Woman's Hour - Singer-Songwriter Josie Proto, Child protection changes, Women and COP26, UTIs

Episode Date: July 28, 2021

An estimated 50% of women in the UK will have a urinary tract infection at some point in their lives and between 20-30% are likely to have a recurrence. For some, these recurrent infections can lead to a significant impact on their health and way of life. Dr Agnes Arnold-Forster, a medical historian from McGill University with a personal history of UTIs has produced a documentary with two others, to shine a light on the experiences of women with UTIs. She and Dr Catriona Anderson, a GP specialised in treating UTIs, discuss why some women feel failed by the system. We need to rewrite the rules of child protection says Professor Carlene Firmin. She talks to Jessica Creighton about her work in this area, how it differs from previous approaches and how it might help the ‘disappearing girls’ Woman’s Hour has talked about recently – those young girls, often in care, at risk of sexual exploitation who regularly go missing. Anna Holland a consultant social worker for the NSPCC joins them.Rising singer-songwriter, Josie Proto, started out playing her grandmother’s guitar. Her frustration towards the extreme measures women feel they need to take in order to simply get home safely has inspired her new song. She talks about her music and performs live with “I Just Wanna Walk Home”, described by Radio 1’s Annie Mac as “The Hottest Record in the World”.There are three months to go before the start of COP26 negotiations in Glasgow - the 26th attempt to agree on actions to combat the climate crisis. But if the past 25 meetings haven't provided a solution, what needs to change to get the results the planet needs? Bianca Pitt, one of the co-founders of the campaign SHE Changes Climate, is convinced that the key is having a lot more women leading at the negotiating table. Bianca explains why women will make a difference. She is joined by environmental lawyer and expert in international climate negotiations, Farhana Yamin - who describes her experience of getting 197 countries to agree, and what she thinks women can bring to a sustainable future. Presenter: Jessica Creighton Producer: Kirsty StarkeyInterviewed Guest: Dr Agnes Arnold-Foster Interviewed Guest: Dr Catriona Anderson Interviewed Guest: Professor Carlene Firmin Interviewed Guest: Anna Holland Interviewed Guest: Josie Proto Interviewed Guest: Farhana Yamin Interviewed Guest: Bianca Pitt

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BBC Sounds. Music, radio, podcasts. Hello, I'm Jessica Crichton. Welcome to the Woman's Hour podcast. Good morning. Welcome to the programme. Great to have you with us. Now, an estimated half of women in the UK will have a urinary tract infection at some point in their lives. But what is preventing women being correctly diagnosed? And why is it that some women are not believed when it comes to their symptoms? Well, we'll be talking to a medical historian and a GP for the answers. Also, yesterday the Independent Inquiry into Child Sexual Abuse said staff and counsellors in Lambeth in South London presided over a culture of cover-up.

Another report in May from the Times newspaper showed thousands of young girls were at risk of sexual abuse whilst being reported missing. We'll be speaking to a social worker and child safeguarding expert about a new approach to child protection. Plus, what's with all this extreme weather recently? There's been flooding in London, droughts in California. Scientists have long been warning us about the consequences of global heating. But perhaps the answer is allowing more women at the negotiating table when it comes to climate events.

I'll be speaking to two women who think just that. Also this morning, we'll have live music in the Women's Hour studio with singer-songwriter Josie Proto, who's written a song about the perils of women simply trying to get home safely. Really looking forward to that. But first this morning, American gymnast and four-time Olympic gold medalist Simone Biles has withdrawn from today's individual all-round final in Tokyo. Now, this is big news. It's made the national press.

Looking at the newspapers here, it's not just made the sports pages, it's made the front pages of both The Guardian and The Times as well. Now, Simone Biles is the most successful US gymnast of all time. She said she pulled out to focus on her mental health after also withdrawing from the women's team final yesterday. We don't know

yet if she'll compete in her remaining individual events. Here she is explaining her decision. It's been really stressful, this Olympic Games. I think just as a whole, not having an audience, there are a lot of different variables going into it. It's been a long week. It's been a long Olympic process. It's been a long long year we're just a little bit too stressed out but we should be out here having fun and sometimes that's not the case I say put mental health first because if you don't then you're not gonna enjoy your sport and you're not gonna succeed as much as you want to so it's okay sometimes to even sit out the big competitions to focus on yourself

because it shows how strong of a competitor and person that you really are rather than just battle through it. Simone Biles there. Now, someone who has some insight into how Simone may have reached that decision is Jennifer Pinches, who helped Great Britain's artistic gymnastics team to a sixth place finish at London 2012 and who now campaigns for change in gymnastics following allegations of widespread abuse

and unsafe practices within the sport. I spoke to her a little earlier and asked what she made of the situation. When I competed in London 2012, there was an immense amount of pressure and I can only imagine how much more that is for Simone Biles. She not only has the pressure of competing at the Olympics but also the expectation and pressure of her reputation that's preceded her you know she's so so strong and so

good and that but at the end of the day she's still human and she's also dealing with incredible unprecedented circumstances around coronavirus and around the culture of the sport needing to change so the amount of pressure that she's under is is hard to imagine even for someone like me who's competed at the olympics but it will be absolutely immense and i think it's amazing that she's been able to speak up and put her mental health first and and make that decision and that her team supported her in that putting their mental health first has not always been the first thing that athletes are able to do. Is this a sign of progress, perhaps? I think it really is a sign of progress.

