Woman's Hour - Iron deficiency, Malintzin, Budget lookahead, Frida Kahlo self-portrait

Episode Date: November 24, 2025

Are you excessively tired with your hair falling out, nails always breaking, brain often foggy or sometimes, despite having youth on your side, maybe forgetting how to form a sentence? These are amongst the symptoms of iron deficiency, often underdiagnosed. Nuala McGovern will be speaking to Dr Sue Pavord, Consultant Haematologist and President of the British Society for Haematology, and freelance journalist Rose Stokes.The Royal College of Pathologists say that a shortage of consultants means that "1 in 5 families are now waiting 6 months or more, and some longer than 12 months" for post mortems. The 'paediatric and perinatal pathology workforce' report said there were no paediatric or perinatal pathology consultants in the South West, the Midlands or Northern Ireland. Dr Clair Evans, the chair of the college’s advisory committee - a Consultant Paediatric and Perinatal pathologist explains the situation further. At lunchtime on Wednesday the Chancellor of the Exchequer Rachel Reeves, will unveil her much anticipated second budget. How could this budget affect the lives of women in 2026? We’re joined by the BBC’s Cost of Living correspondent Colletta Smith, to talk us through what we might see in the red briefcase on Wednesday. A self-portrait by Frida Kahlo has just sold for $55 million in New York. It is the highest price ever paid for a work by a female artist. To illustrate the magnitude of the difference, a painting by Klimt was also sold recently for $236m. Professor Renee Adams is a professor of finance at Oxford Saïd business school and researches the role of gender in the art market, where women’s works generally achieve much lower values. She explains why and what needs to change. As part of the BBC 2 Civilisations series, tonight’s programme looks at the rise and fall of the Aztec Empire and the part that a young woman played in its demise. She was called Malintzin and acted as translator at the momentous first meeting in 1519 between Montezuma, the ruler of the vast Aztec Empire, and the Spanish conquistador Hernán Cortés. To find out more about Malintzin and her role in Mexican history and culture Nuala is joined by Dr Elizabeth Baquedano, from the Institute of Archaeology at University College London and Dr Jessica Fernández de Lara Harada from the University of Oxford.Presenter: Nuala McGovern Producer: Kirsty Starkey

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See holidays differently when you stream the best of British TV with Britbox. Hello, this is Newla McGovern and you're listening to The Woman's Hour podcast.

Good morning, hello and welcome to the programme. Well, Chancellor Rachel Reeves is centre stage this week and on most of the front pages this morning. As she gets ready

to deliver her second budget, we're going to take a look at what is expected and in particular, any proposals that would affect women. So the Chancellor has a busy week ahead. Perhaps you do too. And I'm wondering how you're feeling this morning.

Full of beans or a bit sluggish? Well, we're going to discuss whether an iron deficiency could be to blame for when people feel tired all the time. And I'm really talking about women of a reproductive age. It is more common that you think. We will talk about that. We're also going to hear about the woman who helped the Spanish conquer the Aztec Empire in modern day Mexico.

there is a debate that continues around her to this day. I learned a lot, I think you will too. And staying with Mexico, did you see that a painting by Frida Kahlo sold for over £41 million. It was a record for female artists at auction. But one of my guests says that the disparity in art blows other gender gaps out off the water.

So we're going to talk about that. And I would love to give a little bit of love and attention to female artists this morning. Perhaps you have a favourite. Who is it? Why? Is there any particular artwork? Famous or not, I want to hear about that woman.

You can text the programme. The number is 84844 on social media we're at BBC Women's Hour or you can email us through our website for a WhatsApp message or voice note. The number is 0300-100-400-444. But I want to turn to the Royal College of pathologists that say that a shortage of consultants means that one in five families are now waiting six months or more

and some even longer than 12 months for post-mortems. The Pediatric and perinatal pathology workforce report said there were no pediatric or perinatal pathology consultants in the southwest, the Midlands or Northern Ireland. The college has also warned of a workforce crisis in paediatric and perinatal pathology. These are doctors who conduct postmortems that give vital information

about the causes of death, of infants and babies, including those lost late in pregnancy. And they also help to diagnose and treat six children and that could include conditions that might require wider family screening, for example. I want to bring in Dr. Claire Evans.

She's the chair of the College's Advisory Committee. She's a consultant, pediatric and perinatal pathologist. that role that I mentioned that there is a lack at the moment. Doctor, welcome to the programme. So tell me a little bit about this shortage. Thank you, Neula. Yes, at the moment, we are struggling, I think,

across the UK to maintain services in paediatric and perinatal pathology. And that covers post-mortem examinations of babies and children. It also affects or can impact diagnosis of children's cancers as well and other disease processes that we're involved with in laboratory investigations. So let me drill down into that a little bit. So with the children's cancers that you're working on postmortems but also on children who are currently

ill. Yes. So a lot of my colleagues and I have in essence our role is very broad. So part of our role is in post-mortem investigation, and that might be hospital-consented post-mortems, and some people also undertake post-mortems that have been requested by the coroner, or if you're in Scotland by the procurated fiscal. And then another aspect of our job is actually what we call surgical pathology or tissue diagnostics, where we look at biopsies or tumours that come from the surgeons, from patients to identify. identify what those are and to help direct treatments. Now, the report says that 37% of consultant posts in the UK are lying vacant.

