Woman's Hour - Justice Secretary Shabana Mahmood, Comedian Hajar J Woodland, how often to wash your laundry?

Episode Date: February 5, 2025

Women in prison are resorting to self-harm because of “astonishing gaps” in basic services including strict time limits when contacting their children, according to a new report from His Majesty��s Inspectorate of Prisons for England and Wales released today. The report's author Sandra Fieldhouse joins Anita Rani, as does the Lord Chancellor and Secretary of State for Justice Shabana Mahmood. Singer and stand-up comedian Hajar J Woodland joins Anita to discuss her show, First Love, coming to Soho Theatre in London. After being raised in a household where singing wasn't encouraged, her show explores the boundaries we put up around ourselves and what it means to finally find love and your voice. New research has quantified for the first time how many young people have been diagnosed with gender dysphoria by GPs in England. Academics at the University of York studied a decade’s worth of NHS records and discovered a 50-fold increase in this particular diagnosis between 2011 and 2021. However each general practice will only see one or two such patients each year. Anita speaks to Professor of Health Policy Tim Doran.The French have been told to wear the same T-shirt for five days before washing it, and sports clothing three times. It’s part of advice from the government’s Ecological Transition Agency, which is trying to get people to do less laundry to save water. So how often should we really be washing our clothes? Anita is joined by Professor Sally Bloomfield from the London School of Hygiene and Tropical Medicine to tell us more. Presenter: Anita Rani Producer: Emma Pearce

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

BBC Sounds. Music, radio, podcasts. Hello, I'm Anita Rani and welcome to Woman's Hour from BBC Radio 4. Good morning and welcome to Woman's Hour. She was brought up to believe that singing in public was sinful, but that didn't stop Haja J. Woodland. She'll be here to tell us about her stand-up show and we'll hear her singing. There's been a 50-fold increase in the number of young people who are diagnosed with gender dysphoria since 2011. We'll be discussing a new report that has, for the first time, quantified the actual figures.

And the French Ecological Transition Agency, it's a government agency, have done some handy research into clothes washing and hung out their recommendations to help reduce water pollution, save water and electricity and to help our clothes last longer. The recommendations include bedsheets and pyjamas should be washed every week, woolly jumpers after 15 wears, bras should be washed after seven wears and workout clothes and sports bras after three wears. Maybe the French don't sweat as much as the rest of us. What do you make of these suggestions? Do you agree? What is your washing routine? How often are your towels washed? How often do you change your bedclothes every week? Do you wash them after guests have come to stay or do you not bother? What about your jeans? Have they ever been washed? What advice were you given by your family members? And what washing tips have you passed on to the next generation?

Maybe your children are still bringing their washing home. Get in touch with us in the usual way. The text number is 84844. You can email me via our website or WhatsApp the programme on 03700 100 444. And if you'd like to follow us on social media, it's at BBC Women's Hour. The text number, once again, if you'd like to get in touch with your washing advice, but also if you'd like to comment on anything you hear on the programme, you're more than welcome.

The text number is 84844. But first, prisons are not doing enough to help women cope in prison. And for some, the lack of care to meet their basic needs causes such distress that they resort to harming themselves. That's according to a new report from His Majesty's Inspectorate of Prisons for England and Wales released today. Women make up 4% of the prison population. The rate of self-harm in women's prisons is currently 8.5 times higher than in men's prisons. The research carried out in four women's prisons in England found that officers too often failed to provide straightforward care and support.

It also found what was deemed to be astonishing gaps in basic decency and an over-reliance on using physical force to manage women in acute and obvious crisis. This report comes as the Women's Justice Board met last month for the first time. It was set up by the Lord Chancellor and Justice Secretary Shabana Mahmood, who has said too many women are being sent to prison. She joins me shortly to discuss the findings of the report. But first joining me to discuss the report is Sandra Fieldhouse, who is HMI Prisons' lead inspector for women's prisons. Sandra, very good morning to you. Good morning, Anita.

So you looked into four women's prisons in England. That's Bronzefield, Eastford Park, Fossan Hall and Newhall. Why did you decide to carry this particular research out now? We decided that it was time to dig a bit deeper into what helps women cope in prison, because, as you said, self-harm of the last decade has rocketed. It's now three and a half times where it was in 2013. We know that, as you said, the rate of self-harm in women's prisons is eight and a half times that in men's prisons. And I've been an inspector for 15 years. And for the last eight years, I've been specialising and leading a team that inspects women's prisons.

And what we often hear from women when we go into those 12 prisons is that they struggle with some very basic things. The whole idea of being in prison can be quite distressing. And what they talk about are layers of frustrations that build up. And for some women, it builds up to the point where she actually resorts to self-harm. So we wanted to undertake this theme. We chose four prisons that take women from court. So they hold women who are either remanded or on very short sentences alongside women who are serving longer sentences. But we wanted to choose those four prisons to look at how those women do cope. was really quite depressing. It's interesting that the top priorities for women

in terms of their coping were some very basic things. And the things I will take away from this and use in my future inspecting is that women are really not asking for very much. They're really not. It's some very basic things that you and I would all want in our day-to-day lives. But they struggle to get those, and we wanted to give the women a voice to explain to us.

