Transcript 7

Hello and welcome to Talking to Titans. A podcast from University College London with me Gudrun Moore professor of molecular genetics at UCLA Institute of Child Health.

And me Cathy Giangrande, UCL alumna, art historian and conservation scientist.

Over seven episodes leading up to International Women's Day, we've been speaking to women who have pushed boundaries in their personal and professional lives. They become leaders and role models in their respective fields, and have encouraged future generations of women to follow in their footsteps.

This is the last episode in the series and it's been a real privilege to chat to women with such uniquely inspiring stories of how to overcome hurdles and hear concrete advice for roles across academia. It has definitely left a lasting impact on us and we hope for you too.

Joining us for this episode is one of the UK most ground-breaking Researchers in women's health, Lesley Reagan. Hello. You've had an incredible number of roles. You were the president of the Royal College of Obstetrics and Gynaecology. The first woman to hold that role and 64 years, head of your department at Imperial College, director of the Women's Health Research Centre, Secretary General of the International Federation of gynaecology and obstetrics. And in 2015, you were awarded an honorary doctorate at UCL. This list actually also just goes on. Firstly, Women's Health has started taking up less space in medical research and other health care. What made you decide to specialize in this field?

Well, I think it was quite simple. When I was a medical student, I had a wonderful mentor called Luber Epstein and every year, she would pick two or three students from that year and ensure they went into obstetrics and gynaecology. And so it really was a done deal. That was what I was going to do because I was one of her Pixies that year. And it wasn't until much later in my career, after I spent a lot of time specializing in what's actually quite a small area, that I found myself thinking, how much more of a contribution I could make if I was looking at women's health in its entirety, as opposed to just obstetrics and gynaecology. So I become almost a ball about how important women's health is because I really do believe that there's a famous quote, the health of a nation is determined by the healthiest girls and women. So women in this country number 51% of the population, but they determine the health behaviour of everybody else. Most importantly, I think, I was trained in an era where we did things to patients, no, it was a disease intervention service, you waited for them to have a problem. And then you try to sort it. Whereas what I realize now that most women see health care professionals, not because they're ill, but because They want to do normal things like job, they've got good contraception or have a pregnancy or prevent themselves from getting cycle cancer.

Does it frustrate you that the field woman's health care gets so little money comparatively, and also attention from the medical community?

It is a bit frustrating, but I am an incurable optimist. And that's the only way I could do my job. And every time I meet obstacles, I just try and think about, well, how can I overcome this one? And I'm really proud of the report that we published the LCG, published just at the end of my presidency, in December 2019, entitled better for women. And this was a report looking at life course of women's health. But it was the culmination of about four or five years of me campaigning, trying to get them to understand that when we get it right for women, we save money, because that's always an important issue when you're commissioning for health and I do remember talking to two of our Secretaries of State for health and they will always say politely Oh, yes will write to me about it. And I would write to about what I thought we should do. But really nothing was rocket science. It was just common sense. Let's reorganize the way we're delivering this. And then I think it was just before the the five-year plan was published, one of the civil servants showed me this thing, oh, you must be really pleased that women's health is on the map. Because you've always been saying that women are disproportionately disadvantaged by the funding mechanisms and also the the health cuts. And I sort of took a look at this list and it said, maternity and children and I just saw read about it and I just uncharacteristically fired off. said, You know, I think women's health is more. You know, it's no longer like the handmaiden’s tale that women are there to incubate babies and drop them, right. Women's Health is about the whole life course. maternity and being the bearer of children is just one Era, one part of that life course. I think I was just shocked. And then we published this report and I'm going to spend the next couple of years I hope, trying to get people to implement it. That's easier said than done.

It was always your plan to go into academia?

No, no, no, no, I was I was going to be an NHS consultant. I thought academia was for the boffins. And I never used to think I was bright enough to be an academic.

Why didn't you think you're bright enough? you'd gone to medical school?

I don't know. Because I think girls have this imposter thing that they often do. I'm repeatedly telling my twin daughters who are now 27 year please don't start the sentence with an apology to start the sentence I can do. But I was in Cambridge, I have always seen these women who've miscarried who were distraught. And they kept saying why am I miscarried? And I went to all the textbooks You know, there was no internet then. There was nothing there about how it's because she smokes or drink and I was talking to A colleague there and he just said, Well, if there's nothing to read about it, then you'll just have to do the research and and find out about yourself. And I said, What me, too? He said, Yes, you. So I started him and he he did help me a great deal. And then I was lucky, I got an MRC fellowship to work with him and others and develop my interest in recurrent miscarriage. And I sort of got my thesis and I was very pleased with that. But I still thought that I was going to become an NHS consultant, what I think I wrongly thought was a proper consultant in your clinical work. And I'll confess it was against serendipity. I got married, and I inherited four stepchildren and I realized that I needed to move and to be near them. And so I applied for the first job that came up in London, and it happened to be a senior lecturer post. And I thought, well, I'll do this for a couple of years, and then I'll go back to being an NHS consultant and I just got completely blown over I think the word by the excitement of Having research fellows who were becoming successful,

So that was that Imperial, was it?

