'd experienced challenges with my own mental health a number of years earlier so two or three years earlier I'd had a breakdown and so my journey with learning about mental health and resilience and developing my own kind of knowledge and understanding in terms of how I could

look after my own mental health, develop and build my own resilience and how I might help others to do the same. That had been sort of developing over the previous couple of years. So you had some of the tools perhaps already? Yeah, for sure. I, yeah, I've been been kind of I guess the way that I like to describe it is I had been almost like building this toolkit and I always look down to my waist because it's like a bob the builder toolkit around my waist right with all of these different tools in that have helped to um rebuild that that state of resilience that state of resilience, that state of mental well-being. So you lost Mark.

And, you know, I was reading about the weeks after and you were pregnant and happy with that and holding on to that, which I think a lot of people would relate to, but then lost that baby. And after that, I mean, where did you go or who did you speak to? Because I'm just thinking of other people that are out there that are perhaps going through have gone through something traumatic like in those first hours and days how do you center yourself thanks yeah I um I guess because I'd I was already on that journey of developing those resources. So I already had in place therapists.

I already had in place people that I knew that I could talk to, friends, family, people that I worked with who I trusted and I knew that, you know, that I could lean on and talk to. So I think really it's about having all of those things you know I think it's about building up that kind of that network of support I think professional support is is really important um something that I um I wish I'd had yeah and I didn't was specific bereavement support um following suicide because I think it's a very specific kind of loss um and I and I wish that I'd had some specific support now I've gone on to do a lot of work in that area myself um and I was fortunate that I had other therapeutic support in place

that I was able to lean into. But I think that is something that may resonate with our listeners that that is what is needed after something as devastating as suicide. You were a Samaritan's call handler and you went back to it. I was fascinated by that. Talk me through a little bit of maybe that particular transition. took his life. And I, the support from Samaritans for me as an individual was extraordinary and really an important part of that support network that was in place for me. I took a leave of absence as a volunteer. Do you mind me asking how long? I think it was only three to four weeks.

It's very short. It was a really short period of time. Yeah, I went into the branch that I volunteered at, maybe around three weeks after, and sat down with the branch director and said to her, look, being a Samaritan is a really important part of who I am. And I need to come back. So you were holding on to parts of your identity pre this devastating period.

Yeah, absolutely. Yeah, that was really important to me that I didn't lose who I was in this. And doing that volunteer work was a huge part of who I was and also was a thread in my relationship with Mark also. So I knew that he would have wanted me to continue to do that. You have children. I do. And I'm wondering how being a mother played into those days and weeks after it because that is something that you were before yeah yeah so it played into it in a number of ways um you know in in the very

early days there is a a sense of well i have to keep going i have to continue to put one foot in front of the other however however I'm feeling, because my children need me to hold it together, right? They need me to be there for them and be consistent. So I think that was a really positive thing for me. And the other thing which was quite challenging for me was, you know, my children were quite young. Mark was not their father, but the children were close to Mark.

And it was working out how I was going to talk to them about suicide, how I was going to explain this loss to them. They knew what I did in my work. You know, we talk as a family very openly about mental health, always. And I really needed to understand how I could talk to them about suicide and explain this loss to them in a way that they would understand. And did you get help with that? I did, yeah. Do you mind me asking from who? So a charity called Winston's Wish and their, their purpose is all around supporting children who are bereaved by

suicide. So they have a specialist team of psychologists who are really highly trained in this, in this area. So they were able to give me guidance that was age appropriate for my children in terms of how to have that conversation, how much detail to share with the children and how to create the conditions for them to talk about what they needed to talk about, to ask the questions that they would need to ask. You also shared publicly, you posted online Did that help? Did it help? Yeah, it did help. It did. It really helped. I don't think I realised at the time how much it would um i think for me being able to almost journal you know really from the very early early

days of what happened journaling that sharing that publicly um i think it was it was really helpful a helpful way for me to process what i was going through the emotions that I was experiencing. And I mean, I received thousands and thousands of messages and lots of messages from people that had experienced similar. So I think it was, I didn't feel so alone with my experience. People were kind? Oh, people were extraordinarily kind. Yeah. Yeah. Because you worry about that, you know, online.