Why do you think there is that shortage? Well, we've had a chronic problem of staffing in pediatric and perinatal pathology that has been going on for over 20 years. And simply put, we don't have enough people in training coming into the specialty and at the top end we've got too many people retiring or burning out because of the amount of work and with that in essence we have people who are collapsing under the amount of work that they are being asked to do so that has led to a chronic shortfall and I can understand why it would be particularly a job prone to burnout perhaps as you talk about these numbers that you feel

are way too small for the job that is at hand. But I'm wondering before that, and obviously it's a difficult job, what you are doing, but it is such an important job as well. And I'm wondering why do you think more people who are going through medical school, for example, are not attracted to going for a role like that? I think we have a number of issues

with medical school education, where people just don't know that we exist as a specialty so that that's one aspect we also have a limited route into recruitment and training so we rely on residents coming in from another route of histoposology before then transferring into pediatric what is that histopatology is tissue-based diagnosis so essentially it's and anything that comes from the surgeon that comes into the laboratory that requires assessment to assess whether the tissue is a cancer or not. So, yeah, sorry.

No, I'm just thinking, of course, that would be a pathway that would make sense from there into your field. But, you know, we saw this story this morning because it was parents that they were talking about that we're waiting sometimes six months or more, sometimes 12 months for a post-mortem. Can you explain what that means to that family? Yes. Essentially, it's extremely distressing. We have to actually tease out what that actually means because people are interpreting it in different ways. So essentially, when a baby dies and unexpectedly and suddenly, the baby's case is referred to the coroner, then find a pediatric pathologist to undertake the post-mortem examination. Now, in a number of

centres that you've already mentioned, look, we don't have pediatric pathologists available, so the coroner will have to ask other centres away from where the family lives to undertake the post-mortem. So the baby will be transported to the other centre for their post-mortem examination, which will take a few days to a couple of weeks before the baby is then released back to the family for funeral. But after that, there is subsequent battery of tests and investigation that the pathologist then does before they can put everything together and create the final post-mortem report and cause of death. And it's the delays in getting that final report out that create the problems for the family because they're waiting so long for that final post-mortem report.

Very, very distressing. And of course, I do want to mention if you are listening and you've been affected by some of these issues that we're talking about, there are links to BBC Action Line for help and support. So how do you rectify something like this? Well, there are a number of things that the Royal College of Pathologists would like put in place.

And one of those is continued support from the politicians for training, in recruitment. We'd like to increase our recruitment into specialty and we'd like to incentivise our senior colleagues to stay in profession if they can and not leave or retire early. Okay. Can I go into the two of those for a moment? Recruitment and retention really is what I'm hearing. If you were the person, maybe there's people who are going through medical school, for example, who are listening, I mean, what would your pitch be to? them? Well, my pitch to them would be that they would be missing out on a very

intellectually stimulating but challenging career pathway in pediatric and perinatal pathology. I think people don't necessarily understand that we also feel the distress that the families feel for these cases. You can't not be affected by it. And, and And we don't like seeing the delays that we see. So we obviously would encourage more of our medical students to undertake training in pathology, pediatric pathology and other pathology specialties as well because we desperately need people to undertake these cases. And onto the other end of the scale for those that have been in the role for many years but are burning out, as you describe it, what would it take to retain them?

That's very difficult. I think it's a combination of many factors because while the workload is over the stretched as it is, it's very difficult to persuade people to stay. However, management support from their local hospitals would go a long way to help. And one of the ways they can help is actually improving the staff that actually support our roles,

so administration, staff and technicians. of which there's also a shortfall as well. So having an appropriate number of assistant staff makes our job a lot easier. And what about you personally? I mean, around you is what I'm hearing, people are leaving or not able to cope with the workload. Do you ever go through that?

I think it would be a lie if I said there are times when I do find it very stressful and would think about something else. However, I very much enjoy the job I do and I realise the value of it to the patients and to my surgical colleagues and other colleagues in the hospital. So I can't just walk away. I think that would be doing a disservice to patients.

We did get a statement for the Department of Health and Social Care. Spokesperson said bereaved parents have experienced the unthinkable and any avoidable distress to families in this heartbreaking position is unacceptable. There are a record number of doctors across almost every speciality in the NHS, including pathology and our 10-year health plan commits to the creation of a thousand new speciality training posts with a focus on specialities where there is the greatest need. How do you feel when I read that to you? It doesn't quite match the reality that we see.

And I think the 10-year plan of increasing staffing is very laudable, but as far as I am aware, that that has to be backed by continued political support and appropriate funding. So at the moment, that doesn't seem to sit very well. We shall leave it there. It might be perhaps an area that many hadn't thought about, Dr. Claire Evans, the chair of the Royal College of Pathologists. advisory committee, consultant pediatric

and perinatal pathologist. Thanks very much for speaking to us this morning. And as we've been speaking, of course, about money and where it will be spent, let's talk about the budget. You might have seen the Chancellor Rachel Reeves say over the weekend that she is sick of people mansplaining to her how to do her job. Well, the job

very much in the spotlight today. As I mentioned on the front of most of the papers, it is, of course, the lead-up to the Chancellor delivering her second budget on Wednesday. Now, we know at the heart of it is how to plug a financial hole of about £20 billion. And Rachel Reeves has promised to take action to grip the cost of living. Well, we want to explore how her decisions could affect the lives of women. We have the perfectly placed guest.

