Woman's Hour - Weekend Woman's Hour: Maternity care review, Weight loss drugs and exercise, Wages for housework

Episode Date: December 13, 2025

Baroness Amos, who was appointed by the Health Secretary to lead an independent rapid investigation into NHS maternity and neonatal care in England, has said nothing prepared her for the scale of 'unacceptable care' that women and families have received. Presenter Krupa Padhy is joined by the BBC’s Social Affairs correspondent Michael Buchanan and Theo Clarke, former Conservative MP who also chaired the UK Birth Trauma Inquiry and hosts the podcast, Breaking the Taboo, to discuss the review and what comes next.Wages for housework was a feminist mantra in the West in the 1970s – feminist campaigners arguing for recognition of the economic value of domestic labour. The debate has been revived in India over the last decade with an estimated 118 million women across 12 states now receiving unconditional cash transfers from their governments. Devina Gupta, a reporter based in Delhi, and Professor Prabha Kotiswaran from King’s College in London unpick the impact of ‘wages for housework’ on women’s lives and the Indian economy.When Kaitlin Lawrence was just 22 years old, she collapsed whilst playing netball for the then Super League side Surrey Storm. She was eventually diagnosed with arrhythmogenic cardiomyopathy (ACM), a genetic condition she never knew she had. Following this, she was forced to give up her dream of playing professionally for Scotland and has gone on to successfully campaign to get cardiac screening introduced in the Netball Super League next season. She tells Anita her story. They were joined by Presenter Gabby Logan, whose younger brother died suddenly at the age of 15 years old from an undiagnosed heart condition. Hypertrophic cardiomyopathy.A new report highlights the crucial role of strength training and exercise for people on weight loss drugs. Data gathered by fitness professionals, Les Mills and the not-for-profit industry body, ukactive, shows the impact of weight loss drugs on skeletal muscle mass. Their report says that 20-50% of weight loss is lean body mass, which poses significant health risks such as frailty, disability, reduced metabolism, and increased mortality. Physiotherapist Lucy McDonald and Dr Sarah Jarvis join Krupa to discuss the importance of strength training to mitigate muscle loss.Presenter: Anita Rani Producer: Dianne McGregor

Hello, I'm Anita Rani and welcome to Women's Hour from BBC Radio 4. Hello and welcome to the programme. Coming up, the importance of strength training and exercise if you're on weight loss drugs. Plus, is paying for housework progress? Some might remember the 1970s feminist campaign that argued for recognition of the economic value of domestic labour. We'll discuss what's happening in India where 118 million women receive cash transfers from their governments.

Plus, Caitlin Lawrence was just 22 when she collapsed playing netball. Diagnosed with a genetic heart condition she never knew she had, she's now campaigning for cardiac screening you can hear from her alongside presenter Gabby Logan. But first, poor standards of basic care, a lack of empathy, birth plans not being read or followed, just some of the concerns highlighted in the interim report of a major review into maternity care in England. Baroness Amos, who's leading the independent review into NHS maternity and neonatal care, said this week,

Nothing prepared me for the scale of unacceptable care that women and families have received and continue to receive the tragic consequences for their babies and the impact on their mental, physical and emotional well-being. Well, on Wednesday's programme, we heard reaction from Theo Clark, former Conservative MP and chair of the Birth Trauma Inquiry, and Michael Buchanan, the BBC's social affairs correspondent. Kruper asked Michael about the many investigations and reports into maternity care over the years

and what makes this one different. They've led to hundreds of recommendations, now on 750 recommendations, but fundamentally there is a feeling that care simply isn't good enough in many different areas of the countries. So fundamentally the question is why have them in 750 recommendations and things aren't improving? And that is a question that West,

Streeting the Health Secretary for England has been grappling with since he came into office, frankly. And his solution at the moment, at least, is this rapid review, as he calls it, which is chaired by Baroness Amos. He set it up in the summer. It was due to be completed by December. Now she's saying that her recommendations, which she describes as national recommendations, will be published in the spring. And the reason she says that this will be different to all the other reviews is that West Streeting is committed to ensuring that they are implemented. We've heard the word commitment many times. there'll be women who have gone through the most traumatic experience, families who have lost babies,

who will be questioning that commitment. You mentioned the 750 recommendations. Could you just remind us what subjects they tackle and what they raise? They raise a variety of subjects and some of them have been tackled to a greater degree than others. So for instance, they've been talking about a lack of staff and staffing pressures and there has been some investment into that. There's been an investment as well into digital. medical record so that it's easier for women to carry around their particular charts. It doesn't work as consistently as it should do, but it is an improvement in some areas. The difficulty it has often found is cultural, and that has simply been something that

NHS maternity units have struggled to cope with. When I say cultural, that can mean anything from an ideology over what is the best way for a woman to give birth, and there has been much discussion about normal birth campaign, which was running for a number of years, and basically placed a premium and vaginal deliveries over what was best for the woman. But it's beyond that as well. It is an unwillingness to listen to women, even when the report in reduced fetal movements. It's an unwillingness to investigate properly when things go wrong.