And before we get into what they are, let's talk about what else you found. We'll start with what you mentioned and what I said in the opener, which is about self-harm, because your report states that prisons are not doing enough to help women cope, and it's causing so much distress that some women are resorting to harming themselves. Are you saying then that being put in prison is a direct cause of women self-harming? What we know about women in prison is that they have very different needs to men in prison. When we look at the characteristics of women in prison what we do know is that over 60% of the women have been victims of domestic violence. On top of that will be other women who've experienced other

significant trauma in their lives, such as sexual abuse, being in the care of the local authority, loss of children. We also know that only 5% of children of imprisoned mothers actually stay in their own homes when the mum goes to prison. We know that over 17,000 children are impacted by their mother's imprisonment. But women in prison, more of them are remanded than men, which is an interesting question to ask why that might be. More of them are recalled,

and more of them than men are doing fairly short sentences. I think the average sentence length for women is about 12 months. The average sentence length for a man is almost two years. And women have very different personal needs. We know that far more women have mental health problems. In fact, in the survey for this thematic, 87% of women we surveyed said they have a mental health problem. Were you shocked by that? You've been doing this job for 15 years. I have. I wasn't shocked by it because in our inspections of women in women's prisons generally, that is a rate that women do declare. So more women say they have mental health problems on arrival into prison.

It's about 66% say they have a drug and alcohol problem, which is also significantly higher than men, which always surprises me. I don't know why. I always think it would be the other way around, but it's not. So women are experiencing problems with drug and alcohol even before they go into prison. And many of them, as you said have caring responsibilities and they need help to actually fulfill their role as being a mother a grandmother or an aunt um you you mentioned that we have talked about it on this program listeners may remember the sort of forgotten children and you you mentioned the figure 17 000 children there

you say there's a failure of opportunities for women to stay in contact with their families. For many, they're the primary carers, and some male prisons have been offered better opportunities for women. What did you actually find? What specifics? Well, to put it into context, more women are in prison far away from home. There's 12 prisons across England, and there's none in Wales. Women who go to prison are often sent much further away from home than men do, which makes it more difficult just to simply keep in contact with your family.

It's more difficult for the family to travel to the prison. It's more expensive. It can take hours. When they get there, the visit sessions are amazingly short, often just one hour. And you'd want prisons to be more creative in the way that they enable women to keep in contact with their children and families. And how important, how key is the connection?

The connection is really important. In the survey for this thematic, 94% of women said that this was the most important coping tool for them whilst they were in prison. We had women who were talking to us about the impact of being away from their children, the difficulty they had in maintaining contact. One woman said to me, she was only 19, and she said, you know, I'm 19 years old, but I like to speak to my mum every day because I like to know that somebody out there loves me. I've read the reports and you look at the experience of women within the prisons, but you also look at the experience of people working within the prisons as well. And we've

talked many times on this programme about the shortage and turnover of prison staff. What role does this have to play and what did you find? What we found, again, in the survey was that almost all women said that wing officers were really important to helping them cope, but only 40% of them said they were actually getting that care from officers. They felt that officers overlooked them, that women really said that the small things that officers do can make a big difference for them.

And taking time to chat doesn't cost anything. That's one of the things I've taken away from this inspection. Women talked about officers being burnt out, not having enough time to spend with them. They said they get brushed off. Officers just carry on walking while they're trying to talk to them. Women are described feeling invisible, really. And there has been a lot of new officers recruited into the prison service.

And when we spoke to officers, we ran focus groups, we ran a survey, we spoke to them individually. When we spoke to them, they echo focus groups, we ran a survey, we spoke to them individually. When we spoke to them, they echoed the voice of women, which was quite a surprise to me, actually, because they were feeling burnt out. They used words like overwhelmed, firefighting, not having enough time. Some of the officers were inexperienced, and that might contribute to some of this. But even some of the longstanding officers that I spoke to were clearly impacted by working with women who are self-harming at such a rate on a day-to-day basis. One officer said to me he'd removed 10 ligatures in the course of one day. Well, listening to this is the Lord Chancellor and Secretary of State for Justice, Shabana Mahmood.

Welcome to the programme. Listening to this is the Lord Chancellor and Secretary of State for Justice, Shabana Mahmood. Welcome to the programme. It's a pretty damning report. A lack of care in meeting women's basic needs is causing so much distress that they're resorting to self-harm. 87% suffering with some sort of mental health issue. How do you respond to this? Good morning, Anita. It is a distressing report. It makes for very difficult and very painful reading. And it is a challenge to us, the chief inspector and others have said

it is a challenge to leaders in the prison system and to myself and my officials. And I am taking up that challenge because this is not the picture I want to see for women in the female prison estate. I believe we are sending far too many women to prison in the first place. And for too many of those women, prison isn't working. It's why I set up the Women's Justice Board so we can take a proper look at what we do with the female prison estate and how we care for the women that ultimately do enter that prison estate, but making sure that we have the women going to prison who need to go to prison for reasons of public protection.

But for other women, we've got alternatives that are better for them, ultimately also better for their children. And what about the women who are in need now? Yes, so we are obviously wanting to learn the lessons from this report. There are some specific areas where I think progress has already been made. Some of the issues that were raised, I know, have been dealt with. Others are, you know, much, much longer term solutions. As Sandra was pointing out, we have a cohort of prison officers who work

incredibly hard, but in very difficult circumstances, because the rates of self-harm are so very high, that's a change in terms of what's happening in the female prison estate. So therefore, the requirements and the experience to deal with that have changed. And we do have a growing number who have that experience now. But that is obviously something that we need to think about. We need to make sure that all of the right training is in place so that they can deal

with the women that are there now. But I do believe that ultimately we need to be in a position where we think much more carefully about who goes to prison, which types of women go to prison in the first place. Yeah, you brought it up

and it is one of the big things that stands out from the report is the self-harm. So how do you intend to address this and the mental health crisis that the women are going through? Well, I've specifically asked the Women's Justice Board to look at issues around self-harm, you know, pregnant women, women with young children in our prison estate. That's where we know some of the mental distress is particularly high. So I've asked them to make some recommendations about things that we might do differently for the cohort of women that we currently have. Of course, making sure that all of our officers are trained appropriately to deal with women that are in prison at the moment who are self-harming.

