Woman's Hour - The Cumberlege Review. How has the healthcare system responded to concerns raised by women?

Episode Date: July 7, 2020

The Independent Medicines and Medical Devices Safety Review, also known as the Cumberlege review, is finally being published tomorrow after being delayed by Covid-19. It will focus on three health scandals that have severely affected women’s lives including vaginal mesh implants, an oral pregnancy test called Primodos, and an anti-epileptic drug called sodium valproate. The precise medical details between the cases differ, but what they all have in common is that women were given medical products that weren’t properly tested, and then weren’t believed when they complained of side effects further down the line. BBC Health Correspondent Anna Collinson talks about the background to the cases and the review, and Bonita Barrett discusses her experience of seeking help – and being ignored – when she went to her doctor in pain after being given a mesh implant without her consent. It’s 1957 and Jean Swinney, a journalist on a local paper in the London suburbs, is investigating a story about a virgin birth. As she gets closer to the people involved Jean’s lonely and dutiful life becomes more interesting and she experiences a miracle of her own. Clare Chambers’ book ‘Small Pleasures’ is her first for 10 years and it was an item on Woman’s Hour which sparked the idea. There is a concern that some children and pregnant women have missed routine vaccinations in England during the Coronavirus pandemic. Professor Sonia Saxena from Imperial College, London explains why this must be reversed quickly. Jane speaks to the winner of the Winner of The Arts Society’s national Isolation Artwork Competition in support of young artists during lockdown.Presenter: Jane Garvey Producer: Caroline Donne Interviewed guest: Anna Collinson Interviewed guest: Bonita Barrett Interviewed guest: Clare Chambers Interviewed guest: Sonia Saxena

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BBC Sounds. Music, radio, podcasts. Hi, this is Jane Garvey and this is the Woman's Hour podcast. It's Tuesday the 7th of July 2020. Hello, good morning to you today. We'll chat to Claire Chambers, author of a brilliant book about a potential virgin birth in 50s Britain. It's called Small Pleasures. Claire on the programme today.

And we'll also talk to the award winning portrait painter, Abigail Magorley, who has painted a wonderful self-portrait called Brewing. We'll chat to her on the programme a little later. And I think you can see that very soon on the Woman's Hour Twitter feed at BBC Woman's Hour. something of enormous significance. The Independent Medicines and Medical Devices Safety Review, also known as the Cumberledge Review, is finally being published tomorrow. It was delayed by COVID-19. Now, this review focuses on three separate health scandals, all of which have severely affected women's lives, notably vaginal mesh implants, an oral pregnancy test called Primidos, and an anti-epileptic drug called sodium valproate. Now, these scandals have one thing in common. Women were given medical products that hadn't been properly tested, and then they were not believed when they talked about the side effects, and indeed complained about the side effects. So there's a lot to get into here.

The report will be published tomorrow. And Baroness Cumberledge herself will be on Woman's Hour tomorrow, I should say. Let's talk first of all to the BBC health correspondent, Anna Collinson. Anna, if we can try to put this into context, are we talking here about something on the scale of thalidomide? Well, that's a really good question. Thalidomide caused up to 10,000 miscarriages and deaths in the UK. And here we're talking about three health scandals, which have also affected tens of thousands of people. So campaigners very much believe that this is the next thalidomide, that what has happened to these

women needs to be marked. It is not just women, we should say, because some men certainly would have been given the anti-epileptic drug, wouldn't they? Yes, but the issue with Zodium Valparate is that it can cause deformities and developmental problems with unborn babies if taken during pregnancy.

So that would affect women. Got you. Let's go through then the three very separate scandals here, because scandal, I think, is the right word. Let's start then with the anti-epilepsy drug. What do we know about that? Yes. So this is called sodium valproate. And as I just said, if taken during pregnancy, it can harm an unborn baby, putting them at risk of developmental disorders and birth defects. And yet 17,000 women of childbearing age in the UK are being prescribed sodium valproate every year. They should all be on what's called a pregnancy prevention programme to ensure they're aware of the risks. But

campaigners claim that often isn't happening. And it's estimated 20,000 children have been harmed in the UK after being exposed to sodium valproate. To be clear, this is still being prescribed? Still being prescribed, yes. To pregnant women? To pregnant women. And they're put on this pregnancy prevention programme. There are warnings on the labels, but people are still falling through the net and babies are still being harmed. Right, OK. Let's move on then to primidos. This is something, an oral pregnancy test, which is no longer given. That is something. Yes, that's correct. So Primidos, an oral pregnancy test, which was used by more than a million women in the UK between the 1950s and the 1970s.

