Woman's Hour - R4 Rethink: how might we design our world better post Covid?

Episode Date: June 22, 2020

Today Radio 4 launches Rethink - a series of essays and discussions right across BBC Radio that ask how the world might change after the pandemic. We begin with an essay from Stirling Prize winning architect Amanda Levete asking how we could design the world around us differently. Has being confined to our homes and immediate communities taught us new things about what we need and want from them? How will more remote working change the role of the office? How might we now start to build for better and more equal societies? Jane is joined by architect Elsie Owusu OBE, economist Kate Raworth and 2019 Stirling Prize winner Annalie Riches, all with their own ideas of how Covid-19 could transform our homes and communities.Some medics have expressed concerns over a possible future rise in stillbirths and harm to babies because pregnant women in need of attention may have avoided seeking professional help during the pandemic. Jane speaks to Dr Maggie Blott, Consultant Obstetrician and Lead for Obstetrics at the Royal Free in London and spokesperson for the Royal College of Obstetrics and Gynaecology.Trichotillomania is often referred to as “hair-pulling disorder”. It’s thought it affects 1 in 50 people, with 80% of them women. Why do people do it? And what can be done to help people stop? Jane discusses the condition with Roisin Kelly, who is a journalist at the Sunday Times Style magazine and has written about her personal experience, and Louise Watson, Chartered Counselling Psychologist and Cognitive Behavioural Psychotherapist, and Hattie Gilford who has her own dedicated Instagram account @my_trich_journey.Producer: Louise Corley Editor: Karen Dalziel

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. It is Monday, June the 22nd, 2020, which has a ring to it, I don't know why. And here is the Woman's Hour podcast. Hello, welcome to the programme. Good morning to you. We're live from Broadcasting House and we're also going to put the wreath into rethink on Women's Hour this morning. We'll be asking in what I hope will be a full-blooded conversation how our homes could be post-COVID. Let's just take this as a moment of opportunity to change the way we live, how we live, where we live. Of course, at the moment, so many people up against it in terms of paying their mortgage, finding money for their rent,

not knowing how things are going to be in a couple of months, perhaps longing for a home of their own and currently completely without one. And we don't have enough affordable housing we know in the UK. So much to think about. We will also focus on the way our homes look right now and how they might have to change if more of us are spending more time in them and working there as well, of course. If you want to take part in that conversation, it's coming up in seven or eight minutes time at BBC Women's Hour on Twitter. That's also where we are on Instagram. And you can email the programme via our website. Also today, the hair pulling disorder, trichotillomania, something I never really considered, but it's a condition that really does have a profound impact on a lot of lives, particularly the lives of women. So we'll talk about that a little bit later on Women's Hour today.

First, though, some doctors are expressing concern over a possible rise in stillbirths and harm to babies because some pregnant women may have avoided getting help during the pandemic. Dr Maggie Blott is speaking today for the Royal College of Obstetrics and Gynaecology. She's a consultant at the Royal Free Hospital in North London and joins us now. Maggie, good morning to you. Good morning. So this is not about fear-mongering, you just want to reassure pregnant women and their families that help is still very much available. But why is there this element of concern around a possible rise in stillbirths? Yes, so during the peak of the pandemic, we noticed very quickly across many, many maternity units that we were not seeing the same number of women presenting with symptoms of reduced fetal movements, abdominal pain, vaginal bleeding,

and they just fell away completely. And we were concerned that not seeking help may actually mean that women are missing opportunities to protect themselves and or their babies. And we're very anecdotal. There are anecdotal reports, and I stress anecdotal reports, that there may be an increased incidence of complications in pregnancy, such as late miscarriage or possible stillbirth. So there's a lot of research going into that area at the moment. And what we're trying to do is is really encourage women to come

forward for their antenatal visits and if they have a problem to contact their midwife or their maternity unit to seek help. Antenatal clinics are still physically up and running then are they? They are so we're recommending that women have at least six antenatal visits during their pregnancy. Face-to-face visits are important so that women can have their blood pressure checked, we can measure their tummy to make sure their baby's growing properly, and address things such as ultrasound scans and blood tests. Some visits can be done remotely by telephone or video conferencing. If all that's required is a discussion. But we do still want to see women for their antenatal appointments to make sure that all is well.

But are hospitals safe? Yes, they are. They're very safe. Social distancing has been fully implemented in the antenatal clinics so the clinics are very much the antenatal clinics that were full of women or everywhere have gone antenatal clinics are smaller in size they're socially distanced all staff wearing ppe face masks and and so on and women are screened when they enter the clinic and they also are asked to wear a face mask. So it is very safe to come to the hospital to be checked up. All bleeding in pregnancy is a concern, is it?

Is there some that is just inevitable and perhaps you could just let it go? Well, a lot of the bleeding that we see in pregnancy is actually fairly benign. In other words, it not not a symptom of a serious condition however the only way we can decide that is by actually seeing a woman and examining her and listening to her baby's heartbeat until we've done that we cannot assume that a small amount of bleeding is is nothing is not significant we have to see you to check with them as well. And foetal movement is a difficult one because obviously the foetus doesn't create much of a commotion until, what, week 20, 21, 22?

