Episode 5: Mind the Gap

Transcript

Speakers:

Host - Olivia

Guest – Dr. Jenny Hall  

00:00:03 Olivia Moir 

Hi, everyone! Welcome back to It All Starts Here. This is a podcast focusing on the education and communication of topics in reproductive science and Women's Health. I'm your host, Olivia Moir. and we are here at the Institute for Women's Health here in London at UCL. And today, we're going to be talking about a period that is often kind of overlooked because when it comes to reproduction, socialization will often focus on 2 main areas, which are, you know, either getting/being pregnant, or not getting pregnant. But there's more to it, and it's important to educate on and consider the additional areas in between and the seemingly tiny details that are part of these topics - because when it comes to reproduction, it's often those tiny details that can go on to make a huge difference in terms of pregnancy outcomes and maternal health. 

00:01:01 Olivia Moir 

So today I have with me Doctor Jenny Hall, who is a clinical associate professor and NIH R Advanced Fellow here at the Institute for Women's Health. She is a public health consultant with an extensive background in research using quantitative, qualitative and psychometric methodologies to investigate various topics in maternal health and epidemiology. Her work aims to improve health and social outcomes for women of reproductive age around the world and most recently has been focused on understanding more about pregnancy planning and the benefits of preconception health or health before pregnancy, which is really this area that, as I said, is often overlooked and we're going to focus on today. 

00:01:47 Olivia Moir 

It’s such a unique opportunity to be able to speak and hear from you today on this topic given your mixed methods approach to science and specifically how you've taken the opportunity to investigate these scientific areas from a public health perspective. I've really been looking forward to hearing about this topic from your perspective, given your massively broad background of different sciences and also getting this global health perspective from you giving your research and work around the world. So, let's jump right into it! 

00:02:17 Olivia Moir 

Maybe you can talk a little bit about your current research and why this is something you're so keen on investigating. Where did it all start for you? 

00:02:27 Dr. Jenny Hall 

Well, thank you so much. It's a pleasure to be here. So I've been interested in reproductive and maternal health for a very broad perspective for a long time. So as far back as a medical student, I did a dissertation on HIV using a human rights lens. But I think for me the main thing that drew me in is the kind of social justice aspect of maternal health, so maternal mortality, it is one of the biggest inequities, probably the biggest inequity around the world 99% of maternal deaths happen in low and middle income countries and just with what we already know we could prevent probably at least three quarters of them. But also to think about within the UK, we we now see massive inequalities in our certain ethnic groups or people from more deprived backgrounds. They can have a three to five times increased risk of maternal mortality and and there's no good reason for that. And I think that's kind of what drew me to this area in the first place. 

00:03:26 Dr. Jenny Hall 

And then as I was learning about maternal mortality, I came across this shocking statistic that almost half of pregnancies worldwide are unplanned. So there are literally 10s of thousands of women dying every year from pregnancies that they didn't want to have in the first place. And I guess so with my public health hat on, prevention is always better than cure. So I then started to think about research and how we could understand more about unplanned pregnancy and what the adverse outcomes were and that's why I did my PhD in Malawi looking at whether unplanned pregnancies had poorer outcomes in a rural area in. 

00:04:08 Dr. Jenny Hall 

And are we and finding that my research and other evidence showing that they are dated with increased risk of the baby being born too soon, having a low birth weight and also for things like depression for the mum after birth and those are just the short term, there's also the other longer term consequences let's say for the child's health and growth and development, their education, the impacts on the rest of the family and the other children's and then out onto society. So take a really big impact. 

00:04:38 Dr. Jenny Hall 

So then still thinking about prevention public health, I'm like, OK, well, how can we help people avoid the pregnancies that they don't want, but also recognising that unplanned pregnancies happen to some extent? So how can we work with people who have an unplanned pregnancy to try and reduce their risk of of adverse outcomes? And that's what then led to my NHL Fellowship, which is what I'm just kind of currently wrapping up. And so they've been doing two things, working with people and healthcare professionals about how we can better identify what people are thinking about with regards to a future pregnancy. So we can either help them avoid that if they don't want a pregnancy through contraception, or starting these conversations about how you might think about planning and preparing for a pregnancy so that you can be in the best place before pregnancy and then also working in antenatal care to detect who's currently experiencing an unplanned pregnancy and work out how we can better support them to try and prevent some of those adverse outcomes, and I think the key gap that we've identified here is that we either for contraception to help you not be pregnant or we have our maternity services when you are pregnant and that bit in the middle. where you're thinking about and planning and preparing for pregnancy is completely missing and the women in my research in particular. qualitative research, really felt that gap and I think this is really important because if if you don't know if we aren't helping people understand that there are things that you can and in some cases should do to prepare for pregnancy, then you don't, even if you're planning to become pregnant, you may not prepare. You don't know that there are things that you could or should be doing like taking folic acid before you become pregnant. So yeah, that's kind of where I am at now. 

00:06:27 Olivia Moir 

That`s so interesting, and you know, I I that really resonates with me because a lot of my research that I've been doing has been focusing on that area of sort of prevention. You know, obviously focusing on different elements but something that is often conveyed to us is prevention is the best form of medicine, and that's just really rings true, I think. 

00:06:49 Olivia Moir 

So it's really interesting to hear about that and I think sort of what I'm getting is that when people think of getting pregnant and you'll know more about this, but they maybe just. 

