Reproductive Rights, Teaching Mental Health and Contraception Equality with with Dr Emma Chan | Transcript
CW: miscarriage
Find the episode shownotes here!
Hannah Witton
Hi everyone. Welcome back to Doing It, the Sex and Relationships podcast where sex has never been so nerdy with me, your host, Hannah Witton. This week I'm joined by Dr. Emma Chan. Emma is a doctor working in mental health and is the reproductive and sexual health lead at the School of Sexuality Education. She's also one of the co-creators of the book, Sex Ed : An Inclusive Teenage Guide to Sex and Relationships, and A Green Activist. Before moving into mental health, Emma worked as a doctor in obs and gynae, and so between her experience working with pregnant people, and helping reform sex education, I wanted to get Emma onto the podcast to talk all about what current sex education misses out regarding pregnancy, and how mental health needs to be a part of sex ed. Our talk was so fascinating and far reaching, from how sex education needs to cover important topics including fertility, miscarriage, and the actual experience of being pregnant, not just how to avoid it. We discussed reproductive rights and how to navigate the climate crisis whilst wanting to have a baby. We spoke about mental health, emotional vocabulary, and the importance of teaching communication skills to help young people express themselves. And we also explored how to make pregnancy healthcare spaces more inclusive to trans people, and working towards greater contraceptive equality. I love this chat because Emma shared a lot about how to talk about pregnancy, both in sex education and in health care, in a way that is more inclusive to the diverse experiences that people can have. And please know in this episode, we do talk about miscarriage so please take care of yourself before listening. As usual, you can find more info and links to everything we talked about in this episode in the show notes over at DoingItPodcast.co.uk. And please let us know what you think over on our Twitter or Instagram, which is @DoingItPodcast. If you liked this episode, please give us a rating and review over on iTunes and Spotify. It's really appreciated. And without further ado, here's my chat with Dr. Emma Chan. Hi, Emma, welcome to the podcast. Thanks so much for joining me, I'm really excited to chat with you.
Hannah Witton
Oh, no problem. It's great to be here.
Hannah Witton
Good stuff. So for those who don't know you, you are a medical doctor, and you also work with like the School of Sex Ed, and an RSC facilitator. And I remember, when I first reached out to you about getting you on the podcast, I was really keen to talk about like, obs and gynae stuff as that's like one of your specialties. And then now that I'm like, bit further along in pregnancy and stuff, I realised that I don't actually have any questions about that, that are more general, because I'm like, oh, no, I want to save my stuff for my actual doctors who like know my individual case. And I was curious about, like, how education around things like fertility and pregnancy work when it's often such a such an individual thing?
Emma Chan
Yeah, absolutely. I think that's a really good question. And I think there's sort of, I think there's sort of two slightly different things in there. There's a kind of like, pregnancy, as like a thing in society. People getting pregnant, sort of understanding what everyone in society goes through, or people in society go through, even if it's not like a, it's something that will kind of individually apply to you, or apply to you now. And then there's kind of like pregnancy and fertility, and infertility, is like really personal experiences that some people may never go through, that some people, yeah, may never have. But yeah, I think there are those kind of two things. And I think they kind of, I don't think education does recognise that those are two sort of separate things. And I think, I think within the education system, often, we sort of just reduce pregnancy, for young people certainly, as like, don't do it.
Hannah Witton
Yes.
Emma Chan
This is like a process that you'll learn about later when you're older, I don't know how much older, but sometime in the future, like definitely after you left school, and you don't really need to worry about it until then. So we're going to talk about condoms now. And I feel like that tends to be the sort of like, dominant model within schools, for loads of different reasons. So yeah, so I think your original question was how, how does kind of learning about pregnancy, and fertility, and infertility work in education, and I guess it's kind of, I feel like it doesn't always work, as kind of relating it to experiences that are kind of might be personal and individual, and yeah, it's very kind of detached, it's sort of taught as something that's very detached and not not for you, not for you, child, ever
Hannah Witton
Yeah, do you find then because obviously, you're kind of in a position where you've seen the young person side of things in education, but then also, like, as a doctor, you see, like, the adult side of things, when it's like, somebody's like, lived experience, like, what happens to these young people, who then become adults, who might get pregnant? And then yeah, do you get people coming in being like, what's happening?
Emma Chan
Yeah, I think that's how do you get from like this, like teenager who's told don't get pregnant, to being, or don't get someone pregnant, regardless of what kind of sexuality or sexual having, don't get pregnant. That's all we worry about. To like an adult who maybe tries to get pregnant, or has to deal with, like, infertility problems, or yeah, how does that happen? And I think it's just really, basically, I feel like often, we don't get that we, there's no opportunity to get that from sort of like formal education. So people get that from other sources. I hope, including, like the Doing It podcast, and some of those sources are really good, and really kind of nuanced, and really nice. And some of them are not really.
Hannah Witton
So I did read this article, it was a lot more like US focused, but it was talking a lot about like, the amount of misinformation out there online that is targeted at pregnant people, often like trying to sell them stuff.
Emma Chan
Yeah
Hannah Witton
It might be more of a US problem. But obviously, it's still like an internet thing, which everyone has access to, not everyone, but a lot of people.
