Woman's Hour - The Morning After Pill, The Economics of Care, Women of the Royal Society

Episode Date: November 25, 2019

When journalist Rose Stokes wrote about her experience of getting pregnant after taking the morning after pill and what it revealed to her about exactly how this emergency contraception works (and when it doesn’t), the response online was huge. We look at how emergency contraception works, how safe it is, and ask why women don’t know more.Recent research from the social market Foundation proposed that women start receiving a pension boost to offset the increasing disadvantage of a growing care burden, both with child care and as the population ages. This is one of many policy suggestions that are currently being developed to deal with a problem that all parties acknowledge. But how should we price the care work that so many women do? And do policy makers have the data they need in this area? Kathryn Petrie, author of the report, says not. We ask why the economics profession hasn’t done more on this subject and hear from leading Care Economist Prof. Susan Himmelweit, Emeritus Professor of Economics at The Open University who is working to change that. She explains why a feminist approach to economics is needed to make care work visible.The Royal Society is a Fellowship of many of the world’s most eminent scientists and is the oldest scientific academy in continuous existence. Its charter book contains the signatures of all the Fellows of the Royal Society since it was founded in November 1660. It wasn’t until 1945 that the first two women were elected as Fellows. Jane discusses eminent women scientists with the librarian at the Royal Society, Keith Moore.Presenter: Jane Garvey Producer: Helen Fitzhenry

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. This is the Woman's Hour podcast. Hello, good morning. Now, today on the programme, we're going to have quite a long conversation, actually, about the cost of care. How do you even start to put a price on it? As all the political parties are wrestling with the issue of social care, this morning we discussed the very real impact,

the financial impact on so many women's lives. And we know you're out there, the people who do listen to this programme, many of you I know have caring responsibilities of one sort or another. You may be female, you may not, of course, we have many male listeners with caring responsibilities too. But there really are people out there

who may well be working, be caring for grandchildren and caring for parents. And your life has been changed by that level of responsibility. We're talking about that and how much it's cost you on Woman's Hour this morning. We're going to start, though, with a conversation about the morning after pill. Lots of people, certainly young women, have taken it. But the truth is that many of them probably don't know how it works. There are a lot of myths around the morning after pill. There's confusion as well and plain misinformation. This is on our Instagram feed at BBC Women's Hour from a listener called Kate. I took emergency contraception the day after ovulation and intercourse under the guidance of a

nurse at a sexual health clinic. I told her I'd ovulated so I knew there was a high chance of fertilisation but I wasn't told that the pill was unlikely to work. Two weeks later I had a suspicion I was pregnant. I already had two daughters and my third is now three. It's a story I tell my friends as a warning. That is the experience of Kate. And Emma said, Well, that is why we're having this conversation this morning, because there's a range of views and experiences out there, as you can already tell. Rose Stokes is here. She's a freelance journalist who wrote about her experience of getting pregnant after taking the morning after pill. We're joined too by Claire Murphy, who's Director of External Affairs

at BPAS. Dr. Anne Hanley is a lecturer in the history of science and medicine at Birkbeck University. And Dr Paula Briggs is a consultant in sexual and reproductive health at Southport and Ormskirk Hospital NHS Trust. So a range of views around the table and joining us by all sorts of other technical methods. Rose, first of all, you took the morning after pill and really simply what happened? So I guess, well, what simply happened is that I fell pregnant. It was probably, I've used it a few times in my life, but this time it was after a failed condom. And I took the pill as advised by the lady in the pharmacy, paid for it. How much is it?

It was £30. £30? Mm-hmm. It has gone down since? I think, well, we can talk about that later, but I took the morning-after pill, found out maybe three weeks later that I was pregnant and then had to go through the process of having an abortion. But when I told people about the fact that I'd fallen pregnant

after taking the morning-after pill, there were loads of people that sort of came out of the woodwork and said, oh, actually, I know someone that that happened to. And after a while, I decided that it couldn't be that I know all of the five in 100 women that it's happened to. So I started digging into it a little bit and started researching this article and then kind of and also when I was in the abortion room talking to a doctor I made a comment about having taken it and they said oh well you know that's not that surprising because it's not as effective as they say it is and gave me a sort of arbitrary percentage of what they thought it was more likely to be in terms of its efficacy so then I started researching trying to find information that corroborated that sort of idea and uncovered

during the process when I was talking to someone in fact it might have been Claire that it was dependent on ovulation because the mechanism by which it works is by delaying ovulation. And so I did some rudimentary calculations and realised that actually I had already ovulated at that point. And so it was never going to have worked. And nobody made me aware of the fact when I was in the pharmacy or anything. OK, that's interesting. Claire, it was you that talked to Rose when she was doing this research? I did, yes. I did chat to Rose about it.