00:06:59 Olivia Moir 

They go for it. 

00:07:00 Olivia Moir 

And I don't really. 

00:07:02 Olivia Moir 

Maybe worry too much about the things As for example folic acid to consider in advance of getting. 

00:07:10 Dr. Jenny Hall 

Yeah, I think that's a really common conception and I think that's true for some people. 

00:07:15 Dr. Jenny Hall 

Some people are planners and I guess I'd count myself in there and they will research and they will think about and find out. 

00:07:21 Dr. Jenny Hall 

What they need to do? 

00:07:23 Dr. Jenny Hall 

But the irony is they're probably the the most healthy people anyway, probably don't actually need to do that much, but it's a problem of unknown unknowns. 

00:07:32 Dr. Jenny Hall 

If you don't know if you have no idea that there are things that you could or should do before pregnancy, then the decision to become pregnant and then becoming pregnant you you don't know that there's a bit that your. 

00:07:43 Dr. Jenny Hall 

I think people will often say ohh when I'm pregnant I will do XY and ZI will stop drinking. I will stop smoking, I will lose weight, but that's generally not enough. 

00:07:55 Dr. Jenny Hall 

Most of the evidence is suggesting that doing things once you're pregnant doesn't really make a difference. 

00:08:02 Dr. Jenny Hall 

I mean, for some things. 

00:08:02 Dr. Jenny Hall 

Obviously it does stopping smoking at any point. 

00:08:05 Dr. Jenny Hall 

Makes a difference. 

00:08:06 Dr. Jenny Hall 

But if you're going into pregnancy and we know, for example, in this country, at least half of our population of reproductive age are overweight or obese, so a lot of people going into pregnancy who are overweight, that's not something you can change during pregnancy. 

00:08:20 Dr. Jenny Hall 

And people may not know that being overweight can make it harder for you to get pregnant. 

00:08:26 Dr. Jenny Hall 

It can make it take a longer time. 

00:08:28 Dr. Jenny Hall 

It can limit your choices during pregnancy, such as your choice of where to give birth and give you. 

00:08:33 Dr. Jenny Hall 

Risk of of things like gestational diabetes. 

00:08:37 Dr. Jenny Hall 

Once you're pregnant, you. 

00:08:38 Dr. Jenny Hall 

Can't change any of that and and also we know that if you're overweight going into pregnancy, your child is more likely to be overweight when they're five and if a child is overweight at 5, they're more likely to be overweight as a teenager and then they go on to become a a parent who is overweight. 

00:08:58 Dr. Jenny Hall 

And so you're perpetuating this cycle. 

00:09:02 Dr. Jenny Hall 

So yeah, if you don't know about this and it doesn't factor into your thinking, you don't think ohh. 

00:09:07 Dr. Jenny Hall 

I'm thinking about becoming pregnant. 

00:09:08 Dr. Jenny Hall 

I know all these things, so I will do this. 

00:09:11 Dr. Jenny Hall 

What this is what's important for me to do. 

00:09:13 Dr. Jenny Hall 

You just think I'll get pregnant and then if something I need to fix, I'll fix it. 

00:09:18 Dr. Jenny Hall 

But I also think people rarely flip from not wanting to get pregnant one day to wanting to become pregnant the next. 

00:09:24 Dr. Jenny Hall 

I think there's. 

00:09:25 Dr. Jenny Hall 

More of a a gradual transition, perhaps moving from. 

00:09:29 Dr. Jenny Hall 

It would be the end of the world for. 

00:09:30 Dr. Jenny Hall 

Me to get pregnant right now. 

00:09:32 Dr. Jenny Hall 

Through to ambivalence, or if it happens, it happens or I'm not really trying not to get pregnant through to, you know, then actively wanting to become. 

00:09:44 Dr. Jenny Hall 

Pregnant in some cases. 

00:09:46 Dr. Jenny Hall 

So I think there is an opportunity there. 

00:09:49 Dr. Jenny Hall 

There is a time where people are transitioning. 

00:09:52 Dr. Jenny Hall 

And we need people to know what they could do in that time. 

00:09:56 Dr. Jenny Hall 

Once they start thinking about a pregnancy. 

00:09:59 Dr. Jenny Hall 

Wanting one in the short term so that they can can then take steps to do what they need to do. 

00:10:06 Dr. Jenny Hall 

I think we, we know that people don't really know what to do is is excellent social media campaign. 

00:10:11 Dr. Jenny Hall 

A few years ago by Tommies, the miscarriage charity. 

00:10:14 Dr. Jenny Hall 

They went around filming people on the streets and asked them what would you, how do you plan a wedding? 

00:10:21 Dr. Jenny Hall 

How do you plan for your holiday and people were like ohh, you know, I'll research the weather and I'll book a flight or you know, I'll find a dress or find a man or find a partner in this kind of thing. 

00:10:32 Dr. Jenny Hall 

And when they asked him about how do. 

00:10:34 Dr. Jenny Hall 

You have a pregnancy. 

00:10:37 

There were these kind. 

00:10:38 Dr. Jenny Hall 

Of like Ohh Blank looks, I don't really know. 

00:10:41 Dr. Jenny Hall 

Is there something you need to? 

00:10:43 Dr. Jenny Hall 

Do and. 

00:10:44 Dr. Jenny Hall 

Yeah, and also one of my recent studies we asked, we were asking people whether or not they might be thinking about pregnancy in the next year. 

