Category Archives: Diet & Fitness

Forty years since Fat Is A Feminist Issue

When I sat down to write Fat Is A Feminist Issue 40 years ago I never dreamed, or feared, it would still be in print today. I naively hoped my book would change the world. By analysing and suggesting solutions to body and eating problems, I imagined they would disappear. But in truth, of course, when I was writing about girls’ and women’s body and eating problems, I was writing about inequality, too. And inequality is stubborn. It didn’t look it in 1978, at the height of what we now call second wave feminism. Everything was up for being rethought – families, bodies, education, science, medicine, class, racism, money, sex.

When feminism first appeared, I hadn’t much understood it. At school, we were encouraged to compete with boys for Oxbridge places while soaking in knowledge which would, when the time came for marriage, delight and please our husbands. It seemed ever so dull. Then, suddenly the Sixties spoke to women about their own experience. There was a spectacular protest at the Miss America beauty contest in New Jersey in 1968. There, a woman’s body was marked up as a cow ready for butchering, while a “freedom” trash can was ready for women to dump in bras and hair rollers, and pots and pans. It was the first hint that the way we personally felt about (and suffered) beauty, bodies and caring was a social issue. It looked like the world was changing. And when I published Fat Is A Feminist Issue, the message was taken to a wide audience through women’s magazines such as Woman’s Own, aimed mainly at working-class mothers.

Fat Is A Feminist Issue talked about our lived experience: how preoccupied we could become with eating, not eating and avoiding fat. Emotionally schooled to see our value as both sexual beings for others and midwives to their desires, we found ourselves often depleted and empty, and caught up in a kind of compulsive giving. Eating became our source of soothing. We stopped our mouths with food, and I proposed we could learn to exchange food – when we weren’t hungry – for words.

So far so good. Many of us started challenging the homogeneity of what constituted beauty. We stopped worrying and dared to live from our bodies. But we never saw the backlash coming, or the ingenious forms it would take, from the now rather innocent (“Because you’re worth it”) to the downright nefarious practices of industries that were growing rich on the making of body insecurity. And that was way before social media and the beauty bloggers with their, yes, millions of followers, would begin to reap money as daily beauty labour got instituted in a way that before then perhaps only a Hollywood makeup artist would recognise. Beauty work became relentless and, with it, the ubiquity of judgment and failure. Judgments and failures which, once internalised, destabilised girls’ relationship to their bodies and – as if that wasn’t enough – created an insecurity that hurt their minds.

The story of the past 40 years is grim. It’s a story of malice, of greed and of mendacity. Not content with destabilising the eating of many western women and exporting body hatred all over the world as a sign of modernity, the combined forces of what investigative health reporter Alicia Mundy so aptly termed “Obesity Inc” set about to create new so-called disease entities; these would medicalise and pathologise people’s relationship to food and bodies so successfully that vast industries would grow up to treat problems that these industries had themselves instigated.

In January we learned that one in three women in the UK won’t go for their smear tests. Why? Is it because they don’t know about them? No, they are invited by their doctors by text, email and letter. Why then? Because they feel so bad about their bodies.

This should alarm us. And yet sadly it doesn’t, because we know how ubiquitous bad body feeling is. It is constantly stoked by visual images which invade us, by pronouncements disguised as health directives, by blandishments to do, be, brand, mark ourselves in ways that reward not the human body as a place we dwell in but as an object to enhance the profits of the beauty, fashion, diet, cosmetic surgery, food and exercise industries, no matter one’s age.

So what has changed? Go back 20 years. The porn industry is being mainstreamed. Fashion magazines are normalising pornographic images of girls. Pre-teen girls with legs spread wide apart are looking to camera with a combination of allure, innocence and nonchalance. The girls who read them start going for Brazilian waxes. They don’t learn about labias and clitorises in school, they learn about how to put on a condom. Their genitals are not to be in view for themselves. And when they are in view, they are presented as inadequate and available for labiaplasty.

The search for ‘likes’ is an often desperate search for approval, for safety, for body acceptance

If we go back four years, we see the development of cosmetic surgery apps, games marketed to little girls in which they prepare for the surgery they will have when they are old enough. Already at six they will have been targeted with make-up and fashion and bras. Hourly vigilance is yet to come but the notion of a body ready and available for reconstruction is firmly planted. Indeed, many a girl will already have seen baby pictures of herself that have been digitally altered, so that the idea of “perfecting” and “fixing” becomes part of just what is. It is as normalised as the troubled eating she can expect in her journey through life.

By the time they become preteens, girls have been living on their smartphones. That is where life happens and the saturation of the screen with images and likes, with its constant entreaty to be approved of, should give us pause. Beauty labour has become part of girls’ and women’s lives and now that feminism is back on the agenda we can say, once again, part of our oppression. But, of course, it isn’t experienced like that. It is felt as the expression of personal agency, with the promise that looking good is doing good. But I know from the young women I work with that the search for likes is rather more troubling than that. It is an often desperate search for approval, for safety, for body acceptance – a frequently elusive quest.

