Woman's Hour - Ockenden Review, Puberty Blockers, Student Sex Work Policy

Episode Date: December 11, 2020

This week the first part of The Ockenden Review into Maternity Services at the Shrewsbury and Telford Hospital NHS (SaTH) Trust was published. It urges improvements in the way mothers and babies are looked after, not just in Shrewsbury but across England. We talk to the local MP there, Lucy Allan, as well as Gill Walton from The Royal College of Midwives and Jayne Terry who's an obstetrician in London.We have part 2 of our series which talks to parents about puberty blockers. Today we hear from a mum, who we're calling Nichola, who's seriously worried about her child taking them. And Leicester University are launching a Student Sex Worker Policy and Toolkit. Why? What is it? And does it suggest that choosing sex-work as a option for earn money whilst studying is a good idea? We discuss with Professor Teela Sanders from Leicester University, and Sarah Ditum, who's a feminist writer and columnist.

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. Hi, this is Jane Garvey and welcome to the Woman's Hour podcast. It's Friday the 11th of December 2020. Hi there, good morning and today we're going to focus on the state of maternity services. We'd love to hear from you on the text, it's 84844. Do check with your provider about any possible costs there on social media at BBC Woman's Hour. Loads of comments from you already, not surprisingly. A little later, Leicester University has launched a student sex worker policy and toolkit. Why? Why is that needed?

Make sure you're around to listen to that a little later. And we'll talk too to a mother who believes that her teenager cannot give consent to the use of puberty blockers. First though this morning to the whole horrible horrible review, the Ockerton review into maternity services at Shrewsbury and Telford hospitals. It really does make grim reading as you'll know if you saw any of the news bulletins last night or read of any newspapers or coverage today. Mothers dying in labour, women blamed for the deaths of their babies, a lack of compassion and kindness. And it's not over yet. This review only looked into 250 cases. There are over 1,500 still to be covered. And a criminal investigation is also

underway. We've got expertise in the form of the Chief Executive of the Royal College of Midwives, Jill Walton, she's with us. So too is Jane Terry, an obstetrician at St Mary's Paddington, part of the Imperial NHS Trust in London. Let's go first to the Tory MP for Telford, Lucy Allen. Lucy, good morning to you. Good morning. Now, you spoke about this in the Commons and you talked actually about something very interesting, the imbalance of power between male consultants and female patients when the patients were at their most vulnerable. Is it that imbalance of power that you believe is actually at the heart of a lot of this? I think reading the report, it comes out very strongly

that women had no voice, that women weren't listened to and that it wasn't women-centred care. It was far more sort of consultant-centred care. And very often it is the case that consultants are male and women are very vulnerable during labour. They may not know what to expect and they're more willing to do what they're told or to accept poor treatment. And they were dismissed and they were ignored. And to a degree, if you read those individual cases, they were dehumanised. Dehumanised. Can you give me some examples of that? So page after page, there are individual cases where women were treated with a forceps delivery where aggressive use of force occurred.

When that failed, another consultant got involved. The baby's skull was crushed and the baby died. And then the next year, the same thing happened. They didn't do an investigation to follow up what had gone wrong. The families weren't given any feedback or even treated as if this was an exceptional case and that needed some bereavement support or anything. So I think that is dehumanising. If you treat women in a vulnerable position like that, you are not giving them dignity. You are not giving them concern for their wellbeing or their infants. How long had this particular branch of this trust been allowed to operate in such a way?

Well, this report goes back to the year 2000. So it starts from then. There are clearly cases that occurred before that date. But the report is only looking at 2000 to 2019. But it was going on until recently. And I think it, I find it quite horrifying that as local MPs, we were being told, no, it's fine. These are one-off cases. Don't worry about it. As recently as 2017-18, and you go to the report and you see individual cases of horrific treatment where no investigations happened, no follow-up happened. And that is what concerns me, that either the management weren't aware of what was going on, or they simply normalised it and didn't see it as anything untoward. And the people of the area began to expect this level of treatment. That seems remarkable. Why would they? Well, what was remarkable was that up until the initial report was leaked this time last year, I hadn't had a single case of a woman coming to me saying

