Woman's Hour - Edna Adan Ismail, Smear Tests Over 50

Episode Date: August 14, 2019

Edna Adan Ismail has spent her life improving women's health in Africa, campaigning to end FGM and becoming Somaliland’s first midwife. She was also its first Foreign Minister and is a former First Lady. She was the daughter of a doctor in Somaliland at a time when educating women was frowned upon. She saw for herself how poor health care, lack of education and superstition had a devastating effect, especially on women. At eight years old she herself went through FGM and it was supported by all the women in her family. That set her on a path to oppose it. Now in her 80s, she still works at the hospital she helped to build after retiring from the World Health Organisation. Her story: A Woman of Firsts was recently serialised for BBC Radio 4 and is available on the BBC Sounds App.

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BBC Sounds. Music, radio, podcasts. Hello, Jenny Murray welcoming you to the Woman's Hour podcast for Wednesday the 14th of August. As you may have heard, Marina Wheeler, the estranged wife of Boris Johnson, has been treated for cervical cancer and is urging older women to get a smear test. Why is the older age group at greater risk than they might think? In our series on the essential summer items of clothing, the historian Amber Butchart on the straw hat and a second chance to hear the first in a series called Off the Rails,

we talk to Nakila, who was in trouble and now supports others in danger of following her old ways. If you were listening last week to Book of the Week, you'll already be familiar with Edna Adan Ismail, because her story, A Woman of Firsts, the woman who built a hospital and changed the world, was read by Cathy Tyson. Today you can hear Edna, a midwife, former foreign minister, former first lady of Somaliland, and worldwide campaigner against female genital mutilation, tell her story in her own voice. We know her father was a huge influence on her. Why was he so important? Well, he was a very kind and generous man. And I admired the way he communicated with patients, how he cared for them,

how compassionate he was, and how much time he devoted to looking after the sick. The patients came first. And I admire that. That was a quality I had seen in nobody else before him. And I have seen that characteristic in very few since my father. And it's something that has impressed me as a child and also set standards for me and footsteps to follow and learn from. Now, at the age of eight, the FGM happened. The most severe form of FGM was performed on you by a group of women.

How did you come to accept that the women involved thought they were doing the right thing? Well, it's very difficult to accept when something so drastic and so painful and so damaging is done to you. The people who arranged it were my mother and my grandmother, women I loved and admired and who had cared for me until then. And for them to catch me one morning and arrange for a woman to come with dirty hands and dirty knives, squat me on a stool and cut away healthy flesh from between my legs was something so painful and horrific that to this day I find it very difficult to accept. And the fact that it was arranged on the day when my father was out of town, literally behind his back,

and seeing how angry he became when he came home that evening and found me done, how angry he was, how the tears I saw in his eyes of shock and pain and suffering and the feeling of helplessness that there was nothing he could do about it. The damage had already been done. That stayed with me. And the fact that my father disapproved of it proved to me that what had been done to me was wrong. It shouldn't have been done to me. And it was my, it became my challenge too in later life

to make sure that it does not happen to others. But how were you able to challenge something which you have done all your life that was such a widespread cultural practice but never spoken about? It was taboo. You don't speak about this. Other girls in my neighbourhood, in my town, who had had the same thing done to them, never spoke about it.

You just don't talk about things like that. You don't talk about unspeakable things. It's rude, it's vulgar, it's uneducated. It's just wrong. And you bottle it up. And later in my life, I became a nurse. I became a midwife. And I was going to work every morning and trying to get a baby out from between the legs of a woman whose body had been so damaged. The elasticity that allows the baby to come out of the birth canal was damaged and gone. To get a baby out alive,

we had to cut and open and do episiotomies and extensive openings to let the baby out. But then you don't speak about it. You bottle it up. You keep it inside. The anger builds up until one day, like a volcano, it bursts. And when it does come out, there's no stopping. That's when your campaign must bear fruit. You must see the end of this. You trace the origins of FGM to the 5th century BCE Egypt at the time of the pharaohs. How did it come about?