If that young woman comes to parenting, frantic body preoccupation may have so invaded and insinuated itself into her that she will have schemes for managing food and managing appearance. Midwives and health professionals tell me they have noticed a dramatic change. Today pre- and postpartum mums can show considerable anxiety about their body self, so much so that the rhythm of early bonding is interrupted by rules and regulations, rather than the getting to know of one’s own body’s capacities and the wishes of the baby. For many, the parenting websites with their contradictory and commercially led “advice”, from recommendations for tummy tucks after your C-section to making a bespoke spreadsheet to track your feeding schedule, have turned postpartum into a straitjacket in which getting into pre-pregnancy jeans is the goal. And the anxiety the mothering person might well feel will be inadvertently transmitted to their baby, who will journey through life frightened of food and confused about their body self. A further tragedy.

This is then exacerbated by a rapacious food industry – from the diet promoters to the so-called clean eating movement to the manufacturers of non-food foods. The sole aim of the latter is to produce replicas masquerading as potato chips or cheese for children’s lunchboxes but whose chemical composition strives to stimulate their bliss point: the umami, sweet, crispy feel that means taste buds are stimulated rather than hunger addressed. Appetite, desire, is being undermined by the smells and tastes which beckon all day and yet often don’t deliver the nourishment we crave.

When you grow up absorbing the idea that food is quasi-dangerous, it is hard to know how to handle it. There are no end of experts selling their wares whose books and products end up generating enormous profits, and Weight Watchers’ newest push into the teen market has been criticised for potentially leading to teenagers becoming fixated on dieting. So, too, with other food and diet fads. The desperation that exists to be at peace and dwell in our bodies clashes with the knowledge that such schemas promote or reinforce confusion about appetite and desire. They don’t deliver peace. They deliver confusion. They deliver hurt.

If we weren’t continually assaulted by the merchants of body hatred, we would not be as vulnerable to the assaults

Another huge industry is the world fashion market, worth $ 2.4tn. The UK market alone is worth £26bn a year, with a £1,000 spend per inhabitant. I love clothes but how have we been persuaded to buy that much? The penetration of visual culture says how we look is so essential to our existence that we must spend, spend, spend. And that spend doesn’t include the cost of the clean-up from the fashion industry, the toxins in the water and the sweatshop conditions here and in China and Bangladesh. If the industry continues at its current rate, it will be using a staggering 26% of the carbon budget in 2050. I mention these statistics because it is sometimes possible to feel that when we are talking of bodies we aren’t engaging in serious economic and social issues, but we are. We are talking of large industries and excessive hours spent in persuading us to labour over transforming while attempting to live from our bodies.

It’s hard to get the figures that big pharma makes from products aimed at our bodily transformations. They guard them. But we do know that when they launch a diet drug, they spend a fortune marketing and defending it even when it doesn’t work or causes medical damage. I could go on. There is the cosmetic industry, the cosmetic surgery industry, the doll market, the role of internet beauty bloggers who have followers in their millions and of course the horror for youngsters of living online and being continually scrutinised. But I want us to think for a moment about #MeToo and Time’s Up, where we can see a line, not such a wiggly line, from pervasive bad body feeling to the compromising positions women have been put into in all the spaces where they work and love. If we weren’t continually assaulted by the merchants of body hatred, we would not be as vulnerable to the assaults. I’m not saying they wouldn’t happen; misogyny ensures that. But the shame, the hiding, the confusions that beset us would diminish and we would be stronger in our fightback and our fight to control our own bodies.

The body has become a political project. From rape as a weapon of war to the internal belief that we must be constantly wary about our appetites, to limiting ourselves individually and collectively because so much of our energy is misemployed, we have to act together to find ways through these minefields. The energy from #MeToo, with its reinvigoration of feminism, can help us say enough is enough. There’s just too much anguish, too much sorrow. We need more rage, more refusal and more love.

Children face mental health epidemic, say teachers

Britain’s schoolchildren are suffering from an epidemic of anxiety, depression and suicidal thoughts, yet barely half get the NHS treatment they need, teachers say.

Almost four in five (78%) teachers have seen a pupil struggle with a mental health problem in the past year, with one in seven (14%) cases involving suicidal thoughts or behaviour.

Anxiety is the most common problem, with two-thirds of the 300 teachers surveyed by the mental health charity stem4 having come across a young person at their school dealing with the condition in the past year. Significant minorities of teachers have also encountered at least one pupil with depression (45%), an eating disorder such as anorexia (30%), self-harming (28%) or addiction (10%).

However, many of the teachers – who work in primary and secondary schools and colleges across the UK – say pupils find it hard to get help from the NHS child and adolescent mental health (CAMHS) services. More than a third (36%) of participants said they had feared that a young person might come to harm while waiting to receive treatment.

Less than half (46%) said students were able to access the CAMHS care they needed to help recover, and only 19% said those children receiving treatment were getting the help they needed. One in five (22%) said pupils had to wait at least five months to start treatment. CAMHS services are struggling to cope with the fast-growing demand for support from troubled under-18s. Consultant clinical psychologist Dr Nihara Krause, the chief executive of stem4, will unveil the full findings at a conference in London this week for education professionals concerned at the rise in the number of pupils struggling with mental ill-health. Four in 10 (40%) teachers believe the need for care has grown in the past year while 52% believe family difficulties are contributing to students’ troubles, and 41% identified exam stress and bullying as triggers.