It's often blaming the woman or making the woman feel less or the blame is hers for the fact that her baby has died. And then if an investigation is carried out, it is often deemed to be cursory. It doesn't get to the fundamental issues in the unit. it sometimes maybe blames individuals and crucially it doesn't lead to lessons being learned and so what you get is you get the same mistakes happening

not just within the same units but across the entire maternity system in England. Theo, as former chair of the UK's birth trauma inquiry, these are themes that you will have heard talked about time and time again and indeed yourself, you came on to this programme two years ago to share your own personal experience. Absolutely, I did and I find it incredibly frustrating

that I'm still back here today talking about how maternity care has not improved. So firstly, on Baroness Amos's reflections today, how incredibly frustrating. I mean, is that it? I sat down to start reading her findings, and I thought it was just the introduction. And then I realised that was actually the end of her report. When it was announced by Wes Streeting several months ago that this was going to take place, he made clear that there would be recommendations. That has now slipped, as Michael has said. Is that just kicking the can down the road for families like myself who've been affected by birth trauma and have not received good postnatal care. And the terms of reference that she's

been given are absolutely huge. They're going to require sort of Herculane efforts to be reporting back by spring of what to do. I shared a cross-party inquiry in Parliament, which heard from 1,300 families. And we know very clearly what the issues in maternity are. And families have reported so many times about what the issues are with systemic reform needed in the NHS. And quite frankly, the government has now been in power for a year and a half, they could have chosen to prioritise and fund better maternity care. And to be honest, I don't think it's good enough today that there are no policy recommendations. We had a list of more than 40 in our report to the previous government. The first, which was our headline recommendation, was in fact

adopted by the previous government. I remember standing up in the Chamber of the House of Commons and asking the then Prime Minister Rishi Sunak to adopt the National Maternity Improvement strategy because what we found in the inquiry was that there was this postcode lottery in maternity care. So depending on where you live in the UK, you will actually receive a different level of care. It is not the same care pathways. So I think that's the first thing the government could do is to agree to the previous recommendations of previous governments and implement them and they've chosen not to do so today. Michael, turning back to you, not all families want the same thing. Some prefer a statutory public inquiry. Just help us

understand what's been said here. Yes. There are undoubtedly some families who do think this is the best way to do it. They feel that Mr. Streeting has got a personal commitment to improving care, that he should be given a chance, that Baroness Amos should be given a chance, and that in the words of one campaign that I was talking to, this is the best opportunity in at least a decade, perhaps a generation for maternity care to be improved. But there is absolutely another school of thought, and she, Baroness Amos, is well aware of the criticism and the skepticism. The people who are pushing for a national statutory inquiry are saying that the terms of reference, as large as we heard they are, they're not as big as some people want them.

They don't, for instance, look at NHS resolution, which is a crucial part of this. This is the body that pays out or is legally responsible when errors are made. They don't talk about accountability. And for a lot of families who have been harmed previously, they simply see people walking away from the harm that they have caused, not just the midwives and the obstetricians, but the clinical directors, the chief executive of these organisations, they simply think that this review is incapable of bringing that accountability.

And they believe that by having a judge-led statutory inquiry, these people would be forced to explain what they did or what they didn't do, and there'd be an opportunity for those families to get the accountability that they often feel they have been denied. On the subject of accountability, is there not something to be said about empowering women with the information that they need about their rights, about this whole conversation around better births

that the conversation has moved towards so that they can ultimately advocate for themselves or their families can advocate for them because let's face it, when you are giving birth, when you are pregnant, you are your most vulnerable. You need information to empower yourself to advocate for yourself and for your baby. Is that where they're going wrong,

that women just don't have that information, Theo? Well, I agree with you. I do think that is part of the problem. And I can give an example from my own personal experience, experience. When I had my antenatal classes, birth injuries were really not talked about. I had very little understanding of what a third-degree tear was, which is what I went on to suffer having the birth of my daughter. And it was an incredibly terrifying experience that I was in labour for 40 hours, had a postpartum haemorrhage, and ended up going on to Sagnufer for a significant

