Horizons 40 Pioneering research from the University of Cambridge 02 03

November 2020 Spotlight Contents Reproduction

COVID-19 26 30 04 Foreword Vice-Chancellor Professor Stephen J Toope introduces a special focus on COVID-19 research

06 People powered Meet a few of the many who are helping to address the spread and impact of the global pandemic

08 “In it for the long haul” Biomedical researchers at the heart of the health crisis are also preparing for the viruses that come next

12 Ad Hoc Search for a vaccine (against fake news too), the £10m challenge, looking beyond the pandemic, and more 24 The big picture Fertility futures Set up for life Professor Kathy Niakan talks about some of Four decades after IVF was conceived in Cambridge, How does the environment experienced in the Features the major questions in reproduction affecting sociologists investigate the new ‘haves and have-nots’ womb programme us for diseases later in life – individuals, families and populations everywhere in our fertility futures and even the health of our grandchildren? 16 This Cambridge Life The Mongolian conservationist helping nomadic herders preserve lands under threat from the fashion industry

18 Displaced lives Dr Naures Atto is determined to give voice to the migrants denied a home and basic human rights 42 20 Meltdown 100 years of polar research – and the catastrophic changes to ice sheets at both ends of the planet

22 Fieldnotes Walking on Mount Terror in South Africa, botanist Dr Ángela Cano likes to stop and smell the succulents

Editor Spotlight advisory editors Dr Louise Walsh Professor Graham Burton Professor Sarah Franklin Feature writers Christina Rozeik Dr Tom Almeroth-Williams Professor Gordon Smith 38 Craig Brierley 34 Sarah Collins Design Jacqueline Garget Modern Designers Surviving birth (When) are you going to have children? A brief history of reproduction Charis Goodyear Research at one of the busiest maternity What influences one of the most significant choices From the banks of the ancient Nile to Fred Lewsey Cover illustration hospitals in the world aims to help more women many people will ever make – and how has this the fertility clinics today, 4,000 years of Dr Louise Walsh Sam Falconer survive complicated pregnancies and birth changed over time? making (and not making) babies (in brief) 04 05

Foreword Vice-Chancellor Professor Stephen J Toope introduces a special focus on COVID-19 research.

Image Machines developed by a Cambridge University spinout being used to diagnose infection with SARS-CoV-2 at Cambridge University Hospitals NHS Foundation Trust

To remark that the past year has been Cambridge Institute of Therapeutic powerful contribution to society than unusual is an understatement. Things Immunology and Infectious Disease – Cambridge’s response to this global that seemed unimaginable this time last pivoted almost the entirety of its health emergency. year – the clear and present risk to research towards studying, treating and public health, the shutting down of our testing for COVID-19. And of how the As this issue of Horizons was being institutions, the cutting off of our social University and nearby Wellcome Sanger completed, we learned with deep contacts – were, quite suddenly, the new Institute are leading the COVID-19 sadness of the sudden death of our pattern of our lives. Genomic UK (COG-UK) Consortium, colleague Professor Chris Abell. It fills me with enormous gratitude a major national effort to deliver large- As Pro-Vice-Chancellor for Research that, at the moment of greatest scale and rapid whole-genome since 2016, Chris helped to coordinate challenge, our community rallied and sequencing of the virus to guide UK and support the University’s research rose to the occasion. Colleagues public health interventions. endeavour, the results of which have across the collegiate University worked Others focused on NHS capacity, regularly been reviewed in this magazine. tirelessly to modify teaching and and on the logistics and supply chains He was instrumental in coordinating assessments, develop new systems for for frontline resources like personal the University’s response to the national business-critical activities, manage the protective equipment. An award-winning, need for COVID-19 testing. Much of closing and reopening of buildings, and low-cost, open-source ventilator was what is covered in this special issue put together public health measures to designed for use in low-income countries was made possible, in some way, thanks keep everyone as safe as possible. by a team from the Department of to his personal efforts. He will be missed Meanwhile our researchers jumped Engineering’s Whittle Laboratory, by all of us. into action. Dozens of new research working with colleagues from the projects began on the nature and Institute for Manufacturing and in transmission of the SARS-CoV-2 virus, collaboration with a manufacturer in on finding therapeutics and a vaccine, South Africa. and on understanding the impact A large number of research projects of anything from mental health have also begun on post-COVID recovery, to social behaviour. including studies on the economic Work had already started on this impact of the pandemic on social and edition of Horizons when the national educational equality and, vitally, on lockdown was announced in March. how we can prevent future pandemics. The enforced pause offered an And there is so much more – again opportunity to rethink its contents and again we’ve seen researchers across to highlight some of Cambridge’s the disciplines contribute their time extraordinary contributions to tackling and expertise at this challenging time. COVID-19 the COVID-19 crisis. We often remark on the University of The projects highlighted here are the Cambridge’s mission: to contribute to tip of the research iceberg. You will read society through education, learning of how one of our newest institutes – the and research. I cannot think of a more Credit Cambridge University Hospitals NHS Foundation Trust People Illustrations Words pandemic. global impact of the spread and address the to helping are manythe who Meet afew of 06 Louise Walsh Louise Tracy Worrall

