From menarche to menopause: how reproductive histories shape women's health
01:26:51 Share

Welcome to the LSE Events podcast by the London School of Economics and Political Science. Get ready to hear from some of the most influential international figures in the social sciences.

Welcome everybody to this evening's event and welcome to everybody who is listening in online. My name is Ernestina Koust and I'm absolutely delighted to chair this evening's inaugural event, Professor Tiziana Leone's inaugural lecture. So I could start with my brief introduction with a standard academic slide or I could put up the slide I really want to use.

Because there's a superpower and Tiziana has a superpower and she often introduces herself to her students, her postgraduate and research students, as a data geek. Now this is more than a throwaway term for Tiziana. This is about...

a love and a passion for using, reusing, sniffing out new sources of data, reusing older sources of data in interesting and innovative ways. So we are absolutely reclaiming the phrase "data geek". There will be merch available afterwards. In my introduction I thought, well how am I going to sum up in less than 10 minutes somebody?

to give a flavour, particularly for those of you who may know Tiziana less well. Well, one of the things you could know is that Tiziana loves a timeline. So I thought, you know what, Tiziana, have a timeline. Here's your timeline. Now, this is a very shallow timeline. I'd like a multi-dimensional one where I could layer in all sorts of aspects about Tiziana's career and her life.

But if we're thinking about the evolution of the data geek to Professor Tiziana Leone, we can go all the way back to the early 2000s when she was based in New York working at the United Nations Statistics Division.

working as a demographer. And we can see how throughout her career, which has been at the LSE and at other institutions, Tiziana's work and engagement and advocacy has remained really connected with agencies like UNFPA, for example.

where she was instrumental in advocating for the inclusion of indicators around maternal mortality in some South Asian countries. We can see, for example, her involvement in the work of the UN Countdown to 2015 and then Countdown to 2030, where she was instrumental in advocating for the inclusion of abortion-related indicators in Countdown 2030.

So Tiziana, you get a timeline. It's a very thin timeline, but I hope it also gives the audience a sense of the evolution of Tiziana's career and her implicit engagement within academia and outside academia for the work that she's passionate about. Now Tiziana is going to talk about her research after my introduction.

But I just want to illustrate with just one of so many examples that I could have chosen. It's a piece of work looking at this thing called allostatic load. That's a technical word, it means wear and tear on the body. On the right hand side is a quote from one of the reviewers describing Tiziana's work as a pioneering attempt

at calculating anastatic load with limited data. This is Tiziana's happy space. There is limited data that you've got to work really hard in order to make it work, in order to see what you can do with limited data.

using, I mean this quote from this review is a dream, right? Imaginative methodologies. Again, thinking about how we can use and reuse evidence, in this case really making a point about how women's bodies in the global south are ignored in terms of allostatic load because of data, for example. So just one little teaser before you get into Tiziana's piece.

now Tiziana doesn't know this next bit is coming a really important part of Tiziana's identity is her enabling developing nurturing other researchers whether that's her PhD and postdoc researchers who you can see up on the screen here I am no graphic designer I apologize for how many tops of heads have been foreshortened

in addition to the hundreds, if not thousands of postgraduate talk students that Tiziana has worked with. And what Tiziana doesn't know is that I contacted all of these lovely people, many of whom are in the audience or are online. And I said to them, I only gave them 72 hours to reply, "Agama Tiziana, you want to quote anything to her, you've got to give her a response rate. Tiziana, it was 86%, okay? High response rate."

People who know Tiziana are going to laugh at the fact that I've quoted the response rate. And I said in three words, how would you describe Tiziana? I'm going to read these out because I think they're worth thinking about.

Political, powerful, spectacular, inspirational, supportive, compassionate, generous, bracing, fair, committed, encouraging, creative, inspiring, humble, patient, kind, smart, insightful, are you blushing yet? Practical, caring, brilliant, energetic, inspiring.

ambitious, inclusive, mentorship driven, dedicated, protective, cheerleader, wonderful, helpful. There were some modal responses and I will give you the data later. Unattributed.

I'm including this because I think it's also important at somebody's inaugural event to think about all of the genealogies, the genealogies that Tiziana and her work and her mentorship is then producing.

Also, if you've been anywhere near Tiziana's office, the door art is fabulous. So I've just selected two because they say something really important about Tiziana's work. On the left hand side is a photograph that Tiziana took when she was working. She's got longstanding collaborations with Palestinian researchers.

She is also a massive foodie, which is why this particular piece of graffiti is so important on the left-hand side. And on the right-hand side is a meme that did go viral and really spoke to Tiziana, who is always happy to start the next new shiny research thing.

that's much more fun than finishing the thing that you've already started. But it is advice that she's also always giving her PhD and postdoc students. So I'm really hoping to give you a flavour of the professor who's about to present her research. I'm going to wrap up with this quote, which pretty much every student who has ever been taught by Tiziana, whether or not a research student or a master's student,

that you will hear Tiziana saying. We owe it to the people whose data we analyse and that is something that runs through all of Tiziana's work. So I'm absolutely delighted to invite Tiziana to present her inaugural, I can't say that word, her inaugural research lecture after which there will be a Q&A session and after which there will be a reception outside.

Over to you Tiziana. Thank you Ernestina. First of all I didn't pay Ernestina. I wouldn't have expected that. But you definitely got the top spot for my obituary as well. Because that was top work.

Okay, somebody said that the inaugural is like a wedding but without the stress of having to organise the party and also I want to say that I get to wear my vintage corduroy thick with the elbow patches which were given to me by Palestina but also I take them off because the temperature is not menopausal policy compliant, so I'm sorry.

Okay, so I promise to keep it light and to have lots of pictures and actually, Nestina, I mean, I thought that I really held up because I thought I would cry at the end, but you kind of challenged me there. So what am I going to talk to you about tonight? Because this is all about myself and I'm a bit of an egocentric. I'm going to talk a bit about myself, my socioeconomic determinants and my genealogy.

Then what really kicks me in research, what drives my research, what am I passionate about? A few highlights about my research starting from menopause, from menache to menopause and beyond. And I do apologise, I know that I'm going to talk some terms which might not be familiar. I've tried to define them and then there's going to be lots of memes and gifs and...

Because my PhD students have taught me that and many thanks at the end. So let's talk about me because I said this is about me. I love that tricycle. So this about myself, socio-economic determinants. How do I define myself? I define myself as working-class contraceptive failure from East Rome.

Born after two brothers, ten years afterwards, I, working class defined as the first to graduate in my family. After a long line, strong long line of housewives, my mother wasn't allowed to go beyond primary school because my grandfather thought that she would spend better time looking after her brothers.