So let's just deconstruct a little of what she said. First of all, should the pharmacist have explained how it works, when it works, whether or not it might not work? So, I mean, I think there's definitely, we need to have better information out there about the fact that emergency contraception can fail and it's like and if it's you're taking the pulmonal form the pill form if you're approaching ovulation or indeed if you've already if you've already ovulated then the chance it's if you've already ovulated it's not going to work. I guess my reservation is that we need to be very careful that we don't, I mean, women don't take the morning after pill in nearly the numbers they should be anyway. Only about a third of women take the morning after pill after an episode of unprotected sex.

So it is still one of our best lines of defence after something's gone wrong, after an episode of unprotected sex. And it still has high levels of efficacy. No method of contraception is 100%. I think there's a broader issue here about that we always think all contraception works all of the time. It doesn't. There are issues with the morning after pill. It's not the most's hands, but I absolutely agree we also need to better improve information about it, when it's likely to work, when it's not likely to work, and what the alternatives are. Paula Briggs, how does it work when it works? Okay, I think it's really important to understand that the fertile window is the day of ovulation and five days before. Post-ovulation, women are not going to conceive. So both emergency hormonal contraceptive options work by delaying ovulation,

so they push the process further down the cycle. So if women continue to have unprotected sex, then actually they may conceive later on in the cycle. And I think efficacy with this is incredibly difficult to be certain about because, you know, you need three things to conceive in the first place. You need eggs, you need patent tubes and you need sperm. So if everything's perfect in any one cycle, then the chances of conceiving are about 25%. So it very much depends on timing. And lots of women who do take the morning after pill, we're not going to get pregnant anyway. And I think the really the most important message here is about choices to prevent an unplanned pregnancy with a copper coil being

much more effective than emergency hormonal options. But I'm guessing... And also women need... Go on. Sorry, contraception ongoing. So providing emergency hormonal contraception is half of the equation. You need to make sure that she's being provided with good, reliable contraception. I'm imagining that most women who take the morning after pill are young. And how can you sell the coil to that group, that cohort, Paula? Well, I think that is another misperception that women who take emergency contraception are young. I think lots of older women also use emergency contraception.

I think you make a very good point about selling intrauterine contraception, colloquially known as the COIL. If the provider is in a position to offer all three choices, i.e. the two hormonal options and a coil, then I think the woman is much more likely to accept the option of a coil because it's 99.9% effective. It works up to five days after multiple episodes of unprotected sex and can be taken up to five days after the predicted date of ovulation. So you can see why it's a much more effective method

and also it provides ongoing contraception. It's not comfortable when it's being fitted for most women. So, you know, it's important to be very supportive and to explain that. But if a woman presents at a pharmacy, she may be told about that option and she may say she's going to go for it but she may never present herself right okay so we're back to the old conversation about people or women just not liking the invasive um nature of these sorts of contraception there are there are two different sorts of morning after pills levanel and ella one are they do they differ, Paula? Mm-hmm. So Levinel is licensed to be used up to 72 hours after unprotected sex,

whereas ulipristal acetate, L-O-1, can be used up to 120 hours after unprotected sex. So it's got a longer window of opportunity. And the other difference between these two hormonal choices is that levonorgestrel once the LH surge which is what happens immediately before ovulation if that's already started then levonorgestrel is is no longer effective whereas ulipristal acetate can still be effective but it still has a significant failure rate around the time of ovulation, which is when a woman is most likely to feel like having sex. That's just nature. There's no getting away from that, is there? Right. Okay. If you'd known more, Rose, what would have changed? It's quite a complicated one, because the reason that I was relying on the morning after pill is

because I have had a lot of issues with other types of contraception so with the oral contraception I had really bad mental health problems started having panic attacks and had tried lots of different ones and had had to seek other options and I'd had a coil fitted before that just hadn't taken and was quite distressing and upsetting because it was very, very painful for a long time and ended up having to be taken out. So it's always been an awkward issue for me, I suppose. I would say that that's why I've used it perhaps more than the average person, although I don't know. And I guess I had I known that it wouldn't have worked, no, I suppose I probably wouldn't have spent the money

and or, I mean, I'd rather not have taken the hormones. Right, okay. What do you think about that, Claire? Well, I do, I mean, I think the cost remains prohibitive. Well, it's come down to about... It's come down, so BPAS campaigned very hard to bring it down. So it's now, you can buy 11-a-gestrel for about £15. Let's not kid ourselves. The mark-up is what on that?