00:10:52 Dr. Jenny Hall 

Or so. 

00:10:53 Dr. Jenny Hall 

And even among those who said they were either currently trying to get pregnant or. 

00:10:57 Dr. Jenny Hall 

They'd probably try. 

00:10:58 Dr. Jenny Hall 

With the next year less. 

00:11:01 Dr. Jenny Hall 

Than half of them were doing something in preparation. 

00:11:04 Dr. Jenny Hall 

Even folic acid. 

00:11:05 Dr. Jenny Hall 

So even amongst people who are thinking about pregnancy, they're not preparing. 

00:11:10 Dr. Jenny Hall 

And there's this difference between planning to become pregnant and actually preparing to become pregnant. 

00:11:16 Dr. Jenny Hall 

So that's, yeah, that's what I've. 

00:11:17 Dr. Jenny Hall 

Focusing on in the fellowship and I've been working with women in health professionals about how we can make these. 

00:11:22 Dr. Jenny Hall 

Conversations more normal. 

00:11:23 Dr. Jenny Hall 

What are the ways of opening the conversation? 

00:11:25 Dr. Jenny Hall 

What are the settings which health professionals, how we might incorporate that into to primary care in a way that suits people of reproductive age and health professionals? 

00:11:36 Olivia Moir 

Yeah, it's. 

00:11:37 Olivia Moir 

I feel like there's so many different points at which, you know, an intervention or like that area for prevention can occur. 

00:11:43 Olivia Moir 

But I also feel like a lot of what you were talking about comes down to kind of education on the topic and you know, that's something that we kind of have talked in different episodes of this podcast. 

00:11:55 Olivia Moir 

But I guess. 

00:11:57 Olivia Moir 

Specifically pertaining to this area, you said that you've kind of in your fellowship have been looking at areas in clinic specifically where this kind of prevention could take place. 

00:12:06 Olivia Moir 

But do you think that there's also maybe? 

00:12:12 Olivia Moir 

An element of being able to educate that in school or do you think that that's something like I guess I find something that you know has been true is that unless it's directly affecting you or someone that you've you know had in your life that you care about, it's kind of hard to develop that sense of like really a care for that topic. 

00:12:32 Olivia Moir 

More to try and really understand it so you know. 

00:12:35 Olivia Moir 

A lot of people will become pregnant eventually, but how do you and where do you focus like? 

00:12:43 Olivia Moir 

What is the key area? 

00:12:45 Olivia Moir 

I don't. 

00:12:45 Dr. Jenny Hall 

Know. Yeah. So I think. 

00:12:49 Dr. Jenny Hall 

It needs to be tackled from a few different ways. 

00:12:52 Dr. Jenny Hall 

I think we need a general societal awareness. 

00:12:56 Dr. Jenny Hall 

Of this part of the reproductive life course and and that there are things that you can do so that sort of sets the the bigger background picture of something that is OK to talk about, you can talk. 

00:13:09 Dr. Jenny Hall 

About with your. 

00:13:10 Dr. Jenny Hall 

Friends with your health professionals and so on. 

00:13:14 Dr. Jenny Hall 

I think it's really important to get that message in early in schools and, as you say, it's about getting the right information at the right time and giving loads of intimate information to 15 year olds about things to do in advance of pregnancy. 

00:13:29 Dr. Jenny Hall 

Is not going to be useful. 

00:13:30 Dr. Jenny Hall 

Like you say it's, it's not the right time, but. 

00:13:35 Dr. Jenny Hall 

Getting your message to them that when, if and when, because obviously not everyone wants to have children, but if they want. 

00:13:41 Dr. Jenny Hall 

Children, when they get to that time, just to remember. 

00:13:45 Dr. Jenny Hall 

There are things that they can do before they're pregnant that will have an impact on their pregnancy, on their child's health, even on their grandchild's health. And if you get that key message in, in schools, in teenagers. 

00:13:58 Dr. Jenny Hall 

Then hopefully when they get to the point of their life where they're thinking about whether or not they're gonna start a family, then they're like, oh, I remember there's something I need to think about. 

00:14:08 Dr. Jenny Hall 

They might not remember. 

00:14:09 Dr. Jenny Hall 

I'm supposed to take Photocard. 

00:14:10 Dr. Jenny Hall 

Or the specifics. 

00:14:11 Dr. Jenny Hall 

But they just know. 

00:14:13 Dr. Jenny Hall 

I need. 

00:14:13 Dr. Jenny Hall 

There's something I need to think about here. 

00:14:15 Dr. Jenny Hall 

Let me look it up online. 

00:14:17 Dr. Jenny Hall 

Let me speak to a friend. 

00:14:19 Dr. Jenny Hall 

Let me speak to a health professional and so on. 

00:14:21 Dr. Jenny Hall 

So you've got that seed there. 

00:14:23 Dr. Jenny Hall 

But then also from the health. 

00:14:26 Dr. Jenny Hall 

Decide we could incorporate it into either routine lifestyle checks, so if you're. 

00:14:35 Dr. Jenny Hall 

Sometimes you'll. 

00:14:36 Dr. Jenny Hall 

They'll be there, like while you're here. 

00:14:38 Dr. Jenny Hall 

Do you smoke? 

00:14:39 Dr. Jenny Hall 

Do you drink? 