“Schools face huge challenges in dealing with mental health issues in their students, and teachers are on the front line. They witness first-hand the devastating impact of pressures such as exam anxiety, bullying, and family problems. The consequences of these problems are serious, often life-threatening, and teachers are desperate to help,” said Krause.

“Yet at a time when the need for preventative, early intervention and specialist services are soaring, schools are finding it increasingly difficult to provide the help their pupils need. There’s an urgent need for better support mechanisms in schools, as well as decent funding for the range of mental health services children and young people need.”

Ministers unveiled a long-awaited green paper on reducing mental ill-health among children and young people last year. But its proposals, which hand schools a key role, were recently criticised by MPs on the Commons health and social care and education select committees as lacking ambition.

A government spokesperson said: “Making sure children and young people have the right support when they need it is vital. That’s why we are giving an extra £300m to provide more support linked to schools, including new support teams to provide quicker support to children.

“We recognise there is more to do – we’ve extended our schools and NHS link pilot to deliver training in 20 more areas of the country this year to improve links between 1,200 schools and their local specialist mental health services.”

And Now We Have Everything review – the shock of motherhood

Lately I’ve found I gobble up birth stories. I read them all. As I don’t have children, nor do I seem to want them, perhaps my curiosity has to do with how little I know about this common, pivotal experience. We’ve each been formed, grown in, and either pushed or pulled from a woman’s body, yet for most of my life I’ve learned less about childbirth than I have about, for example, the intricacies of trench warfare. Should nothing but stories concerning pregnancy and early motherhood be published for the next 10 years, it would hardly redress the vast historical imbalance between what humans experience and what has been judged worth documenting. More English language literature has probably been written about medieval jousting than about childbirth. This lack is yet another of patriarchy’s gifts.

But I’m in luck: there has been an upsurge of books that focus on motherhood, and this memoir is a vivid, though often harrowing example of the genre. Meaghan O’Connell became pregnant at 29, sooner than she had planned; though anxious about the timing, she and her boyfriend, Dustin, elected not to have an abortion.

“What if, instead of worrying about scaring pregnant women, people told them the truth?” O’Connell asks. “What if pregnant women were treated like thinking adults? What if everyone worried less about giving women a bad impression of motherhood?” Her account is energised by her devotion to revealing the truth. Dating in New York, she says, meant she knew “how not to need anything”; “Wanting a baby was a desperate quality in a woman, like wanting a relationship multiplied by a thousand.” O’Connell hoped for a child but she also had doubts. (After learning she was pregnant, she panic-Googled phrases such as “I regret having my child”, “baby age 29” and “writing career, baby”.)

O’Connell is ​open about the ​sometimes ​competing ​feelings of fear and desire, shame and artistic ambition

O’Connell intended to have a natural childbirth but after more than 24 hours of painful labour she asked for an epidural – it was little help, as the anaesthetic failed to numb part of her body. There turned out to be a “blind spot”, five square inches where it felt as though a demon was “chopping” at her “from the inside with a pickaxe”. As further ineffective epidurals were administered she shouted that she wanted to die. Then, at last, she had a caesarean section. Weeks of bleeding followed, and her body was so ravaged that, the first time she looked in the mirror, she wept: her “entire middle section” was “covered in purplish red gashes” and was hanging like a balloon that had been deflated, but was “also, somehow, full of wet dough”.

O’Connell’s chronicle of her life after her son is born includes frank, striking descriptions of physical problems such as mastitis: the milk-duct infection, she writes, is “like having the flu and then getting stabbed in the tits at the same time”. Breastfeeding was initially so painful that her breasts felt like skinned knees on which she had to crawl. The stabbing analogy returns when she explains what it was like to attempt sex in the months after having given birth: “postpartum knife dick”, she and her friends call it, shooting pains that result from low oestrogen. Before giving birth, she considered sex and intimacy to be “the main reason to be alive or the surest way to feel alive”; afterwards, for a year, her body was so hormonally altered that she’d have preferred sex didn’t exist.

O’Connell is open, too, about the competing feelings of fear and desire, shame and artistic ambition. The first time she left her son for an hour so as to go to a cafe and write, she felt as if she might cry – this time, from happiness. “I was always doing math with the hours, testing the limits of time, trying to see how much living I could get away with.” Contrary to popular belief, breastfeeding wasn’t “one of the most incredible experiences of your life”. She did her duty, wondering all the while whether its importance had been oversold; it was “sometimes lovely but more often not”. Then, there was the continuing parental terror, the persistent gut feeling that her beloved child was about to die. In giving birth, she realises, “we created a death”.

Midway through And Now We Have Everything, there’s a wonderful scene in which O’Connell’s friends pay her a visit shortly after her son is born. Conversation is stilted until she asks if they want to see her stretch marks. Yes, they say, eagerly. They are aghast at what she shows them, while she is embarrassed but relieved. “I needed witnesses”, she says. “I needed my reality confirmed.” Her book is a testament, a gift to mothers who might want their realities confirmed, as well as to everyone else.

NHS trusts win legal fight over Virgin Care child health contract

A decision by Lancashire county council to award a £104m contract for children’s healthcare services to Virgin Care has been thrown out after a legal challenge by NHS trusts.

A high court judge found the local authority’s process was flawed and the contract for services for children aged 0-19 should not have been awarded to the private provider late last year.