I mean, exactly. It's probably the only product in the pharmacy that has the biggest mark-up of any product in the pharmacy. What, 400%, 500%? At least, yeah. Really? I think it's outrageous what women are being charged in order to have basically

a conversation with a with a pharmacist this pill is being bought for a couple of pounds sometimes and women are you know being charged an arm and a leg and what's actually you know already a vulnerable time for them so I think there's you know still work to be done on that I think actually if we could bring the price down even further, then I think this barrier of, so Rose talked about, I'd rather not have had that hormonal input at that time. And I do really appreciate that as a sentiment. I think that's widely shared. I do also think though, that one of the barriers sometimes to women taking it is concern about the health risk. You talked at the beginning about women being concerned about infertility if they took it too often.

And I think there are so many misconceptions around the morning after pill and the safety of it. You know, the progesterone form has been around for decades. This is a very safe hormone. It can be taken as many times as needed, even within the same cycle. Oh, can it? Because I've got young daughters who've asked me questions about this and have been told by other people that you cannot take it more than twice or three times in a year or else. Yeah, I mean, that's simply not true. And I think we've spun these misconceptions in order, perhaps, to stop women using it too often,

or they've spread in this way. This is a kind of moral judgment. Absolutely. And I think this is what is so interesting about the morning after pill is it's almost like within this tiny pill are a whole wrapped up within it are all about supervising women. The narrative of women who use it is somehow kind of reckless and feckless rather than actually being women who are taking a responsible, making a responsible choice after something has gone wrong. You know, I think that we need to start talking about the morning after pill in a different way. And I think that obviously has to include better information about efficacy

that, like all contraceptive methods, it's not going to it may not necessarily work. Yes. And better information about the coil being alternative. But recognising that actually there are lots of good reasons why for that woman at that individual moment, actually having this invasive device fitted might not be right for them. It's a brilliant method of ongoing contraception, of course. But, you know, it's actually asking women to have something quite invasive fitted. And of course, feminists will be screaming at the radio here, STIs for a start, they're still out there, whether you're using the coil or you need condoms as a barrier method of contraception to protect you from STIs. Also, STDs, whatever the current, are they both the same yes same thing okay so i've got that right

but also um men are fertile all the time if they're fertile and uh women aren't well that's that's exactly putting it out there yes okay absolutely um let's let's bring in our historian uh dr anne hanley i was only doing that to cover myself for all the people um you you are are our historian. So on the question of morality and the way women's lives or sex lives are policed in this area, what do you say about that?

Yeah, listening to the conversation so far, this resonates completely with some of the work that I've been doing. We were talking earlier about making sure that women have choices when it comes to their reproductive health. But as you were saying, it's also the corollary is information. And they are the two things that have been very fraught in the past.

Because the assumption is that if you provide this information to women, it's going to encourage immoral behavior. It's going to encourage that sexual fecklessness that we were talking about. And this is not in recent years. This has a long history going back into the 19th century. Thinking more recently, though, when the contraceptive pill was introduced onto the NHS in the 1960s, it was introduced in 1961. It was only available to married women until 1967. The assumption being that if you made this reproductive technology available to unmarried women,

if you gave them the information about this technology, they would see this as a license to go out and have sex with lots of different men. And it was very much the moral policing of women's bodies. And the truth is we haven't really progressed as far as we might like to think. No, we really haven't. with lots of different men. And it was very much the moral policing of women's bodies. And the truth is we haven't really progressed as far as we might like to think. No, we really haven't. I mean, is this an area that is quite controversial still, would you say?

Yeah, whenever I talk to my friends, whenever I talk to colleagues about sexual health and reproductive health issues happening today, it is fascinating and deeply troubling for me how much today's issues resonate with what I look at in the past. Really? This is from a listener on our Instagram feed. I've taken it several times, had a variety of experiences. The first time I asked for it at 20, the man on the counter tried to send me out of the chemist telling me we don't do that here.

It was only because a female colleague had overheard him that he was corrected. There's been a lot of negative experiences when trying to get it, but never from women. The last time I had to use it, I was treated with respect and it was a genuine surprise. So there we are. There's a very contemporary experience of doing this.