When does it all start? So foetal movement starts, it varies a little bit, but as early as 18 weeks and as late as 23 or 24 weeks. And we ask women to really start concentrating on fetal movements after about 26 weeks. Babies develop patterns of movement. And it's when that pattern changes that we want to see you to check that your baby's okay. So a mother will know that her baby's movements have changed. They may have reduced.

They may be less obvious than they were. And if you feel that your baby's movements have changed, it may be an indicator of a problem developing. Often it isn't. But again, the only way that we can discover whether it's a problem or not is by seeing you and checking you and your baby. And when it gets to the point of birth, I know it's difficult to generalise, but on the whole, will a woman get the birth she hoped for? Yes, she will. We haven't changed anything about the birthing process. One of the things that did not change during COVID was the fact that women still gave birth and we kept our birth centres open as much as we could. Many hospitals continued to facilitate water births and the choice in

childbirth continued. Their partners are still welcome in the labour ward and in the birthing centres to be with their partners during childbirth. The thing that has changed is a lot of hospitals are unable to allow or facilitate postnatal visiting because of the problems with social distancing. And we're looking and working on that at the moment. The birthing process, the choices and the safety around giving birth is just the same as it always has been. I'd like to actually refer listeners back to a programme that we did on Women's Hour, Monday the 25th of May.

There were some unforgettable conversations on that programme. It was about pregnancy and childbirth and indeed the early weeks of motherhood during lockdown. So if you missed that programme and it's something that would interest you or be of help to someone you know, go to BBC Sounds and listen to Woman's Hour from Monday the 25th of May. Maggie, I'm delighted to be able to speak to you because like many people, I watched the hospital documentary

that was filmed at the Royal Free. to be able to speak to you because like many people I watched the hospital documentary that was filmed at the Royal Free and during that program you actually were present at the birth of a young a baby obviously a young baby a baby to a young woman who'd had who had Covid and this was at a time when really you didn't understand the possible impact of Covid on pregnancy. Yes we were very much feeling our way in the early days. We had information about effects of pregnancy with MERS and SARS, but we didn't really know about it with coronavirus, this current COVID-19 pandemic.

And we didn't know the effect it would have on pregnancy. But what was clear is that although most pregnant women either have very few symptoms or very mild symptoms, a small number of women, particularly in the later part of pregnancy, who contract COVID-19 become very unwell very quickly. It's a respiratory virus, so it basically presents with cough and shortness of breath. And of course, in the last third of pregnancy, women find it more difficult to breathe because of course, in the last third of pregnancy, women find it more difficult to breathe because of the pressure of the baby pushing up on their lungs. So what we

observed with this particular lady is that when she came in with fairly mild symptoms of coronavirus, very quickly over a course of two or three, four hours, she deteriorated quite rapidly. And we made the decision as a multidisciplinary team so myself a consultant anesthetist infectious diseases consultant and intensive care consultant we made the decision that we would deliver her and then she would may need to be transferred up to intensive care and of course it was the first time that I had done or we actually had done a cesarean section in full PPE so it was a really really steep learning curve we had practice for it beforehand we'd run drills and simulations but that was the first time we'd done

it and the baby was fine as it turned out and so is so is the mother so that was a good result but yeah but obviously we also now have learned more and about the additional risk to women of colour who are pregnant. Now, we also know that you definitely should limit your contact with other people in the third trimester of pregnancy, whatever your ethnicity. That's right. So it seems that a big study that's been done by UCOS showed that the average, the mean gestation of admissions for COVID was 34 weeks. So we know that women in the third trimester of pregnancy who get COVID are more likely to be affected. So the advice for the last trimester of pregnancy is to stay at home as much as you can. Shield, socially isolate yourself and just basically stay away from people. If you have symptoms of coronavirus, get in touch straight away.

And a message particularly for women who are a higher risk group, so BAME women, women who are slightly older, obesity, and women who have other comorbidities in pregnancy, really need to get in touch very early on if they suspect that they might have contracted COVID. Ring your midwife, speak to your maternity unit or your GP, get advice about whether to be seen early and that is as early or as soon as possible. Yeah, I don't think, well, I think you've done a brilliant job

of emphasising that help is necessary in some of these cases of incidents in pregnancy and it's available. You are there and you are very keen to help. Thank you very much indeed, Maggie. Appreciate it. That's Dr Maggie Blott, consultant obstetrician and lead for obstetrics at the Royal Free Hospital in London, speaking there on behalf of the Royal College of Obstetrics and Gynaecology. And our programme about having a baby and also the early days of motherhood in lockdown is from Monday, the 25th of May.