inform policy.” good best can science the ensure quickly, to questions right the to address utmost our doing “We’rein UK,” the says. she of spread changing patterns the of understanding our is as quickly, building is virus very future interventions. developing principles for for and reopening schools options on advice shape to used been has evidence The spreads. a pandemic how to model in turn helps reproduction ratio, which R, virus the out to work contact into come people when and modelling the transmission on an is expert Julia Gog Physics Theoretical and Mathematics of Applied Department JuliaProfessor OBE Gog Science and Policy. and Science and Cambridge’s Centre for for Emergencies (SAGE) Group Advisory Scientific the via government the universities – and advising and inchildren, schools and among particularly COVID-19, focusing on the of spread been has she crisis, the of start the Since influenza. like diseases infectious of “O H er team looks at how how at looks team er ur knowledge of the the of ur knowledge powered

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test samples from Colleges. from samples test student collect and deliver and kits test to prepare staff and students clinicians, workingProgramme, with COVID-19Student Testing Pooled wide Asymptomatic University- the of logistics the for responsible been also has weeks. four just ventilator sharingin system an emergency tested built and designed, and PPE, millions of items of donated hub for logistics temporary a manage up and set design, helped They staff. and equipment beds, of shortages to anticipate and patients of flow the to manage principles information engineering adapted team the hospitals, and supplies.” patients of flow the be would and materialsproducts it of instead wards; be would of production linesinstead it settings: industrial from know we what to apply offered We COVID-19 patients. in asurge with to deal operational changes needed the make to scrambling they could help. thought staff and students Cambridge of ateam and he apparent, became pandemic the of scale the as but, year March before operations this hospital about little very knew he admits McFarlane Duncan of Engineering Department McFarlane Duncan Professor S W “ Hospitals wereHospitals ince August, McFarlane McFarlane August, ince orking with local local with orking Blakemore. that concerns Sarah-Jayne aquestion is This pandemic? during contact face-to-face a haveteenagers reduced when happens what so throughout adolescence – actions ofdevelop others mental states, feelings and the to us recognise enable that brain the of parts The social. inherently are Humans of Psychology Department Blakemore Sarah-Jayne Professor decisions are being made. being are decisions policy pandemic-related when people young of needs the an organisation highlighting Reachwell, up setting in life.” of a young person’sportion a largetemporary, represent even if only restrictions, and distancing social their Waves development. of for this crucial is when lives atimein at their peers with in person to interact chances fewer had have people young

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post-pandemic future. wellbeing inand UK’s the of job creation, sustainability questions UKthe to tackle in and Cambridge others with will working she be Institute, Productivity £32.4m national new the of inform future policy choices.” lessons these to ensure and tostandards, living damaging will particularly be pandemic why aware of the to be it’s essential “but pandemic, aglobal of hit economic the to avoid possible it’sthat not says Coyle Diane Economist PublicPolicy for InstituteBennett CBE Coyle Diane Professor prosperity.” repairing the engine of to publicto health turn from needs focus management crisis the before long be not to.Itwill to stick something need big, how matter no plasters, sticking fiscal But to people’s livelihoods. damage limit immediate the to to try spending to massive rightly, have, world turned

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COVID-19 07 08 09

As the COVID-19 pandemic sent Britain Fast into lockdown, researchers on the Cambridge Biomedical Campus were Facts at the heart of the University’s response 150 scientists at the to this unprecedented challenge. Cambridge Institute of Therapeutic Immunology and Words Craig Brierley Infectious Disease re-focus Illustrations Zoë Barker research on COVID-19

