Woman's Hour - Under Pressure, Julia Chain, Hyaluronidase

Episode Date: December 6, 2021

In our series Under Pressure we've been looking at what happens to relationships when couples are put under extreme strain: how do they cope? Today we hear from Kate and Annie who live in Northumberland. This year marks the 30th anniversary of the Human Fertilisation and Embryology Authority. In March, Julia Chain was announced as the new chair of the HFEA. Now Julia is calling for the 1990 Human Fertilization and Embryology Act to be updated. She joins Emma to discuss the changes she wants to see.We talk to Deborah Bull and Jill Baldock about how dancing can lift your mood.A report out today from the Institute for Fiscal Studies says there's been 'almost' no progress towards closing the gender pay gap in the last 25 years. Professor Lucinda Platt, who's on the panel of the IFS Deaton Inequalities review, and who researches inequality at the London School of Economic, explains why not. If your facial fillers aren’t to your liking, or worse injected in a dangerous spot, you can get them dissolved with a substance called hyaluronidase. But women are reporting nasty side effects including swelling, tissue loss, burning sensations and headaches. A cosmetic surgeon, Daniel Ezra, is studying this to try to establish exactly what's going on. We hear from him as well as our reporter Melanie Abbott.

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

BBC Sounds. Music, radio, podcasts. Hello, I'm Emma Barnett and welcome to Woman's Hour from BBC Radio 4. Hello and welcome to today's programme. Monday morning is here again and for some of you, another week will mean not being pregnant again. And forgive me for going right in, but when you're struggling with infertility, it's all you can think about. Monday morning, right through until Sunday evening.

And so it goes on and on. Every conversation is blighted by it in some way, especially those with friends and family members perhaps telling you they are pregnant. And while you wish you could be happy for them, you're struggling to be. Not because you're a bad person, but because you simply cannot achieve what seems so easy for everyone else. Those conversations really knock the wind out of you as you try to feign some kind of happiness. And yes, you are mindful that there are plenty of other complications and heartache that people go through and have on the way to having children. Even if you're in a situation where perhaps you can relate to this or it was a long time ago, you may remember, though, if you can't get off the starting blocks to fall pregnant in the first place,

your mind goes to all sorts of places. If I sound like I know what you may have gone through or are going through right now, it's because I do. I have been there. And it's desperate when you'd like to conceive and you can't, year after year. My first guest today has made headlines in the last few days regarding the industry she's meant to regulate, IVF clinics. Julia Chain is the relatively new chairwoman of the Human Fertilisation and Embryology Authority and is calling for law changes which would include her organisational body getting the powers

to fine IVF clinics that sell unproven treatments known as add-ons. They can cost thousands and there isn't enough evidence to show they definitely have an impact. Having gone through IVF myself, I can attest to if a fertility doctor were to tell you to jump while drinking a cup of scalding tea, you wouldn't even ask how high, you'd already be in the air. Now listen, you may not have gone through IVF, you may not be able to. It's of course a huge privilege, especially if you do not qualify for it on the NHS. But what I wanted to ask today was what lengths have you gone to to get pregnant, you and your partner? You can text me here at Women's Hour on 84844. Texts will be charged at

your standard message rate. On social media, it's at BBC Woman's Hour or email me through our website. You don't have to give your real name. And as I say, it may not have involved IVF, but the road to having a baby can be a very long one for some. And it is often incredibly lonely. So let's open it up here on Woman's Hour and be amongst friends and feel that we can talk freely. Also on today's programme, as doctors prescribe dance and yoga to women struggling with depression, why do we all need to move? And perhaps we can get you moving too. It is Monday morning after all. I haven't really moved from the kettle to the desk. I think that's about the extent of it this morning. And of course to get here to the studio. And the stubbornest of gaps, the gender pay gap. A report out today

from the Institute for Fiscal Studies concludes that there's been almost no progress towards closing the gender pay gap in the last 25 years. I'm just going to say that again. Almost no progress towards closing the gender pay gap in the last 25 years. Why? We'll find out. What can be done about it? We hope to hear more. But first, a few days ago, Julia Chain, the chair of the Human Fertilisation and Embryology Authority, made a plea for the 1990 Act governing fertility clinics and practice in this country to be updated. She argues that after 30 years, the science and culture around IVF has changed so much and the law needs to catch up. Julia Chain, good morning. Good morning.

Thank you for being with us today. What changes are you calling for? Well, there are a range of changes. We're not saying, the Act actually, it's extraordinary that bits of it are still very much relevant today. And even after 30 years, we wouldn't want to change. But there are areas where the medicine and the science and the social mores of today have completely outstripped the Act. So, for example, we like to look at the inequalities in the Act. The Act recognises a couple as being a man and a woman. That is totally inappropriate now for 21st century Britain. There are many other family formations and there are inequalities in the Act with regard to, say,

for example, same-sex couples and actually single women or men who wish to start families. As you know, IVF treatment is predominantly private, 65% self-funded, only 35% NHS funded. And therefore, clinics have been, it's an increasingly commercialised sector. Clinics are now successful businesses and many of them offering excellent treatment for their patients. But there are clinics who, as you mentioned it in your introduction, offering add-ons or other treatments to patients which they might not necessarily need or even benefit from. And we have no powers to regulate this increasingly commercialised sector. So, for example, our sanctions range from a sort of slap on the wrist to the nuclear option of taking a licence away.