Why am I saying this? Because that actually gives you a context of why this means a ton to me. It means a huge deal to me. And to be honest with you, when I was in the tricycle, but even later on, I would have never expected to be right here, right now, to have this title in front of me at the LSE. And although it looks pretty much close to the city centre, it was

wasn't as glamorous as that in terms of the way where I grew up. I mean it wasn't the set of The Wire for those of you who know The Wire but it was pretty much one of the favorite places of the neo, not neoliberal, neorealism Italian directors from

Pasolini to De Sica and Rossellini, Fiorafan. And actually my roads were where that scene of Anna Magnani was shot. That's the highlight of my career. Of my childhood, sorry.

I forgot completely what I was going to talk about, so I mean, bear with me. So, Stambo, just two key events. Sorry, I won't keep it too long. I will get into the research in a minute. But two key events, just to tell you how I really, really didn't expect to be here. One is that, coming from a kind of...

working-class background, I wasn't really expected to go to university first and even in going to university people like me would just do either political science, law or economics. There is no chance that I would have done law, no chance I would have done economics because I wasn't really aiming for big salaries. So I would have done

social science and it was only until two months before I was going to choose my path that I was doing technical techniques for tourism because I thought I couldn't really do the path to university that one teacher one teacher said one sentence which changed my life because she saw that I really got carried away with the project on the trends on Italian tourism and I put

every single graph that was out there and every single data she said hmm I think you might be interested in statistics and then I found out that there was demography and it was the link between geography and maths and that was it so that was the first stumble the second stumble was when I was doing the Erasmus do you remember the old good Erasmus at the University of Southampton there was a professor Ian Diamond that said to me in the corridor

"Tiziana, have you ever thought about doing a PhD?" And at that time, that's more or less his voice, isn't it? At that time, I didn't even know what a PhD was. So I only applied for a PhD in South London. And it's mainly because I wanted to get out of Rome and I wanted to get out of my parents' house. So that's how I'm not here. I know this is not really a good career advice, but that's how I'm here. Okay, that was a bit too long, but I just wanted to let you know because this is all about me tonight. Anyway...

So, Geology. I mean you preceded me but I give you just a bit more detail. These are the people that really formed me. Giampiero Dalla Zuana for my Master's degree in Rome who are still in contact and we're still collaborating and the amazing Andrew Wang which is a shame that couldn't come tonight, probably all

who set the bar really high on mentorship. If you think you have it really hard when you read my stuff, imagine him doing it for the first time. The whole paper was red. He also taught me to switch off the radiator in the office and leave the windows open in the winter because that means that students wouldn't stay for too long in the office. LAUGHTER

And Nestina, yes, this is my dream team. If there is anything I could die tomorrow, I mean, I'm really proud to have had...

At least a tiny, tiny contribution. It's a shame I haven't got any feature over there. These are the ones who are done and are in an amazing career and these are the ones who are about to go out, hopefully, no, not hopefully, I'm going to get rid of a couple of them in the next couple of months actually. And for anyone in this field, you would know that this is the Real Madrid of PhD students.

and it's not related to me at all. I mean the thing that I've learned from them, how I've grown being their supervisor is just amazing. I mean some of them and actually the thing that's really amazing that their genealogy follows up is that I'm going to start supervising a PhD student with Valeria who's the top there on the right and they've all gone to amazing careers so I think that's worth 10,000 papers really.

Okay, let's start with the real stuff. What drives my research? I think that, and Estine has mentioned already one which is the data, but let's start with the kind of piece de resistance which is the women's health. I often find myself justifying why I'm looking at women, why you're not comparing women and men, why are you just looking at women in terms of health.

There are tons of reasons. One reason is that we know that in terms of crisis and in low resources, women are always much more negatively affected in terms of health.

We also know that in terms of access to wealth and health outcomes, there is always stereotypes and barriers which are faced much more by women than by others. We also know that their health and well-being is not going to impact just them, but also others. But the thing that has driven more the kind of themes of the last few years, probably seven or eight years, has been the kind of move from seeing women just as

reproductive being that they're there just and the importance in terms of research funding and attention is really pretty much around them as mothers and because of their children and

And when I was thinking, I said, why am I justifying myself? I just need to tell you one thing, because I mean, according to if we look at the transition and the fact that we're having fewer and fewer children, you just know that women have between 300 probably and 500 periods during their lifetime.

That's a lot of bleeding because I mean when you say, and I can see already people might start calculating in their head how many times they've had it. That's about on average 2,000 days in their lives that they are bleeding with all the implications that that has. So that's one of the major reasons why women sell. I will tell you more and then that's what I'm going to concentrate on the papers.

Data, well, as Stina said it, you owe it to the people that you've collected the data from. If you're bothering to collect data and keep people busy, mainly now that we've been deprived of many data sources that have been shut down, those are precious. And there is so much rich information that we need to do. And also take it as a challenge. It's really good fun to, and the paper that you quoted is the one that I've had most fun and the most painful to do.

Lastly, and this I have to also thank the Department of International Development where I've moved seven years ago. This comes from more from a kind of global health approach to things because if you work in social epidemiology or bio-demography you come across a lot of people that worked with the amazing

Scandinavian data or with the Millennium cohort studies where you've got all these variables and lots of big samples and follow-up and longitudinal analysis. Well, first of all you will find that data in low-income countries have a much lower level of attrition anyway, so take that. But the other thing is that they would tell you that, but we know that, why are we studying it?

Well, I mean, global health is about this, the learning process. Try not to assume that what you found in a high-income country is necessarily going to be the same. And I had to fight this quite a bit before arriving in international development, actually, because there were a lot of preconceptions. So I think that is yet again another challenge. So how do I approach... And yes, I do love a timeline.

She's a woman after all. How do I approach this? This is just the selection of kind of bio-demographic events which I take into account.

My approach to this and the ultimate goal when I look at women's health is really pretty much looking at the process throughout their reproductive life and their health and how that affects their health later in life. So I'm looking at from their child development to their pubertal stages, the pregnancy and antenatal care up to perimenopause, menopause, the aging process, and then ultimately

Yes, and death, because death's the end. And I see this, and I see pretty much ageing as a process, not something that happens at the age of 50, 60, 70 or 80. It's something that is throughout. And the fact that you're looking at countries with low resources means that you're going to have events in between which they are going to affect the pathways and trajectories.

