Woman's Hour - Trump one year on, Family estrangement, Testing on pregnant women, Caroline Mitchell

Episode Date: January 20, 2026

We are a year into US President Trump's second term. He says he will tell European leaders "we have to have" Greenland at this week's forum in Davos, Switzerland and impose tariffs if they oppose him. Trump regularly hailed himself as the anti-war president on the campaign trail - and he's described himself since as the "president of peace" - but there are some who accuse him of waging a "war on women" since taking office. So, after a year back in the White House, how have the policies of President Trump’s administration impacted women? Nuala McGovern is joined by Anne McElvoy, an executive editor at Politico and Jennifer Ewing, Spokesperson for Republicans Overseas UK. Brooklyn Peltz Beckham, the eldest son of the Beckhams, has said that he is not in touch with his family and does not want to reconcile with them. We don’t all live our family lives on social media, but most of us do have moments when we question whether our relationships with them are good for us. How do you know when you’ve reached the point when the right thing to do could be to walk away? Eilidh Dorgan and psychotherapist Dr Sara Young discuss. More than 90% of medicines have never been tested in pregnancy, leaving millions of women worldwide facing an impossible choice, go without treatment, or take medication you’re not certain is safe for your baby. The World Health Organisation is preparing to work with scientists, doctors and drug developers on what could be the biggest shift in decades, rethinking whether pregnant women should take part in drugs trials. Nuala talks to Martina Penazzato from the Science for Health Department at the World Health Organization (WHO) and Dr Teesta Dey, Maternal Technical Consultant at the World Health Organization and a Maternal Health Researcher at the University of Liverpool.Caroline Mitchell spent almost 10 years working for the police, including as a detective in the Criminal Investigation Department, before becoming a full-time writer. Her latest novel, The Ice Angels, has tinges of the Nordic-noir genre and is the first of a series featuring Elea, a Finnish detective whose daughter went missing 10-years earlier. She tells Nuala about the importance of writing for her and why the cityscape of Lincoln and Finland feeds into her work. This programme has been edited since broadcast.Presenter: Nuala McGovern Producer: Andrea Kidd

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Watch with a free trial now at Britbox.com. Hello, this is Newell McGovern, and you're listening to The Woman's Hour podcast. Hello and welcome to the program. Well, Donald Trump is on his way to the Alpine Town of Davos for the World Economic Forum. We are going to be there to examine how this term of his presidency

has affected the lives of women on the anniversary of his second inauguration. And although Mr Trump is grabbing the headlines, the most read story on the BBC website this morning is about Brooklyn Peltz Beckham. The eldest son of the Beckham says he does not want to reconcile with his family. Part of his statement was the following. I have been controlled by my parents for most of my life.

I grew up with overwhelming anxiety. For the first time in my life, since stepping away from my family, that anxiety has disappeared. We're going to be speaking about family estrangement. and I'd like to know from you, if you are or where estranged from a parent or from your family, did stepping away make a difference? How? You can, of course, be anonymous.

To get in touch with the program, to text is 84844 on social media where at BBC Women's are, or you can email us through our website. For a WhatsApp message or a voice note, the number is 0-3-700-100-444. Also today, we'll discuss what the World Health Organization is calling a generational change. Their plans to include pregnant women in drug trials. And the author Caroline Mitchell, with her latest novel

The Ice Angels. She will be with us. It's set in Finland and Lincoln. But let us begin. We are a year into President Trump's second term. President Trump has said he will tell European leaders, we have to have Greenland at this week's

forum in Davos, Switzerland, and impose tariffs if they oppose him. Well, Trump regularly hailed him as the anti-war president on the campaign trail. He has described himself since as the president of peace. But there are some who accuse him of waging a war on women since taking office. So after a year in the White House, how have the policies of President Trump's administration impacted women?

I have a couple of women to speak to about that. I've Anne McElvoy, executive editor at Politico. She's going to help us answer that. She is in Davis this morning. and Jennifer Ewing, spokesperson for Republicans overseas UK. Good morning to both of you. And let me begin.

I suppose everybody's awaiting President Trump. What's expected with his appearance? There will be a couple of very visible women in the delegation. Yes, absolutely. I mean, I think when Donald Trump arrives in Davos, I was here the first time you came, you're never going to miss it. Part of the airspace always ends up closed.

even the, you know, even kind of phone reception is reduced for security purposes. It was also quite dramatic. And I think in this context, particularly of the Greenland crisis, and that big transatlantic standoff, which this seems to have been widening day by day in the last week. You've basically seen him, you're tilting at everyone from Kirstama to European leaders. So I think the aim of this is to see whether there's any common ground that can be found here in the icy snows of Davao. but it's on pretty thin diplomatic ice. It's a largely male delegation, I should say, you know,

got Scott Bessent, the Treasury Secretary, Howard Lutnik, is he a commerce secretary and all of those, those big cheeses across business and economics, it's this kind of gathering. But when you look to the support team of Trump, you know, from Susie Wiles, his chief of staff, Mr Caroline Leavitt, you know,

he's very prominent spokeswoman. What you do see is that there are women around Donald Trump. It's maybe not the manosphere that a lot of people predict, given some of his saltier comments about women in the past. Let me throw that over to you, Jennifer, who's with me here in studio. I was looking at the makeup of President Trump's administration. And Catherine Dun Tempest, who's a director at the Brookings Institute think tank

in Washington that leans left, said for the Biden administration, at the one-year point, it was 50% male, 50% female. Now in the Trump administration, it's 84% male and 16% female. I mean, that doesn't look good for representation. Well, I'm not sure where those numbers are coming from and if that person is looking at just the direct cabinet

or women in his sphere and his leadership. What I am told and what I believe is that it's about 33% of the important roles in the administration are filled by women, which, while it's not a 50% Biden, because he's not trying to box tick, and, you know, do quotas, he's actually hiring these people on meritocracy and who is the best for the job. But with regards to historical GOP, you know, whether it's Bush or Reagan or previous Republican presidents, that rakes quite highly. You'll see, yes, his chief of staff, he just meant, his spokesperson, Department of Labor, Department of Homeland Security, Department of National Intelligence, Education, Small Business.