It's something we've been fighting to change with Gymnasts for Change in the UK and around the world recently, following all sorts of terrible revelations about people's experiences in the sport unfortunately you know physical and emotional abuse that's been happening health hasn't been put first so the fact that Simone is now able to stand up and say you know what I need to put my health first in this situation. Mental health as well as physical health is definitely a sign of progress and that her team and her organisation has supported her in doing that. I think for too long it's been glorified that, oh, you know, just go for a medal. It doesn't matter about your health. Medals are all that matters.

And a really good example of that is Carrie Struggs' performance and how she helped the US win gold. And I think that this is a key example of how that's changed and how we're saying, you know what, medals are what we're here competing for. But at the end of the day, your health is still more important than that. And we're not glorifying, you know, pushing yourself to potentially dangerous limits in order to get that medal. Well, yes, you mentioned the danger there. And of course, if you're not mentally in shape, it can be physically dangerous, can't it, to compete in a sport like gymnastics? Yeah, I think it's hard for, if you haven't done gymnastics, to understand.

But obviously, the amount of time you have in the air and these skills is so technical and you have milliseconds to try and make a decision on how to land safely on your feet and if your mental game is not there and you if you do get what's called being lost in the air people refer to it as twisties um it's very very dangerous you know if you um can't get that spatial awareness to know where you are know where the floor is and where the ceiling is then then you can literally die. It's life or death situation. So by stepping back, she's done a very important thing,

not only for her mental health, but for her physical health as well. What do you say to all those people that have called her selfish for pulling out? It saddens me that I've seen people online calling Simone selfish for pulling out. If anything, it was a selfless decision. She's put her team first. She said, you know what, I can't perform my best today. But she's had every confidence in her teammates to do so and she's been there on the sidelines, carrying chalk, supporting them,

giving them the words of advice that they need. And she's absolutely a part of that team and a leader that's helped them win the silver medal. If we look, Jennifer, at this issue more widely, I wonder how much the mindset that athletes have to adopt, you know, the kind of win at all costs, suppress all emotions to make sure that you can reach your goal. How much does that impact on mental health? It's so much pressure. It's hard to it's hard to get a grasp on it. But there is a huge impact on mental health? It's so much pressure it's hard to it's hard to get a grasp on it but there is a huge impact on mental health. Gymnastics is a very physically demanding sport but it's equally very

mentally demanding. You're up on sometimes you know a beam 10 centimetres wide piece of wood doing incredibly difficult skills and there's only you that no one can help you it's a lot of pressure on you as an individual to perform in like I said doing very dangerous high risk skills and that's part of what makes it so exciting in that you do have to be absolutely at your physical and mental peak but it's also what makes it very important to put health first. And of course this is exasperated by the fact that the Tokyo Games is very different to any other Olympics. It's in the midst of a pandemic where friends and family and support systems haven't been able to be there for these athletes. So that makes it even harder, doesn't it? There's never been a Games quite like this in the middle of a pandemic.

So the athletes out there competing without a crowd, without their friends and family able to be there in the crowd to support them, are already, you know, they're already under immense amount of pressure. But now they're under that additional pressure and with that lack of support they would normally have. So it's incredibly difficult situation. But Simone Biles, you know, she is pushed through having kidney stones at a world championships, being a survivor of Larry Nassar. She is one of the toughest gymnasts. And so for her to step back and say, actually, I need to focus on my mental health today, just shows that this is not a kind of, oh, she's not tough enough situation. It is absolutely incredible the amount of pressure that she and the gymnasts are under. Yeah, I just think it's great that she's been able to put her health first and empower other people to do the same. That was the former GB gymnast, Jennifer Pinches,

talking to me a little earlier. Now with me now is Lindsay Woodford, who's a senior lecturer in psychology and programme leader for sport and exercise psychology at the University of West England. Good morning, Lindsay. Good morning. Great to speak to you. Welcome to the programme. Now, we heard Jennifer there talking about pressure on athletes. And of course, there is always going to be pressure to win medals. But I wonder if there's a difference between the pressures put on sportswomen in comparison to sportsmen? Yeah, no, interesting question. There's been a lot of research that's looked at the differences between male and female athletes and the way in which they experience pressure and also mental health problems. And I think, yeah, something to highlight here is that actually we often think of athletes as being superhuman.

And sometimes perhaps it comes as a surprise to us when athletes do report that they're experiencing mental health problems. Well, actually, we do know that the athletes are just as likely and sometimes more likely to experience mental health problems than the general population. But with regards to women and women in sport, there is a tendency for women to report mental health problems more than men do, which is possibly due to the masculinity that surrounds mental health in men. So it might not be that there is a difference in the experience. It's just with regards to how it's reported and also how I think it's received by the general population and also by those who compete and work in high performance sports.

Simone isn't the first athlete, the first sportswoman to do this. If we look at the wider context of this, recently Naomi Osaka also said, you know, hold on a minute, this is a bit too much. I need to step away to protect my mental health. Are we seeing a change amongst sportswomen, do you think? I would really like to hope so.