What do you suggest is the conversation we should be having, Anne, around this, do you think? I think the conversation in part needs to be on why is it that we still feel so queasy about discussing women's sexuality in public? Is this something to do with the idea that women are inherently sexual creatures? It goes back very far into the past where the idea is that if a woman expresses sexual desire, she is, for all intents and purposes, a prostitute. That is the type of rhetoric that we were dealing with. Do you think that's just embedded in parts of our psyche? Even women have this internalised misogyny in this area too. It is deeply ingrained and it was very much an aspect of popular public discourse

well into the latter half of the 20th century. Even today, a lot of women seem to feel very uncomfortable talking publicly about sexual desires, sexual practices possibly because of a concern that they're going to be seen as morally vacant Morally vacant, right, what a thought, Claire I was just going to say, I always find it not to get into bashing of men's sexual health needs as well. But I think it's interesting to see, you know, when we looked last year when Viagra was launched over the counter,

the posters that were, you know, literally felt like every chemist you walk past had a massive poster of, you know, for Viagra in the window. It's, you know, it was all over the tube. And it's, you know, and that's brilliant. But it's just, we do not have the same open-armedness about women's sexual health needs. It just, the portrayal of women, you know, needing emergency contraception is so different. And, you know, from our perspective, we think it's really important, actually, that emergency contraception comes out from behind the counter that it's on the shelf available to buy. Women don't have to have this

interaction with a pharmacist if they don't want to. Right but if they do have an interaction that needs to be an informed interaction and the pharmacist needs to tell you the facts about it. Absolutely but that should be an optional consultation and we need to find a way to better get this information to women.

But I think that conversation comes from actually getting rid of the stigma around emergency contraception, taking it out of this of this sort of framework where there are so many barriers, financial, the consultation, all these things put in women's way let's get it on the shelf let's make it a product that's next to the tampax that's next to the caniston that's in women's eye line and let's actually have a proper conversation which explains efficacy that talks about other options helps women understand their bodies but make sure that women know this is a product they can use and they should never feel ashamed to use it that's your view but a quick word from paula do you rate it paula honestly the morning after pill? Yeah, no, it has a place. But I think the most important thing for women is education about when they're likely to be fertile. And I think for Rose, you know, there are methods like natural cycles, which actually have been shown to be highly efficacious. It can be difficult to predict when ovulation occurs, but by using different means to assess that, then you can develop a window when unprotected sex would be an issue. And I think that would go very well with emergency contraception being available to buy, you know, on the shelf, as it were.

Thank you very much, Paula. We really appreciate your help this morning. Dr. Paula Griggs, consultant in sexual and reproductive health. You also heard from Dr. Anne Hanley, a lecturer in the history of science and medicine. And we also heard too from Claire Murphy and from BPAS, British Pregnancy Advisory Service, and from Rose Stokes, the freelance journalist who started it all off really, this conversation. Quick word, Claire, really quick. Shouldn't girls, let's be honest about this, girls be taught at school in biology when they can get pregnant and how they can spot when they've ovulated i yeah i i i absolutely agree i think i think women i think girl and women i think we all need better information about about our bodies and i think yes it's it's it's high time

we had a more open conversation about this well we could have it now actually how can you tell when you've ovulated um so you will um you will, you should have a sort of stringy plug that you'll have when you wipe. And I think, you know, as Paula was saying, things like natural cycles, these sort of apps are actually really helpful at helping women, you know, chart their bodies, you know, and their changing patterns. It sounds ridiculous to pin you down on this. A kind of plug of creamy, relatively thick mucus when you wipe your bottom.

Okay, wipe your bottom. I can't believe I just said that. People will know what I mean. Right, thank you all very much. Really appreciate it. And we can, of course, get involved as well on Instagram or Twitter at BBC Women's Hour. Email the programme whenever you like

via the website bbc.co.uk slash womenshour. A bit later in the week, on a Friday, we're going to be talking about why Halifax is the place to go for lesbian day trippers. I'm sure for all sorts of day trippers, but particularly lesbians because of you-know-who whose name has completely escaped me. Yes, Jack, Gentleman Jack.

Yes, got there in the end. That's Halifax on Woman's Hour on Friday. And also this week, have you raised your child to be multilingual in a non-European language to give them a sense of their heritage? How hard is it if you're the only people who speak that language in your part of Britain? Contact the programme via the website. That's bbc.co.uk slash Woman's Hour. You'll get there. Now, you might

have heard of the Royal Society. It was founded in the 17th century, and it describes itself as a fellowship of many of the world's most eminent scientists. It is the oldest scientific academy in continuous existence. And I went there last week to look at its charter book. It's effectively a really grand autograph book with the signatures of all the fellows of the Royal Society since its foundation. So they're all in there. Isaac Newton, Charles Darwin, Christopher Wren. But when did women start to make an appearance? I asked Keith Moore, the Royal Society's librarian. As fellows, not until 1945, which is very, very late, I think we can all agree, there had been women associated with the Royal Society before that.

And it wasn't really a done deal in the early days that women wouldn't become fellows. There were certainly women who were very good natural philosophers. Margaret Cavendish, the Duchess of Newcastle. Yes, but she was widely derided, wasn't she? Yes, she had a nickname, Mad Mad Madge because of her strange continental dress. She'd been in exile, of course. Also, she thought a little bit of her own intellect,

so naturally that made her barking mad. Indeed, yes. But actually, her books are pretty well regarded these days. And she visited the Royal Society in the 1660s. She saw demonstrations of science. And she was a very critical thinker in this area, so she didn't just take it as the Royal Society's fellows were doing interesting and correct things. She herself was mildly amused by what they were doing.