And it's still available on BBC Sounds. So to rethink this is a series of essays and discussions it's all over Five Live this week and Radio 4 and the BBC World Service. It's about how the world might indeed probably should change after the coronavirus pandemic. It doesn't all need to be gloomy. This is an opportunity for us here. We are going to have a conversation this morning about the home, how it looks now, how it works for us or not, and how it might be in the future. I've got some fantastic guests to hear from in a moment or two. Two architects, Elsie Owuso and Anna-Lee Riches, and the economist Kate Raworth. But first of all, we're all going to

hear from the Sterling Prize award-winning architect Amanda Levite. Here she is asking how we could design the world around us a bit differently. We cannot unknow what has happened. We cannot ignore the risks our future holds and we cannot go back to normal without reflecting deeply. This pandemic has raised overwhelming existential issues, issues around race, inequality and the environment but it's also revealed the breathtaking power of collective responsibility and shown that radical change is possible. With the entire office working from home each of us has established our own rhythm to suit our personality and circumstance. It has brought a new balance to our lives and given us more control over our working day.

It's going to be hard to give that up. As much as I miss the spontaneity and joy of face-to-face contact with my team, our remoteness has led to a heightened sense of collaboration. Adversity has reminded us that we all have a part to play in our interconnected world, to be more responsible, accountable and generous, and to appreciate the importance of small things, searching out that corner of sunlight on the front steps and chatting to passers-by. Lockdown has thrown into sharp relief the hardship of those who do not have the luxury of generous indoor space or access to a

garden. We have got to rethink this imbalance. Space and nature are a need, they are not a luxury. But need alone will not lead to change, desire will. We need to desire a more equitable society and then design a more equitable model around that to create places where we can live better together and live better with nature. Places that promote a network of cooperation and where people can rediscover the art of living and where well-being, not efficiency, is the measure. Historically, buildings and cities have been shaped by pandemics. At an urban scale, the 1870s cholera outbreak in London led to the creation of the sewage system, wider streets and Victoria embankment. At a microscopic scale, houses in 16th century

Spain were painted with lime because its antibacterial properties helped prevent the spread of the plague. It's a lovely example of need evolving into the vernacular and although unknown at the time, it was one of the first examples of nanotechnology in action. Nanotechnology inspired a research project we embarked on pre-Covid, a collaboration with a professor of biological physics at Hawkeswood University. It feels particularly relevant now with a new focus on science. In times of crisis there's a tendency to retreat into the comfort of what we know, but we must resist this and continue to dream. With this project we're rethinking how to use nature's strategies in

trees to grow the materials of the future. By extracting the lignin from wood, manipulating the cellulose structure and infusing bioresins, we aim to take the research out of the lab to make a new material that is stronger than steel, a better insulator than glass, and that lets the light in. It will be, in effect, transparent wood. If we can reconcile nature and technology, we can find new ways to build that are positive for our environment. And by reconciling responsibility and freedom without contradiction, we can design new models for living. Opportunities to affect radical change are rare, so we have to act now and we have to make sure we remember.

That is the architect Amanda Levitt. She won the Sterling Prize. So did one of our other contributors this morning, Anna Lee Riches, who won the Sterling Prize for a goldsmith street in Norwich. That was the name of your project, wasn't it, Anna Lee? Good morning to you. Yes, good morning. And I know I talked to you about that at the time.

Also with us, the architect Elsie Owusu. Elsie, good morning. between neighbours, wasn't it? Yes, that was part of the aspirations of the design. It was also trying to be very low carbon in use and reduce fuel poverty. And I'm kind of struck with thinking about it. It was very unusual because it was all council housing. So there was a kind of long-term aspiration for building a community and reducing fuel poverty that pure council housing has the ability to do

because it's not subject to viability and kind of sales values. So that gave Norwich a very long-term view on quality, maintenance, which is very unusual. But why can't that philosophy be extended then, Annalie? Why not? Why not do that now? Well, I think that a lot of housing delivery models are based on value and sales. So, you know, making the most value out of plots so you can then, you know, reprovide social housing and taking that, taking a scheme away from that model actually gave it a more long term view than kind of a short term financial kind of calculation,

which is what housing, you know, social housing delivery tends to be based on. Right. Amanda said in her essay there that with the entire office working from home, she said towards the beginning of it from home, she said, towards the beginning of it, of course, Kate, we have to remember that a lot of people are not able to work from home. I mean, our previous guest, Dr. Maggie Blott, isn't someone who can work easily from home. This is a reality for some of the middle classes. Doesn't even mean it's easy for them, this notion of working from home. Absolutely true. So many people's jobs depend upon showing up. Key workers, shelf stackers, staff in hospitals, they have to show up and use their hands directly

in the workplace. They cannot work from home. And we are, I think, hugely grateful as a society suddenly realising the importance of them showing up even in times like this. Other people's jobs that are more down the line on the computer, those can be done from home if you have a laptop, if you have a space where you're not also simultaneously trying to homeschool kids. So it requires time and privacy and focus to make it work. But the earlier point Annalie made about the short-termism of a lot of housing and the way it's thrown together in some cases. Surely this is a chance, Kate, for all that to end. So the point she made, I agree with

so much. Who owns the housing project and their vision of what it's for matters massively. Let me give you an example of the city of Vienna. In Vienna, 60% of residents live in high quality, but really affordable housing that's either owned by the city or by cooperatives. And that means that the owner, the co-op or the city is investing in long term housing for the community. It's very, very different than when it's owned by a private property developer who wants to get the highest return for their buck. So it really matters who owns the housing. Yeah. Elsie, what would you like to say about that? You're also an architect, although not an architect who's worked for a big company. Is that correct? Actually, just to correct you, I have worked for a big company. I worked for