Yeah, absolutely. You know, and it takes real bravery know real courage to be able to to stand up and try and you know shake this this culture up a bit that talks about this winner all costs mentality and that you know it doesn't matter the sacrifices you make to your physical health your mental health um you know and especially like a sport like gymnastics you know the toll it takes on you physically you know from these athletes that compete when they're injured you know when they're ill um you know and they're competing when they're you know their mental health is also struggling and i think you know perhaps this is the you know the the last part to finally come to the fore and to really highlight you know

the pressure that these these women are under and but yeah the impact that it can have on their mental health and i think if we look at you, the context of the global pandemic as well, and that, you know, as a variable, as a risk factor, when we think about gymnastics as an aesthetic sport. So typically female athletes in aesthetic sports like gymnastics have a much higher risk factor for mental health problems. You know, you lay a global pandemic on top. My research recently was looking at the impact of COVID on athlete well-being.

And one of the results of that study was that athletes who had pre-existing mental health problems, actually that was exacerbated during the lockdown period. So, yeah, absolutely. I think that's a part of it as well. And hopefully with more athletes, you know, as you said, you know, like Naomi, like Simone coming forward

and talking about the impact sport has on mental health, hopefully it will empower other athletes to come forward and also for younger athletes to actually challenge this now and challenge that culture that, you know, it's not OK

to sacrifice my mental health in the pursuit of a position on a team or in the face of a medal. Well, here's hoping that Simone Biles comes back safe and well soon. Lindsay, very good to get your thoughts. Thank you for coming on. My pleasure. Now, an estimated half of women in the UK will have a UTI or a urinary tract infection at some point in their lives. Close to a third of women are likely to have a reoccurrence, with older women more likely to suffer from them. That's according to the National Institute for Health and Care Excellence. Dr Agnes Arnold-Forster is a medical historian and researcher at McGill

University who has suffered with them. She's produced a documentary about the experiences of some women with the condition. One of the women featured, Jill Donker-Curtius, is in her 60s. She's been dealing with chronic UTIs since she was 16 years old and says treatment hasn't changed. I had some very bad ones. The last one three years ago was really, there was a lot of blood and I was really very frightened thinking I had cancer or something because I'd never seen that before.

And I went and saw a female doctor. Well, she was very relaxed about it and said oh that's very common and I suppose I should have been pleased that she said that but I actually felt well it may be common but it's really frightening and it's really horrible why is this blood I don't understand why it's happened now you know they've got the medicine and the medicine is this and this is how it goes it's like a script you know and actually I think I've learned that I need to take more charge of my own health for my own body and I have to have the confidence which is not easy because you don't feel you know to put my case forward and not just you know take what is given really and it's a hard thing to do

in a doctor's surgery because they're the experts there's not been much change um how doctors treat UTIs from when I had them at the beginning I think it's pretty standard well let's discuss this further shall we um we're joined now by Dr Agnes Arnold Forster and Dr Kat Anderson who's a GP who specializes in treating UTIs. Good morning to you both. Good morning. Welcome to the programme. Good morning. Kat, firstly, what is a UTI for people that aren't aware? Because there are quite a few different types, aren't there?

Yes, indeed, there are. A UTI is an infection that infects the urinary tract. And that may be either the kidneys, the tubes that lead from the kidneys to the bladder that we call the urinary tract. And that may be either the kidneys, the tubes that lead from the kidneys to the bladder that we call the ureters, the bladder or the tube that leads from the bladder to the outside world, the urethra. There are different types of urinary tract infections. There's acute UTI, and that's the sort of UTI that comes on suddenly

and is easily cured with a short course of antibiotics. And then there is recurrent UTI. And recurrent UTI has got two definitions. It can either be two or more episodes within six months or three or more episodes within 12 months. And then the previous contributor mentioned chronic UTI. This actually hasn't got an official medical definition, but we do recognize a cohort of patients, quite often women, who suffer with frequently recurrent or even constant urinary tract infection, and sometimes even just urinary tract infection symptoms, which can lead to misdiagnosis as something called interstitial cystitis, when in fact, some of us that specialize in this area

and provide more detailed testing recognize that it's not actually chronic cystitis of no known cause, it is actually underpinned by infection and often starts its journey as acute UTI evolving through recurrent UTI and becoming this constant UTI, which to be honest is devastating for patients. So Agnes, just tell us about your experience with UTIs and the problems that you had with diagnosis. Absolutely. So I had my first UTI, I think I was 16, 17. I'm now 30. So after that first infection, I then lived with an infection every maybe three to six months for the next 10 years. And repeatedly going to the doctor, repeatedly being told either that there was no evidence of an infection in the dipstick testing they do in your GP surgery being fobbed off by saying well just go

home and take over the counter medicines or saying oh I don't want to give you antibiotics or kind of implying that it was all in my head and after years, I went on a longer course of antibiotics, which seems to have cleared up for now. But it was just a kind of incredibly protracted experience of an incredibly frustrating experience of not being taken seriously and being repeatedly undermined by the people who were supposed to be there to provide care and support my doctors. And this seems to be a trend for quite a few women not being believed about their symptoms. There's a history of this, isn't there? Absolutely. So the testing that we now use to diagnose UTIs was developed in the 1950s by someone called Edward Cass. And since multiple researchers, doctors, scientists have recognised that the testing is inadequate or only applies to a very small number of cases or was initially designed to only apply to a small number of cases. And so what we have here is sort of a 70 year period plus.

