Woman's Hour - Tahmima Anam, Genome Sequencing, Twinnie

Episode Date: June 1, 2022

Tahmima Anam is an anthropologist and a novelist. She's a big fan of silence and believes it can been harnessed to challenge sexism and expose bad behaviour. We talk about the pros, cons and ethics of genome sequencing for new-borns. A new pilot will be running shortly, so we speak to Vivienne Parry, Head of Engagement at Genomics England and Rebecca Middleton, who has an inherited brain aneurysm disorder and is a member of the panel representing parents and health care professionals.Do you know what "fexting" is? Do you do it? It's in the headlines because the First Lady of the United States, Jill Biden, has admitted that she 'fexts' with her husband. It means fights over text. So we're asking is it a good way to row? Behavioural psychologist and relationship coach, Jo Hemmings helps us out. In Japan abortion pills are illegal, but that's due to change by the end of the year. However it looks like a woman who's in a relationship will need permission from her male partner before she gets them, plus the cost could be out of reach for many. We speak to women rights campaigner, Kazuko Fukuda, and the BBC's Mariko Oi in Tokyo.And we've got Twinnie, the singer and songwriter from York. She describes her music as country pop, and her new track is called Welcome To The Club.

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

BBC Sounds. Music, radio, podcasts. Hello, I'm Andrea Catherwood and welcome to Woman's Hour on BBC Radio 4. Good morning and welcome to the programme. Today, what is your response if you hear a sexist joke at work? Some of us admit that we've laughed along and then kicked ourselves afterwards. Most of us wish we could think of a lightning-quick response that cuts the joker down to size. But what about total silence?

Tamina Annam used her training as an anthropologist to study and decode office culture. She thinks that women often talk too much at work. We feel we have to be enthusiastic, nod along, chip in. I wonder if any of that resonates. And instead, she's suggesting that if we said absolutely nothing more often, it could work wonders. I'll be talking to her about it later. I'm really hoping she doesn't stay quiet today. But also, I'd like to know what you think.

Do you agree that women try too hard to be likeable in the workplace and could shutting up a bit more often be a useful tool? Or will you get ignored completely? Maybe your workplace is so equal that this conversation no longer needs to be had. Please do share your thoughts and your experiences. You can text Woman's Hour on 84844 or on social media, it's at BBC Woman's Hour

or you can email us through our website. We're also looking at fexting today. That's fighting by text. I guess it's another way of communicating, staying silent. It's how Jill Biden apparently settles disputes with the President of the United States. So we want to know, does it work for you? And many of us think of Japan as a wealthy and progressive country, but you might be surprised to learn about its abortion laws. We've got two guests from Tokyo to talk about the latest attempt to liberalise the law. And country pop singer Twinny will be performing live in the studio. But first today, every day in the UK, children are born with treatable genetic conditions. Newborn babies are already routinely screened for some serious health issues with what's known as the heel prick test, which was first introduced over 50 years ago. The next project due to start next year through the NHS is exploring the possibility of expanding the screening from nine conditions to include many other rare diseases by sequencing and analysing the genomes of newborn babies.

So what will this offer parents and their children and what are the disadvantages and the ethical considerations of having this information? And how close are we to a national programme of sequencing the genomes of all newborn babies? Well, with me to discuss this are Vivian Parry, Head of Engagement at Genomics England, which has designed and will run the pilot, and Rebecca Middleton, who's inherited a brain aneurysm disorder and is a member of the panel representing parents and healthcare professionals. Vivian, welcome. Let's just start with the basics. Can you explain to us what genome sequencing is? So you will remember from school perhaps that your genome is your body's instruction manual.

You inherit it from your mum and dad. You've got a copy in almost every cell of your body's instruction manual. You inherit it from your mum and dad. You've got a copy in almost every cell of your body and it's made of DNA and it's written in DNA's special code. And there are three billion letters of that code. And what sequencing does is it reads literally letter by letter that code. And then there's the analysis, which can compare that code to see where there are changes which might be responsible for ill health. Now, the simple bit, perhaps, is actually getting this information in terms of it's a simple blood test for a baby, isn't it? Yes, absolutely.

So the sequencing and obtaining the blood, or it could be saliva, we're not quite sure yet, is the easy bit. The tricky bit is the practicalities. How do we do it without putting too much burden on healthcare staff? How do we do it in a way that supports parents? How do we ensure that they're given information in a way that helps them in their onward lives with babies who may have a serious health problem? There's all of that. And then there are the

ethical issues. What conditions should be included? All of that kind of bit. And we have done lots and lots of work already with parents, with health professionals. And we've got some really clear messages from that already. So we know that people do not want to know about conditions that can't be treated in childhood. They do not want to know about conditions that occur later in life. And they absolutely don't want to know about conditions where there's not only no treatment, but the kind of possibilities of those conditions later in life. So, for instance, they don't want to know about