NIHR COVID BioResource creates one of the largest banks of biological samples in the UK to understand how COVID-19 symptoms relate to the immune system

New testing devices reduce time to diagnosis from 26.4 h to 2.6 h, halve time patients spend on COVID-19 ‘holding’ wards and prevent 11 ward closures

Cambridge University and Wellcome Sanger Institute became the centre of the national COVID-19 Genomics UK (COG-UK) Consortium using genomic surveillance to track infections “In it for the long haul”

When I first meet Professor Ken Smith very different place. There are fewer disease, virology, cell biology, global in his new office, out of instinct we go people about. Hand sanitiser dispensers health and pathogen surveillance. to shake hands. There’s an awkward greet you at the entrance and signs Running at about 50% capacity, moment as we remember the public remind you to keep your distance. CITIID’s labs have had around 150 health advice and stop ourselves, opting But beyond the visible transformation, scientists working on COVID-related for ‘elbow bumps’ instead. something fundamental has changed. areas, including researchers from labs It’s 10 March and we’re at the CITIID was one of the few University across the Cambridge Biomedical Cambridge Institute of Therapeutic buildings to remain open throughout Campus. Some 60% of the Institute’s Immunology and Infectious Disease lockdown. As the world faced an group leaders also work at one of the (CITIID), which opened in autumn 2019 unprecedented threat, Smith knew his hospitals on the campus, including in the Jeffrey Cheah Biomedical Centre team had vital expertise that could help Addenbrooke’s Hospital, part of with Smith as its Director. Less than two fight the pandemic. Cambridge University Hospitals NHS weeks after we meet, Britain entered “The Institute was really set up to Foundation Trust (CUH). COVID-19 lockdown as SARS-CoV-2 swept across deal with this sort of thing,” says Smith. the country. He had intentionally recruited people Back to basics SARS-CoV-2 is a Professor Ken Smith By the time I return months later, the with a broad range of expertise, including coronavirus: spherical, with ‘spike’ Director of the Cambridge Institute of building – and, indeed, the world – is a immunology, inflammation, infectious proteins on its surface that bind to → Therapeutic Immunology and Infectious Disease 10 11