I mean, I'm originally a back as the 19th century, who are being mismanaged by their healthcare professionals, being disbelieved, and having to find alternative sources of support, either in each other, in communities, either, you know, traditionally, in real life communities, and more recently, online ones or on Facebook groups. And it shouldn't have to be like this, you know, you should be able to find the support and care you need from your doctor. Kat, why is it women predominantly that suffer with this in comparison to men and particularly older women? Right, okay.

So women have approximately three centimetres of urethra, the pipe that goes from the bladder to the outside world, whereas men have approximately 20 centimetres of urethra, the pipe that goes from the bladder to the outside world, whereas men have approximately 20 centimetres of this pipe. And because of the shorter pipe, plus the closeness of the anus, the vagina and the urethra, the bowel bugs can make that trip, that short trip and actually gain access into the urethra and ultimately into the bladder. Certain risk factors such as sexual intercourse, dehydration, sometimes even going in hot tubs, swimming pools can actually make the situation worse and help the bugs on their journey up into the bladder. It's interesting what Dr. Arnold Forster was saying about them not being taken seriously in the misdiagnosis. We do use dipsticks, but unfortunately up to 50% of dipstick tests

are negative with the patients, yet those bacteria will grow in culture. And unfortunately, the cultures are flawed as well. So we're not helping the patients at any step on this journey. But unfortunately, the GPs are not helped either. They are caught in this space whereby they use these tools. They are not provided with anything better. And they are really caught by the guidelines as well. But if the guidelines are looked at, even the NICE guidelines 2015, they do say that patients should be treated empirically based on their symptoms that present and not rely on tests such as the dipsticks. But unfortunately, this doesn't always translate into practice.

Why did you decide to make this documentary then Agnes? So I've one of my oldest friends called Rita Connery and has also had in some ways a much worse experience with UTIs also since she was a teenager and we've been friends all this time and despite all the kind of pain and suffering and anxiety that a UTI causes one of the sort of silver linings is that it does mean that you can core sort of produce a connection you get a sort of develop a feeling of solidarity with other women going through similar experiences and so we've been talking about this sharing best practice supporting each other for you know the past 15 years um and just recently i work on a project that's funded by the welcome trust called healthy skepticism which is about

thinking about how we can improve health care and as part of that project me and rita decided to team up and make this documentary to highlight not just our own experiences, but also the experiences of some people who've had an awful time with it, really. And we've had Jill as one of the examples of those people that we featured in the documentary,

but also others who, people like Joe, who had a chronic UTI for a decade, had sepsis, was unhospitalized, has told us about how she felt suicidal. You know, this is something that has a devastating impact on people's lives. And it's something that needs better coverage, more awareness. And it needs people who might be experiencing these symptoms alone and without the kind of support that me and Rita have been lucky to have with each other and that they need to know what is out there and available to them and they also need to know that what they're

experiencing can be resolved by good care. And in your documentary you highlight the support that women can find in Facebook groups as well. Yeah absolutely so this is something so there's one particular Facebook group that three of our participants co-run, it's called the Embedded Chronic UTI Support Group. And it's exactly about doing this, about providing support to each other, but also about advocating for change and for, you know, recommending treatable sort of options for treatment that actually work and that can actually help people transition out of a period of chronic suffering into towards wellness and towards feeling better in themselves. Well that is very positive and Kat just just lastly what what more

can be done about this there there are a lot of women suffering? Well one of the measures that that can help is recognising where you can access better testing. It is difficult to access this, but there are some private facilities where you can get more exacting testing because, unfortunately, as Dr Arnold Forster had mentioned earlier, the testing that was set up had a threshold that was set far too low in terms of the quantity of bacteria. And this was discredited back as early as the 1980s, but unfortunately didn't catch on. There are labs, I have a lab focused medical diagnostics where we drill down and we do more

exacting testing where we do find the bugs that are responsible, even in the cases where they say there's no infection present. We find infection in virtually every single case of chronic cystitis. Additionally, for our postmenopausal women who are much more likely to get relapses of their original UTI, I mean, 36% of young women will experience a recurrence within one year. Over 55% of women who are postmenopausal will suffer relapse within one year. They can use extra oestrogen to help shore up the defences against these bugs. So using vaginally administered oestrogen can really help in putting that barrier up against infection and helping heal when there is inflammation in there. Additionally, we can be very much aware that this condition exists and put in extra safety measures to not get that original acute UTI in

the first place. I've long believed that we could do with a health campaign highlighting the fact that women should always pee before and after sex, that you should always stay well hydrated when this condition runs in families. And indeed, there is some evidence that there is a certain genotype that makes women more likely to get this type of infection. Be very aware right from the outset and try and ward it off. That's good that there are some solutions in place. Dr Agnes Arnold-Foster and Dr Kat Anderson, thank you so much for joining us on the programme today. I do have a statement as well from Dr Anne Connolly, who's from the Royal College of GPs, actually the lead for women's health, and says that GPs take concerns about women's health, including urinaryPs take concerns about women's health including urinary tract infections extremely seriously and are highly trained and skilled to care for patients. If