Emma Chan
I think that's a really interesting thing. So I work for the School of Sexuality Education, and like I kind of came at that from, from being like, particularly working in obs and gynae, and people just knowing very little about their bodies until kind of they were actually like pregnant, and no one had really spoken to them until that point about, like, what it pregnancy was like as an experience, and that's kind of how I got into it. But I think, I don't think that is a US thing that's sort of one of the few sources that you'll come kind of pregnancy and fertility at is from like people trying to sell you stuff and essentially being like a customer rather than a student, or a friend, or whatever, other roles. Like I with a with a, so one of the things that I see, like I've noticed quite a lot is not necessarily like inaccurate material, but like, sort of bias stuff that's quite biased around kind of pregnancy and fertility. So I, with a friend, developed to, like period tracking app, because a lot of what I saw, what what a lot of like the kind of commercial apps kind of do is like they're trying to sell you something like as a product and some of the advice they're kind of giving you kind of supports that being a product rather than that being necessarily educational. So if you're not like a patient or a friend, or you're a customer, that's your role, like there are very specific, there's a very specific kind of bias that you get, I think, and it's not always what you need or want. Yeah, yeah. Does that sort of answer your question?
Hannah Witton
Yeah. It's just it's so interesting to me as well, because I guess that like pregnant people are like, for lack of a better word, like a lucrative market. Because yeah, we're like big spenders, but also like we're really vulnerable.
Emma Chan
Yeah
Hannah Witton
Like physically and emotionally during that time where like, there's a lot of things to potentially be anxious about. And so yeah, there's a lot of, and then also with the lack of education of just like not having that foundational knowledge of like, what the experience is about to be for you. Yeah, I think it can be really tricky to navigate with a lot of like bad actors trying to manipulate you a lot of the time.
Emma Chan
Yeah, definitely. Or not even like bad, I think there definitely are bad actors, but like not even bad but just sort of like their their kind of agenda is different from yours. Like a lot of stuff, so one of the big things when I was, so I'm quite passionate about having about the need to sort of talk to young people about pregnancy in like a non judgmental way so not in a framing it like you must never get pregnant, which I think unintentionally otherwise is the kind of message that is put out there
Hannah Witton
And you never know there might be a pregnant young person in that room, as well.
Emma Chan
Absolutely, yeah. It's not like it's not unheard of. And also like, even if even if those people in the room, like pregnancy isn't a thing for them now, personally, like they might have, like, older siblings, or parents, or people around them that kind of pregnant and just sort of, like, kind of shrouded in this kind of like mystery and like, it's not for you, like makes it even more taboo and even more. So one of the things that I found a lot when I was in, like clinical practice, I work in mental health now, so I don't work so much with sort of pregnant people. But when I was working in kind of gynaecology, like quite a lot of the sort of work is around sort of seeing people who are having like problems in early pregnancy. So specifically, kind of early pregnancy bleeding, and potentially that's a sign of miscarriage. Miscarriage is incredibly, incredibly common. I think it's like overall, something like one in five recognised pregnancies end in miscarriage. So it's a very common experience. And I've, basically everyone I've ever met who's had this really incredibly common experience, thought that it was really rare, that it was something that they had done, because that's not not that's not the sort of narrative of normal pregnancy that they've heard. So they think this is a really unusual experience, and it must be something they've done, they've done something wrong, because like, why else would this be happening? And a lot of like, I spend a lot of time talking to people about how this was a really common thing. Yeah, and I think that is that is completely like an education thing, because we don't, we tend not to talk about anything beyond how not to get pregnant.
Hannah Witton
Yeah, it's like not even acknowledging the like, maybe wanting to get pregnant, and that not also like, potentially going to plan as well
Emma Chan
Yeah, definitely. Yeah.
Hannah Witton
So you mentioned that you now work in mental health. So I wanted to talk about that a bit as well. And I'm curious about how that intersects with the relationships and sex education work that you do. Because I mean, from my experience, like I don't even remember mental health even being touched on in general, let alone in how it relates to how we relate to each other, and ourselves.
Emma Chan
Yeah, definitely. I think, I think something that I've just become very conscious of is how when we sort of talk about relationships, and sexuality, is how, how sort of limited in like general conversation like our sort of like emotional vocabulary is. So we do do workshops for young people about like relationships and like, what, what kind of healthy relationship looks like and even like, what kind of healthy conflict looks like, but we don't, I find like often, not, not always and you do get some really, like really kind of switched on young people who are obviously having conversations with lots of people around them and their kind of families. But often, like, you literally kind of ask like how it was we do a lot of like, watching video clips of and sort of trying to kind of analyse stuff and trying to bring in like a broader like, like other areas of the curriculum, for example. Kind of like looking at like media, and art, and literature, and whatever, and yeah, we just ask quite like quite simple questions, like so how do you think this person is feeling?
Hannah Witton
Yeah.
Emma Chan
And like, sometimes you get some really lovely, nuanced response, and sometimes, like, it's just people just like, I don't know, like what is that? Oh, another one that sometimes stumps students, we ask them like, what qualities do you have that you kind of bring to a good relationship? Like, what do you value in yourself? And again,
Hannah Witton
Oh, what a question, oh my god.
Emma Chan
Yeah. Yeah. And and that's, that's often our sort of opening gambit. In terms of like, yeah, kind of Hi, I'm Emma, I work for School of Sexuality Education, here are the ground rules, what do you value about yourself?