something had gone wrong during her birth. And I've been the MP in Telford since 2015. As soon as that report was leaked, I became inundated with emails of people saying, but that happened to me, that happened to me. And the recurring theme was, I was told it was a one off. I was told it was something wrong with me. I was told that perhaps I was to blame for being lazy and all sorts of horrendously quite extraordinary remarks that they kept coming in different different women coming forward confidentially to to tell me as their MP their story. Right, I want to bring in the listeners and do get in touch at BBC Women's Out on social media. Kate says, I want maternity services to be designed for and around the people using them. Let's get rid of terminology like normal, failure to progress, teach staff about the language of grief and how to care for patients and families when things go wrong get consistent processes for sharing information with harmed families use of language it does crop up a lot and actually lucy there is all sorts of quite offensive language around obstetrics and gynecology things like what's the incompetent cervix stuff like that the

men are simply not spoken about the male anatomy is not discussed in this way is it yeah and the whole sort of too posh posh to push um when actually there's some really good reason why cesarean section's required um yes i think you're right i mean it's it's a service designed by men for women. It's not, it should be women much more participating in both languages. And this normal birth, I take exception to the idea that a normal birth should be of greater value because women feel they have then failed. There was a lot of shame around some of this when women came to talk to me that they had failed to have a normal birth and therefore their child. Good time to bring in the the royal college of midwives lucy made the point there jill walton that this can be regarded might be regarded as a service designed by men for women what do you say to that uh good morning jane um well most of the midwives caring for women are women. I think there's 187 male midwives in

the country. There is definitely something about how important it is for women to feel empowered during their experience of pregnancy and birth. And in order to feel empowered, they have to be trusted and listened to and advocated for. And that is absolutely key. And I think there seems to be a history of culture in some maternity services that don't allow women to have that voice. And that screams out through the report. I mean, the RCM have read that report. How many of us, Jill, are used to challenging male authority, particularly, and I've been there myself, particularly when that man, and it was a man in my case, will be delivering your first and much loved child.

Are you not really going to say, oh, I don't think I want that. Thank you. Are you? Well, I think that's part of the role of the midwife. The role of the midwife is to be with women and to help women to be their voice where they're not able to. And that's absolutely the right approach. Women and midwives need to know each other. They need then to be able to advocate. The midwife then needs to advocate for the women and to make sure that everybody is doing what they should be doing right and listening to women. So can I ask you then about continuity of care, Jill, because that's been a topic that lots of listeners have mentioned.

Here's one. I had by fluke the same midwife for antenatal care, labour and then my first postnatal visit with my firstborn. But multiple different midwives for the second child. I had an independent midwife for the third because I knew the difference that continuity of carer made. Why is continuity of care apparently so difficult to achieve, Jill? The evidence for continuity of care is really astounding. It improves everything, experience and outcomes. It's difficult to achieve because there's quite frankly not enough midwives around to deliver it completely now we know some really good continuity of carer teams around the country who are doing amazing things with women particularly those women who are very vulnerable but what we need is a whole

upscale of that approach and it's not just continuity of midwifery care it's continuity of care across the whole maternity team. So if you have, if you've got complications in your pregnancy and you need to get to know your obstetrician, that you've got continuity there too. So continuity, people getting to know women, start doing the right thing for women because they get to know them. Yeah, but it just doesn't seem to happen. That's my point. It might be wonderful, but most women don't seem able to get it's my point. It might be wonderful, but most women don't seem able to get it. But do tell us, by the way, if you have had brilliant continuity

of care in your antenatal treatment. Jane Terry, obstetrician, are you conscious that actually sometimes people in your role within maternity services can be quite dismissive of women at their most vulnerable? Well, I think that this report certainly is, you know, it's devastating reading and all the details about the cases is particularly harrowing. But it's the lack of empathy, lack of kindness and compassion that really, you know, is so distressing to read about. Certainly, unfortunately, this isn't the first report we've had about maternity care that has pointed to culture and lack of empathy. You know, going back to Robert Francis's report, Morecambe Bay. And so it is something that really is worrying that, you know, we have to listen. We have to appreciate that this is happening. Absolutely. Yeah, it was not that long ago since we did a whole programme about the Cumberledge Report, the Cumberledge Review. Again, women being victims of

poor, poor treatment. And that's a polite way of putting it. Can I just ask you about, here's a text from Charlotte. I had a consultant tell me there are always women like you looking for an excuse to have a caesarean. When I asked what was the safest way to deliver after having had surgery for an ectopic pregnancy, he followed it up with, you'll know if anything goes wrong during natural delivery as the pain will cut through any epidural. Great. That was just what I needed to hear. You, presumably, Jane, would never dream of speaking to a woman like that, but there's no doubt there are consultants who think it's all right. Well, we have to listen to the women. And, you know, if this is the case, what we need to do is focus on women-centred care.