appropriate urine dipstick tests can be used to identify UTI infections in conjunction with assessing a patient's symptoms and guidelines have recently been updated to ensure these tests are effectively assessed in practices but GPs also need to have better access to diagnostic testing in the community. When a patient suffers from recurrent bouts of infection along their urinary tract, GPs will often refer them to a specialist, such as a urogynecologist and urologist for treatment. Now, that last discussion that we had on UTIs was inspired by a listener email and we're looking for more great ideas, a whole week's worth in fact, because as you already know at the

end of August we'll be running our annual listener week where every item, discussion and interview is suggested by you. We've had loads of fantastic suggestions so far, but if you've still not sent one in, there's still time. Don't worry, you can email us via the website or put a comment on Instagram, send us a message on Twitter, for example. And if you don't mind one of the team giving you a call, you can leave a phone number with us as well. I look forward to reading about all of your brilliant ideas. Now, yesterday, the Independent Inquiry into Child Sexual Abuse said staff and counsellors in Lambeth in South London presided over a culture of cover up. The report said abusers were allowed to infiltrate children's services from the 1960s to the 1990s. Many involved in this area says the system continues to let vulnerable children and teenagers down. A Times newspaper report at the end of May showed thousands of girls,

some as young as 11, are at risk of sexual abuse whilst being reported missing. Many have criticised the existing support systems in place. A new approach known as contextual safeguarding has been described as a rewriting of the rules of child protection. So how might it help these girls and other young people at risk? I'm joined now by Anna Holland, who's a consultant social worker from the NSPCC, and Professor Carleen Furman, who has developed this new approach over the last few years, I should say. Welcome to you both, ladies. Hi. Hi. I think Carlene first it would be good to get an idea of just what contextual safeguarding actually is.

Hi so in short our child protection system was designed to respond to abuse within family homes so when children came to harm within a family home, you assess the family and you assess parents' capacity to protect their children. Cases of sexual exploitation and other forms of harm beyond family homes in public spaces, parks, shopping centres, schools, children's residential units and so on, suggest that far more contexts need to be assessed when children come to harm. If we want to protect a child from being sexually exploited in the park, we need to assess the park, we need to identify who's exploiting them in the park, and put support in place into that context. We safeguard that context, as well as support the family and the young person affected. And while that may feel like common sense to many of our listeners, that's not what our child protection system was designed to do. It assumes that when

something goes wrong with children, we look to their parents to understand why. And in cases of sexual exploitation, criminal exploitation, serious youth violence and peer to peer sexual abuse, we need to look far beyond parents to identify a solution. So, Anna, as the Times report stated, thousands of young girls are at risk here. Is there a need to rewrite the child protection rules currently? Yeah, I mean, I think what Carleen has mentioned sheds a really good light on that. I think there is a need to widen the lens here. I think, you know, many of the situations around missing children and young people and we're talking about boys as well as girls here can mean that we need to look to context outside the family home. Sometimes you

know of course we need to assess and look for issues that might be going on within the family that could be driving that but we need to also be really curious around actually what situations the young people going missing from but also what might be drawing them in, what is impacting, what's happening for them. And also recognising that all children are vulnerable to this form of exploitation. It's not just girls, it's not just children that are missing, you know, that there is a vulnerability in adolescence that can mean that, you know, any young person can be exploited. And I think there's something important about recognising that so that children and young people from other contexts feel they can come forward and talk about this.

We don't want to reinforce stereotypes that it only happens to certain children. So, Carlene, what are the consequences here when child services get this wrong? Well, the consequence is that we looked to the wrong place and risk continues. So very early when I was developing contextual safeguarding, I reviewed six cases of sexual assaults and beyond the family home and three murders. And in all those cases, the individual children who came to harm or were suspected of causing that harm were assessed by

social workers and their parents. And when parents were found to be doing all they could to protect those children, those cases were closed to children's services and no one had oversight of those children. In addition, while police investigations continued into what happened, that rape on that stairwell, that rape in that park, there was no safeguarding response to that park and that stairwell. So even when people were convicted of criminal offences and even when they went to prison, the stairwell featured in one of the cases I reviewed remained a hotspot for sexual assault for another six years with other children using that stairwell to commit sexual assaults against other children.

And there was no understanding about what on earth was going on on that stairwell that meant it had become a hotspot for this type of behaviour with lots of different young people using the same stairwell for abuse and we see the same patterns in our high streets and shopping centres and parks or that's where that happens don't go there as if that we accept that and we and we encourage children to stay away from that park or stay away from that youth centre children should be safe in our public spaces and we should not be accepting that they're at risk of exploitation in those spaces and that's why it's the rewriting of the rules as anna said it's an expanding of what we currently do the children act 1989 is excellent as a legal foundation for responding to um challenges within the family home what it doesn't do is respond to risk beyond the

family home and as a society we need to understand that we have a collective culture and need to create safety for children. It doesn't stop with their parents. We all have a responsibility to create safety in public spaces, in school environments and so on. And contextual safeguarding just offers us a framework to communicate how that might happen. Well, Anna, as Colleen said there, there's many agencies involved with this in protecting children, not just child services. What role can education play here? That's your area of expertise, isn't it? Yeah, I mean, certainly as a social worker, we work really closely with schools and those in the education sector. And I think they've got a really key role. They are where young people are the majority of the time. Hopefully, we hope when