So there are a lot of women president. And what's important in it is the women who work with him, you know, think he's a fantastic man to work for. So I've never understood that. And I mean, people would expect there to be more female representation rather than previous Republican presidents because obviously they're more in the past and you would hope that more equality is coming to the four.

But we do know, Jennifer, for example, that Mr. Trump did say to terminate, he wanted to terminate every diversity, equity and inclusion program across the entire federal government. And of course, that includes women and would reduce their visibility and power. Do you agree with that action? No, I do not. I believe in, you know, equality of opportunity,

not equality of outcome. And as a matter of fact, I think a lot of the previous administration, Biden, for example, his, you know, pointing out, I'm going to choose a black woman, Katangi Brown, to be on the U.S. Supreme Court, or I'm going to choose a black woman

to be my vice presidential candidate hurts those women because Katangee Brown might be the most qualified Supreme Court justice there is, but the fact that it was pointed out that he is going to choose a black woman, everyone's going to be questioning, is that the only reason she was chosen? So I think it's much better to go back to meritocracy. Let's have the best people for the job. We don't, for example, look at Secretary Scott Besson and jump up and down and talk about the fact that he's gay. It doesn't matter. You know, he's an excellent secretary, you know, treasury. And so who cares what his sexual preference is?

And if it comes to Katanji Brown, some would say instead that black women were under-representative and also that there were issues of racism at times within selection procedures. Let me turn back to Anne because another big issue, of course, throughout the election campaign was abortion. Mr Trump repeatedly took credit for breaking Roe v Wade, a US Supreme Court ruling in the early 70s, which made abortion a constitutional right. Many commentators predicted that a national abortion ban would come into force if Trump were to win.

It hasn't happened, though. How do you understand that? Well, I think Donald Trump has always understood, particularly in his time in the presidency, that he has felt that abortion is not something that he wanted to fight a big battle about. But at the same time, he knows he has a Christian conservative base that's very important to him. And so I'm wondering, Jennifer, does it, do you think it matters what Trump himself thinks about abortion rights, his own personal opinion?

Does it matter to his base? No, I don't. But what's interesting, and Anne just pointed out the Christian conservative base, they actually did not appreciate Trump's stance on abortion. because he went way more to the center. He read the room of the country, which is most people believe in legal abortions within limits, right? So actually, Trump was the moderate going into the election versus the Democrats who felt, you know, you could go to 40 weeks or whatever. So what the Dobbs decision, Roe versus Wade, is as it's more, you know, commonly known, did is put it back to the states. And that is consistent with, you know, conservative governments and small governments.

This was not great law in 1972, and it wasn't great law now. So it was put back to the states. You'll notice that a lot of states immediately codified it into their law that abortion will remain legal. And of course, as you pointed out, there's not been a national ban, which is something that was, you know, fake news. I just wanted to say, sorry, because the line just dropped just because I didn't want to be mistaken. I'm going to come back to you. Anne. He has actually pushed back on abortion.

Yeah. it's an interesting I suppose paradox perhaps in the support that there is for Mr Trump. Anne? I'm so sorry. Right. Yes, absolutely.

Look, I think this is more complicated than it seems sometimes from the outside. It is true, as Jennifer says, that I think he wanted to shake off. He didn't want to go into this, be the abortion or anti-abortion president, but there has been a weakening of universal rights to abortion under Donald Trump,

and I don't think one can easily go past that. It's all right, so I gave it back to the states, but what if you are someone in a state that is moving in an anti-abortion direction and you need determination and you want determination, your rights are not what they were. So I do feel it is reasonable to say that and it's not easy for some women, particularly lower income women, to move and to go elsewhere to secure an abortion. However, it's interesting in the last couple of weeks, I think Donald Trump has said,

well, it comes off and down to these things and who funds what, and that is a keyhole way in which you get abortion sort of stuff done or not done. He said to Republicans, they need to be flexible on this issue. And I think that speaks to his underlying view of this, that it's something he feels he has a conservative and in some ways very anti-abortion coalition to keep together. The likes of Charlie Kirk and Charlie Kirk's widow who make that one of their big topics and female podcasters who are anti-abortion, anti-choice, you know, in that sense. But at the same time, no, he does not really want to be defined. I think he just sees it as politics. The way Donald Trump sees everything is politics.

What policy do you think, Jennifer, has most benefited women? Sure, but I think, I mean, this is the crazy thing we always talk about abortion when it comes to women. And I think that's so reduction in it. I mean, I think why can't women's biggest issues be safety? Why can it be the economy? Why can it be under Trump that women have had historically low unemployment? I mean, let's not forget that over 40% of American women. women voted for President Trump. So they obviously loved, for example, the fact that he was going to

close the border. I mean, we had 300,000 children go missing under the Biden administration because of the open border. That's a lot of human trafficking that does inadvertently, you know, affect women. So that's a problem. Women in sports, that is pretty much a 70-30 issue. Trump was very outspoken about that, like keeping men and boys out. of girls' sports. That's a very popular issue. And just let me be really transparent with that. You're talking about the presence of transgender people, so trans women, people that are born male who identify as women, keeping them out of women's sports. Well, yes, especially in children. Like when it comes to, and that's like I said, it's an over 60, 40 issue in the United States.