That is also absolutely crucial. But the fundamental question, if we roll it back, is to ask that question about who we are sending to prison. And if we are not sending those women to prison, what we're doing differently in order to help them, for example, recover from drug and alcohol issues maintain family contact and so on so i think it's a it's it's a big piece of work that we're undertaking but it is absolutely designed to try and eliminate some of the problems that have been found in this report um the costum reports i'm sure you're aware of this nearly 20 years ago recommended that custodial sentences for women must be reserved for serious and violent offenders who pose a threat to the public and community solutions for non-violent women offenders should be the norm your own figures show there were over 3,600

women in prisons in 2024 and the numbers are expected to increase to 4,200 by 2027 so how does that work well look I um I had the Causton report in mind, actually, when I made the decision to set up the Women's Justice Board. In fairness to the previous government, they did have a female offender strategy. And for a period of time, they made some progress on diverting more women away from prison. But unfortunately, in recent times, we've seen a rollback of that. And the numbers of women going to prison, as you've noted, has started to increase again and is still projected to increase further. That's why I decided we needed a different approach. We needed to bring together experts in the field who have worked closely with female offenders. We wanted to bring all of those people together to put forward some ideas, some new proposals for how we might do things

differently where women are concerned. And I think the interaction of the Women's Justice Board alongside the other review that I've ordered, which is from David Gauke, which is an independent review into sentencing, I think the combination of those two pieces of work will enable us to make changes that ultimately result in know, result in the vision that Jean Causton laid out 20 years ago. The Women's Justice Board, as I understand, is only planning to meet four times a year. And these external experts have been selected by ministers. So how effective and independent can it be? And when are things going to change? Well, I can assure you and your listeners, these are independent individuals who are experts in the field.

They have deep experience of working with women in the prison estate, working with women who've come out of prison, diverting women away from prison and particularly for women with mental health conditions and domestic abuse victims as well. So we have a broad range of people who are fiercely independent. Their work will be public. It will be open to scrutiny. It will make recommendations to ministers. I think in order to make sure we get the changes we need as quickly as we need them, it is important for them to have that connection with us as well. But they are there for challenge. We all agree that the status quo cannot continue. We all want to see a step change. And I'm confident that this is the right group of people

who will work at pace to make the recommendations that are needed. And as I say, it's not just the work of the Women's Justice Board that I think is necessary to change things for women in prison. It is the work of the David Gork Review as well, who is specifically looking at sentencing in relation to women, I think the combination of those two things will enable us to see change and to see change quickly. Pia Sinner, who's the chief executive of the Prison Reform Trust, who sits on the Women's Justice Board, said the problems this damning report has found are not new. The prison service has known for a long time that the provision for women in our prisons is woefully inadequate and

inappropriate, with inexperienced staff and even the most basic of gender sensitive provisions not being available they are too frequently an afterthought for a system designed largely for men do you agree that you're overseeing a system that was designed largely for men i i do these are not new problems they are problems. All I would say is myself and my team are new and we have come in with a specific decision that we want to change this. We don't believe the status quo is acceptable. We think that the harm that this does isn't just reserved for the women who are being re-victimized by the system, but to their children as well. That is something we want to stop. And that is why we've come in, made some immediate policy changes that I believe will result in the sorts

of proposals and future change that will turn things around. How quickly will this happen? Women only make up 4% of the prison population and still something as basic as the clothes that they're provided with aren't designed for women. Some women are given men's tracksuits. Well, I've tasked my officials on some of the specifics that the report raises on clothing, on anti-rip clothing. There was a shocking finding in the report relating to the washing of underwear. Those are changes that have already... Yeah, they're not allowed to use washing machines

to wash their underwear. That has already been changed. I mean, you know, like anybody else, I was pretty horrified to discover wash that has already been changed i mean i uh you know like anybody else i was pretty horrified uh to discover that that had been happening but that has already been rectified so i think there are some practical um uh suggestions that were made in the report and issues that were highlighted that we've already taken action on uh the longer term issue is of course about the cohort of women that go to prison uh and and the bigger group of people that shouldn't be in prison um and and that is the work of the women's justice board and i believe

the sentencing review um i'd like to bring up the issue of children um who at 17 000 figure the estimated 17 000 children are affected when their mums go to prison every year it's something that we've discussed here on women's hour in fact on november on the program we discussed the forgotten children who fall between the cracks when their parents are imprisoned and in some cases there are no records that their parents are in prison we spoke to conservative party chairman richard holden and labour mp jake richards about it there is cross-party consensus on the issue that there is a massive problem here so what are you going to do about that well we've got a specific manifesto commitment that we are in the process of fulfilling which is to do with the children of prisoners and to make sure that data is shared properly so that

they don't slip through the cracks and as you say um fall fall out of the system entirely so we we're already moving uh on the data sharing that's needed to make sure that these children are protected. Separately, of course, I would want the Women's Justice Board to be making us some recommendations that look specifically at what we do with women who are mothers and women who are mothers of young children in particular as well, because as I say, we are passing down the harm down generations. 17,000 children are affected. Of the women that go to prison, half are mothers, and in 95% of those cases, the children leave the family home. That cannot continue. We do need a step change. It will require changes around sentencing practice, the practice around who is remanded to prison and who is out on bail it will also need some alternatives to custody as well so all of that I think is is big change but it is change that is absolutely necessary and these numbers

I think speak for themselves. And whilst we have you here I think it's important to get your thoughts on something else that's in the news today that you've announced that the three-year time limits for child sexual abuse victims to sue for damages will be removed in England and Wales. This follows a recommendation laid out in the 2022 independent inquiry into child sexual abuse led by Professor Alexis Jay. What do you hope will happen as a result of this? Well when the government came in we inherited a situation with the recommendations made by Alexis Jay that had not been actioned. And we wanted to make sure that we, you know, we made a decision we were going to crack on and make some progress. And my department has been looking carefully at the recommendations that she made that relate to the work that we do.