Yeah, yeah. So I went to Imperial in 1990. And my first two research fellows were incredibly successful. And I'm very proud of the fact that they're both my consultant colleagues now. But I was particularly excited by the fact that I had a hand in training other people who became successful and going to an international meeting and seeing them get applause was I just always disliked inferior colleges and notoriously male, heavy,

did it end up being an obstacle? I

 think so. But I always remember my father, who was a big influence on me, commenting one time was when I was quite a young consultant. And I said, I didn't understand this really, I never used to be aware of all this agenda base and women was sort of, you know, have to work harder and fight harder. And he said, Oh, rubbish. He said, it was always they said, but you just chose to ignore it. And he was usually write about the things he was an extraordinary character. He left school at the age of 12. He was basically self-educated. And I just don't know where he got his vision from. Because he was quite determined when I was born in the middle 50s that girls would have the same educational opportunities as boys. And that wasn't common, then

Did you find your school was supportive of you to go on to to do medicine?

Well, sadly, no. They all said, well, you never get into medical school because my dad who said, Look, if you want to do something, then you just got to work hard and do it. You know, if there's one intervention in medicine that I would select, it would be education,

what areas of women's health do you think are still misunderstood in the workplace?

I think if you look at it as a life course, you know, the first thing that needs to happen is that I would say school is workplace. One of the service we didn't is better for women report of over 3000 girls and women showed that one in five girls when they had their first period, they didn't know what it was all about. I remember using this statistic and someone saying which country you're talking about, about this country. Our society doesn't talk about periods. And it's extraordinary. And it because most women will have 10 or 12 periods every year for 35 years of their life. And then, you know, the whole thing about contraception. What we're seeing in this country in England, in the UK, is that the unplanned pregnancy rates about 45%, when I'm not for a moment, saying that they're all unwanted, not that at all now, but we know, for example, that if you space your pregnancies by 18 to 24 months, infant mortality falls when you have birth spacing, and it's quite dramatic figures. And then we get onto the pregnancy years. Many of them will will show characteristics during that pregnancy either mentally or physically, have problems they're going to have later in life so why not have a really robust postnatal visit where all this is discussed. And then Of course, the big one that I think we're making some strides on about workplace and women's health is understanding the metaphors, often what happens is menopausal may have a sympathetic local doctor who gives them a bit of hormone replacement to get them over those horrible hot flashes, probably doesn't have an employer that understands that we take time off. We do have to encourage research and an awareness of it. And I spent quite a lot of time the last few years talking to company boards, leaders, frequently men and when I've pointed out that, you know, what they could do is really have much better productivity in their company. If they were to understand Firstly, the needs of women during their reproductive years, which we shouldn't we started to do you know, your pregnancy is relatively protected now. But certainly, menopausal women get them really, really bad crack of the whip. And interestingly, whenever I've talked about how much more productive women would be if they were given The opportunity of flexible working, or temperature control in their office or, you know, easy access to health care if they need to go and see a doctor. Most of those men will turn out to be Superman. I have no idea but of course, makes complete sense. So it wouldn't be difficult to achieve if we got the narrative right.

Jumping back in the cycle. What are your views on egg freezing?

I tend to see women who've had problems getting pregnant or problems miscarrying, and by definition, they've therefore grown older. But I regularly now see women, youngest women who say to me, they want to preserve their gametes for the future. They want to get their career going. I think the thing about egg freezing and fertility, modern day fertility treatment is it is raised expectations dramatically, with very little evidence to back it up. This is a good way for as costly as well. This is not much different for when IVF was being introduced. So it was Yeah, it was like the big the big white hope wasn't it the new thing that it opened, but I come back to my point about it raised expectations. And people thought women thought that was fine I always have IVF not so easy not so easy. You know, if you if you sought treatment with that sort of percentage, good outcome for your broken shoulder or your your problem kidneys, you think What? You want me to take all these drugs, and it's going to have that 65%

if you're 44 years old, as well…

but I don't want to knock it off because I think it's been the source of enormous joy to many, many couples and a great, great breakthrough in science. My reservation about all of these assisted fertility treatments is the the false expectations that are raised against the backdrop of as a commercial venture and people are making money out of what is effectively vulnerability.

How have you found a balance in your life you've done so many things between your professional and Personal life?

Well, I say I think my daughters and my safety for all. They are twins, identical twins. That was challenged when I was pregnant because I was convinced that everything was going to go horribly wrong, that they were fine. They were born early. They were very healthy, but they were little and they needed a bit of help at the beginning. But they thrived on maternal neglect, but by which I mean, I was never around to go to the coffee mornings. I might never you know, and I didn't tend to drop them off at school and now he did that. But I used to ring fence time with him and I think now they're older. They're very appreciative I got my own life. And they're great friends. I'm you know, I recount them once my my closest friends and you're a good role model for them. Yeah, I think so. I think so. Because you you know, somebody People often ask me, you can women have it all? And I think I would answer yes, they can have it all but not necessarily all at the same time. I didn't plan what was going to happen. Things sort of happened to me. I've got this philosophy in life operating Please don't make appointments, you either grab them or you miss them. And I don't think I've ever regretted doing something even when it's gone wrong. But I would hate to regret the fact that I hadn't, you know, jumped over the top of a cliff or jumped into a swimming pool.