Yeah. In the main, you know, I had a very, very small number of not positive responses. But overwhelmingly, the response I received was so supportive. You spoke at the beginning of our interview with that idea of a purpose that came to your mind pretty early on. Do you want to tell our listeners what it is now or kind of a little bit what that narrative has been and how it's evolved? Yeah I mean gosh it's been the most extraordinary journey really so really early on I you know it's very clear to me that I needed to find a sense of purpose in this and I wasn't sure what that was I'd already begun the process of retraining so I went on to train as a mental health first aid instructor for adults and for

children a suicide first aid and suicide intervention instructor for adults and children, a mental health coach. I didn't really know why I was doing all of that stuff really, except that I wanted to learn. And then it became clear to me that a way that we, I could help a lot of people, reach a lot of people was was by working with organizations to help them to look after the mental health of their people and so that's that's what we do we help businesses to create psychologically safe workplaces um we do that through training education support and is that now your full-time career? Yeah. That's your life's purpose? It really is my life's purpose, yeah.

I mean, I spend, outside of what we do in the business, I also speak professionally. So I speak at conferences and events and anywhere where people will listen to me talk about mental health and suicide. And they are listening to you today and it is very hopeful and uplifting to hear how you found that path.

But before I let you go, Claire, are there still bad days and how do you cope when maybe one gets you from left field? Yes, of course, there are still bad days. I don't think you ever get over an experience like this um I think you learn to live with it I think it becomes a part of the fabric of your life and who you are um and you know how I cope with those difficult days is um is through looking around me

and seeing the positive impact of the work that we're doing. You know, knowing that by sharing my experiences, by doing the work that we're doing, that, you know, we're ultimately making a difference for a lot of people. Claire Russell, who now runs Mental Health in Business. And I do want to let our listeners know, if you've been affected by the issues we've been discussing, you can go to the BBC Action Line for help we've also posted some links to support on our website and tomorrow

on our series Rebuilding Continues I'll be speaking to Martine Wright who was the most injured female survivor of the 7-7 bombings Thank you Clare Thank you Let me see, we're going to go to Sudan in just a moment but I want to read a quick story

talking about public proposals like engagements, marriage proposals cringe fest or romantic this is from Tilda As a young and naive student I was proposed to by my older boyfriend in the courtyard of a leisure park he had auditioned and choreographed a host of dancers

hired a brass band composed a song and had a velcro tuxedo made so he could transform quickly. While it was an amazing effort, it was the most baffling and cringeworthy experience of my life. Instead of saying yes, I said, all right then, because I was so flustered. We started to plan a wedding, which would also gradually become quite a big show about him. In this particular case, the wedding never happened and the proposal should have been one big red flag. Very glad I see that now. Proposals even should not be a show. 84844, if you would like to share your story. Thanks very much, Tilda, for that. Now, on Women's Hour, I want to turn to Sudan.

Sadly, there is more evidence of the widespread use of rape and sexual violence reported in that conflict, which began, you'll remember, in April. The fighting continues between the Sudanese army and the paramilitary rapid support forces, or RSF, as you'll also hear them called. There's reports from activists saying 20 people died over the weekend including two children more than four million women and girls are at risk of sexual violence across sudan according to the world health organization women played a prominent role in that movement that ousted the former president omar al-bashir um i have back with me nima nema el bagheird, CNN's chief international investigative correspondent who's reported regularly on the conflict in Sudan. So good to have you back with us, Nima.

Thank you for coming into the studio. Tell me a little bit about what you're hearing about this increase of use of sexual violence in the conflict. I was watching some of your reports that you've done that, I mean, really harrowing footage that was coming out from Khartoum. Yeah, we were able to obtain and verify a rape video, which is not normally, I imagine the BBC has the same kind of standards around airing something like that. And so for the first time in CNN's 43-year history, we aired parts of it because the rape, the use of rape and sexual violence to subjugate not just women, but the men around them has very much become a weapon of this war by the RSF, going back to a methodology that they first began perpetuating about two decades ago. And with this, how difficult is it to get evidence and for women to come forward to describe exactly what's happening to them? We, you know, we're kind of almost split in two on this. There's the fact that four years ago, women led a revolution and sexual violence was threatened against them at the time by the forces of the then dictator Amr al-Bashir and it was really interesting to see that in a lot of places, generally urban

areas, but in a lot of communities women were hugely supported in ways that kind of went against the conservative tenor of our culture and I think we're seeing that again. But what that's what's that what that's resulting in is that it's an intensifying of the sexual violence that it almost seems like women are being punished for daring to push back, for daring to stand their ground. Dua Tariq, who is an artist and activist who has decided to remain in Sudan with her four-week-old baby and to continue to volunteer with the network of the Women's Response Rooms. And it was set up to support women in the country. I know there might be a little delay on the line for our listeners, but Dua, thank you so much for joining us. Congratulations on the birth of your baby. But tell me a little bit about what you are hearing and seeing in the city of Khartoum.