Well, nobody really knows, but this is what I've heard in my research and I wanted to find out where it originated. And I believe the River Nile was the most important god and there were gods for everything the god of the sun, the god of the water, the god of whatever and the river, the god river of the Nile was the

god of life and to appease and prevent the Nile from drying up virgins were given as sacrifices to the Nile, to the god of the river. And in a paganistic period, in the Pharaonic times, virgins, if the river did dry up, it would be attributed to a non-virgin having been given to the god of the river and angered the gods. So to make sure that all virgins that were being brought up to become future sacrifices to the gods

would be infibulated, stitched up from a very young age, to ensure their virginity and not bring dishonor to the family of the daughter if ever the river dried up because that family would be accused of having given a daughter that had not been pure enough to be given to the gods. You were the first girl from Somaliland to win a scholarship to study in the UK. Yes, I was very privileged. And, you know, again on this FGM question, you describe in the book how you were asked for a urine sample as part of the medical exam you had to have before your training, but said you couldn't

because of your FGM. What did the sympathetic nurse say to you about it? Well, it was a question of refusing to have a medical examination, a thorough medical examination, and not pursuing my lifelong career of nursing. Or having, because they had grown bacteria from my urine, they needed a sterile specimen of urine through a catheter. And of course, it could not happen in my case because of the infibulation. And when a nurse saw me sitting there in this dilemma of what do I do? This is going to be the end of my career. This is going to be the end of my ambition. She understood that there was something lying beyond my refusal to have a catheter specimen.

And she must have been informed about it. She might have become acquainted. She may have traveled abroad and found out about infibulation. And she came up and sat with me with kindness and compassion and said, is it because it cannot happen? Is it because there is no way to do a cath specimen? And I said, yes, because I didn't know how to tell anybody about this. And she understood. How much was known about FGM in the UK in the 1950s?

In my years of nursing and in my following years as a midwife in London in 1960s, from 1954 to 1961, I had never seen one single case of an infibulated woman. And I had delivered hundreds of babies of different nationalities, but I never came across an infibrillated patient having a baby or having a prenatal examination, for that matter. So it was only when I went home after my qualification and my return to my country, Somaliland, that I was faced with a woman in labour on the table trying to push a baby out through a very closed-up passage. You begin the book in Mogadishu in 1975,

where you tackled the military director of the Medina Hospital in the most extraordinary manner. Just explain what you said to him. I had a premature baby that was weighing less than a kilo, fighting for its life. I had spent three days fighting, feeding this child, clearing its airways, feeding it through a pipette. And I sent out an empty cylinder of oxygen to be refilled.

Twice the cylinder returned to me empty. And if I don't have oxygen for this baby, I would lose this child. So the only way I knew how to make the stupid idiot of a man understand that I had a life, the baby's life was in danger, was to burst into his office and say, I want you to come with me and shoot a baby. Because if you don't want that baby to live, then come and shoot it. And if you don't want patients to live in this hospital, then why call it a hospital? And, you know, in anger, that was the gist of what I said. And you got what you needed.

I got what I wanted because there was no way I was going to walk out of his office just to go back and watch a little baby die. There are so many thingss in your life. You've fought throughout your life, you know, military dictators who imprisoned you. Yeah, house arrest, detention. Yes, the most extraordinary life. But in 1997, you sold everything you owned

to build a women's hospital in Somaliland. Why were you prepared literally to build it brick by brick? This is something I've wanted to do all my life. My country, Somaliland, was literally level to the ground. Everything that had existed before the war with Somalia had been flattened. Hospitals were level to the ground, homes, schools, dwellings. I had come to the end of my UN career. I was entitled to a very comfortable terminal benefits and pension. And I've been there, I've done that,

I've owned it, I've had it. I've lived my life. And what were trinkets going to do for me? What was a Mercedes going to do for me, as much as I love the car. So I just sold it, recycled my life, turned everything I had into gold cash, went home, built a hospital, and I'll live on it, and it's the best thing I've ever done. And I am so blessed to have had this idea into my heart to do it.

The final thing I wanted to ask you about is, last year the religious authorities in Somaliland announced the most severe form of FGM, which you suffered, is banned. How optimistic are you that things will change for women there, and of course in other places, because you have said it's not just an African problem. It's a global problem because you have more women in Europe or America coming from any of the 16 countries where FGM is practiced,

having babies and living in your countries. It's no longer confined to Africa. How confident am I? Well, 42 years ago, when I first started the campaign against FGM, this is not a campaign I started yesterday or the day before. It's something that I have been fighting for 42, 43 years. I've gone to prison talking about it. I have been called names.