The case hinged on the scoring system used by the council when it reviewed rival bids for the deal, which the trusts claimed had been applied incorrectly.

The contract for delivering the Lancashire’s healthy child programme, which includes providing health visitors and school nurses, was advertised in September.

After the tender process, the local authority announced its preferred bidder was Virgin Care, part of Sir Richard Branson’s Virgin Group.

It was chosen over the existing providers – Lancashire Care NHS foundation trust and Blackpool Teaching Hospitals NHS foundation trust.

On Friday, the judge, Justice Stuart-Smith, upheld the trusts’ legal challenge, saying the council’s decision to score Virgin’s bid more highly than theirs was not adequately supported in its notes of the scoring procedure.

After reviewing them, he said he had “come to the conclusion that the reasons given were not sufficient in law in the circumstances of this case”.

A spokesperson for both trusts said: “As public bodies, the trusts are always reluctant to resort to legal action, in particular against other public bodies. However, we felt that we had submitted a strong bid and wanted to gain clarity on why we had not been successful.

“We believe the connectivity with other wider NHS services is important in terms of being able to fully meet the needs of the children and families who access these types of services in a joined-up way.

“We are proud of the services within this contract and our teams that deliver them.”

Virgin Care had been due to begin the five-year contract in April. However, after the legal proceedings began, the trusts were granted an extension until April 2019.

The council said this would stay in place while it considered its options.

Shaun Turner, the local authority’s cabinet member for health and wellbeing, said: “Putting services out to the market is not a political decision, it is simply part of what the county council is required to do in order to meet its legal obligations.

“Although we’re disappointed in the outcome of this judgment, we are reassured that with the exception of the moderation element, the county council’s procurement processes was appropriate and that individual panel members were not found to be at fault.”

Turner said the council would not be rerunning the procurement process or inviting new bids, as only the final part of the process had been judged as being flawed.

“Our existing contract with LCFT and Blackpool NHS Teaching Hospitals trust runs until March 2019, so there will be no disruption to these services,” he said.

“We recognise this is a stressful time for our health visitors and school nurses. We value the vital role they play and will continue to support them in delivering the best outcomes for our children and families.”

Virgin Care has been a growing provider of healthcare contracts awarded by NHS bodies and county councils, and offers similar child health services in other parts of the country.

The company was awarded £1.6m by NHS commissioning groups this week after legal action over a children’s services contract it missed out on in Surrey.

After Gosport, Jeremy Hunt’s new bill is the last thing patients need | Peter Walsh

This week’s report by the independent panel on Gosport War Memorial hospital is shocking to those who have not so far been involved. I had the privilege of meeting some of the families back in 2008 when Action against Medical Accidents arranged legal representation for some of them at the inquests of their family members, and began to campaign for an independent inquiry and release of information that was being suppressed.

Some of them have now been trying to expose what went on and demanding action for more than 20 years. They have now been totally vindicated, and have received apologies from the government and some of the organisations involved. While that may bring some degree of relief, all of us who are passionate about patient safety need to know what will actually change as a result.

The way the independent panel pulls together all the key elements of this sorry episode in one report has had a dramatic effect. It was shocking enough that the hospital seemed to have a “disregard” for human life, and knowingly oversaw the inappropriate administration of huge doses of powerful pain killers which led to shortening of life. But that shock was heightened by the way everyone from individual doctors and nurses to management, commissioners, health authorities, regulators, the police, and even ministers allowed things to continue that way for so long, and put their own interests before the patients.

Health secretary Jeremy Hunt.

Health secretary Jeremy Hunt. Photograph: Daniel Leal-Olivas/AFP/Getty Images

So what happens now? Neither the report nor the government’s response give us much cause for optimism. The health secretary, Jeremy Hunt, talked about how things have changed for the better since the original events at Gosport. He rightly pointed out that following the Mid Staffordshire public inquiry the government (finally) brought in the statutory “duty of candour”. Yet even as he spoke, a draft bill he is putting forward – the health service safety investigations bill – is being scrutinised by a select committee. It is hugely controversial, as it would introduce something it calls a “safe space” in patient safety investigations. This is defined in the bill as a “prohibition” on sharing any information obtained in an investigation.

That means not even a patient who was the victim of an incident, or any of their family, would be party to that information. Nor could they use any facts in the final published report to seek justice through the civil courts or tribunals. There doesn’t seem much candour in that. This measure, if it is allowed to go ahead, would destroy any trust that patients or families could have in NHS investigations, and lead to a more adversarial culture where people turn to legal action and seek disciplinary action straight away.

Criminal investigations and prosecutions may follow what has happened at Gosport. There certainly needs to be accountability, and that should apply to people in positions of authority at every part of the system that allowed this scandal, and subsequently fobbed off families and staff who raised concerns, while trying to keep a lid on it. There will be people in positions of authority in the NHS today who presided over this. Accountability should extend to those in the Department of Health – including ministers. No one should kid themselves that Gosport is irrelevant to today’s NHS.