ACE2, a receptor found on cells in the and to look for other factors that might We have to be prepared not just for this people up, to work out ways in which we and Non-executive Director on the “It’s not going to go away in a hurry,” upper respiratory tract, nasal pharynx help the virus to enter cells. They are virus, but also for the next viruses that might help that recovery process.” Board of CUH. “Building on Cambridge’s says Smith. “A bit like the flu, it will come and lungs – which is why the virus can also using their expertise in proteomics come along. If we can identify new drug Another reason for following patients expertise in genomics, we can tease and go and be something we will have spread by airborne infection. – the study of proteins – to work out how targets, which we could use as antivirals, over a long period is to measure how long apart the complex picture of coronavirus to deal with in an ongoing fashion.” “There’s still a question mark over the virus manipulates the host cell’s then that might help us in the future.” their immune response lasts. Typically, spread in the UK, and rapidly evaluate He believes that, even if we cannot what ACE2 actually does in the airways,” machinery to enable it to replicate, yet Smith, too, is interested in the our immune system produces antibodies ways to reduce the impact of this disease eradicate it through vaccination, we says Professor Paul Lehner, who leads evade the immune system. immune system, and in particular the that will neutralise the infection should on our society.” will improve its management with CITIID’s Intracellular Immunity Team. Lehner admits his work may not role it plays in the severity of COVID-19 we encounter it again. No one knows if In eight months, over 100k viruses antiviral and anti-inflammatory drugs, His group is using genetic approaches produce any ‘quick wins’, but that is not – why does the disease kill some people this will be the case with SARS-CoV-2 have been sequenced, providing a and therapeutics based on antibodies to understand why ACE2 is important the point. “We’re in it for the long haul. while others remain asymptomatic? infection. unique tool to investigate clusters of against SARS-CoV-2. Smith has teamed up with Professor cases in hospitals, care homes and “Even in the absence of a highly John Bradley and colleagues at the Testing times As the pandemic started the community. Now, with £12.2 million effective vaccine, I think it’s likely Snapshots National Institute for Health Research to take hold, Smith realised his team government funding, COG-UK will that our medical care will improve. (NIHR) Cambridge Biomedical Research could also help on another front: to expand capacity to meet an increase in We’ll be able to intervene earlier, The intensive care medic The superbug sleuth Centre, to establish the NIHR COVID relieve some of the intense pressure the COVID-19 cases expected this winter. and more effectively, and the mortality BioResource. This builds on the existing NHS was facing by providing improved For hospitalised patients, genomic rate will drop.” national NIHR BioResource, initially set testing facilities. Together with the surveillance is also being used in Before COVID-19, experts had long up in Cambridge, which collects blood Infectious Diseases team at intensive care units to monitor secondary been warning of the risks of the next samples from healthy volunteers and Addenbrooke’s Hospital, CITIID helped infections by antimicrobial-resistant pandemic. H5N1 bird flu, SARS, MERS patients to examine the links between establish a screening programme to test genes, environment and health. hospital staff frequently and to help the A “small army of volunteers” from hospital tighten up infection control CITIID and other laboratories, plus measures. In numbers... medical and nursing staff from CUH, Rapid point-of-care testing in helped recruit patients, ferry blood emergency departments became samples across the campus and process possible using SAMBA II machines them, working seven days a week for the developed by Diagnostics for the Real first month. World, a Cambridge spin-out company “Intensive care specialists are like the Twenty years of clinical research Smith’s work entails detailed analysis set up by Dr Helen Lee. Virologist canaries in a coalmine: they’re often experience in infectious diseases in of which immune cells are present and Professor Ravi Gupta showed that the the first to spot something that’s new the UK and overseas has helped to how this changes over time (a technique testing devices provided a diagnosis and worrying,” says Dr Charlotte prepare Dr Estée Török for her work known as immunophenotyping). By within an average time of 2.6 hours Summers, a University Lecturer in on COVID-19. marrying this information up against the compared with 26.4 hours for standard Intensive Care Medicine in the Török works in the Department of patient’s medical records, it’s possible to laboratory tests. The average length of Department of Medicine. By January Medicine, and at Addenbrooke’s see how the symptoms of COVID-19 time patients had to spend on a this year, “it was clear from colleagues Hospital, where she focuses on using relate to changes in the immune system. COVID-19 ‘holding’ ward almost halved in Asia there was something very genome sequencing to investigate the “The aim is to identify abnormal and 11 ward closures were prevented in nasty heading our way.” transmission of pathogens in hospital pathways that might be targets of the 10 days after implementation. This was the very challenge she’d and community settings. existing therapeutics, but also to identify Gupta then showed that combining trained for: her specialism within In March, she turned her attention people more likely to get severe disease,” the SAMBA tests with antibody tests SARS-CoV-2 genomes sequenced by the COVID-19 Genomics intensive care is in respiratory to SARS-CoV-2. Together with he explains. “The ability to predict allowed them to identify 100% of 100kUK (COG-UK) Consortium in eight months starting March 2020 illnesses and she had been part of the colleagues, she set up a system to + disease outcome is something we need COVID-19 patients. CUH has since preparations for the previous MERS rapidly sequence clinical samples and to have, as early treatment is likely to be implemented this combination of tests coronavirus. “It’s no exaggeration to analyse epidemiological and genomic more effective.” in the emergency department. pathogens like MRSA – ‘superbugs’ that and Ebola all threatened to spread say that my career has been exactly data from COVID-19 patients at In just a few months, Smith’s team can no longer be treated by frontline beyond regional boundaries but about preparing for a pandemic. Addenbrooke’s. This information was has created one of the largest, most Genomic expertise Cambridge medicines. Speed of diagnosis is crucial. fortunately failed to become pandemics. I couldn’t be sure how bad it would fed back to the hospital clinical, intensively immunophenotyped cohorts University and the nearby Wellcome In most hospitals, it can take days to get “In a way, we have been relatively be, but I suspected it was likely to be infection control and management in the country. Over 200 COVID-19 Sanger Institute lead the COVID-19 a result, during which time the patient lucky so far,” says Dougan. “Even with the biggest challenge in our lifetimes teams to help investigate and manage patients have had blood samples taken Genomics UK (COG-UK) Consortium, would have been given a broad-spectrum SARS-CoV-2, this could have been a so far.” suspected outbreaks of infection. throughout their stay in hospital, and a national initiative that includes the antibiotic rather than a more appropriate much more aggressive and virulent virus, Because of her expertise, “COVID-19 is a global public health samples will be taken at one, three, six NHS, public health agencies and treatment. for example impacting children.” He Summers has advised the Cabinet emergency that requires national and and 12 months later. The team has also academic institutions across the UK. “This is not good because antibiotic argues that richer nations have gradually Office, the Chief Medical and Chief international collaborative efforts,” recruited healthcare workers who Viral samples from patients with use drives the emergence of antibiotic lost their sense of danger concerning Scientific Officers, and major funders she says. She herself is involved in screened positive for COVID-19, allowing confirmed COVID-19 are sent to a resistance and you can actually make the epidemics and serious infections. “We on issues such as ventilators and COG-UK, and the RECOVERY trial, study of those with asymptomatic and network of sequencing centres for case worse,” explains Professor Gordon must reacquire this instinctive memory. developing therapies for COVID-19. which is investigating potential mild disease. large-scale, rapid sequencing. Dougan, another member COG-UK. We shouldn’t have to rely on luck.” At the same time, she led a treatments for COVID-19. She also One of the more surprising aspects of The results enable changes in the virus “Because we can tell [the medics] within That’s why having an institute like GSK phase 3 multicentre trial for set up and ran the Cambridge arm COVID-19 has been how long recovery to be tracked at a national scale to a few hours, then they can give a much CITIID – together with the huge a COVID-19 therapeutic. It didn’t of the Oxford vaccine trial, screening can take. Even some patients with only understand how it is spreading and more targeted treatment to the patient.” collaborative research effort towards stop there: Summers was chosen and vaccinating several hundred mild disease have reported taking whether different strains are emerging. combating COVID-19 that has taken to lead the bronze intensive care volunteers in just over three weeks. several months before they have fully “This virus is one of the biggest Ready for next time Twelve months ago, place across Cambridge – has been so unit crisis team at Addenbrooke’s “With a dedicated and enthusiastic recovered. threats our nation has faced in recent no one had heard of COVID-19. Now, important, says Smith. “What we are Hospital, helping to reconfigure the team it is possible to achieve “There’s a lot more long-term damage times, and crucial to helping us fight it social distancing and lockdown – even learning about the relationship between entire hospital. extraordinary things.” than we’d envisaged,” says Smith. “We is understanding how it is spreading,” the R number – are part of everyday infectious disease and our immune just don’t know the rate at which the explains Professor Sharon Peacock, who conversations. The coronavirus has systems will help us in this pandemic – Dr Charlotte Summers Dr Estée Török different aspects of disease improve and leads COG-UK, and is also Cambridge’s changed our world dramatically: is it and it will also help us to be ready for correct. That’s why we need to follow Chair of Public Health and Microbiology, here to stay? what comes next.” • 12 13