Fields & Mawson for nine years as a partner, and there were 80 plus of us in that practice. But my own practice has always worked from home since my daughter was very small and I ran out of excuses when she hit her 40s but we have always worked from home but it's always been considered to be not quite a proper practice and just to say that of the 40,000 odd architects, 50% of them are sole practitioners or micro practices. And a lot of those are women who may have left the workplace to have children. So working from home for most architects is standard practice. And I think the interesting thing is that it's now recognized as a way in which large practices can work. So I think that gives small practices and remote working practices credence to begin to work on much larger practices

and to take their place in the work in mainstream architecture. So I think from that point of view, the challenge of COVID has actually presented a great opportunity. Well, because you have been used to working from home, presumably you haven't found the lockdown a particular professional challenge, Elsie? Well, actually, it's made us realise that, well, the practice came together physically on Wednesday. So we had a studio day on Wednesday. And the only difference has been really that the studio day has become a Zoom day.

And we've been able to introduce our clients. So we've had long conversations with clients by Zoom, which has meant that it's been more integrated. We also have projects in Ghana and Nigeria. And those teams have felt much closer to us because we're all working in the same way and Lagos and Accra have been locked down in the same way as London has. So it's really felt, you know, we understand there are challenges for people who don't have the luxury of bigger spaces.

But then that brings us to the question of why don't people have spaces and we need to, larger spaces, and we need to be thinking about lockdown or the potential for lockdown as a repeat process. So that really gives us all pause to think. And I think that it's been a great leveller, COVID, because you haven't been able to buy your way out of the situation that everybody else is in. And also, I guess, Anneli, it's an opportunity for, well, it could be more democratic because on Zoom, nobody knows exactly who you are or where you're from. Yes, possibly. I hadn't really thought of it like that.

You know, I've done, I don't know, my meetings, I've given lectures on Zoom. It's a bit strange not being able to see who you're talking to. But actually, it probably will change my life because I had a massive commute and I've now realised I didn't need to put myself through that anymore. Yeah, well, does that actually mean you'll never commute again? I don't know. In my dreams, I wouldn't, but I'll probably need to show up occasionally. Will the average? I think it's quite interesting in terms of people choosing.

Obviously, not everyone can choose where they live because they actually have to physically turn up to work. And ironically, you know, people working, key workers working in central London don't live in central London. It's too expensive. So it would be great if there was an adjust. Whereas, you know, people who could afford to moved out and could afford to remove work leave, people could move and be next to their jobs. That would be great. But, I mean, you say key workers can't live in places like central London, and indeed right now they can't. But right now central London is full of empty, entirely empty,

or like this one that I'm in now, almost empty, office places and spaces. The truth is we probably don't need this office space. It could be housing, couldn't it? Yes. I mean, you know, the future of the office is quite interesting. I mean, I don't think we need the spaces that we need. We were using. We've done a survey of people who work for us,

and interestingly, I think nearly everyone would like to carry on some element of them working, even if there was, know maybe two days a week in the office so yeah yeah we could we could can I just say that the other thing that we need to think about is how we make buildings um and I think the traditional way of making buildings brick on brick is a real challenge for traditional building sites, because with social social distancing, you can't have people falling over each other doing the plasterwork and brickwork. So I think that the move from making buildings brick on brick to making buildings as we make cars is going to be really really important because that's going to keep people safe when they're making making making homes and it's also going to allow the quality of the work that we produce homes that we produce to be incredibly improved. So that's been my experience of looking at buildings in Sweden,

where there are companies who make houses in the way that Volvo make cars, you know, and just the thinking of the quality, the qualitative difference, I think, and the social distancing and factory health and safety is going to be really important as we think about the future of housing. Kate, what would you like to say? Yeah, so this is fascinating to me. If we were to walk around a big city centre pre-Covid, we would see towering office buildings, traffic packed with commuters. And if you look up the skies, you'll see crisscrossed with flights of intercity travellers. And this is very much based, I think, on a 20th century vision of work, which says employees must sit shoulder to shoulder, executives must meet face to face. And COVID has shown us it's not necessary. And actually, climate change tells us it's not possible. We can't do