We don't have powers to fine clinics or impose economic sanctions when they missell products or services. Let me come in at this point. So you say, what's a slap on a wrist? What does that mean? We just might say to the clinic, you know, please consider not doing this or that, Let me come in at this point. So you say what's a slap on a wrist? What does that mean? We just might say to the clinic, you know, please consider not doing this or that, which is really not very effective when you've got a clinic who, for example, is suggesting or encouraging a woman to buy an expensive treatment that may not have been proven to be healthy. We know from a BBC panorama a few years ago that the majority of these so-called add-ons haven't been proven in the sense of there isn't enough evidence to say whether they work or not. It's very different, of course, to take part in a trial or be a part of something that's going to hopefully make the evidence for it.

But right now, how big a problem is this? How many clinics would you say are selling unproven treatments that can be to the tune of thousands? Look, I think that most clinics are abiding by the consensus statement that we entered into in 2019 with a whole range of doctors, clinics, embryologists on and those clinics abide by that statement which agree that they are not going to offer treatments to patients that are not proven to be helpful in them having a baby but as clinics become increasingly commercialized there is pressure on them perhaps to offer treatments which patients will pay for that they might not need it. It's not a big problem, but it still exists. What percentage of clinics?

I think it's impossible to say what percentage because not all clinics are offering the same sorts of treatments. And let's be clear, there are a range of patients for which some of these add-ons might be helpful. But what we want to be able to do is say to those clinics who perhaps are not being completely upfront with patients about the benefit of these treatments, you know, you have to give patients completely transparent and clear information about what you are selling them, particularly when patients are, as you yourself have said, so vulnerable. Sorry, so you can't say how big a problem this is, but it's enough of a problem that you now wish to change the law.

I know you want to change it for other reasons as well, to be able to fine these clinics. Why not name and shame them? Well, we are... You can do that now. You don't need a law change. And I have to tell you, there are many people who would help you with that. Many of the people who've paid for such add-ons and they perhaps still do not have a baby for that reason or other reasons. I think it's very important to understand that most clinics are offering patients a good service and they are being completely upfront and giving them very good information

about what treatment they can expect and what they need. And also, let's be clear, you know, some clinics are offering patients innovative treatments, which are not yet frozen as part of research trials and asking patients if they wish to participate in research trials. Yes, but we're not talking, you're the one who's brought this up. I'm the one who's trying to get to the bottom of it. You seem now quite reticent about what you could do before the law is changed, or perhaps not. If you have the ability...

So, you know, looking at this, since you made your comments, and, you know, full disclosure, I've written a column about this and I've talked to people in the industry. I've made films about this particular element as well as a journalist. We're building on the great work of Panorama. We looked at this a few years ago in a landmark piece, which people can look up. Why not take away the license from those clinics that you know are selling add-ons that are unproven? Right. I'm not being reticent. Let me be very clear. If clinics are

offering treatments, including add-ons, to patients that, for example, are within our red traffic light, so they're not proven and so on, we want the power to fine them or to have other sanctions against them to stop them doing it. It feels that most of these clinics, though, on the whole, offer a lot of their patients also providing an excellent service and mainstream IVF. So taking away their license would be really an inappropriately severe action. I think it'd be much better to have a range of sanctions, including fines, which would, I believe, be much more effective. And let me be clear, clinics are beginning to change their behaviors. So this is not something that clinics are completely not taking notice of. We've seen over the last two years better behaviour by clinics and we want to encourage that. So have you taken a licence away

from any clinics that are doing this? We take away licence from clinics only in most extreme circumstances where they have really broken the law. Right. It's just that it's interesting that some people who run these clinics think that you do have that in your power and if you're going to be serious about it, you should remove licences, but you think that's too severe. No, I think that we have to look at a range of sanctions. If we find that clinics are delivering a service to patients that is so outside their licence conditions or in breach of their licence conditions, then we would consider taking that licence away. It was quoted from one of the women that got in touch this weekend saying that they had several, one of these add-ons, endometrial scratches through their treatments. Every time was very painful. It never resulted in positive outcomes. She says, when I look back now, I realise we spent thousands on endometrial scratches for no good reason. What evidence should you ask for if you're going

through IVF to know if it's proven or not? Right, so we have a very clear system of, we have a traffic light system actually, and we've said that patients must be clear that there is evidence through randomised control trials, which this is the accepted sort of gold standard for the medical profession that shows that those treatments are effective. Actually, and it's worth saying that we are beginning to look at this whole area because there is now some suggestion among the medical and scientific community that there are other ways, as well as randomised control times, trials looking at efficacy, and we will look at that. But at the moment, the gold standard is randomised control trials, and that's what we look at. And you can go to your website, the Human Fertilisation Embryology Authority, and have a look at these traffic lights that you've referred to.

I mean, it should be said it's quite a lot of labour in itself, no pun intended, very much no pun intended, to be going through IVF then to be trying to decide what you should be doing and what shouldn't you be doing. And some people would say all of these things should be made free if they're going to be helpful to people, because there's some concern that some are not helpful. They're actually could be unhelpful, which is why there has been also concern about this. Do you think IVF doctors, very much it's linked to money, of this. Do you think IVF doctors, very much it's linked to money, of course, do you think IVF doctors should tell you when to stop? I think that IVF doctors who are obviously the experts in this should look at the medical, obviously, how patients, and I'm sure they do this, how you know how patients are doing each patient is