So even the Democrats are not going to fight on that. And you ask, like, how has Trump been helpful to women. He's been very big proponent of women's sports, safety in women's places, you know, jobs and empowerment for women and obviously safety and security, not just in the border

but, you know, cracking down law and order in towns. And of course not everyone would agree with the premise of women's safety in that arena. It's a contentious issue, but I do know interestingly, last year I was at the inauguration covering it and we have

happened to be in a bar. You remember it was, I can't remember minus what, freezing temperatures at that time when we were in a bar. And every time he announced that policy, people would get up and cheer. It was his base, obviously, that was there in that particular bar in Washington, D.C. as well. But I want to move out, and I want to look internationally, Anne.

Huge reductions to US aid were made last year by the Department for Government Efficiency. Six weeks after US aid was frozen, the US Secretary of State, Marco Rubio confirmed that 83% of the agency's programmes would be eliminated. Many organisations say women and girls were disproportionately affected by diminishing aid, particularly in conflict areas. Do we know exactly how that came to pass, Anne,

or what the impact of that reduction was? Well, I think we are still seeing the impact of that come through, remembering that obviously funding and particularly funding, for sort of overseas projects via USA. The funding sort of drips to a class, if you like, you know, the taps can be turned off in some cases. Immediately I just found myself going to a website when I was looking for something

was actually about disinformation, but it's just as disinformation, for instance, that feeds into maternal health or getting, you know, getting a vaccine or something like that, which can be, you know, very harmfully sewn, often by China or with, with Russian, presence to stop people in parts of Africa with a sort of contested zones of interest from getting

access to healthcare. Now, when the US sort of absence itself from that, then disinformation readily takes hold. That just sort of disappeared. That was the State Department pushback, was we sort of clever way of tagging disinformation so that people, when they saw it pop up on their mobile phones, could see immediately that it was questionable. That has all gone. So in a sense, to count the cost of that down the line, don't you, when women are not getting the information they need. In terms of things like malaria, like access to reproductive healthcare contraception, particularly we're seeing a lot like Bill Gates and his foundation stepping up. But there is no doubt about it. You know, when USAID is cut in this way, and in some ways, you know, you can understand

the Trump position, they're not going to take over everything that the Democrats thought was important or do it in the Democrat way. And organizations do. Because, you know, bloated and they do become about jobs for the people who work there. But when you go at it in this way where things are simply, there was no sort of process of saying, is this working, is it not working? Could we maybe finesse this or move this budget over to something else to be more cash efficient? That was not really the approach. The approach was these a Biden era projects, Obama era projects, Obama care on maternal health care in the US or women's health care. They are just targets because Donald Trump doesn't like them. So yes, there is damage.

from that. What do you think about that, Jennifer? Was it too blunt an instrument or the way they went at it? I do, actually. Yeah. I think I do. I think once Doge started covering this waste, fraud and abuse of which there was some appalling examples of the way the US tax dollars were being spent around the world, that they used a heavy hammer and just took down everything in a hurry, quite frankly, and a lot of good projects, certainly ones that affected women globally, were taken out with those. So yes, I do think that was a mistake. Having said that, he was, you know, he was elected on an America first agenda. And the United States of America is well known. We have a $38, you know, trillion dollar deficit. We do not have money to just spend all around the world. And he was given a mandate to concentrate on

on America and the women of America. So of course there are going to be programs that are shut down. And that, unfortunately, is going to affect people around the world. Hopefully, other countries, hopefully the private sector, you mentioned the Gates Foundation, other people can pick that up. But yes, it could have been handled a better way. Probably not to the tune that the U.S. aid would. Just before I let you go, Jennifer, Greenland Trump on his way to Davos,

do you feel Republicans are behind him on? his hard stance on that the US needs Greenland? You know what? I think we're going to end up with Greenland under our control. And I think it's going to take a 10-minute speech for Trump to explain to American people how important the Arctic situation is. So yes, I do. Before I let you go on, with that, do you think Greenland would come under US control? I think it will come under US influence. And I think the question is, is there a way to square this circle in which Arctic security

comes back to being something that we take as a joint endeavour. I think a little bit of the edge is coming off Donald Trump's pronouncements on that, but it's Donald Trump, so you're never sure till he gets here. And sometimes not even then. Thank you so much for speaking to us, Anne McAvoy, who is in Davos,

the executive editor at Politico, also to Jennifer Ewing, spokesperson for Republicans overseas UK coming into our studio this morning. Thank you so much. Thank you. Now, a number of you've been getting in touch with me over our... our next item, and that is about family estrangement.

I read a little of the statement from Brooklyn Peltz Beckham earlier. He is the eldest son of the Beckham's. In a series of Instagram stories, Brooklyn addressed his 16.5 million followers directly. He said, I do not want to reconcile with my family. I'm not to be controlled. I'm standing up for myself for the first time in my life. He went on to address a number of tabloid stories, including why his wife didn't wear a Victoria Beckham dress at their wedding.

and he said that in his family Brand Beckham comes first. My family values public promotion and endorsements above all else, he writes. Family love is decided by how much you post on social media. There has been no response from the Beckham's. Now, of course, we don't all grow up in the spotlight. We don't all live our family lives on social media.