Innovations, explorations, news, TECHNOLOGY VIEWPOINT views and discovery. Read the Support for Risky Talk full stories and many others at The public appetite for cam.ac.uk/topics/COVID-19 scientific evidence during low-resource the pandemic has been voracious. But communicating countries it well is a fiendish balancing act. How can governments From early on in the COVID-19 crisis, give clear advice while also Cambridge researchers have been acknowledging uncertainty? working with colleagues in countries How can scientists debate that have particularly poor access to complex evidence while medical equipment, PPE and public supporting strong health information. interventions? And how can Among these enterprising projects, the media scrutinise public the Open Ventilator System Initiative health measures without (OVSI) designed an economical and undermining them? easy-to-fix ventilator based on readily Professor Sir David available components in low- and Spiegelhalter navigates the middle-income countries. By May, the principles and pitfalls of first ventilator suitable for intensive care communicating evidence in a was being manufactured in Africa. pandemic as part of the Risky Others supported a ‘maker’ Talk podcast series he hosts. community in Malawi to print masks and Read more shields for local hospitals. Cambridge Ad Hoc. → bit.ly/riskytalk engineer Dr Lucia Corsini is now using the experience of working with Malawian RESEARCH VIEWPOINT engineer Maya Nkoloma to develop a Search for a vaccine ‘blueprint’ for using digital fabrication technologies in future emergencies. A Cambridge-developed vaccine Engineer Professor Andrew Woods candidate against SARS-CoV-2 could Epidummyology and architect Professor Alan Short begin clinical trials in the UK early developed a series of simple, low-cost next year with £1.9m funding from the “A platform ventilation designs that would limit the government. dispersal of coronavirus in marriage halls Professor Jonathan Heeney and team to translate used as emergency COVID-19 hospitals at the Laboratory of Viral Zoonotics and in India. Cambridge spin-out company DIOSynVax the vast array Dr Rosalind Parkes-Ratanshi adapted have taken a “revolutionary” synthetic a phone-based system to help the DNA approach to generating a vaccine of complex Ugandan Ministry of Health monitor against the virus. those in quarantine during the “We’re looking for chinks in its epidemiological coronavirus pandemic; and Dr Ebele armour, crucial pieces of the virus that Mogo helped translate WHO COVID-19 we can use to construct the vaccine to terms that public health guidelines into 18 of the direct the immune response in the right most spoken languages across the direction,” explains Heeney. we are currently African continent. The researchers used 3D computer