different. And what is medically best for that patient. And it may be that additional treatments, additional cycles is what patients need. And it may be that patients you know, who are paying should be actually saving their money and paying for additional cycles, rather than paying for expensive treatment add ons. But there may also be certain situations. I'm not a clinician, so I don't know what they are. There may be situations in which the doctor says, this is heartbreaking, I know, but it's time that you stopped. How long would it take until you know you can change the law? What's the next step? Well, I'm quite impatient about this. But as you say, I'm newly appointed and I'm beginning to understand that the wheels of government move rather slowly. But we are going to be asking doctors, clinics, patients for their views on what bits of the law need to be changed. And we hope to have proposals to the Department of Health

and Social Care by the sort of back end of 2022. And hopefully, Parliament's obviously very busy, particularly at the minute, but we hopefully get some parliamentary attention after that and move forward quite quickly. Because there are also other, apart from treatment add-ons, there are also other inequalities in the act that we'd like to... Yes, well, you referred to one at the beginning with regards to same-sex couples

and there is a married lesbian couple known as Wegan or Wegan on social media. You'll probably be aware of this. You've launched a landmark legal test case to see if they can have a review of this against the NHS fertility sector in England, claiming it discriminates against LGBT families. It's known as the gay tax by some. Would you support those changes? You know, where there is a lesbian couple, same-sex female couple, whether they're married or not, or in a civil partnership or not, even if one is donating their own eggs to the other partner, they still have to undergo additional screening as if they were both donors. And that is completely inequitable.

We will hope to have them on and see where that is up to as well, as well as them of course hearing from others Julia Chain thank you very much for explaining your mission this morning the chair of the human fertilization and embryology authority there many messages coming in in response to the question as I said doesn't have to involve IVF but of the journey and the lengths that you went to to have a baby to get pregnant or to support your partner my thoughts go to every woman or perhaps on your own I should also say excuse support your partner my thoughts go to every woman or perhaps on your own i should also say excuse me for that my thoughts go to every woman sobbing in a toilet

at home or work hiding their monthly grief as their period arrives that sense of dread as you feel the premenstrual cramps coming and know that they signify another month without a baby another month when you start to lose hope desperate that no one will ask you questions about when you're going to have a baby, how many babies you want, assuming that all it takes is wishing it were so. I now have two beautiful children, but I will never forget that monthly heartbreak.

I vowed then that I would always assume that any woman might be going through the same and would never ask those awful, insensitive questions, even though they are well-intended. And another one here says, five rounds of IVF and two miscarriages. In order to afford the later IVF rounds, I donated half my eggs to women

who couldn't produce their own at a subsidised cost. It's absolutely terrifying. You have to write a one-page letter to any potential children born of the donated eggs, which they can ask for when they're of age. Summarising a life into one page is so hard, says Shannon. And another one talking about how they are so changed by this entire experience. And I will come back to many of these messages, which also include notes of thanks that we're going there and we're creating the space to have that conversation.

Please do get in touch. The number you need is 84844 to text or on social media at BBC Women's Hour. But it's been reported today that yoga and dance classes will be prescribed by GPs to women who may be depressed. This Girl Can, do you remember that campaign by Sport England? Well, now they're going to be classes launched early next year from the same campaign. They're based on previous successful sports campaigns which had that same name, which is why you may recall it. Now, Deborah Bull used to be a professional ballet dancer, of course, a long and illustrious career, now a crossbench

peer in the Lords and vice president at King's College London. And Jill Boldock is a professional dancer and adjudicator for All England Dance. Deborah, I thought I'd start with you. What do you make of the idea of this being prescribed? Because apparently not enough women are going to some kind of fitness and dance is thought to make them feel better. Well, there's a lot of evidence around this. And of course, the whole idea of social prescribing is not new. It's in the NHS long-term plan. So it is within the toolkit of doctors to recognise

that when a patient comes to see them, it's not just the physical and the psychological thing that they're looking at, but they need to look at the social, the emotional, the environmental condition of that person. So treating the whole person is recognized as being a positive step. The thing about dance, I guess, it is universal. It does involve the whole body. It's visual.

It's auditory. It has motor skills. But crucially, it also involves imagination, ideas, feelings, and it's visual, it's auditory, it has motor skills, but crucially it also involves imagination, ideas, feelings, and it's social. So you can see there that there's lots of things that you would treat within a dance class or treats perhaps a medical word, but you would be giving people a social experience, you'd be giving them a kind of routine, you'd be giving them positive outcomes, interaction with other people. So what I think people are finding is that there's better adherence to treatment because frankly it's fun it's a fun thing to do. Jill where are you on this I can't imagine there'd be much discord

but tell us why dance? Absolutely I think it's all been said actually that was wonderful you can go and have a cup of tea then it's fine yeah I think I will actually um but I think it's all been said, actually. That was wonderful. You can go and have a cup of tea then, it's fine. Yeah, I think I will actually. But I think it's great that the NHS are actually going to prescribe it because very often the motivation actually to think, oh, I must go to a gym, it can be quite daunting. So that process is something, if you haven't been to a studio, it's the very last thing you want to do, enter this place of the unknown. And I'm 68, so I've lived in dance studios all my life. And so it's quite familiar. So it's

actually having the motivation to enter these areas. And really now, when you think of what we've been through, you just think, oh, just get in comfy clothes and go and have a go. And really, I like to feel as though the word dance can be quite daunting as well. And so to the general public, it's just saying movement to music and the music is essential. And as long as you find the right place to go to and you feel comfortable with it, you find the right place, the comfortable place. The teacher who's going to understand you and teachers, those with experience, have gained so much over the years. I've had births, deaths and marriages and I've been involved in them all and every sort of lovely stories that I get. And so it becomes part of your life

and it's essential to keep fit because, you know, I've got seven grandkids. I want to pick them up from school every day. I just want to run around. When you're not feeling so good, Jill, I can't imagine it, but on those rare occasions, do you just stand up and start to move? Do you actually do it in your day-to-day life?