Hannah Witton
Wow
Emma Chan
And people are really, really stumped. And I don't think that is that they don't have answers. It's just they've never been thought to like, they've never been asked to like, articulate those things. Like, it's like, often there'll be like, even with quite chatty classes in general, there just be silence for a little bit. And it's like, what do you, yeah, value about yourself as a person.
Hannah Witton
That's so interesting, because I also I assume that if you asked like the reverse question of like, things that they don't like about themselves maybe, or don't value, like people would easily be able to list off, like so much stuff. But I think that's such a powerful question for everyone to kind of like, take a moment and be like, hey, what makes me a good partner? Like, what do I value in myself that I think would make me in a relationship?
Hannah Witton
Yeah, it was. When you said the reverse question, it was interesting. I thought you're going to say like, what they look for in other people, which we do actually ask them. And they are often much more like fluent about like, what they value about other people. And I think there is something about this, like, maybe it's a bit of a like, more British thing
Hannah Witton
Yeah, I was thinking that too.
Emma Chan
Yeah, yeah. But I think that's really sad that like, you can't, like, I think it's still, like possible to be like a modest, empathetic self-reflective person is still, like, recognise that, yeah, these are things that I like about myself. Yeah.
Hannah Witton
I think that if that's something that maybe you're struggling to come up with, like, I just thought that a good like thing to do to kind of like help you start that list is to ask like, a good friend, or like some family member who's close to you to be like, hey, what what do you value in me? And then get them to just like, shower you with compliments, then you can be like, oh, yeah, me, I am a bit like that. Like, yeah,
Emma Chan
Yeah, definitely. That's actually kind of like a therapy technique. I do sometimes do it if they're really struggling, like, what would a good friend say about you? And you're not being it kind of gives you a bit of detachment, and you're not saying like, what
Hannah Witton
I think that I am amazing, you're going like, my friends say this about me.
Emma Chan
Yeah. Like, I've heard that as a tip for dating profiles as well. Like if you're struggling, because you're quite a kind of, yeah, a quite a modest person, like, what would a good friend notice about you? What do you think they would say about you? So yeah,
Hannah Witton
I just wanted to pull up something that you mentioned earlier about how you do workshops on what healthy conflict looks like.
Emma Chan
Yeah.
Hannah Witton
And I'd love to dive into that a bit more about like, yeah, what, what is healthy conflict? And like, how do you navigate that? And how can you discern the difference between a healthy conflict and a not healthy one? Because I think like, a lot of people say things like, oh, well, me and my partner never argue so it's a perfect relationship, or like, oh, we bicker all the time. And so all like those, those those people, they bicker all the time, so their relationship must be terrible. We have these kind of like, quite black and white assumptions about what conflict is and what it looks like, and if it's a good or a bad thing. Yeah, I want to ask about that.
Emma Chan
Yeah, I think that's been a really interesting one for me personally to deliver because I think I'd never, I'd never really thought about that before. With some of the other stuff, maybe it's like stuff that I've been kind of taught through my, my job, or like, I had a good kind of sense of. But I realised that I didn't actually, like some of it was, like not, not new concepts necessarily, but things that I hadn't really thought about in myself. And I think that's quite an important thing as well, like with all with all areas of kind of sex ed is like thinking about, like being self reflective and actually, what am I like, not just assuming that you know the answers, which I think I think like the the current sort of set up for school sex ed often does that. That like, well, you're an adult's you must have everything together.
Hannah Witton
Yeah
Emma Chan
So it's been quite an interesting. Yeah. So I think I kind of accept, like, like, except implicitly accept the idea that actually a good relationship isn't that you always, absolutely perfectly agree with each other, and you'd never argue about anything. I kind of recognise that. And students usually recognise that as well. There'll be, so I sort of asked, like, does does a good relationship mean you never disagree about anything? And they're like, no, there definitely is is like room for like, disagreement. That's fine. But yeah, personally, I've never really, like sat down, before I'd done the workshop, was I've never sat down and asked the students, I'd never done what we asked the students to do in terms of like, what actually does that look like? And what what are you trying to do with a kind of a kind of a conflict that you want to get resolved or was like, a healthy way of kind of trying to come to some agreement, or, or not. And what does what does like an argument that's that's, like abusive or harmful, what does that look like? What's the difference between those two things? That wasn't something that I'd really personally like thought about, yeah.
Hannah Witton
Yeah. So what are some of the kind of like, tips I guess, if it can be done succinctly at all of resolving conflict?
Emma Chan
Yeah, so I guess it's about like what you're trying to do. So you not, you're on the same team, you're like, not necessarily just denying your experiences, like not, yeah, actually, it's fine and I'm wrong. But like, what, like trying to listen to the other person, and where are they coming from? And yeah, I think I think the most sort of succinct way I've ever heard it described as like, coming at things as if you're on the same, well you are on the same team rather than trying to like, point score and win the argument.
Hannah Witton
Yeah.
Emma Chan
And I think that's quite interesting to do in, in a school environment, because often we do really privilege this idea of being like, good at debate, and being clever, and winning the argument, and the worst thing that can happen is that you have to say that you were wrong. Where actually, yeah, we kind of encourage, like, if you've said something wrong, or you think actually talking through things, you've made a mistake, then it's like, it's, it's, it's fine to apologise. Like, that's, that's the correct thing to do. Which I think we also really don't, as a cultural thing, we don't really accept.