00:14:39 Dr. Jenny Hall 

Let's check your BMI. 

00:14:41 Dr. Jenny Hall 

We could incorporate into that something around reproductive and menstrual health. 

00:14:44 Dr. Jenny Hall 

So it could be something like how are your periods? 

00:14:47 Dr. Jenny Hall 

It could be. 

00:14:48 Dr. Jenny Hall 

Are you thinking of having a baby in the? 

00:14:50 Dr. Jenny Hall 

Next year. 

00:14:51 Dr. Jenny Hall 

Something that opens that conversation and and provides that again that touch point and the answer you know either way is is useful for the person to consider and for the health professionals so they can guide them either with contraception choices or. 

00:15:05 Dr. Jenny Hall 

With preconception. 

00:15:08 Dr. Jenny Hall 

Obviously, we all know health services are very overburdened right now and and that might not always be possible in some situations it will and that's great. 

00:15:18 Dr. Jenny Hall 

But people are becoming more digitally. 

00:15:19 Dr. Jenny Hall 

Literate and. 

00:15:22 Dr. Jenny Hall 

Sometimes things around section reproductive health people would prefer. 

00:15:25 Dr. Jenny Hall 

To have. 

00:15:26 Dr. Jenny Hall 

Do something online that they have more autonomy over, that they might feel is more confidential. 

00:15:32 Dr. Jenny Hall 

If they don't feel comfortable discussing aspects of of sex and reproduction with anyone. 

00:15:36 Dr. Jenny Hall 

So I think also having sort of digital. 

00:15:38 Dr. Jenny Hall 

Tools for people to be able to to self manage because a lot of this isn't. 

00:15:42 Dr. Jenny Hall 

For most people, particularly complex, it's general lifestyle advice around healthy diet, healthy weight, cutting out smoking, those kind of things, making sure you're up to date with your immunisations or your cervical smear, or those kind of things. 

00:15:57 Dr. Jenny Hall 

There are a subpopulation. 

00:15:59 Dr. Jenny Hall 

People who have existing medical conditions, et cetera, for whom it would be important to speak to a health professional. 

00:16:05 Dr. Jenny Hall 

To talk about their medications or their Disease Control. 

00:16:08 Dr. Jenny Hall 

For example, if you're diabetic or asthmatic or epileptic, those kind of things, it's helpful to have that discussion before you're pregnant, so you can make sure that's all optimised before you enter pregnancy. 

00:16:19 Dr. Jenny Hall 

So I think it's having this sort of. 

00:16:22 Dr. Jenny Hall 

Addressing it from many angles and actually we we published a paper on that in January in The Lancet public health, where we set out. 

00:16:28 Dr. Jenny Hall 

This model of. 

00:16:31 Dr. Jenny Hall 

Sort of societal level awareness education as well as health services and digital tools. 

00:16:37 Dr. Jenny Hall 

To provide that context where it is routine and normal to talk about these things. 

00:16:43 Olivia Moir 

I'll have it. 

00:16:43 Olivia Moir 

Yeah, I love what you've said. 

00:16:44 Olivia Moir 

And I think, you know, my kind of my background is in genetics. 

00:16:49 Olivia Moir 

So my brain kind of goes to these places of all the different interconnected ways you know. 

00:16:55 Olivia Moir 

Obviously when I study between your genes. 

00:16:58 Olivia Moir 

How that affects everything else down the line, but I think that is so true about maybe everything and a lot of different topics, especially in health, because sort of what I'm getting from what you've said is just that. 

00:17:11 Olivia Moir 

A lot of the topics to focus on that will help with reproductive health and help with this sort of gap period of when you're planning to be pregnant or just in advance of that is having an understanding of what makes you healthy and and what will help you in your day-to-day like it comes down to. 

00:17:31 Olivia Moir 

Exercise that comes down. 

00:17:32 Olivia Moir 

To eating the right foods for your body, it comes down to all of these different. 

00:17:37 Olivia Moir 

Topics that you. 

00:17:38 Olivia Moir 

Know obviously relate to reproduction, but also just relate to having a healthy lifestyle. 

00:17:44 Dr. Jenny Hall 

Yeah, I mean, there are very few things that are absolutely unique to that period. 

00:17:49 Dr. Jenny Hall 

So obviously there's a photo acid recommendation. 

00:17:51 Dr. Jenny Hall 

It's recommended you take it ideally. 

00:17:53 Dr. Jenny Hall 

At least two months before you become pregnant, and that helps to get the blood folate levels up high enough. 

00:17:59 Dr. Jenny Hall 

And we know we've known since 1991, I think that folic acid will reduce the risk of neural tube defects. So that's when the spinal cord. 

00:18:08 Dr. Jenny Hall 

Doesn't close properly. 

00:18:10 Dr. Jenny Hall 

And and yet we still have, you know, it's only about one in three people who take it before they're pregnant. 

00:18:17 Dr. Jenny Hall 

And shockingly, it doesn't get better if you're on a second pregnancy. 

00:18:20 Dr. Jenny Hall 

We're still managing not to women that you know. 

00:18:25 Dr. Jenny Hall 

OK, well, you didn't take it before this time. 

00:18:26 Dr. Jenny Hall 

You're taking it now. 

00:18:26 Dr. Jenny Hall 

That's great next time. 

00:18:29 Dr. Jenny Hall 

I'd take it beforehand. 