I'm motivated by music. And as long as I've got good, happy music, yeah, I'll have a playlist and love it. Somebody said to me recently, oh, what do you think of Strictly Come Dancing? I said, I don't watch it because I'm usually dancing myself somewhere else. Well, no, I mean, Debra...

I don't want to sit and watch that. Exactly. There's a sort of perverse irony, Debra, to how popular Strictly Come Dancing is, isn't there, Debra? Because a lot of people, millions of people are sat down watching other people dance. No, I think that's interesting, isn't it? I mean, I always say that dance is one thing we all do in our lives. I mean, Jill's mentioned births, deaths and marriages.

Typically, you know, weddings is the place where we all have in common that we dance. We all listen to music too, but we don't all play instruments. So strictly, it is a sort of reverse where we are all sitting and watching. And I think we do enjoy not just the visual spectacle, but the, and I hate this word, but the journey that the competitors go on because they genuinely do learn things and we watch them learn. But I think there's another point. Jill's beautifully spoken to that sense of well-being. But there are some real benefits here. You know, the evidence so far on social prescribing shows that there are drops in the numbers of people needing to consult their GPs, needing to go into hospital. There are rises in the sense of well-being, drops in loneliness,

increased self-esteem and real, you know, return on investment to the NHS. The figure I've got from research is between £4 and £11 return on every pound invested. But, Deborah, I was going to say, if you don't, the problem with something like Strictly, I suppose, with its popularity is it can make you think you have to be really good. It can make you think I have to be able to dance. And then there are people, I know you say everyone does it or it's in our lives, but there are people who just don't.

Well, very, very few, I think. But you're right. I mean, people say to me, oh, well, should everybody go and do ballet? No, of course, everybody shouldn't go and do ballet. It's a very particular kind of exercise. And you can get the benefits, as Jill says, from many other types of dance. It is important that you find a rapport with the community and the teacher. And it's also really important that you like the music. You know, no point going to jazz if you hate jazz.

Go to a samba class or go to a zumba class you know it it doesn't really matter what what type of dance it is the point is to to get moving to get moving deborah you have inspired us jill final word to you um what's your song what's the one at the moment that's getting you moving is there a particular one i've got a few let me see actually there's a great, it's Tom Jones. Yeah, no, no, no, he's great. Gosh, we love Tom Jones. And it's an Irish song. Anyway, I've got quite a lot, actually.

Well, I can see there's a poster of Queen behind you, isn't there? Just so I can see in our video. Yeah, we will rock you. Any of Queen numbers, yeah, Don't Stop Me Now is such a goodie. There's some prescriptions there from Jill Moldock and Deborah Bull. Thank you very much. You don't have to be professional. It's about getting moving.

So get some music on after this. Stay with us, though, of course, and do do that at some point today. Try, try. I'm going to do it. But let me tell you about the latest in our new series, Under Pressure, which is about what happens to relationships when couples are put under extreme strain and how they cope. And these couples have been opening up to us. Kate and Annie live in Newbiggin in Northumberland

and Joe Morris went to meet them and they introduced themselves. I'm Kate Bromwich-Alexandra with a hyphen. With a hyphen. That's important, is it? It is, yes. And I'm Annie Bromwich-Alexandra, and I'm Kate's wife. So you live in a remote fishing village. Did you have any doubts about moving here, someone quite remote, as a lesbian couple? There's been times when we were younger when we wouldn't have considered it for a second.

When you're a young dyke about town you need a city you need a community you know I think for me I just got to the stage where you know well they can either like us or leave us alone I don't care so we just came and we were just ourselves and New Begin has been nothing but good for us and to us, hugely supportive. So when this happened... I've been diagnosed with blood cancer, myeloma, multiple myeloma. I'm on the lowest dose of medication now because everything that I've had has failed.

I'm comfortable. I haven't asked the big question about timings or anything like that. That's been probably the last three or four months that we've had those sort of discussions with my oncologist. I'm not going to ask. Was it a joint decision not to ask? Yeah. It's Annie's decision really. It's her life. If she wants to know then I'll go along with that. I would rather not know. Why do you not want to know? It would feel like we were on a countdown. They're not soothsayers, are they? They're just doctors.

I'm not as frightened as I was. I'm accustomed to it now. I don't need to know how long it is. It has changed everything. I'm not just her partner, I'm her carer. And that's a massive change. I just wish it could be different. But it can't. It is what it is. I hadn't settled that corner down with enough glue, had I? So where are we going? Into the hallway. And you can climb aboard Sisyphus stairlift

ready for the off? shall I pipe you aboard captain? sorry microphone aye aye just negotiating the turn do you snake your clothes down? Just negotiating the two. Did you sneak a kiss then, Kate? I did, yes.

Does she often do that, Annie? Yes. Nothing like a kiss on a stairlift, is there? No. Who knew such delights were ahead of us. That picture on the wall is a picture of the sky above Canock Chase, the night sky, on the 22nd of July 1988. And it was our youngest daughter, Alex, who got it made for us for our 30th anniversary.

Why is that place special? Because that's where we went the day we met. Yeah. Flirted on the benches. It was such a lovely place. Birds, coots and deer among the trees, if you were quiet enough. We used to see them lots, didn't we?