And, you know, exactly as Lucy and Jill have mentioned, that it's got to be a service designed for the women and their families and their partners. So, you know, we're not only looking after the woman, the baby and also, you know, the partner with them. So the point about it is that it needs to be individualized. And when we are working in the National Health Service, as you questioned earlier, Jane, why is it not happening? You know, it needs huge change to be able to provide this continuity. And certainly something that Lucy was talking about this, about male obstetricians and female obstetricians, if I can address that, that when you mentioned, Lucy, that, you know, it's more often that the consultants are male, you know, that's not really the proportion now. More female medics are going into

obsenguiny than the male. Certainly where I work, I work with some fantastic male obstetricians and it's developing that way. However, one doesn't need to be female to be able to show kindness, compassion and empathy and understand services. You know, we don't need to have a heart attack to be able to treat a heart attack. So, well, I mean, honestly, compassion and kindness really are the least we should expect of a national health service. I think we can all all agree on that. Can I just ask a question about, for example, C-section rates? The C-section rate in this trust at Shrewsbury and Telford was very low. How does somebody listening now who is pregnant, how do they find out about whether their local trust, Jane, might be somebody somewhere that offers a low level or a high level of caesarean sections, if indeed that is what they would like?

There are the percentages of caesarean sections reported. And I think this is probably the fundamental error. Where we look at proportions of cesarean sections, is it a helpful marker? In this circumstance, this trust was an outlier because they were wildly lower than average. But what is the right rate for a cesarean section? You you may need a well that's what i'm asking you may want to be yes what does she look for yeah she needs to she needs to engage in a conversation early so this is important for women who are pregnant at the moment who are reading this and are scared they're worried they need to be able to start that conversation trusts um publish their own uh data and um that is looked at by the local maternity systems and then that is reported further on so it's quite easy to find

the proportion of cesarean sections but it's important that we don't go through the whole pregnancy and then you know in the last, let's have that discussion early. Because that then needs to be discussed and all the risks and everything discussed and a plan made. So we don't know when she's going to go into labour. And, you know, we need to be able to listen to her early on and start those conversations. Right. I mean, of course, not every woman has even the faintest interest in a cesarean section, but it was really interesting that there was such a low level of C-sections at that trust. Jill, what about, I mean, we cannot generalise about maternity services because every woman,

every pregnancy is very singular. And we've had communication from listeners who felt they were scared into intervention. In fact, many who would like a home birth and would dearly love to have that, but didn't feel listened to in that regard either. I think it's about building on what Jane just said about women centred care. The really important thing is that the conversations with women about helping them understand the risk and benefits of the choices they have. And that might be about place of birth. But it's about the midwife in the first instance, particularly, and then the obstetrician, listening to what the women think about those risks and benefits and also their values, what they want. And I think the most important thing is when the woman then makes a decision that's based on understanding risk and benefit from her perspective, it's about

really supporting their view, really supporting that they've made the decision for themselves. Now, things change. And I think in the report, there was a lot about keeping on top of things that change during pregnancy and particularly in labour. So there's an ongoing conversation with women about this has now happened and now your risk is slightly changed. Can we talk about that? And let me help you understand what's happening. So constantly involving women in the decisions about their care and checking all the time that they understand what's going on. Just going back a little bit to what Jane was saying as well. What's really key for me in terms of moving on from this report and building on all of the work that's been done already around safety of maternity services? And, you know, I'm worried that women who are

currently pregnant will be worried. And so we all and they will be. So what can we all do? And I think some of the key things that have changed is that the multi-professional team, particularly obstetricians and midwives, are working really hard to support each other, listen to each other and respect each other so that women don't fall down the gaps. In the RCOG, in the RCM, we call that one voice. And we have one voice in trying, all of us, to improve the safety of maternity services and the culture and the compassion and kindness that is really, really needed when we care for women and their families at a really vulnerable time. We shouldn't really have to say that we need compassion and kindness, should we? But I'm hoping, yes, I'm hoping we can end briefly, if you don't mind, Jill,

on a positive note for exactly that woman who could well be listening now, who is in the eighth or ninth month of pregnancy and may very well have heard the stuff yesterday and just thought, well, I'm now, frankly, really very concerned. Well, the most important thing is to if you are worried you're pregnant and you're worried, speak to your midwife straight away and express why you're worried. So she has an opportunity to talk to you and make sure that you are listened to. That is really important. And midwives out there and obstetricians will definitely want to do that. They will want to talk to women, particularly if they're worried. Yeah, thank you very much. Really appreciate it. Jill Walton from the Royal Connager Midwives. You also heard from obstetrician Jane Terry and from Lucy Allen, the Conservative MP for Telford.