this anymore. So Zoom and online tech has been brilliant for making CEOs and executives realise they don't need to fly across the world to have a chat. They can do it on Zoom. The employees can work from home if, as others are saying, Elsie and Emily, that we need spaces in our homes. And gosh, we really need to not be homeschooling small children at the same time. But also, I want to say that if we're going to move to prefab buildings, which is a really interesting technological development, they need to be undoable as well. We need to be turning our building materials into circular design so that buildings are clicked together and can be unclicked and the materials used again and again. And that

actually will lead us to buildings that can be repurposed, moved around internally, and much more multi-purposeable for the future design of families. So I think those things have to go together. The future design of families? What do you mean by that? Well, so the spaces that families want to live in. One family might have said we want three bedrooms, and others, actually, what we want is two bedrooms and a home office so we can work from home. Right, got you. Might we see an end to the open open plan thing or open plan with spaces that i can move the walls and i can i can set this flat

up in a way that really works for the layout of my family does open plan work for anyone annalee i think i heard you snorting there well we're often pushed to doing open plan even for a three-bedroom house um because of this idea about it being more valuable, getting more money for it. And it's a dream. I think we might have seen the end of that. I'm so glad I don't live in an open plan house. I'm homeschooling and doors are great. And being able to, you know, shut doors, turn the TV on, have a Zoom call. It doesn't work in an open plan. Yeah, I mean, I suppose this might lead people to make the perhaps lazy assumption that homes were designed by men for men. I mean, I'm not saying that. I wonder, though, whether some people might, and it might even be true, who knows. But the notion, for

example, and I hadn't really thought about this, of the kitchen always overlooking the outdoor space, if you're lucky enough to have one, Annalie, what about that? Oh, yes, that's one of my probably rants against the suburban housing model, which is what we're seeing, like 90% of new housing being built in the UK at the moment is suburban. It's a suburban density. It's very much based on car ownership. And it's kind of a type of housing that was, you know, plastered around urban centres in the 50s and very much this idea that the man would go to work in a car, the woman would watch the children in the back garden. And it's very anti-street.

I think hopefully what COVID has made us realise is that streets are great. They're a social glue. It's really important. I thought Amanda's essay and her observation about sitting on front steps rather than playing in the back garden was really key because that's what I've noticed. People are craving some kind of social connection, using tiny spaces to be able to say hello to people. Well, I remember play streets. Why can't we have play streets anymore. Anybody? Yeah, well, I mean, I think constant battle with highways, engineers on road design when you're doing any housing, you know, doing anything that is walkable

where pedestrians have priority over cars, where cars are slowed is very difficult. Would it help mental health in some cases, perhaps in many cases, Amanda, if you were to work in the kitchen, be in your kitchen and look out, not at the backspace if you happen to have one, but at your street, at your neighbours going by? Annalee? Oh, yes. I think, I mean, I know that I have stared out of the window to try and see people during this time,

to try and have some out of the window to try and see people during this time, to try and have some kind of social connection. And I think that suburban housing, it's not just the kitchen facing the garden. It's also the fact that there are three parking spaces in the drive. There's no connection to your street, really. And I think it would be interesting to find out which type of housing has been more successful in creating social connections. I'm a board member of the Quality of Life Foundation. We're just doing a survey at the moment to find out which homes have been more resilient to the COVID, the implications of it. And that will be very interesting coming back. Let's talk about cars because

they've been referenced a few times Kate houses we've got to stop this the the car isn't relevant or it won't be relevant certainly private ownership of cars will be a thing of the past won't it in 10 years time we need to make it that way we need to travel on foot on bikes on public transport and we need to make it much more accessible to people's neighbourhoods for sure. So actually, one of the really great things that many cities have taken the advantage of during COVID is to making a transformation they already knew they wanted, turning car lanes into bike lanes, or even into dining zones for restaurants or into pick up and drop off points for city services. So moving the car out of centre stage in our cities

and on our streets, bringing back two feet and two wheels as the priority. And then even in some neighbourhoods, especially in some European cities, making the car as a respectful visitor, pass through even at 10 kilometres an hour. So totally displacing car centricity of the 20th century and saying, actually, people walking, biking, scooting come first. Cars, you can come in when you actually follow that that flow. Yes. Elsie, do you think, though, that you might encounter resistance to these these notions which seem entirely right, but may not suit everybody particularly people with money well um i think that um you will encounter resistance but here we're talking about life or death you know so um every every day we see the numbers of additional deaths ticking by on our on our tv and i think that gives us pause for thought and also when you when you look at the numbers in China, the spikes that happen and the occasional lockdown. So I think we have to keep reminding people that this is real people's lives we be talking about the disproportionate number of BAME, BAME deaths and infections is that we have to recognize that some people are more at risk than others.