they're not when they're not at home and and I think it can really start with with culture as Carly mentioned as well so you know it is about giving you know the right messages to children and young people it is about having I guess courageous conversations with them as as education staff so to give a bit of an example, we might, you know, talk with schools around sort of exploitation and you might get attitudes that are quite strongly held by young people in terms of, you know, quite victim blaming language

or, you know, you know, sexual assault doesn't happen to boys or, you know, well, if they were hanging around in that stairwell what did they expect um and i think the the the conversations we need to have need to open up and be curious about that you know what what are some of the attitudes and experience for young people that are driving these attitudes how do we challenge that in a in a way that expands their curiosity and and helps adapt behavior rather than blames them,

rather than shuts them down and said, shh, get out of the classroom, I can't believe you said that. Actually, we need to be curious about the messages we're giving young people in education, so that if something does happen, they're not immediately thinking, oh, well, I heard about this in school. I heard that it was dangerous to go out at night. I heard that I shouldn't talk to people online that I don't know. And now something's happened and now I can't tell anyone. And what's the feedback been like, Carleen, from social workers, from youth workers in regards to this new approach? I've been really encouraged by the feedback from a range of professionals about contextual safeguarding. You know, when I first proposed it as a concept, we were aiming to maybe try it in one local area,

get 100 practitioners on the network to speak with us. We now know 53 local areas in England, Wales and Scotland are adopting contextual safeguarding to help them think about how they change their response to harm beyond families. But we also have over 10,000 practitioners accessing our online contextual safeguarding network, sharing their experiences through blogs and podcasts of how they have been able to create safety for young people in residential children's homes, in parks and public spaces, on high streets. And it brings them back to why a number get into social work in the first place, which is to create the conditions in which families can stay together safely, where we come in at the intersection of individual decision making and the harm that people face and try to

do something about that. It gives them a different language to do what they know to be the case. And this is where we were really challenged with what was being asked of social workers when there were inquiries into sexual exploitation 10 years ago, five years ago, there was an assumption being made that social workers were just not responding. They just weren't doing anything about these issues and they needed to work harder. When in reality, simply saying, okay, this child's being exploited, now we respond, that wasn't going to be, that was never going to be enough. We definitely needed work at the time to move from seeing children as being responsible for the harm that they were facing

to recognising they needed support. And that's where the energy went five to ten years ago. But that was then based on an assumption that once we recognise this child is being harmed, we've got a child protection system, social workers respond without seeing our social workers are using tools and a system that was never designed to respond to sexual exploitation so i compare it to the transport announcements we get very often around packages suspected packages see it say it sorted we were never going to be able to just see it say it and then sort child

exploitation we're in a position where we can recognize it so we're seeing it we can say it's abuse we can say these children are victims so we're saying it it is not sorted because we didn't have a system that could sort it and contextual safeguarding is one contribution it's not a silver bullet to giving social workers a better structure in which they can try to offer protection for young people who are being abused. Anna, what would you say to those that might be worried about a young person who's having problems? What can they do, particularly now, you know, the last 18 months in Covid and lockdown and restrictions? It's been very stressful.

It has been, absolutely. And I think it's added a huge amount of pressure to families lives to young people's lives and so you know I would always say to any adult that's worried about a young person and they can they can you know to talk to someone about it you can contact the NSPCC helpline and we'll make sure the contact number for that is up and for young people as well you know they might be worried about something that's happening for themselves, they might know about something or be worried about something that might be happening for maybe one of their friends or someone they know, is that there is always someone you can talk to, you know, you can talk to, you know, parents, carers, friends, parents, friends, carers, it's the summer holidays at the minute, so schools aren't

as accessible. But there are organisations like Childline who provide sort of telephone and online support for young people that are worried. And we know the language, Carleen talked about language, but we know that it can be really hard sometimes to find words for what is happening or for what young people may be worried about. Sometimes they're not sure how much they should be worried. So talking it through, I think, is always a really important option. Anna Holland and Professor Carleen Furman, thank you so much for your time this morning. Our rising singer-songwriter Josie Proto started out playing her grandmother's guitar. Growing up, she was frustrated by the extreme measures women needed to follow to safely get home. So she wrote a song about it.

I Just Want to Walk Home has been given the seal of approval from Radio 1's Annie Mack as the hottest record in the world. Josie is in the studio with me now. Big smile on your face after I said hottest record in the world. Very good morning to you. I've been looking forward to this because you're going to give us a little bit of a song later, aren't you? Yes, I am. Yeah. Brilliant. Now the subject matter, I have to say, feels very pertinent considering, you know, the recent Sarah Everard case. Is that what informed the song? There was so much discussion around like Sarah's tragic death and the situation, I think more what informed the song was the response

and the narrative surrounding her death that was so frustrating for, I think, not just me, but nationwide, women all over the nation, feeling so frustrated with the way that people were responding to the to her death um and I felt like it wasn't um it wasn't giving us the representation that we wanted and tell me about the video it features a a wide array of different women doesn't it yeah so the video is out today um and I it's one of like the the one of the things I'm the most proud of it's one of the, like the, the, one of the things I'm the most proud of. It's an incredible, I had, we had like, you know, 30, 20 to 30 women who all came in and lip sunk to my song and they

weren't, you know, actors or actresses. They were just women that were passionate about this and wanted to be there and wanted to talk about it. And, and they were so passionate that afterwards we ended up actually filming loads of conversations with them about and questions um because they were they wanted to talk about it and they wanted to have these conversations and it was so empowering the room felt incredible when they were talking about it was such an incredible experience and i'm so proud of it and it looks fantastic and it's such a powerful video congratulations thank you um this isn't uh your only song that's caught people's attention. There was another song of yours, B-Tech Lily Allen, that went viral on social media and led to a record deal.