And that was around the time limits. I hope that it sends a signal to victims and survivors that we are taking these recommendations seriously. We are moving at pace to deliver them so that they're not gathering dust on a shelf somewhere. We made the announcement today.

I know that other government departments who relate to other of the recommendations that be made will also be making announcements in due course to show that we are taking this seriously and we will implement these recommendations. Lord Chancellor, Shabana Mahmood, thank you for your time this morning. Sandra, I'm going to come back to you. You heard what the Lord Chancellor had to say. What's your reaction? Well, the chief inspector has the role of inspecting treatment conditions in prisons. So I can't really comment on the wider agenda of where to go in future with who gets sent to prison or alternatives to prison. But what I can say is that women in prison, they do make up less than 4%.

They do get overlooked. Prison governors often say to me that they lack the autonomy to deliver services in a way that meets the needs of the women in their care. So I think there needs to be more done to free up prison governors from the rules and regulations that apply to the men's prison. Did you speak to the governors? Did you speak to the governors? Yes, yeah, yeah. We speak to the governors in our core inspections and we inspect every woman's prisons at least once every four or five years and often more than that. And during this thematic, yeah, we spoke to the governors and other leaders in detail.

I think the other thing to say is that sometimes when prison governors try to make things happen, like we were in a prison last week and we were being told that women could now wash their knickers in a washing machine when the inspector went out to some of the wings some of the women still could not wash their knickers in a washing machine so there's a difference between policy and what actually happens on the ground so making changes needs to be seen overseen from prison governors and to make sure it happens thank you you very much for speaking to me this morning on that report we were discussing there from the Women's Justice Board. Thank you very much. 84844 is the number to text.

I'm Sarah Treleaven and for over a year I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth.

How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now. Now, my next guest had a childhood shaped by a strict religious upbringing where women were expected to keep quiet and singing in public was off limits.

And yet, she's become a professional singer and stand-up comedian. Having grown up in the UK in a half-Iranian household, music always played a part in Hadja J. Woodland's life. But at 11 years old, her dad told her singing on stage for women was forbidden in Islam, which led her to believe it was sinful and that she could never do it herself. Well, she'll soon be performing her debut show, First Love, which is all about finding her voice. And we can hear a bit from the show before we speak to her. You know you're not so old, but you're not so young

And it's time to make decisions instead of having fun Sarah says it's the best thing she did And Beth can't imagine a life before it. And at the age of 38, don't leave it much too late. But maybe now it's time to get Botox. I think it's time to get Botox. Hadja J. Woodland, welcome to Woman's Hour. Thank you for having me. Good morning.

She can sing. I can sing. You really can sing. Thank goodness. And Botox. Have you had it? No, I haven't. No. Although I have sang that song at a very high-end gig and then I thought I'd throw it in as a funny thing

and then I looked around and everyone in that room had Botox and I wasn't sure it was the right choice. There was no reaction on anyone's faces. Yes exactly yeah I didn't know they liked it. So let's talk about that you performed First Love at Edinburgh Fringe Festival last year it's coming to London congratulations tell us about the show what's it about? The show is I suppose the tagline is finding love and finding your voice and it was almost an accidental show I suppose last August, actually last June, I was going to the Fringe anyway, as I do most years, to see what's out there and enjoy it as a punter.

And I thought, maybe I can just do a few songs. I'm used to, you know, I'm a professional singer. I can often put on an hour show of just a load of popular songs that I like to sing. And then I, as I was applying for this, I sort of started to write a story around it and then I as I was applying for this I sort of started to write a story around it and realized I had a few original songs that formed this story about my marriage and it was I'd written the first song about my marriage when I was 22 about meeting him and then there was kind of the the ups and downs of it and then there was a song right at

the end as well afterwards and grieving it and yeah yeah, I put those songs into a story and talked about, yeah, put it into the context of growing up not being allowed to sing as well. So I think that whole thing of wanting love, especially when you've got maybe a difficult relationship with your dad, is quite a relatable thing for a lot of people. And it was all tied together with, yeah, singing and singing in love. Yeah, doing the thing that you were told you weren't allowed to do yes yeah so explain that so you were always good at singing I think so yes uh you know my songwriting was quite interesting as a child you know wrote

about pocket money and things like that really important life experiences you were looking at you obviously had a good way of observing your own life always. Yes, I think so. Did you have to keep your talent quiet? This is the interesting thing about what I've delved into in the show, is that the conflict is very much internal. So even though my dad had told me I couldn't sing on stage, I did anyway in my teens. I just didn't tell him. Did you feel immense guilt?

Massive guilt, huge guilt. And there were certain times where I wouldn't sing at all. I went through quite a religious phase when I was 14 to 16 and I didn't sing at all. So it always felt like this huge conflict, like I want to do this, but I'm not allowed to. And it was it was fine to sing like that wasn't a problem. I was allowed to. So I actually sang to the Princess of Sharjah when I was 16 as part of the International Muslim Women's Conference for Young Women. I ended up going there on this incredible trip and sang to her. And that's fine because it's just in front of women.