But some of us do have moments when we question whether our relationships with our family are good for us. Maybe you have. How do you know when you've really, reach the point that the right thing to do could be to walk away. 84844 if you'd like to get in touch, a number of you have already. Here's one. I stepped away from a narcissistic sister.

It is the best thing I've ever done. Sad in a way too. It would have been lovely to have had a caring, fun one. I can now live my own life. You can also get in touch at BBC Woman's Hour. I want to bring in Ely Dorgan, who I read her article this morning on which is just on this written just a couple of days ago. Also, Dr. Sarah Young, who is a psychotherapist who has worked with people going through it.

You're both very welcome this morning. I'd like to begin with you, Eyley. You've been through this and you're really questioning whether stepping away is the most healing thing to do. With your experience, if you're prepared to share a little. What do you think, where is your head up now on what it means to step away? I mean, I think over the past maybe 15 years, I've kind of gone back and forth and I would spend a few months at a time when I'd maybe stop talking to my mom and things would kind of reset because there was maybe the threat that I'd, you know,

not speak to her again. And then I kind of, I stepped away almost two years ago. And I think that what was really helpful was I had my own family, my husband. And so kind of having that support network and that strength. And at the time, you know, I really thought, this is just until one of us dies. Like I'm just, you know, I've closed the door. But I think that over the past maybe six months or so, I think, you know, I have children and I question whether, you know, what's best for them and should they have a grandmother in their life? Because it's the only one that they would have. And, you know, I think that she has the potential

to be a good grandmother. And I think there's space there potentially to enable that relationship. And then kind of within that, I've begun to think about whether it's possible for us to have a relationship and not in like a normal way, not in a way that most people would have with their mothers,

but in a way where there's boundaries. And I think that ultimately what I've realized is that you don't have any control over other people, but if you can kind of change your own outlook or have more empathy or I didn't know. I mean, it's a huge ask and not most people can do it. And I just thought the way you framed it was really interesting, Ili. It's is parental estrangement always the healthiest option?

Question mark. And your short answer is it's complicated as you described to us. Sarah, let me bring you in here. Could it be the healthiest option? In certain situations, it can be. over the years that I've worked with young people and adults like Ily, it's very complex and it's not as easy to just step away. Certainly when you have a family like I was saying, it brings in a different dynamic

and then you can be drawn back into those relationships. It often depends on what the parent is like and what they're presenting issues are for the child. Indeed. Isley, did you want to come in there? Oh no, I don't think that was me But I know No worries Let me read a couple of the comments

That are coming in And of course, Ili, we haven't got your mother To tell her side off the story And we do know I mean, I definitely felt it Reading about Brooklyn Pelt's Beckham As well

That no matter what the opinions are It's obviously a very sad situation For any family that goes through it As my listeners are telling me Here's one I've been estranged from my mother For a number of years It's tough because the world

has an idea of what mothers should be and she is not like that at all. I do get judged for cutting her out of my life. It's also made aspects of my relationships with other family members hard. However, I am truly happy for the first time in my life. It's strange that we expect people to continue with family relationships when we would not tolerate those behaviours from other people that we are not related to. Sarah?

Yes, perfectly put. I couldn't have put it better myself. It's often the expectation of others. And I think even for Brooklyn, going through. going public, you're still going to go through a grieving process. He's still going to grieve the loss of what he or the family that he wanted or the family that he had, you know, there's so much complexity to it. And like I said, you need a good support network around you.

That would be the advice is get the support you need to help you through it. If you are going to step away? Yes, definitely. I mean, yeah, certainly. I might go back a couple of things. steps and I'll bring in another listener here as well who says, I can only admire Brooklyn Pelsbeckham for stepping away from his family.

I've had a similar situation with my mother and father for most of my life and I'm constantly thinking it will get better. Unfortunately, I'm always wrong and it causes me, my sister and our children, enormous anxiety. I'm now 62 and I still feel like a child with controlling parents who are never happy and always have to blame someone

else. Thank you for covering this. If somebody is at this point, because I think Eiley was outlining that it's constantly evolved as well the way you feel or the way the relationship might be. If you are that at that point, like the listener who gets in touch with us, is there advice to anyone that you can give who might be at that point before they break completely away?

Is there any other ways to mitigate the situation? I think the person, you know on some level if this relationship is destructive, you may not openly acknowledge it, but you'll know, you'll have a felt sense of somebody who's very controlling of you. Often the relationships are quite where the parent or the sibling, like the lady said, then be narcissistic or, you know, have elements of some challenges themselves

that are then projected onto the child or the young person or adults. So I think beforehand, I would certainly, explore therapy and get a really good therapist to have that conversation with to support you to make decisions like that. And getting the person who you're having the issues with into therapy with you? No. No. I wouldn't if that person, no, because if you're, if you've got a hypothetical, narcissistic mother, then goes into a therapy room with the child. That's a really negative dynamic. That child or young person or adult, young adult or 60 year old needs to have that space to be able to work through what they need to work through. It's not to say that the parent can't come in

or isn't able to come in at some point. But when somebody's in therapy, it's the other person, like Ily said, they don't change. So it's about knowing what you need to do. I think two words are coming up to me as I speak to you and Ailey. I'd like to bring you into this as well. this kind of controlling is one that I'm hearing from the listeners as well. The other is acceptance. And I felt, Ily, reading your piece that you're trying to see, can you meet them where they are? Or is there a level of acceptance that you might be able to, I suppose, embody? Would that be fair?