And some of the groups that I've been talking to have been talking about care homes and the alternative to care homes, particularly the BAME populations. My clients are saying, we don't want our elders to go into care homes. We want them living next door to us. How do we do that, Elsie? And so this has actually given us a reason, an extra boost to say, you know, if we want Pam, who's being looked after by jenny next door to live next door to each other we don't want pam going into a care home how do we do it because you know she's in her early 80s and how do we make that provision fast yeah um so this is you know a real sense of

emergency yeah but so okay that all sounds wonderful but how do we do it elsie um well you can come and have a look at the project that we're doing in newham so so um the way we do it we start off by consulting really closely so we understand who the people are that we're working for um who the houses are for and we get the churches the faith groups the local authorities and the housing providers working really fast so that we can produce at volume at speed and to high quality um and it may take a year or it may take six months but it's going to be definitely a lot faster than the traditional way of doing it um which is mucky and hairy and dirty. So the alternatives are there. I could zoom, but we just have to fire them up.

You know, we just have to say this is an emergency and we have to do it. Yeah. And as Amanda illustrated in her essay, the cholera outbreak of the 1870s led to really important changes. This social history is so important and often, of course, gets forgotten. But so there's no reason to believe that the coronavirus and the impact of it will be wholly negative. There could be some real positives in our relatively immediate future. Thank you all very much.

Really interesting stuff there from the architects Elsie Owusu and Annalie Riches and the economist Kate Raworth. So let us know what you think about that at BBC Women's Hour on Twitter or you can email the programme Kate Raworth. So let us know what you think about that at BBC Women's Hour on Twitter or you can email the programme via our website. And later on today, the historian Peter Hennessy

is going to be on Radio 4 talking about how to make a moment like 1945. That's on the Lunchtime News, The World at One. Baroness Hale, once of course President of the Supreme Court, is going to be on at tea time on PM talking about rethinking jury trials. And the historian Margaret Macmillan will be on The World tonight at 10 o'clock tonight here on Radio 4. And I did hear the very good novelist Nicky Gerrard on Five Live this morning as part of Rethink talking about dementia care.

So Five Live talking about dementia care throughout the day today. Thanks very much to all our contributors there. Tomorrow on this programme, I'm going to be talking to a prison doctor, Amanda Brown, who currently works at Bronzefield Women's Prison. Quite a challenging role that and we'll hear all about it from Amanda on the programme tomorrow. Now to trichotillomania, which is referred to often as the hair pulling disorder. Why do people do it? Why are women more likely to do it? And why is it so difficult to stop? Rasheen Kelly has written about her personal experience. Hattie Guilford is somebody who has also done this. She has pulled her hair and I think is trying her very best to stop doing it.

She is on Instagram at mytrick underscore journey underscore. I think there's a couple of underscores in there. I'll get it right towards the end. And Louise Watson is a charted counselling psychologist and a cognitive behavioural psychotherapist. And Louise, you have helped clients with a wide range of issues, including this one, over the years. Very briefly, why do you think people do it?

There's not really a firm answer as to why people do it. There's suspicion that there may be, as with a lot of mental health disorders, that there's an underlying genetic reason for it. It seems to be a response to both under-stimulation and over-stimulation, interestingly. So people will do it when they feel very stressed, perhaps. People who suffer from trichotillomania will report doing more pulling or more intense episodes of pulling when they're stressed. But it also happens when people are bored and under-stimulated as well.

So it seems to be a way of correcting an imbalance in stress and tension in the body. We've had some really interesting and perceptive emails from people about this. I'm just going to read this or a paragraph from one of them now. I won't mention the listener's name, but she says, having trichotillomania is an all-consuming behaviour that is part of every part of your life. Of course, everybody's experience of it is different, but I've struggled with it for many years and I've come to revere it in a way. I feel it's given me perspective

and a sensitivity that few people have. The sensation of pulling a particular hair out, one with a long, sticky root which you eat, closely related disorder called trichophagia. The whole act encompasses it is a kind of marvel that not many people will ever know about. I don't think I've pronounced that correctly, have I, Louise? But is it connected to trichophagia? Trichophagia, yes, that's something that not all sufferers have, but some sufferers will have additional rituals after pulling the hair out. So they may inspect the root very closely and then sometimes they will cue the root off or sometimes eat the whole hair,

which can be dangerous because then obviously as the hairs build up in the body, that can cause problems with the GI tract. Right. Rasheen, tell me, why did you start? Do you know why you started? Do you remember it? Yeah, so I can remember the first time. So with me, to start with, I pick from the ends of my hair. So split ends, or if I can't find a split end, I'll pull my hair until I create one. And I just remember the first time I found a split end, I was probably about 12 or 13, having a bit of a difficult time at home with my parents arguing things like that and I just kind of was sitting on the stairs trying to trying to get out of it all and I was just examining my hair and I found a split end and I pulled it and I was just I don't know I was so fascinated I remember going and showing it to my sister and telling her um and then I think it

turned into a habit but it's become a lot more that. I just I'm doing it all the time. Hattie, is it the same? Was it the same for you? So I started pulling out my hair when I was about eight years old. I actually used to bite my nails, first of all. And I'm sure Louise will be able to explain this better than I can. But they're part of a family called body focus repetitive behaviors. So you've got skin picking, nail biting and hair pulling. And they're all part of that.