00:18:30 Dr. Jenny Hall 

We're still not doing that. 

00:18:31 Dr. Jenny Hall 

It's actually lower in second pregnancies and and many, many countries around the world have been fortifying staple foods with folate for many, many years. 

00:18:40 Dr. Jenny Hall 

We don't in the UK, it's recently been agreed that we will. 

00:18:46 Dr. Jenny Hall 

But we're only going to fortify white flour and not at a high enough dose. 

00:18:52 Dr. Jenny Hall 

So people are still going to be needing to take the folic acid tablets beforehand. 

00:18:57 Dr. Jenny Hall 

And the reason it's so important to do it before is because then your tube closes so early in pregnancy that actually by the time you realise you're pregnant, even if you start taking it then. 

00:19:07 Dr. Jenny Hall 

You've probably missed the boat. 

00:19:08 Dr. Jenny Hall 

Like it's not gonna do any harm. 

00:19:09 Dr. Jenny Hall 

You should still take it, but for it to be most effective, you need to be taking it before. 

00:19:15 Olivia Moir 

Yeah, that's it's it kind of brings also up this topic that I was really, you know, interested to hear from you. 

00:19:22 Olivia Moir 

About is just in. 

00:19:23 Olivia Moir 

Your career, you know, are there certain misconceptions that you find? 

00:19:27 Olivia Moir 

I mean, obviously. 

00:19:29 Olivia Moir 

There are different elements of that I think now there's misconceptions because of, you know, a lack of education in in different areas of the schooling system. 

00:19:40 Olivia Moir 

It comes from different parts though, I mean. 

00:19:43 Olivia Moir 

Technology is, you know, very useful for a lot of things, but. 

00:19:49 Olivia Moir 

It's also it can, I think, be harmful if you are finding things or you're Googling things or you don't know what you're looking up or you're diagnosing yourself or you know, people just want to know and they want to be able to have an answer and they want to be able to make a plan, I guess, or instruct themselves bring comfort to themselves. 

00:20:08 Olivia Moir 

But I I guess I wonder. 

00:20:11 Olivia Moir 

You know misconceptions I feel like can. 

00:20:12 Olivia Moir 

Come from there and what? 

00:20:14 Olivia Moir 

Have you found in your career in your research in in clinic? 

00:20:19 Olivia Moir 

What are certain things that you feel like you would love to address? 

00:20:22 Olivia Moir 

Or maybe that you're constantly, you know, addressing with with certain groups of? 

00:20:27 Dr. Jenny Hall 

People. Yeah, I mean. 

00:20:29 Dr. Jenny Hall 

I guess the cross section reproductive health. 

00:20:31 Dr. Jenny Hall 

So many misconceptions, so many around contraception, and what it does and doesn't do and. 

00:20:40 Dr. Jenny Hall 

It's not. In some cases, it's not that the information isn't out there or available, but it's not. It's not in the right format, so we haven't got enough people on TikTok putting good content rather than anecdotal content. Not to belittle anyone's individual experience, but one person's experience isn't reflective of. 

00:21:02 Dr. Jenny Hall 

Necessarily everybody else is, I think. 

00:21:06 Dr. Jenny Hall 

Specific to the work around preconception, I think the thing that we grapple with most is it gets dismissed as. 

00:21:16 Dr. Jenny Hall 

Well, most people don't plan their pregnancy. 

00:21:17 Dr. Jenny Hall 

Most pregnancies are unplanned, so it's pointless even trying to talk about preconception health. 

00:21:25 Dr. Jenny Hall 

As I said earlier, yeah, globally around 45% of pregnancies are unplanned. In the UK, our most recent estimate, which is over a decade old, is also that 45% of pregnancies are unplanned. 

00:21:38 Dr. Jenny Hall 

So that that is big and we need to do something about that. 

00:21:41 Dr. Jenny Hall 

If you flip it more than half of pregnancies. 

00:21:43 Dr. Jenny Hall 

Our planned. 

00:21:45 Dr. Jenny Hall 

We do have a huge potential. 

00:21:48 Dr. Jenny Hall 

To be reaching people and I think we kind of it, it's. 

00:21:52 Dr. Jenny Hall 

Too easy sometimes for people to brush aside as people don't find their pregnancies. 

00:21:55 Dr. Jenny Hall 

We can't do anything about this, and I don't think that's right. 

00:21:59 Dr. Jenny Hall 

I also think. 

00:22:01 Dr. Jenny Hall 

In terms of unplanned pregnancy, and this is a comment that really stuck with me when I was trying to get my my current research funded. 

00:22:08 Dr. Jenny Hall 

One of the interviews on the panel basically dismissed the issue of unplanned pregnancy as well. 

00:22:13 Dr. Jenny Hall 

This is just about contraception in the kind of if you women would just take your pills, this wouldn't be a problem. 

00:22:19 Dr. Jenny Hall 

And I think that's just so. 

00:22:20 Dr. Jenny Hall 

Naive that having free contraception should mean that we have no unplanned pregnancy. 

00:22:26 Dr. Jenny Hall 

And I think both with preconception and unplanned pregnancy, there's a real tendency to individualise these issues and make. 

00:22:34 Dr. Jenny Hall 

It the woman. 

00:22:34 Dr. Jenny Hall 

'S fault if she has an unplanned pregnancy. 

00:22:39 Dr. Jenny Hall 

And I don't think that's the case. 