Hannah Witton
Yeah
Emma Chan
Yeah, it's about being the cleverest. It's about having the best argument. And I think we sometimes take those skills from other areas of our life and kind of bring them in to, bring them into a sort of personal relationship, where they don't, I think belong as comfortably,
Hannah Witton
I definitely felt that like, at the beginning of my current relationship, oh my God, this is like bringing back so many memories. Because my partner loves a debate, and like, loves kind of like exploring a lot of like, philosophical ideas and stuff. And if I, if he, like, presented an idea to me, and I disagreed with it, and then he, you know, carried on exploring it and stuff. But he's very, like, I don't know, direct, shall we say, and I would start getting really upset because I felt like he was attacking me. And we would get into these, like, really heated debates, like, luckily not about us and our relationship, it was always about these kind of like, hypotheticals and stuff. And then I just remember, this being a pattern and like sitting down with him and just being like, I feel like shit when we have these debates, like, I can't handle it. And then he was then he explained, like his thought process to me, which was like, I'm not trying to win the debate. I'm trying to, I want us, together, to find out what the right answer is together. I'm not, he's like, I don't think you're wrong, and I don't think I'm right. I'm trying to he was like, I'm trying to work with you, for us to like, find a joint conclusion. And I was like, oh, you're not arguing with me? He's like, no, no. And so like, I was like, Oh, okay. And it just like frames the entire thing so differently to me now. And I, and actually, that was really helpful. It was actually really helpful that we went through that in terms of like, hypothetical debates, before it then came to like, stuff that was actually to do with us and our relationship and then being like, okay, actually, what we're trying to do here is we're trying to, like, figure this out together, rather than and that I think it does allow for you to be like, oh, yeah, you're right, I'm wrong. Okay. Yeah, let's, you've got a good piece of an idea here. Let's take that. I think that this idea that I've had is actually really worth examining.
Emma Chan
Yeah, I think there's, there's also something really interesting about like, so a lot of what you're saying, like, I recognise in like, previous, like, relationships that I've had, and, like various relationships I've had. And I think there's also like a slightly interested, interesting gender thing as well. I think, like, I think when you're younger, I think girls tend to be rewarded for like, empathy and emotion and that that can be, I find it really hard not to respond in a really like, emotional, and like, way where like, being kind is the most important thing.
Hannah Witton
Yeah.
Emma Chan
Whereas I've been, I've been in relationships with people who have been certainly socialised in a very, like, male way. And what has been really valued is kind of like intellectual argument and like being right. And I think those two things just really badly combine. And there is, I really recognise that thing of like, I'm not actually debating, I'm not actually attacking you, I'm attacking an idea. And it's like, yeah, but sometimes that idea is part of who I am.
Hannah Witton
Yeah.
Emma Chan
And also, just like invalidating an emotional response can be difficult. So yeah, I think it sounds like you come to a really healthy place where you can recognise that kind of what's the kind of hypothetical debate and what is actually, I don't know, like meaningful personal content.
Hannah Witton
Yeah, yeah. It is interesting, because I think one of the things that has been quite successful for us is really learning the other person's communication style. Because now, like, I know that he responds better to like, more like rational arguments, or what he would call a rational argument. And so like, if I want to bring something to him, I'm like, here's my PowerPoint presentation as to why. Why this should be a thing, or like, why I'm right, or whatever is not like, I'm right. But here's what I'm proposing. And like, by kind of like, tuning into how he best responds, it's like, normally I get the answer, the response I want, because he's just like, oh, yes, yeah, no, I that makes he's like, that makes perfect sense. Yes. I'm sorry. Or okay, yes, we can do this. And I'm like, yep great, thank you.
Emma Chan
Yeah, yeah.
Hannah Witton
Hacking it.
Emma Chan
Yeah, definitely. Yeah, I think, yeah, I guess that's part of it, like trying to, like, that's part of going back to this, like being on the same team. Like, if he tries to win the point, and you try to like, just like vibe and feel the things, and you're both doing different things, then that doesn't help that doesn't help either of you. So like, trying to be like, so we have these different approaches and where can we kind of what are we trying to work on? And yeah, I think that's, that sounds really, that sounds really healthy.
Hannah Witton
Moving slightly on, but also kind of like, bringing it back to like, pregnancy stuff as well. So like, one of the things that is in your Twitter handle is green campaigner. And I wanted to talk about like, environmentalism, along with sexual justice and sexual rights, and also like reproductive rights, because I think, at least in the West, there's a lot of conversation around like the climate crisis and having kids. And that's something that either a lot of people think about, or like, it's definitely something that I got asked a lot about when I was very public about trying to get pregnant.
Emma Chan
That's really interesting. Do you mind me asking what the sort of like, frame of that was when you were asked?
Hannah Witton
It was kind of like, do you think about the climate crisis in your decision to, like, have children? In the way that we were trying to have children, which is like to have piv sex and have a biological child.
Emma Chan
Yeah, yeah, absolutely. So kind of like, what sort of almost like, slightly implied, like, why don't you just adopt, kind of thing?
Hannah Witton
A little, yeah, a little bit.