a percentage risk of Alzheimer's, for instance. Absolutely. Can I just ask a question that I don't really quite understand the answer to? When you actually do this genetic sequencing, will therefore it be known? Will all that information be there? And it's just a question of what the clinicians then tell the parents, or will they only look for the bits that the ethics committee or whatever decides to look for? No, very clear here. So it's like throwing three billion balls into a ball pond and you're just looking for 200 or so red balls amongst all those balls. You are not looking for anything that you haven't told the parents about in advance. So

doctors, health professionals will not know something that parents don't know. They will only look for those things that parents have been told they're going to look for. Fabulous. That's extremely clear. Thank you for that, Vivian. Rebecca, you have an inherited genetic condition and in fact, the diagnosis of it saved your life. Before we go on to talk about your role, could you just tell us a little bit about that? Yeah, so I was diagnosed in 2014 with familial brain aneurysm syndrome. Brain aneurysms killed my grandmother at the young age of 34 and my mother a few days before her 60th birthday. But it wasn't until my uncle died of an aortic aneurysm that the family got together and started to think,

is this a coincidence or is this something more than a coincidence? So I agreed to kind of pick up the mantle and go ahead and do some research. Through that research, I underwent screening and that screening found an aneurysm and I was diagnosed with the familial condition. So they agreed that there was some genetic pattern there. It was hereditary. And then I underwent regular brain scans, regular monitoring until 2018, when the brain aneurysm looked to be growing. And that means it's unstable.

So I was at risk. So I underwent brain surgery too. Thank you very much for explaining all that to us. I'm so sorry to hear about your mum and your grandmother but it really, it must have been amazing for you to actually find out this information and indeed it has been life-changing, life-saving. Absolutely, you know, my children wouldn't have a mother

without this life-changing and life-saving? Absolutely. You know, my children wouldn't have a mother without this life-changing and life-saving surgery. As an adult, it was remarkable. You think you are kind of healthy, and I went along in my 20s and 30s believing so, just the usual kind of illnesses, nothing spectacular. And then to be hit by this huge sort of genetic hereditary condition that has an impact not only for me, but also my daughters, my sisters, my nieces as well. Brain aneurysms, the familial kind tend to run through the maternal line. And it certainly has done in this case as well. So it has been absolutely life changing. And I have been on this journey. I am now part of the 100,000 Genomes Project. I have an ultra-rare condition, I understand that, and at the moment I don't have

a result. I don't have a genetic result, so they haven't found yet my spelling mistake, but I live in hope. I live in hope that my data that's in the National Genomic Research Library will one day be picked up by a clever researcher and I will get a result. It won't help me, but I'm hoping it will help my daughters and eventually, hopefully, grandchildren too. Now, Rebecca, you are part of the panel of parents, doctors and nurses that are considering this research. What is it? We've heard a little bit from Vivian about what people don't want, but what are they telling you about what they do want from this research? The whole process was kicked off by an extensive public dialogue process. And through this, we learned that the public were broadly supportive of a newborn screening programme.

And this pilot project wouldn't have gone ahead unless we had, you like that green light from that public dialogue process but what they did tell us very clearly is to take your time to get this right they understood that the nhs is under strain they understood that there would be ethical challenges ahead so they wanted us to work through all of these slowly and carefully and ensure that we're designing a service that is co-designed with parents and that we get it right. And that's what we're trying to do through this pilot programme. Vivian, can you give us some examples of the kind of conditions that could be discovered and indeed treated through this programme that currently are not picked up with the Heal Prick test? So one might be severe combined immune deficiency. I'm sorry, there's a lot of long words here, but that can be. These are where children have very susceptible infection.

You probably know it as the boy in the bubble type of disease. And that can be treated with a bone marrow transplant very early in life. And that's the baby sorted. I mean, they should have a pretty normal life thereafter. That's a quite expensive thing, but there's another one, which is hereditary fructose intolerance,

where all you need to do to stop the baby being severely ill is to take fructose and sucrose, so two sugars, very common sugars, out of the diet. There's another one, pyroxidine-dependent epilepsy, that can be treated with daily doses of vitamin B. So there are lots of very simple interventions that can be done for these diseases. And of course, if it wasn't picked up very early on through this sequencing, it might be discovered later, but by then it would have taken ages and perhaps the child would have been ill in the process. Indeed. I think that what we're seeing here is we're seeing a window, a window of time in which the NHS can act to do something,

either to reduce the impact or even prevent completely these conditions. And that's hugely important. And yes, sometimes these symptoms, and they're not, they may be symptoms that are actually quite common. And sometimes you think, is this my baby just being a bit slow? And we all know that babies develop at different rates. And often parents are falsely reassured, when there is a problem and then it takes ages this diagnostic odyssey for the baby to be properly diagnosed. Vivian I just wanted to check a couple of things about genes I think that probably we are familiar with for example the BRCA gene it's that mutation that can increase the risk of breast cancer severely in women. Is something like that going to be checked? I think from what you're

saying that you wouldn't be checking for that because it's not an illness that happens in childhood. That's true. But here's an ethical dilemma for you. I don't know what we all listeners think about this. But if a baby had a BRCA variant, then the mother is likely to have it too. And should you be checking then the mother, so this is about the mother and who is at actually prime risk at that particular stage in her life of developing breast cancer and what would that do to that family? So we don't have the answers to those sort of dilemmas. At the moment, BRCA will not be or is unlikely not to be part of this. But here's another dilemma is that we all know that even if you do have some of those BRCA genes, it doesn't necessarily mean that you will get breast cancer. Because what