My marriages suffered from it. And it's the first time that I have been called names. My marriages suffered from it. And it's the first time that I have a government and I have a religious fatwa backing up my campaign. It's not all I wanted. I want total abolition. But then using the old Mahatma Gandhi philosophy, when you're hungry, even half a loaf is better than no bread at all. So if I get a fatwa criminalising the most severe form of FGM,

it's a good start and it's for future generations to keep fighting it and fighting all the other forms. Edna, Adan, Ismail, thank you very much for being with us this morning. And by the way, the BBC recording of A Woman of Firsts is available on BBC Sound. Thank you. Thank you. Now, just over a year ago, we broadcast a series called Off the Rails. It was about young people on the verge of getting into trouble

and the workers and volunteers who try to pull them back from the edge. Well, today there's a second chance to hear from Nikila. She now works in South London with young people. She knows what she's talking about. 13 years ago, she left prison after being jailed for drugs offences. Jo Morris asked her what had led her to getting into conflict with the law. What was she trying to find? That is a really good question. What do I think I was looking for? A voice. It was the fact that I didn't feel like I had a voice. And then to go out with this group of people and be the voice and have so much of an active role. Roles changed from feeling like

the black sheep to feeling like head of the throne. Because I was one person at home, but this horrible little girl out on the streets. Head of the throne. Yeah. Yeah. But at home I was sweet and innocent, but I wouldn't melt. My mum wouldn't know nothing. I wore a very good disguise.

So your mum had no idea what you were doing? No, not for a very long time. Take me back to you as a teenager. What were you like? Me as a teenager? I was savage. And that's the word I can kind of identify with now. Savage? Savage. I had no respect for other people. I didn't have, didn't respect myself, so it didn't allow me to have respect for other people, peers, friends, people in the community. What was your home life like, Nikila? Did you live with your mum and your dad?

No, so I lived with my mum. My mum... Oh, wonderful woman. My saying, my mum's my success and my dad could have been my failure what do you mean by that? so my dad's a substance misuser he's a crackhead

plain terms, lovely guy but like I say everyone has something that they love in life and unfortunately his addiction is drugs so for me at home my mum's old school and some of the way she grew us up isn't the way

that I've seen the western world and that kind of growing up happening for young women or young people of my age group and at the time my mum was bringing forth quite a lot of her traditional Caribbean ways and I don't know I didn't feel like I belonged in that setting for many years because of sexuality my family knew but it wasn't accepted within the household so for me I didn't really belong because you were gay or yeah yeah so for me I didn't really belong because you were gay or yeah yeah so for me I didn't I didn't ever feel like I belonged can you remember the sort of moment when you began to get in real trouble was there a turning point I was being bullied by a group of girls I came from a background of when I grew up my mum did a lot of extracurricular activities.

So I went through drama school. I played the violin at grade five. I did running and athletics. I had a whole mix of opportunities I could have gone down. And for me, that's where I stood out. I was different to the rest of the young people who were commuting. So my travel journey was a bit of an issue because I would draw attention from other schools and other girls or other students,

which then led to me becoming a victim. And what I mean by that, I stood out. So for me, different wasn't cool. So for me, I had to find a way to become cool and fit in with that. And that was stop playing the violin. Instead of playing the violin, I took the money and I ended up buying drugs so I can start my own little revenue. So my mum would think that I'm going to school playing the violin and each term she's giving me the money to pay for the lessons and I wasn't paying for the lessons because I didn't want to become that person who I was getting picked on every every week because I've got the

violin and yeah it just so what sort of things were they saying to you name nerd, hairy legs, my shoes, I kept cussing my attire. How I just came across and it was no fault of my own, it was what my mum could afford. I had to then start to do something about this issue because it was spoiling who I was as a person. In my eyes I kind of saw it as there's two people two types of people in this world people who take the the stuff that thrown at them and people who don't and the switch just came so I became the aggressor enough's enough let's go and get these girls now so I had um plucked up the courage and um done this girl in for the humiliation, for how long I've been feeling how I felt.

And I went for one friend in one week and I went back for the other friend in the next week. But we batted her. What did that feel like? Power. Sense of power. It was like, OK, I am somebody now. My voice has been heard. I'm awake. The street's awake. They're listening.

And that's just where it went. There was no turning back. So you had a reputation. Yeah. And it made you feel powerful. Yeah, greatly. What did people call you? Malfi. So I was known as Malfi. That was, like, your street name? Yeah. Yeah, yeah. Cocky little tongue. And how old were you then So I was known as Malfi. That was like your street name? Yeah, yeah, yeah. Cocky little tongue. And how old were you then?