Why does it matter? Because exactly that, the experiences, the trauma, the trajectories, the eco-social environment within which individuals are, are going to affect later life outcomes. A bit of theory, because we all love a bit of theory. Where do I come from and how do I build my theories behind what I will present in a minute?

I have three frameworks which I would say I use interchangeably but also together. The first one is the life course theory which is a multidisciplinary approach that examines how individuals' lives unfold across time influenced by social, personal, individual, historical context.

The second one, the trajectory, the kind of vehicle social is more the kind of way in which you model the data, in which you model the trajectories and the ways in which, I mean we never think about that, but if you think about your life experiences, it's all about sliding doors, isn't it? You could have gone one path, but you've gone another one. And I'm always so grateful to that teacher that told me about statistics, otherwise I've got no idea where I would have gone.

The weathering hypothesis, which I can't remember who was giggling because the author is Geronimus, yes, the author was Geronimus, is about the cumulative impact of experiences. It's basically around how the trauma or the way in which we are perceived by people is going to affect the way in which we live.

we live and age at the same time and this could be from gender, sexuality or race. So these are the kind of three ways in which we determine our later life outcomes. So what am I going to talk to you about briefly now? Well I'm going to present you basically in

in half an hour, seven papers, don't worry just the key highlights because the way that I was seeing this is basically to do some taste talk, I mean and it was much more fun than writing the promotion document, taste talk of what I've done in the last seven or eight years and just looking at where I'm going first.

I can already warn you there's going to be more questions than answers, but it's just to tell you that this is the new beginning for me in terms of where I'm going.

So the first one is basically where I've started, which is how are women ageing? The second one is looking more at the reproductive periods of the bookends, so the age at first period and the age at last period, so menarche and menopause. Looking specifically at characteristics around premature menopause, and I'm going to go more into the details.

And the last one is the ultimate game is how all these bio demographic events, outcomes, add up to the aging process. So let's start with how women are aging. And then I just mentioned it before, I see aging as a process.

This starts pretty much from I started from the midlife. I just thought um We always look at when we look at surveys on aging. We always look beyond the age of 60 So I said why are we not looking at the Middle Ages? Why are we not looking post reproductive periods and and my question there was are women aging at the same speed are they aging at

like their ageing in high income countries because I mean remember that we are looking at settings where there is a higher level of fertility, there is a lower level of resources in health systems and often they are linked to conflict, stress, trauma which could lead to different speeds and pathways of ageing.

So this was the very kind of the kickstart of my interest in this biomedical research. It was the first paper where I was simply trying to plot the path

of a couple of measures of ageing across six countries with surveys which are comparable to each other obviously various levels of development. So GRIP strength, for those of you that know it, this is the kind of gold standard, but it's one of the best ways to objectively measure decline in health

What you do, you have something called the manometer where you ask the interviewee to squeeze it with both hands and then you measure the average. This is an excellent measure which you can do if you know the model of the manometer, you can even standardize it and weight it. It's an excellent measure because it's pretty cheap, I think it's about $100, something like that, and it is replicable in low-resource countries as well.

So what do I see from this first measure? Well, a steady decline around the age of 40, 45, 50, which coincides very coincidentally around the perimenopause and menopause. And this was kind of growing at different speeds in different countries, but the trend seems to be more or less the same.

The second thing that I measured was cognitive functions. These are usually used for dementia or cognitive decline. So this is a set of questions that you then summarize in an indicator. The trend is more linear. It doesn't seem to be as dramatic in terms of the depth as the

the physical one but still you can see that in some countries it's still in the midlife where the decline is really happening. So I mean that was the first thing that set me off in thinking we're probably focusing too late, we need to start earlier to look at aging and the process. So then I moved on to the key

kind of bookends the

If you work in reproductive health, you will know that usually we concentrate between the ages of 15 to 49, which I find limiting, but we're grateful for anything that comes to us now. I mean, I'll just take anything, to be honest with you. Yeah, by the way, if I say this, I'm going to mention the Demographic Health Survey a lot. The Demographic Health Survey is defunct. It's just been killed by the dodge.

So what I wanted to see is that what we weren't really questioning is we know that in high income countries the age of first period is going down.

because of improvements in nutrition and health, although I've been told that actually if you look at pre-historical data it looks like it was lower than it was in the middle ages, so actually the trends have been shifting around, but there is definitely a strong link to nutrition whether it's the proteins or whatever.

We know less about menopause. There seems to be a kind of shift towards the right, towards older ages, so kind of expanding the reproductive period. So I thought in countries where you have lower control over accessibility to family planning, or where you are more at risk of reproductive morbidity, how is that kind of weighing out? How is that going around?

So I thought I would look at this. Why is it important? I think for three key issues. One is from the biomedical perspective, because we know that if it's too early or too late for both menarche and menarchus, this has got linkages to cancer and chronic diseases. This is mainly because of the exposure to...

to estrogen and to hormones so the exposure to certain hormones actually gives you a higher risk to chronic diseases so it's important to understand whether there has been major shifts

Secondly, from a demographic perspective, which is where I started from, they determine the reproductive span, the exposure to the risk and the exposure to conception. I mean, we all know that it's one of the, well, we don't all know, but if you're a demographer, you know that this is the typical Bungard model, the approximate determinants of fertility. And thirdly, which is probably the most important thing,

Periods in the puberty and menopause have a great impact on well-being and self-worth.

It's very culturally driven, I mean even the impact of the timing of both of them. It was really interesting, we did a workshop a few years ago on the cultural insights into menopause and you will go from being desperate because you're not able to bear children to being absolutely rejoiced because you don't have to use

pads anymore, you're not bleeding anymore and that's it, you're free to do whatever you want. So it is important. It's also a great indicator of daily activities. We know that during puberty there is a risk of school dropouts, there is a lower

number of physical activities being taken up. We know about dropouts in sports. So it is an important indicator to understand both.

Ultimately, I was driven also by the learning bits. I was driven by the fact that we knew that things were going in a certain direction in high-income countries. Nobody had ever actually looked across countries to look at secular trends, and there hasn't been really a systematic analysis of all the data available. So what did I find? And I will give you seriously just the headlines.

Well, first of all, it was interesting because I found out in my data hunt that it was much easier to find data on menopause than on menarche.

Menarche doesn't seem to be a question that is included standard in questionnaire. So I've only looked at about 29 surveys in around 17 countries, but what I've been able to do is really reconstruct the histories from women that were born from the 1930s.

I mean, I know that any statistician in the room would say that I'm really pushing the trend there, but it is there. I mean, it's not strong, there are lots of outliers, but there is definitely a trend in the decline in the age of menarche. So yeah, more or less is probably what we would expect. We did some kind of sub-analysis by socioeconomic levels, and obviously the histories are quite different, and it's quite interesting.