Emma Chan
It's very implied.
Hannah Witton
But yeah, it's really interesting, because I definitely felt a little bit defensive, at first, of like, oh, yeah, we, you know, like, there's something that we thought about and I felt like I had to kind of like justify my decision. And then actually, there, there were a few other people who then responded to that being like, you don't have to justify anything.
Emma Chan
Which to be fair is like my gut reaction. Yeah, so I think there is a really thin thing that runs, I think it runs across kind of like, different areas of kind of, like social justice and kind of, kind of environmental activism is this idea that is like this focus we put on like individuals. And actually, like, it's, it's really, it's really human to want a family, right? It's really human to want kids, to an if that means if you having a baby, you having a family means that like that there's a like, impact, like negative environmental impact, then that means the way we're kind of doing people and society isn't working, that doesn't mean that you're, like, wanting to have a baby is like is causing climate change. It's to do with how we, as a society, do like how we're doing our lives in general. And the change needs to come from like a wider, like systemic change, right? So that that being a person doesn't cause all these things. Not that, like, it's like, it's not that you, Hannah Witton having a baby is causing climate change. I think that kind of runs across a lot of like, yeah, social justice things, and I think often, and I think it's a really important thing to kind of talk about because often I think those arguments about like, oh, you shouldn't have a baby, because that's going to consume more resources. That's kind of taking problems which are caused by, you know, big systems, by governments, by private industry. That's taking those problems and making it feel like it's an individual's responsibility. And that also that that that person making different decisions will fix that problem, when actually, it's the responsibility of governments and big kind of multinational companies to change their behaviour, because they're the ones that are causing that.
So I think it's, yeah, so I think it's a really interesting conversation. And I think it's, it's a way that sort of, sometimes us wanting to kind of enact a sort of a sexual rights, or our social rights, or our just like, wants to enact our kind of very, like normal, fine, individual rights gets framed as, oh, this is problematic, when actually it's not. Yeah. Governments do that, you know, in a way that sort of, like, like, like, makes means that they completely like, try and it's like, look over here at this individual decision. That's the problem. So it's like, the problem is that we're not, like these individuals are not recycling rather than that we have this hugely wasteful system that consumes lots, and it's kind of predicated on the idea that we consume lots. Yeah, so there's a bit of a sideways, yeah
Hannah Witton
No, it makes a lot of sense. I remember one comment that I saw as well, was saying something like, oh, well, when we say that we're like, you know, trying to fight climate change and and the climate crisis for the next generation. It's like, well, then who is this next generation that was supposedly trying to save the planet for?
Emma Chan
Yeah, yeah. I've seen like, not, not a lot, but I've seen some as well, like, people that that kind of take those, like, correct, what are seen as correct choices, like...so there's a big thing about like, oh, you should only have one baby, because that's that will be like, half as climately impactful as having two babies. Which is, again, like a slightly bizarre logic to me. And I think it's about like, no, we need to change society so that you can have two babies, and that doesn't wreck the planet. Yeah.
Hannah Witton
Yeah. I think, yeah, it just makes me think about just like, reproductive justice, in general, I think as well. And kind of like, the history of it, that to have just like, I don't know, like, there been times in history where, depending on who you are, either, you're like, encouraged to have lots of children, or you're very much like not encouraged to have lots of children, I think you can very easily slip into, like, racism, and classism, and all sorts when it comes to talking about reproduction like that.
Emma Chan
Yeah, like when I think when you, so I would always come at things from like an a, kind of, like, reproductive rights. So you have rights over your body, and that that includes the right to have to not have, to not reproduce to have like, education and access to health services and contraception and whatever, whatever you need to do that. But also that the kind of it's equally important that you have, like you are enabled to you have the education, the resources, whatever, you need to have to have a family as well. And that's they're, they're parts of the, those things aren't in conflict. They are parts of the same, same rights. Yeah, yeah.
Hannah Witton
Yeah, I guess also, I'm interested to know how all of this works out, like on an interpersonal level, especially in like the RSE context, again, around like, reproductive rights, especially when it comes to like, when it's in a relationship. So like, it's between just like two people and that, like, do you see amongst younger people, like pressure in relationships to kind of like, use a certain kind of contraception, or not use it or, like, how are those conversations playing out with young people?
Emma Chan
Yes, that's a really interesting thing, I guess I feel like the situation is, or certainly from my experience, the situation's a little bit constrained by the sort of the types of services and stuff we have available to us. So almost all, a majority of contraception is for people with wombs, and that that doesn't seem like it's going to change anytime soon. There's sometimes every now and then, every few years, there's a kind of like something crops up with there's a contraception, a new contraception other than external condoms and vasectomies for people with penises, but that never seems to actually come to fruition like I know.
Hannah Witton
Yeah, and condoms and like, vasectomy, are two extreme sides of like contraceptive options for people with wombs.
Emma Chan
Yeah, yeah. So there is, yeah, so there is often, so I feel like the burden of contraception often falls on women, like the the kind of contraceptive administration.