And the way it would work is a woman would take two pills and if they bled, it meant they were not pregnant. Now it was removed from the market in 1978 but the manufacturer sharing now part of Bayer has always denied a link between the drug and deformities in babies but hundreds of families disagree and have been campaigning for decades for that to be acknowledged. And that means, well this all means that there are going to be ramifications potentially. The review is published at midnight tonight so we'll know much more this time tomorrow,

which is when we'll be able on this programme to hear from Baroness Cumberledge. But the ramifications are financial. That would be one thing, presumably. That's definitely what the campaigners and people affected are hoping for. I mean, what's important to recognise with these three health scandals is while they are different, and they happened across a space of 60 years, there are a lot of similarities like you already touched on. All of these are women, most of them are women who are affected. We've heard time and time again, they were not warned about the risks or in the case of Mesh, not told about alternative, less invasive options that they could have had. When they reported problems, they weren't believed.

They were made to feel like they were going mad, that they were being irrational. And their stories were only heard after determined patient-led campaigns, which often took decades and a great deal of determination and patience. I think a lot of our older listeners will be hearing you now and thinking, I do feel I've heard all this before in other and not dissimilar circumstances. Let's go on to vaginal mesh, which is something that this programme has discussed a lot over the years. And by the way, any listeners who've got a point to make at BBC Women's Hour on Twitter or you can email the programme via our website, bbc.co.uk slash women's hour, of course. Talk about mesh then and the impact this has had on thousands of

women's lives. Yes so this was seen as a quick fix to treat incontinence and prolapse so often was carried out after a woman has given birth. Studies suggest one in ten women will experience complications following a pelvic mesh repair and it's thought around a hundred thousand women have had a pelvic mesh repair so that's around 10,000 women that are affected. Once in the body, the mesh can stiffen and erode and sometimes cut tissues and organs. And that can lead to complications, including chronic pain, difficulties walking. We've heard many cases of lost jobs, broken relationships. I've spoken to many women who felt suicidal because of what they've gone through.

The use of pelvic mesh is currently paused. Not banned. Not banned. That is key. It's currently paused in NHS hospitals. That pause was brought about by Baroness Cumberledge within months of her starting her review. She was appalled by the stories that she was hearing. And that pause will be lifted that we've been told when certain conditions are met. For example, specialist centres for procedures and removals, appropriately trained surgeons and a national database where every operation is reported and recorded. Anna, stay with us. You'll also hear in a moment from Professor Carl Hennigan, who is the director of the Centre for Evidence Based Medicine at Oxford. So we'll get his perspective after we've heard from Benita Barrett, who is from North Yorkshire. Benita, good morning to you.

Good morning. Tell us what you went through when you were given a mesh implant. For me, I just knew straight away that something was wrong. And I was told that it was bruising from the surgery because I'd also had a prolapse repair at the same time. I believed him for the best part of a year every time I returned to the hospital. And he kept saying that it was still a matter of bruising from the surgery. But after a year, I had an episode where for three days, I could could hardly walk I kept experiencing shooting pains in my groin every time

I took a step and I was really really anxious about it um I went back to the hospital and he again told me that it was bruising um at this point I actually told him that I'd had a look online and I found that there were a lot of women um that weren't complaining of bruising they were complaining of something else and he dismissed it completely and referred me for an MRI he said it must be my back um and obviously the MRI came back it said that that there was nothing wrong and I was just um put on the the dump basically I was referred to the pain clinic and and that was it mid-40s and you've just got to deal with it for the rest of your life and there's obviously nothing wrong with the mesh as far as they were concerned.

This, I think, will again be ringing bells with too many of our listeners. You were, well, the modern day term, I know it's not actually in itself a modern day term, gaslighting. It was all about you imagining things, Benita, which is a pretty horrific experience to go through, isn't it? Completely. For more than a year year i just felt like nobody was listening um you know you they assume that you're either hormonal or it's in your head or you know it's it's that time of life because you're in your 40s you know it must be the menopause it's that's causing the aches and pains and and so on and i ended up actually having to take it into my own hand to get some answers stay with us i want I want to talk to Professor Carl Hennigan of the Centre for Evidence-Based Medicine at Oxford.

Carl, we have heard all this before too often. Women, it's all in your heads. Get over yourselves. Yeah, I find that, you know, tremendously an emotional story. This idea that complains, dismissed, ignored. I've heard that hundreds of times. I've even when Cumberledge did a presentation at Parliament, hundreds of women say the same story. And I think it's a really important issue in where we've gone wrong in the health care. And I think the difference is with thalidomide, what you said, it is similar, but with thalidomide, it's very visual is similar but with thalidomide it's very visual the problems

you can see instantly whereas with this ongoing pain dysfunction disability seems hidden away and for many years these women have been in huge problems and i have to say the campaigns that have come together to bring this forward have been represented. A number of women have been amazing because they've been so persistent in saying there's a huge issue that we need to do something about. Do you think something on this scale could have happened to men, Carl? I think that's a very interesting issue. And the issue I come to is to say I don't think so. The first thing is to say women engage with health care at much younger ages.