birth injury, which had to be repaired in theatre. And that was not something that anyone had talked to me about before. And sadly, my experience is not unique. I mean, I've heard from literally thousands of families across the UK in the last few years with very similar shocking stories. So I absolutely agree we need to better inform mothers. And I think we also need to trust women. Like we know our own bodies and we also need to be listened to by NHS professionals and that's something that came through strongly in Baroness Amos's reflections today is that families are not being listened to. But that's not breaking news. We already know that. We actually already know what the issues are in NHS maternity care. One of the policy recommendations that I think

would really help to address this situation and ensure that no mother endures these horrific stories that we've heard today is by having a maternity commissioner. I think that having a dedicated person who is really apart from party politics, who is appointed by the Prime Minister, is not going to come and go in government reshuffles,

but whose job it is is to oversee and make sure that these policy recommendations are implemented would go some way to relieving some of these problems. I got the previous government to agree to cross-party recommendations, and what happened a few weeks later, the general election was called and then there's no onus on the new administration to agree to the same. So I think we really need to make sure that maternity is cross-party.

It is far above party politics. We need to ensure that every government is committing to the same. And I really hope that there will be teeth to the findings for Amos next year. But I also don't have a lot of faith that that is the case. Nothing has changed since I published my own report in Parliament last year. Michael, this is happening under Labour's government. But what steps did previous Conservative governments take to address these issues? Well, they certainly set up the three inquiries into Morkan Bay,

into Shrewsbury and Telford and to East Kent. And these were absolutely crucial and much wanted by the families in those areas because it allowed them to get the answers to the questions that they had been raising in some cases for many, many years. And these were really, really important for the families. I think it's fair to say, however, that whilst they were important for the families involved, they did not change the dial on improving maternity care across

England. And I think there are a number of reasons for that, crucially, there was a failure by the previous government to pursue the implementation of the recommendations. And so if you look at what happened in Morkan Bay, for instance, there was recommendations come out of that. Then Morkan Bay was effectively

left to mark its own homework. And there was no oversight from ministers or from the NHS system in terms of pursuing it. I remember the day after the Shrewspirit report came out, there was a Conservative Health Secretary at the time who said, we will go after the people that were responsible for this harm

and to my knowledge, and I am willing to be corrected if I'm wrong, I don't think anybody's been held accountable for what happened in Shrewsbury. And that's when we get back to the accountability point I made earlier on, as a lot of families are saying, you can't simply keep telling us what the problem is you have to, A, change it and

B, hold people responsible because they believe that only if you hold people responsible will meaningful and sustain change happen. And a lot of people say that comes from a grassroots level, that comes from a cultural change. I want to say thank you to the midwife who's just sent us in a message because sometimes it's really hard to hear from midwives about their struggles because they're scared of speaking out. Let's be honest. And here's one who says, I am a burnt out midwife. I'm currently off work because of this. There are not

enough midwives, no jobs for newly qualified midwives being offered. I work for a trust. I feel has a good ethos culture and provides good care. But how can this be provided when midwives are valued and certainly not paid enough for the work and responsibility they hold. And I want to expand on that with this statement from the Royal College of Midwives that says midwives are committed to safe, compassionate women-centred care, but chronic understaffing and inadequate resources are undermining their ability to deliver it. So we know that efforts are ongoing to recruit more midwives, to train more midwives. But I've had conversations with midwives who talk about a hierarchy within the system that

makes them voiceless. when they do have concerns, they often struggle to voice those concerns. Well, firstly, I think it's important to say that there are some fantastic midwives out there doing very good care today in the NHS. But it's also fair to say that there are some very bad examples. We need to be looking at the culture within the NHS. And I do think there is a point about training for midwives. But a lot of the stuff we're talking about is actually not even requiring extra additional funding. I mean, some of the examples of stories I heard were really basic things like mum's not being offered at a glass of water,

being told when they've had a C-section to go and walk to the canteen and collect their own food when they've just come out of major abdominal surgery. Those are not things that require additional funding from the government. They are about compassionate levels of decent care. But I do think the government has a choice. Do they want to invest in maternity care? And they should. And I find it really shocking that maternity negligence compensation claims

are in fact larger than what we spend on the frontline on maternity care. So let's just think about that for a moment. that is mothers who are having to sue their hospital for poor care during or post-delivery of their baby. And in fact, if we were able to reduce the level of things like vaginal tears being misdiagnosed or missed and mothers being sent home and having to come back to A&E with their newborn baby and then discovering they've actually suffered at a third or fourth-degree tear, which will be a lifelong changing injury, then in fact the government would have more money to put back into frontline maternity care.