Yes, we used to see them. People used to say, I've never seen deer on canning trees, but you've got to sit still. Yeah. If you sit still and wait, they will come. And that was our family tree. And it has Annie and Kate. 10th of December 2014, so it was when we got married.

And you've got Susie, Katie and Alex. Yeah. Your daughters and your granddaughter. Katie, who hates being called Katie now. She's Caitlin. Your granddaughter? Yeah. Preserving our relationship has always been our number one priority.

From the very beginning. When we first met and when we fell in love and we decided we wanted to be together, I cannot tell you how demanding we were of each other because we'd had relationships that hadn't worked for various reasons. We never wanted to be in the position where we had fights. We don't fight. I came from a family, my parents, my mother in particular, would say horrible things and would use physical violence as well. And she would say to people, oh, we just scream our heads off at each other and then it's all forgotten. And it wasn't forgotten. It definitely wasn't forgotten by me. How did you two meet?

We were introduced by a mutual acquaintance. She used to say to Annie, I know this woman, I think you two would get on because we were both very political and feminists and we went for lunch and I knew instantly that I was in trouble. I just felt like I'd been hit by a bus. And I was in a relationship with somebody else. She was just coming to the end of a relationship with somebody else, long-term relationship.

33 years ago in 88, what were your first impressions of Kate, Annie? I immediately held out my hand to shake hands, which was very, very formal, and I thought, this woman is going to think I'm completely barmy. I just had to make contact with her. You wanted to touch her? It was just different to anything that I'd ever known, and I was also a little bit distracted

by thinking of all the shit that it was gonna bring down on my head. We just talked and talked and talked. We were flirting with each other. I've never flirted in my life. I mean, forget it, it's the 80s, isn't it? Things were very different for lesbians. In Staffordshire as well.

That year, it was the year of Clause 28, when all the dreadful books were taken out of school libraries that were going to... Corrupt all the children. Corrupt our children. We'd both been on the marches and did our bit. I was not going to pretend any more about who I was. Had you pretended in the past?

Well, yes, I had. And when you said, Annie, you said you were where a whole load of shit was going to come down. Is that because you were already in a relationship? Yes, yeah. My life was in a complete mess. Then there was Kate. So you were very physically attracted to each other. Are you still? Oh, yeah.

Oh, yeah. Oh, yeah. Myeloma has done Annie's body a lot of damage. All chemo has an effect on your sexual self. So the sexual side of our relationship, I can't believe I'm saying this, may have changed, but the intimacy hasn't. And that is really important for us. I have to be a lot more careful because she has delicate bones.

So I have to be careful how I hold her in bed. Touch is such an important thing. You're able to still share a bed? Yes. It's taken a lot away from us, has myeloma. in bed, touch is such an important thing. You're able to still share a bed? Yeah. It's taken a lot away from us as myeloma. It's not taking that. No. We'll fight it all the way on that one.

I don't want Annie to feel like I'm her carer. Why not? Because I'm her partner. What does this point in your relationship feel like? Well, it feels... Well, it undoubtedly is, and it feels like the hardest thing we've ever had to face.

And yet, amazingly, we haven't lost our ability to laugh at things. And we allow ourselves to cry when we need to. It feels like we've been brought to the nub of what life's all about, really. Yeah. Annie is living... You're both living with Annie's terminal illness. It's such a stressful time in your lives. Why did you want to talk to us?

When was the last time you heard a story about an older lesbian couple? And there's lots of us about, but there's still a lot of people that are very isolated and afraid and have homophobic families. And let's face it, the world's pretty bloody hostile at the moment in all sorts of ways not least to women I think we'd like talking about our relationship well I like talking about our relationship and Annie joins in well you know I've had a lot of steroids I can't remember much. I would say that was the case before you ever had steroids, but never mind.

How dare you? That on there, the lesbian symbol, we had that made as the first public declaration. We hung it in the window and thought, well, you don't like it tough? Everywhere you look, there's just lovely things to look at. Another friend bought us that just after Annie's diagnosis and she'd lost her partner to cancer.

It's a quote by Martin Luther King. It says you don't have to see the whole staircase just to take the first step. I think it's very apt and very true, but Annie doesn't need to take the first step even now. it's very apt and very true but Annie doesn't need to take the first step even now she just has to sit in Sisyphus. When did you both come out? It's a funny question to ask now isn't it? You come out all your lives you know. What do you mean by that?

Well, because people are always assuming, even though I think you just have to look at us surely, you know, but apparently not. We're always assumed to be sisters wherever we go. Oh, yeah, we get lots of that, especially as we've got older. How do you feel, Annie, when people think you're sisters? We are part of the sisterhood. Yes. I can't let go an

opportunity really of doing a bit of teaching of making some comment and maybe they'll remember it then when they meet the next gay couple. There we are in the Morpeth Herald. So this is when you got married? Mm-hmm. So you were the first lesbian couple to get married in the whole county of Northumberland? Yes. That's quite an achievement, isn't it? Historic marriage at the town hall. It didn't make any difference in terms of our relationship,

but it means if we go somewhere that such things are important, like hospital, Annie introduces me as her wife, and I get treated differently than if I was her partner and there's our two daughters Susie and Alex Susie's the older one Alex is the baby so what's the age gap between them 20 years Susie's from my brief foray into heterosexual marriage. It was just a brief foray? Extremely brief, yes. I was 18 and by the time I was 20, 21 I was living with a woman in Litchfield. So what happened, you might be asking? Because I was raised in a Catholic family who had very fixed ideas about how things should be and I'd never heard the word lesbian

until I was in my 20s and read it in the News of the World. They were talking about the killing of Sister George, which is a great advert for lesbians. The film with Beryl Reid and Susanna York? Yeah. And I thought, oh, that must be what I am then. As soon as I heard the word lesbian, I looked it up in the dictionary, as we all did. Every lesbian back then, that's what they did.