Hannah Witton
Oh my God, contraceptives administration. That is 100% what it is
Emma Chan
Yeah, yeah. One of my colleagues kind of framed it as that and I think that's a really great like, word. And we try and teach, we try and like promote the idea that actually, contraception is, is everyone involved kind of business. Yeah, I'm not sure how successful we are at that. But definitely, I think like a good first step is, I think a good first step is just telling everyone about all the contraception that's available, regardless of like, what kind of sex they're having, or what sort of bodies they have, like just just having that as an absolute, like, baseline that just everyone like, even if you don't have a uterus, you have seen a mirena coil, and you know what it looks like, and you have some idea about how it works. I think that's an important first step.
Hannah Witton
Yeah, I remember like, not really, I don't think I saw one, yeah, until I was an adult. Like we weren't, I don't think we were showing them in schools, even though it was talked about. I kept I had the Mirena coil for a while and when I got it taken out, I asked the the person who did it be like, can I keep it? And they put it in a little thing for me and so I have my coil at home. It's quite nice as well, as a sex educator as well, I think I'm like, this is this is what a mirena coil looks like, as well, like, this is the size, yeah.
Emma Chan
Yeah. We have some of the like the sort of like dummy ones, like sex ed pack, and it's got like, like the implant as well as another one that's really nice to, to show people. Although the implants really an interesting want to talk about, with kind of teenagers. So the implant for so it's kind of like match, if people haven't come across it before, it's like sort of match, the length and sort of size of a match and it's kind of made of sort of slightly slightly squishy, flexible material, and it's just implanted under the, under the skin. And it sort of stays there for for up to a few years. And a lot of a lot of teenagers have come across it, a lot of sort of like, like older siblings will have one or they'll kind of there is, like often, often, that's the only kind of device they kind of know about, like when you're showing them the kind of, the hormonal coil, they'll just be like, what on earth is that? But that there is often good knowledge about an implant, and what it is, and where it goes. If not quite how it works.
Hannah Witton
Maybe it feels like a more accessible middle ground for people in terms of like, you've got the pill, which you have to take daily, and then like a coil, which gets inserted into your uterus, which I think there's also like, potentially, like fear around the pain of that insertion as well. And then, I guess also like the time as well that it lasts, people are like, okay, three years, you know, like, yeah, then we'll see. Whereas like something like 10 years is like, what does my life even look like in 10 years?
Emma Chan
I think there's definitely something about like being able to touch people's, like people's implants as well. There's something about like, you might
Hannah Witton
There it is, there's my contraception, like it's still there.
Emma Chan
Because often, students will know where it where it is kind of goes and they'll have like, touched like a siblings or like, you know, I don't, there's something really because
Hannah Witton
More exposure to it.
Emma Chan
Yeah, because I completely see what you mean about the like, it's kind of an intermediate thing, but like something that there's, I think generally quite poor knowledge about in this country is like the hormonal vaginal ring.
Hannah Witton
I know I have one friend who has used that and like that was her contraceptive of choice, but I don't, in my personal life, I don't know anyone else
Hannah Witton
Is that in the UK or is that somewhere else?
Hannah Witton
Yeah, someone in the UK
Emma Chan
Because I, so when I went to, this is this is quite this is quite a few years ago when I was in medical school so things might have changed, although my sense is not. We got taught about like, different contraception by by a sexual health nurse, and they were saying that the vaginal ring is like the I think, I think it's probably still true, but at the time, it was like the, the number one hormonal contraception in Spain.
Hannah Witton
Wow.
Emma Chan
But in the UK, it's actually quite hard to get hold of in the UK. I've recommended, because I think it's really good. So it's, again, it's this kind of like, so it's hormonal, it's super, super effective, because it's a device that you put into your body. You like you don't, it's not like the pill, like if you vomit a lot, or you forget, it just won't work, it's less reliant on kind of memory. But it's something you can insert yourself. So you put it into, it looks like a kind of a sort of a rubber ring. And you put it into the vagina, you can just do that at home and it stays in for several weeks, then you take it out and then reinsert after a week, so it's it's like something you have like quite a lot of control over, so I think like the methodology, like the method is like really, really sound. And so I've actually recommended it to a few friends, who've like asked, yeah, cuz I've become that friend.
Hannah Witton
Yeah. Love being that friend.
Emma Chan
Yeah. And like a couple of them like, oh, yeah, this sounds this sounds really good. And a couple of them have tried and just not been, like GPs have just been really unwilling to, to do that. Because it's not something they're kind of familiar with, and they sort of, I think, perhaps unwittingly kind of push their own agenda. So yeah, that's an interesting one. But apparently, yeah Spanish healthcare services, it's much more much more popular.
Hannah Witton
That's so interesting. I love hearing like, little facts about like, cultural differences in all of these things as well. Because I'm like, why is it? Is it like, promoted more there? Or like, if there's something about Spanish people that they're just like, yeah, the vaginal ring, bring it on? Like, it's yeah, it's so interesting to me. I love it. We have some questions from folks on Instagram that I wanted to pose to you. This, this one kind of relates to, so I first came across you when I saw you speak on the panel at the School of Sex Ed's book launch. I remember one of the things that you talked about on that panel was about, like how biological sex is, like, so much more complicated than what we got taught in school. It's not as clear cut as like, male, female, and, and all of that, and somebody also asked, and I, they're referring to, like, obs and gynae here, how do you make a very woman focused specialty more inclusive for trans people?