However, the systemic and cultural problems visible there are still an issue today, and addressing them will be much more helpful than punishing individuals. The themes from Gosport are consistent with more recent scandals such as Southern Health, Morecambe Bay and of course Mid Staffordshire. We need to provide meaningful protection for staff who try to do the right thing by reforming the law to protect whistleblowers, and create a Freedom to Speak Up Guardian (or new body) with more teeth to be able to support and protect staff. We need to ensure patients and families are listened to, and are fully involved in investigations. We need to promote and enforce the duty of candour – not undermine it. A good start would be to get rid of the inappropriately named “safe space” provisions in the draft bill.

Peter Walsh is chief executive of Action against Medical Accidents

Love Island normalises emotional abuse – and we call it entertainment | Lizzie Cernik

Filling a secluded Spanish villa with a selection of scantily clad twentysomethings and several TV cameras might not be a recipe for everlasting partnerships, but it’s certainly a hit for ratings. Since making its comeback in 2015, Love Island has established itself as Big Brother for the Snapchat generation, attracting more than 3 million viewers. But this week the reality show took a darker turn when Adam Collard, a self-styled Don Juan, displayed worrying signs of emotionally abusive behaviour towards his fellow contestant Rosie Williams.

Pegged by viewers as a raging narcissist from the moment he entered the villa, he was quickly accused of “gaslighting”, a malicious form of mental abuse designed to alter the victim’s perception of reality. During long-term relationships it’s often used as a method of control, belittling the person on the receiving end and destroying their confidence and self-esteem over time.

In Adam’s case the behaviour came after he lost interest in the woman he had spent 10 days pursuing, and found himself drawn to newcomer Zara. Rather than admit he was a flighty, hormone-driven 22-year-old who couldn’t keep his pants on if he tried, he proceeded to dismiss and ignore Rosie, repeatedly accusing her of being crazy in an attempt to turn the tables. He finally cemented her heartbreak during a row, delivering the blows with a self-satisfied smirk, cruel eye-rolling and the emotional maturity of a boiled potato.

Of course, relationships that kick off with televised sexy time on a popular gameshow are unlikely to result in fairytale endings. But, regardless of the length of courtship, contestants should have the right to respect and basic human decency, without being branded a “bunny boiler” for expressing a modicum of emotion. Many of us have fallen victim to the charms of a feckless Romeo, and blaming a woman for succumbing to sweet talk is just another form of casual misogyny, one we’ve almost accepted because it’s so common.

While some have defended Adam’s actions as a laudable attempt at being a lad, Women’s Aid has issued a warning about psychological abuse, urging viewers to recognise unhealthy behaviour in relationships. His actions, described as “manipulative” by viewers, demonstrated “clear warning signs of emotional abuse”, something that needs to be highlighted as problematic.

It’s not the first time reality TV has come under fire for depicting psychological abuse, with women regularly made to feel inadequate or “insane” for revealing emotion or questioning a man’s actions during an on-screen relationship. Last year Made in Chelsea’s latest villain, Harry Baron, was heavily criticised on social media after manipulating a woman he was dating to foist the blame on her. Over in Brentwood, The Only Way Is Essex has been slammed for its promotion of “toxic masculinity”, with both James “Lockie” Lock and Myles Barnett accused of abusive behaviour.

Despite concerns about misogyny, our dedication to reality TV shows no sign of waning. For many viewers, the shows create excitement and drama, an antidote to busy lives and dreary commutes. And besides, contestants know what they’re getting into – don’t they? In fact, we’re so involved with these shows that we manage to overlook the frequent psychological abuse, despite its prevalence offscreen.

According to the latest partner abuse survey from the Office for National Statistics, emotional abuse is the most commonly reported type of cruelty in relationships, experienced by more than 62% of the women who responded and 56% of men. Figures from Women’s Aid suggest that 95% of domestic abuse victims have also suffered as a result of coercive and controlling behaviour, with these actions often proceeding physical violence. In 2015 this type of emotional abuse was formerly recognised as a crime, punishable by up to five years in jail.

Despite heightened awareness, it’s still worryingly common, with mental health organisation HelpGuide suggesting the problem is regularly minimised or unrecognised by victims. Whether the perpetrator is male or female, psychological abuse often begins slowly, and controlling behaviour can be easily misinterpreted. In the early stages of a relationship, emotionally abusive partners are also known for “love bombing”, showering their partner with obsessive adoration and affection, which can make the abuse even harder to spot.

Though psychological manipulation affects both sexes, in reality television the perpetrators are usually men, who religiously adhere to archaic dating stereotypes in a bid to be unofficially crowned as shagger of the year.

From Adam’s snakey antics in Love Island through to the grand – and frankly creepy – romantic gestures of the Made in Chelsea gang, we’re normalising the idea that women are disposable prizes to be collected like stuffed Disney toys at a funfair. Though contestants choose to go on these constructed reality shows, Love Island and its competitors should still have a duty of care to the people they televise. Humiliation and emotional abuse might be good for ratings, but taking advantage of human vulnerability for entertainment has consequences. Reality shows aren’t going anywhere, so perhaps it’s time we stopped condoning the behaviour of contestants and made some real noise about its impacts.

Lizzie Cernik is a journalist and features writer, covering relationships, travel and women’s issues

Comments are pre-moderated to ensure the discussion is about topics that have been addressed in this article

Should doctors be free to refuse patients an abortion on personal grounds?

A rise in the number of healthcare providers who refuse to provide abortion services based on their personal beliefs is having a devastating impact on women and girls around the world, a new study has claimed.