I haven't said about the genome is that although the genome you are born with is the genome you die with, the way that it works is influenced by your environment, by the other genes that you inherit, by your age, by all sorts of other variables. So this is a thing called penetrance. In other words, how likely is it when you have this particular change that you will get, if you like, I don't mean to trivialise this, but the full fat version of the disease, or will you get a much lesser version of it? And at the moment, the way we're thinking is that the conditions that will be on the list are those conditions where the baby is highly likely to get the condition in a severe form. For instance, spinal muscular atrophy might be one of those. Rebecca, you're on the panel that's considering these difficult ethical issues, something like the BRCA gene. What is your view on

that? I mean, it does make a lot of sense that if the child has it, then maybe it would be a very big red flag that the mother should be looked at as well. Yeah, absolutely. And then there are other conditions, familial high cholesterol, that if the baby has that condition, then it's very likely that one of the parents or both of the parents have it and their siblings and other family members could be affected too. This is a huge ethical challenge and there are huge ethical questions ahead of us and that's why this project is ethically led. There's also plans to form a public ethics group including parents to help us tackle these and to run throughout the next year to ensure that we are getting everybody's thoughts and opinions to help shape that ethical framework and to support the team

who are trying to tackle these very big questions. Of course, because there are also issues that even if you consent for this to be done to your baby, the information that comes out could affect, as you say, it could affect siblings or step siblings or cousins and people would immediately have this information or have a question mark over their own health, even if they didn't want to be part of it. Vivienne, can I just ask about the cost implications? We are very aware, I think, at the moment of how stretched the NHS is and how the waiting lists are growing for conditions that could be treated right now.

Simply put, is there space is there money to to be looking into the future like this there are a few things to say here first of all health economics is going to be a big part of this we are going to look at is it going to deliver value for money and value for money is a horrible phrase because people think that health can't have a value put on it. But for instance, if I mentioned people with severe immune deficiency, there is a high cost intervention, which is a bone marrow transplant. But actually, the hospitalisation of the child and the adult all through their lives is going to be very much more costly. So that's one thing. The other thing is this research project is being done with research funding. It's not the NHS funds, but it will be the NHS which will decide whether it rolls it out,

looking at all the health economic data that we have gathered during the time. But there are health economic benefits. It's not just a cost here. Vivian, when do you start recruiting for the pilot? And who can take part? If someone's listening at the moment and they're expecting a baby, is it something that they could possibly be signing up for in 2023? Hold your horses. We haven't yet chosen the final selection of hospitals that are going to be involved. All I can tell you is that they will be across a range of geographies, different population demographics. So we make sure that we have a diverse population that are involved in this. And people who are in those hospitals arriving for their care will be offered the chance

to take part. It will start next year, it will finish in 2025, there will be a period of evaluation then Genomics England will give all that information to the NHS for them to make a choice about whether to roll it out more widely. Vivian, do you think that this is what the future holds, that full genetic sequencing for newborn babies? I take all the ethical issues on board and I understand that we're going to have to think about this very carefully a lot. But when you look at the economics of healthcare as well,

is this something that, you know, the genie is out of the bottle and once we can do this kind of thing, we're not going to stop. I think that you have to do this hand in hand with the population and with ethical input, because you have to have trust in this. And you have to have a system in which people can be sure that the data that they're giving in terms of their genome is not going to be abused in any way and that they're not going to be placed in any worse position than they were before this kind of test. So I do think it's the future. I thought when I joined Genomics England that it was the most exciting science project that I've ever been involved with. And I've reported on many science projects in the past.

And I still think that now. But I do think that this has to be done, hand in glove with the public and health professionals all along the way, because the most important thing that people told us, as Rebecca said, is we need to get this right. Vivian Parry and Rebecca Middleton, thank you very much indeed. Fascinating stuff. Now, I know that it sounds counterintuitive to suggest that staying silent can challenge workplace sexism. Tamina Annam is an anthropologist and a novelist, and for the past 10 years, she has actually spent her time working in the world of tech startups, where often she was the only woman in the room. She was struck by how alien the language and the culture was to her.

And she says she was overlooked, interrupted, patronised. I wonder if that sounds familiar to anybody. Indeed, she sometimes felt like she had immersed herself in a remote tribe. So she decided to use those anthropology skills to decode this office culture. And in doing so, she came up with a revelation about how many women try to be liked to fit in and feel they belong. When in fact, a more powerful tool might be to say nothing at all. She's here to tell us more today. Tavina, you spent most of your career in academia and you also wrote novels, so you hadn't actually ever really worked in an office.