It's quite interesting to look at how we might actually find that the trends might go up and down because we've seen a rapid decline in lower socioeconomic groups mainly due to high fat content diets. So that's something that we would definitely need to keep an eye on. When we move on to the other paper on menopause, this was much more

kind of time consuming. This one was 307 surveys. So yes, I do own all the DHS surveys that there are out there. And people do come to me and ask them, even the data librarian at DLSC.

This is something that we didn't expect. The age, mean age menopause, which it was a kind of cunning demographic technique that Alice O'Gemmell worked out, is going down and this is also controlling for long, sorry not long lasting, LARC, long, locked active reproductive contraceptive methods.

And when we... Sorry.

And when we look at two subcategories, which I thought were pretty interesting. So I was also looking at premature and early menopause. Premature is before the age of 40 and early is between the ages of 40 and 44, which we know are linked to lots of other diseases, risk of osteoporosis, risk of cancer and chronic diseases.

there is actually a war in increasing trends, I mean that's probably an outlier in the ADIZ data, and is much more prevalent than it is in high income countries. So that's another kind of key result from the analysis that we've run.

And then I thought, and this is my current kind of flung, I thought, okay, what if I add some kind of external

exogenous trauma to this to include either conflict or drought or tsunami or earthquake to the variables and see how that actually pans out. And this is pretty much ongoing work which has been on my computer for the last couple of years which is pretty much the Batman and Robin slap in the face.

So what's my thinking? My thinking is that obviously you've got your eco-social kind of environment and your outcomes are determined by your experiences.

And in particular for the timing of the menarche and menopause, this is linked to genetic, socioeconomic, behavioral, and also linked to the stress hormone. So it looks like when the cortisol, the stress hormone, is hit during your childhood, that could have an impact on menarche.

So far, all the studies that looked at the interaction between conflict and menarche have not really been conclusive. They have either shown that it was too early or late. Usually too early means before the age of 11, and late usually probably beyond 14, but everyone kind of puts their own... There isn't really an agreed cut-off point. So I thought, but nobody has really looked at this...

systematically. So guess what? I went back to the DHS. This time I only selected those countries where there has been a conflict and so I ended up with seven countries and 17 data sets. And I specifically tested the timing of the conflict because I've got data where I can go back

So the interesting thing here, and I haven't seen this done before and obviously I have to say that, is that the strongest impact is in the first year of life, starting from fetus. And that creates a negative impact, so it means that it's actually earlier, menarche is earlier.

This is still felt if the conflict is between the ages of one and five, but if it's between the ages of six and ten, the effect is delayed. So it depends pretty much on what stage of the development this happens. Now you would say, okay, what's the issue there? Well, the issue is that mainly in a setting of precarity and instability and insecurity,

The age of puberty, the age of sexual maturity of girls does matter.

And in fact we've seen one of the Real Madrid team, Valeria, she did study this in Iraq for example and then conflict led to earlier marriages as a safety protection from the family. And there are changes which could actually affect mental health later in life. So it does make a difference.

Another thing just to just briefly this is pretty much very much ongoing we have recreated 40 years of data for Indonesia and we've looked at the impact of weather related disasters instead so here drought tsunamis flooding because there is always there was a lot of literature saying I

disasters might increase fertility, disasters might decline fertility. What we found out, and this goes back to the, maybe this is just clear in my head, this goes back to the kind of shifts of the patterns of the transition as well, is that what really changes the effect is the level of fertility. So at high levels of fertility, the disasters increases the level of fertility

but a low level of fertility, disaster decreases the risk of having a child. So this is something that we're disentangling and we need to look more in detail. But the beauty of this

really to be able to put together, I think, something like eight surveys and reconstruct the fertility across 40 years. Hi, I'm interrupting this event to tell you about another awesome LSE podcast that we think you'd enjoy. LSE IQ asks social scientists and other experts to answer one intelligent question, like, why do people believe in conspiracy theories? Or, can we afford the super-rich?

Come check us out. Just search for LSE IQ wherever you get your podcasts. Now back to the event.

the really the reason why I started all this which is putting it all together I know there are lots of pieces in my timeline that are still missing in terms of the other kind of outcomes that are not there which is looking at so when you put them all together and we look at all the experiences and all the reproductive events what

what happens to the health of women, to their aging process. So this is work, these are two papers, one published, which Anastina mentioned before, and one again that is on my computer that needs to come out, that Haney and myself have worked on, with Haney being really patient with me. And

And yeah, basically this is the going back to the theory. This is really the kind of theoretical, well, conceptual framework that we've put together. And this is based very much, and that was where I said I had a lot of fun, because this is very much trying to squeeze every single bit of juice out of the Indonesian data. This is not DHS actually.

the Indonesian Legitimum Data trying to create the histories of women from the age of 18 in terms of their childhood events, then the adult events and then the reproductive histories. We've looked at two types of samples which were determined by the outcomes that we were looking at.

And for the first one, the allostatin loads, we were using a smaller sample with fewer variables for grip strength. We were using more variables. In the first one, I used the kind of structural equation modeling of pathways, trying to see what were the possible

kind of mediators which consider the socio-economic status and as well as the demographics. The second one I was trying to look instead of clustering of experiences because we, because often you see that women experience a certain pathway which is very much linked to their socio-economic characteristics might have some links to their experiences later in life.

So what are the key results? Well, so Allostati Loads is brilliant and that's possibly where I just went for. I really want to do something about Allostati Loads more than anything else.

So I found out about this measure which is a composite indicator where you measure your blood pressure, your sugar level, your cortisol, your creatine which is your risk of cancer. All of these things, you put them all together in a composite indicator and that gives you a number that is assigned to you which is meant to describe your level of well-being.

There are lots of criticisms, I'm not going to go into that, but still I think that the point of this is that we really wanted to then replicate it with another measure to see whether we got the same results, just to talk to the distractors as well. So the first interesting thing is that we didn't get any really association with the level of fertility, the number of children didn't matter.

Terminations which here, because of the sample, we had to link everything together, which linked miscarriages and induced abortion, they did have a negative impact, but consider that because we couldn't control for all of them at the same time, there could have been a selection effect. And what really mattered, it wasn't the number of children. What really mattered is when did they have children.

And in particular the first child, which goes back to my point of it is important to understand when the first period starts. Because I mean, we can already see what's coming up. We couldn't control for menarche here because we just didn't have the data. Paradoxically, it doesn't seem to be important. I think it should be standard in everything.