Over the past two decades, at least 30 countries – including, most recently, Ireland, Chile and Argentina – have taken steps to improve access to abortion through legislative changes.

Many medics have sought to exempt themselves from these new laws, however. As a result, doctors, nurses, midwives, pharmacists and even entire hospitals around the world have denied women access to abortion care in countries where the procedure is legal.

The report, Unconscionable: When Providers Deny Abortion Care, published by the International Women’s Health Coalition, is based on consultation with 45 experts in 22 countries, from Italy and Ghana to South Africa and Uruguay. It found that more than 70 jurisdictions have provisions allowing medics to refuse care based on their personal beliefs, a phenomenon known as “conscientious objection”.

South Africa has the most liberal abortion laws in Africa, but this has not resulted in the consistent availability of abortion care and fewer than 50% of licensed facilities provide services. Unsafe abortions outnumber official procedures by two to one in the country.

The Guardian spoke to two practising gynaecologists, based in Johannesburg, about conscientious objection.

Dr Tlaleng Mofokeng

Tlaleng Mofokeng

Photograph: Michael Bonfigli/IWHC

Runs a women’s private health practice and is chairperson of the sexual and reproductive justice coalition, which campaigns for safe and legal abortion

“I’ve been an abortion provider for 10 years now and most of my experience has been in the public sector and in the past four years in the private sector.

While South Africa liberalised abortion in 1997, there hasn’t really been a political commitment from the leadership. Now the issue of medics refusing to give women the procedure they are requesting has increased so much that some of us feel the system itself has become an enabler of violence against women. First, it does not discipline health workers who are dishonourable in my view. Second, it doesn’t support providers in the system who are offering abortions.

In South Africa, we are starting to see younger medical students coming up who are interested in studying the procedure. They are finding their medical schools, their consultants, the head of departments of obstetrics, are not helping them in the learning process. A lot of clinical training around abortion is left as an optional extra.

Abortion is stigmatised by health professionals who won’t speak out and affirm the fact that women have a human right to autonomy, and that their rights should be respected. But it is further stigmatised by the system. There are instances where abortion clinics have been moved to the back of the hospital, where there is no signage to say that an abortion is something offered by core services.

Because so few medical doctors and nurses are doing the procedure they find they have a lot of patients to care for on a daily basis, often unsupported by management and with lack of proper medication or stock. Sometimes procedures are delayed, so you might have a patient who comes in at four weeks or six weeks pregnant and, by the time they get an abortion, they are in their second trimester.

A lot of abortion providers speak of being burned out or exhausted. People think this means we can’t do the work, or the work is too much. But what it really speaks to is the lack of support from the rest of our colleagues. So the stigma patients face, a lot of us as service providers are facing from those who do not want to offer abortions.

In rural areas, if one clinic does not offer an abortion a woman might have to travel for as long as five hours just to get to the next facility, where there is no guarantee the response will be any better.

Also, a lot of patients unfortunately have to deal with lifelong complications. Young women often have to have hysterectomies, because in South Africa unsafe procedures outnumber safe procedures by two to one. That is a disgrace if you look at the type of legal framework that we have.

I constantly receive messages from women asking where to go to get an abortion. Some clinics shut down overnight and you never find out why. It is very frustrating for us even as civil society members who want to help, and have the technical knowledge, to actually then get in the system and start doing right by some of our patients.”

Dr Murishe Ledwaba

Gynaecologist and obstetrician based in Johannesburg

“I qualified as doctor in 1984 and became a gynaecologist in 1995. I’m self-employed and have my own private practice in a larger clinic, working alongside other practitioners. I provide antenatal care and carry out gynaecological checkups and operations. The private clinic provides the nursing staff, but I have my own receptionist.

I prescribe contraception, but I do not prescribe the morning-after pill or carry out abortions because of my religious beliefs. I cannot decide which women should have an abortion just based on what that mother feels about the baby. While the law does provide women with the right to abortion, the rules also allow conscientious objectors based on personal beliefs. So we cannot be forced to provide abortion care.

If women approach me about having an abortion I talk them through their reasons. In a situation where the person has an unwanted and unplanned pregnancy, the rationale is not necessarily medical. In that moment abortion may seem like the best option to them but I will discuss with them why they want to terminate. I’ll talk them through their options and alternatives, such as adoption, and I invite them to look at the short-term and long-term consequences.

In terms of the procedure, some women end up requiring blood transfusions. Others suffer damage to their uterus or cervix, or end up with an infection. The effects can be emotional as well, with some women suffering acute depression after the procedure. And there is a risk they might not be able to fall pregnant again.

Patients have the right to choose but, as health providers, we also have rights. I work in a huge clinic and there are other doctors there who provide abortions. Each is an independent practitioner, so there is no overall policy at the clinic.

Many women seeking a termination are not using contraception. If they are not ready, they should be taking precautions. If it was a case that there was a medical problem with the foetus, there are others who will do it. But as a Christian I don’t perform abortion under any circumstances.

Advert for same-day abortion on a Johannesburg street

Same-day abortion is advertised on a street in Johannesburg. A 2017 study found 32% of South African women do not know abortion is legal. Photograph: John Moore/Getty Images

Legalising abortion has not done anything to stop women having backstreet abortions. You see it openly advertised everywhere. Unlike before, when these people could be penalised, there is no deterrent and services are advertised on the street.