Just tell me how odd an environment it seemed to you when you arrived in tech startup. Thank you. Yes, I had never had a proper job until about 10 years ago. And I also got that job in a very unusual way. My husband started a tech company and I started helping him. I was between novels and I started helping him on writerly things, writing copy, recruiting people. And I realized that I had never been in an office before and I had never been surrounded by office culture. Now, this is a ubiquitous culture that almost all women at some point in their lives enter, unless you're an academic like

me. And I couldn't believe how alien it was. I couldn't believe how different it was from, let's say, university, where you have female role models and professors and people running universities, I realized that the workplace is a hierarchical institution. It's mostly led by men. And there is a culture that we have normalized that we wouldn't necessarily consider to be appropriate in other contexts. So even though I worked in the startup, I was on the board. I had a lot to do with the culture. I was able to change it for the better. When I was dealing with external people, investors, sitting on boards, having meetings, there was a kind of language that felt completely alien to me. There

was a kind of normalized, like casual sexism. Someone said to me, you know, let's open the full kimono as a joke, as a way of saying, you know, let's divulge. Let's open the full kimono. Yes, that is an actual thing that people said totally deadpan. And at that point, I sort of stopped. And of course, I laughed nervously, as we always do. Then I went home and I thought, what do I do in this kind of situation? I don't want to be the person who sits there and says, well, I think that was deeply inappropriate.

Although I wish I could. That is one of the reasons that it's so difficult, though, isn't it? Because when somebody says that, and they say it as if it's the most normal thing in the world, what do you do? Well, exactly. And actually, not laughing along with a joke is something that feels culturally kind of inappropriate or culturally like a taboo. So one of the ways that we participate in tribes is by laughing along with their jokes. So then I started asking other women about sexist jokes in their workplace and I kept a kind of list and it was shocking to me. Almost every single woman I talked to said, I heard this joke or I was at this office party and this really random thing happened. I laughed along, I went home and I had, you know, felt bad.

So interesting. I wonder, I mean, I know that you said that office life felt a bit like a kind of a foreign culture that needed decoded. You also said that you were interrupted, you were overlooked and patronised, but that all happened to you by people who were otherwise really nice.

That's one of the difficult things, I suppose, about everyday sexism, isn't it? Because, I mean, if a man is, or a woman is, is very difficult, very boorish, then it's much easier to perhaps have a confrontation. But what about when they're being really nice to you? Yes, exactly. And those are the ways in which misogyny and patriarchy are kind of embedded into our culture, where we kind of accept these little insults or these casual humiliations that happen to us every day. And it's really difficult to call those out. And I had to come up with strategies for how to cope with those while still participating in the culture, because obviously this was a place that I love to work. This was a job that I really loved. It didn't always happen to me.

And I didn't always want to be, you know, the person that was raising my hand and saying, oh, I'm outraged every single day by something. You came up with three things that you find, three strategies. Talk us through them. Okay. So the first one is called stillness.

And one thing that I find really difficult is having a totally passive face where if I'm, you know, if I'm in a meeting, I feel that somehow it's my duty to be like a social, like lubricant almost, you know, weaving people's conversations together, being expressive, kind of nodding. So stillness, I found it was very powerful in a meeting, especially to be very still and not to give away in my face, the sense that I was there kind of to make people feel more comfortable. Okay. The second one is called holding. So I would hold silence instead of trying to fill a silence. And when, when there was, let's say a sexist joke, um, I didn't feel like I had to laugh and I didn't feel like I had to protest. I could just be completely silent and maybe the other person would hear for the first time what they were actually saying without me having to point it out. And the third one was waiting, which I promise not to do, which is when people ask me a question, I would wait three seconds before replying. And there was something very powerful about not feeling like I necessarily had to reply straight away, that I had to be positive and make the person feel better about

their question. I think women are naturally empathetic. I think we want to make people feel comfortable. And somehow in the workplace, that means that we get less of an opportunity to just hold our power. It's so interesting. I like your phrase, a social lubricant, because I feel that sometimes, particularly women feel that that idea of being very enthusiastic and chipping in all the time and having lots to say and filling those gaps is something perhaps we do to make ourselves more likeable. Perhaps we feel we'll simply be ignored if we stay silent. Yes, I think likeability is a problem. I think we feel in order to succeed in the workplace, we have to please others. And that we're not just judged on the

merit or the content of our work and on our productivity, but rather on how comfortable we make other people feel. And that is how sexism is deeply embedded in the workplace. It makes us feel like somehow, I had a friend who said, my boss told me I have an undiplomatic face. It's worse than that, because I listened to your TED talk. And you said that you wanted to retrieve that very sexist trope of resting bitch face. And I hope I haven't shocked our listeners who haven't heard that phrase before. Can you just talk us through what it means and why you'd like to revive it, why we should have more of it? Yes. Well, thank you for letting me say resting bitch face on air.