Interested in your take on this, Claire says all these problems with maternity services were being talked about when I had my kids 25 years ago. I can't believe so little has changed. Interesting that the lead midwife immediately rounds on the consultants, says another listener, Marcus, who she describes as mainly male. There are systematic and cultural issues here. And if midwives and consultants, some female, worked really well together, these units would be far safer. I know a lot of you have got personal experience. Do let us know what those experiences have been this morning. We really appreciate it.

Now, last week, the High Court ruled that children under the age of 16 were unlikely to be able to give informed consent to puberty blocking drugs. The Tavistock, which runs the only clinics in this country offering the treatment on the NHS, is seeking to appeal. All new referrals for under 16s have been suspended. Anybody on the drugs already will have their cases reviewed and a court order will be needed to start or continue treatment. Well yesterday on the programme I talked to a mother we called Jen whose 14 year old was due to start assessment for puberty blockers this week. Here's a short clip. I mean she you know she would have taken the blockers two years ago because she's it's a simple equation for her but for us obviously we've

educated ourselves about it and had long discussions with as many people as we can find who know about these things and now she's thinks that's it she's not going to get them and she's expressed that her worst fear is to have a male puberty and who develop all those male characteristics which are irreversible and that she would feel she couldn't find it difficult to leave the house would be terrified of being recognized and misgendered she already struggles a bit with her body and is very you know if she's having a shower she's in and out as quick as she can she doesn't you know she's not really in her body she's just as terrified i think is the only way to put it. Well, you can hear just how distressing that issue is for that family.

And if you'd like to hear that interview in full, you can go to BBC Sounds and hear yesterday's programme. Today, another mother, we're calling this mother Nicola. Now, she has a slightly different story. She has real concerns about the treatment her child desperately wants. So my daughter first mentioned this to me when she was probably about 11 or 12, where she was upset about being a girl rather than wanting to be a boy. I think that's how it sort of started.

And then it developed over time from from I wish I was a boy I want to be a boy to I am a boy. The first inkling I had was sort of top year of primary school isolated from socially isolated from the girls and found her home with the boys but as they grew up I think she found that she didn't quite fit there either. And her solution to her social isolation and her anxieties was to want to become a boy. And she did a lot of research online and came to me with a fully formed idea of, mum, I want to transition to be a boy. I want to take puberty blockers.

I want to take cross-sex hormones. And when I'm an adult, I want to take puberty blockers, I want to take cross-sex hormones and when I'm an adult I want surgery and as a parent that's quite an onslaught to cope with. Yeah, I don't want to interrupt but you said her solution which suggests that you believe that she thinks that transitioning would solve her problems. Yes. Yeah, and you're not sure about that though, are you? No, I'm not. And I think because I'm not her, I've got a broader perspective. I can see how this has developed.

I can see how bullying through school and she's also on the autistic spectrum, that she is looking for a solution to all of her problems to her anxiety to her low mood to her social isolation um to her feelings of not fitting in she's landed upon this as a solution and that once she's transitioned all of these other problems are all going to go away whereas we see it far more that if this is something that as an adult she wants to pursue, she needs to sort out her other mental health issues first, that you can't embark on transitioning from one gender to another without being very stable and have a true understanding of where these feelings have come from.

OK, I mean, I'm not criticising you, but is that your view as her mother or is that the view of any medical professional that you have consulted on this issue? I think medical professionals are very wary about what they do and don't say. The medical professionals that we've come across have affirmed her insofar as they use her chosen name and her chosen pronouns. But certainly local mental health services are very much, this isn't our remit. JIDS is the only service that we have. And therefore, we're not going to touch this we're waiting for jids to to sort this aspect out right now that is the gender identity development service and your i was going to say well i need to check on this is your daughter happy with us all calling her your daughter or would they rather we call them something else? So to us at home, we use her given name and pronouns.