So my mum paid me a pound for every nail that I stopped biting when I was eight and I absolutely nailed it. And unfortunately started pulling out my hair. I was obsessed with the root, sort of the follicle at the end. And I think I sort of, again, sort of started as a habit, but obviously it's grown into a lot more than that now. I should say on Instagram you are, because it's well worth following you if people can relate to this, at my underscore trick underscore journey. And there's a lot of helpful information there. Louise, can you stop? And indeed, is it dangerous if you don't? As I said, it's only really dangerous if you are consuming the hairs

and you're consuming them in enough quantity to cause yourself some problems with your stomach and intestines. Otherwise, it's not dangerous, but it can cause a lot of problems for people's self-esteem. Obviously, they can have bald patches on their head where they've pulled the hair from. People that pull from their eyebrows and eyelashes, obviously that affects their appearance and there's a lot of shame around the disorder. I think although it is more prevalent than people think, it's not very well known and people don't understand what it is and so they don't seek help perhaps and feel very embarrassed that it's perhaps just them that has the disorder. So it's brilliant that Hattie's publicising this on raising awareness of it on

Instagram so that people feel that they're not alive. Yeah I at least can hear some local wildlife in Louise's home there are one of the wonders for everybody being at home when they're on the programme. Hattie I know you've actually been able to stop haven't you? How is that going? Yes so towards the end of last year sort sort of in October time, I suddenly just got this feeling that I was ready to stop. And it might sound strange and I tried to stop before, but I don't think I'd stop that hard. I've always found hair pulling very soothing, you know, through anxiety, stress, boredom, all of those. But last year I kind of knew I was ready. And I partook in a sort of pull-free Friday that somebody on Instagram was doing,

and I really recommend that if people want to stop pulling, is doing it in short bursts. So not trying to just go cold turkey because it won't work, but try not pulling for 10 minutes or half an hour, an hour, and sort of set yourself little goals like that, and you'll sort of help yourself build up. That was Hattie Guilford, who has wrestled with it and has packed in hair pulling.

And I know it's really, really not easy to do that. So well done to her. You also heard from Roisin Kelly and from the Chartered Councillor and psychologist Louise Watson, whose cat made a spirited attempt to join in at one point. I'm loving the little bits you find out about contributors when they're all at home and their animals are on the prowl and trying to participate as well. To your emails on what you heard on the programme today, this from Maggie. I have had trichotillomania since I was about 12 or 13 and I'm now 62.

I only knew that it had a name a couple of years ago. I've had no help specifically and friends and family noticed it, but they just said stop it rather than realised I had a mental health problem. I've also had anxiety and panic attacks and depression since around the same age. The first time I was really able to talk about it was with a hairdresser a couple of years ago and she didn't judge me. Well, I'm glad to hear that, Maggie. I would hope that nobody would judge you for that because so many of us have got similar habits, haven't we? And this just happens to be yours.

Another listener says, I've had this since I was four and I'm now 29. It is hard to establish a cause at such a young age. Therapists are keen to pin it on trauma. They always seem a bit disappointed when nothing springs to mind. As a result of not being able to pinpoint a cause, finding a solution seems to be more difficult if not impossible. I've tried every cure and trick in the book over the last 20 years, from therapy and medication to starving myself, well obviously don't do that, and a range of alternative remedies and supplements. My relationship with it is hard to define and I seem to pull every minute of every hour

and probably have currently about 40% of my hair missing. For the last couple of years I've had a pixie crop and I've passed it off as just shaved patches, as a kind of edginess. Any bald spots I colour in with black eyeshadow. And yet I'm the least bothered about it I've ever been. Acceptance has been a huge part of the journey and it's transformed my mental health. Well, there we go. Acceptance is obviously key here. It's interesting that that contributor has just decided to live with it, I suppose, and just accept herself. And our previous contributor felt a little bit better because her hairdresser hadn't judged her for it. So there you go.

I think this is really important from a listener called Georgie, who says, I'm just listening to your conversation with Maggie Blott about the possible increase in stillbirths because of the lockdown. I had a stillbirth a couple of years ago at 32 weeks and I lost one of my twins. I just want to say that this was absolutely devastating. I had PTSD and I struggle every day with what happened. So to any woman thinking twice due to corona about whether to go ahead and get checked, please you must go. Don't put yourself at more risk of what has absolutely destroyed my life and will continue to do so every day. Well, to that emailer, obviously, I extend my sympathy.

I think that has to be one of life's toughest of experiences. So, Georgie, my sympathy to you and thank you for sending that email to us and also just passing on your firm belief that any woman who's concerned just needs to go and get checked out. I couldn't agree more. Thank you for telling us about what happened to you. Marilyn says, I've just listened to that discussion about the positive changes that could happen after COVID. Well, we live on the very outskirts of suburbia near the North Downs. Now, during lockdown, my husband and I went for a walk every evening through the deserted streets. With complete families at home, probably including

teenage and early 20s offspring, it was very noticeable just how many cars were squeezed into the parking space outside each home. The average in our area was three per household, but four wasn't unusual. How depressing to think that one day, quite soon possibly, all these cars will be back on the road. When we started walking, the only traffic on the roads was the shopping online delivery vans, and the peace in our area was an absolute treat.