Samuel Peep says something very interesting about Margaret Cavender. She says that when she came to the Royal Society, the fellows were slightly fearful of that. They thought that ballad makers in London would write about it. So they were quite worried that the Royal Society wouldn't be seen as a serious place. Therefore, they were quite careful about their reputation in the early days, and they thought that having women around might impact on that. Right, so they were mocked anyway, and the addition of women was just going to make it worse? That was just one step too far.

All right, OK. So can you share, who is the first woman to be recorded in this book? It's actually Queen Victoria. Because, of course, the Royal Society is the Royal Society because it has royal patrons. So in this volume, you'll see fellows signing over the years. And every now and again, you'll find a royal page. And here is Queen Victoria's royal page so she's the first woman to sign. Right so Queen Victoria lovely noted but actual

female scientists. Actual female scientists you have to get to 1945 before you get one. Now there had been lots of other women associated with the Royal Society before 1945 and in fact people had been published by the Royal Society. Probably the most famous example of that is Caroline Herschel, the astronomer whose papers appeared in the Philosophical Transactions. And what was she notable for? She was an astronomer. She swept the skies looking for nebulae and stars.

She's probably most associated with her discoveries of comets. And those are the things that she had against her name in the philosophical transactions. And what about really famous names, Marie Curie? Marie Curie is an interesting case. Now we have a couple of documents here that you might like to see. So these are the council documents about elections of women. So this is from 1900, when it was first proposed that women might become candidates for fellowship of the Royal Society. So there were some letters written to the Royal Society asking the question, why weren't women allowed to become fellows? And the Royal Society

received a certificate, a proposal certificate, for Hertha Ayrton, who's a very good physicist. And they took a legal opinion on whether or not they could elect Mrs Ayrton as a Fellow of the Royal Society. The lawyers came back saying that they couldn't, just because, and I paraphrase wildly here, just because the charters and statutes say that any person may become a fellow of the royal society a woman isn't necessarily a person in the eyes of the law particularly if she's married because then she's effectively the property of her husband so that scotched the election quite a lot of rancor to stomach that one yeah i know it bad, isn't it? But they did take another legal opinion. And this one is just after the First World War. And in 1922, they took another opinion which said that actually, yes, they could elect women as fellows.

So that's the interesting story about Marie Curie. Why didn't Marie Curie become a fellow in that case? She clearly was never proposed. What's that, professional jealousy then? I don't think so, no, because Marie Curie would have been proposed as a foreign member of the Royal Society because she wasn't British or from the Commonwealth. And therefore, it was actually slightly easier to become elected that way. Effectively, one fellow would just have to sign the proposal book and then it would have gone to council. But as far as as we know there's no evidence that Marie Curie was ever proposed can I touch this is that yes yeah um let's just go right up

to this so when does this this finish oh it's still not complete so where was fellow still sign it yeah okay so can I have a look at the most recent uh most recent page I think yeah so this would have been in uh of this year, July 2019. And this is around about 60 fellows being elected each year. And how many? I'm looking, I'm trying to interpret the signatures. People's handwriting is pretty, it's pretty, still pretty dreadful. That's one of the constants throughout this book. There are some female first names.

You will see some women there, yes, that's right. Carolyn, yeah. Christine, I think. But is that Moira? No, Martin, and there's a Sarah. So I would say it was still 80% male. Yeah, but that's not unfair, I think. Let's go back to 1945 and see if we can find the first two women who were elected as fellows. So we've got to 1945 and two women, finally two women, do make an appearance in the book and we really need to know,

we should, everybody should know these names. I fear that actually most people don't. So let's talk about them. Who is the first? That's right. So Kathleen Lonsdale is an X-ray crystallographer, which is trying to understand molecular structures using X-rays as a means of trying to understand the arrangement of atoms in particular substances. She's actually slightly more famous, I think, for her work in prison reform. She objected to paying air raid wardens taxes during the Second World War. They put her in Holloway Jail. And when she came out, she was really a fierce campaigner

for reform in women's prisons. Very interesting character. That's interesting. OK. I'd never heard of her. I should have heard of her. And the other woman? Marjorie Stevenson is a biochemist. Again, not probably terribly well known, but from a scientific point of view,