I'm joined by the BBC's Cost of Living correspondent. Galetta Smith. Good morning, Coletta. Good to have you with us. Good morning, Lula. It's nice to talk. No mansplaining here. Whatever the chance is saying. And a lot of reaction to that this morning as well. But what do you think, getting into the specifics, the Chancellor means by getting a grip on the cost of living? She's been talking about this one for a good few months in the build-up to her budget, saying, listen, she's got three key priorities.

She's talking about NHS waiting lists being cut. She's talking about the national debt being cut. But she's also talking about reducing the cost of living. So there are still big question marks about what she actually intends to do about that. And what's actually within her power to do when it comes to. the costs of living. She's talking about getting inflation down. Energy bills are still being banded around what the government can do about that. Let's talk about removing VAT from them. There's also big pressure, of course, on the Bank of England to try and cut those interest rates,

but she's not in charge of the Bank of England. They're an independent body, so it's not up to her whether those interest rates come down. But the hope is that as inflation drops, then interest rates will come down as well. And inflation, in large part, is within the government's control because one of the reasons we've seen inflation going up again through the summer this year is because of last year's budget. So the Chancellor added on lots of extra cost to businesses, extra national insurance, extra wage rises, and they've been passed on almost immediately to us as customers when they kicked in in April. So that's why we've seen through the summer products that we buy, everything we're spending day in, day out,

getting a little bit more expensive over the summer. So the fear is that if that happens again and inflation pushes up, that's a problem. So the hope is that that won't happen in this budget for us as customers that we will see inflation starts to fall a little bit faster.

So really, whether it's energy bills or the weekly shop, for example, those very day-to-day expenses that people have, which of course Coletta you're totally aware with your role. May I move on to another area? And there has been speculation about the two child cap on benefits. So that currently means the parents can only

claim universal credit or tax credits for their first two children. Is it likely to be lifted? So this is the one rumour over the last couple of months that's actually been sticking around. There's been a lot of things that have been in and out of the suggestion box, so to speak. The government are always talking about flying kites, this idea of like, oh, we'll just put an idea out there and see how it lands in the press and with the public. But this one, the Chancellor, just seems to be pretty consistent on. So as you say, it's a limit on the amount of top-up benefits that can be paid to parents who are on universal credit. So you can only get that extra support for your first two children and no more after that. Now, this may sound very

obvious to our listeners, but it's worth thinking through that, of course, you're not then just impacting child number three or four if you're not paying that cost, but you're also impacting child number one and number two, because the family, of course, just share their finances out between all of the children. So as a consequence, we're talking about half a million children who are currently in poverty, that if that policy was in place, was lifted even, they would be lifted out of poverty. So that is what the Chancellor keeps talking about saying, listen, we don't want to be penalising children for choices made by their parents, but it comes with the price tag. So that's going to cost about £3.5 billion a year if you're going to reverse that totally, which

seems to be what the Chancellor's suggesting doing, rather than saying, oh, you could have three children or four children, you know, just sort of raising the limit, but actually removing it entirely. So, but big changes there, but yeah, it does come with a cost. And how has anything been floated on how to pay for that particular expense? So not the specifics of sort of which increase would fund what extra payment but lots and lots has been floated about where extra money can be raised and actually one of the big ones is one that often people don't notice so it's what we call frozen thresholds so that means that the chancellor isn't going to raise the point at which we start having to pay tax in the first place and those increased higher levels of tax

if you're working so it's interesting to see as perhaps pensioners that the level is about £12,500 at the moment. If you just on a state pension, you slide in just under that level. So you earn less. If you're just getting the state pension, it's less than that rate that you start paying personal tax. But if that rate is frozen for beyond, potentially right up to 2030, the Chancellor's suggesting,

then that means that as the state pension rises, as people's income rises, we have to pay more tax. So it's a way of the government gaining tax without necessarily adding an extra tax somewhere. As you go over the threshold. As a consequence, exactly, you have to pay tax there or you have to pay more of your income is covered in those higher tax rates.

Interesting on the rates. I mean, related in a way, the government has said women are the key to unlocking growth and that could potentially mean trying to support women in the workplace. Any rumours that you've heard? that you feel might give an indication on what might be said? Well, as you say, the government has set out their sort of mission or their policy around it.

They're saying that women could drive 125 billion pounds of growth to the UK economy every year. They have put forward plans for that enhanced dismissal protections, particularly for pregnant women and new mothers. That's currently being consulted on that doesn't close until the end of January. So I don't think we're going to hear anything on that in the budget. Previous governments have made pretty significant announcements in budgets about early years. Child care, very little, though, around wraparound school care. That's always one that sort of glided over a lot of the time in terms of supporting women

and indeed all parents in the workplace to be able to juggle that work, life and school balance. So whether there's anything that's said, we'll have to wait and see from the Chancellor this year. I mean, there have been complaints about underfunding of the new childcare provision scheme from some quarters. Providers, parents saying that they're footing the shortfall, for example. Do we think that there might be any announcements in respect to that area? Yeah, it's a really prickly one, I suppose, Nola, this one, because it sounds good, doesn't it? sounded good when the government announced this idea of extra funded hours for nursery places, for younger children. It sounds like a generous giveaway for the government, but actually it has

to work in the real world for that to work for parents. And as you say, there's been a lot of criticism from providers and we're seeing childcare providers closing or simply not taking on those extra children because they can't fund those extra hours because the government aren't necessarily giving them enough money to match the cost that it costs to have those children in their nursery setting. And indeed, parents, as a result, are just unable to get those places massively oversubscribed.