00:22:40 Dr. Jenny Hall 

I I mean, our contraception services are struggling. 

00:22:46 Dr. Jenny Hall 

They have had funding cuts more than the last decade. 

00:22:49 Dr. Jenny Hall 

There aren't enough sexually productive health doctors who are specialists in contraception and the way that we Commission and pay for our contraception. 

00:23:00 Dr. Jenny Hall 

Others actually costs doctors to provide that service, and so it's unviable for them to be offering certain contraception. 

00:23:07 Dr. Jenny Hall 

So we're making it more and more difficult for people to access contraception and then hitting them over the head when we say, and I've got an unplanned pregnancy. 

00:23:16 Dr. Jenny Hall 

So yeah, lots of issues, I think. 

00:23:19 Dr. Jenny Hall 

But I I think. 

00:23:21 Dr. Jenny Hall 

I don't want to make it an. 

00:23:22 Dr. Jenny Hall 

Individual solution to the problem by saying what everyone should have a plan. 

00:23:27 Dr. Jenny Hall 

I think that's an important part of it, but in order for people to have a plan, we also need that to be something that society is supportive of and is not. 

00:23:38 Dr. Jenny Hall 

And a plan is no good if you can't enact it, so we need to. 

00:23:42 Dr. Jenny Hall 

Provide the services such. 

00:23:44 Dr. Jenny Hall 

That when people don't want to get pregnant, they are able to not get pregnant. 

00:23:49 Olivia Moir 

And I think I mean back to when you know earlier in this episode when I was sort of saying. 

00:23:55 Olivia Moir 

You know I'm. 

00:23:55 Olivia Moir 

Just I'm really, really excited to have you here because. 

00:23:58 Olivia Moir 

Of the sort of holistic viewpoint that you take on this subject, I really appreciate that. 

00:24:04 Olivia Moir 

And I really think it's so important and I feel like we've talked about that even. 

00:24:08 Olivia Moir 

Other is this topic requires, as you said, society to kind of take a a step back and maybe consider the different elements that are a part of it and the different factors that play into it and you know, agreed that comment kind of really bugs me as well because. 

00:24:28 Olivia Moir 

I mean for different reasons, but you know. 

00:24:32 Olivia Moir 

One example of that is is even if you have access to contraceptives. 

00:24:39 Olivia Moir 

That's not sort of the only factor. 

00:24:42 Olivia Moir 

I mean something that is just so real in this topic is that it really oftentimes comes down to the person, like the woman who who's getting pregnant and. 

00:24:56 Olivia Moir 

As much as it's. 

00:24:57 Olivia Moir 

You know, she's she's the one that's gonna be carrying this baby, you know, ultimately, hopefully it's it's her decision. 

00:25:05 Olivia Moir 

There's a whole other party that's involved in that process and I guess I wonder specific to this, you know, topic. 

00:25:15 Olivia Moir 

There's a lot of people that do also want to, you know, give their opinion and get involved. 

00:25:19 Olivia Moir 

And I think it comes down to society being able to say, listen, it's not just on the woman that you know is getting pregnant to take the steps to get there. 

00:25:29 Olivia Moir 

And and I think it going forward, it would be helpful to have the role. 

00:25:34 Olivia Moir 

More incorporated for the partner who's involved in that. 

00:25:38 Olivia Moir 

And I guess I wonder, do you feel like in your research in, in your clinic? 

00:25:43 Olivia Moir 

And your practice, are there certain kind of points in that where you see that there could be the inclusion of that other person to help out and to help with the planning process and to to alleviate some of the burden or the the weight that the woman or the person getting pregnant has to carry? 

00:26:03 Dr. Jenny Hall 

Yeah, absolutely. 

00:26:04 Dr. Jenny Hall 

So I think it's very easy to focus on the woman and overlook the role of the man and definitely research in this area has lagged behind. 

00:26:11 Dr. Jenny Hall 

But there is more and more being done on the role of the father, where we're talking about heterosexual couples in. 

00:26:21 Dr. Jenny Hall 

In the the child's long term health, so overweight fathers have overweight children. The father's mental health before the baby is born is important for the child's mental health. 

00:26:33 Dr. Jenny Hall 

You know, there are genetic and epigenetic factors going on to affect the sperm quality, the sperm and the semen quality affect the environment. 

00:26:41 Dr. Jenny Hall 

That the child is conceived in and you know these things can have effects on on the baby while it's developing. 

00:26:48 Dr. Jenny Hall 

And after. 

00:26:49 Dr. Jenny Hall 

So there is this increasing recognition of the role in in that. 

00:26:53 Dr. Jenny Hall 

Sort of. 

00:26:54 Dr. Jenny Hall 

Biological pathway. 

00:26:56 Dr. Jenny Hall 

So back to that sort of message in schools, the message is there for everyone, for you. 

00:27:01 Dr. Jenny Hall 

If you're thinking about becoming a parent. 

00:27:03 Dr. Jenny Hall 

In the future. 

00:27:04 Dr. Jenny Hall 

It's important to think about your health beforehand, I think. 

00:27:09 Dr. Jenny Hall 

Where it comes? 

00:27:10 Dr. Jenny Hall 

To contraception, decision discussions and decisions, this is a really interesting area because. 

00:27:16 Dr. Jenny Hall 

As you say, ultimately it's the woman who's going to be taking them. 