The headline for the second one, where we have a much larger sample and we have a much more well-accepted measure and objective, were quite similar when it comes to the detriment. This time, we could actually split induced abortion. And there is definitely a class of the facts with clear inequalities. So that's the most interesting thing. And there is an education and wealth gradient as well. Interestingly--

the women in rural areas seem to have a rural advantage or maybe there is an urban disadvantage which I thought that could be a paper in itself

But the interesting thing is here you could actually see the positive effect of having a child because this is in line with the literature which shows you that a small number of children could actually have a protective effect possibly in older age. So this is what we got so far.

So what have I done in the last 7-8 years?

I think that probably in terms of summarizing what we have seen so far and this is this and by the way what I should have said one other thing that I am interested in is we know pretty much there is a lot of literature in high-income countries that sees women living longer but living less healthily than men so I mean

One thing that we need to disentangle really is how much of this is their reproductive histories and their moral changes. So we've seen that there is potentially a faster ageing in societies with little to an existence of a care system. We might be looking at shifts in the reproductive ages and we need to keep an eye on this. And when we account for trauma and stress, this could be much more important.

And also there are pockets of cumulative stress in reproductive histories which determine the long-term impact of women. I want to stress on context because that was one of the key messages and mainly from the analysis of the papers on crisis. Because although I'm a master, I mean you've seen it, I've managed to compare 300 surveys

That's just the beginning, that just gives you a descriptive analysis at the very beginning. What really matters is then looking much more in detail of what's coming afterwards. So what next? Well, I think I've got lots to do. I mean, I've got enough data to last me from beyond retirement, but don't worry, I've got plans.

So there are more studies with comparative analysis of mapping. We still have got lots and lots of data to go through and the exciting thing is that there is more, and I mean that's one of the reasons why I got into this, the exciting thing is that we're getting more and more biomarkers, biometrics, and from low and middle income countries and

I mean, I'm just going to name Costa Rica, Mexico. There's so much of Indonesia that might be coming up. Unfortunately, they are not funded by USAID. So there is hope out there.

There is definitely need for more data, particularly at times of crisis. We need to have data systems preparedness that can test to what is going on because in terms of policy making it is important to look at this in the future.

And we need lots of money to do it. So I'm looking for three million pounds if anyone has got any. I've got a project that is almost over and ready. So with that... Well, I guess no, actually they're asking about cost-effectiveness. How can we save money? So yeah, no, probably I should go somewhere else.

And that's it, but so now there is my Oscar moment because I want to, and that's where my PhD students are learning from you. So I want to thank, and this is definitely by no means exhaustive because there are lots of people also in this room that have helped me, but I want to just

kind of mention the key ones which have been kind of pivotal and important in basically just carrying me. I mean I'll probably never do that but I always dream to do it. Yeah that's that's Andy Vedder by the way. So this is just a few selection here. That's

that's Ian Diamond, that's other people, to my friend, colleague, mentor and editor-in-chief, I'm always so grateful, to my PhD peers which have been painfully spending early mornings and late nights talking about

calendar data and all the rest to the others and I want to mention one above all which is you're probably wondering what that woman in the left on the left there on the top that's my kindergarten teacher

Yes, Nadia, and which I looked up when in lockdown. She taught me that at the age of four, it's really good to stand on a table and shout a Bella Ciao, a song of the partisan resistance of Italy to the top of your voice and just take your shoes off. And I just thought, yes, because she said, just be exceptional and just think outside the box.

So to all these women, and including, I want to actually mention the person that took me from nomads to studying and preparing for calculus in those 40 degrees Roman summers, my angel. So to all of you, thank you, and beyond. And you know there are lots of you in this room. And one more thing, too...

To my little family that has to put up with me every evening and weekends and I tell them, no, no, I need to do one more thing, I promise that. And even on no work day, poor thing, on a Sunday, that, yeah, I just put you through all of that. Sorry and thank you. To my real family, no, to my real family.

You are my iPhone. To my original family, which is my parents, in particular my dad, my enabler, the guy that was sat in the kitchen with me all those years ago telling me,

sign that form because if that's what you do, go and do it. That was the PhD form because at that time we wouldn't sign it and we wouldn't send it by email. And I had to post it as well. I don't know how I managed to get there on time because I signed it at the last minute. And he said there is always going to be a place for you back here. And if it wasn't for him, I wouldn't be here. Thank you. And that's it. Thank you.

So if you have a question, please do just raise your hand. There are stewards with roving mics. So just raise your hand. We're also taking, it's very fancy, I've got a tablet here. If there are questions coming in from people who are listening online, then we will see those questions as well.

If not, Tiziana and I will sit here and have a chin-wag. Oh, sorry, there's a hand there. Yep. Hello.

it is on no i didn't realize what sort of talks like the question i was originally going to ask is going to be about race but no this has been a totally different talk first off they haven't allowed you enough time and also this talk is very high brow for me but i've got most of it i had an hysterectomy at 40 in my 40s and after that i've started menopause and i'm still going through it and it's been worse in the last years and i think some

Some of it is due to stress and listening to what you're saying I think I really thought that but recently I've started to do something that I gave up doing 16 years ago and I'm wondering I just suddenly thought it's been less so thank you for letting me realise why it's suddenly been less in the last three months so I think that's all I've got to say really. Girls, so I've heard

or younger black girls are supposed to start puberty younger, I've heard it being said that it's because of their hair products. Have you got anything on that? Great. I wouldn't be able to comment on that. I don't know. In your research, I didn't know if... Yeah, no, I'm wondering because, I mean, there is definitely... There is a lot around genetics and nutrition, so I'm wondering. But, yeah, I'll look it up. Sorry, I'm not knowledgeable on that. But thank you. Thank you. Somebody here in the white T-shirt?

Hi. So I just had a question. It was kind of like a throwaway comment, but it kind of stuck with me, that you were mentioning in the last bit about the work that's still ongoing, how there may be a link between a positive health impact on women in later life who've had children

Am I misinterpreted? Yeah, with a small parity, so one or two children could have a protective effect. Right, and I just wanted to ask what's behind that? Is it more because you have family to look after you in later life, or is it just completely biological? What are the reasons behind that? I think it's a mixture of biological and also the social network

and being looked after. I mean I didn't have the chance to actually look by age but there is a lot of evidence in the UK or in the US about that. Thank you. Tiziana, we have a question that's come in first of all online and then we'll get a question in the audience. So there's a question here from Alaka Basu at Cornell. Oh, Alaka. How are you? Yeah. Yeah, Alaka is listening.