Yes, thank you so much for having me and for this amazing opportunity and actually to be able to listen to these amazing women's stories and sharing other stories from my from the women of my community. Right now I'm in Khartoum, east of Khartoum one of the hot conflict

areas of the war right now. And actually the area when the clashes first broke out in April. I'm seeing the least I can see is the random shooting as my area is controlled by the Arasep, the militia. And we're 15 minutes away from the military headquarters. So we're kind of like in the shooting the whole time. We're seeing fighter jets flying over and bombing houses and also the spread of the militia that control the neighborhood and stuff. We're seeing a lot of violations on daily basis, arrests from shooting and killing also,

and not forget to mention the looting, the houses and stuff. So what about you though, Dua? Like, do you go out? You have this newborn baby. Yes, actually before going into, before having my baby, because I just had the baby four weeks ago, so that, I mean, for the past four months before having the baby, I was able to go out.

We have routes inside the neighborhood that we take to go to the emergency response rooms and where people gather. And also my neighborhood is kind of like a mixed neighborhood between like middle class area that's occupied by the militia and then we have the local area which are where the most of the population of the area live. It's kind of like giving us a margin to move. Dua'a it's ni'ma. I just think it's amazing that you're on because you are such a great example of what women in Sudan are choosing to do and the risks they're choosing to take to document what is happening. I wonder if you could just share with people what you're documenting for, because there's been such an absence of the international community on this conflict. Why is it so important for you that these violations are recorded?

Actually, it's very important as a record and actually to acknowledge what happened to these people, to the people of Khartoum and the conflict areas in Sudan in general. And also to expose the violations is very important to lay the ground for the upcoming civilian government and why we are so anti-the military rule and actually not giving either of the parties a chance to just escape what happened during this war. And it's also important for the resilience of the people themselves because people feel supported when they are being heard or documented. We're doing a lot of documentation within our area from conducting interviews into taking pictures or into even listening to the stories of the people being violated.

So it's kind of like very important even for people's mental health. And also it's important for the community to share and for these stories not to be forgotten because it's a part of the Sudan history and what happened. And I feel what you're doing and also what Nema is doing in her work is documenting and providing the details of what is happening on the ground.

But I'm wondering, like right now, is there anyone who can change what's happening on the ground? I know Salima Ishak is head of the Sudan government's Combating Violence Against Women and Children unit. It's also partly funded by the UN. And she has also documented the rise of sexual violence and rape as part of the conflict. But does she have any power to change things? Because, of course, that will be what the women and girls want to happen immediately. I think what has changed is because of women like Daraa, who've been speaking to us and survivors, is that the international community's

position on this you could really feel a an unwillingness they were falling back on the old tropes of the both-side ism right like we're going to get a deal whether or not the people on the ground want this deal in this way and that's what happened four years ago where a lot of the civilian leaders that Dua was just mentioning were forced to deal with the RSF despite the RSF's implication in the previous genocide. I think that the most powerful thing that women are doing right now is making sure that the world cannot say it did not know. And you mentioned the RSF in particular, and you mentioned both-sidism. And I know most allegations have been put towards the RSF.

Would that be a correct characterization? Go ahead, Dua. Yeah, I think what happens when we document these stories, I mean, there is this idea right now that the localized mutual aid for people, that's the day before our work right now in the emergency response rooms and the women response rooms as well. So the international community has proven that it's completely failed to meet the current circumstances in like what's happening in khartoum and the interference is kind of like it does not exist in most of the areas and it's only um on a high level that does not

talk to the people and the the the the issue is happening right now so what you're experiencing right now is people are tending to to to to to rely on the localized aid giving aid to mutual aid to each other support to each other like this amazing response rooms and not uh relying on the international community because right now the international community is kind of like better lives and when the sounds of the police is higher than the civilian sounds, that's a real issue. That means that the international community

cannot function in such a complex context as they claim. So it's kind of like it's up to the people right now to support each other. Nema, I also would like your thoughts on some of the reports I was reading when it came to sexual violence, which is happening.