00:27:20 Dr. Jenny Hall 

And so ultimately it has to be her decision. 

00:27:23 Dr. Jenny Hall 

But it would be, I think, good if there is sort of shared decision making process. 

00:27:30 Dr. Jenny Hall 

I've done a bit of work around reproductive autonomy with a particular way of measuring it. 

00:27:34 Dr. Jenny Hall 

This is one of the aspects of measurement that that I work on and and in that we look at sort of different aspects of reproductive autonomy, decision making. 

00:27:43 Dr. Jenny Hall 

Communication and freedom from coercion. 

00:27:46 Dr. Jenny Hall 

And really interesting is that in the decision making area, we tend to see more shared decision making around contraception and whether to become pregnant and whether or not you would have an abortion in people who are married or in long term relationships than in people who are not and that. 

00:28:04 Dr. Jenny Hall 

Makes sense in terms of the. 

00:28:07 Dr. Jenny Hall 

It measures it. 

00:28:09 Dr. Jenny Hall 

It counts that as women having lower autonomy because they are not the ones who have final. 

00:28:12 Dr. Jenny Hall 

Way, but I think sort of the the distinction of sharing the burden of the discussion and the agreement is helpful. 

00:28:21 Dr. Jenny Hall 

It's very rare for a person to come in for a contraception appointment and bring their partner with them, but it doesn't mean to say that conversations haven't happened. 

00:28:30 Dr. Jenny Hall 

And I think that is something that we can encourage. 

00:28:33 Dr. Jenny Hall 

As long as by inviting the partner into the space, we don't limit women's autonomy, some evidence from Malawi. 

00:28:40 Dr. Jenny Hall 

Where they were trying to improve uptake of contraception by bringing men into the discussion and whereas before women had been able to access it discreetly to some extent without their partner knowing, particularly now you can have an injection, there's no visible sign that, that, that, that, that has happened in some instances bringing men to the discussions then. 

00:29:01 Dr. Jenny Hall 

Limited women's ability to access contraception that might not be true everywhere, but I think it's an important thing to to be aware of as well. But I mean, the underlying principle of men or partners being involved in the discussions and decisions. 

00:29:18 Dr. Jenny Hall 

But it's still being, you know, the woman's ultimate decision, her bodily autonomy, that's still crucial. 

00:29:24 Olivia Moir 

Yeah, I think you've you've hit the nail on the head with that one for sure. 

00:29:28 Olivia Moir 

It's it's, yeah, it's such an important topic and and I kind of look forward to. 

00:29:34 Olivia Moir 

Through my career investigating that more, the role of, you know, not just the woman but the man or the partner. 

00:29:41 Olivia Moir 

Of course, in making these different decisions. 

00:29:43 Dr. Jenny Hall 

And I think this. 

00:29:44 Dr. Jenny Hall 

Touched on society a few. 

00:29:46 Dr. Jenny Hall 

And and I think that's also really, really important. 

00:29:49 Dr. Jenny Hall 

We've seen Massive falls in fertility in Europe over the last few decades. 

00:29:54 Dr. Jenny Hall 

So Italy I think. 

00:29:56 Dr. Jenny Hall 

Their total fertility rates, the average number of children born to women in a lifetime, something like 1.1 or 1.3. 

00:30:02 Dr. Jenny Hall 

So their population is crashing and they're not unique. 

00:30:06 Dr. Jenny Hall 

It it most places in Europe we are below what's called replacement level. 

00:30:10 Dr. Jenny Hall 

So in order for our population to stay stable in terms of births and deaths, the average number of children and women would have in her life. 

00:30:18 Dr. Jenny Hall 

Time has to be just above 2, something like. 

00:30:19 Dr. Jenny Hall 

2.4. 

00:30:21 Dr. Jenny Hall 

We've been below 2 for for many years and and and that is because society has not recognised the changes in societal structures that we need. 

00:30:33 Dr. Jenny Hall 

Since women have become an integral part of the workforce, it is virtually impossible for a two parent working family. 

00:30:43 Dr. Jenny Hall 

To manage in today's structures, our childcare is so expensive that that women have to give up work or someone, and usually it's the woman has to give up work for the first few years of a child's life to care for that child. 

00:30:56 Dr. Jenny Hall 

Before school. 

00:30:56 Dr. Jenny Hall 

And so that's having a. 

00:30:58 Dr. Jenny Hall 

This disincentive on on women also as well on couples, because when we ask people when you're thinking about having a baby, what are the sorts of things that you think about beforehand, what's important and it's things like either education or their job, like getting to a certain point. 

00:31:15 Dr. Jenny Hall 

And obviously it's having a partner that you want to have a. 

00:31:18 Dr. Jenny Hall 

Their child, with its finances, its housing, it's those kind of things that are influencing people's decisions about whether or not to have children. 

00:31:26 Dr. Jenny Hall 

And so it's becoming, I think, more common to not to have children by choice or to have fewer children. 

00:31:35 Dr. Jenny Hall 

Yeah, sorry. 

00:31:36 Dr. Jenny Hall 

There was something else I was going to say it. 

00:31:37 Dr. Jenny Hall 

Just slipped my mind. 

00:31:39 Dr. Jenny Hall 

Yeah, I. 

00:31:40 Dr. Jenny Hall 

Ohh yeah, sorry to come back there. 

00:31:42 Dr. Jenny Hall 

Climate anxiety like that is something now that really. 