So that's what the Chancellor has to properly scratch her head about this week. If she's going to try and announce some schemes like that, what she doesn't want to do is what the previous government has done here in announce a policy that sounds great, but actually doesn't necessarily work as well in the real world. We did have a conversation on that last week on Women's Hour on Wednesday if anyone listening would like to listen back.

Okay, let's go to the other end for those that have left the workplace. Pensioners, people talk about the triple lock and whether that's at risk. So the triple lock guarantees the state pension goes up each year in line with either inflation, spoken briefly about that, wage increases or 2.5%

whichever is the highest. what rumblings have there been? So at this stage, pensioners can relax. We are certainly still within that triple lock world. It's likely that the Chancellor will confirm that increase of 4.8% from April 2026, which is a significant increase for pensioners this year. I suppose at some point there is going to be the question of

will the triple lock come to an end. It's a brave government that takes that on. but probably one that is realistic. When it was introduced, pensioners' incomes were relatively much lower than the, certainly than the rest of the workforce after decades of underinvestment. So it did need a significant boost, but at some point it will potentially go over or be more than the amount that workers are receiving, which is difficult to justify. So at some point, a government's going to have to remove that triple lock,

but of course, pensioners are the ones who often vote in force, so it's a, dangerous thing to mess with let us stay with pensioners many of our listeners will remember last year the government rejected it was the Parliamentary and Health Service Ombudsman recommendation to pay compensation to the

WASPY women and they were the women against state pension inequality very quick backstory the campaigners say that 3.6 million women born in the 1950s were not properly informed of the rise in state pension age to bring them into line with the men.

Might that decision now be reconsidered? Yeah, so it is being reconsidered by the government. We heard that announcement a couple of weeks ago, but what we don't know is what their new decision will be or even when they will reach a new decision. So it's possible that we will hear something in the budget about this, either an announcement or even a timescale for an announcement because we don't have that at the moment.

The minister who announced it was very clear to say, It doesn't mean that payouts are definitely coming, but just that they're back on the table again so that the government are considering again. But the idea that having dismissed those waspy women and said, no, you won't receive a payment and now said, actually, you might again, to push them out again would be very bad publicity.

So I would imagine something is coming. The question is just when. Kalata Smith, thank you for spending some time with us. I know you've a busy week ahead. Coletta is the BBC's cost of living correspondent. Thanks very much. So many of you have got in touch with your favourite female artist.

Here's one. I recommend Rosina Vacmeister and her fabulous cats and street scenes. Here's another. My late mother has left a lifetime's work of oil paintings which are amazing. She attended the Royal College of Art in the early 50s, taught by Francis Bacon, among others.

However, it's so difficult to get Annie in She definitely did her 10,000 hours and became a master painter, but the art world only seems to be interested in my father's work. They met at the Royal College of Art and married a few years later. There is still a glass ceiling for women. Well, I think that's something my next guest might agree with. And what we're talking about this? Well, a self-portrait. Did you see this by Frida Kahlo?

It sold for $55 million. That's 41.8 million pounds. in New York, and it shattered the auction record for any artwork by a woman. So lots of people celebrating this, but my guest, Professor Renee Adams from the Oxford Side Business School, perhaps not so much. Renee research is the role of gender in the art market and has said that the art market blows all the gender wage gap numbers out of the water. Renee, welcome.

I think we're just going to get your microphone sorted there. You're very welcome. I think we have you now. Renee? Thanks so much for having me. Can you hear me? Yeah, I think we still need to boost you another little bit. I'm just going to read a couple more of the comments that came in

from my listeners while we get that sorted. Right. Louise in Yorkshire says, my favourite artist is Tracy Savage. Her work is such fun to look at. And each time I look at one of her paintings, I find something different. She paints scenes from my local Yorkshire coastline. How beautiful. Each individual building is painted in such an imaginative and also quirky way.

Okay, one more. Joan Erdly, wonderful Scottish artist. Favorite picture of hers is Carteline, Cateline, Catalan, I might be mispronancing that. Forgive me, somebody will message me and tell me how that's correctly pronounced in winter. 844, if you would like to get in touch. Right, we have sorted out the line with the professor. Welcome, Professor René. Thank you very much for having me. Lovely to have you with us.

Now, why aren't you as happy as many other people seem to be about Frida Kahlo? Well, I'm not so happy because I think Frida Kahlo deserves to break a record for a man, not a record for a woman. So I'm not happy about the framing of, you know, this is something that we should be so excited about. Now, because if we talk about record-breaking sale prices, for example, we talked about the female artist there, but if we turn to a male artist, Gustav Klim, also sold last week, but it went for nearly four times more. Why?