One thing I think for pregnant women out there at the moment who are listening to this, the overwhelming likelihood is that they will have a safe birth and that they and their child will walk out of a maternity unit as happy as the day is long. And I think we always need to remember that. The problem we are talking about is that too often it doesn't go well and there are reasons for that not going well and there are things that lots of people believe can be changed

to ensure that more and more women and families are walking out of maternity units with that happy-bounding baby. That was the BBC's social affairs correspondent, Michael Buchanan and former Conservative MP and Chair of the UK Birth Inquiry, Theo Clarke. Health and Social Care Secretary Wes Streeting said, I know that NHS staff are dedicated professionals who want the best for mothers and babies and the vast majority of births are safe, but the systemic failures causing preventable tragedies cannot be ignored.

Harmed and bereaved families will remain at the heart of both the investigation and the response to ensure no one has to suffer like this again, because every single preventable tragedy is one too many. And if you've been affected by any of the issues you've heard today, please visit the BBC Action Line website where you can find links to support. Now, wages for housework has been a feminist mantra in the West since the 1970s, feminist campaigners arguing for recognition of the economic value of domestic labour.

But it appears it's been happening in India for more than a decade, with an estimated 118 million women across 12 states receiving unconditional cash transfers from their governments. According to a survey published earlier this year, in 2024, women in India spend five hours a day doing domestic tasks, 7.5 times more than their male peers. Well, Nula was joined by Professor Prabha Kothi Swaran from King's College in London and Davina Gupta, a reporter based in Delhi.

She began by asking Davina, What was the political thinking behind these direct cash transfers for women, which began in Goa in 2013? We are talking about the welfare schemes that go back to the 80s, and Tamil Nadu, which is in southern India, stands out in that regard. Because women have been targeted with schemes like free meals. They've also been given subsidised scooters, mixers, bicycle for girls, gold coins for bride. So this is the kind of welfare schemes where women have been rewarded for their ballot for the particular party that they are voting for. So in Goa, what you rightly said, was the first experiment with a direct transfer of cash for women. And it started with about $1,200 a month, and that's about $13, and it was later raised to $1,500.

But it was unconditional, and it was aimed at middle-to-low-income women to help them manage the rising cost of living. Crucially, it also included divorced women and widows. I mean, these are groups that are often marginalised socially. And today, there are more than 100,000 women in Goa that receive this money. And they have grown now as the numbers that you talked about as most states have adopted this. So, Prabha, you've heard of this longstanding interest in the value of women's work. How do you see the unconditional cash transfers? I think at the very least, it signals a dramatic expansion of the Indian welfare state in favor of women.

So, of course, cash transfers are not new in India. We've had, as Divina has already mentioned, several conditional cash transfers, for instance, in the form of maternity benefits, for instance, in the form of cash transfers to girls so that they stay in secondary school and in higher education. So there are various ways in which you provide universal services, but you also provide a slight incentive to bring people in, girls in particular, into these welfare services. So in that sense, cash transfers are not new.

India. What is new, and I think dramatic, is the fact that these cash transfers are given to women anywhere from 18-21 to 60-65 and with no strings attached. So this is what is most dramatic and innovative, and it goes directly to the women. And do you think it was, how would I say, a well-received potentially political tool, as Davina was outlying in one way there? Yes, definitely. I think some of these larger promises are brought in by politicians. So there is an electoral dimension to it. But then there are also structural changes that have occurred in the Indian context,

which have made the female voter as a game-changing sector of the population. So here we are talking about decentralization of political power, the ability of women to vote in local elections and be voted into local urban bodies and village bodies and so on. And we see a higher rate of registration by women, voters, higher voter turnout. And apparently, according to experts in the past five years, more women are part of a voting constituency compared to men. So it's natural that political parties will want to have something that pleases women in their agendas. But not all states

where these cash transfers are promised translate into electoral outcomes. And when we have talked to women after the elections, often we typically talk to them a year after these cash transfers have been implemented, and they tell us, no, you know, we did not vote because of the cash chance. Davina, there was some concern from feminists that it could, this cash transfer, discourage women from joining the workforce or indeed whether it might further entrench gender roles. What has happened, as you understand it? Well, unlike you say the skill or job-linked schemes, this particular cash transfer is not designed to boost female workforce participation.

And that remains quite low in India. There are a lot of women who do not join the workforce or have to leave the workforce if they are into sort of an ambitious career part, just because of this double duty of care at home and managing work, and then there are societal norms that don't encourage that for many women. Now, this particular scheme of direct cash transfer is fundamentally a welfare program. So in Delhi, for example, a low-income woman would get an equivalent of $10 a month. And on top of that, there's also free rice and wheat quotas given to such families.