My goodness, you've had a pretty productive lockdown. What have the last few months been like for you? Absolutely insane. I'm that really annoying person that's like, you know, started a hobby in lockdown and actually done all right out of it sort of thing. And I've been writing and playing guitar for a very long time. But in lockdown, I was bored and sung my song, Be Take Lily Allen, which was essentially a song made up of any sort of hate that I'd been given about my about my music and posted on TikTok. And then like literally in the evening, I couldn't turn my phone on because I was it sort of went a bit mad and then yeah so my past year has been incredible I've like

signed a record deal which is insane and it's like has been my dream since I was like 14 and I'm doing it kind of full time now so it's really exciting. That is exciting so where can listeners hear more of your music and tell us what's next for you? Everywhere, on all platforms, anywhere you listen to music normally you can find me. And what's next is just writing more stuff and releasing more stuff. I'm just really enjoying being able to play songs that mean something to me and I'm so passionate about to people and for them to listen. I can really tell that.

Big smile on your face as soon as you walked into the Woman's Hour studio. Let's give it a whirl then, shall we? I've been looking forward to hearing you sing live. Everyone, this is Josie Proto, who is going to sing her song, I Just Want to Walk Home. I left my hair in the taxi Cos the driver was a creep Chatting on my dead phone just want to get home you okay with where we are because I see nothing changing it's beyond frustrating I just want to Beautiful. That singer-songwriter Josie Proto, who started out playing her grandmother's guitar to ending up with a record deal.

That was her singing her record, I Just Want to Walk Home. Thank you so much for that, Josie. Thank you so, so much for having me. Thank you. Absolute pleasure. Now, the extreme weather is back in the news. It never really left, did it? In the past few weeks alone, we've seen heat domes over the Pacific Northwest, flooding in Germany, China and London, and severe drought in California. So what's going on? Scientists have been warning us about the consequences of global heating for decades. Currently, the Intergovernmental Panel on Climate Change is preparing its latest assessment of the science.

And there's also COP26. That's the UN Climate Change Conference of the parties happening at the end of the year. But how have things moved on since the last event? Bianca Pitt, one of the co-founders of the campaign She Changes Climate, thinks the key to solving the climate crisis is having more women at the negotiating table. She joins us now and also Fahana Yamin, renowned environmental lawyer, expert in international climate negotiations, and the person behind the concept of net zero. Welcome to the program, both of you. Hello. Thank you so much for giving us the opportunity. Of course. Good morning. Now, Farhana, you've been at more climate summits than most people. What exactly happens at these events? I don't think Farahana can hear us. They've got bigger and bigger.

Paris was around 30,000 people. And what happens is there's a government negotiation part, a formal part, and then there's a huge discussions, collaborations, new initiatives organized by women, by civil society, by local mayors, by indigenous people, by students. So all of that, you know, constitutes now what a COP gathering is. But the core of it is these government negotiations, which government delegates do. And obviously there's a huge media presence as well. OK, and what are they like currently in terms of gender representation? They're a lot better than they used to be. They were pretty

male dominated at the delegation level. There's now a much greater number of women participating but not enough at the senior levels. So the heads of delegation, the person who is in charge of your country's position, is typically an older man. That's the composition. And like many areas, there is gender balance increasingly at the younger level. So in the 20s and 30s, when you do an age analysis, and we have the age analysis because every year the figures by age demographics and the number of women in different bodies different

committees, for example, that are set up and they've got better, but in some cases that progress has been reversed. So there isn't a steady arc of progress here. We need to be vigilant and need to campaign. It's a bit annoying given that it's 2021 and, you know, we shouldn't have to be fighting for a seat at the table and our share of voice. We're just having a few technical issues with your line, Farhana. So I'll move to Bianca. And what would change look like if more women were involved, do you think? So thanks very much for giving us the opportunity to speak about this today. We've looked at research and that has been very, very promising. So we've seen that countries that have more female parliamentarians have stricter climate policy

and better policy implementation. Research of board composition shows the same. So where we have more women on boards, we have better climate policy and better policy implementation, even within companies. Women are more likely to ratify international environmental treaties they are more likely to create protected land areas and we've even seen recently that for example women women's spending is causes few emissions and men spending. So I think just generally as women seem to be benefiting climate, considering climate in their actions, in their decisions, in everything they do, we would see that there would be immediately improvement

with a decision making. If we look at peace negotiations, we found that for example, truce is 64% less likely to fail when women are included and is likely to last longer. Agreements that included women had better outcomes. This is research conducted by UN Women. And in general, if you look at specific