And obviously, you talk about that aspect of it was women that rose up really to create the change or to look for change within that Sudanese society. But then in a way, it is a tool used by fighters to humiliate the men. Absolutely. So what we're seeing is very much two methodologies. So in the center of Sudan, in Khartoum, in the surroundings, and it's a phenomena that has been happening for years, that basically, if you break the girls, as we would say in Arabic, then you break the men. But then separately in Darfur, they're falling back on this idea of ethnic cleansing. So humiliating the women,

raping the women, impregnating the women is also about eradicating. It is the specter of genocide, because it's about removing those bloodlines, diluting those bloodlines. And that's what the female survivors are telling us is literally being said to them. But I think, again, just going back to this idea that Dura was saying, the international community has said that it can't function in these kind of complex circumstances. Well, then what are you there for if you can't function during conflict and war? And Sudanese women are once again leading the way to save themselves, but also each other. And I loved what the Dua said. And I don't I don't even know if your leaders, sorry, your listeners clocked it when she said, you know, it's about creating the framework for the civilian leadership.

It's this idea that the Sudanese have not given up on democracy despite everything that's happening. And women once again are at the forefront of that. Nema El-Bagir, CNN's chief international investigative correspondent. I mentioned her report that is still online in reference to this story. And Dua Tariq, who is an artist, an activist and new mum as well, and volunteers with the women's response rooms, which have been set up in Khartoum thank you both so much thank you I am getting some of your stories on proposals

here's Jessica my wonderful fiance asked me to marry him at midnight on my birthday on holiday in Spain however instead of sitting by the pool as he asked I got in so he had to ask me in the water I said yes without hesitation and we ballroom danced in the pool under the moon and stars private and beautiful not anymore Jessica we all know about it it sounds wonderful right now since Covid there has been a rise in the popularity of home health tests and perhaps that's no surprise as we got used to testing right at home for Covid and also coupled with potential long wait for a doctor's appointment now. But can at home fertility tests really help you plan for a baby? Well, a report in the British Medical Journal found that some DIY tests that were sold in the UK to measure oestrogen levels may give misleading results.

Recently, you might have heard on Woman's Hour, we were discussing fertility anxiety and which might play into the rise of the use of these tests journalist sophie gallagher told us that she and her friends worry that it won't be easy for them to conceive despite having no known health issues and joining me now to discuss the fertility kits and how reliable they are to monitor your fertility is the author of the bmj report Wilkinson and also Dr Ipo Kratis-Sarris a consultant in reproductive medicine and director of King's Fertility. You're both welcome to the programme. Emma why did you decide to look at this issue? Hi thanks for having me on. Yeah so I'd done a previous investigation also for the BMJ looking at the marketing of these home health tests. So these are tests that you

buy a kit online, it gets sent to your home, you use a finger prick to take a sample of blood and then you send that off and you get the results. And these are marketed for all kinds of things and fertility is one of those. And because of that investigation, somebody who had recently worked in one of these large laboratories that process the tests for the online retailers had got in touch with me to say they were really concerned that tests for estradiol so that's the main form of oestrogen in the body were being done despite issues having been identified with how reliable the test could be when it was being done on the finger prick sample so that's where my investigation started. And what did you find? Yes so it took a really long time to unpick all this

but essentially back in sort of towards the end of 2021 it became apparent from laboratories doing sort of internal validation studies on these tests that when you're using the finger prick blood samples, the estradiol results were coming back lower than it would if you were doing the same test from blood taken from a vein in the same person. So it was kind of raising concerns about the reliability of this test. And it seemed to relate to the test tube that was being used. There was a gel in the test tube and that was impacting the results. What we found when we started to ask questions, there was one laboratory who never processed the test because they found they were so unreliable. Another who, after some months, had changed the way they do the test,

changed the test tube. And another one who had looked into it for some months had changed the way they do the test, changed the test tube. And another one who had looked into it for some months and then told the online retailers that there was this issue, but you could just use that to interpret the test. If you knew about the issue, you just take that into account when you're reading the results. And they continued to process them. And this is what insiders were worried about and came to me and said they didn't think this was safe. Right so let me turn over to Dr Hippocrates. Good to have you with us. When you hear some of the reporting that Emma was doing I'm wondering what your reaction would be or how effective or reliable are tests like the ones we see marketed?