very interesting indeed. And it's surprising that we haven't heard of some of these people. I think if you have a look at some of their peers on the page here, who was being elected at the same time, well, here's Barnes Wallace, the bouncing bomb guy on the same page. JZ Young, very good zoologist. They're in that very grand company. But they deserve to be there? They certainly deserve to be there, yeah. That's Keith Moore, who is the librarian at the Royal Society in central London. And over the next couple of weeks, we're going to be looking and talking about some of these women

and the Royal Society Fellows, female Royal Society Fellows, who definitely deserve to be much, much better known. So that's coming up over the next couple of weeks on the programme. Now, as promised, what does it cost to care and how do you even start to put a value on it? If there is a price to be paid, it is likely, of course, to be paid by women, as many listeners to this programme know only too well. You'll also know that social care is in crisis, but politicians from all parties have traditionally found the issue simply too hot to handle. So a recent report by the Social Market Foundation looked in detail at some of the challenges of the 100-year life. It had a whole number of suggestions in the report, amongst other things, were all sorts of ideas, including the idea

that women should get extra pension to offset the burden of care. But I mean, there's much more to the report than that. And we'll explore it in a moment or two. With me this morning is Alison Holt, who's the BBC social affairs correspondent. We've got Catherine Petrie here, chief economist at the Social Market Foundation, and Susan Himmelveit, who is Emeritus Professor of Economics at the Open University. She's in Belfast. She's also a feminist economist. So Alison, first of all, over the years, we've had green papers, white papers, we've had consultations, there've been reports, but we're no nearer actually finding a solution, are we? No, I mean, we have had more

than a dozen reports, green papers, white papers, royal commissions in the last 20 years. And there have been a couple of times when we've got close to coming up with a solution for funding adult social care in the long term. But each time it's either turned into a political football or just become been viewed as being too difficult to deal with, perhaps because of the amount of money that needs to be put in at that point in time. At the heart of all this is that the mystery, and it is a mystery to many people, if you have a broken leg, you go to an NHS hospital. If, unfortunately, you have dementia in your declining years, you've got to pay for care. And people don't understand. And I can see why they don't understand. Yes, they don't understand until they're confronted with that situation. And then it becomes a huge shock.

I think one of the other things is at the time when the NHS was set up, social care was perhaps a bit of help at home. It might be coming in to make you a meal or a cup of tea, a bit of cleaning, that sort of thing. It has changed fundamentally since then. We don't tend to have cottage hospitals where the sort of lower level of care would be provided. That happens in people's homes and often it is care workers who are providing more and more skilled support for people. So when people are confronted with that dilemma of where does the care come from, they are often quite shocked to find out that they will be expected to fund their own care.

Which of the parties have come up with original ideas as we head towards the election on December the 12th? Well out of the main parties manifestos which we had coming out in the last week Labour has the most detailed and developed plan. It's talking about free personal care so this is a system that already operates in Scotland that was introduced about 20 years ago. At that point in time, it was said to be too expensive for England. Labour say they would introduce that they also talk about putting 8 billion pounds into prop up the existing system, which I think there's general agreement is overstretched and underfunded, and also a cap on the total amount

that people would pay over a lifetime towards care. So it's quite a comprehensive and developed scheme. The Conservatives talk about building a cross-party consensus. Their guiding principle is no one will have to sell their home to pay for care. And they talk about putting £1 billion a year in for the next five years. Now, it's really important to note with that £1 billion a year, that's to be shared between adult services and children's, and both are overstretched. Experts have looked at that and say that's just not enough for the current problems of the system.

The Lib Dems say £7 billion a year would be paid for through a one penny on tax rates. And that would go into propping up the NHS and the care system. But to start off with, the concentration would be on care and that they would have a cross-party convention to come up with that long-term plan. There's a lot of this cross-party stuff going on, isn't there? Okay. Basically, there's no great idea here. There's no one big original idea, is there? Right. No, no. There are a combination of ideas. And the interesting thing is, is that talk about cross-party discussions?

Because we have seen social care ideas become kicked about in previous general election responsibility well 2010 labour's ideas for the future of adult social care were dubbed a death tax by the conservatives and then we had to reason a last time a dementia tax for the conservative idea so that is one of the reasons why they back away from making really concrete plans and they talk about talking right um talk about talking well that is where of the reasons why they back away from making really concrete plans and they talk about talking. Right. Talk about talking. Well, that is where we are and we're talking. So Catherine Petrie of the Social Market Foundation, your report was looking at the reality of the 100 year life. And it makes grim reading for women, frankly.

Yes, we're living longer, but we're going to have more responsibilities and we'll have less money. Yeah. Put simply, that sort of sums up the report. So we know that sort of born today, women, well, sort of general children have a one in three chance of living to 100. For women, that's likely to be increasingly longer. So sort of women do outlive men and that's going to continue to happen. So we know that there are a range of things associated with 100 year life that might negatively affect women, such as the need for care.