But there was this idea of being on stage and also your voice is part of, it's considered part of your aura, like your hair, stuff that should be covered. And so when I was wanting to, sorry, I'm back in that Princess's Palace remembering. I know, I was actually with you there. I was singing a very strange choice of song. What did you sing? I sang a Prince of Egypt song. It was Mariah and Whitney.

There can be miracles when you believe. And then someone afterwards told me that was about the founding of Israel. And they thought that was an interesting choice. And I just sort of didn't. I was like, oh, well, yeah, I'm sure it's a lovely song. So I hadn't really thought about it. But yeah, it was really about the internal conflict. So I was singing all the time at home.

But whenever I wanted to sing, it wasn't something I could explore. I couldn't be a professional singer. So there was always a sense of, why are you even doing this? So how did you become one then? By accident, I think by accident. So when I was about 22, I sang in a couple of pubs. So I moved to London for university. There's so much.

So much. Muslim woman, no singing, no performing. It's not singing, it's the performance. And here you are, now you're in a pub. Yes, now I'm in a pub. There's also the class element to that as well. So I think I was raised very much, you know, don't draw attention to yourself.

That's also really bad. Of course. And so who do you think you are? Why do you think people want to listen to you? So there's all these layers involved. So I would never say mine's at all a traditional Muslim story. It's not, this is not.

Or maybe it is. I don't know. What is a traditional Muslim story? Well, exactly. I think it's very easy for a lot of people when they i don't know well what is the traditional muslim well exactly i think it's very easy for a lot of people when they go oh you had a strict muslim muslim upbringing so you couldn't be a singer yeah and it's far more complex yeah because my dad he wasn't around that much either so i could i just didn't tell him it's just when your parent i think most people can relate to something when your parents plant a seed but you're not to do that and then it's the kind of questioning and the why that that's

really it is that it is that seed that you carry throughout your life and it comes up in various different ways and actually the process of writing this whole show has helped me delve a bit deeper into those elements and how we I think feelings are a big thing if you're in a family where your feelings don't necessarily matter you don't have to express you don't know how to express what you're feeling in any moment that really comes through and I've had to really sit with especially at the fringe um you know you're doing this small room and I was so grateful for people to be there I just loved that people had spent an hour with me and because it was free I didn't feel guilty that you know it was I set myself low expectations but the gratitude I felt at the end was because they had let me sit with some of these feelings.

I'd sat with these songs and some of them are connected with them. And I think I felt very much like a child just being like, thanks for listening to me. But I am trying to become more of a performer and realise that. Was it quite a bold, rebellious act to then make it a profession? And how was the family reaction? So I think there was a bit of a gap from 18 to 22. I went to university and singing was a little bit of a, I think I liken it to love because it's something you just can't help. I just needed to sing.

I just wanted to sing. And so, you know, if I was ever a karaoke night or something and there was, you know, or even seeing singers on stage, like I want the mic. And it's not because I want to be an attention seeker. I want to be sent to stage. It's just that this feeling from within. And so it does feel like love in that way. And I will again, the complexity is my mum sort of stopped becoming a Muslim when I was when my parents got divorced and and so we all sort of drifted apart in many ways I went to university stopped wearing headscarf and and saw my people didn't see me as a Muslim so I started to stop I stopped seeing myself as a Muslim um and then that gave me in a weird way a lot of freedom but also you just start going oh well I can just do anything I'll try this I'll try that and um and I even though I became a singer,

it was more out of necessity. I think I moved down south and I didn't have much money and I thought, oh, well, I can sing. So I addressed it a bit in the way that you might be a plumber. I'd go into venues and be like, oh yeah, I can sing simply the best for you. Yeah, I'll do, I'll sort that out for you. You're obviously very resourceful

and you're obviously somebody who really manages to get yourself where you want to be because actually you have been on Woman's Hour before. In the year 2004 you were only 18 years old and you came on to talk about keeping a teenage diary. I think we should have a listen to you. Let's go back and listen to Hajar at 18 years old. Recently I've actually started writing just a very short journal. And I found that when I focused it on a certain person, I could write it so much better. When I went to Barcelona a few weeks ago, I went as part of a group, I met someone who I formed a very close relationship with. And they don't live near me at all. And they're out of the country at the moment.

And I found writing that diary to them every time I wanted to speak to them was so helpful. I had a lot of things to sort out between my relationship and theirs and writing it down just got all my thoughts so much clearer. I wrote in about five times a day just because I just so needed to speak to this person and to tell them how I was feeling but I'm not particularly private in that sense if someone were to come across my diary my mother for example I wouldn't mind because it's it's got explanations in there so if she finds out what I've done in any sort of situation I know I've got my reasons for it and that hopefully if she knows about that then she'll be able to help me through anyway

should she wish to so much to unpick there oh my gosh that was what was that like hearing yourself you know what I remember saying that and actually that's the one bit that I had in my mind when I was wondering if you were going to use a clip and yes that was my first kiss my first kiss was in Barcelona on a mountain amazing um and and yeah but I really struggled with the guilt and it's so funny the way I phrased it, you know, my relationship with this person. Yeah, no, it was my first kiss and I... I love how you were trying to be ambiguous and we were all like, yeah, that's a boyfriend.