Well, I think it's very concerning, obviously, that companies knowingly allow tests which are not validated, or at least not representative of what we're trying to test to go to market. I think also there's a wider issue here, not just about the specific test, but also the ability of anyone now to be able just to test for whatever they want, almost like a DIY self-diagnosis. And I think there's a wider issue there, irrespective of the test is accurate or not. But of course, as a practitioner, I expect that when I request a test, that I'll get a result which is valid, and then I'll make decisions based on that. And there's only one worst thing about not having a test, that's having a result which is valid and then I'll make decisions based on that. And there's only one worst thing about not having a test, that's having a test which is wrong

and then making decisions based on wrong information. It's better not to have a test at all, actually. Well, because that's really the issue with this story that I was thinking about, which people may have taken some of these tests that were on the market. They get a misleading result.

Let's say they may think that everything is fine, oestrogen wise, etc. And going forward with that, happy in that knowledge. But it could be wrong. It could be wrong. And it's not just the oestrogen test. Even if, for argument's sake, we had a fertility test which is accurate in its reading, the interpretation of it can be quite complex. And without having the full story, it can either lead to false reassurance,

or it can lead to false anxiety. For example, a very common test which is being used, which is AMH, anti-malarian hormone, which is a test that looks at ovarian reserve, has very little predictive value in itself for spontaneous pregnancy. It means very little when you just do it without a particular indication. And that's very dangerous in itself as well, let alone the test maybe not being accurate in the first place. I understand. Let me go back to you, Emma, because you did mention Eurofins laboratories in your reporting. Can you explain what you found there? Yes. So Eurofins is one of these large laboratories that processes the tests for online retailers. And that was the company where sort of this red flag had been raised to me

initially. And they said they started to look into this in November 2021 but it took them a while to do these internal validation tests it took a while to kind of generate all that data and it wasn't until September October time 2022 that they went to their clients and said look we've found this issue when you're testing these finger prick blood samples the readings may be lower um and they said you know they wanted to let them know so that they could know have that information uh in order to help interpret the tests um and they sort of left it up to the online retailers whether they wanted to continue with that or not um other laboratories that we spoke to had taken a different approach and completely removed that,

the type of test tube that was being used that seemed to be affecting the results and had tested and switched to a different test tube. Now, just as we went to press with this article, Eurofins got in touch with us to say that they no longer do estradiol capillary the finger prick testing and we don't know exactly at this point exactly when or why they made the decision to stop but that's the latest information we have. We also contacted Eurofins country pathology directly we didn't hear back but in response to the BMJ report just a little more they say they're committed to

patient safety and the integrity of test results evidence they say by our continuous conducting of validation studies and verification work on testing platforms and methodologies it says county pathology UK welcomes further discussion around regulation and sharing of best practice to enable patients and health care providers to make informed decisions around testing. But I think this is important, Doctor, because I feel I'm bombarded even when I'm walking around with the various tests that are being marketed. How do you see a best practice way when this issue comes to light, particularly when it comes to fertility testing? I think what you've just mentioned is exactly, for me, the crux of the problem. And we're

entering a new world where we're moving away from the traditional paradigm where you have a patient that has a question, goes to a doctor, they do an assessment, and then they ask for a host of tests, which they interpret afterwards. What we're seeing now is a direct to consumer health care approach where you bypass the expert. The expertise now is find other online or social media, whatever you want to call it, where people can directly self-diagnose or tick a box of online technology. And then the interpretation can be very very difficult and misleading and I think that that is dangerous. Now it doesn't mean though that technology should not be embraced and used and I think considering all the pressures that we're having with the NHS

we should look at innovative ways of doing it but it should be done in a fashion which is correct evidence-based and it doesn't bypass expertise, which is very important. And it's not exploitative either. Have any patients come to you after doing at-home tests, DIY tests? Yes, a number have come. And it's also a very long discussion to try to understand why they did the test, which is always a good starting point, and then to see what they want to learn from that test. A lot of the time women will come and they'll be worried that they have low ovarian reserve, they never thought about it, and say well are you trying to conceive? No, so what is your worry? So and it's important and these are nuanced tests and just to make a point, if for example I saw a

test that was out of kilter with what I was expecting, the Easter dove for an example example, then as a clinician, I would start thinking maybe the first time, second time, but definitely I would then start raising red flags. What's going on here? I've seen thousands of thousands of tests. I know where they should be. So you can start picking up and have this safe netting when you have expertise backing information, not just randomly picking and self-diagnosing, which is what these online tests encourage as well. I understand. Well, I want to thank both of you for really shining a light on that issue. Emma Wilkinson was with us as she is the author of the BMJ report. We also had Dr. Hippocrates Saris, a consultant in reproductive medicine and also director of King's Fertility.