I was 14. And then I would just, the respect levels that come with it, yeah, it's something that you can run with, take and run with it. And yeah, for myself, I took it and I ran with it. And I just wasn't that girl no more where anyone could trouble me. And from that incident with those two, I never turned back.

That authority, having that authority within the streets, you could go to North, East, West and South and you can hear that person's name or somebody. That authority and that power, yeah, I think south and you can hear that person's name or somebody that authority and that power yeah I think it's it made me get worse before I calmed down and I literally lived in action

at first I was on the edge and then I crept in and crept in and became the core and once I became the core I didn't know how to pull myself out of it because after a while that's the only way I did know it's the cohort, I didn't know how to pull myself out of it. Because after a while, that's the only way I did know. It's the only things I did know.

So, yeah, it became challenging. So it sounds like you didn't feel like you were listened to. No, not at all. No. No. I've always, for many years of my life, I felt like I wasn't listened to. I just felt like I was just that person who was there, seen and not heard.

I say that all the time. With our culture, it's seen and not heard. And how did that make you feel, not having a voice, or not being heard? Nothing I could do about it. So keep my mouth shut and get on with life until I'm of that age to vocalise myself. And you did?

Yeah, I rebelled a lot of times. I fought Ian, I moved out the house, the family home, just fed up with rules. There's a saying in our Caribbean background, two big women can't live in the same house. Yeah, and I thought I was a grown-arse woman, yeah, well before my time. So you started out selling weed. Yeah.

Then you moved on to fighting. How did things escalate? How did things escalate? Greed. How serious? I started getting involved with other drug gangs and dealing with more quantity of drugs, of crack and heroin. And, yeah, I was selling heavily in Scotland, Glasgow, Birmingham, all over, all over Britain, I was commuting, selling drugs.

Do you wish someone had tried to help you? Nah. Nah. I was getting money, and at the time that was what I saw as important. So for me it was the greed. That was my mentality. I've got a criminal record, I've got my ten stars, no-one can trouble me, I might as well go for the greed. That was my mentality. I've got a criminal record. I've got my 10 stars.

No one can trouble me. I might as well go for the money. I'm going to clean up. That was my mentality until when reality hit. So eventually you got arrested. Yeah. What happened? So I got arrested in Scotland for misuse of drugs with intent to supply Class A and Class B.

So how old were you when you were sentenced? 17. 17? Mm-hmm. I got four years. 17? Yeah. So young.

Yeah. And where did you go to prison? Courtenville in Scotland. Scotland? Scotland? That's a long way from South London, isn't it? Way out of your comfort zone. Yeah. And where did you go to prison? Courtenville in Scotland. Scotland? That's a long way from South London, isn't it? Way out of your comfort zone. Yeah.

How were you feeling when you first arrived? Oh, petrified. Yeah, that's when the reality kicked in that I'm in prison. When I did arrive, the room I arrived to was, it was like a dark cave. There was just this girl sitting on the bottom bunk, rocking. The room was pitch black. Had this white sack over my shoulder.

And the tear just went slap. Hit the ground. I said, I can't do this. I said, I cannot do this. The officer said, would you like to make a call? I said, yes, please. I phoned my mum. And I explained to her her I can't do this

I was crying like she said you can you put yourself in this situation only you can get yourself out of it chin up you got this I got on with it I made the good thing out of a bad situation and it was the best because I found myself I found a role I found a role. I became Wysie, as they called me in there. I'd give advice, I would support girls. Wysie like an owl? Wysie, yeah, yeah. The best time of my life, though. The best time of your life?

I mean, that surprises me, not many people say. No, the best time. I call it the big T. What does that mean? Because it allowed me to have time to see where I wanted to place myself in the real world when I came back out. It gave me the opportunity to be in another world and look into the real world. I believe if I went to a prison in London, it would have been the same environment,

fighting, people you know, that reputation. And I just kind of realised that that whole bad girl South London attitude needs to be left in South London. Why did you listen to your mum then when you hadn't always listened to her in the past? At the end of the day, she's always, always, out of everybody else, always going to be there. So it just went to show that I should have been treating her right in the beginning because she's, regardless of whatever road or direction I go in life,

it always comes back to mum. She's my everything. She may not have understood me when I was growing up, but I allow her to, I now treat her where she overstands. Nine years ago on Saturday, I went to prison. Nine years ago. Look where I am nine years later. Basically now, you're a senior youth worker in this youth club.