She is known at school and to the mental health service by her chosen name and pronouns, which is something that was in the past quite a contentious issue because she felt very much that we were undermining her identity and we felt very much that it had foreclosed any exploration any wider understanding of her situation we see that there is nothing wrong with her with who she is and that the others around her by saying yes you're a boy and yes we'll call you your name and pronouns are saying that yes there is something inherently wrong with you being a girl and you need to transition to solve that. So has your child as we speak ever been assessed at a

gender identity development service clinic of any kind? No, she's currently on the waiting list. Do you know how far down the waiting list? So we understood that it would be around two years, so any time now we would be expecting to be sent an appointment. So what do you make of the ruling last week from the High Court? I think from our perspective, it puts in an extra safety net, I think is the way that I see it, that it's an additional layer of ensuring that everything is explored and everything is looked at in a broader sense,

that our child is seen as not just a trans child, but a child who is suffering from gender dysphoria and that those feelings may come from a multitude of different places. So is that your biggest concern, that your child, partly or entirely because of their autism, isn't able to consent to taking puberty blockers? No, I don't think my child's autism doesn't enable her to consent to puberty blockers. I think her autism contributes to why she has situated her difficulties within issues around her gender identity. I think she has landed upon this as something that she can actively do something about, that the social isolation, the difficulties that she has with interaction, and all of those

things to do with her autism, she can't fix other people's approaches to her. She can't fix any of that. She can't wave a magic wand and take it away yeah um but if she situates all those difficulties within a context of her gender identity that's something she can actively do something about and i don't think it's her autism that makes her feel like this i think it's one of the contributing factors that makes her feel that if she doesn't conform entirely to a stereotype of what it means to be female and that the changes happening to her body through puberty that she doesn't like and she has a lot of anxiety around that she feels that that is because of gender dysphoria rather than the same kind of adolescent angst that many many girls go through and also the anxiety for autistic

teens going through puberty it is an extremely significant period of anxiety for them resistance to change is massively heightened when these changes are happening to her and she sees puberty blockers as a way of taking that away, of taking that anxiety away. Stop my body developing. I'll stay where I am. Thank you. But where does that leave your child now 16? Have you had conversations over the last couple of days about all this? She hasn't raised it with us. We tend to allow her to come to us if she's got questions, if she's got queries, if she's got issues. She doesn't like to be put on the spot for conversations

and she hasn't raised it with us. So I'm not entirely sure what her perspective is. But of course, because your child is now 16, the ruling, well, it doesn't actually include them, does it? So in fact, if your child rises to the top of that waiting list, there's every chance that they will be given puberty blockers. is that if there is any doubt for 16 and 17 year olds that clinicians might think that going through the courts might be a course of action that they should take so I wouldn't say that the ruling doesn't at all apply to my daughter I think it does because I think there is enough evidence that my child's difficulties are complex and that that could cast doubt on her true understanding of exactly what puberty

blockers and cross-sex hormones are going to do. And of course without being too intrusive at 16 puberty will be well underway anyway won't it? Yes yes and I think that's also part of that maturity process that understanding that puberty itself is a bodily process that teenagers go through. And it's not just a physical process. It's a psychological and behavioural process too, that their interactions with others, their relationships, their friendships, all of those feelings contribute towards their development of their identity. And I do think that that's very important. I can understand when people who have children who are very distressed,

as my daughter has been very distressed, are looking for a way to instantly take away that distress. But I think it's looking at the long-term consequences that are unknown that worry me. And how would you say you'd been treated? Because you are, I hope you don't mind me saying this, you are somewhat sceptical about all this, aren't you? Well, you have doubts, let's put it that way. And I'm not, by the way, I'm a parent, I've no idea how I'd react in this situation. How have you been treated? It's very difficult because I don't think anybody has reacted to us in a

malicious way. I think a lot of professionals are equally as, I suppose, scared about making the wrong decision about how to address my child, how to treat my child, how to support her. And we are equally as worried that we might have got this wrong. But often by going against our wishes and affirming my child's new identity, they often undermine our caution. And that can set up friction between myself and my child that wasn't there before. And that can be quite difficult. Nobody has come out to me and said, you're doing this wrong or anything. They seem to have been quite understanding about why I'm sceptical.