Thanks for all your messages coming in. Public marriage proposals, not just a cringe fest, but a coercively controlling cringe fest with no room allowed for a negative response. 84844. Another. Ray, public marriage proposals,

no and no and no. How embarrassing to be put out into that situation and how difficult. How do you say no or I'll think about it in front of a happily expecting crowd and partner? Awful, awful, awful idea. Gosh, there's not a lot of love for the public proposal here. Another, Julia, maybe it's something to do

with being a grumpy older person, but my life experience has given me a profound distrust of romantic gestures. To me, romantic gestures are an ego trip and a cover for a lack of real empathy. Julia not holding back on how she feels. Keep them coming. 8-4, 8-4-4. Now, have you ever been in, or maybe you're in, a situationship? It is the subject of the debut novel of my next guest.

Taylor Dior Rumble is an author. Her book, The Situationship, more than friends, less than official. Pretty good definition, I think, there. And the book follows the life of Tia, a young journalist in London, trying to make a success of her career and also her love life. The book is published by Murky Books, the publishing group created by the rapper Stormzy. It's been termed the label's first rom-com and Taylor Dior is here. Good morning. Welcome to Woman's Hour. Good morning. Thank you for having me. It's nice to see you. Nice to see you too. Okay, we need to get into this term, the situationship. Right. It's bandied around quite a lot now. Yes. So I would go as

far as to say that the situationship was the great pandemic before the real pandemic happened to us. It's something that's terrorized, I think, a lot of millennials and Gen Zers out there. So let's, how would you describe it? What is that relationship that's in a situationship? So I would describe a situationship as a romantic relationship without the label, without any real sense of security. So again, you're a bit more than friends, but you're not serious enough to maybe commit to one another. On both sides? So I feel like with situationships, it tends to be typically one-sided, but, you know, like relationships do evolve and the times have evolved as well. So sometimes it can be like both people are scared to commit as well. But I feel like typically situationships are one-sided,

which that's what makes it so difficult. I mentioned Tia. You were a journalist, like Tia is a journalist. Have you got experiences of situationships? I've definitely had my fair share. And the book was inspired by a lot of things that myself and my friends had been going through and our frustrations with the dating scene

and trying to find someone to connect with. So yeah, definitely some real life inspo in there. And what is the challenge, do you think? Because, I mean, it's a story as, you know, long as time immemorial of the person who is somewhat unavailable or not ready to commit in the way that perhaps the other partner is. What do you feel and see or your friends talk about in the dating scene right now? I think right now it just seems like a lot of people don't want to put any real effort in. And I think with the rise of social media and how common like dating apps and using those apps have become, there's always this idea that we have like this unlimited choice and someone is just a swipe away.

So I feel like because of that, we're a lot less inclined to maybe put in effort with one person at a time and and really invest in getting to know that person because you just think oh there's someone else like just right after I swipe so I think there's that and also I just feel like um again this could be as as old as time but I feel like people are scared to just be open and vulnerable. I feel like with social media that exasperates this need to constantly be perfect and have every single thing figured out because you're constantly comparing yourself to

other people. I was struck with that really in the first pages when Tia's getting ready to go out and see this guy and she says it has to be flawless. She had to be flawless. I was like flawless. I mean talk about a tall order and then the night has to be flawless. She had to be flawless. I was like, flawless? I mean, talk about a tall order and then the night having to be perfect. But I think you were tapping into an unrealistic expectation.

100%. I feel like because of social media, there is this pressure for every single moment to be picture perfect and in slow-mo and be social media ready. And I feel like that does reflect in our dating lives we're so scared of embarrassing ourselves possibly or or sticking our neck out in trying to like open up to somebody that we don't take that leap of faith that I feel like finding someone takes. Let me put that in another sphere which is the work sphere Tia struggles to

get her ideas noticed um she's working as a journalist as I mentioned do you think that's an experience that many young journalists face and you particularly talk about young black women um again those experiences were definitely inspired by a lot of the real feelings I had working as a journalist as well as um my peers and my colleagues and um I do think unfortunately it is a it is quite a common experience I mean in the UK there's only 0.2 percent of working journalists are black even though we make up like three percent of the population and so I feel like um it it can be difficult when you're trying to present these stories that a lot of people in the newsroom