traits that distinguish women from men, they are perceived to be more trustworthy, more public-spirited. They're shown to be more caring and empathetic. It's, I think, well understood that women's leadership is considered to be more collaborative. Women are more likely to be civically and socially engaged. And they're also less motivated by their own success than men. I see. So there's lots of evidence out there. Fahana, has being a woman for you helped in international negotiations? Has it given you the edge, do you think? Oh, no, I think it's been hugely complicating and difficult. And I've had to seek the solidarity and support from many female colleagues just to get through the everyday sexism, racism, and those stories are rife now. And now our young women should not have to go

through that. And older women should not be, you know, discounted as they are, and not given the positions of authority and the positions of power. And that's what it comes down to when it's positions of power, there is this huge reluctance, there's an old boys network internationally and in national delegations um and so it's as i said we've made huge progress but uh it's it's it's it's too much you know it isn't too much in 2021 for even the uk presidency to have um you know nominated at the beginning of this year, an almost entirely male, any competent woman, please, can you include us? And the norm really should be, that we should challenge is, no one can speak on behalf of someone else. You know, there is still this norm, why do you need to have a seat? You know, why don't you just let others speak for you? And that's the norm that

is really pernicious. There is still an unspoken norm that it's okay you don't really need to speak for yourselves you don't need to bring this diverse experience you know others can do it better for you um so that is colors you know so much of of the way in which the day-to-day operations work um and it's fantastic that you know we are through bianca's campaign, She Changes Climate, there has been many new appointments that they've hastily then had to make, which are trying to balance the UK presidencies for this important call. Now, Bianca, as Farhana has mentioned there, it's a very complicated issue, isn't it? So how do you

look at, you know, the fact that on one hand, as women, we will argue that men and women should be treated equally, while on the other hand, suggesting that women somehow have this special skill that make them more suited to saving the planet? How do you weigh up the two things there? I think, you know, ultimately, we need to have radical collaboration now. We have to show that we can sail the choppy waters that lie ahead together. And we call that having 50-50 vision. So we need women and men to co-lead these efforts. It can't be, the international climate negotiations can't just be run and negotiated by men. You know, as you wouldn't sail the world with one eye firmly patched up, you would always make sure you have two eyes firmly on what lies ahead.

So I think that's one thing to consider. And we need all the skills that men and women bring in to make these international efforts a success. We also need, however, new and fresh perspectives being brought on board. And for that, we need new architects, people who have previously not been involved, who have not been heard, who have not had the possibility to really give their input. Because what we need to do now is redesign all the systems to create a sustainable future. We need to redesign the finance industry. We need to redesign transport. We need to redesign the energy system, the food systems and so on.

And for that, we need new architects to come on board. And we argue that these new architects are women. Yes. Now, Farhana, there's been 25 of these UN climate change events already. The 26th is coming up a bit later this year. So has enough been achieved for you in your mind? No, no, we're very far from, you know, the big goals that we set ourselves, which are enshrined in law in the Paris Agreement. So not enough emission reductions have been delivered, not enough financial support for vulnerable communities and countries has been done to mobilize, you know, the great constituencies of the world, not just women, but also the world's young people, also the world's workers, you know, all of these, the indigenous and local communities that own resources. So that's what this is really about.

I hope that the women who are championing, you know, a place at the table are also, by the way, championing the rights of other constituencies, other major groups to join in what needs now to be done, which is a complete transformation of society. And you don't do that by a narrow base of decision-making with a very skewed elite dominated by men, actually, globally by men. Most of the polluting industries are chaired by men let's face it that's the truth uh it's then none of none of the big fossil fuel companies are

chaired by women they have very few women board members so challenging you know vested interest and power can only be done by bringing in all of these other constituencies and if you don't bring in the obvious one women at all levels you're not going to get as far in considering you know the rights of our young people the rights of indigenous people the rights of farmers the rights with those with much less power and workers and that's what i'm going to be working on and where my energies are going because i think for the last 25 copsPs, 24 of which I've attended, 23 of which I've attended in person, we haven't had, you know, this mass mobilisation. That's what's into decision-making. They must see themselves represented.

They must see a role for themselves. And that's why I'm calling on, you know, many of the people in power to to make way for hannah yamin and bianca pitt thank you very much for joining us on women's hour this morning and now just before we go i'd love to read that the responses that we've had on utis has been absolutely incredible from our listeners someone has written in to say when my mum was in a care home with dementia the women and men too were constantly getting UTIs. This is common throughout homes, as a recent study shows, and puts a huge amount of pressure on hospitals. So

many of you getting in touch saying thank you. Thank you for talking about this issue. Absolute pleasure. Thank you for your company today. I'll be back on Woman's Hour with you, same time, same place, 10am tomorrow. Thanks for listening listening you can join me live for tomorrow's program at 10 o'clock hello there i'm simon armitage i'm just heading down the garden path so this might be a good moment to tell you about the new series of my radio 4 podcast, The Poet Laureate Has Gone to His Shed. This shed, actually. And the shed's been quite a lonely place this past year for fairly obvious reasons, so it's great to be able to plump up the plastic cushions,

set up an extra fold-away chair, and natter about life and creativity with talented and thoughtful people. Guests include the Yorkshire Shepherdess Amanda Owen, broadcaster, DJ and gardener Joe Wiley, and Smith's guitarist Johnny Marr. Put your ear to one of the many knotholes in the wall by searching for The Poet Laureate Has Gone to His Shed on BBC Sounds.

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

How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.