Now, it helps them to stretch their household budgets further, but there is no clear indication that if it incentivizes women to work or not to work, what it does is that it, I think, throws focus on how women are important for political parties, but it remains to be seen whether these political parties then can invest in things like fair pay or equal opportunities or something as simple as, say, for public spaces and transport, and strong child care systems that can actually encourage them to work and leave their care responsibilities. Interesting. I mean, I'm also thinking, as you speak, DeVina, about marriage, about that particular contract. Prabha, back to you. I mean, was there any reaction from men or did it affect marriage marriages coming together

or perhaps when they were in them when cash transfers became part of the picture? We have to understand that, you know, 92% of women in India, married. And as Devinas already mentioned, the workforce participation rate for women is very low. So therefore, in order to run a household, women need money. And for that, they have been traditionally reliant on their husbands. And the way they think about it is they assume marriage to be a labor contract or a transaction in a certain sense. They believe that they perform unpaid work for the household. And in exchange, the husband maintains them. So in comes the cash transfer. So we have a context in which women are heavily dependent on men, have to often haggle

for, you know, cash to pay for the kids' school or, you know, tuition or for their own needs, or for their own food needs, for instance. But suddenly you have these cash transfers which are going directly to their bank account. And we've surveyed extensively about 6,000 women across five of these 12 states. And when we talk to them, you know, formally what they tell us is the daily levels of conflict have come down in their lives. They feel a sense of dignity and respect because they don't have to beg their husbands for these small amounts of money. So there is a subtle shift in the marital bargain because now it seems

that the state is intervening in this relationship. And is there signs of backlash? We also study this very rigorously. And of course, I think culturally men do think that there are a lot of schemes which are for the benefit of women, which they are not getting access to. For example, several states now have fair free travel for women in public buses. So there is some level of resentment against women, and also the sense that maybe this is being funded by taxing, say, products that men consume like liquor, you see? So there is that equation, that conversation is very much there in society. Do we know whether all the money promised makes it into the hands of the women, Davina? Well, anecdotally, I can tell you that I was covering

state elections in Bihar in November, which is the eastern state of India, one of the poorest states as well. And women turnout here has been traditionally high. So political parties often promise this kind of a cash transfer. And that time, the party that was in the state had promised to transfer a $100 one-time payment to women over there. Now, when I spoke to a lot of women at different rallies, they said that while this money has been promised, they're yet to see it in their bank accounts. And a lot of times it's also because they don't have proper documents for it. And then they don't have, say, an ID proof or they don't apply for it or don't know how to apply for it. And that's why it's not always that this money sort of comes in.

And I was reading a research from PRS legislative research, which is another think tank in India, which has shown concerns with the eastern state of India, Assam, and the central state, Chathisgar, saying they are the two states in which they have noticed the lowest transfer to women. And it also ties in with the fiscal sustainability. of the state. Do they have enough money to spend on these welfare schemes? Because these are states which themselves are struggling. So there's always a deficit. And that's what impacts rolling out of these schemes. But that would have been a lot of money, $100, for example, compared to the usual payments that take place. That's right. But it was a one-time payment that was promised just

before the elections. And no surprises there. The party that promised it has actually one. Of course, there are the factors. But this is one of the reasons they're citing for their winning. Professor Prabha Kothi Swarren and reporter Davina Gupta based in Delhi. Still to come on the programme, the importance of strength training for women, and remember you can enjoy Woman's Hour any hour of the day. If you can't join us live at 10 a.m. during the week, all you need to do is subscribe to the daily podcast. It's free via BBC Sounds.

Now, in 2023, Caitlin Lawrence was just 22 years old when she collapsed whilst playing netball for the then-super league side, Surrey Storm. She was eventually diagnosed with arrhythmogenic cardiomyopathy, a genetic condition she never knew she had. She was told by doctors that she could no longer play professional netball but was determined for other players to not go through the same experience. She since campaigned successfully to get cardiac screening introduced into the Netball Super League from next year. I began by asking Caitlin about that day in 2023. I was warming up. It was just any other day up in Oldham, so pretty far away from home.

And I actually don't remember it. This is just from video and from what my friends have told me, but I just collapsed. I didn't feel anything. I'd felt fine all day. And then the next thing I know is that I'm in an ambulance with people telling me that I had collapsed. I had been unconscious for six minutes and that I was lucky to be alive.

So you woke up in the ambulance, taken to hospital. What did they find? At the time, They didn't really know anything. There was no reason to believe it was a heart condition at the time. They had done some bloods. I had a slightly odd e-cg, but my echo was absolutely fine. There was no lasting symptoms.