I know, but I think there was so much, what's interesting is when I was 18, it was so much about this persona because I'd had this kiss and during these two weeks in Barcelona for this, it was the World Parliament of Religions, I was going on a media training thing there and I felt, I know I didn't wear a headscarf for about a week of that time and i felt such guilt and so

when i came on women's hour i think i was back to being like you can be a good muslim again and i was wearing uh i remember wearing a dress over jeans because of trinny and susannah but i had um a three-quarter length sleeve and i was like that's me being a you know i'm pushing i'm being a bit modern three-quarter length and i had my headscarf on again properly pinned underneath and that was me trying to be a good Muslim again it was me really trying to correct this teenage teenager that wanted to come out. It's quite a big deal then to remove the headscarf how was that when did that decision come about? That was at university so first year of, I was at King's College, London. And I had, I'd sort of, just before university, I didn't wear it every now and again. I think that was simply because I just wanted boys to like me. And when I went to uni... The whole team, they just kind of want to fit in. please, please like me, boyfriend. But I, at university, I didn't, every now and again,

I wouldn't wear it. And then I'd try again and, you know, double down on it and wear it properly. And it was actually a male Muslim friend of mine that said, well, you might as well just take it off altogether instead of flip-flopping. And it was just interesting to me that I still needed almost the permission from a man to tell me just stop wearing it altogether. And again, it was about trying to make myself make sense. I wanted the outside world to see me as a consistent person. And I just, I'm not really, and I wasn't. I'm very conflicted.

There's all these different layers and, yeah, complications to my upbringing that I think I just need to accept. I'm not, you know, I can't just, I always wanted to be a normal British girl. And then I wanted to be a good Muslim. And I couldn't find a synergy between those two at all. It was a real struggle. And I think also within my upbringing, I was constantly, whatever I did,

there was always something better or different I could do. If I wore skirts, they might be too tight. Or combat trousers would be too boyish. Or to be honest, even when I started wearing a really religious dress, my dad said, oh, that's too religious. And when I stopped wearing it, he said, oh, yeah, I was really proud of you when you wore that. So it was just all this mixed messages. Absolutely. And when you're growing up between cultures and different worlds, there's all sorts of complications that you have to sort of navigate when you're a teenager. I wonder what you would say to your 18 year old self now and I also wonder what you would how things might be

different if you were growing up now because the world is so the world is so and there's so many empowered young Muslim women who are very confident in their identity and very proud to you know but you know wear whatever they want firstly I'd have better fashion sense that I've been raised now I think I see lots of Muslim women. I'm just looking at them enviously. They just look incredible. The hijabs and the jilbabs, they look beautiful. Whereas for me, I didn't really have a template for that at all. And my mother had never experienced it.

She converted, so she didn't know what, you know, she was raising her children the way she hadn't been raised. And my dad was as well, really. So because we were in this very little weird, our own little entity, it was it was very hard to to fit in it would have been different now I mean telling my 18 year old self it would probably just be be selfish just stop worrying about how everyone else is looking at you or what you need to do or um like what would be the most selfish version of you do how would

they be acting and I honestly think that's because that feels uncomfortable, but it probably brings you more to the middle ground of where you want to be. What do you hope people are going to take away from your show? Silliness and playfulness. I hope that they enjoy it. It's much funnier than it was in Edinburgh. I've written new comedy songs for it. Hopefully there's enough stand-up in there and jokes that it's relatable.

I hope they feel warm. That's the general, yeah, the general sense. I want people to come away from that, from the show, just feeling a bit uplifted and that they've carried, they've gone through the character's journey and yeah,

feel that we can just be ourselves and play with life. I think that's the main thing I'm taking from it. And I hope they do too. It's been such a pleasure speaking to you. Thank you so much. And it was so wonderful watching you listen to that tape of 18-year-old you. Hadja J. Woodland, thank you so much. Thank you so much.

84844 is the number to text. Lots of you getting in touch about your washing rituals um washing surely it's down to the sight and sniff test that's what i use anyway no point overdoing it who's going to count how many washes jumpers have had says jackie and another one here saying i think uh that we're all overusing water and electricity as a result of washing i got a pair of jeans that the manufacturer recommended to not wash for six months i wash things only as necessary and do a lot more hand washing to save water and care for delicates better now new research has quantified for the very first time how many children and young people have been diagnosed with gender dysphoria by gps in england academics at the

university of york studied a decade's worth of NHS records and discovered a 50-fold increase in this particular diagnosis between 2011 and 2021. However, each general practice will only see one or two patients each year. Here to tell us more is Professor of Health Policy, Tim Doran. Tim, welcome to Woman's Hour. um yeah thanks for having me it's our pleasure first of all i think we should understand how you define gender dysphoria or how you defined it for this research well i think yeah what we're looking at is anyone who has a record of gender dysphoria or gender incongruence or related diagnosis uh on their primary care records so there's there's actually uh something like 2025 diagnoses which sort of fall under that umbrella.

And I think one of the difficulties of doing research in this area is gender dysphoria has evolved as a diagnosis over the period that we were doing the work. It used to be known as something called gender identity disorder, was considered a mental health condition 10 or 15 years ago. It's now been changed to either gender dysphoria or gender incongruence, depending on which classification system you're using. But really what it's referring to is a persistent and intense distress arising from a perceived mismatch between biological sex and experienced gender. And why did you want to carry out this research and how did you go about it? Well, it was part of a program of work that the University of York undertook to support the Cass Review which published last year. So Hilary Cass when she

started out on that review was struck by a lack of robust evidence in the area so she asked NHS England to commission independent research into gender dysphoria in this age group and the University of York undertook that research. So there were three main components to that. One was a series of systematic reviews on the existing evidence around diagnosis and treatment and that was published at the same time as the CAST review last year. There was then a series of interviews with children with gender dysphoria and their families and then there were data linkage studies. So one using primary care data or general practice data which is what we're discussing today. And then there was going to be another data linkage study using hospital data. That second study didn't go ahead. And so then how many children and young people were you able to calculate have this 20% of practices in England. So we were looking at records for about 3,500 children