I think it's really important for us to take what is a sexist trope, which is a woman's face in repose, not being pleasant. Okay, this is something that women have been, especially older women have been called. And I think we need to harness the power of resting bitch face at every age to hold a kind of stillness and, you know, resist the desire to please others in your face. Your parents were activists. They were freedom fighters in the Bangladesh War of Independence. There's a whole other interesting side to you

that we just don't have time to go into today, I'm afraid, because you're a novelist as well. I just think that you probably grew up really wanting to speak your mind and being trained by your parents that you've got a right to speak out and say what you think. It must be very difficult for you to to use silence as your weapon of choice. Exactly. And actually, I feel ambivalent, recommending to young women that they

should be silent. I think speaking out is absolutely politically our number one tool for creating institutional change, which we know is like the most important thing we have to do right now in the workplace to close the gender pay gap and to make it easier for working women to participate in the workforce and to advance and to grow and take on positions of power. On the other hand, sometimes small cultural changes can have a really powerful impact. And if women collectively felt that they didn't always have to be likable at work, that they could hold silence instead of always feeling like they had to fill a silence, I think we could really change the expectations that are put on us in the workplace.

Tamina, you've given me a lot of food for thought. Thank you very much indeed, Tamina Aman. Thank you. Now with the Platinum Jubilee just around the corner, BBC World Service is looking at the Queen's extraordinary global profile and her role in diplomacy and soft power. Much of that takes place behind the scenes. And in The Royal Diplomat, Emma Barnett speaks to those who have seen her in operation and worked with her on the thorniest of global issues. She came to the throne in 1952 at a time of crisis as the British Empire was disintegrating in the aftermath of World War II. Her role as head of the Commonwealth placed her at the heart of global crises. She visited Ghana, Zambia and South Africa as a diplomatic envoy, helping to mediate in the racial politics of post-colonial Africa.

Here is the late Natnuno Ameferto, who's a historian and former mayor of Accra, speaking about the Queen's trip to Ghana to meet President Kwame Nkrumah in 1961. The Queen had the youth, the personality. She could appeal to the vanity in men like Nkrumah by making them feel that they are coming to her help. She came here not only as a very powerful political figure, but also as a woman. She was one of the few females who could stand and look coming from a straight in the eye. There was no other British politician who could have done what she did. The British politicians were all reminiscent of the old order. So that's what

the British gained from that encounter. Well, you can hear the Royal Diplomat presented by Emma Barnett on BBC World Service tomorrow morning. It's also available on BBC Sounds. And don't forget, you can get in touch with us via text 84844. Text will be charged

at your standard message rate. Do check with your network provider for exact costs. And we do have quite a few texts today. We've got quite a lot of people talking to us, in fact, about the idea of being silent. I agree, says Eileen in Ealing, that some females talk too much in the office

because they want to be popular. She says that she's now retired and she's glad that she doesn't have to listen to quite so much of that. Another interesting one, and I think this is from Leslie Barron, She says that she's now retired and she's glad that she doesn't have to listen to quite so much of that. Another interesting one, and I think this is from Leslie Barron, who says that they react to a sexist joke, but with a deadpan face saying, I don't get it, and then keep on insisting I don't get it to get the teller to expand on the joke. And apparently that works very well.

Now, do you ever vexed you may not be familiar with the term at all i think in fact it's just arrived on a lot of our agendas after we saw it in a news item from jill biden it's hit the headlines because the first lady of the united states told harper's bizarre that she fexts meaning she fights over text with her husband the president of the United States, of course, Joe Biden. She says it started when he was Vice President to stop them bickering in front of Secret Service agents. But is it really a good idea to use technology and, in this case, written messages to have a row with your significant other? Well,

here to discuss this with me is the behavioural psychologist and relationship coach, Joe Hemmings. Joe, just explain to me what is fexting? Did I get that right? You did get it right, Andrea. So it is fighting over text. I'd rather think of it as rext, I mean, resolving over text. Because the minute you start fighting over text, you're already sort of going, you know know sort of into a difficult place i mean i guess on the basis that walls have ears and the white house walls certainly have more ears than most there are times when you would need to take your disputes um disagreements into a private place and doing that via text might be a good idea but i think generally for most people to get into that fighting over

text is really not a good uh conflict resolution uh process and the outcome generally probably isn't very good either I mean I suppose the fact is that if you I mean most of us aren't being looked over by overlooked rather by secret service agents but you know you might live in a crowded house with kids around or parents around or you share a flat or something. So perhaps it has its place. But I just wonder, it's so easy to misunderstand somebody. I mean, there's no nuance in text, is there?

Yes. So we know there's no nuance, there's no tone in text. We can't tell if it's said slightly tongue in cheek or if it's said with extreme anger. There are no visual cues either. So when you're having a disagreement argument with somebody you you can look at them you can watch their body language there's none of that going on um you sometimes get people who are quite perhaps more articulate than the other person so they will can turn quite nasty in a war of words on text perhaps things you wouldn't say to somebody's face. So it can escalate quickly. So I think there are times, as you say, when we all have to do it occasionally.