Emma Chan
Yeah, I think that's a really, really good question. It's a really good question. I am not sure I have a brilliant, comprehensive answer other than that, that's something that we need to do. I guess, I wonder if, and if anyone, anyone does have any answers, then please, please do get in touch. I wonder if there's something around giving voice to people's experiences. So one of the most sort of biggest, like resistances I find, to sort of change within services is like, oh, well, we don't really need to do this, because that it's not really needed, and there's so few people that it kind of relates to. And I think, like, I think that's wrong, because even if it's only a small number of people, that small number of people still, they still have rights.
Hannah Witton
Yeah
Emma Chan
But but also like sometimes, sometimes the experiences are much less rare then we kind of assume. So not fitting into not fitting into a kind of very, very sort of typical gendered, cis het paradigm, like if you're talking about like someone who's a trans man that might, who is pregnant, that might not be super common, but actually just not like that very specific instance. But just like some way not kind of fitting into a cis het paradigm and going through pregnancy and fertility experiences. That's actually pretty common. Like it's common to have some sort of, like for you or your relationship or, or something to to not kind of fit into that paradigm. Yeah, that is actually super common. So I think maybe giving voice to people, giving platform, and space, and time, and if you're working within the service like an audience to people that are being open to hearing people's experiences where they don't have kind of typical experience. I'm thinking really specifically of Freddie McConnell, have you come across him before?
Hannah Witton
I recognise the name. Is he a trans man who was pregnant?
Emma Chan
Yeah
Hannah Witton
Yeah, I think I've seen him speak
Emma Chan
He's a journalist. Yeah. He's, I think he's sort of sells himself as like sea horse dad. He's had now two pregnancies where, yeah, he's been - so he's a trans man. He's also like, very, very, like, very masc looking. I think even when he was quite pregnant, like, even when he was like, in his third term you wouldn't look at him and think that's a woman with a moustache, you would think that's, like, that's, that's a very kind of typical, cis, man. Yeah, and he's he's done quite a lot of work about his experiences. He's made a documentary about it. Yeah, yeah, and I guess, like, just just kind of listening to that and I remember just listening to some of his stuff and, and this was after I'd kind of stopped working in O&G, and just thinking about some of the stuff that we did, and some of the things that happened, I'm just like, how, yeah, how would that work? How would that work for this person? So, yeah, kind of listening to people's experiences. If you're working in services, giving your time to that, yeah, or thinking about how else you might platform those experiences? Yeah, yeah,
Hannah Witton
I really love your point about how like, just either not conforming to, like our assumptions about people's gender, or gender expression, or sexuality or like relationship status, like, like, there's so it's so much more common than we think that people don't fit into these, like really neat boxes. Like, our midwife for one of our recent appointments asked me and my partner if we were married, and we were like, yeah, and, and she was just like, oh, very rare these days. It's just like, yeah, we we kind of very much do fit that mould of maybe like, what people are trained to kind of like, expect to come into the clinic and stuff. But I just thought it was really nice that she acknowledged that like, yeah, that's not really the case as much anymore.
Emma Chan
Yeah, yeah. And I think there are so many, like, I have a friend who has, who her and her partner had had a baby together, and that they're married, two married women. And, like, the way they treated, like, my understanding is the way they treated her, her like her wife, like the try and like make comment, they'd make a lot of assumptions even within that, so that they recognise that they were like a couple. So they didn't necessarily know that so my, my friends, the non pregnant person, is a trans woman. So they try and like make, but they made a lot of assumptions when they saw two women presenting about like, the, like, they must have had fertility treatment, and they try and like make common ground with them based on that, like, oh, who's your facility specialist? And they'd be like, no, this is like a bio baby, we had PiV sex.
Hannah Witton
Yeah
Emma Chan
And just like, and I think that sort of played into I, I don't know, maybe speaking a bit beyond like my experience. I wonder if that played into, like, my friends like gender dysphoria, because, yeah, I don't know. Just kind of not accepting some of the the experiences they've had or just yeah, assuming that they didn't exist. Yeah. Yeah. So yeah. Yeah.
Hannah Witton
You just don't know unless you ask like how people got pregnant or, like, what their gender, sexuality, relationship structure, family structure is, ns all of that,
Emma Chan
I guess, as well with like, with, with healthcare professionals, like in terms of like how we can change services, like it's okay to ask, like you would ask, there's all sorts of stuff that we just wouldn't assume about people. Like in a lot of medicine, we would never assume like that people did or didn't have certain health conditions. We'd ask them. But like will often completely assume what kind of like reproductive organs people have.