So you had your second daughter together. Obviously, you're both her mums. Which one of you is the biological mum? Well, I'm not going to tell you that. I could tell you and then kill you after. So you've made a conscious decision not to? We have made it. Well, it came from Alex, who was always very open about her origins. She realised that people would ask her, which one is your real mum? And she said, well, they're both my real mum. But we didn't adopt her. We fought for the right to have parental responsibility.

Yes, joint parental responsibility. Joint parental responsibility that wasn't available to same-sex couples. We got the help of a wonderful barrister in London, said it's not a gay issue or a lesbian issue, it's a human rights issue. So he worked pro bono for us which was just as hard because we couldn't have afforded it. And now a brief told us that we were the first outside the High Court and that Alex would be written up in the law books as child A, which he's quite chuffed about actually. Do you see yourself as pioneers. That sounds a little bit pompous. I suppose it's about being true to

yourself isn't it? Deciding not to hide and not to always pretend to be something that you're not so that other people that you don't care about won't be upset. You've been through so much and are going through so much as a couple. Have you ever thought that this relationship might not be able to take the pressure? No. Not for a second. We've seen people getting upset with each other

and cross with each other in the waiting room, haven't we? Yeah. Feeling everything that everybody sat there is feeling and they're sort of sniping at each other about something or other. That's so sad. You know I can't escape now because I can't carry a case now. I couldn't get my luggage out. You'd have to get me to carry it out to the door.

That was good big thanks to Kate and Annie there and talking about that series which is called Under Pressure you can find the rest of it on the Women's Hour website Sarah's messaged in with regards to trying for a baby

and that conversation we were having earlier I think it links in a little bit with what we're talking about with Under Pressure saying five cycles of IVF with donor eggs over two years at two clinics,

no funding available, but we were helped by family. We were successful in the end and now have wonderful twin boys who are 16, but our marriage didn't survive the ordeal. I found the whole experience dehumanising and we lost all intimacy as a couple as getting pregnant became the sole focus of our marriage. Thank you so much for feeling like you could share that one, Sarah. And if I can, I'll come back to more of those messages. But I mentioned a report out today from the Institute for Fiscal Studies concludes there's been almost no progress towards closing

the gender pay gap in the last 25 years. The gender pay gap measures the difference between men and women's average pay. And this report found that raising the minimum wage has helped close the gap for lower earners, but there's been no similar progress for graduate women, which means barely any change to the gender earnings gap. It's come down from 24% to 19%. The government has said the national gender pay gap has fallen significantly, and 1.9 million more women were in work compared to 2010. Well, Professor Lucinda Platt, who's on the panel of the IFS Deaton Inequalities Review and who researches inequality at the London School of Economics, joins me now. Why are we still with barely any change, Professor Lucinda Platt?

So, yeah, I think, I mean, this is quite a startling finding when we look at the pattern over time. So what this report showed was it looked at the whole sort of earnings, weekly earnings pay gap, and it looked over this 25-year period. We think, okay, so the earnings pay gap has changed. It's reduced from 53% to 40% when you take into account the fact that women are slightly less likely to be in paid work at all, that they do lower hours if in work and that they get lower pay, that pay gap that you referred to. But if you look more closely at this change over time, we can see that it's almost entirely driven by the fact that women have gained qualifications over the same period.

And given that higher educated women are more likely to participate in paid work, do more hours if they do and earn higher earnings than lower educated women if they pay paid work, we can see that it's almost like a sort of mechanical function of the fact that women are getting more highly educated, not sort of wider social change. And I find that, you know, I think that is kind of quite the startling finding of it. So that explains why some of it's gone gone a tiny amount's gone in the right direction but what explains why it's not shifted in the way that people would have hoped over 25 years yeah so that's also to do with the fact that who where the changes has happened happened you mentioned that the the pay gap bit of it the bit that's related to actual actual earnings has

reduced from around 24 to around 90 19%. But that's been affected more at the bottom. So it used to be that it was lower educated women who face these larger gaps. Through things like the minimum wage, we've actually seen those gaps, that that's changed. And there are now lower gaps at the bottom in pay than there are at the top. So we're seeing highly educated women facing these larger pay gaps. And again, that's why we haven't seen it. Why? Because I think there are a number of reasons. One is the fact that top earners, and we've seen increases in top earners,

top earners are more likely to be men. So you just get this bigger gap between higher educated men and women. But also what the report really clearly showed was how these gaps open out after the birth of a child. So after the birth of a child, women reduce their participation, they reduce their hours if they do stay in paid work, and their participation maybe for shorter, longer times. And as a result, hours, the hourly earning gradually, the gap in that gradually gets bigger. They lose experience or they shift to jobs which are less highly paid. And so these gaps increase.