But if that becomes your your normal way of communicating, if you're having a disagreement with someone, generally speaking, the best thing you could ever do if you're going to have a round, we all have them, is to have a disagreement face to face in a calm, private place rather than doing it by text message. You mentioned calmness and I just wonder, is there ever the opportunity to think, OK, look, I'm just I'm so angry about this that I just think I wouldn't be able to control my emotions face to face and I would explode. And maybe taking some time to be perhaps in a different room or a different, I was going to say country, but that's a bit severe. You know, just simply being away from the other person and writing it down. Is there a time when perhaps that is a better thing to do? I suppose there are a couple of times when it's a better thing to do? I suppose there are a couple of times and it's a better thing to do you could write it down for yourself because I think you know journaling we know sort

of helps us when we're feeling quite anxious so writing it down looking at it and thinking how am I going to present this to my partner whoever it is you're having a disagreement with um is helpful as is yes possibly writing it to them um but So you've got a chance to edit it. You've got a chance to read what you say before you send it. They're all ways of stepping back from your anger or your anguish at the time. But generally, it needs a response. You're sending out something to the ether via text. You're going to get a response.

It's really after a response it's really after that it's the positioning of it's the argument that can take place from that so you send someone a text out of the blue they don't know how you're feeling and it's quite angry although you've moderated it the response you get will be very different to the one you would have got if you'd come down and spoken to them face to face however difficult that encounter might feel or how you might anticipate it being difficult and of course you might not get an encounter a response at all and that silence might be relatively deafening um i wonder just before you go do you think that technology does negatively impact relationships overall i mean i know we've

heard of you know fubbing where your phone snubbing that means that you're you're using your phone um and ignoring your partner maybe when you're out for a drink or dinner or even sitting you know sitting at home um is it is technology a problem for relationships it can be fubbing is one of them i hear time and time again with couples that i counsel uh literally when we have our quality time together when we're doing this when we're on our date night you know he she is on the phone um that's one of the worst things you can do but you can use technology to your advantage you can send a quick text message during the day saying you're missing somebody or looking forward to the evening it's how you use it and how you make sure it has a positive impact in your relationship and not a negative one. So I don't think there's a simple answer to does it impact relationships badly. Actually, it can influence them very well, but it can also affect them quite badly

if you don't use it wisely, I suppose, and judiciously in your relationship. Jo Hemmings, fexting. I don't know if it's going to wheel its way into our lexicon, but thank you very much indeed for joining us today. Now, even though Japan is one of the richest countries in the world, it scores poorly when it comes to gender equality. At the moment, abortion pills in Japan

are illegal. It's due to change that law soon, but it looks like a woman who's in a relationship will need permission from her male partner before she gets them. As well as that, the pills could cost over £600, putting them out of reach of many women and girls. Women's rights campaigners in Japan are demanding changes to the proposed laws around abortion pills and more movement on reproductive rights generally. Kazuko Fukuda is an activist for women's sexual and reproductive rights in Japan.

In 2018, she started a women's rights advocacy movement called hashtag Nandenino. It means we don't have. And Marika Oi is the Asia business correspondent for BBC News. And both join us today from Japan. Kazuko, this new law is to do with abortion pills. But male consent, I believe, is also required for surgical abortions. So for all terminations, for people, for women that are in a relationship, that might seem very surprising to most people. Yes, but like it's already decided in the maternal protective law after the law. And I feel that so many people still don't know about this, the existence of this law.

And people are surprised when they hear the news saying that we might steal the consent from the spouse is needed when they we take the abortion pill but still it goes like this so it's very surprising and sad to hear about that kazuka what happens if you are not in a relationship if you're single you you presumably don't need consent then for an abortion yeah we don't need it in the law but but then like on the ground, sometimes the doctors still require the consent from someone like the partner because they are afraid of being sued. Right. I know last year there was a very sad case of a 21-year-old woman who was arrested after the body of her newborn baby was found in a park in central Japan. The woman was given a suspended prison sentence, but she told the court she was unable to enter pregnancy because she couldn't get written consent from her partner. How common is that situation?

Like we hear such cases time to time, and about half of the children who were killed by abuse are like zero years old babies in Japan. And most of them were killed on the day they were born. So we can imagine that this kind of cases happens in that cases. And then like women are always the one who were criticized. But like behind that, there are tons of like lack of systems such as sexual education or access to contraception. Marika, these are quite terrifying stories and I think will be surprising for a lot of people.

What is the reaction in Japan when stories like this are broadcast? I have to admit, as Kazuko said, it's quite unknown. And I have to say, the first time I read into this particular law was when there was that debate over that abortion pills. And obviously, the law is very old and completely out of date. And I have to say, you know, a couple of my friends have had an abortion, and I reached out to them when I found out about this law and they said that their doctors didn't actually ask for a partner's consent. So I think it can be done if you find the doctor. But at the same time, the fact that this law still remains is quite

surprising. And also, but at the same time, you know, when you talk about women's rights in Japan, women are often treated almost like a reproductive machine. And I can count so many incidents where senior politicians have spoken about women as if, you know, we're just the baby making machines, saying that the declining birth rate is because of young women's selfishness to keep working and so on. So to that extent, it's not that surprising either. That is really quite staggering to hear. I wonder, therefore, is there much support openly for more liberal abortion rights in Japan? Or is it something that's not discussed very openly? Marika? It has been discussed at least quite publicly in recent years.