And when I ask people to provide me with the evidence, they can't. They can't provide me with the evidence that this is going to fix her difficulties. And so your doubts continue. But your child doesn't waver? She has wavered over the last few years. She's had periods where I suppose you could describe her identity as being slightly looser. But even during those periods, she would still sit there and say, this is the course of action that I want to take.

But I don't think the fact that she's presented this way for her adolescence necessarily means that when she's 23, decisions with a more mature, more rounded, more experienced perspective. And to put her forward for an experimental treatment, I don't think is the right way to go about it. So the course of action, as we speak now, you are still waiting for your first appointment at GIDS. Yes. And you will go to it when you get to the top of the waiting list. Yes, yes. I want to help my child.

I don't sit there and say that if she decides as an adult to transition, that this is a bad outcome for her. That's not what I'm saying. What I'm saying is when her identity is not yet fully formed, when who she is is still evolving to foreclose any other options for her when she is a child. I'm sceptical that that's going to be the solution. Well, that's the voice of a woman we're calling Nicola. She is a mother talking about her child. And if you want to hear yesterday's interview, as I said earlier, go to BBC Sounds and you can hear the woman we're calling Jen talking about her child and their experience. Now, Leicester University has an event next week. It's launching a student sex worker policy and toolkit.

Well, what is it? Why is it needed? I asked one of the people behind it, Tila Sanders, who is Professor of Criminology at Leicester University. Well, student sex work has always existed. This is not a new phenomenon at all. I've been researching with the sex industry for the past 20 years, all different types of projects in brothels, in lap dancing clubs. Students have always been there as part of the sex industry. So we have some research findings which we can build on. And I think now it's the time really to do something useful with those in terms of higher education. As you'll know, student welfare, student health safety is really quite pivotal. We know that from this year. And this is an area where it often gets

swept under the carpet. Universities don't like to talk about it very often. But it's really important to think about the students who do engage in sex work and are taking education, taking university degrees. Okay. Now, I think this is based on research that was done, what, five years ago at a Welsh university. What proportion of students in that research were found to be doing sex work of any kind? It's around 4 percent. And it was obviously female, male, trans. That's an important piece of research, the Swansea research there that flagged up male sex work as well. It's very difficult to find numbers in relation to any type of sex work or sex work

market because the numbers are very fluid. People move in and out of the sex industry all the time. People may not define themselves as sex workers, particularly if they're doing webcamming or other types of online services that are not direct contact. So it's really difficult to get an actual handle of numbers. But we know that there's always students who are working across the country and essentially engaging in sex work to get themselves through university. Right I mean you've mentioned that there are some male sex workers and indeed trans sex workers but surely the overwhelming majority are female. Definitely yes we know certainly that the overwhelming majority are women, so this

is certainly a gender issue in relation to thinking about supporting young women who are in education, overseas students as well who come to the UK to study. Often they can find themselves being approached by websites, for example, or engaging and signing up to websites, not really sure about what they're doing. There is no doubt though Tila that many people will find this deeply depressing you're saying it's an acknowledgement of a reality rather than something that is frankly an area of life most people would never want their student offspring to be involved with. For sure but we have to remember that students have always looked for part-time work. Yeah but Teela with the greatest respect there's part-time work and there's sex work they're not the same. But the sex markets have changed when we talk about sex work people think

direct personal services escorting the sex markets have changed rapidly over the last 10 years lots of people working online lots of people doing non-direct sexual services we know the rise in things like only fans and webcam in those markets that are much more appealing because they're online they're flexible well don't go out some people would say they were quotes safer but we know that during the course of the pandemic, that sort of sex work has become more popular. Those platforms have become much more successful. But there's also been an increase in stalking, for example. And some of the people involved in that kind of work are actually more vulnerable as a result of doing it, aren't they? Definitely. We work with an organisation called

the Revenge Porn Helpline and they deal with image abuse. So that's when people put images on or create content and they're abused. And they've worked with us very clearly on the student sex work toolkits for staff and for students. And they're very concerned about the numbers of students who are being manipulated because their image is online. So I think the point to say is, yes, it's out there. There was lots more to be done in terms of safety and thinking how people can work safer. But I think the time is now to take this into higher education to say, what is your duty of care as a set of institutions that have students? Yeah, again, I mean, some people would say emphatically, Tila, that a duty of care in an environment like a university would be to do everything you can to deter any student from doing this sort of work. Well, I think the point is really that sex work is generally legal. It's a legal activity between two consenting adults.