Yeah. I mean, I think basically, you know, if you think about the price of an artwork, there's artwork itself that's really important that determines a price. But the other thing that's really important is the identity of the art. artist. And so if Gustav Klim sold for more, then obviously that means that people value his identity more than the identity of Frida Callo. So who decides value? Well, that's an interesting question. So obviously, the buyer has to pay the price, right? So in this case, the buyer has

decided that the Klimt work, for example, is much more valuable to them than the buyer of the hollow work. But then obviously, you know, there's a lot that feeds into the price, which the buyer is influenced by. But I suppose then who is the buyer? Because if this is happening across the board with female artists, as opposed to male artists, always receiving less, particularly with these big blockbuster sales, so to speak, who holds the power?

Well, I would say historically men have, right? So historically, the people who collect art are people who have wealth. And there's, you know, as we know, there's a big inequality in wealth. So men have typically had more wealth than women. And obviously, you know, it's not just that the men have the wealth, but also societal perceptions around the value of women's work feed into the pricing. So with this, it can be quite difficult at times, a bit murky to try and get sales value.

but I heard that the pandemic meant that a lot of transactions started happening online so you could start doing more transparent analysis. I mean, how would you describe the gap? It's huge. So what we found in our research on the secondary market, which is basically auction prices, is that the gap was on average about 40%.

So women's work sells 40% lower. If you look at the, so, What I did during the pandemic is I collected data from art fairs, which is part of the primary market. And so there we found that the gap was very similar. And so what's interesting about that is people always say, well, this is changing, right?

So now women's work is going to be valued more. But this is a very recent data that I've looked at, and the gap still seems to be persisting. So how would you solve this problem if there is a way to do so? Well, you know, I'm an educator, so I believe that education is really important, research is really important, and simply highlighting to people that, you know, people have this idea that the market somehow works and that price is equal to quality, but that actually, that equation breaks down in the art market. And I think it's important for people to realize that. What I found fascinating is whose signs and artwork can make a difference to the price. So, you know, whether it's signed by a man or a woman, quite frankly. And I was seeing a story today about LinkedIn, actually,

and there was this collective experiment that found switching a female profile to a male profile and bro-coding text, so more masculine language instead of more female-centric language, led to a big increase in reach, even though LinkedIn, the site very much denies favouring posts by men. And then I was like, I wonder did like women artists ever pose as men, We know whether, you know, their value or their worth of their artwork changed in any way if they did. Yeah, well, you know, that's interesting. I think it's difficult because so much of the sales rely on, you know, the identity of the artist. So there's a lot of marketing that goes around about which shows they've been.

So it would be very hard to hide whether you're a man or a woman. But I've done some research on secret postcard auctions where the identity of both men and women is hidden. And what I find there is that the prices are the same for men and women on average. So if you don't know the identity, then the market doesn't price the identity. And essentially, the price seems to be driven by what the artwork is. But if you do know that identity, then the discount arises for women. So I suppose there is the artwork, there is the buyer.

And then there is the structure that's around it. I mean, there's obviously society. but within the smaller structure of, you know, museums, gallery owners, the collectors, I suppose, which would be the buyers as well. Do you think they're also predominantly male now? Yeah, I think it's sort of a fundamental, you know, like we know that there's a lot of data out there suggesting that, you know, museum directors have historically been male, galleries have been historically run by men,

guerrilla girls have like a longstanding advocacy sort of protesting against this phenomenon and I think while it's changing it's really difficult for gallery owners to change everything on their own because a lot of what they do is influenced by prices for example that happen in the secondary auction market so you know there needs to be much more concerted effort

in order to change things Well, this morning we are giving love and attention to female artists. Let me read out a few. Shari says, my favourite artist is my daughter-in-law who manages to paint in between running around after her two small boys, my son and their dog in their tiny cottage. And she has posted a beautiful scene that her daughter-in-law has painted. Here's another. My favourite female artist is Vogue photographer Lee Miller. I saw an exhibition at the Brighton and Hove Museum and Gallery, and it was truly amazing.

I just saw one recently in the tape Britain. I agree. Lee is my favourite because she never gave up or let anyone. and tell her what she could or couldn't do, even though at the time it was difficult for women to be photographers, I will always be inspired by her and wish I could have met her. Yeah, I suppose we're really talking about a recent history. I mean, even Frida Kahlo is recent as well

when we put it in perspective. So maybe things will change. Renee Adams from Oxfordside Business School. Very thought-provoking. Thank you very much for joining us. Thanks very much for having me. Now, I want to talk to some of the parents in our audience, who are perhaps in the middle of trying to get support for their child

with special educational needs. If so, we want to hear from you, particularly if you're applying for an EHCP, that's an education, health and care plan, and maybe you're finding it difficult. What are the main barriers? What are the stumbling blocks? And also, how has this process made you feel? I'd love you to get in touch with your experience. You can text Woman's Hour. That's 84844. On social media, it's at BBC Woman's Hour. Or, of course, you can email us through our website as well. We'd love to hear from you. Okay, one more on the artist. No, there's going to be more throughout the program, but for now. Being Welsh, says Alex, I must call attention to the wonderful artist Gwen John, whose gentle portraits of women and children are so touching. My favourite is often none, though, who seems to have a wry sense of humour in her picture. Aren't these lovely? 84844 if you want to get in touch. Now, I want to talk about tired women. There can be many reasons why you are struggling with fatigue,

maybe even right now on this Monday morning. So let's take a look at one potential culprit. Iron deficiency or ID is considered a global public health concern. Young women are a particularly high-risk group owing to regular menstruation and at times their diet. And according to the World Health Organization, at least a third of women are affected worldwide. Here's some more stats from Nice,

the National Institute for Health and Care Excellence. They say iron deficiency causes some 57,000 emergency admissions to UK hospitals each year. Well, I'm joined by the freelance journalist and columnist Rose Stokes. Also, Dr. Sue Pavid, who is a consultant haematologist at NHS Hospitals Oxford and President of the British Society for Hematologies and good to have both of you with us.