Hannah Witton
Yeah, which is a huge part of healthcare
Emma Chan
Yeah, based on their name. And, and there are some really inelegant, yeah, there's some really inelegant, I've seen some really inelegant like ways when people don't fit into that like paradigm. So like when we, when, when I've looked after, like, or when I've had, like handover for patients that are transgender, there'll be like this huge, like, oh my God, like, you'll see like referral letters, like, basically, the point is, this person, you know, had a fall, broke their arm, maybe it's broken their arm and we need that to be investigated. But they'll just be this long, like history of like, every gender clinic appointment they've ever had in word like the like the letter to a&e. And you're just like, where they've like, mixed up the pronouns, and just like, what the information you want to know is, what happened to this person? And what they have hurt. And like, none of this is relevant. And if you feel it is, you can ask
Hannah Witton
Yeah, well, slightly different, but still on kind of like the pregnancy topic. Somebody asked, as a doctor, how do you strike the balance of birth/pregnancy being a natural process and a medical event? This intrigued me
Emma Chan
Yeah, that's, that's a really, so how do you strike the balance between birth being a natural, like a natural thing, a thing our bodies do and it being something. Yeah, I? That's, again, a really good question. And I'm not sure if I do that well. I'm not sure I kind of, I guess, I guess, being like, very comfortable about what the limits of your knowledge are. So like, I've never given birth. I don't know, I don't know what that's like. And even if I had, like, I still wouldn't really know what that's like for everyone, just for me. So I think just being honest that, that I understand there are some times like problemative, kind of medical, like that pregnancy is seen as kind of like, a disease. Like it's kind of tricky to see you go to a hospital, all these things, it's kind of like treated like a disease when actually it's like a normal, normal body process. Like kind of just acknowledging that that exists. And also that, like, people are very different, and then that's, that's fine. And, you know, no two people's experiences are going to be the same., and nobody will kind of know what pregnancy is like for anybody, including, like, even if they've gone through the same experience, or it's the same type of experience, it's not the same experience, because there'll be loads of different things. Yeah,
Hannah Witton
Yeah. There's definitely been points in my pregnancy where I've been like, I was born to be pregnant, like, this is so natural, and like, this just feels so right. And then other times where I'm like, this is, yeah, I need medical intervention. This is, this is a medical thing that's happening to my body right now.
Emma Chan
Yeah. Yeah, I really, I have really interesting conversations with people I know who've had who've been pregnant and given birth. And it's really interesting, I find that sort of older people tend to be a bit more like, open to the idea that it's different to everyone. Like, I think, when someone who's a similar age to me, like a few years ago, had their first baby, and was just like, she just became like, in her mind. I felt like she became like, the authority on pregnant, on being pregnant, pregnant and having babies. And like when I talked to my mum, my mum was like, oh, well, like, when I had you, and when I had your brother later, that was completely different experiences. And, like, just a bit more open to that. But my friend, after her one baby, was like, oh, yeah, I know. I am the mother, the mother now.
Hannah Witton
This is the experience of pregnancy.
Emma Chan
Yeah. And then when other friends got pregnant, she'd be like, oh, well, you'll need this and this, and this is what happens and blah, blah. And it's like, you're definitely an expert on your pregnancy that you just had, but I'm not sure, and it was really interesting because I'd had like, obviously, I've not had like an experience, like a personal experience, but I'd seen a lot more pregnancies than her, and I've met a lot more pregnant people than she had this point, and like helped deliver a lot more. Yeah, yeah.
Hannah Witton
Yeah, it's definitely interesting because I, I'm in a position where like, I really haven't encountered that many pregnant people, at least pregnant folks who I'm close enough to, like, actually ask some of the more like, intimate questions to, and have those kinds of conversations with. So I definitely felt like I was, like, you know, I have some ideas about what pregnancy entails. But it's very much just been like, we learn as we go.
Emma Chan
Yeah. Yeah. There is something about like, collective knowledge that I think is different from like, my parents generation. That like we tend not, yeah, I think it goes back to this kind of like idea that we don't teach young people that, like, pregnancy is something that relates to them. It's something that they mustn't do. And we kind of, yeah, I think it kind of goes back to that, that we just like, like, I don't remember, really, like seeing a pregnant person when I was a child, really, or like knowing anyone who was having a baby or, yeah. I think my mum's experience, my dad's experience is certainly a different, like he had sort of older siblings, and he was in a sort of, like, more of a kind of community where you sort of did, yeah, did know that a bit more.
Hannah Witton
Yeah. The collective knowledge is definitely something that I've come across, like since being pregnant. And that is definitely I find very useful. And a friend of mine, actually, who just recently gotten pregnant was messaging me being like, can I ask you about discharge in pregnancy? Like, like, there's just so much like, what happened to you? And I was like, oh my God, yeah, there was so much like dripping. And, yeah, it's just really interesting of just like, wait, is this normal? And kind of like, yeah, but then also, like, having to caveat that, like, it happened to me, and it was fine for me. But you never know, like, obviously, like, you know, your body better. So like,
Emma Chan
Yeah, that's actually that is something that I bring up in, so we talk about like anatomy and vulva and vaginal anatomy and like, we talk about discharge, and I talk about it being different and like pregnancy is one of the the examples that I give that, like, you might have a lot of quite white white discharge in pregnancy, and it's just all about what yeah, that is a like, really specific example I give because I've had that experience, like not personally, but of kind of looking after people that are just like, what is happening?
Hannah Witton
Yeah, just like, why is my underwear soaked all the time
Emma Chan
Yeah
Hannah Witton
Well, Emma, thank you so much. I really enjoyed this, this conversation. Where can people like find you online if they want to?
Emma Chan
So yeah, so I write a blog, squishsquashsquelch.com, which has been a bit poorly maintained recently. But yeah, I kind of stick on ideas about kind of sometimes things that have kind of come up in, in sort of, in sort of sessions, and I don't really have time to answer, all sorts of things that are slightly supplemental to some of the stuff I d in school, but yeah, yeah.
Hannah Witton
Amazing. Well, thank you so much. And thank you all for listening.