And universities are not there to give moral judgment in relation to what people do. No, but they are there. They're all about aspiration. That's why people aim for university. It's about something different, something better. It's not something... But we're not talking about sex work as a job here. We're talking about supporting students who are doing sex work in the university environment. So we're talking about inclusive learning. We're talking about not discriminating against somebody. We're talking about not being judgmental. If you find out your student is doing sex work or they've been outed or they're being blackmailed, often they will come to university

staff. University staff don't necessarily know what to do. That is Teela Sanders. Let's get the view of Sarah Dighton, who's a feminist commentator and journalist. Sarah, good morning to you. Good morning. Now, Teela is pretty adamant there. It's all about providing necessary support. No judgment, just support. What do you say to that? Well, I think it's very important that universities are able to engage with the fact that students are getting involved in the sex industry and I think it's completely inadequate for universities to do that if it's not from the from the perspective that the sex industry is enormously harmful to women and has a really toxic influence on men as well um so yes it's quite troubling to hear that um especially troubling

in what respect um well i think like the nature of the economy means that students really are going to be likely to turn to um sex industry more than ever before you know the service industry is under huge pressure. And that's always been traditionally where you would go to for a part time job. So things like escorting or OnlyFans or sugar daddy websites are going to seem increasingly appealing. And if universities aren't giving the message that these are not safe, you know, empowering, secure ways to make money. They are actually exploitative sites of abuse, dangerous things for young women to get involved with. And I think it is really worth emphasising that you're talking about young women who are 18 to early 20s,

which is not an age necessarily where you are fully equipped to make all the decisions about things that might affect you for the rest of your adult life. Well, your digital footprint is going to be ever more important, isn't it? There's no doubt about that. And your anonymity isn't guaranteed anymore. It's so, so troubling that things like, you know, like fans or like webcaming are perceived as less harmful but they actually expose the women who engage in them to you know potential lifelong blackmail and re-traumatization so there was a absolutely chilling piece in the new york times um i think last week by nick kristoff about the way Pornhub was reposting, constantly reposting images of abuse that women or images that women had, you know, consensually given to

sexual partners. Not necessarily on OnlyFans, but had exchanged, you know, thinking that they were secure, thinking that they would be something that only existed ephemerally and then they exist on Pornhub forever and ever and ever essentially and you know these are you know something that may have seemed like nothing to send a picture that just seemed fine in the moment of doing it can be something that actually comes to represent a period of abuse distress you, humiliation in lots of ways and is used against women. And if you're not able to actually, you know, talk about the real life consequences that this stuff can have, then universities are really letting their students down.

Sarah, thank you very much. The University of Leicester, of course, would say it was doing its best to protect students. But interesting debate. You can get involved as well at BBC Woman's Hour. That was Sarah Dittum responding to the earlier conversation with the Professor of Criminology at Leicester University, Teela Sanders. Chrissie says, why turn an instructive item into telling off a professor before we heard what she's doing for students taking sex work jobs to pay for their studies. If it was drug support or consent, would you stop us hearing about it on the basis that drugs and harassment are bad? Chrissie, thank you. Yeah, time against us,

but actually, I do take your point there. You make a reasonable point about the actual interview. Sarah says, as a journalist, I made a programme on this subject for Channel 4 back in 1993. I was astonished at how easy it was to find students who were supporting themselves with part-time work in the sex industry. I started my research by walking into a strip club on Dean Street in Soho and met three young women straight away who were stripping in a basement in front of old men. What I learned was that for many students in this line of work, stripping often led to escort work and then sometimes to prostitution. Many of the students I met seemed to have poor mental health

as a result of their anxieties about what they were doing. From John, I find it disturbing that students would be undertaking sex work rather than looking after their own sexual development. From Christine, unbelievable to equate sex work with a part time job, primarily run by men for expensive and there are poor students who cannot find flexible work and well-paid work to meet the costs of university. Carly, myself and my flatmates worked for an adult chat line 20 years ago to pay our way through uni. Frankly, it was hilarious and it paid £9 an hour and that was a fortune. It's not all negative. Lots from you as well on the first conversation today about midwifery and about maternity services and obstetrics in the UK. Nurses and midwives who challenge things are branded as troublemakers, says this listener,

and management will make their lives a nightmare. The Nursing and Midwifery Council and the Royal College of Nursing side with management. That's their view. Jane said compassion and kindness are the least we should expect from an NHS, but for tired, stressed, pressurised staff, those attributes become optional extras. In other words, they require adequate funding as well as the right culture and the right training. Joanna says, shout out to my midwife who advocated clearly and strongly for my voice as an autistic woman during my birth and postnatally. I felt enormously protected by her. Another listener says, it was the women involved in my natal care that made my experience a misery. The male consultants were far and away more understanding and more professional.