who had had a diagnosis of gender dysphoria at some point. So what you're looking at is an increase in prevalence of gender dysphoria in everybody under the age of 19 from about 1 in 60,000 to one in 1,200. So if nationally that's equivalent to an increase from fewer than 200 cases in 2011 to over 10,000 cases in 2021. But I should say it remains very rare in children under 10. So if you focus on 17, 18-year-olds who are most likely to be affected,

prevalence has increased from less than one in 10,000 to just under one in 250 or about 0.4% of 17, 18 year olds. And what proportion of the children are being prescribed puberty blockers via their GP? Well on the records that they have within primary care there were fewer than 5 percent had had a record of puberty suppression and around eight percent had a record of taking a cross-sex hormone but um those those figures are lower than we see uh in uh the specialist center the gender identity development service uh clinic based at the tavistock rates there were closer to% and there's there's reasons for why we might see that discrepancy so one reason is that GPs are often reluctant to prescribe off-label which is

essentially what they would be doing with with puberty suppression it may be that these hormones are being prescribed elsewhere and they're not being recorded on the clinical computing systems within primary care. But also we know that after about 2016-2017, the waiting lists were getting very long for attending the identity service at the Tavistock. And so there will have been waits for them to get in, to get assessed, and then to then be referred on to the endocrinologist and to start on these treatments. What were the biggest surprises for you Tim? Well I think that again the studies that have been done previously have all been based within the specialist centres so this was the first study that really looked out at primary care what was happening in general practice which is

where most patients first present and so the increase you know this sort of 50-fold increase I think was very striking but again I should emphasize it's gone from being an extremely rare condition to being just an uncommon condition it's still not seen very frequently within primary care within this age group so So as you said before, the average general practice is only going to have one or two patients with this condition. So that was striking. I think the rates of anxiety and depression, we suspected they might be high, and we did compare the rates within children with gender dysphoria

to the rates in children with autism spectrum condition or eating disorders. Those are groups that we know have very high rates of anxiety and depression. And the rates of anxiety we were seeing in children with gender dysphoria were of a similar level, but the rates of self-harm were even higher. So just over 50% of these children had a record of anxiety, depression and or self-harm. But children with multiple conditions were at particular risk. So around 73% of 17, 18-year-olds who had both gender dysphoria and an autism spectrum condition had a history of anxiety, depression or self-harm. What do you want policymakers to take from this research?

Well, I think there's clearly an urgent need to tackle vulnerability to mental health difficulties and to improve mental health support for children and young people experiencing gender dysphoria. We're going to need robust networks to provide guidance and support for primary care services who have the responsibility of coordinating care for children with these complex needs and say you know despite this rapid rise the average practice isn't going to see more than a couple of patients within this age group and I think also any future research needs to address the causes pathways to diagnosis and the interactions of gender dysphoria with mental health conditions supported by improved data recording which includes having greater clarity around sex and gender there's there's still

a degree of confusion even even within general practices about what they're recording when they record sex and gender and what about the general public? What would you like them to take from it? Or what do you want them to hear from what you're telling me? Well, I think, you know, again, it's important to say that this is still quite uncommon for children within this age group to get to the point where they receive a diagnosis of gender dysphoria but it's likely to be the tip of an iceberg so there are going to be other children who are sort of questioning their gender who won't actually reach that threshold or won't actually

present to primary care because again if you imagine sort of 14, 15, 16 year old it's quite a thing for them to sort of go into a general practice, either with or without their parents to discuss this. So I think some sort of awareness around that. But again, I think, as you'll be aware, this is a very sort of charged area. There's a lot of noise, ideological noise, political noise around this issue. And I think I'd want people to look at this and sort of try and keep it in proportion yes it's something that seems to be uh increasing quite quickly and we want to know what the reasons for that are and you know we can we can I can discuss those um but also just just to be uh you know to keep it in proportion it is still quite an uncommon condition well what's it like being an academic in this area it can be challenging. I think a lot of researchers and institutions

still won't go near this topic because the debate around it has become so toxic. You're really walking into the middle of an ideological mud wrestle. I think people often assume that you're on one side of the debate or the other, which means they'll either be inclined to accept your results uncritically or reject them out of hand depending on whether they agree with the position that they imagine you have neither situation is good i think the research really needs to stand or fall and so merits not the real or imagined beliefs of the authors but obviously if you sit on the fence you're restoring fire from from both sides but i think it's important to emphasize as researchers we don't face the kind of challenges that patients or their families do you know we can always walk away and do something else that's not a luxury they have um tim professor

tim duran from the university of york thank you very much um for sharing that research with us on the program this morning and if you have been affected by anything on the program today you can find support online by going to the BBC Action Line website. Now, one that I know will get your attention, well it has, because lots of you have been getting in touch about it. How often do you wash your T-shirts or your knickers? A French government agency has been issuing advice about how often people should do their laundry. It's all about the potential to save water, reduce the wear on your clothes,

but it's come up against a lot of criticism. Here are just some of the guidelines about how long to wear things before washing them. Bras, seven days. T-shirts, five days. Jeans, 30 days. Sports clothes, three times. That sounds very sweaty. But it does say knickers should be after one day. Well, joining me is a woman who knows everything there is to know about hygiene and washing, Professor Sally Bloomfield, Chairman of the International Scientific Forum on Home Hygiene. Sally, welcome to the programme. What's your reaction to this guidance? Generally makes sense. But I think to get to the bottom of this issue, we really have to start to understand that there's a big difference between cleanliness and hygiene. We've got this strong conviction these days that dirt is where germs,

harmful germs, lurk and breed. And we need to be very clean to get rid of these germs. And that's not really the case. Germs don't breed in our clothes and on our towels and socks and so forth. Germs breed on our bodies. So we've got things like on on our skin we've got staph aureus that breeds on the skin that could be MRSA 30% of us carry that permanently on our skin in our poo we have got E.coli which breeds in our poo and contains E.coli and hopefully not hopefully not too much of that on your clothes though well the traces of, you're going to have to got a small trace and you have got quite a large number of E. coli organisms. And it's fine if they stay where they are. But if these organisms, for example, skin organisms get into cuts and bruises, they can cause an infection.