They engage through contraception, through childbirth. And if you look at what's happened to women, it's not just these three interventions. There are many others, the PIP implant, the eShore. So there's a huge swathe of areas where women have been treated badly, if you like, throughout the health service that you just do not see in males. And largely throughout the last 50, 60 years, it's been a male-dominated society of doctors and surgeons who've done this to women. Benita, what do you think of that? I agree completely. I just think it's an absolute scandal that we're made to feel this way.

And what's quite frustrating for me as well is that whenever any woman steps forward and talks about this, which is an embarrassing subject, none of us want to talk about something so personal. But I think you normally find as well that a lot of women that have been through the surgery will also then say, oh, well, you know, you obviously didn't give yourself a decent recovery time or or maybe it was just a surgeon. It's not that, you know, we're all in this together. In some respects, it was almost a roulette. You know, you wouldn't send your mother or your sister for an operation knowing that there was a one in 10 chance of them being permanently disabled. Carl, this is not, let's be honest about it, it's not a good time to start criticising the NHS, is it? Well, look, I think there's an important aspect about all healthcare interventions. They have the equal to do great benefit and harm. It's called equipoise. And we've just seen trials happen for drugs like dexamethasone. What we found in many of these

interventions is there's been no evidence underpinning them, particularly for safety. So this is a really important point in time for us to step back and think of the importance of informing women, educating them, but ensuring the evidence is in place. And it's important to recognize with thalidomide, that was a landmark that led to a sea change in the requirement for drug trials for their regulation. Particularly with mesh now, what we're looking for is a sea change in the regulation, because currently many of these meshes go on the market with little or no evidence. But why wasn't the lesson of thalidomide learned then, Carl? Because we very quickly be able to move on. And if it doesn't directly affect you,

you don't actually go there. You don't see it happening around you. So it requires something like this big review to bring all of these separate cases together to point out what's going wrong. The key now is that when this review comes out, is that we take it seriously and act on it. Right. Well, I really appreciate your help with this very important subject this morning, Carl. Thank you. And Benita, thanks to you as well. I know that, Anna, you've spoken, as you've already said, to so many of the women impacted by this. They must be, well, I suppose looking forward isn't quite the right phrase, but tomorrow is going to be very important to them, isn't it? It's going to be an absolutely huge day for all the, not just the women,

but the families around them who've been affected by these three medical treatments. Just listening to Benita, there was something that really struck me. I've spoken to more than hundreds of patients for more than three years looking into mesh. And the word she used, dismissed, felt like she was left on a dumping ground at the age of 40. I've heard that so many times. I can't tell you. It's depressingly, there's this sort of depressingly systematic theme that I keep hearing every time I speak to these people.

Each story is shocking and horrible to hear, but there's a real, there is that pattern. One thing to think about as we go looking into the review is what the campaigners and families affected are hoping for. They want an acknowledgement, ideally an apology for what's happened. They hope for some form of compensation. Mesh victims, for example, have lost jobs, aren't able to live the lives that they wanted, and they'd like some financial support to help with additional care. While for Primidos and Zodium Valparate parents, they're terrified about what will happen to their children when they die, who is going to look after them. But finally, there's real hope that the healthcare system will learn lessons for the future and prevent future harm. And a key for that is

transparency, as Carl just touched on, that patients are properly consented and that a record is kept. So if there are problems, we're able to flag it up as quickly as possible. It's very important that I say that, of course, if you are taking prescribed medication, do not stop taking that medication without consulting your doctor. But I just want to mention, thank you, Anna, just stay with us actually just for a second. A listener has tweeted to say, I have three grown up children and took sodium valproate throughout my pregnancies. At no time did I get any warning about potential damage to my babies. And bear with me, it's just slipped out the computer screen. Hang on a second. Let's get it back. This is the 21st century operating here. I'm going to get there. I did at one point go for mouse training. I'm not sure it paid off. At no time did I get any warning, says the listener, about potential happened there. Again, just to emphasise, if you are being prescribed drugs, you must not stop taking them without getting medical advice first. But Anna, there's just one illustration from one individual listening to this programme. And you've spoken to many of these women too. And the cost, the emotional cost of having to campaign is colossal. It never leaves you, does it?

Absolutely. And in the case of Primidos, they've been campaigning for decades. And as Carl said, each campaign has required a great deal of determination and patience. On top of the people who are leading the campaign are often victims themselves. So they're dealing with all those issues and then also the campaigns themselves. We've mentioned guilt, that sort of guilt that a lot of the mothers feel who took primidose or took sodium valproate,

they blame themselves for what happened to their babies, even though they weren't warned of the risks and it wasn't their fault. And finally, just one thing that I was going to mention regarding something that a primidose victim had said to me. He said that he basically was born without hands and other life-changing injuries. He's now 50 and he spent the majority of his life not knowing why he was the way he was. He found out four years ago.