Good morning to both. Good morning, thank you. Morning, Neyla. Let us, perhaps, I was mentioning, you know, feeling a bit sluggish, feeling a bit tired. Is that fair, Dr. Sue, on what people would be feeling?

What do you think are some of the signs of low iron levels? Yes, absolutely. Yeah, thank you, Neula. I like the way you introduced it and you framed it because I refer to this as the silent debilitator.

It just comes on slowly over someone's lifetime and is accepted as the norm. So you asked about the general symptoms and signs, exhaustion, hair loss, muscle weakness, breathlessness. There are so many symptoms. And the reason for that is because iron is needed for every single cell of the body. It's a key component to mitochondria, which are the engine rooms of every cell. and so the symptoms are numerous. And I learned this morning it's a mineral, which I don't think I really realised before.

But so you outlined some of the stuff there, Dr. Sue, and I think I mispronounced your name, is Pavud and not Pavud. Yes. Good to have you with this. Thank you. Rose, you wrote an article for The Guardian about how you were affected by iron deficiency.

Tell us more. Well, the article actually was about other women, but it was born out of the fact that After having my second son in last year, I guess it's still last year, I was really, really tired. I mean, tired's probably not the right word, exhausted, couldn't really do anything more than the bare minimum in terms of looking after my kids. Brain fog, memory, and I used to sort of joke that it was like, you know, mum brain, all the usual things. But I also had other symptoms, like my hair was falling out again, and I went to the dog. doctors a few times and every time was told oh well you know you're a mum of small children

what do you expect kind of thing and but the the level of exhaustion was just so intense and I used I had a funny taste on my tongue all the time how would you describe it like metallic okay um and then I thought and I kept getting tongue ulcers as well this is like a weird thing that I've only just understood was related and uh breathlessness dizziness like the doctors that I spoke to because I have a higher BMI said oh well postnatal you've gained weight like you need to diet and exercise and but at that point I was so exhausted I couldn't I couldn't even conceive of the idea of exercising like I mean I'd put the kids down at seven I'd have to get straight into bed and I think again it happened slowly and quickly in a way but it wasn't until I

started to know like it's not so now sort of it's very clear when you missed all your symptoms You're like, how did I not know? Well, no, because I've had an infusion. That's the important thing. So I went into the doctor. Eventually, I said, look, can you just do a blood test? And when it came back and I looked at the results myself on my app, I looked it up online, and it said ferretin 15.

And I looked at up online. It said, iron deficiency can cause all of these symptoms. Great. So we went back to the doctor kind of victorious thinking, OK, we can solve this. There's something going on. And they were quite dismissive. And they said, oh, well, it's not that.

and I don't think that would explain your symptoms and it was just one of those things where I then posted online and about 100 women came back to me. I'm not even joking, it's the biggest response I've had for anything. Eventually, when I went back, another doctor did take me seriously,

went through a process of trying different iron pills which none of them agreed with me and then finally got an infusion. What are we in November? Two months on from my infusion now and I just feel like a totally different person. Okay, so there is a lot of stuff to unpack the doctor. No, but there is because number one, her levels were low

and I'm seeing this from another listener who's got in touch. Just as my daughter had a ferretin level below 20 when it should be over 100. We had to go private to get an iron infusion, a common treatment in the States, which rapidly improved her symptoms and brought her ferretin level up to normal levels. We're talking about iron. We're talking about ferretin. What's the difference?

Okay, well, ferretin is the goal. standard test for iron deficiency. So it's a marker of the iron stores. Okay. So it's a simple blood pressure. So even when it's a low figure that doesn't

automatically, from what I'm hearing from our listeners and also from Rose, trigger a response for a more in-depth intervention, shall we say, from a GP at times. Well, actually, Nula, it

should do. I think it's harder when the ferretin is not low because people forget to understand that actually ferretin can be pushed up and be misleading. It can be pushed up by inflammation, by infection, by pregnancy. And so it can be misleading and people miss the diagnosis. But when it's low, that is diagnostic of our deficiency and should have attention paid to it. But what Rosie has what described is really typical of what women feel. Symptoms were wrongly attributed and in her case to her busy life

with her children, her busy work and being overweight. So we see this symptoms being wrongly attributed to different things. Is there a very wide scale on what is, and I put this in inverted commas, normal for iron levels? Well, that's a very good question, actually, because there is an arbitrary threshold, if you like, which is the lower limits of what is described as a normal range.