A woman at my antenatal clinic told me if my baby died, it would be my fault. And my GP had to step in. Laurie says scandalous that continuity in maternity care is not the standard of service. It indicates again how women's health and respect for them still pervades a medicalised, male-dominated system. It's outrageous that midwives are still having to fight for this. What does Lulu say? I'd like consultants who read your notes before they speak to you. I had one shout at me because I wasn't seeing my midwife again until 32 weeks, which was what my midwife had asked speak to you. I had one shout at me because I wasn't seeing my midwife again until 32 weeks, which was what my midwife had asked me to do. Also hospital midwives trying

to recommend Slimming World. I saw an NHS dietician who was horrified that their first option had been that service. And from Sue, stop treating women like incubators. It's easy to feel like only the baby matters. Many issues can be prevented. First time mothers should have much more emotional and who took the time to contact us today. And of course, this is a conversation that will continue on Women's Hour over the years to come. And actually, the Ockenden report findings that were published yesterday are just the start of a much, much longer process. And there is a criminal case ongoing as well, as we said. Now, Dame Barbara Windsor has died, as you will know, an enormously important cultural figure, actually, for those of us who grew up in the 70s, watching the Carry On films. She was absolutely the epicentre of those films,

always the one providing the laughs in a multitude of politically incorrect but nevertheless highly amusing ways. She's died at the age of 83. She had Alzheimer's disease, which she made public and raised a huge amount of awareness of the condition, of course. She talked to Jenny on Woman's Hour back in 2005 when she was 67 and very much in her pomp in Albert Square as the landlady of the Queen Vic. Jenny asked her a little bit about her younger partner Scott because at the time Barbara was recovering

from a nasty bout of Epstein-Barr virus. There was a lot of press about you being 67 and Scott being just a little bit younger, 26 years younger at 41. But how did you deal with those pictures in the papers of him pushing you out in the wheelchair well um it was fun because it brought back all the memories because they did say when i first uh met and i've been with him 11 years now she should be thinking of getting a good night's sleep and she'd forgotten he'll be wheeling around in the wheelchair well it came a little bit too sooner than i thought at 67 and um and it no it wasn't nice at all but I got papped, paparazzi'd and we looked so hysterical because not only did Scott have me in the wheelchair

he had a zimmer frame for when I got out because I had to go to the doctors so I had to walk the last bit and he also had crutches as well oh you've got to laugh haven't you when you say that this little young man pushing this old bird along and i and i and i but funny enough people could then see how ill i was because people say funny things i think well what's wrong with her you know what's happened to her was she what she got you know or she's throwing a moody you see or something like

but you did go back to his senders for a couple of specials i did when sam got married yes i was feeling better feeling better that was after about a year of it and they phoned me up because they were in trouble in the show there'd been certain things happened so they needed a storyline to cover to get rid of a certain person so i said um i said to my husband, Scott, what will I do? And I went to the specialist. He said, well, just to do two, but take it easy. And I thought, if I can't do that, freestanders, because they were in trouble.

And I know, you know, for me... It would have been brilliant for your career, hadn't it? Well, love, there I was, Jenny, you know, playing not the first or the second or even the third theatres, doing my one-woman show going round the countryside, not very happy, I was in terrible debt. And then they asked for me to play Peggy Mitchell and I paid off my debt, I've loved it,

it's reinvented my career, I've played my age, it's all the wonderful things, you know, for me. So I thought, well, if I can do that for him, and I had a smashing time. And I said, oh, this is a piece of cake now. What I didn't realise was I was only doing two episodes and everybody else was doing eight. That's just a little taste of an interview that Barbara Windsor, the late Dame Barbara Windsor, gave to Woman's Hour in 2005. It's really good to hear her, actually. Very, very important figure and a hugely talented actress. Woman's Hour is back with the best of the week tomorrow afternoon,

either on the radio or in podcast form. Or, of course, we're back live Monday morning, two minutes past ten. Have a good weekend. I'm Sarah Treleavenvan 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.