Yeah. And I think, you know, it's kind of easy for me to say this right now because I haven't spoken to her for two years. And it's just something I'm mulling over in my own head. So the practice of it is going to be much more difficult than the theoretical idea of it. And I think one of the most difficult things is grieving the fact that, you know, I think that you keep kind of holding on to the strand of hope that you're going to have a relationship that you hope to have. And I think part of it is really letting that go before you explore a different relationship. And that's really hard, I think.

How much headspace does it take up for you? I mean recently because I've been writing about it more but we live in different countries and it doesn't really take up that much headspace I have to say another message after years of trying to have a good healthy relationship with my mum I decided to cook contact eight years ago unfortunately she had a very destructive and toxic personality and it was badly affecting my mental health

I miss having a mum but I don't miss her as a person sadly Sarah can I come back to you with the on the word controlling because that's come up, I feel, so many times, whether it's from Brooklyn's Post or indeed the ways listeners are getting in touch with me. Yeah, and that controlling parent dynamic to child, whether you're 60, you know, whatever the age, dynamic, it's still a parent to child.

And when you have a controlling parent, it doesn't matter whether you're living with them or living in a different country. They can still sometimes have an impact on you and boundaries are essential, but also our clients that I've worked with in the past I'll often say to them why would you go back to the person to help you heal

when they're the person that caused the harm so it's very hard with that mother dynamic especially with that attachment to stay away because you always or there's often that holding on to hope that it'll change that something will be different if I bring my children have they got the potential to be a good grandma

but to hold that boundary to keep yourself safe. Often if a parent is all about themselves, children can shine a light and they'll reflect and get what they need as soon as the child says no, then it can change. Obviously we haven't heard from the Beckham family yet, as I mentioned. There was an aspect that Brooklyn talked about, them putting their lives on social media. and it was Hadley Friedman this morning actually on the Today program

she talked about so many generations do that with their children now you know what I mean people that are parents now for example and that children don't give consent it's an interesting concept isn't it about where resentment or control can arise particularly online Sarah yes certainly you know there's a lot of parents as a parent myself, you know, you have to think about those things and understand the impact of if you do, you know, I have this conversation, my son's 15 now and he's had posts when he was little

that he wanted to pick up a penny for our fundraising, you know, and he'd say, take a video of me, but now, if I said to him, I would, I'll always ask permission even when he was little, I'd be like, do you, do you want to do this? And, but also understanding that children haven't got a clear understanding at that age of why or what it's for, the exposure they may be exposed to. And yes, you're right.

I think for the beckons, they are that crossover, that bridge into social media generation. And sadly it is, it is a lot like that now on Instagram and TikTok in those platforms.

Back to you, Ali, just to get your final thought. I mean, did writing about it and obviously these conversations that are happening and it isn't funny, it's exactly I suppose in the zeitgeist at the moment. We had Prince Harry who was back in the papers yesterday

because he was in court. We have Brooklyn Pelsbeckham posting this morning. I suppose how does it feel at the moment to speak about this? I mean I think it's been interesting because there is kind of such an appetite for it because I think it is something that like, you know, millennials are kind of doing more of. I think for me, what's

been kind of therapeutic is writing about it, but then also in some of my articles I've written, I've spoken to therapists and you're kind of getting, you know, multiple different opinions from different therapists and that's been kind of helpful to reframe it for me. So it's been kind of an interesting opportunity to not only like have a catharsis in writing about it, but also speak to experts about it and get some kind of expert opinion. Ily, thank you very much. And for people who want to find your article, I'm going to spell your name, which is E-I-D-L.

Actually, it should be E-L-E. Give me one second. I have a feeling that it's spelled incorrectly. I'm a thing. I'm going back to the article to get an exact. E-I-L-D-H, Dorgan. People can guess that one. And thanks also to Sarah Young, a psychotherapist.

Lots of messages coming in. I am reading them 844-844 if you'd like to get in touch. Now, more than 90% of medicines have never been tested in pregnancy, leaving millions of women worldwide facing an impossible choice. Do they go without treatment or do they take medication that they're not certain is safe for their baby? Now the World Health Organization, the WHO, is preparing to work with scientists, doctors and drug developers

on what could be the biggest shift in decades, rethinking whether pregnant women should take part in drug trials. And it is, they're calling it a generational change, really. It's the most significant since the thalidomide scandal of the 50s and 60s. That led to those strict drug safety rules for pregnant women that are still used in the UK today. With me is Martina Penadzato, from the Science for department, from the Science for Health Department at the WHO. Also, Dr. Tis today, who's maternal, technical consultant at the World Health Organization and also maternal health researcher at the University of Liverpool. You're both very welcome to the program. Tista, let me start with you.

What drugs would potentially be trialled on pregnant women? So really, Nula, the issue is that we're trying to understand the safety and effectiveness of any medication that a pregnant woman is taking during her pregnancy. And we know for the vast majority of women, we know, for the vast majority of women, they're taking, so 70% of women are taking some form of medication at some point during their pregnancy. However, 98% of these haven't actually been tested in a pregnant or lactating woman. And we know the physiological state of a pregnant woman is different to a non-pregnant state. So your circulating blood volume is 40% increased, for instance. And there are loads of other biochemical shifts that happen. So that means trying to extrapolate data from a non-pregnant

non-pregnant form into the pregnant state. Yes. We don't know that these drugs are, in fact, as effective or as safe. That's what I was wondering, what the confounding issue was, Tista, like, is it how the pregnant body metabolises drugs or is it more concern about the harm that that that particular drug could do to the baby? So I think it's, the issue primarily is in terms of how the pregnant state can metabolize that medication.