When I was training to become a gynaecologist, my senior consultant did not do abortions. So that was a blessing for me, and in our unit we did not do the full training. I attended one session where it was being demonstrated, but I said I will not be using this skill.

The problem we have is that in some cases women have multiple abortions. There needs to be more done to provide information about contraception.”

‘He is the great survivor’: Jeremy Hunt’s ascendancy

In January this year, Jeremy Hunt’s days as health secretary appeared to be numbered. He walked into Number 10, his regular NHS pin badge missing from his lapel, as rumours swirled that he was facing demotion to the business department. Two hours later, he emerged from his meeting with Theresa May not only still in post, but with a beefed-up brief to cover social care.

Now Hunt has secured a funding boost for the NHS well beyond expectations, and has become the longest serving health secretary in history. His longevity is so remarkable that even May has taken to teasing him about it. At a journalists’ dinner earlier this year, she joked that if Jeremy Corbyn became prime minister she would be “breaking rocks in John McDonnell’s re-education camp … But of course, Jeremy Hunt would still be health secretary.”


What are the financial pressures on the NHS that have built up over the last decade?

Between 2010-11 and 2016-17, health spending increased by an average of 1.2% above inflation and increases are due to continue in real terms at a similar rate until the end of this parliament. This is far below the annual inflation-proof growth rate that the NHS enjoyed before 2010 of almost 4% stretching back to the 1950s. As budgets tighten, NHS organisations have been struggling to live within their means. In the financial year 2015-16, acute trusts recorded a deficit of £2.6bn. This was reduced to £800m last year, though only after a £1.8bn bung from the Department of Health, which shows the deficit remained the same year on year.

Read a full Q&A on the NHS winter crisis

Hunt’s renaissance has been a triumph in its own right. But it has also led many observers to ask if the MP for South West Surrey has an even bigger job in his sights. With the funding battle behind him, few Conservatives would be surprised if Hunt’s ambitions turned from the health service’s future to his own – in No 10.

“He’s on manoeuvres, there’s no doubt,” one senior backbench MP said. “The question is how far he is really prepared to push it.”

Even those outside of his party acknowledge his ascendancy. “Jeremy Hunt is in a very powerful position now, the only question is how much he chooses to deploy that power,” his former Lib Dem junior minister Norman Lamb said. “He is the great survivor. He has a skill for seeing off political disasters.”

Lamb said Hunt now felt far more confident to make spending demands public. “We all know it’s pretty much impossible to get sacked these days so he can choose to be much more vocal about it,” he said. “Ultimately, it doesn’t go far enough, there’s no certainty about where the money is coming from and it does all feel quite fragile, but it is a significant shift.”

NHS bosses who until recently viewed Hunt with disdain are now full of praise for his dogged, and ultimately successful, campaign to be the first public service to be taken out of the austerity straitjacket. David Nicholson, the former NHS chief executive in England, tweeted some personal praise – “Longevity has its benefits.”

“I’m not usually Hunt’s biggest fan but he’s played a bit of a blinder, you have to say,” a senior NHS official said. “When May came into No10 in 2016, she was very hostile to the NHS, so for Hunt to win her round was remarkable.”

His friends say Hunt, whose NHS lapel pin is firmly back on, is “genuinely passionate” about getting the right resources for the NHS.


Does the UK have enough doctors and nurses?

The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors per capita. Greece, Austria and Norway have the most; the three countries with the fewest are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals.

NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem.

Read a full Q&A on the NHS winter crisis

An ally of Hunt, who saw the negotiations with Hammond up close, said: “For Hunt, this was not about helping the NHS but also about his moment in history. If it had been only 1.5%, he would have walked. Now he’s going to be the health secretary at the NHS’s birthday and is the one who has taken the NHS out of austerity.”

One of the health policy experts Hunt used to help him build his case was struck by how some of those around him saw him winning £20bn more for the NHS as, in part at least, also his pitch as a potential future Tory leader.

“Brexit’s paralysis of most normal government business means few ministers are actually able to get anything major achieved in their areas. In a future leadership contest, Hunt will be able to say ‘I saved the NHS’, which is no small thing,” he said.

Hunt seriously considered a bid for the leadership in 2016 after David Cameron stood down but did not have the support to mount a realistic bid, having taken a daily battering for his handling of the junior doctors strikes. He was a vocal supporter of remain during the referendum but two years of EU negotiations later, Hunt told LBC he was now a Brexit convert, because of the “arrogance” of the EU Commission’s approach.

A number of Conservative backbenchers said they had begun to see him as a more plausible “unity candidate” than many of his main cabinet rivals.

Tory MPs said they understood Hunt would be highly unlikely to challenge May and would only consider a run should a vacancy arise. One source said Hunt was effusively supportive of May in front of colleagues at cabinet. “He spends a lot of his time saying how great the PM is,” one cabinet minister said.

Several MPs have floated the theory that Hunt is now one of the two most plausible “born-again Brexiter” candidates, alongside new home secretary Sajid Javid.