He said women should not be treated like guinea pigs for new drugs or devices. Proper testing and regulation needs to be in place. Anna, thank you very much indeed for talking to us. And we'll keep an eye on this story, obviously, because it will be developing throughout tomorrow. But you can hear from the person who's in charge of that review, Baroness Cumberledge will be on Woman's Hour tomorrow morning with Jenny. Thank you very much indeed, Anna. And if you want to contribute some of your own experiences, please do email us. I think probably email would be better for this bbc.co.uk slash woman's hour tell us if you know anything more about any of the three scandals in the

cumberlage review published tonight now there is some real concern that some children and pregnant women have missed routine vaccinations in england during the pandemic a professor sonia saxina is a researcher in child health at Imperial College London and she's written about this in the British Medical Journal. She is also a GP in London. Sonia, good morning to you. Good morning. So this is all about people deciding that in the coronavirus pandemic they won't go to the GP surgery. Is this what lies at the heart of this? Yes, that's a very strong part of it. Over the first few three weeks of the lockdown, there was a fall in 20%, we now know, in the number of measles, mumps and rubella vaccines, smaller falls in infant vaccines. We're still trying to do as much research as we can to really understand what that

is. But we have certainly put it down to the public being urged to stay alert, protect the NHS, save lives. In those first few weeks, they were actually advised to stay at home. And a report from the Institute of Health Visiting in May, 752 health visitors were surveyed. And we found that 60% had reported that their contacts with families who told them that they considered cancelling or postponing their child's vaccinations. And this is a desperate problem. The parents have told us that they are worried about exposure to coronavirus for their young infants. And they're worried also about overburdening the NHS, which has been the overwhelming message that they've received.

Right. I mean, in defence of the government, it's very, very tricky to get the messaging clear in a situation like this, isn't it? And they were criticised when they changed the message from stay at home to stay alert. People said, oh, well, that's not clear enough. So in their defence, it's hard to see how they can win here. But your real concern, and presumably you're seeing it as a GP, is that people have taken it too literally, and potentially their children are going to be, well, they could become very ill as a result. Yes, I mean, we are where we are now. I'm not particularly levelling blame at anyone. We did the best that we could. But vaccination was never deprioritised. It was always an urgent and important and essential service. And there is a time window of opportunity. So I'm keen that parents themselves are not blamed. They're really responding to very strong messaging and they're fearful. And parents are much more likely to get their children vaccinated and pregnant women to uptake those vaccines when they feel safe and supported. And of course, all of that was lost during those first few weeks of lockdown.

They didn't have family, community support. Many elderly parents had to stay at home that would normally have offered support and encouragement to go and get this done um so so we were really surprised that there was such a dramatic response what i'd seen in my surgery was that for the first few weeks everyone just locked down but we now have got to reverse these falls because as we head into autumn, we're going to see flu re-emerge. And of course, as the lockdown opens up, there's going to be a lot more exposure. So it's really, really important to protect the most vulnerable in society. And I have to say that all the research that we've done has shown that there are strong inequalities in the uptake of vaccination. It's very sensitive to this sort of change in the health system and in the public perception of whether things are safe or not. But also, it tends to be lower in some inner city areas

and among some very vulnerable groups. Because there's a distrust of authority, do you mean? Well, there's lots of research about what the reasons are, but at both ends. So at one end of the spectrum, you've got first time mothers who simply may not know about having to go along and get the vaccination done. Some pregnant women are unaware that it's important to get the whooping cough vaccine after 28 weeks. And we important to get the whooping cough vaccine after 28 weeks. And we want to get those messages out because those infants need protection from the very first few days of life, not wait until their routine vaccines. And some vaccines are, you know, taken up at a high level, but others are much less,ptake is much lower. So so there are multiple reasons for why this happens. OK, you mentioned that difficulty in awareness.

Sure. You mentioned that the whooping cough vaccination now given to pregnant women. I know that you did a study that tracked thousands of children from birth to 13. And what did you uncover in that study about those children who didn't get all their vaccines? What happened to them? So I think what we need to be clear about is that vaccination in this country has been a fantastic success story. But there are a small number of children who miss out on their vaccines every year. And that varies. Now, one in three infants will get admitted to hospital in their first year. If they miss their vaccination, then that will double. So we're getting one in two, something like that.

And these are vaccine preventable diseases. But more importantly, perhaps, we followed these children across the whole of childhood and that missed vaccination will confer an additional risk of them being admitted to hospital with a serious infection and indeed other conditions it will make their asthma worse and so forth two to four times more likely across the whole of childhood so if that critical window is lost, then you've removed that lifelong immunity. And that is a real tragedy. And, you know, anti-vaccine sentiments have been present all the way through even Edward Jenner. You know, it took 150 years for us to eliminate smallpox.