Yeah. But you also mentor young people at risk of getting into trouble like yourself. Yes. That's a long journey from prison. Yeah, I know. Who do you live with now? I live with my mum, so I'm back home with my mum. It's nice.

It's nice to be able to have somebody or my mum now understand me the way I wanted her to understand me, maybe when I was younger. Be able to have open conversations and be honest. Two big women can't live in the same house. Can do now. Yeah, they can do now, yeah, because I'm not a big woman. I'm still my mum's youngest daughter. Nikila spoke to Jo Morris.

Now, still to come in today's programme, I did promise the history of the straw hat, but we thought we might wait until the weather improved a bit. We do have the serial, the third episode of the Latvian Locum. Now, earlier in the week, you may have missed a discussion about how to fill the long summer holidays, especially if it's going to be wet. And yesterday, the Bonk Buster.

Why are we no longer keen to read them? Don't forget, if you miss the live programme, you can always catch up. All you have to do is download the BBC Sounds app, search for Woman's Hour and there you'll find all our episodes. Now, as I'm sure you've heard, Marina Wheeler, the 54-year-old estranged wife of Boris Johnson, was treated for cervical cancer earlier this year and is now urging other women over the age of 50 to make sure they go for their smear test when they're called. Up to

50 you're invited for a check every three years, over 50 it's every five years and over 65 you're invited only if one of your most recent tests showed an abnormality. Young women are called when they're 25. It's now 10 years since Jade Goody died from the disease at the age of 27 and raised the profile of the availability of testing It's also 11 years since the vaccination of the HPV virus known to cause cervical cancer was introduced for girls That comes for boys in September So who now needs a smear test and why might the take-up have gone down? Well Anne Connolly

is a GP who speaks for the Faculty of Sexual and Reproductive Healthcare. She joins us from Leeds. Kate Sanger is the Head of Public Affairs for Joe's Cervical Cancer Trust. Kate, how common is it in women over 50? So there's a misconception that cervical cancer is a young women's disease. And as we can see from Marina's story this week, it can affect women of all ages. It's more prevalent in younger women. So that's women around 25 to 35. But as I said, it affects women of all ages. And it's really important that we know this and that women of all ages know how they can reduce their risk of the disease.

What about women over 65? Because we've had a couple of tweets. One said, it came from Judy, I was told by the practice nurse at my GP that at 70, I was too old for a smear. She said even if she did one, they would refuse to process it at the hospital. Yeah, so cervical screening stops at 65. So if you're over over 65 and you have been up to date with your cervical screening and you've not had an abnormal result recently the evidence shows that your risk of developing cervical cancer is very very low. We are living longer so it might be something that needs to be looked at in the future as to whether the screening age should be increased however what's most important to remember is that cervical screening attendance actually falls as age increases.

So we see women at sort of the last stage of screening, in there between 60 to 64, and attendance is actually falling. It's quite low. So encouraging women to find out more about screening and take up that invitation is most important. Anne, why do you think the take-up of tests is falling in the over 50s? So, good morning. Women are very busy. They're working. They're trying to get appointments.

They often, if they've missed an appointment, they might think it's too late to go for one, and if they've missed one, they have a fear that we as GPs might tell them off there's lots of myths out there they don't think it'll happen to them there's a thing about it being mainly in young people they don't have symptoms so they don't think they need to have a test sometimes and they may have had an experience that wasn't great when they were a bit younger um so what do you mean an experience that wasn't great when they were a bit younger. What do you mean an experience that wasn't great when they were younger? As if I needed to ask that question. Exactly, exactly.

So the majority of smears are absolutely fine. We, as women GPs, often take them and the nurses are our main source of taking smears and we as women, we've had smears um but sometimes the experience might not be quite so great and there are tricks and tips we have and women who come in they should make sure that they talk through what's going to happen they understand what that's going to happen they bring a friend if they want older women may feel it's going to hurt a little bit more because sometimes they need more lubrication.

We've got a different size speculums, you know, the instrument that we put in so we can use smaller ones, larger ones, whichever is necessary. So we have trips and tips to make it easier. And do you always warm it? For speculum I mean.