modelling of the SARS-CoV-2 virus bombarded with Image Maya in a prototype mask structure to make a library of synthetic Read more → bit.ly/CGC_COVID genes that can train the human immune into plain English.” system to target key regions of the virus – while avoiding parts that could worsen NUMBERS the infection. “Our approach – using synthetic DNA to deliver custom-designed, Maths at home … also the brainchild of PhD immune-selected vaccine antigens – Over 1.5 million UK schoolchildren, student Charlotte Milbank, is revolutionary and is ideal for complex parents and teachers accessed who is explaining the trends, viruses such as coronavirus,” adds free online maths resources for ages data and terms around Dr Rebecca Kinsley, Chief Operating three to 18 from NRICH – a maths COVID-19 in everyday words. Officer of DIOSynVax and a postdoctoral outreach website provided by the

researcher. “If successful, [our approach] University’s Faculties of Mathematics Read more COVID-19 will result in a vaccine that should be and Education. Resources were tailored → instagram.com/ safe for widespread use and that can for pupils working from home to epidummyology be manufactured and distributed at help them get back on track when low cost.” classrooms reopened. 1.5m 14 15

NUMBERS TECHNOLOGY VIEWPOINT

Now open for applications Cambridge University is one of 22 founding members of the Trinity Challenge, a £10m global search for ideas “Tracking to protect the world from future health emergencies. Formed from a coalition of organisations and individuals Go COVID-19 in business, academia and the social sector, the Trinity Challenge will support winning ideas with access to people, data and resources. will continue Viral! to be a major priority for