The contraceptive pill even took many years to get the parliament's approval. When, for example, Japan's parliament approved Viagra within something like six months. And you do have to wonder whether the fact that there are so many more male politicians in this country is a factor in that. But at the same time, these issues have been discussed. And, you know, I actually applaud young women like Kazuko, who've been speaking out about it, because I'm now 40. I had three children in Singapore, where I work. And I did think about, do I go back to Japan to give birth? Because obviously, my parents are still here. But then, you know, I heard that a lot of doctors aren't really supportive of epidural and when i heard that i was like no way i'm staying in

singapore good call there's still very conservative views among especially elderly japanese doctors i would say and marika we've also heard that uh these the new the abortion pills who that up to now haven't been legal if this law does, they're going to be extremely expensive. I mean, £600 is quite a lot of money, particularly for young women, for vulnerable women, people who may well need those pills most. Why are they so expensive? Is that something that is it's possible may change? Again, that's something that has been discussed before about the contraceptive pill, morning after pills in the past as well. You know, is it because of those male politicians or the conservative view about not wanting to allow women to have access to those to those medications and so on? That is really difficult to answer, because obviously that is not an official view of the Japanese government. You just occasionally hear from elected lawmakers

who say something and you go, oh my goodness, is that how you actually think about us women? And no wonder these laws are still there. But it is really hard to know why that is. But at the same time, the country is trying to increase the number of female lawmakers. And at the end of the day, that helps. I think the number definitely helps. Of course, there's always an argument about, you know, sexism and so on. But I think that would really help. Marika, talk to us a little bit about those numbers. I mean, I know Japan's parliament is mostly male, and that clearly seems to be significant in terms of women's rights but just how male dominated is it? I think the last time I wrote an article about it and I checked less than 10 percent of Japan's lower house of parliament which is the more powerful parliament

are women which is one of the lowest in developed economies. Japan has always ranked very low in a gender equality ranking around the world. I do have to say, I've covered this topic many times over the last 15 years at the BBC. I do have to say that, you know, when we get compared to other countries at the bottom of that ranking, you know, I don't think Japanese women feel oppressed. You know, my mother was a stay-at-home mother. Both my grandmothers were as that as well. But I don't think they felt ever oppressed by my father or my grandfathers. And also, a lot of the times those housewives control the finances of their home. So the salaryman,

the fathers would give all their earnings to their partners, and the women actually control it. So in a way, women actually do have quite a lot of power. But at the same time, those laws, the societal pressure, you know, all the expectations that because I chose to keep working after having three children, the expectation of you must perfect everything, you know, that pressure is definitely there in Japan. And that makes it really difficult for me to, you know, ever wanting to come back to this country, if you like, because it's just impossible to be that superwoman all the time. It is impossible to be a superwoman. I think we all know that.

Marika Oi, thank you so much indeed. And Kazuko Fukunda, thank you very much as well. Now it's time for some music. And Twinnie, singer and songwriter from York, is here. Storytelling is a key part of Twinnie's music. She grew up listening to country music icons like Johnny Cash, Bob Dylan and Dolly Parton. She describes her music as country pop. Her first album, Hollywood Gypsy, came out in 2020 and her new EP is called Welcome to the Club. Twinnie, welcome to Woman's Hour.

Thank you so much for having me. Twinny, tell me a little bit about your kind of music and who your music's for. I really strive my music to be inclusive. Welcome to the Club is kind of like this metaphor for welcome to the world and it kind of highlights this human experience. And, you know, it was written in the pandemic and I was seeing so much division and sad and angry people. I wanted to put something out into the world that was actually going to bring people together

and I think that's amazing what music does and does do. So, yeah, that's kind of, it's for everyone, basically. Tell me a little bit about your heritage because it's been a huge influence on your work as an artist. Yeah, I think the best thing that any artist can do is tell their truth because, you know, it's so unique. We're all so unique. I grew up in, well, I went to school, but my heritage is from Romani Gypsy heritage. And I kind of grew up in these two worlds in society.

And that, you know, in itself had, there was a lot of conflict within myself and hiding parts of myself in society. So that's kind of like really the backbone of my music. My first album, which was released in the pandemic, was called Hollywood Gypsy. And it really kind of, you know, represented these two worlds that I grew up in. And I didn't know which version of myself to be. I would often

change. But then, you know, as you grow older and you experience life, you realise I'm so blessed to have that experience. And it's made me much richer in my art and as a person. So you were one of the first, I believe, in your family to actually go on to secondary school? Yes, I was, yeah, which is quite an experience, actually. Primary school wasn't too bad, but there was definitely people, you know, it's not just in my culture. I'm sure many kids have experienced this,

but I was always like the odd one out because of people knowing that I was a traveler, which is unfortunate. But that does happen. And yeah, I felt like when I went to my dance music college, that was the first time, you know, people really embraced me. They actually called me Gypsy Lee because they'd, you know, seen the musical film. I don't know whether you've ever seen it, Gypsy. And it was, you know, a place where I felt included and seen and heard. And, you know, it's full of seekers and dreamers.