But it is just a benchmark. And like all benchmarks, people can fall above it, people can fall below it. What's really important in the assessment of iron deficiency is, yes, the blood test, but also the risk factors, the symptoms, the signs and also what forthcoming of. are important in the life. And I'll get to iron infusion in a moment and I should say for anybody who's thinking, oh, that's me. Do consult your own GP

if you have concerns about how you are feeling. Rose mentioned iron tablets and we know that iron tablets aren't, what's the correct word? Tolerated. That is exactly the word I was looking for. Tolerated by people, by some people, you can get terrible indigestion, you know,

all that. patient at times. Many people will talk about it and different people have different brands that they're into, etc. Would that usually be the first line of defence? Absolutely. Iron tablets can work extremely well, particularly if they're taken correctly. So that is first thing in the morning on an empty stomach with a glass of water or some vitamin C, an hour before any food, drink, tea, coffee, dairy, anything. because most things will actually inhibit the absorption of iron. Vitamin C is the only thing that enhances it.

So taking iron tablets correctly will really help the absorption and therefore help the tolerance. Can we... Sorry, go ahead. Please go ahead. I was just going to say that giving iron tablets are really important early on so that its iron deficiency is managed before it becomes really severe. because once it's severe, then really the only option is intravenous iron. And intravenous iron is so effective.

It's transformative for women with severe. And I want to get that in a moment, but I'm going to go back one step more before the iron tablets. Can we not get what we need from our diet? Once iron deficiency has been established, dietary improvement is insufficient. to correct the deficiency, but having a diet rich in iron will help prevent iron deficiency developing. I mean, I always think of kale. What else will you throw out there?

Well, actually, kale is, it is rich in iron, but it's not very absorbable. Absorbable iron is hemion, and that is in red meat, in chicken, in fish. Liver. Yes, perfect. My mother used to always tell me when she'd fried for me on a Friday. But let's go then at the other end of the scale. Like an iron infusion, that was new to me. I hadn't heard about that previously.

Obviously, our listener has, obviously Rose has and she's done her article on it. But that is privately what I've heard so far, which is going to be an expensive option. Is it possible to get it on the NHS, Doctor? Well, yes, we have a very big iron deficiency management service in Oxford. It actually took me three years of a business case to get this through. And very quickly, our referrals just escalated.

And we now see almost 1,000 new referrals a year. So through increased education and awareness, we have had that influx of patients. But Oxford is fairly unique in that. It is difficult to get it on the NHS. And so, you know, there are private infusion pinnics around. Let me turn to you, Rose. You have more information on this.

I feel like there's going to be an exodus to Oxford and Bath, but I live in Bath and I had to go through three different types of oral iron, but once I had tried them and not been able to tolerate them, I was then referred to the Royal United Hospital in Bath, and they gave me an infusion within a week. And what is that? It's like into your arm. Yeah, so it's essentially, I went to the end.

Anemia clinic, they put an IV in a cannula and you sit there. I think it's like under an hour it took and you have to get your sort of blood pressure checked and because during it and the nurses look after you, but it was like fairly low. I mean, it was not difficult and afterwards you can feel a bit fluey for a couple of days. But after that. But after that, yeah, I would say it was, it was, it was. It was very subtle, and now two and a half months on, like, even my husband is like, whoa, because I can do stuff. Initially, it was just, like, getting to the end of the day and being like, right, we can sit and watch some TV or being able to get up with the kids in the morning and not feeling like I was dying.

Like, my kids are really big fans of early mornings. That's most kids, yeah. Yeah, unfortunately, for me. And I think for me, it's built as I've gone on, but I've started to notice improvement. in areas where I didn't even realise that that was being affected. So that is a good result. But Dr. Sue, let me turn back to you as well. There is also a person who got in touch.

This is Root from Stamford. You're talking about iron deficiency causing extreme hardness, but please be aware of a common condition called haemochromatosis, the Celtic disease. Yes, indeed, I know many Irish people with it, which is iron overload where the body cannot get rid of excess iron, which then builds up in the body and if not diagnosed and treated

with venusection, I'm not sure what that is, in time it builds up around the organs and can cause serious illness. And tiredness. And tiredness. Okay, okay, so that's very interesting. Yes, that's a genetic cause of iron overload. So actually, Neela, I've just produced a book

on iron in clinical practice and half of it is about iron deficiency and half of it is about iron overload. but people who are iron deficient, they are not at risk of getting iron overload if we treat them. Right, but from what I've heard with people with haemochromatosis,

the symptoms sound pretty similar. I think the point is you have to get your ferretin level checked. And every expert that I spoke to you for the article said that. I asked them, should we all just be taking it? Because in my case, I was told that 50% of pregnant women end up iron deficient, and I said, well, why aren't all pregnant women? women taking iron tablets. And I think the point is that you need to screen everybody, find out where they're out,

and then you can advise. You know, I feel like everything we're talking about today seems to be feeding into the budget announcement on Wednesday, which, of course, it always takes money to pay for some of these things. But really interesting, also a number of listeners getting in touch in relation to this too. So thank you for your comments. The freelance journalist and columnist Rose Stokes, thanks to you, and Dr. Sue Pavid, consultant hematologists at NHS hospitals

Oxford and President of the British Society for haematology. Thank you both very much. We did ask the Department of Health and Social Care for a statement, but we have not yet received a response. Here's one on iron deficiency. I suffered a bad case of restless legs and was told by my friend it could be

due to lack of iron. I had very heavy periods and also bleeding due to constipation and haemorrhoids. Poor thing. I mentioned it to my doctor who did a blood test. I was very low in iron. Put me on iron and it cured the restless legs. That's a good ending to that story. Now, we talked a little bit about Mexican artist earlier,

but we want to return to part of present-day Mexico. We want to learn more about the young woman at the centre of the fall of the Aztec Empire. The empire existed from 1325 to 1521. Its capital's ruins are now under present-day Mexico City. And tonight on BBC 2, the Civilisation series, tells the story how the Spanish conquistador Hernan Cortes conquered the empire and removed its leader,

Magdezuma, with the help of, and she's got a number of names, but we'll go with Melinstein by his side for now. We'll get into both of her names in just a moment. I'm joined by Dr. Elizabeth Bacetano from the Institute of Archaeology at the University College London and Dr. Jessica Fernandez de Lara Harada from the Faculty of History at the University of Oxford.