A new online game that puts players in the shoes my team. of a purveyor of fake pandemic news is the latest tactic in efforts to tackle the deluge of coronavirus Questions misinformation that is costing lives across the world. Go Viral! has been developed by Cambridge’s that still Social Decision-Making Lab in collaboration with media agency DROG and the UK Cabinet Office. remain will It builds on research from Cambridge psychologists which found that, by giving people m a taste of the techniques used to spread fake news keep us busy £10 on social media, it increases their ability to identify VIEWPOINT RESEARCH and disregard misinformation in the future. for years.” “Fake news can travel faster and lodge itself Lower skills for 50 years? deeper than the truth,” says Dr Sander van der “The crisis Schools have fully reopened Linden, who leads the project at Cambridge. after the nationwide “Fact-checking is vital, but it comes too late and is not over. shutdown in March but, lies have already spread like the virus. Professor Daniela De Angelis, with COVID-19 cases on the “We are aiming to pre-emptively debunk, whose team at the MRC But as we live rise again, researchers like or pre-bunk, misinformation by exposing people Biostatistics Unit is informing Professor Anna Vignoles from to a mild dose of the methods used to disseminate the government on tracking and through these the Faculty of Education are fake news.” predicting the spread of the virus watching intently to see what The latest findings show that a single play of challenging happens. a similar game the research team developed “Shutting down schools pre-COVID, Bad News, which has been played experiences has impacted all children but over a million times since its 2018 launch, can children from low-income reduce susceptibility to false information for at we are also households are more likely to least three months. lack the space, equipment learning and home support to engage fully with remote schooling. RESEARCH led by Burchell, suggests that furloughed from them.” Those with pre-existing workers and those on reduced hours conditions are at risk of Cut hours, not people had the same risk for poor mental health experiencing a worsening of as those who remained in full-time their mental health. This has The pandemic has dramatically affected employment. But data from April and to be taken into account in the working lives of millions in the UK. May shows the likelihood of mental how we come out of this Many now work from home, while others health issues doubling in those who lost pandemic.” had hours cut and thousands lost their all work due to coronavirus – with some Professor Andy Neely, A recent study she co-led jobs completely. 58% falling into the “at risk” category. Pro-Vice-Chancellor for on behalf of the Royal Society The government’s furlough scheme To mitigate a mental health crisis as Enterprise & Business highlights the potential supported workers and businesses hit furlough rolls back, researchers say the Relations, introduces impact on the 13 year groups by the spring lockdown. Dr Brendan UK should emulate ‘short-time working’ Beyond the Pandemic, of students affected by Burchell argues that while furlough schemes used by many European nations a new online series in lockdown and estimates that, was “aimed at the financial fallout” of to share out working hours. which we ask our experts: without action, around a COVID-19, it also stemmed the tide Says Burchell: “As well as the what have we learned that COVID-19 quarter of the entire of mental health problems predicted individual misery caused, the costs will help us recover well? workforce will have lower by experts. of poor mental health to the UK’s Read more skills for 50 years after the Research from the Department of productivity and health service are → bit.ly/BtPand mid-2030s. Sociology’s Employment Dosage team, vast, and cannot be afforded.” 16 17

Respect for the Mongolian landscape is engrained Onon Bayasgalan Cambridge Gates Scholar within her, says Onon Bayasgalan. Her work is and Masters in Conservation helping herders in her home country to preserve Leadership livelihoods and lands that are under threat from [email protected] the luxury fashion industry. Interview Charis Goodyear Photography Nick Saffell

I would watch as my grandmother Projects like this require personal sprinkled milk to honour Mother relationships built with time and trust. Nature before breaking the soil to Over a period of four years, I would plant seedlings. Respect for the natural regularly stay with the same community world was something my grandmother of herders. I listened to their stories, had grown up with, and in turn taught shared meals with them and slept in their me. It’s a mentality that is entwined with yurts – in the winter the temperatures Mongolian culture. would drop to –40°. Every time I returned to the community, I was reminded of why The Mongolian landscape is vast, I had chosen to work in conservation. harsh and untamed. Crucially for the nomadic herders who live there, it’s not Collaboration with businesses was partitioned off into pockets of land. equally important to the project’s Herders make up 40% of the population success. We worked with a fashion and being able to roam freely and graze house among other private and public goats is essential for preserving their sector organisations to develop a model livelihoods. of working that benefited everyone. The herders are vulnerable to The idea that you can separate exploitation during the two-month economics and conservation is an ‘combing’ season when cashmere illusion. We need to understand how is gathered from the goats. They rely our desired goals fit into the wider predominantly on cashmere for their economic system and try to find a win– income and it’s very much a buyers’ win solution for both conservationists market, with middlemen using and businesses. Until we do, our psychological tactics to persuade victories will be small and localised – the herders to sell at a lower price only when we work collaboratively for fear of the price dropping further. will we see widespread change. Under pressure to produce more To learn how to do this better, This cashmere for the fashion industry, I enrolled on Cambridge’s Masters the herders increase their herds to sizes in Conservation Leadership a year ago that the landscape cannot sustain as a Cambridge Gates Scholar, the indefinitely. Over time, the grasslands first from Mongolia. One of the most are becoming deserts – it’s estimated mind-blowing concepts I’ve learnt that 70% has now been damaged, mostly about is the‘doughnut economy’. As a Cambridge due to overgrazing. Larger herds mean cohort we discussed whether it was less food for the goats, lowering the possible to rethink the whole paradigm quality of cashmere, which fetches a of economics. Doughnut economies lower price at market. involve making sure that the economy meets the social needs of humans while I helped set up the Sustainable respecting the planetary boundaries. Life Cashmere Project while working for the I’m convinced that this is the sort of Wildlife Conservation Society in approach we need to sustain land, Mongolia. The project promotes livelihoods and business. sustainable herding while protecting the livelihoods of herders. We established What inspires me? In a word: Onon quality and sustainability standards and Mongolia. I hope one day I will be taught the herders techniques, such as able to take my grandchildren to the sorting cashmere by colour and combing grasslands and say: “What you see it in a specific way to increase the value before you is how it looked when I was of the wool, which reduces the need for a child – and how it looked when my Bayasgalan larger herd sizes. grandmother was a child.” • 18 19