What's been your biggest achievement? Lesley?

Well, I'm became head of department. I think I managed it somewhere that it was the first time that ever been a woman had a department in the country. And I think we managed to change the ethos from asking for help is a strength not a weakness, because I think that often is particularly problem for women, nothing good if they're asking for help, but they're perceived as being weaker. And I think the work recently promoting women's health as an entity as opposed to just segments of super specialization. I'm proud of that because it really is changing the way people look at it. And I think that means that there will be better funding in the future, and more importantly, better outcomes.

Do you have any career role models?

I think I've been incredibly fortunate because I have met and being looked after by Lots of people. When I was a junior trainee in London before I went to Cambridge, a wonderful mentor who believed in me and encouraged me to reach that extra bit higher. Cambridge, I, my best clinical mentor was a man there. And he still sits on my left shoulder in the sense that it was all about doing a good job, but giving 105 or hundred and 10%. And anytime that anyone was tempted to take a shortcut, he was sort of tap tap tap. How about networking? How big a role do you think that plays in a career? Oh, I think it's invaluable. I think one of the things I've learned most in the last 10 years certainly since I've started getting interested in women's health and its entirety is that you can travel a lot farther and a lot faster. If you don't mind who gets the credit along the way? Yes. And when I've been sort of altruistic sounds a bit over the top, when I sort of put people together and said that you go sort this out all you know, I think you can help each other The payback is enormous in the long term. So I think that's all about networking. And you may not be able to utilize the connection or this result, but something good will come out of it.

So you're a facilitator in a way, aren't you bringing people together?

And I think that's absolutely right. I think facilitating progress is something I really enjoy. I get united and it's not a sort of a headline thing or a big banner up there. But I know I get a warm buzz from thinking Yes, we've got we've we've Yes, yeah. And we've, we've actually got over this hurdle. What advice would you give Lesley to younger women going to mid cielo in higher education? I would say and I do actually mentor quite a few younger women now. My advice is, you know, you do need to work very hard and become an expert at what in your field. Because that way, you have the self-confidence to be able to go and punch above your weight of it. And I often say when people are anxious about all the I don't know I can do this will say to them, you know more about this subject than anybody else here. So you know, you can do it. No, I think it's finding finding things that make you self-confident. Which doesn't mean you don't carry on doubting it there is still really weak as possible. I don't think to my song got someone gonna find me out. Now, I don't really know everything about this.

But do you ever stop? No, I don't think it will ever stop with ourselves.

I don't see men with this sort of self-doubt. Yeah. I mean, women don't tend to put themselves forward. You know, I have to go and say, why don't you do this put in an application. I expect if I said to you to today, all look, this is interesting job. Have you thought about applying for it? You probably come up with reasons why you're not best qualified. But that doesn't mean you can't overcome that. It's not a bad thing to be a bit self self doubting and self-questioning, should I say. But it's important that it doesn't paralyze you and stop you doing things.

Lesley, thank you so much for joining us today.

Thank you very much for having me.

Well, that was a very interesting discussion with Lesley particularly, I think, stood out for me was the whole life course and the importance for women across, you know, probably from age, maybe 1011 through to pregnancy and then carrying on through menopause, that kind of hormone related life course is something men don't have the same

challenges or challenges. Yeah, at every stage are affected in a different way.

And I think it is perceived to be very private. Yeah, people don't really know what to say when a woman in the committee room suddenly goes bright red in their neck and starts to sweat saucer swear and also leave the room maybe in the past that was misread as some kind of tremendous embarrassment and it becomes an embarrassment.

I know when I'm was bringing up my boys. I mean, like we were very, I was very, I still am very open about all these things with them. It's,

it's just the whole p group needs to understand the differences.

Thank you very much indeed for listening. This has been the last episode of the series of talking to Titans in this series, really we've tried to pitch it so that younger academics, young students, people in the early part of their career, can learn from useful pieces of advice. And I think for me, if you know, thinking back, I would probably have liked to have heard these amazing women say, reach out for help.

Yes, I do on your own. Yes, I would totally agree. And that you're not alone. Because everyone it's amazing how many people feel the same way and you're just not able to sometimes, you know, express that or share that. We probably need to be some possibly more supporting each other without people having to have to reach out for help. Yes to be more aware when people when someone's obviously clearly not.

Yes hoping coping.

I do think that people like Ijeoma and Sarah and others are working very hard to keep that on the agenda now.

For more information, please go to www.ucl.ac.uk forward slash UCL dash minds forward slash Titans. If you liked this episode, leave us a review in your podcast app, share it with your friends and tweet at UCL with the hashtag Talking to Titans. The series was a whistle down production.

This podcast is in memory of Professor Maria Bittner, Glindzicz