I was talking to my 18-year-old niece the other day and she was horrified when she looked at my arm and she said, what's that? And of course, it was the scars of my smallpox vaccination. But this generation hasn't really seen cases of measles. Well, that's the problem in a way, isn't it? Because measles can do horrendous things. But if you've never witnessed it, partly, of course, because of the success of the vaccine, maybe you think it's not that serious an illness. Exactly. And what we do need to do is actually get these really strong messages across that we don't want to frighten everyone, but we just want to use that public confidence that we built up during those first few weeks of the campaign to battle coronavirus, to say that, you know, it's reminded us that infectious disease is a threat to the whole population.

We need to capitalise on that messaging. Sorry to interrupt, but surely it's up to a GP surgery, or you tell me, I understand you're busy, to ring up people who've missed their vaccinations and get them to come in. That's absolutely right. So we've done systematic reviews that have shown that where you've got really strong systems, a call and a recall, that that's the best way to get. So you need two things. You need the confidence in the first place, but you also need the supply of the vaccine and you need everything to be in place to be able to contact people in a timely way and checklist them through. And certainly in my practice, that's what we do. We will reach out to parents in a timely way and get them to come in. There might be reasons why they don't come in. But if there are some people who miss those vaccines, that follow up can sometimes fall through the net. So absolutely, for sure, strong primary care systems, where we've got belt and braces, and we've got the capacity to follow up on those missed vaccinations. I don't want to put the wind up people unduly,

Sonia. But are we looking as we stand at the moment, potentially, because of the shortfall in the numbers taking up the measles vaccine, are we suggesting that there could be an absolutely appalling, perfect storm in the winter of perhaps more coronavirus cases and an epidemic potentially of measles and the standard winter flu as well, all in the mix. That's absolutely right. I mean, these factors are going to align. So at the moment, you know, if you think you've got 700,000 infants born roughly every year in the UK, we've already missed about 35,000 in the first few weeks and months. So if that the longer that continues, you're going to have to catch up on that. Or what's more likely is that some of those infants will remain unvaccinated or miss one or two of those doses. And as we head from summer into autumn, we're going to see what we see every year. So on top of that, we will we will have flu. And as children get back to school, there will be more exposures. So, you know, I think that we are heading for real difficulties.

And of course, coronavirus itself is a threat. And even if a vaccine for that can be developed and rolled out at that point, we're still going to have to work on public trust. I was going to say, there will be more people who will be, as they are anti other vaccines, they'll be anti that one as well. Let's hope we haven't got one, I should say, at the moment, of course. Thank you very much indeed. I really appreciate it. Professor Sonia Saxena, who's a researcher in child health at Imperial College London and also a GP. By the way, do listen back to our Vaccines edition

of Woman's Hour broadcast in November. You can find that, of course, via BBC Sounds and on the Woman's Hour website. Tomorrow, we're looking at school leaving rituals. You get the sweatshirts these days. There's a prom often. The signed T-shirts do the rounds. There's often a school trip. And, of course, the incredibly emotional primary school mega assembly where everybody weeps buckets. I can still vividly recall the ones that I attended. I have to say back in the day when I left school not really be possible for a multitude of good reasons.

Let us know via the website, because I imagine some children are really feeling that they are hugely missing out this year. BBC.co.uk slash Woman's Hour. Now to a fantastic new novel. It's called Small Pleasures by Claire Chambers. Claire joins us now. Claire, good morning to you. Hello. And what is brilliant about this, amongst many other things, is that it was sparked by Woman's Hour. So take us back

to 2001 when you were listening to the programme. Well, I was listening sort of in that casual way you do when you're doing something else. Can you not say that, by the way, Claire, because I imagine that people just sit completely still and listen to every single word. Staring at the radio set. Preferably, yeah. I think I was doing something else and half listening. And I became aware that I was listening to this extraordinary story of this woman who claimed to have a virgin birth and had a really kind of solid story to tell about it, which seemed highly plausible. And the investigation that went into it it where in fact they they couldn't

really disprove her story and i remember thinking that this this would make a really good novel and i i left it sort of hanging up in my mind like a piece of flypaper hoping other things would stick to it yeah um but it it struck me that it might it might not be a funny story and at the time i was writing what i considered you know know, romantic comedy. And I just felt this might have a darker edge to it and might not be something that I could tell. Well, I'm going to delight the audience now by playing a little clip from Woman's Hour. But just to put it into context, this was a feature broadcast on this programme back in 2001. It was about something that had happened in 1955, when the newspaper, the Sunday Pictorial, launched an appeal asking for stories of women who believed they might have had a virgin birth.