So early pregnancy has negative effects you say, what about later start of childbearing? It doesn't seem to have an effect, it doesn't seem to have an effect but then you have a sample where you've got very few women that start late, that's the thing but yeah no it doesn't have an effect. Okay it doesn't have an effect on the data that we've got at the moment? Yeah that we've got at the moment, yes. That was so interesting, thank you.

I get my question is about the politics of your research and how you navigate it because some of these areas are really quite fraught politically. People feel really strongly about their own choices but also like governments having policies, you know, pro-natalist policies. You know, if you have findings that suggest that people should have

that it might be helpful or beneficial for women to have more children or fewer children or at what ages they do it, but potentially has really quite a powerful impact both on people as individuals worrying about their own choices, but also potentially in terms of policies that policy makers might want to take these things into account. I was just wondering how you navigate that in your data-based

empirical sort of research? Yeah, no, that's an excellent question. I mean, I start from the banner that everyone should be able to have their own choices in their own time, whatever they prefer. So I think that this is within the framework of you need to do whatever is needed for people, for individuals to be able to make their own choices. But yeah, no, I understand. I mean,

In a way I'm lucky because I'm working alone with around from countries, my research doesn't really get much attention in the news. I mean the Daily Mail doesn't really look for me so I don't have to deal with controversial questions that maybe somebody like when they're working in the US or UK might have. So I mean fortunately I haven't had to deal with it. But yes it's really difficult and I mean I struggle to

as an academic and i think actually academics in general struggle to get that message across that doesn't get distorted by the news in terms of even just the the pro-natalistic or the anti-natalistic kind of rhetoric so yeah no it is it's really it's really something that we struggle with

Because I mean, I start from the idea that everyone should have the number of children whenever they want it. And in fact, this research should be about enabling people to have them in a healthy and safe manner. We've got a very lively online set of questioners. It's my brother. I don't think it's your family. It might be.

There's a question here from Chelsea Bunky who says, "Thank you so much for the talk. In your slide on the impact of conflict on fertility reversing between women with high and low fertility,

What's the threshold between high and low? What measures are used? How are you defining high and low? I wasn't measuring a threshold. It was the number of children. So it was really going with the number of children women were having. I will go back to the second question, which is from Neelam Makani, a current student, who says, "Thank you, Tiziana, for the amazing talk. I'm proud to have learned from you." I think it's important to hear this stuff.

Neelam has a question about how in lots of different cultures, shame around these topics, including menstrual shame, is something that continues to persist and impacts people's experiences. And in your work, what role, if any, do you think shame has played or is playing in what you're seeing in the data, thinking about the socio-ecological model?

Well, I mean, I can't measure the shame with the data that I have, or at least I haven't actually looked for something, but that's an important point. But it definitely is one of the reasons why I got into this topic as well. I mean, as an early starter, I still remember my great aunt telling me not to touch plants when I was having my periods, because I would have killed them.

And she really believed that and I was scared to death that I would have killed the plants. It was kind of you go into hiding kind of thing and it's really traumatic when you're 10. Yeah. So yeah, it does make a difference. That's why I think actually the cognitive functioning, the mental well-being is really important around puberty. It's a hormonal rage.

That's the technical term. I can see three more questions. So one person, Kate, thank you. And then definitely seen there's a hand up here. Yeah, Kate. Thank you very much. I was quite interested in the work that you were doing relating to the various types of shocks that can affect these processes. And I imagine that you're familiar with the

work on the ways in which economic shocks also can affect demography. So the stalled demographic transition where you've had long periods of structural adjustment that actually have set countries back. And I'm wondering if you look at all on the way that economic shocks, long periods of austerity, affect any of these processes, whether that's come up at all in your research.

Yeah, that's a good point. I mean, I'm really looking at disasters, although I mean some stuff. I mean, it'd be interesting to see how the latest Trump era, that probably compares to a bit of a disaster. But I'm really interested in the major shock, like distraction type of thing, or...

But yeah, there are lots of studies, mainly in European countries, around fertility and austerity and economic financial crisis. And Wendy, am I right in thinking that there is mixed results as well? It's not clear. But I mean, these, I wouldn't expect so much of an impact on biomedical outcomes unless there is really kind of pure poverty where nutrition is going to be heavily affected.

Actually the

because you're really looking mainly for menarche you're really looking at between 9 and 16 or less the reason really in H heaping there because you wouldn't really place it it looks like there is the kind of recall is quite good so that would be the main one the and also the menopause is

when was the last time you had new periods? So it's measured in months since. I mean, there are other problems, but yeah, the age being is not really much there. Yes, so green cardigan and then Daisy. Thank you so much. I'm wondering, what have you seen in the data regarding breastfeeding and time of length of lactation, if anything? I haven't actually looked at it. That's in my

It's my to-do list. I haven't looked at it yet. But I mean, there are definitely studies that show that stress and trauma affects lactation. So yeah, actually, you've just given me a tease. Hi. Thanks for the talk. It was really great to listen to you speak again. I was really wondering whether your research may have-- or whether you're thinking of also extending it past menopause, because

I know that you might understand that menopause is a bit of a gray area in that, okay, it's the last period that you had, but then sometimes periods return even after a couple of years. And so like how, yeah, how health is actually impacted by this kind of back and forth with women who have, I guess, I'm not sure if there is a term for that kind of menopause, like

It's quite a great area. Sorry Lizzie, I'm not quite sure I get what you're saying. You said beyond menopause? Yeah, so like, I guess in terms of there's a lot of new therapies coming out in terms of for menopausal women and people and so like how this has impacted also health

I'm not sure if I'm making sense. I mean, you mean like HRT and things like that? Yeah. As far as I know, the data I've been looking at doesn't have those data, but I know that there is a movement to increase that. So yeah, watch this space. But definitely that will be kind of one of the variables to account for. I mean, how the kind of aging process is then mitigated as a mediator with the HRT. Yeah.

Yeah, that's a very good point. Adora. So, Adora and then Wendy. He's got a mic.

Thank you very much, Professor Lee. And it's really lovely to hear this entire journey from your journey. I think since you're thinking about the future and what lies ahead, I thought maybe let me ask those questions. So I think the first one is really about the DHS. You know, a lot of your work being in LMICs and no thanks to the

current president that doesn't exist anymore so what are the plans that you have going forward in terms of data that you be able to use to expose some of these

very interesting findings that you showcased today. And secondly, it's really about interventions. I do not know if in the course of your journey you've thought about testing effectiveness of interventions to target some of those allostatic loads that you highlighted and maybe some potential for implementation research within this space. Over to you. Thanks. Thanks, Dua. I mean...