If you're living longer, your parents are living longer, there's a chance that you'll have to provide that care in some form of your life. And it's likely that will fall on you as a woman, as over a daughter-in-law or a daughter rather than as a man. That affects not only your wealth accumulation in your life, but also your pension assets and how you then can live the rest of your life, given that you're likely to be in retirement for around 30 odd years, at least at the moment. Right. It is impossible to put a price on the value of care, isn't it? Because what about a woman at home, caring for small children, preparing them for school, being there when they get back from school, this is hugely valuable. But how do you put a price on it?

Yeah, it's also really difficult to value, but also to estimate how much, how many hours people are doing. So we estimated in a report last year that carers do around 149 million hours a week in total in the UK. How you value that, it's unvaluable. It's cooking dinner, it's getting people ready for work or helping children get ready for school. It's not something that has a clear economic value. The ONS have tried with maternity leave. They've said that roughly someone on maternity leave is doing around £700 a week of economic activity. That is a significant amount of money that they are sort of removing from the state.

But also during that time, they're not accumulating pension savings. And that's where our recommendation for a government top up to savings comes in. Yeah, I'm glad you mentioned that. So, Susan, are you as feminist economists trying to find the information that would help people like Catherine? Well, I think there is some information, but I think Catherine probably knows this. We do have some estimates of the value of care. And you can estimate it in two ways. You can either say, well, how much would it have cost to provide that on the market? And that's the way that the ONS is used to value all the unpaid labour that is done in the economy. The other way is to say, how much do the people doing the unpaid care lose out in wages? And

again, you could measure it by their wages for the job that they would be doing otherwise, or in general, what would the average wage be? And in all those different ways, for different countries, it's been done. It's been done since the 1995 Convention on Women in Beijing, which required governments to put some effort into doing such estimates. And in nearly all countries, it comes out to somewhere between a third and a half of the value of GDP. So it's a large, it's a huge contribution. But what would change if governments really took heed of these facts? And what do you want to change, Catherine? I think one of the most difficult things is

actually making this sort of part of conversation. It's recognising the lives of carers and what they're doing and not, financial is one aspect, yes, the government could recognise it and add it to GDP if that was what they wanted to do. But it's understanding their life satisfaction, as well as the economic value that they're creating and recognising this group as someone who are sort of pivotal to the success of our country at the moment. They're increasingly under pressure and doing things that the government frankly should be doing. What do you mean? So the sort of those missing out on care due to sort of restrictions in local authority budgets and means testing of all those different things means that increasingly the family are stepping up where a social care system would have previously come in.

Right and by family we don't entirely mean women but we largely mean women. Yeah so when we've looked at the data we have available you know that women are doing more hours of care men are there and men are doing a specific number of hours particularly those caring but we also know that women are doing more of the sort of harder tasks they're doing things that a social care system should have previously been doing like medication eating meals all of those sort of activities that just shouldn't be necessarily falling on family at the moment. I think that's entirely right. And we basically have an economy that has benefited hugely from the fact that more and more women have been out taking jobs and in employment and paying taxes as a result of that.

But we haven't paid the costs of that. And the costs of that are the care that they would otherwise be able to do, possibly unfairly be landed with, but nevertheless we did have a system that relied a lot on women's unpaid labour. So when you said, well, there wasn't an awful lot of expenditure on social care when the National Health Service was set up, well, that's not surprising because there were a lot of women around who were doing it unpaid. Those women are now out at work. They're contributing the economy in a different way. And I think the norms that are supporting the current system,

which do land most of that unpaid work on women, are changing. And so even if we wanted to continue to rely on that system, I don't think we could do so. It's a very big report, broad report, Catherine, but you start with girls' education, actually, and point out that girls outperform boys routinely throughout education, but then enter the so-called wrong professions, perhaps even do the wrong degree. And that's where all the trouble starts. Yeah, so I was careful not to use the word wrong. I just have. I had my speech marks, fingers twitching. So we know that women are more likely to choose occupations

that are associated with lower wages. They tend to go into creative subjects. OK, so I've got to unpick that and say it may just be that jobs traditionally done by women are, guess what, not paid as much as those traditionally done by men. Yes, that is part of it. There are wage gaps within occupations still also. But there is, so for instance, economics, I know well as an economist, women do not study economics anywhere near the rate of men.

People often say that's associated with maths. Women don't like maths. And yet the numbers studying mathematics degrees are much higher. And so it's the way that certain professions position themselves towards women to see seems or strive for them and they know they can succeed. Quick word from you, Susan. Well, I think I think the issue about professions, one of the things that's interesting has been found out is that any profession that has a care component to it tends to get lower

wages. It's actually, there's a care penalty in a type of job. And one reason perhaps for that is that this is seen as a natural feminine characteristic, not something that you have to learn because women tend to learn it in the home and therefore it isn't paid for.