And that was because there had been a flurry of interest in the subject after scientific research into reproduction in animals and plants. Now, a load of women came forward to the Sunday Pictorial in the 50s and they were questioned and rejected. But one woman, a German lady called Emma Marie Jones, Emmy Marie Jones, was convincing. And the journalist Audrey Whiting was covering the story. Now, this clip is from the feature that Woman's Hour did in 2001. Finally, it came down to Mrs Jones and her daughter. And they were subjected to, again, very, very close examination,

cross-examination almost, you know. Did they tell any lies? Was the mother exaggerating? I went to Hereford, to her home. But she was a delightful person. Mrs Jones gave her account of the pregnancy to the newspaper. For a long time I'd been suffering from a chronic form of rheumatism and I put it all down to that. Mrs Jones gave her account of just smiled at the doctor. I was sure he had made a stupid mistake. I told him, you must be wrong. I simply cannot be pregnant.

Three months ago, I was in hospital. In any case, there has been no opportunity, so it can't possibly be true. Now, apart from anything else, there were no male doctors at all. It was, as she said, staffed by all women. And she said when she was in hospital, apart from anything else, even if she wanted to have sex with anybody, she couldn't

because of her rheumatism, she just ached all over. And so I remember saying to me something like, you know, it's as almost as though it's a child of God. Claire, I'm not surprised that, to put it mildly, piqued your interest. It's got everything now, hasn't it? The central character in your book is a journalist then, a woman called Jean Swinney. Now, tell us about Jean and the life she's obliged to lead in the 1950s. Well, I thought I should tell this story from the point of view of the person who's researching it. And her predicament is that she's living with a rather needy, what you might call a sort of social agoraphobic mother.

Of course, her mother's condition is never diagnosed and certainly not treated. It's just regarded as one of those sort of quirks of human nature, which is infinitely weird and various and nothing can be done about it. So she's sort of stuck living with this needy mother. Her only sister has managed to escape this fate by getting married. It was a case of whichever sister marries first will escape and the other one won't. And Jean is the one who's left behind. But it's a sort of soft imprisonment because she's not housebound with her mother. She's allowed to go out to work and that's fine. But it's almost as if going out to work has used up all her credit

and there's none left over for a social life. So every time she wants to do anything fun, this has to be negotiated and sort of her mother has to be manipulated into accepting her absence for five minutes. It's an incredibly claustrophobic existence and of course one which many women of the time and indeed today are obliged to lead with caring responsibilities of one sort or another. She is the journalist who goes on the trail of the supposed virgin birth and in doing so she comes across the Tilbury's and a woman called Gretchen, who is indeed a German lady who feels she may have had a virgin birth.

Yes. And so Jean's remit is to investigate the story. But in doing so, unfortunately, she becomes rather enamoured of the Tilbury's and rather attracted to Gretchen and her lovely daughter and her husband. And so her sort of investigation becomes somewhat compromised by her natural inclination to believe Gretchen and to want to sort of help to prove her case. And she gets sort of entangled in their life. But it's really about the miracle that happens to Jean. So the ostensible miracle

of the virgin birth is somewhat overtaken by this miraculous blowing apart of Jean's limited and confined life as she discovers friendship and love and maternal feelings at perhaps the 11th hour. Yes, I mean, that's what I loved about it. It was also, let's be clear about this, a love story between people who aren't usually the leading players in love stories. No, I wanted it to be about people who are unfashionable and unglamorous and unattractive, but those people still feel sexual passion and attraction

just like everyone else. And I just wanted to make that as as true and as as moving and as real as possible I should say it is also a bit creepy that the scenes set in a sanatorium for example which is where Gretchen was when she believed that she became pregnant there's there's a lot going on here and um I really found it incredibly absorbing as I do hope I've made clear so I also just want to squeeze in a quick reference to the fact, Claire, that you've been writing for a very long time. And at one point you might have been somewhat discouraged. But this book has had fantastic reviews and you must be really, really pleased with it.

Yeah, I'm really excited about the reception it's had. And it gives me great hope, you know, to think for other writers who may feel that they've been a bit in the publishing wilderness or writers who are not yet published and think, oh, the publishing industry is only interested in young people and celebrities and the new. But in fact, I was really encouraged that several publishers looked beyond my rather, what's the word, not stellar sales record.

Don't be hard on yourself. And just sort of took to the novel and thought, well, we really like this novel and we want to publish it without worrying too much about whether I was somebody who had a good track, as they call it in the industry. Well, as I say, I think our listeners, many of our listeners will absolutely adore this book and will want to seek it out. So thank you very much, Claire. Claire Chambers. And the novel is called Small Pleasures.