We're mainly on plastic devices now so it isn't the same issue as it used to be when we were using the cold metal ones There is some self-testing which is being tried in London at the moment Anne How does that work? So the self-testing scheme is going to be rolled out

and piloted in London in the beginning of next year and that will be looking for HPV. So HPV infection, as Kate's already said, is the cause of the majority of cervical cancers and this test will be a cotton swab that

women can put inside their own vaginas and take their own samples. If this shows that they have HPV infection, then they will be invited to go for a more formal smear. And the estimate is that it may be that it will only be about one in seven women who will then actually need the smear. And the women who don't have HPV infection will be deemed to be so low risk that unless they had any other symptoms, they wouldn't need an examination.

So it looks as though it's going to be a great way, if it's successful, of encouraging more women to have their tests done. Kate, what was the impact of Jade Goody's death? I mean, I said it was 10 years ago ago and there was so much publicity around it. How much did it change the understanding of the disease and its causes? So as you said she obviously had a very high profile battle and a high profile death from the disease and she really raised the profile of cervical cancer as a cancer. It does remain a rare cancer and that's partly thanks to the cervical screening program and as a result of her high profile experience with disease about 400,000 extra women went for a screening appointment which was absolutely

fantastic to see especially as we're seeing screening attendance falling but that was very short-lived and since then we've seen attendance for year on year. And also Jade Goody, as you said, she's 27, Marina is 54. It can affect people of all ages, so it's so important that we're looking at women across the age groups, the eligible age groups, and look at the reasons which might be preventing them from taking up an invitation. Now your organisation warns that cervical cancer will be most common over the next 20 years in women between 40 and 60. Why?

Well, as you mentioned before, we've got the vaccination programme, which was introduced in 2008. And we're seeing young women who have had the vaccination starting to come into the screening programme now. And the evidence has shown that those women are showing much lower cell changes, abnormal cell changes, so that the cells that could develop into cervical cancer, which is really fantastic. It means we're going to be seeing reduced diagnoses of cervical cancer in young women. It's women who haven't been eligible for vaccination who are going to be in the most at risk groups. And that's women who are currently in their 30s, currently in their 40s. In the next 20 years, that's where we're going to be in the most at-risk groups, and that's women who are currently in their 30s, currently in their 40s, in the next 20 years.

That's where we're going to see the increased incidence of cervical cancer, especially if we don't start to improve uptake of screening. Anne, how important is it that women in this age group, when they come to the doctor, don't get embarrassed if they think, I might have HPV and consequently cervical cancer because of sex. Exactly. It's one of the biggest problems that we have at the moment is the huge myths around HPV infection. It is a sexually acquired infection, but we have to remember that the majority of us will have at some point had HPV.

It's so normal this is men and women which is why it's so important that we're going to start immunizing boys as well and it becomes a normal infection that we live with and don't have any symptoms from and then like any viral infection most of us will get an immunity to it and then the problem will go and it but in some women men it will last for many years in some it will only be there for a short time so it doesn't say anything about sexual promiscuity or recent sexual changes it just is when the test is found and you're found to be positive it maybe you've had that problem from or that virus infection there for many many years but it's causing a real concern and as you say it does put some women and women off screening because they are concerned about how they'll feel if

they're being told they've got hpv infection if if there are symptoms of the cancer, what are they? What are the signs, Anne, that you should look out for? So certainly bleeding after sexual intercourse is something that women should go and see someone if they have that experience That may also be due to other reasons but that's one of the main ones If you have a change to your discharge, your vaginal discharge.

But bleeding after sex is the main pointer that should make women go and see somebody to be examined. One of the other tweets that we had came from Susanna Anne and she said please examine why there is an upper age limit for routine smear tests and now Kate said earlier maybe this needs to be revised as we're all getting older I you know who knows more women may be having unprotected sex as they get older than might have occurred before. Does it need to be revised? I'm sure, as Kate said, there will be a revision at some point. What a study a few years ago did demonstrate was, though,

that if women have had a normal smear in their last years of having their smears done up to the age of 65, then that means that they are pretty protected till they're over 80. And we know that the instance of cervical cancer is lower in our older women. So it's all about the benefit versus the costs of a test, isn't it? and that will have to be re-evaluated but at the moment 65 does seem to be the see the be the recommendation for all the right reasons just briefly kate how effective is the gp recall process does it work so for women who've had a cervical screening um for those women who've had an abnormal result and picked up and had treatment and the majority of those women will never need treatment again

and that's what the research shows so by attending your smear test and it's the best protection against cervical cancer i was talking to kate sanger and ann connolly and if you need more information on cervical cancer screening please go to the Women's Hour website there's really good links on there. Now to Edna and Ismail we had so much response. Christine Lloyd said amazing woman. Sue Belton said absolutely shocking and inspirational. What an amazing woman. Alan said, in tears at the story of this wonderful, inspirational woman, Mary Jane Harbottle, Esquire, said, Just been listening to this breathtakingly brave, resourceful woman being interviewed.