Okay. can store, can absorb, can translate. But remember that medications are not just for impact for pregnant woman. It's her baby. But actually that diad of the woman and the baby is so inextricably linked. Of course. So we can't disentangle one from the other. And often, I think in the past, that precautionary principle that has been applied

means that unfortunately the benefits that could reach a mother, you know, she has perhaps a chronic disease or she has a, a symptom or a sign that is affecting her quality of life, gets neglected in the sense of this potential risk that actually hasn't been evaluated correctly. And more importantly, we're taking the autonomy away from that woman to make the choice of can she be part of a clinical trial? Pregnant women are able to weigh up those risks and those benefits.

We're able to provide them that information. So should we not have a responsibility to do that, to give every woman a choice? Martina, do you think, was it the thalidomide scandal that really stopped the thoughts of trialling drugs on pregnant women? Yeah, certainly that was an event that really caused a lot of concerns and really shot our health community. And I think that a lot of the policies that were put in place after that were really influenced by that experience. But it's quite interesting to see how recent work has gone back. to that specific case and noticed that if we had actually investigated the drug in a clinical trial,

we would have actually spared all those birth defects that emerged from the use of the drug. And so... Can I stop you there for a second? Because when you say if they had been tested in a clinical trial, do you mean a clinical trial that would have included pregnant women? Indeed. Or allowed women on a clinical trial to get pregnant and potentially stay on the study drug, which is typically something that doesn't happen because women are intentionally excluded from drug trials

or are recommended to use contraception in order to avoid getting pregnant during the study. So as a result, obviously, data is never gathered, right, as part of this main clinical development programs. And so there is an intentional effort that needs to be put in place to actually include in a timely manner women in the clinical trials and allowing them and supporting them to potentially stay on the study drug. if they do get pregnant as a result. I suppose just part of it that I don't understand, coming back to thalidomide, if they had been in those clinical trials,

would those birth defects not have occurred? They would have been picked sooner. I think what happened back then it was that some of these data was gathered as the drug was being used in clinical practice. And I think that's what we end up doing in many cases, now. So doctors and pregnant women are, you know,

asked to take decisions with very little data, whether to use or not a certain drug. And then they might decide to go ahead because sometimes they don't have a choice because they have chronic condition that do require treatment. And then, you know, these type of data is then followed up, but it takes time to, to gather these information. So if we are able to include women in clinical trials, pregnant women clinical trial sooner, obviously the, the important amount of information that we need will be generated sooner.

With some of the medicines used in pregnancy, the labels are, for example, use only if no other option, no research done. Which I'm sure is quite a scary thing, Tista, for any mum to be, to have to decide whether to use or not. Absolutely, and I think it's both scary and it is confusing. What women want is information. They want to be able to understand and make those decisions as to whether they want to continue a medication or not. I think more so for a woman, if you imagine, who is experiencing a chronic condition. They have severe depression. They have epilepsy.

They've been on treatment throughout their life that is working for them. They fall pregnant. At this point, they now need to make a decision on whether they continue that pre-existing drug that was working for them. Do they switch to a new drug, which may have different side effects, take time for their body to adjust. And equally, you would hope that when you're making that conclusion, you have information to guide you as to whether that's safe and effective for you and for your baby. How do you make that decision you go to your health provider to ask a trusted person, what's your advice? They don't have the data or the evidence to guide them. So we're in that

position which leaves many women having to either take a medication off label or equally without understanding the full side effect profile. And for me, I think that is something that we can better on. Right. And I think Manny would agree on that. However, let me come back to you, Martina, this generational shift that WHO is talking about, including pregnant women in drug trials. I'm trying to imagine what women might come forward for that. Your thoughts? Yeah, I think that certainly one angle that we need to make sure it's supported adequately is the active role that women will have as a community within the design, the conduct, and then the dissemination of clinical trials. And this is obviously a good practice that applies to any population. But in

this specific case, because of the challenges and the reluctance that some women might have to contribute to clinical trials, it would be particularly important. And we know that there are certain disease communities that have been a little bit more forthcoming in this sense, taking as an example, the HIV community where a lot of research has occurred or also for pregnancy-related conditions where, of course, some of these drugs are really essential for the health of the pregnant women. So again, engaging with the community and including them from the very beginning of study design and implementation will be really, really important. And it's one of the things that we are capable. So you talked about study design,

what sort of steps need to happen? Yeah. So at WHO, we're really putting greater emphasis in really increasing and strengthening the clinical trial ecosystem as a whole. And actually, this is work that was championed by the UK government a couple of years ago and supported by the UK Department of Health and Social Care. So it's really work that it's in general kind of allowing us to strengthen the clinical trial ecosystem. Within that, we are already providing some strong endorsement to a more timely inclusion of pregnant women into clinical trials. And that needs, of course, completing the pre-clinical studies,

so the studies before we move into the investigation in humans to be completed sooner so that we can indeed allow us to have more information once we then include women in the clinical trials. And then, as I said earlier, the appropriate enabling environment from a regulatory standpoint, but also from a support standpoint,

to assist women to stay on the study drug if they choose to do so. And I think that's going to be certainly something quite important. So what we're trying to do right now is to develop tools that can be supporting scientists and those out there that are keen to contribute to clinical trials and the inclusion of pregnant and lactating women in those trials.

And so we really hope that some of the material that we are developing together with our colleagues across the organization and with some of the partners out there will be able to really concretely support a stronger research done in this space. Do you think it's the long way off, Tista? I mean, to actually have women, pregnant women, safely take certain drugs? I think first and foremost women are interested, and that's the biggest, you know, driving point.