That was Susan Himmelveit, who is Emeritus Professor of Economics at the Open University and also involved in that discussion. Catherine Petrie, who is Chief Economist at the Social Market Foundation. Not surprisingly, plenty of you had a bit to say about this. And here is one email. Can you relate the impact of the cost of care for women to the raising of our pension age for me to 66 with a loss of around £50,000? I had to reduce my work hours through my 50s to help with the care of my parents. I couldn't afford to stop work, but also I was afraid I wouldn't get back into the workplace if I did give up my job. Of course, I had no idea how long my parents would need care and support, and it turned out to be nearly a decade. Women's lives are very different still to men's. We are still the prime carers greatly affected by the financial impact. Thank you for that.

And this is from Meg, who says the government should set up a care volunteer system where you volunteer and receive credits that you can use in the future. Young people can volunteer and benefit, for example, when they have children. Credits can be given to your elderly parent who doesn't live nearby. Well, it's an idea. Janet said, how is it that free childcare is offered to allow parents to work? But this isn't seen to be applicable to those who have caring responsibilities for disabled or older family members. From Emma, I looked after my mother with early onset dementia for a decade. I managed to keep my job, but only by reducing my hours to 20 a week. She died when I was 41, and I went back to full-time hours. I'm 51 now, and recently requested a pension forecast. For nearly 20 years NHS service,

I am only due 10 years pension. Shock and worry for the future, says Emma. And that is a really clear illustration of the pension impact of this. And I wonder how many of us actually think about, we don't even think, well, I personally hadn't really begun to think about pensions until really very recently. And it's short-sighted, but I'm sorry about that, Emma, you obviously don't deserve that outcome. Now to the earlier conversation about the morning after pill, and actually on that note, Vicky says, don't call it that. It is emergency contraception as it can be effective even if taken later. Women have had abortions because they thought it was morning after only. OK, Vicky, I take your point. Sadly, everyone who's contributed to this discussion has used that expression,

so I'll just dance around it. Anonymous says, I needed to take it recently, but after doing research, I discovered that if you have already ovulated, it doesn't work. I really didn't know what to do, so decided to just get the morning after pill anyway. The pharmacy was out of stock. After a bit more googling I discovered that the copper coil is a really effective emergency contraceptive. I had it fitted at a local clinic and all was fine. I felt absolutely mortified about having to go into a clinic for emergency contraception but the doctor was lovely. Well that that's good. Chakra says,

back in the day, my GP said, I can't give you the morning after pill. I'm a Christian and let me warn you, don't try any other GP in my practice. I ended up having a traumatic abortion. That's horrendous. Anonymous says, I can't believe what I'm hearing. About 20 years ago, I got pregnant following a split condom. I went the next morning to the pharmacy, paid for the morning after pill Anonymous says, stable relationship but not one I wanted further commitment from. I also strongly believe that the morning after pill may have damaged my unborn baby and that it would be a high risk to continue with the pregnancy. I felt I had no choice but to request an abortion. I was devastated and have felt guilty all these years ever since. Women should know the facts, says that anonymous listener and I won't mention this listener's name either, but this doesn't really need to be anonymous. Anyway, she just says, I listened with great interest

to your item on contraception. Two years ago, I found myself on a girl's holiday. I love that. She just found herself. She had no idea she was there. And then all of a sudden she was on a girl's holiday. We've all done it, love. And the topic of contraception came up. One of my close friends, somebody in a long-term relationship, explained that she was using a natural method, the cervical mu the month, as I'd been led to believe my whole life. I felt really angry and let down in so many ways, in particular by the education system. As a 33-year-old educated woman, how could I not know this? I still feel like I've been kept in the dark for such a long time, as though I'm not to be trusted with my own body. Well, there we are.

I mean, that's kind of what I was getting at at the end of that conversation this morning. For heaven's sake, we should all know, shouldn't we? It's so obvious, and yet it isn't. Anyway, thank you to that listener for drawing further attention to that point. And thank you for listening today. And tomorrow on the programme, amongst other things, we're going to be hearing from two Irish women's experiences of Ireland's industrial school system. Hi, everybody. I'm Caitlyn Jenner, and I am a guest on Simon Mundy's

Don't Tell Me the Score podcast. We talked about everything, the Olympics, trans issues, and all the lessons that I have learned along the way. I really enjoyed recording the podcast and I hope you enjoy listening to it. You can hear it on BBC Sounds. Just search for Don't Tell Me The Score. 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.