00:31:45 Dr. Jenny Hall 

Particularly into younger generations, thoughts about whether or not to to have children, or how many children to have is what are we doing to our climate? 

00:31:53 Dr. Jenny Hall 

What's it gonna be like for our children or? 

00:31:54 Olivia Moir 

Our grandchildren? 

00:31:56 Olivia Moir 

Yeah, absolutely. 

00:31:57 Olivia Moir 

And I was just gonna say I I had a friend the other day who kind of found he was he. 

00:32:04 Olivia Moir 

He had, you know, I told him. 

00:32:05 Olivia Moir 

About what I was studying at. 

00:32:06 Olivia Moir 

School. And he was like. 

00:32:08 Olivia Moir 

Well, you know, I would, I would have thought that because of what you study, you would not want to have kids going forward. 

00:32:15 Olivia Moir 

And that kind of I mean. 

00:32:18 Olivia Moir 

I was like. 

00:32:18 Olivia Moir 

Jar I didn't even know what to say in that moment, but it's so true. 

00:32:22 Olivia Moir 

I mean, these conversations are totally being had and they're important ones to have and. 

00:32:30 Olivia Moir 

As you said, it's so important to kind of think about, you know, we've had advancements in certain areas in terms of giving equal access to different things, to women, as well as other areas. 

00:32:41 Olivia Moir 

But there has to be kind of also advancements in society to be able to support that and I think. 

00:32:49 Olivia Moir 

Hopefully going forward, that's going to be, you know, climate at the center of that and and society kind of covering how to navigate that that's I guess the hope. 

00:33:01 Olivia Moir 

But my hope, but I'm wondering you know. 

00:33:04 Olivia Moir 

Going forwards in your career, in your research and in your practice, what are kind of your big goals or or what you're kind of hoping to see in this kind of space? 

00:33:15 Olivia Moir 

What are you hoping for? 

00:33:20 Dr. Jenny Hall 

But I'd like. 

00:33:21 Dr. Jenny Hall 

It to be routine and normal for people to talk. 

00:33:24 Dr. Jenny Hall 

About preparing for pregnancy, it's they're not. 

00:33:28 Dr. Jenny Hall 

I'm not suggesting everyone can go up to each other on. 

00:33:29 Dr. Jenny Hall 

The street and go. 

00:33:31 Dr. Jenny Hall 

Are you gonna have a baby? 

00:33:32 Dr. Jenny Hall 

Are you gonna have a baby soon? 

00:33:33 Dr. Jenny Hall 

Cause that's you know, nobody likes that. 

00:33:36 Dr. Jenny Hall 

But either in the context of getting that education in early so that people know when they get to that time in their life, they can look for for information or speak to health professional. 

00:33:46 Dr. Jenny Hall 

Getting it in into a range of health professionals, sort of. 

00:33:50 Dr. Jenny Hall 

Because once these things become routine, they become less scary and I think some people are worried in in news I did with health professionals there like, oh, I'm not sure what to say. 

00:33:59 Dr. Jenny Hall 

About preconception care. 

00:34:00 Dr. Jenny Hall 

And then actually they. 

00:34:01 Dr. Jenny Hall 

All the things you could say in. 

00:34:02 Dr. Jenny Hall 

Preconception care cause as we've. 

00:34:04 Dr. Jenny Hall 

Said it's not like there's many things that are unique. 

00:34:07 Dr. Jenny Hall 

It's general. 

00:34:08 Dr. Jenny Hall 

Good lifestyle advice. 

00:34:11 Dr. Jenny Hall 

I think finding a a digital tool for people to be able to do this, that's something that I'm working on. 

00:34:20 Dr. Jenny Hall 

We've developed an initial platform that will it takes people through some questions. 

00:34:25 Dr. Jenny Hall 

It then gives them some feedback about how likely they are to have a pregnancy in the next year. 

00:34:29 Dr. Jenny Hall 

And then depending on that advice for contraception or advice for preconception. 

00:34:33 Dr. Jenny Hall 

Or advice for both. 

00:34:34 Dr. Jenny Hall 

As well as sort of general advice around consent or links to to sort of external advice, and we want to build that out to to become a platform that people can then work on their plan, develop a plan. 

00:34:45 Dr. Jenny Hall 

Because I guess my ultimate kind of goal is everyone has the information and the agency to be able to think about these aspects of their reproductive health. 

00:34:53 Dr. Jenny Hall 

I suppose I'm starting on quite a small area, but this is just one part of people's reproductive life course. 

00:34:59 Dr. Jenny Hall 

There are so many other aspects of section reproductive health that it would be great to build out into. 

00:35:05 Dr. Jenny Hall 

So that they can so they can know that these are things that they can think about and that they can make choices for themselves and that services are provided in a way that enables them to meet those goals. 

00:35:18 Dr. Jenny Hall 

So I really would love to see everyone having the number of children they want, whether that's none or for like. 

00:35:25 Dr. Jenny Hall 

It's just about empowering people to to make that choice and actually the ability to enact it. 

00:35:32 Dr. Jenny Hall 

Yeah, absolutely. 

00:35:33 Dr. Jenny Hall 

I think that's so great. 

00:35:34 Olivia Moir 

And and I'm really. 

00:35:36 Olivia Moir 

I feel really excited to see kind of you know everything that you do and and to be able to to watch that it's going to be so cool.