So you carried on playing? I wasn't allowed to play for the first month or so. They wanted to know what was wrong, and I was really lucky I had some incredible cardiologists. They thought there might be something to do with my heart. I had an MRI, and they said, for the moment you can't play, you had myocarditis, which is scarring on the heart.

But they didn't know why. They just thought this can happen when you're playing elite sport. There's no reason that it is anything else. So I was allowed to do a very gradual return to play, which I was very lucky Surrey Storm, the doctors, the physios, all the medical staff there were incredible, making sure that I was very comfortable. But then last summer, you'd been playing a match

when you got a call from the hospital. What happened? So I was playing for London Pulse, so I was trialling for their next-gen team, which is just the one below super league. And it was a pretty hot day, so all of us felt quite ill. I thought I had heat stroke. And then I got a cool two days later

because I just had a small recorder in my heart that was checking things to tell me that I had had a heart arrhythmia of 294 beats per minute for 11 seconds. Put that into context for us. Your maximum heart rate is 220 minus your age. So at the time, mine should have been about 198, so it's almost 100 beats per minute over that, which... Scary. Yeah, and I didn't feel it.

What did the doctors say about that? How dangerous was that? I should not be here today, is what I was told. That is now two separate incidences where I was told that I should no longer be here, which is obviously the worst thing you can possibly hear. Yeah. So what was the diagnosis? So at that moment, I was then diagnosed with arrhythmogenic cardiomyphopathy, which is a genetic condition. But at the time, we didn't know that we had any family history of it

because nobody has ever presented with it, because it's often due to the strain of elite sport. So what did that mean for your netball career? I was told that I would never play netball again. I would never play elite netball again. And my aim was, I was in the Scotland senior squad. My aim was the 2006 Commonwealth Games, which are home games, 2007 World Cup, and that was taken away immediately.

How devastating was that to hear that news? It's the worst news you can, as an athlete, that you can possibly hear. It's that, well, on Sunday I was playing extremely high-level netball and by the Wednesday I would never play any form of that level again. You've described it as like grief. How did you cope with it? How did you deal with it? I think I didn't cope very well at the beginning.

There was a lot of denial. I was about to start a new job. There was a lot of reason to put my focus into that and I just couldn't look at netball. I couldn't watch it. I didn't want to be around any of it at all and I think the grief in that sense was the start of it was denial and anger as well

because in that moment you think why is it me I was so healthy I had done everything that I could to make sure I was healthy and at the gym and running to make sure that I could be the best possible athlete and yet it was something that was completely out of my control and it just took it away from me in an instant

So what support did you have around you? I was very lucky with my family and friends. I had some incredible options with therapy, both from the NHS and also the netball players association had offered me some. And you were fitted with a cardioverter defibrillator? Tell me, explain what that does. So, yeah, so I'm now implanted with an ICD, just a really small defibrillator. The medicine is incredible. I do not understand it at all. But it gives me that support that if another arrhythmia occurs, if anything happens, I can be immediately shocked in my heart shocked back into a normal rhythm.

You can't play anymore competitively, but you decided to channel all that energy into campaigning. So tell me when you decided that that was going to be your next passion, your next mission. I think maybe when I was still sitting in the hospital bed, if I'm being honest, I think hearing that news and knowing that I could never play again at that level, but it is such a small and non-invasive procedure to check whether. you have a heart condition and I was very lucky to then find cardiac risk in the young and knowing that they do ECGs both for elite athletes and also for kind of anyone in the public immediately I thought England netball they already screen their senior players but we need

to be screening the netball super league as well because now it's professional and we focus so much on ACLs and ankles which is so important and always talked about because there is an ACL crisis in particular, but your heart muscle is the most important muscle in your body. It's keeping you alive. So why aren't we testing it? I mentioned that we're joined in the studio by presenter Gabby Logan. Gabby, you've been listening to Caitlin's story and this sadly happened. It's very close to home for you because this happened to your younger brother when he was 15. What do you make of Caitlin's story? He didn't have an outcome like Caitlin because he died almost instantly. He had a hypertropic

cardiomyopathy and was playing in the garden actually but he was a high level sports person he'd been signed for liege united he was about two months away from starting his professional football career and um one of the things that we couldn't relieve was that somebody could get to that level of sport because he was about to sign for the top leads would won the league that year they were the top club in the country and he wasn't screened and we found out that in italy young players in syria were screened and this wasn't something that was that unusual i mean this is this is 30 years ago so times have changed and so much so that my son who now plays professional rugby was screened when he was in an academy at 16 and there was a little red flag with him