You're both very welcome. Thank you. Shall I begin with you, Jessica? More than one name. Malinsin or Malinsh? Yes, that's a very good question. Thank you. We don't know very much about what was her birth name. We do know that she was baptized and given the name Malina, which, according to some accounts, then was interpreted by her indigenous counterparts as Malinsin. But it is very unclear. what was her given name at birth. So we can only speculate on that. So what are you going to call her for today? I think I'm going to stick with Malinsin. Okay, great.

So Malinsin, are you on board with that, Elizabeth, as well? Absolutely. Okay, because there's a lot of debate about this woman. So how would you, Jessica, describe her? Because she has been referred to as Eronen-Cortes, the Spanish Conquistador, as his wife, his lover, than others saying that she was actually an enslaved woman that was given to him? Yes, I think there's still some debate on whether, you know, her taken by some indigenous groups to other indigenous groups would count as a cultural exchange or more as slavery.

I would say that she was a very young woman when she was taken from her family and given to other indigenous groups. and later by these indigenous groups were the Mayas to the Spaniards. So I would consider that she was given as a slave and actually as a sexual slave. And she seemed to though, however,

rise up through the ranks, so to speak, Elizabeth. She's being described as Cortez's secret weapon. How important was her role in the fall of the Aztec Empire? Well, I think going back to what Jessica was saying, I think that she was first of all given by her parents, or by her mother rather, who had remarried a young ambitious man who wanted the air that they had had being the important person and got rid of Malinsin by sending her to this trading. people who were based in Chicalanko off the Gulf Coast of Mexico.

So this is a trading port. These people are buying slaves. They are buying all kinds of merchandise. They are the Phoenicians of the Americas. They are really trading. And then Malinsin is given away very early on. We don't know. She was probably eight or 12 years of age.

So she was a young girl, she was given away before she was 12, so she was young. And one of the practices of the Mesoamerican people, both the Maya and the Aztecs and other groups, had in common to give women away in allegiances. So in order to create alliances with other groups. That the women would create that link. But tell me about her role with courts. And particularly, I believe she was a translator when she was with him. Yes.

In really, I suppose, when he was opposite, Magdizuma, who was the ruler of this empire, but probably didn't realize the threat that was in front of him. Yes. Well, Malinsia was a very intelligent woman. She spoke two languages very well. She spoke now it, her native tongue, but she also spoke John Talmayah, one of the Maya Tongues. So she was a very capable translator and she was actually the center of Cortez's enterprise. She was really pivotal in the conquest of Mexico as a translator. So if we take the

narrative that she was a slave, that's the only role she didn't do. She was actually in charge of the enterprise of the Spanias. And we see her in the artwork from that time. which is just incredible. But Jessica, she has been a divisive woman in Mexican history if she is, you know, really this pivotal person in making the fall of the Aztec Empire happen. Some people seeing her as a traitor, other as a victim of circumstance.

Does that polarised opinion continue? I would say that the predominant view of Malinsin in Mexico is as a traitor. And these discourse of Malin as having allied herself with Spaniards and helped them to conquer Mexico has also fueled gender violence in the country in more contemporary times. Also, the idea of Malinsin as the indigenous Guma

who became subordinated to the Spaniards in the conquest of Mexico has maintained the subordination of indigenous peoples in the Mexico, so it has contributed to maintain some racial and social and cultural hierarchies in Mexico to this state. So my view is that, Yes, she continues to be seen mostly as the traitor to the Mexican nation.

It's really interesting, though, because President Claudia, a shine bomb, female president of Mexico, has brought her back into consciousness. I did see there was a festival, even taking a look and celebrating and talking about the history of this woman. I want to thank Dr. Elizabeth Bakedano and also Dr. Jessica Fernandez de Lara Harada for joining me this morning. You can, of course, watch civilizations rise and fall. on BBC 2. It's tonight at 9pm and all the episodes of various different civilisations are available on iPlayer. I want to watch them. I really enjoy that one on the Aztecs and I learned an awful lot so you might as well, particularly with this pivotal woman at the centre. I will be back here tomorrow, 10am. I do hope you'll join me then.

That's all for today's woman's hour. Join us again next time. After Anthony Easton's father passes away, he goes through his dad's old suitcase. It's filled with. with cryptic clues, neatly stacked German money, a family tree he doesn't recognise, and also finds his father's birth certificate, but bearing a different name. From BBC Radio 4 on the History podcast, I'm Charlie Northcott, and I've been working with Anthony Easton to understand his family's dark history and how they lost a fortune worth billions today. What happened to his family, their business empire, and all.

the money. Listen to the House at number 48 on BBC Sounds.