And if the organisms from the poo gets into our urine retract, it can cause a urine retract infection. And if we don't launder our clothing, if we don't do it properly, they spread to other people's clothing in the washing machine and then they can become infected. So it's not about whether our clothes are clean. And clean is important to us, isn't it? I mean, it's very important to us. Well, what about this advice that the French given about laundering their clothing then? They're saying washing T-shirts after every five days, even in the summer when it's all hot and sweaty. Well, yes, that's where I don't agree because I think what we've got to focus on is clothing that is in close contact with our body. And that means pants and T-shirts and all those sort of things. And also when we become more active,

we're shedding more organisms, we're sweating, we're sweat causes the number of skin scales and bacteria to slough off our skin onto our clothing. So it's when we're active. So I really think when it comes, yes, I absolutely agree. Our knickers,

we should wear a clean pair of knickers every day. But t-shirts, you know, if you're out and about, if you're sweating, you know, you're depositing these organisms onto these. So it's about focus. It's what we call targeted hygiene. Are some germs good, though? Oh, yes, yes. And it's difficult because I hope you noticed I kept talking about harmful germs because some are harmful but but most of them are non-harmful which again is why we don't need to try and get rid of all this idea of cleaning everything is an overkill what we really need is to do is to target our cleaning activities in at times when there is risk of harmful germs spreading does that make sense yeah yeah I'm going to read a couple a few of our listeners have got in touch with their when there is risk of harmful germs spreading. Does that make sense? Yeah, yeah.

I'm going to read a few of our listeners have got in touch with their washing habits. Someone said, Anna said, sheets and towels weekly, always change guest bed sheets, even after just one night. Learned from my mother as a child, sports bras after every outing.

Other bras are a bit of an inconsistent blind spot. Jeans, trousers are like outside pants. They need washing. What do you think? It's difficult. We haven't got the data to say this is how often you should, this is how often you should. Hygiene at its best is immediately on.

So when we wash our hands after going to the toilet, that's immediate, isn't it? We can do it when we've prepared a chicken in the kitchen. We clear up and we wash our hands. That's immediately, you've eliminated the risk if you're coughing and sneezing to deflect your coughs and teeters. That's the most effective hygiene. But we of thumb, knickers every day, rule of thumb, T-shirts when you've been using them for something that is sweaty. I mean, you said about, you know, smelly T-shirts, smell producing bacteria aren't harmful, but they're a good indicator that you've been sweating. And there's a good indicator that sweat has put harmful bacteria on your skin so it's a good indicator even though being smelly alone

doesn't mean harmful bacteria. I mean some people might not like the sound of reducing the amount they wash their clothes but there is an environmental factor to this isn't there like they would save energy and water we all would if we washed less. Yeah, absolutely. So I think, you know, the idea that we have to wash every item of clothing every time we have worn it, you know, doesn't make sense. It's just not sustainable. Everything these days is about balance between cleanliness and hygiene and the environment. You know, once you're doing any sort of laundry, you're either using heat, you're using water, you're using detergent, you may be using some sort of biocidal product.

All of them are part of the laundering process, but all of them are a key part of preventing the spread of infectious diseases. And they are key to pandemics and preventing antibiotic resistance. You know, many of the strains now that we've got in our poo are may not be pathogenic but they're carrying resistance determinants moving around the community so it's about this balance between but that's why we say

target your hygiene in the places and the times where there's there's real risk that's clothing close to your skin well sally you are the expert and we've got you here. So how often should we be washing things? Could you give us some direct instructions, please? What's important to wash most frequently? Like, give us a breakdown. Okay, so we've said that. Under clothing, particularly our knickers,

because they come into contact with a very sensitive area of our skin. And then bras and T-shirts. Those are the things, obviously, when we go to sleep, if we're wearing pyjamas. But you see, we're less active at night, so we're not shedding as much onto those. Obviously, if we sleep without pyjamas and stuff, then it becomes more important to launder our sheets.

Towels, very important. How often? Because we rub our skin, we rub the sensitive parts. They really should be laundered once a week. And then when it comes to... And what about sharing towels? Should we be sharing towels? Definitely not.

Absolutely, definitely not. There's quite a lot of data about outbreaks of MRSA from uh sports centers where people have grabbed and shared each other's towels um so absolutely vital not to do that so it's common sense if you know that the germs are coming from people they're not they're not growing in your towel they're not growing on surfaces then it becomes it becomes common sense sally thank you so much i know we started this item discussing how we're trying to save on water and electricity by washing only as much as we need to i now just want to wash everything uh so thank you sally sally bloomfield professor sally bloomfield there and a couple of your messages coming in.

Richard says, we wash too much. We're paranoid about smelling both our bodies and our clothes. I've spent over 40 years sailing on toll ships, sometimes weeks at sea with no fresh water other than for drinking, tea cleaning. Ships crew, both males and females, can go for long periods without washing anything. And I can assure you, bad smells are not an issue. Maybe not for you, but for the rest of us, possibly. Anyway, join me tomorrow for more Woman's Hour. That's all for today's Woman's Hour. Join us again next time. I'm Natalia Melman-Petrozzella.

And from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen first on BBC Sounds. doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I

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