A tough listen in places, but such an inspiration for all young women. And Alison Chapman said, very inspiring listening to the campaigning woman who developed a women's hospital single-handedly in Somaliland. And then again, lots of response from you on smear tests. Anne said, I had a report back from my last cervical screen saying it was abnormal. When I phoned the doctor's surgery to rearrange a further test in about a year, they said I would not be eligible because by then I would be over 65. I felt this was appalling, took it to various services, including my MP,

and in the end had to go privately for a further smear test. Rosie said the National Federation of WIs is currently campaigning on Don't Fear the Smear to encourage women to attend for the test and get people talking about the importance of it and it was the WI that campaigned for the cervical screening programme way back in 1964. Julia said, I was diagnosed with HPV in my late 50s, early 60s. I hadn't been for a cervical screening for some years and made an appointment with my doctor. I was refused a test as I was over 65. Roberta said, I stopped having them a few years ago because they were getting more and more

painful and I was told by the nurse that they do as you get older because they have to go further in to get to the right place so I don't understand how this thing you can do yourself would work if the right bits are not at or near the entrance to your vagina. I'm 69 now. Carol said, I had regularly attended smear tests all my life, had a few irregular results and a minor procedure at about 50 years old. Since my menopause 12 years ago at the age of 50, I've experienced serious vaginal atrophy

with the result that about six years ago I could no longer tolerate the smear test as the pain was too severe and the nurse couldn't actually do the test I was told not to bother anymore and no alternative means of attempting the test were given to me as someone who tries to take care of my health and take preventative steps against illness including always having regular mammograms and bowel cancer tests, I feel that I've been left to take a chance. Are there really no other ways of testing for cervical cancer for women who physically are unable to have the normal smear test?

Sheila said, I took part in a self-screening pilot here in Scotland about 30 years ago. Often wondered why it wasn't rolled out the take-up of the bowel cancer self-screening is good people do prefer to do these screening tests at home if possible Mike said a friend of my mother's was refused a smear test in her 60s she later died from untreatable cervical cancer hence I would say to not have a cut-off date if patients requested a test. And then someone who didn't want us to use her name said, when I was having my last smear test, I mentioned to the nurse that my daughter was having her HPV immunisation the same day. The nurse actually commented, oh, it seems such a shame to vaccinate them at this age.

They're not all promiscuous, are they? At the time, I thought it was funny that she should have so little regard for what she was saying. But in retrospect, what an appalling attitude. And finally, Heather said, I went, as I always have when called to my GP practice for a smear test, aged 58, with a brisk and deficient, no-nonsense practice nurse. I gritted my teeth and got on with it as I always had, but this time it was agony. I bled afterwards for the rest of the day.

It was painful to walk out of the surgery, but I did so without mentioning it, trying to keep my dignity intact. I was horrified to receive a letter a week or so later to say that they had collected insufficient cells and I would have to have a repeat test. The horror of the previous test was still too raw, quite literally, so I ignored the letter. When I received a follow-up letter, I made an appointment with my wonderful female GP to discuss it. She put me on a four-week course of daily HRT pessary because she suspected post-menopausal vaginal dryness

and told me to come back in a month's time and that she would repeat the test herself. She carried it out slowly and with great sensitivity and the result came back negative. Hooray! Hooray indeed. Now tomorrow I'll be talking to the award-winning author and former Children's Laureate, Mallory Blackman, about Crossfire, the new novel in her Noughts and Crosses series, and I'll be talking to the composer, Errolyn Wallen MBE, who was the first black woman to have her work performed

at the BBC Proms in 1998. Join me tomorrow, two minutes past ten if you can. Bye-bye. Beyond Today is the daily podcast from Radio 4. It asks one big question about one big story in the news and beyond. I'm Tina Dehealy. I'm Matthew Price. And along with a team of curious producers,

we are searching for answers that change the way we see the world. Subscribe to us on BBC Sounds. And join in on the hashtag Beyond Today. I went down, you went up. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who's faking pregnancies. I started like warning everybody. Every doula that I know. It

was fake. No pregnancy. 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.