I wish I had more positive news. I mean, yeah, no, I've got a couple of positive news. Like, for example, I discovered that the Indian sixth wave is not funded by USAID, so it's going to come out soon. And, yeah, I've been promised that it's going to come out soon. So, yeah.

Well, and don't say that to my friends. Also, I mean, what is it? Is it end of March? So we've got three years and ten months to go. So I'm hoping that someone else might take it up. But then I hoped that David might come back with labor and look what's happening to development. So, I mean, I'm not quite sure.

What I'm really hoping for is that maybe countries now they can take up and find new donors. Although I really can't see the light at the end of the tunnel. I mean, I definitely have enough data to last me for the next 15 years.

But I really fear for future generations in terms of what we can do because, I mean, my job is easy because in terms of your next question, I'm just looking at the determinants. I'm just looking at mechanisms, pathways. The interventions is the difficult bit, isn't it? Trying to translate that into policy, which is your work, is more what you do. But, I mean, that links to me looking for money as well because one of the things we want to do is –

trying to understand mitigating factors, what people do in the communities. That's what we don't know. What do you do in the fields and the ground? I mean, are any of these taken into account really? I think we are even one step

earlier than this because aging hasn't really entered the the the kind of agenda um i mean you i was i was asking um the assess the the the surveillance sites do you collect any data or stuff and they said well look we're still dealing with the adolescent pregnancies so aging is not really

something that donors are interested in. It's not cool, it's not a cool topic, is it? I mean, if you look even at the master's degrees in aging and gerontology, they're all collapsing. Students are not interested, which I don't understand because, I mean, that's where the money is going to be. But...

But yeah, sorry, that was probably a convoluted thing. But yeah, you're right. The difficult bit is going to be the... I'm going to ask you, do you see any hope in the DHS or the collection in the future? Actually, I don't know what I want to tell you about this. No, I do. I think it's a...

It's a tricky time and I think the answer has to be within the countries. I think there's an opportunity with these sort of funding cuts for countries to look inwards. There's no reason why USAID should have been funding data collection in LMICs in the first place is what I think. So I think it's an opportunity. No, absolutely. I mean, it wasn't sustainable that way, but it definitely was an enabler and to cut it completely off like that to send everyone home was just not...

It's decades just gone into fumes. Okay, Wendy next and next is from White Top. Is this one closer to my mouth? Better, yeah? First of all, I just wanted to say how delighted I am to be here and watching you present results that I first saw at BSPS meetings and seeing actually published and also thinking back to sort of seeing your promotion portfolio and thinking how

how much earlier you should have gone and just to congratulate you on the contribution you made. So it's just wonderful to be here and to see you getting the recognition that you probably should have gotten years ago is wonderful. My question actually, I think I was having similar thoughts to my friend down the row. I'm wondering how much measurement error there is in menopause

variables and how that might actually influence some of the results that you're looking at because measurement error might vary by some of the social determinants that you're looking at and I don't recall seeing you present that before or hearing you talk about it but I'm sure you've thought about it because I know how carefully you think about things. Yes, I would have to open the paper again but yeah there is obviously measurement error but it's not as big as one would expect.

And it makes me think about how much can you actually remember about your last period. But because of the age of the women that we're looking at, it's quite recent. So yes, there is an issue related to the fact that obviously we're looking at younger women, but the way in which we have estimated it allows you to actually have women that will remember more because it's quite recent. But yes, that's something that needs to be explored more.

Thank you. Hello, thank you so much for today. It was a really interesting and insightful presentation. I was wondering, particularly the menopause age coming more forward is quite striking, and I was wondering if through your research you've looked at the use of contraception or how it impacts, if in any way,

the age coming forward or if this is a variable that you've considered or perhaps came across in other research because it would be interesting to know if this has an impact given the use of contraception is the in modern times yes we did we did actually do the calculation um with and without certain types of contraceptive use um contraceptive methods and there was no difference it didn't affect the trends a couple more questions have come in

One from Ivana Valencia Cortes, another one of our students. Again, thanking you for this wonderful presentation and for the research that you do. She wanted to ask your understanding about any links between experiences of violence, including sexual violence and onset of menarche, or whether or not your focus is more looking at population-level crises and trauma.

I haven't actually looked at that so I wouldn't be able to know but yeah I guess that would be one of the variables it's just it would be really difficult to measure so I'm looking more kind of relational level. Yeah. But yeah, definitely. Oh, sorry. Yes, back in the audience and then we'll go back online. Sorry. I want to go back to the data nerd. Which gives you greater pleasure? The methodology or finding the data? Oh gosh, finding the data.

I still remember, actually I forgot to mention this, I still remember the first time I opened a whole census where they actually forgot to remove the names as well. So I thought,

and I could see everyone and I just thought, "Whoa!" There were millions of people just on my screen and that was amazing. And then I had to delete all the names and I'm not going to name the country. But yeah, now that's finding data. Actually sitting in the office of the Lesotho census... It wasn't that, that was it. That was it. Sitting next to the IT guy and

and begging him to give me their CD with the data and he said no we can't, no please I've come a long way. That's probably what I like the most. You know her very well to ask that question. Well we were at 7 o'clock in the morning talking about calendars. A question here from one of your co-authors, Haynie Weissman in Paris at INED.

Asking why do you think fertility increases in high fertility societies and decreases in low fertility societies due to conflict? She hopes she understood your graph right. Yeah, no, I went pretty quick. No, that was disastrous. The short answer is I don't know, to be honest with you.

I really don't know. I wonder whether it's perceptions of mortality, again, whether it actually goes back to perceptions of mortality. This is very much, I ran the model and I left it there because I didn't have the time. But yes, it's a good point. I wonder whether it's at times of crisis, because you see more mortality around you, whether there is that.

But then why does it go down when it's nowhere? Yeah, but why would it behave differently in different fertility societies? Well, probably it's a different set mind, different cohorts. Yeah, that's a good question. I can see Tiziana's brain working. She's like, oh, how would I model that? Because I need to justify the results. Yeah, I just put it there. No, that's a very good point.

Oh, there's another question there. Just while the mic is going there, I have a question for you. Let's ignore the issues around resources and funding of surveys. If you could have one, maybe two questions inserted into surveys, what would they be? I'm not giving you any room, you're not having any sub-questions. Which age group? Nationally representative, you pick the age group. Oh, gosh. She's like a child at Christmas.