“Jeremy’s stock is undervalued and Sajid’s is overvalued,” another Tory MP said. “Sometimes colleagues look confused when you mention his name, but that could be because they’ve never really thought about it, not that they are against it.

“You need to have someone who can expand their appeal. Jeremy has a lot of people you could potentially add to his tally, you can’t really say that about Sajid and you definitely can’t say that about Michael Gove.”

Embracing Brexit at this late stage is not a universally popular tactic, however. “To be honest, that actually makes me think less of him, not more,” one minister said.

Another move that has piqued colleagues’ interest is his emerging role as “minister for the Today programme”, a role once held by Michael Fallon, as the government’s most trusted attack dog. With Fallon gone, Hunt was the man sent out on the airwaves after the messy departure of Damian Green.

His main obstacle to Number 10, at least at an election, is his public image which he will hope the funding boost can repair.

As culture secretary, he only narrowly survived a Leveson inquiry examination into his relationship with James Murdoch. He is a multi-millionaire, made from the sale of the website he co-founded, Hotcourses, before making the leap into politics, and his finances have come under fire, most recently for failing to declare the purchase of seven luxury flats. His tenure in the health department saw the first strikes by NHS doctors in 40 years. .

There are tough battles to come for Hunt, especially on social care reform which may prove even more difficult given the Tories’ toxic “dementia tax” policy from the election. One Whitehall source said Hunt probably felt less personally attached to social care reform than NHS funding, but knew he needed to confront it.

Lamb said Hunt needed to prove he could be just as bullish on social care reform and funding. “He absolutely has to turn his attention to social care now. He has said it will need more money. But now they need to deliver.”

“He is a very, very ambitious man, but he does really care too about a properly funded NHS and he doesn’t mind if he has to carry quite a lot of shit to see it through,” the Whitehall source said.

“He has fought really hard for this victory and he now has that stable relationship with the health service. When you have that, it gives you space to start thinking longer-term.”

Alzheimer’s link to herpes virus in brain, say scientists

The presence of viruses in the brain has been linked to Alzheimer’s disease in research that challenges conventional theories about the onset of dementia.

The results, based on tests of brain tissue from nearly 1,000 people, found that two strains of herpes virus were far more abundant in the brains of those with early-stage Alzheimer’s than in healthy controls. However, scientists are divided on whether viruses are likely to be an active trigger, or whether the brains of people already on the path towards Alzheimer’s are simply more vulnerable to infection.

“The viral genomes were detectable in about 30% of Alzheimer’s brains and virtually undetectable in the control group,” said Sam Gandy, professor of neurology at the Icahn School of Medicine at Mount Sinai, New York and a co-author of the study.

The study also suggested that the presence of the herpes viruses in the brain could influence or control the activity of various genes linked to an increased risk of Alzheimer’s.

The scientists did not set out to look for a link between viruses and dementia. Instead they were hoping to pinpoint genes that were unusually active in the brains of people with the earliest stage of Alzheimer’s. But when they studied brain tissue, comparing people with early-stage Alzheimer’s and healthy controls, the most striking differences in gene activity were not found in human genes, but in genes belonging to two herpes virus strains, HHV6A and HHV7. And the abundance of the viruses correlated with clinical dementia scores of the donors.

“We didn’t go looking for viruses, but viruses sort of screamed out at us,” said Ben Readhead, assistant professor at Arizona State University-Banner Neurodegenerative Disease Research Center and lead author.

Gandy said the team were initially “surprised and sceptical” about the results, based on brain tissue from the Mount Sinai Brain bank, and so repeated the study using two further brain banks – in total 622 brains with signs of Alzheimer’s and 322 healthy control brains – and detected the very same genes. “We’ve tried to be conservative in our interpretation and replicated the results in three different brain banks, but we have to at least recognise that these diseased brains are carrying these viral genomes,” he added.

The scientists could not prove whether viruses actively contribute to the onset of disease, but they discovered a plausible mechanism for how this could happen. Some of the herpes genes were found to be boosting the activity of several known Alzheimer’s genes.

David Reynolds, chief scientific officer of Alzheimer’s Research UK, said this element was significant. “Previous studies have suggested that viruses might be linked with Alzheimer’s, but this detailed analysis of human brain tissue takes this research further, indicating a relationship between the viruses and the activity of genes involved in Alzheimer’s, as well as brain changes, molecular signals, and symptoms associated with the disease,” he said.

However, others were more sceptical. Prof John Hardy, a geneticist at University College London, said: “There are some families with mutations in specific genes who always get this disease. It’s difficult to square that with a viral aetiology. I’d urge an extremely cautious interpretation of these results.”

The viruses highlighted are not the same as those that cause cold sores, but much more common forms of herpes that nearly everyone carries and which don’t typically cause any problems. The study in no way suggests that Alzheimer’s disease is contagious or can be passed from person to person like a virus – or that having cold sores increases a person’s risk of dementia.

There are currently 850,000 people living with dementia in Britain, and the number is projected to rise to a million by 2025 and 2 million by 2050. But despite hundreds of drug trials during the past decade, an effective treatment has not yet emerged.

“While these findings do potentially open the door for new treatment options to explore in a disease where we’ve had hundreds of failed trials, they don’t change anything that we know about the risk and susceptibility of Alzheimer’s disease or our ability to treat it today,” said Gandy.