And so we're seeing these patterns. And this affects higher educated women just as much as lower educated women. And it also affects those couples where the woman earns more as much as where the man earns more. So it's kind of not a logical economic decision. And so we see those gaps widening for women after childbirth and we see an overall net very limited gain over time in reductions in the pay gap and in the earnings gap. When I ask anybody who's familiar with this what needs to change,

often the response is looking at countries where subsidised or very affordable childcare is in place and that's often the answer. But I wanted to ask something slightly different, but of course, go with it how you see fair. Is there a point where one has to accept that perhaps it will never be fully closed if there are perhaps the want or the need for there always to be a parent at home if it is about childcare and perhaps that will always lean towards women? I don't know. But, you know, if it is about childcare and perhaps that will always lean towards women? I don't know. But, you know, if it's 25 years and it's not closing,

where do you come out on that, having looked at the history of this and where we are? Yes, I don't think it's just going to be something that spontaneously closes on its own. We can't just look at past trends and think, OK, then these trends are going to continue. There's a limit to the extent to which women can get more educated, for example, which has been part of the closing of the gap.

And there's a limit to which they can get their foot on the career ladder. That's not going to be the solution. I think childcare is a part of the solution. But again, you say the fundamental issue is that it assumes that there is a mother who is going to take responsibility for work. So childcare helps women to participate in the labour market. It doesn't necessarily help men to participate in caring work. And until we get that shift, I agree it's going to be hard to close the gap.

So I think that's now where we need to focus attention as well. I think it's a sort of dual pronged attack, if you like. So and the experience of other countries has shown that you can increase men's involvement in caring you can um uh make um paternity leave better paid uh better remunerated and make it aware it can only be taken by men so rather than having sort of shared parental leave which is based rather low uptake that's where we went under the claude cameron years was do we think we need to change policy now i think we need to focus much more on dedicated paternity leave rather than a decent amount of it and having it well remunerated.

So, yes, it's a start, but it's not going to get us to have this overall shift where men think that they are as equally responsible and where it makes sense and where employers think that men are equally responsible. And there are those countries, of course, that say use it or lose it. And it's part of that process. We shall see. Professor Lucinda Platt, thank you very much for your time and expertise. Now, to our final discussion today around facial fillers and a report here.

They are big business, mainly used by women who believe such a treatment will improve their appearance and perhaps make them feel better about themselves. Now, whether you agree with that or not, how to safely remove such fillers is increasingly being discussed on social media, especially since some women are reporting severe side effects to the enzyme used to dissolve them.

Our reporter Melanie Abbott is here to explain more. What do we know, Mel? Yeah, I've been looking at a Facebook support group. It's called Botched Fillers and Hyaluronidase Damage. There's around 2,000 people on it, mainly women, and many have used this enzyme called hyaluronidase, which is injected into your skin to dissolve fillers. Now, we've spoken to women on this programme who've had to use it in an emergency when filler is injected into an artery, cutting off the blood supply. And this leads to what's called necrosis of the skin. The skin starts dying, goes black.

It needs reversing as soon as possible. But there are people who use this when they just don't like their results. They don't like the outcome. Now, this support group, it's got people on it from all over the world. And looking through some of the messages, the side effects do sound painful sometimes quite terrifying yes and and tell us a bit more about what you've been hearing or what things you've seen yeah comments like my health is so bad now i look old in my 20s another one i wish i'd kept my filler lump the dissolver

completely destroyed one side of my face. Another one, my eyes collapsed, my nose widened, my nose is swollen, its shape has changed completely. Some women also report really worrying side effects, things like fatigue, muscle pains, burning sensations. Now, lots of people are upfront about getting fillers, but the women I spoke to were all really quite embarrassed about having something that you might consider vain, and then they're embarrassed about it going wrong. So actors are speaking their words. Now, this woman told me she had lip fillers that she didn't like. She had hyaluronidase injected twice, but it didn't get rid of all of the filler. So she

then went to a third practitioner. I had good feelings about it and he said the only way to fully resolve the issue is to dissolve it again. But he said that the other practitioners hadn't been using enough dissolver so he would use a lot more which I now know you're not supposed to do so he dissolved them and just sent me on my way. I started having issues two days after.

The first thing I noticed was my lip on the left side turning slightly blue, then my left side of my face went stiff and started burning. Then it went to my neck, a horrible burning pain and made my neck stiff. That stayed for around a week, then it started to progress throughout my body, causing me to have stiff muscles, constant pain throughout my body, stiff knees, legs, muscle spasms that are constant, itchy hands, random rashes, crippling mental health. I'm four months in and there seems to be no end to it. For some women it can take one year to even see improvements. Can you be sure it was the hyaluronidase and not the filler? It certainly is not the filler. Immediately after the last dissolving I had all my issues. We never had any sort of reaction before this. What about your GP?

Could they offer any help? No doctors care or want to help us. I've been to my GP and seen a neurologist. They just say oh we can't help you you're having a foreign body reaction. We are slowly and slowly withering away. I just think this enzyme is so evil. Some members of our group are having fat grafts due to the damage they have suffered. How much more will it take for doctors to listen to us? That's one woman's experience. Another I spoke to said she now faces an operation. I had fillers in my face, but I felt the practitioner overfilled. I wasn't happy. It didn't look at all natural.

It was the opposite of what I wanted. I decided to get the filler dissolved, but had problems very quickly. That evening, I couldn't focus on my vision. It was very blurry. Over the coming days and weeks, I developed extremely painful dry eye symptoms. This led to a number of issues concerning my eyes. I had problems closing my eyes properly when sleeping as well as issues opening my eyes freely in the morning upon waking. I was so distressed that I had to attend A&E at one point for medical assistance. I still get dry eye symptoms now though, I have eye drops to help manage the symptoms.