And it was the first time I ever felt like, well, really embraced myself. And I thought from that moment on, I'm just going to be myself because that's my superpower. I'd rather, you know, people like I'd rather you know people like me for me rather than people like me for not being me or pretending to be somebody else which I think you know this EP Welcome to the Club is kind of a call to action to be authentically yourself and I feel like you know we need in this day and age to be much more accepting of each other and, you know, and celebrate each other's differences. Does that Romani gypsy heritage that you come from have a strong culture of storytelling? Is that something you grew up with?

Yes. I mean, they often listen to a lot of folk music, country music. And I feel like I've got such an eclectic taste of music. I was listening to people like Shania Twain, the Spice Girls, and Dolly Parton. And my grandparents were listening to The Rat Pack. And my dad was listening to Billy Joel and Queen. And I actually ended up doing my first job with Queen, which was amazing.

Whoa, hold on. How did you end up doing that? So I started in musical theatre, really. I'd always done music, but I'd find the music industry really hard to penetrate. I didn't know anybody in it. So I've been on stage since I've been four, so it was kind of like this stage school kid.

And we were taught that if you could do, you know, sing, dance and act, and it's an art, it's a discipline, that you would work more. And I got my first job when I was 18 and We Will Rock You which is a musical in the West End which was incredible. So tell me a little bit about this song that you're going to sing for us now. This song is called One Heart it's on the EP that comes out on Friday and it really um is you know a story of unrequited love um and I think that's something

we've probably all experienced at one time or another or will do. Yeah, so it's based on my life story but I hope that it relates to a lot of other people's as well. Wonderful. Well, the guitarist accompanying Twinny today

is Barnes. He's with us in the studio. So off you go, guys. I knew you've been acting distant Didn guys. I knew you've been acting distant, didn't listen. I knew you've been going out late with your friends then promising me

a call. Now it's 3am and heard from you at all. No. I knew you weren't being honest. Eyes were guarding you from looking at you You were starting to see us differently Not the perfect picture that we used to be

Wow, Twinnie, thank you very much indeed. That was one heart. And Barnes, thanks for the accompaniment. Twinnie, you write your own words, you write all your own lyrics and your own music. You started out by writing poems. Yeah, when I was really young. And like just singing songs around the house,

you know, just gibberish from very early. There's like a video of me at like nine months old or something ridiculous. Yeah, I just, I think I realised I really loved entertaining people and still do. I don't think what makes the best feeling in the world for me is that true connection and the connection between you. I mean, we all miss that in the pandemic,

that live sense of connection. And that is a drug for me. I know that you have gone on social media and talked quite a lot openly about the fact that you think that the the Romani Gypsy and the Irish Traveller groups remain some of the most marginalised in the UK. When you were growing up did you think there weren't enough role models in that community that you could look up to? I still do. It's actually embarrassing that people beat the drum for inclusivity and I do not know any other travelling woman

or travelling man really that is doing what I'm doing. I would love for people in my community to follow their dreams. You know, I want to see radio presenters, TV presenters, music people. So hopefully for the next generation, I'm being hopefully a good example of like it can be done. But yeah, it was really difficult growing up. I didn't have anyone. And you're now supporting young female talent as well,

even though you're still very young yourself. Yeah, I started a collective in the pandemic, which highlights women. It's called I Know A Woman. It's a home for all music makers with men, but we put on writing camps. And I think I found that, and we released music, I think I found personally,

like to get into the music industry was really, really difficult. And I want to make it easier one with you. This is from Mike. He says, I'm a 64-year-old man and I am married to a French lady who's 56. And I live in France and your programme helps me to understand women, he says. He says, I still don't, but I try. I'm currently having a dispute with my wife and I find it easier to write a letter and to think about it than it is to send it. And it helped. He has been listening to the programme and he says that he has heard us easier to write a letter and to think about it than it is to send it. And it helped. He has been listening to the programme and he says that he has heard us and says that texting can lead to a heated, silent dispute

and rather inflame the situation. And we've also heard from Ruth, who has said that she agrees about the power of silence. There are situations where vocal activism doesn't feel safe and silence can be more powerful. Well, thank you all very much indeed for getting involved today. I'm glad that you didn't say silent and gave us

your views. Thank you very much. We will be back tomorrow at the same time from me. Goodbye. That's all for today's Woman's Hour. Join us again next time. Hi, I'm Andy Oliver and I'd like to tell you all about my Radio 4 series, One Dish. It's all about why you love that one dish, the one that you could eat over and over again without ever getting tired of it. Each week, a very special guest will bring their favourite food to my table and we'll be unpacking the history of it.

And food psychologist Kimberly Wilson is on hand to talk us through the science bit. What food reminds you of your childhood? What's your favourite place to go for dinner? What do you have for Sunday lunch? What's your favourite dessert? Do you say plantain or plantain? What food would you take with you to a desert island?

What's your favourite type of chilli oil? What do you have for breakfast? What's the best pasta? What's the one thing you love? So if you're the sort of person who's already planning what you're having for lunch while you're eating breakfast, then this podcast is going to be right up your street. That's One Dish with me, Andy Oliver. Listen now 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 was faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this?

From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.