Now, here's another of life's winners, Abigail Magorle, who has won the Art Society's National Isolation Artwork Competition for her self-portrait. Abigail, good morning to you. Good morning. And congratulations. I should say you're only 20. You are studying at the University of Leeds. That's right, isn't it? Yeah, that's correct. Yeah, I know that because they've just tweeted very proudly about you. And I don't blame them. You're in your second or third year now?

I've just finished my second year. So currently working towards the third one. Right. Okay. and i guess your university circumstances are perhaps not exactly what you might have thought they'd be at this stage in your academic career so um let's talk a little bit about brewing which is the title of the painting it's a self-portrait um just describe it um so basically it depicts from quite a high um kind of like bird's eye view angle and me um with a cup of tea relaxing in quite um a thick kind of bubble bath um so I think painting um myself was definitely a very daunting daunting task it's not something that um I do I think it's one of the

first self-portraits um I've ever kind of approached. And it's a very intimate, very kind of like personal scene, somewhere where I've retreated within lockdown for my kind of home comforts. So not only am I the focus of this piece, I'm inviting people into this kind of comfortable space. Yes. And allowing people to be part of that very personal experience. So self-portraits are not something you would normally do? No. I think it's something I'd definitely do going forward. I think that I was very uncomfortable with the idea at first,

but I had to kind of build that comfort up through the levels. So first I had to be comfortable with kind of being photographed in the position at first and then being comfortable like analysing myself because you build a very personal relationship with the kind of subject of your work when you're painting it. So I had to be very comfortable with analysing the kind of details of my own form and then I had to be comfortable with having that moment shared with quite a large and broad audience um which is it's definitely built up um and I can now say that I'm kind of I would happily have it kind of spread everywhere now which it obviously is I'm just looking at it it feels very odd to be talking to somebody who's self-portrait I'm

looking at at the same time but anyway um you the expression on your face is sort of unreadable I've got to be honest it's um it's brilliantly enigmatic it's I'm someone who perhaps like yourself takes comfort in baths I mean if I'm having a bad day I call them two bath days and I might have one in the morning and then one later is that is that something you felt you had to do more of in lockdown um I wouldn't say um I had to do more of it's something I do regularly uh anyway I really enjoy a bath I kind of like them more over showers and especially with a nice hot cup of tea it kind of just like makes a kind of perfect experience and I do I do see where you're coming from I do think that you have to kind of look for those little comforts especially when you're isolated in your I do think that you have to kind of look for those little comforts,

especially when you're isolated in your home, especially when you've kind of got really small parameters. That escape is definitely necessary and it's definitely something that I've needed. But to be fair, I think the experience of lockdown itself has kind of made me realise how much of a hermit I actually am. You mean it suits you yeah so i it's it's kind of the the change in my lifestyle it hasn't been that dramatic um but so the baths have kind of just been steadily steadily as you as you go really but um

uh but definitely it's somewhere something that I will be doing regularly as I continue through the lockdown. I don't know how someone like you who's put so much of herself into a piece of work can bear to let it go. Does it not hurt you to let go of something like this? Do you want to sell this? I do. I think when you put so much time and effort into a piece and you've spent so many hours kind of staring at it it's it becomes something different so people will look at it in a different way to the way I do um I see it as very much completed I'm ready for it to kind of um to kind of leave how many hours of work is actually involved in something like this um it's it's a lot um i'm not gonna lie well i just haven't got a clue 40 45 i can't even kind of guess i i think it's more um but i kind of

get lost in the hours to be fair um i don't really time it especially with pieces that aren't commissions where you kind of don't um judge it like that um but i i would definitely say it's a good month's worth of work is that your dog um just trying yes he's he's getting really stressed out on me i don't know why what's the name um he's called austin he's a little corgi oh corgi yeah very regalal. He's trying to get my attention. All right. Well, let's not ask too many questions about why he needs your attention. It may be time for him to go somewhere.

You never know, Abigail. Possibly. Yeah. Okay. Congratulations to you. I love this. That is the award-winning portrait artist, Abigail Magorle. And it is a fine piece of work, her self-portrait Brewing.

You can find it on the Worms Hour Twitter feed. It's in some of the newspapers as well, actually, today. She is, it's worth saying, she's only in her second year at university, so a name to keep your eyes on. If you're interested in art, then it's something you should definitely make sure at least you have a look at. I'm, as I

said, a particular fan of baths. I know perhaps in terms of the environment, I shouldn't be as keen on baths as I am. So I should say I thoroughly enjoy a shower. That's just for balance. I don't really enjoy a shower, of course, but it's just something you have to do. Occasionally you have a shower, isn't it? Now, a lot of stuff from you today with good reason, because there was a lot of important content on the programme. Let's talk about vaccines. Linda says, I've just been listening to that item

about the lack of take-up of inoculations during lockdown. As you said, it may not be the moment to criticise the NHS, but whilst there is absolutely no doubt that the NHS on the front line have been amazing, I don't think the same can be said for some GPs. Our surgery has become a fortress during lockdown and it's virtually impossible to get through the door, let alone see a doctor. Luckily, the weather has been wonderful,

so that at least we haven't had to queue for prescriptions in the rain. When all this is over, it would be great if someone would look into this issue and have the courage to ask where the GPs were during this time. As for the infants not taking up their inoculations, Well, to be fair, that was something that we discussed with Sonia during that interview. And I don't think it's fair to say that GPs are not doing anything. I'm certainly from my own household's experience when we did need a doctor at some point during lockdown. And they were very, very swift to call us back and have a conversation on the phone. So I'm not sure I buy that GPs are not doing any work.