Worryingly, I notice volume loss and hollowing to my face. There is slack skin around my jaw, mid-face and eye area now. The texture of my facial skin is discoloured in places, feels strange to the touch and is lacking in volume too. I just didn't feel like I looked right at all. I didn't want people to see me. The pandemic was almost a saving grace as I wasn't going out. The skin under my eyelids is all thin, creepy and wrinkled following the hyaluronidase injections. I now need surgery to repair the lower eyelids.

It is also painful too. I can't wear eyeshadow as it hurts to sweep a soft makeup brush across my thin lids now. Mel, how frequent is this? Well, we should say it is rare. One cosmetic surgeon I spoke to, Patrick Treacy, told me he's injected this hyaluronidase thousands of times, never seen a problem once. But he did say that he thinks some practitioners may be using too much of it, maybe getting a bit heavy handed. Another, Daniel Salas, said that he was seeing more and more women who feel that they've been damaged by this treatment, a loss of volume to that natural facial structure.

Now, hyaluronidase dissolves something called hyaluronic acid, which occurs naturally in the body, and it does bind together the skin's structure. So if you damage that, it might be more visible in the face. We can create more of this hyaluronic acid. The structure can recover. But of course, the ability to do that diminishes the older you get, like most things, unfortunately.

Now, Daniel Salas says he hasn't come across people with the more serious symptoms that I mentioned. And the regulator? Yeah, the regulator told me they've had nine reports of bad reactions from hyaluronidase, which has been used to dissolve fillers so far this year, including one fatality. But they do stress a reported reaction doesn't necessarily eye and face plastic surgeon at Moorfields Eye Hospital and medical director at Neo Healthcare. And he's done a study looking into adverse effects of this enzyme that is used to dissolve filler. What have you found, Daniel? I recognise it was a small sample, but what have you found? these accounts from patients and I'm certainly hearing very similar things every day running through my aesthetic practice of which a large proportion is patients with complex filler related complications. So we conducted this study to answer a series of questions because as you've all described when hyaluronidase was initially proposed as a treatment to reverse fillers it was heralded as a bit of a miracle therapy, but over the years, we're hearing more and more

from a whisper to more of a clamour of voices of people really describing significant complications. So we wanted to look at what safe doses and dilutions of this might be and also try to evaluate outcomes. And although these are patients in my practice and there could well be a selection bias, but we found that about 20% of patients who've had highly oily days reported adverse outcomes,

which were usually hollowing or deterioration in their skin quality. We also found that interestingly, doses, the high doses of highly oilyase did not actually relate to worse outcomes. But also, interestingly, what were significant associations of poor outcomes and complications were actually the duration that the filler was injected for and also the amount of filler. Because filler can last a long time or not? Well, it certainly can. And I think a lot of the narrative about filler, particularly when going to aesthetic clinics, is that it's a natural product which dissolves after a while. But it's clearly not the case. And I've certainly had many patients who've had filler still in situ for 15 and even up to almost 20 years. And patients will often go back, have top ups because they feel it's gone, but then they accumulate very large amounts of filler, which is just storing up problems, particularly if they're going to have it dissolved at some point.

But you still give people filler, don't you? As part of your practice or not? Do you still give people filler? Do you still do that? Should it still be used? There'll be people listening to this thinking, well, perhaps we shouldn't be giving people fillers. Well, I'm sorry, I've got a really bad connection here.

I was asking about whether you still use filler. I'm so sorry if you can't hear me. Do you still put it into people's faces? So sorry. We're going to have to abort that conversation. Daniel, Ezra, thank you very much for giving us some insight there into what you have been finding. And of course, that is a big question perhaps for those

who are also now looking at what they've had done and are regretting of it. Thank you so much for so many of your messages today which have been incredibly honest and emotional with regards to the road to getting pregnant there's an anonymous one here which said i did 13 rounds of ivf over almost 10 years and it consumed my life while i was holding down a busy senior job there's of course a lot of research now people saying they want on on how it affects women and work, and that will take us back perhaps in some ways to what we were talking about with the gender pay gap.

But we tried every treatment available, no matter how tenuous, acupuncture, endometrial scratch, embryo hatching assistance. We felt desperate. We're talking about some of those unproven treatments. And all of our friends were having children. The NHS IVF treatment for us was five days a week, which just doesn't work.

Bodies don't stop on the weekend. We had lots of helpful advice in quotation marks. Just relax. Don't worry. It will happen. From people not knowing that I'd had an ectopic pregnancy and simply couldn't fall pregnant as I'd had both fallopian tubes removed.

A friend told me that miscarriages were nothing. My mother told me she couldn't understand as she'd never had a problem. In the end, it took a wonderful surrogate and the kind support of a surrogate agency to help us have our lovely son. We feel lucky as many people do not succeed, but very damaged by the process. We spent in excess of £100,000 on the whole journey. My goodness. Thank you so much for your candour and honesty. I'll be back with you tomorrow at 10. That's all for today's Woman's Hour. Thank you so much for your time. Join us again for the next one. Hello, I'm Felicity Finch. You may know me as Ruth in The Archers. I'm just asking for a few

seconds of your time before you listen to the Woman's Hour podcast. This Christmas, thousands of people across the UK will be without a safe place to call home. But you can help change that. St Martin's helps ensure that people experiencing homelessness can find and keep a safe place to live. Your gift could support someone to take the next step towards a more secure future. Please support the BBC Radio 4 Christmas Appeal with St Martin-in-the-Fields by donating online on the Radio 4 Christmas Appeal website. Whether you give every year,

or if this is your first, thank you. Now enjoy your podcast. 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.