I think Agent Menakee should be everywhere. Agent Menakee, there we are. Yeah, he should be everywhere. Professor, thank you very much for the presentation. We go back 30 years. I wanted to ask you about where your research will take you in the future. And actually it's a bit of a fantasy moment. If you project whenever you're going to retire, you said you may retire.

at some point, not hopefully in the distant future, but at that moment in time where you've looked back and you've really achieved everything you want to in your research, what is that holy grail position that you're aiming for? So what is that ultimate north star, let's say, that you're really aiming for, where you look back and say, do you know what, I've done it.

Well, it's to start... Ah, that's a very good question. To start a longitudinal survey in Palestine. That's my dream. And by the way, thank you for stopping me, you and Sabine, all those years ago, from filling in the form. This is going back to my... Because Malone and I used to be housemates. Filling off those forms for hair hostess of British Airways. LAUGHTER

Because my brother said, probably they're online, they thought I should have, they made me do the exam for ticket controller on the high-speed trains. But then I went up one level and when I was about to graduate, I was about to fill in the forms for British Airways and Marlon and the other aspects said, what on earth are you thinking? So thank you.

Sliding doors moment. There's a question here at the front. Or has somebody else got a mic? Sorry, blue shirt. Thank you. Thank you for the research we're doing and we hope to hear more of it. Such a gift to come here as a member of the public that isn't an academic, I see. I just had a question about the variables. So you mentioned lots of correlation. And one of the questions I have is genetics because you talk about hormonal range, but

Which is the most important? Have you categorised which is the most sensitive of the lot? You've got so many different variables. I'm just curious. Is there any one standing out? Yeah, probably it's the socio-economic aspect.

status, but I mean you mentioned genetics and that's definitely in my future plans because a colleague of mine made me think that with machine learning you could actually try and link up the kinship relationships within the household. So that's something that I've got in plan in trying to link up the kind of

links within the household of mother and daughter or anyone within the household. So definitely that's another stage of modeling that I want to think. And it seals the loop between monarchies and menopause with only the same person. I've looked at them. I've looked at them. There isn't, well, we've got only limited data where they're both. And if there is a relationship, seems to be going opposite directions. So earlier, later, but it's not that strong.

So you talked about the questions that you wanted to add. I want the shade. What is the question that everyone's using or you see used a lot that you want to kill? That you're sick of, you don't want to ever see that variable again or that question again in the survey. You can kill any question, I give you that power. Oh gosh, if you can kill that question, I never thought about that.

It's just that it's too precious. You can't kill anything with it. You need to keep them all. Well, don't keep the bad questions. I'm thinking about the question that combines stillbirth, miscarriage and abortion into one. Let's kill that question. Yeah, kill that one. Or the ones about preferences. The one about preferences, yeah.

If you could go back to a point in time, how many children, yes. How many children would you have? And stuff like that. No, no. Fertility desire. No, fertility desire, I hate it. You're still awake. Kitty. I want to know why you would kill fertility desire. That's interesting. Is it just when you could... If you could go back in time? Or when you can see how many... Because I would have thought...

Maybe I'm thinking of longitudinal data, but I think knowing how many women, children a woman wants to have and then seeing. No, I mean it's cross-sectional because sometimes they put too much weight in the answer and they just overload the meaning of what they... But I mean, look, I'll keep that one as well. These days you can't be choosy, really, whatever you've got. I'm sure we can squeeze something out and manipulate it in a way that makes sense. Great, I'm excited. It's good. Yeah.

Hello. So proud to be here. I guess I wondered, and I wasn't sure from one of your earlier answers if this is actually a stupid question, but whether you thought or there was any possibility that your bookends were just moving earlier in the timeline at a population level. Is that what you were saying or were thinking? Yeah, at the population level, yeah. The averages are shifting towards the left.

Do you ever think, are you going to investigate why? Yeah, that's the next stage. I mean, this is just the last few years. So yeah, I've got enough stuff to do. I just need a couple of sabbaticals.

say it louder for the record. Where is my head of department when you're dating? I just grabbed the mic as it passed me by. Congratulations as well. Very, very, very happy for you. Yes, and for all of us that we have a fantastic professor. You escaped the picture, but you should be there as well. A fantastic professor in our department, which is wonderful to have. So, yeah, just...

Just thinking about what Kate said about moving to the left, and also think about your future research directions. Obviously, with being a qualitative researcher, thinking about micro-level, everyday kind of research, to what you've been mapping here in terms of the data at the population level, when...

Do you wonder, I think you probably do, what those shifts mean for women's everyday life and how do they experience them? Are they noticeable? Are the changes big enough to be noticeable to everyday people? What might women think of these changes in the countries that you study? What might they mean for them?

Yeah, do you have any thoughts about that? Well, I mean, I guess that, yeah, despite the fact that I'm so attached to the geekiness of the data, I mean, that's the underlying factor of why I'm studying this. Because, I mean, it is a massive shift for a girl to have your period at 10 rather than 12, or for a woman to have your menopause when you're 36 rather than 45 or 50.

not just because that is a biological shift which is going to have consequences on your physical well-being but also on your mental well-being and I think that's the major reason why we need to look at these shifts because it changes perceptions as well. I mean if you look at even the weight culturally that is put into that

change into puberty or that change into menopause, which is the kind of dark side. I mean, it's also the perception that others have around you about you as a person, an individual, and that defines you. I mean, that's one of the reasons why I think why it is important. I mean, the other day,

It's not that I'm showing off, but when I was at the House of Lords, they were saying, "Should we put... How can we manage to save money for reproductive health?" Reproductive health is health. It's healthcare. It's non-negotiable. It's part of half of the world's population.

And so I just don't think that you can think of these things as a specialty or a niche. I mean, it's part of who you are or who defines you in terms of how it shapes you as a human being. So it is important and I think about that a lot. I want to draw this to a close now and invite people to join Tiziana outside the reception.

I've just seen, okay, it was just somebody making a suggestion of an event that you should go to. I've got information coming in on every channel here on the iPad. I want to thank Tiziana, I want to thank everyone for coming to celebrate with Tiziana and to hear about her work. I think I particularly want to give a shout out to the school teachers that spot the child.

who is loving her data and suggests that maybe they should think about doing social statistics at university. So here's to that school teacher that spotted that. And thank you, Tiziana. Well done.

Thank you for listening. You can subscribe to the LSE Events podcast on your favourite podcast app and help other listeners discover us by leaving a review. Visit lse.ac.uk forward slash events to find out what's on next. We hope you join us at another LSE Events soon.