because when he wrote on his form yes there's been an incidence of a heart condition in the family they took his case a little bit more seriously but it was reassuring to know that across other sports protocol had changed because obviously Daniel at 15 years old had that incredible career ahead of him and there's so much of your story Caitlin that was bringing me on the edge but it was the moment you said the thing I loved had gone sorry I feel like I've sat in this chair

and done this a few times I've cried in front of you I'm so sorry but there are so many parallels your passion for Scotland which is aligned to the sportsmen in my family my son and husband and you know I did a law degree so how important is the work that Caitlin's doing? Amazing

because this is a very simple non-invasive test and it might bring some heartbreaking news. But it will be very, very few who have that. But my God, if you save a life and you save a future and coming to terms with the end of a sporting career is an awful thing. I went through it myself when I finished gymnastics. It's a horrible thing because you think nothing in life is going to give you that same buzz and passion. It's going to happen to a sports person, whatever stage you get to. That moment will come. And for Caitlin, that has come a lot sooner than, you know,

you wanted it to. But you've already done something incredible. And I feel like you're going to do more incredible things. agree with you. Have you been back on a netball court? I didn't enjoy it. You can be physically ready, but I think mentally you won't always be ready and I just decided that it wasn't for me anymore. But it gave me that opportunity to feel like I had decided to step away and objectively I know it wasn't, but it was really

nice to be able to step on the netball court and decide that that was my last time. Caitlin Lawrence and Gabby Logan. Gabby had joined us to talk about this year's sports personality of the year. And if you'd like to hear that interview, you can catch it on BBC Sounds. Just look for Thursday's program. Now, we're increasingly hearing about the benefits of strength training for people as they age. Well, a new report is shedding more light on the crucial role that strength training can play for people on weight loss drugs. Around 2.5 million people are using GLP ones or weight loss jabs in the UK. For many, they've been called game changes

in tackling obesity and related illnesses. Data gathered by the fitness company Lay Mills and the non-for-profit fitness industry body UK active shows the impact weight loss drugs can have in our body's lean muscle mass. That's the mass of everything in your body except fat. Their report says 20 to 50% of weight loss is lean body mass and that this poses significant health risks. But muscle loss can be countered by strength training.

Well, Kruper spoke to Dr. Sarah Jarvis, who's a GP, and to Lucy McDonald, a musculoskeletal physiotherapist who specialises in muscle joint and bone problems. So how do weight loss jabs impact muscle mass and strength? Just like any cause of rapid weight loss, you end up not only losing weight, not only losing fat, but also muscle. So it will occur if you're on a diet, not taking the weight loss meds, or if there's another cause of reduction. in appetite, or say, for example, cancer treatment or anything where you're suddenly losing a loss of weight, you'll lose both fat and muscle. And are women more vulnerable to this kind of muscle loss whilst on these weight loss injections more than men?

It's a complicated answer to that because we have a lower proportion of muscle mass anyway. So that's in part why we find it more difficult to lose weight potentially because we find it more difficult to build muscle. because, for example, we have lower levels of testosterone. So in a way, yes, in direstery, yes. Sarah, I'll turn to you. Why is losing muscle mass such a serious health concern? Oh, it's a hugely important health concern.

And what we're seeing, particularly as people get older, is that the more muscle mass you've lost, the greater the risk of falls. And of course, we know that falls could be associated with fractures and even if they're not, They are absolutely linked to lack of independence, to losing your independence. And we cannot underestimate that. Now, what we're seeing with the GLP ones is that in the studies, people were given lots of advice on, for instance, you know, exercise on protein intake as well as resistance training and so on.

But of course, what we're seeing in real life is that that's not happening. And that's what really worries me about the. difference between these studies which are, you know, very much what a drug can do and the real life, which is about what a drug does do. And particularly because now so many of these weight loss drugs are being given privately, which means that we don't have the same degree of control over what advice people are given. And so as standard practice, if you were offered these resources, these drugs within an NHS GP surgery, what advice is offered to women when it comes to strength training and taking these drugs?

So the first thing we need to point out is that it's great that these drugs are now sometimes available through GP surgeries. Until June this year, they were only available through what we call Tier 3 weight services. Now they're sometimes available, but to put it into perspective, by 2028, as we gradually ramp up the number of people who will be eligible for these drugs, it's estimated that there'll be about 220,000 people

who will be eligible out of, about 3.5 million people who should be eligible according to what Nice, the National Institute of Health and Care Excellence says. And that means that of perhaps 1.7 million people who are taking these drugs, the vast majority over probably about 1.6 million, are getting them privately.