Not everybody, I have to say, agrees with that car-free paradise notion. From Sandra, I'm listening to Woman's Hour in our house built in 1999. When we bought our first new house in 1970, it was a wimpy and their houses were built with low fences, about a metre high. So when we were in the garden, we saw and spoke to our neighbours regularly, if only at weekends or in the evening. But now we have a two metre high solid timber fence put in by the builders. And the houses are so arranged for maximum privacy, which is, of course, very antisocial. The only area where we can meet is the front. We spoke to our neighbours more on VE Day than in previous years.

Luckily, we do live in a market town with decent food shops. That's interesting. And Sandra is emailing from Louth in Lincolnshire. So thank you for that. Listening to your conversation about houses, my bungalow has a kitchen at the front, says Leslie, and it's great. I can see my neighbours coming and going, the children playing, callers, etc. It's a source of interest and engagement and a real positive in the current situation.

I'm retired, so I am at home quite a bit and I really enjoy having my bedroom and living room at the back, but the kitchen at the front as a real advantage. It isn't common enough. I don't know of any others, says Leslie. So there you go. I have to say, Leslie, I would thoroughly enjoy having a view of my neighbours' comings and goings. I really would. Yeah, you should believe me. You wouldn't believe what goes on on our street. Sue says, I'm listening to the programme, the discussion about housing and people not using cars. Well, your presenter doesn't know anything about my life. I live in North Devon in a village, steep steps into the village, no public transport, nearest town eight miles away. Do you really think I'm going to walk or bike or scoot into the town? I'm 69 and I think not. Why can't your guests think past

southeastern England and all their towns? I am a keen environmentalist, but you've got to be realistic. No, Sue, thank you. Obviously, we were talking about what the future could be, perhaps possibly should be. But obviously, we have to take into account the reality of people's lives and rural public transport on the whole is no good or not good enough. And for all this car-free stuff to become a reality, public transport has got to be vastly improved, hasn't it? Quite a few people mentioning the bedroom tax and the impact of that, among them Linda, who says, we were overcrowded. I would like to use my so-called spare room

without being penalised when I'm out of work. I don't like relying on having a lodger, she says. This from Wendy. Oh, her kitchen overlooks the garden. But why do they put the sink under the window, she says. I do not spend hours at my kitchen sink. No, but Wendy, maybe you would if you had a view of your neighbours' activities. That's what we're saying. I think I might spend, I'd get rid of the dishwasher and do it all by hand if I could know what my neighbours

were up to. Or maybe it's just me. Sandra says, I live in retirement flats and we've been able to chat in our garden each day, socially distanced on our respective benches. Sandra says, it has been a mental health saver. I don't doubt that, Sandra. I think that's so important, isn't it? Just somewhere to go where you can have daily contact with other people. Carol says, I think we should make cars in the future no more than a respectful visitor. Housing now needs to be designed around people, not cars. My local group trying to increase cycling safe routes has found Highways England incredibly resistant

to any ideas around provision for non-car users. A £15 billion project for an underpass that nobody wants is currently underway on the A69 as a result. That's Carol's view in the interests of balance. I suppose I ought to say that I'm sure there are many people who warmly welcome that underpass on the A69. This is from Nick Phillips, who is the chief executive of the Arms House Association. Nick says, interesting conversation about housing design. Arms houses are designed to encourage neighbourliness. This is part of the

reason why they're considered so valuable in creating close micro communities. Kitchens tend to be designed to look over the common grassed courtyard and onto neighbours' front doors to enable better interaction. Arms houses have been in existence since the 10th century and more are being built today than in almost any other time in history. So there you go. That was already happening. And you'd have to hope that more of that will be done in our post-coronavirus future, which can't come quickly enough, can it? Thank you to everybody who contributed today. We are back live tomorrow. But of course, the podcast will be available at a time to suit you tomorrow, too. Thank you very much for taking part. Among our guests tomorrow, but of course the podcast will be available at a time to suit you tomorrow too.

Thank you very much for taking part. Among our guests tomorrow, Dr. Amanda Brown, who is the doctor in residence at Bronzefield Women's Prison. Hi, I'm Catherine Bowhart. And I'm Sarah Keyworth. We're comedians separately and a couple together, and we're the host of You'll Do, the podcast that gives you a little insight into perfectly imperfect love. Yeah, forget nights in with this one and hashtag couples goals. We want to know the whys and hows of sticking with the people we love and asking a few of the questions that are meant to help us develop intimacy. So why not give it a listen and subscribe to You'll Do on BBC Sounds. I'm Sarah Treleaven and for over a year, Sounds. 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.