Well, I know that it isn't true. This from Liz, listening to your programme. And I would like to make you and your listeners aware of another issue with regards to children and babies. My daughter is a married first-time mum with a nine-month-old baby and she has already been contacted by her GP surgery to tell her that her daughter will not be able to have her 12-month developmental check-up due the end of September, which is really the first contact she would have had with a healthcare professional since she was just a few weeks old. What she has been offered by letter is a

questionnaire to complete and return, after which a healthcare professional will call her to discuss any issues arising. Yeah, okay, so that's obviously a change. This emailer says, I'm a practice nurse and I've been working over several clinics around Leicester and have continued the immunisation programme throughout lockdown, but found that the uptake was improved maybe because parents were off work and more were able to attend or the pandemic made them more aware of the problems of missing vaccines. So there you go.

There's the flip side of that story. Lynette says she's confused. My son was due to have boosters given at school this summer term, including tetanus and HPV, but that hasn't happened. I'm not sure whether there'll school because they were off sick on the day or something. And you can just ring up your GP and book an appointment for that, as far as I'm aware. Now, to the really important issue of the Cumberledge review, as I say, Baroness Cumberledge herself will be on Women's Hour tomorrow. This listener says, I just wanted to say that I have had mesh inserted and actually it changed my life for the better. Post baby incontinence meant I couldn't dance anymore and I've danced since I was three. After 20 years or so of very little exercise I can now go to my beloved dance classes. Having said that, as a middle-aged incontinent woman,

the way you are treated in the health service can be scandalous with very little empathy, dignity or respect. Adam Kay's words on Women Like Me in his book, This Is Going To Hurt, say it all. We apparently, with our incontinent genitalia, made him feel sick. To that listener, I can actually say I've read Adam Kay's book and I know what you mean. I actually, there were parts of that book

I felt really uncomfortable about. I know it's been a huge success. Yeah, probably can't really say any more except to say that I know what you're getting at. From another listener, in 2016, I had ventral mesh rectopexy surgery to repair a rectal prolapse and affected bladder muscles prolapsing as well. A mesh sling was inserted and it improved the symptoms for six months. Afterwards, it all went downhill. I, like many other women, have had problems with maintaining employment and quality of life, unable to do the activities I used to. And I also feel I've been given umpteen pain relief forms with no real resolution.

Hearing the current discussion on all this helps me know I am not alone and I just don't know who to turn to for an improvement. Sorry about that. I do hope that a lot of, there are so many people who are involved in all this and I hope that what's going to come out over the next 24 hours or so will offer you some hope for the future. Anonymous, I would really like to be anonymous. Well, don't worry, you are. I want because I want to tell you about something that affects a very private member

of my family. She's been in pain from mesh for at least five years, to my knowledge, but it may be much longer as she really doesn't like talking about it. This was inserted to the mesh because of a prolapse and no one can help because we understand there is no alternative treatment. Well, again, keep your ears peeled over the next 24 hours or so. Hopefully more stuff will be produced that will offer some kind of resolution to the many, many thousands of women whose lives have been impacted by all three of those scandals addressed in the Cumberledge Review. I'm just going to mention this from Kathy. He says, couldn't you have made today's programme more depressing? You aren't trying hard enough.

Look, this is a magazine programme that addresses a whole range of topics. I get what you mean about today's programme, although Abigail, whose self-portrait was so brilliant, was not in that category. And Claire's book wasn't either, because it's a brilliant book and we like celebrating female achievement. This is an intriguing, I won't mention the author of this email, but they just say, good morning. Don't forget to mention, it is scientifically possible to have a baby without having had sexual intercourse. But those babies are always girls and never boys. It's part of the mother's existing body.

There is a scientific name for it. Yeah, there is. The name is Parthenogenesis. It's common in the animal kingdom, which was sort of where that Woman's Hour piece from 2001, referring back to a story in the 50s, came from. I don't think it's happened in humans, but what can I say? I would suggest you all have a jolly good read of Claire Chambers' book.

Complicated area, this. Okay, let's end the programme here. Busy edition. We're back tomorrow, live, or Jenny is, three minutes past ten, and then the podcast will be available later. 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.