Now, if you went into a Tier 3 weight service, then they've got all the bells and whistles all associated. They've got physiotherapists. Fantastic. stick. They've got advice on protein intake. They've got advice on how to reduce your portion size and how to maintain, how to stay on these drugs. What we're regularly seeing and what the real life studies of what's happening out there in the real world show is that people aren't. I mean, I've had people who have come in and said, you know, oh, well, I can still afford the weight loss

drugs because I've given up my gym membership. That is the worst thing you can do. Well, that leads me nicely onto the many messages that we have. This message says, I'm a 75-year-old woman. She regularly weight trains at the gym and she says, I love it. It's improved my strength and my positive outlook. However, I have just discovered a small hernia. I don't intend to stop, but I now have to modify my training. And this person asks, I am a 49-year-old female. I don't enjoy strength training. The first one, that's brilliant. We need more and more stories like that. And I certainly come across plenty of very fit older ladies who are very strong, which is brilliant. With any kind of exercise comes the risk of injuries. And the great

thing about your listener is that they have said that they're going to modify their routine rather than stop. And that's really, really important because a lot of people with the first sign of injury might just entirely stop their program for fear of making it worse or other injury. So that's a really important component to modify and then progress and build up from there. I would say the vast majority of us, strength and conditioning training, isn't top of our list of fun things to do. So the best thing to do is to do it with friends. I mean, as women in particular research shows that we're much more likely to exercise if we're with friends. So joining a local community group or getting a couple of mates together and going around to

someone's house and working at in the garden or whatever, that's the way forward. We're more likely to do it and we're more likely to stick to it. And with all these things, consistency is key. If you can do it, something that becomes part of your routine. So, for instance, if you think about resistance training, whether it's using resistance bands or using small weights, I use resistance weights when I'm out walking my dog or when you're out for a walk and you can actually use them. another friend of mine uses her dog lead

and she does the sort of strength training and flexibility training going from front to back, moving her arms over her head, that sort of thing. But if you tag it on to something you're already doing, it makes it much easier.

So if, for instance, you go out for a walk every day, put your resistance bands or your lightweights in with your keys so that when you leave the house, you don't forget to take them and then you will do it. And either that,

or doing with a friend, I entirely agree about doing it with a friend, is really important. The importance is consistency. That's really good advice. Sarah, I also want to ask you about how menopausal women respond to weight loss jabs in terms of muscle retention. So we know that when you get to the menopause, you sadly are much more likely to lose more weight. We know that the lack of estrogen in the body, as the eastern levels in your body drop, it has a fundamental impact on your body. We've already heard that women, unfortunately, have less muscle mass. They also, sadly, as a proportion of their weight, have more body fat.

And unfortunately, as I can attest, that body fat increases when you reach the menopause naturally, even if you don't gain weight. But that doesn't necessarily mean that you need to give in to the inevitable. It doesn't necessarily mean that you need to accept that you're going to gain weight and so on. It just means that you need to pay that much more attention to a combination. And it's not just resistance exercises. Resistance exercises are really, really important. These are exercises that push individual muscle groups. But aerobic exercise, of course, is also a really generally good idea.

Julia's been taking your advice. She has messaged in to say, I don't drive, so I walk everywhere and carry my own shopping. And this is my exercise. as I lack the motivation to exercise in the normal way. And that's important, isn't it? Because not everyone enjoys going to the gym. Oh, it's huge. Yeah, it's a really important point.

You do things that will fit in with your life. So, you know, make a vow that you're going to walk up the stairs. You're not going to take the lift or the escalators. Make a vow that you're going to park at the far end of the car park. Get off the bus. One stop earlier. All these things will add up. Now, those are, of course, aerobic exercises.

And we do also to maintain body muscle. we do also, especially, sadly, as we reach a certain age, need to do those individual muscle strengthening exercises too. But you do need to bear in mind that resistance training is pulling or pushing against the resistance of an object. And that could be your own weight. We don't need to be doing heavy weights. We don't need to be building up lots of muscle. And indeed, I would say from the point of view of continuity, that it's actually better to be doing light reps or resistant to training that you can do more repetitions

of, lightweights, more reps. Dr Sarah Jarvis and Lucy MacDonald. That's all from me. On Monday's programme, Scottish soul artist Brooke Come talks about her album, Dancing at the Edge of the World, which has had huge success and marked her breakthrough year.

Do join us then and enjoy the rest of your weekend. Hello, I'm Noola McGarverin and I want to tell you about a BBC podcast called Send in the Spotlight. The number of children with special educational needs is increasing. Too many parents are having to fight to get those needs met and councils are spending money that they do not have. Against a backdrop of government reform,

I bring together families, teachers, experts and decision makers to reimagine the system. Listen to Send in the Spotlight on BBC Sounds. Thank you.