otherwise wouldn't really know about. And especially when you're new to the workforce and there's like all this office bureaucracy and politics that you can't really be taught and you kind of have to learn as you go along. So, yeah, I would say. What was the experience of writing the book like for you? It's your debut novel. You went from being a journalist, boom journalist boom straight into this and you're the first rom-com from Erky as well um I'll be honest the the writing experience itself the journey was a bit chaotic just because I hadn't gone to uni before I've never written anything you did google how to write a book I definitely googled how to write a book because I was like how do you start start this thing? But luckily for me, I was very clear on how I wanted the book to end and how I wanted this young woman to feel and what journey I want and how I wanted her to feel at the end of this journey. And I worked my way backwards. So writing it at the start was quite difficult.

But then once I found exactly how I wanted readers to feel after they completed the story, then it was a lot easier from there. But in terms of working with Black Murky Books and being the first rom-com, that was, it's just been amazing. It's been, it's been so lovely just working with people committed to pushing unrepresented voices to the forefront of publishing. You did it during the pandemic. You mentioned the pandemic at the beginning of our interview. How is that? And I know you lost your dad during that time, and I'm really sorry about that. But I'm just thinking about all these different emotions that must have been coursing through you as you wrote.

Do you know what? I started writing the book properly maybe a couple of months after his funeral. So in December 2019, then the pandemic kicked off like February 2020 I would say and like in hindsight it was really cathartic that I had something to focus in on every single day and I think for my mum and my sister as well as we were grieving together like lockdown was kind of kind of the perfect opportunity for us to just sit with our feelings and slowly try and work out how we can go back to normal living without the expectations of like a nine to five and what the world was like before lockdown but writing the book was really cathartic and it was just nice for

me to have to tap into my worries and what my life was like before my dad got diagnosed with cancer you know when the my biggest worries were if that guy was going to text me back or if I'm doing enough at work to get that promotion. So I kind of feel like writing the book saved me in some ways from going a bit crazy. And it was just nice creating this kind of world filled with banter and a little bit of drama and a couple of steamy moments. It was a really nice escapism. And I think that's why I love romantic comedy so much you're an author now how does it feel oh it feels insane I feel so grateful and blessed and I'm just excited to write more stories and just connect with more people lovely having you in Taylor

Dior Rumble's book the situationship new word more than friends less than official uh is out now thank you so much for coming in. I'm going to do a few more romance ones while you're here. You might as well listen to these. My son proposed to his partner of seven years last August in front of family and friends at my husband's 60th birthday last year. It was perfect. The crowd cheered and they're getting married four weeks today.

Congratulations to them. Another man proposed in a London iPod. Oh, yeah, the London Eye in one of those pods. Just as it started moving, she said no. All passengers were stunned into silence for the rest of the trip. Excruciating. I think a lot of our listeners are coming out, though, on the side of this woman or man. Agree with others.

Public proposals are manipulative and selfish. If you really care about the other person you will allow space for a no rather than public pressure to say yes it would always be a concern that they're more interested

in promoting themselves than the relationship and the topic of romantic men has come up with my daughter I've told her to be wary of boys men that shower her

with gifts or flowers she has romantic dreams of what a boyfriend should do for her I've told her trustworthy nice boys are the ones that treat her as an or flowers. She has romantic dreams of what a boyfriend should do for her. I've told her, trustworthy, nice boys are the ones that treat her as an equal, not as a princess.

Mm-hmm, says Taylor. Mama knows best. Mama knows best. Well, join us tomorrow. We will continue our series on rebuilding my life. Martine Wright was rescued from the wreckage of a bombed tube train

on what became known as 7-7. Very severe injuries. We'll hear how she has rebuilt her life. And also the cookery writer, Bea Wilson. Looking forward to speaking to her about her life in the kitchen. That's all for today's Woman's Hour. Join us again next time.

Can you just tell me who he is? No. Has he got any distinguishing features? His anonymity. What's his name? Banksy. I'm James Peake and I'm on a mission to find out how Banksy became the world's most famous and infamous living artist. He could literally be anyone. Banksy essentially humiliates the art world. With dealers, critics and someone who once worked deep inside Banksy's secret team. Do you wish you didn't know he was?

Sometimes I wish I'd never heard of Banksy. The Banksy Story, with me, James Peake, on Radio 4. Listen now on BBC Sounds. How's he smell? Like paint. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who 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.