I spoke recently at the Birth Trauma Association Conference, and during that conference, there were several women that came up to me and said, you know, this was a really big problem for me with hypermesis, for instance, in pregnancy, and I didn't know what I could take. And that really paved the way that women are really... Hyperamuses? Vomiting during pregnancy. People would have heard.

Various people that have had it, yep. Yep. So very, very severe vomiting during pregnancy. It really affects a huge number of women. And they don't know which medication is safe for them to take. So women themselves are coming forward saying we really want to be part of this. But as Martina mentioned, this takes a multi-stakeholder approach. We need several levels of bodies involved.

We need our ethical and regulatory. bodies to be aligned on the appropriate practices that require women to be part of clinical trials. And the International Council of Harmonization are actually producing the E21 guideline, which we've been members of the consultation process for. And that will be in the next sort of year or so, that that guideline's there. As Martina mentioned at WHO, one of the key practices that we're putting in is a toolkit to actively support researchers and clinicians in involving pregnant and lactating women in trials. What are the tools? What are the tools? that they need to make this action a reality.

And then we're also trying to work with all different bodies, private sector bodies and wider bodies to show the incentive for why involving women in these trials is important. It isn't just a short-term issue. It's the long-term impact that has on a woman's health for her able to contribute effectively to society, to carry out her job, to be a mother, to be part of the society that she wants to be in.

So these are really wider ramifications of this work and why it's really important. Really interesting. Dr. Tees today and Martina Benazato. Thank you both so much. Thanks for your messages coming in as well on family estrangement. Here's one. I stepped away from a lifelong toxic family dynamic where I was scapegoated, which caused deep emotional harm. Distincting myself has been liberating, but grieving the loss in therapy was essential.

There's real stigma around estrangement, even though it's far more common than we realize. And for the first time in my 50 plus years, I feel free and secure. Keep them coming. 844 if you'd like to get in touch. Now, sitting across from me is a woman who spent almost 10 years working for the police in various roles. As a Bobby on the Beat, educational talks in schools, a detective in the criminal investigation department. But now she's a full-time writer. And her latest novel, The Ice Angels, has tingees of the Nordic noir genre.

It's the first in a series featuring Elia, a Finnish detective whose daughter went missing 10 years earlier. It is a page turner. It at times is grim, but it is always gripping and gives an insight into the minds of criminals, the police and victims. Caroline Mitchell, we're going to start with the reading. Good morning. Good morning.

So this is, just to let people know, you hear the perspective of a kidnapped child, and yes, you may find the reading distressing. So, Pervu, Finland, 2006. A comet of pain shoots up my back as we are jolted by a bump in the road. My face is pressed so hard against the car door that my neck feels like it's going to snap. Gagging, I try to breathe, but I'm overcome by the stink of fish embedded in the blanket thrown over my head. I try to focus on the memory of my school bag lying in the snow.

Someone will find it, right? They'll call the police and... Stop crying. The man leans on my back. stealing whatever breath I have left. He's not big, but he has a weapon. I choke back my tears, scared he'll electrify me again. So that is a flashback to 10 years ago, 2016, and this kidnapping is revisited throughout the book.

Where did the idea come from? Oh, well, I have so many ideas in my head. It's hard to keep up with them all. But I wanted to create a new crime thriller series, and my brother lives in Finland, and he was forever telling me about the landscape over there. I just found it fascinating. I used to say you're not far from a forest or a beach or a lake.

And I've also moved to Lincoln recently and I've just fell in love with Lincoln and it's beautiful cathedral. And I thought, I'd love to write about a character who comes from Finland to investigate a series of crimes in Lincoln. And there's a connection there because it's about girls who've gone missing. And then when she looks into the crime,

she discovers a link to her own daughter who was taken 10 years before. And the protagonist is, Aaliyah, this very dynamic, in some ways unusual woman that's on a mission, really. And she's going to be really a central character in this new series. Yes, she is. I just love writing powerful women. And as a detective, our ex-detective myself,

I never really got closure on many of the cases or often things didn't turn out the way I wanted. So I love writing about really strong. women in fiction and having that closure. And I loved her character and she's full of good humour at times as well, which I think is necessary because at times it's very dark. And I did, it's very evocative, which obviously is a, is kudos to your writing. But I was wondering what it's like to write some of those scenes, even the one that you read,

for example, trying to get inside the mind of a child who has been kidnapped. Yes, to be honest, I got into writing because it was like therapy for me. I grew up in Ireland in a very small little place, small little village, kind of in the middle of nowhere really. How do you pronounce it? I'd never heard of the village before. It's for ban. For ban. It's for ban. County awfully, yeah. County offly, yeah, right in the centre of Ireland next to the canal. So not a lot went on. So joining the police really was a baptism of fire. I mean, in my first time on the streets, I was just thrown into a murder and, you know, had to go to court.

And it was really, my tutor said to me at the time, look, if you can survive. that you can survive anything. But after nine years of dealing with victims of domestic abuse, stalking, things like that, it does creep into your head. So for me, writing was therapy. And it still is. And I think it really helps me to cope with everything. I was about to say, do you think it's necessary to get those words down on the page after

what you've seen? Yes, I definitely do. I think without it, I'd probably be in counseling. Yeah. But with the writing, yeah. And it's, I tell myself it's fiction at the end of the day, you know, but I do have a lot of thought. in my head that I like to get out onto the page. How do you, because you've been incredibly successful with the books that you've published. Was that expected?

No. No, no. I was very, very fortunate. A series of things happened. And I met the right agent at the right time and the right publisher. And they said I had a very unique writing voice. So it all went from there.

And do you understand why people seek out your books? you know, being quite frank about, you know, tales that can be horrendous. Yeah, I think it's a form of escapism and entertainment. My books are very fast-paced. They are. They're described as page turners and I love to throw in these bombshells and very big twists. And I always ask my editor when I give her the book, did the twist get you at the end? So I think it is purely escapism and entertainment.

Because I think with some of them, and I'll mention this, is kind of a distressing scene as well. Someone scrapes the ice off the face of a child who has died. Do you ever worry that you've crossed the line of something being too dark? No, I don't think so. I think these things do happen in real life. And I think if anything, we're covering... But that's the bit that's so alarming.

If you think about it, you're covering what it feels like to be a police officer that actually has to do that. And not a lot of people know that. People have this idea of the police that were just rigid. people and you know we're human we're mums i had some more for small children when i was in the police i had children home i empathized a lot that's why it affected me so much i think and i think if anything it gets out there if people read this and see that this police officer is actually going home and having a little cry they realize actually police are human and the things they have to deal with you just wouldn't believe on a daily basis so i'm hoping that will give them more

compassion um also and your characters are rounded and i think there's an aspect that you want to keep, to not let cases go cold, even in real life? Yes, definitely. I always say, well, light a candle for the people who are missing, you know, and keep them in mind. And it is also an insight into policing and how it works that in some cases when someone goes missing, the more online presence you can generate for that person, the more pressure there is on to investigate because it's all budgets the end of the day.

It's budgets. And so if there's more pressure, there'll be more budget. and that's why I always say. What do you think, though, because I talked a bit about social media throughout the program, but there is also that aspect of social media, which you'll be no more aware than anyone. Like the case of the armchair detectives, there's been a number of cases, often actually that include women or children, where members of the public are said to have caused havoc in police investigations and for local residents, for example, where something happened.

That's actually why I started a true crime channel on YouTube for that very purpose. to, you know, because people can go too far and I wanted to be the balanced voice. There's a lot of true crimeers out there who will slate the police and say they're doing a terrible job and for me I wanted to draw back on things and say, look guys, you don't realise

the politics that goes behind certain things, you don't realize that there's a budget that actually it's great to, you know, there's a balance really. It's great to shine the light on that person who's missing but also have compassion for the families involved. Right. You offer writing courses.

Yes. What would your tip be to aspiring writers? You start with tension straight away. Yes, I do. I mean, mainly it's just sheer perseverance. You don't have to be hugely educated because a lot of the times people worry, am I good enough or am I too old?

I didn't have a degree that wasn't available to me growing up as a child in Ireland. You just have to write. You just have to sit down and get out the thoughts that are in your head and it will get better in time but the only way you're going to improve is by keep writing, keep writing. And you were doing it with four small children

and a full-time job. Yes. I used to get up at five in the morning. I would write on my commute on my laptop and people would kind of look at what I'm writing then slowly back away. I'd say if they read a few lines, they'd be like, oh my goodness. I did kind of back away after that.

But I squeezed in time wherever I could and I'm glad I did. It was worth the sacrifice. So you're going through all that at a million miles an hour. But I know you've also been very open about going through the menopause and the challenges that that raised. I'm wondering how that has been for your craft.

Oh my gosh. It hit me like a steam train, honestly. It's so hard. And I think DeVina Call's book really saved me, if anything, because she wrote such a brilliant book on it. And I thought, oh, I'm actually not alone. At one point, I thought I had Alzheimer's because my dad had Alzheimer's. So I really was seriously worried. Did it affect your memory? What was it? What way would you say it was the impact? Yeah, everything. My memory went. I'd be trying to pitch a book to my editor once

and my mind just went blank and I was so embarrassed. Things like that. I think people just have to have an understanding of it. It's just a tough time to go through. And thank God for HRT is safe to me. And, well, I see another plot perhaps in another. Don't cross the menopausal detective. Alia, let me see.

I'm thinking Alia is late 40s maybe. Yeah, yeah. Oh, you don't want Elia when she's menopause. She's bad enough. I'm already looking. Looking forward to hearing from Aalienex. Thanks so much for coming in, Caroline Mitchell. Her new novel is The Ice Angels and it is out now.

I do want to let you know tomorrow's programme. We're going to hear from the MP at the heart of an inquiry into the harmful chemicals in hair and beauty products. Also, how does a working class Liverpool Pudley and Copa Cambridge University? Jade Franks is going to tell us she had a hit show at the Edinburgh Fringe. All about that. She's now on tour. so that is at 10 o'clock.

I want to just read some of your messages on estrangement. I had very successful family therapy with my father 10 years ago. It was a relationship that was incredibly difficult and I had entrenched depression as a result. I thought it would never change, but it has. And now we have better boundaries and a loving relationship. I'm so grateful to our therapist for the change we were able to make. And I know I'm also incredibly lucky.

But my then 65-year-old father, a war baby was prepared to go to family therapy and mend. relationship. I'll see you tomorrow. That's all for today's woman's hour. Join us again next time. I'm Paul Kenyon and for Radio 4 and the History Podcast, this is two Nottingham lads. When the invasion happened, it was completely hell on earth with the sounds. The sad thing about war is people lose their empathy and their humanity. I want to know how two men from Nottingham ended up on opposite sides in the war in Ukraine. And what became of them after a chilling encounter in a prison in Danyetsk. Out of all the places in the world where I meet someone from

Nottingham, it's in captivity on two sides of the conflict. It's a story about how and why you pick a side in a war that's not your own. You can listen to two Nottingham lads first on BBC Sounds.