The ‘refugee crisis’ triggered by the outbreak of Dr Naures Atto Faculty of Asian and the Syrian Civil War in 2011 transformed Europe’s Middle Eastern Studies attitudes and actions towards migrants. Yet, public [email protected]

awareness of these seismic shifts remains limited. Words Tom Almeroth-Williams Even less well known are the experiences of those who have been turned back at borders, detained, deported, separated from families and granted DISPLACED asylum far from home. Whether in parliamentary debates or Holland just to gain time and see if well as more than 200 stakeholders of minoritised indigenous groups,” the media, migrants’ stories have been changes meanwhile will happen in Syria, working in migration. The project’s Atto says. drowned out by concerns about security, so we can go there again. But, I can’t do recent reports – covering the transit To this end, she raises awareness in integration and preserving European that anymore. I am so tired. I cannot countries of Turkey, Lebanon, Greece, the West through talks, exhibitions and ways of life. For the past three years, change camps anymore and sleep in a Italy, Poland and Hungary; and the film. She has also given expert testimony RESPOND, a Horizon 2020 project, has bed that is not mine [she starts crying]… destination countries of Germany, in asylum cases and aims to help people been investigating migration governance You reach a state where you dislike Sweden, Austria and the UK – draw retain some elements of their cultural in 11 countries by foregrounding the everything… you feel as if Europe is attention to numerous state-specific identity after having lost everything back insights of asylum-seeking migrants. suffocating you. But that’s what God circumstances and failings. home, including hope for a future there, RESPOND’s principal investigator gave us, to be refugees.” The UK screening interview faces as they establish new lives in unfamiliar at Cambridge is social anthropologist In 2015/16, nearly 800,000 asylum- criticism for the evidential weight placed host countries. Dr Naures Atto. “All humans develop seeking migrants arrived in Germany, on it, but also for the behaviour of In late 2020, she curated Displaced a deep connection to their home and stretching the country’s cut-back interviewers and translators. Other Bodies and Hearts, a digital art homeland. It takes something huge to reception and procedural systems concerns focus on the UK’s increasing exhibition featuring work by migrant make someone decide to leave,” says to breaking point. Having survived use of detention centres – one asylum- artists that represents the suffering and Atto, whose own family fled Turkey treacherous journeys over land and sea, seeker told RESPOND: “It was a proper hopes of peoples forced to leave their in the 1980s. “But more and more, new arrivals encountered lengthening prison… I was shocked, especially homelands. Some of the most poignant migration is seen as an internal security delays and procedural errors. after the bad experiences of being and disturbing pieces were created by issue not a humanitarian one. At the Nearly 12% of asylum-seekers in prison in Iran”. Assyrian and Yazidi artists who survived same time, people ignore the fact that interviewed by RESPOND reported The project’s researchers also draw Islamic State’s genocidal violence. most displaced people desperately want failings by immigration officers or attention to problems that have One painting, by Yazidi artist Narin Ezidi, to do something positive with their lives.” lawyers – including the loss of papers, transcended borders. In addition to now living in Canada, depicts the 19 The scale of the humanitarian crisis in identities and files being mixed up, pervasive delays and administrative Yazidi women burned to death in cages the Middle East has made it all too easy erroneous changing of names and failings, the team links a restrictive turn in Mosul. Atto is also directing and for individual atrocities to go unnoticed. dates of birth, and incompetent in policymaking to a significant reduction producing a film in which displaced In July 2014, the Iraqi city of Mosul translators. These failings had decisive in refugee rights, opportunities for family migrant women inform us about the lost its entire Christian population, effects on their chances to secure reunification and access to legal support extreme challenges which they have a community established almost 2,000 protection status. and social welfare. had to overcome. years ago. Having captured the city, ISIS When told his papers had been lost, Project co-ordinator Soner Barthoma She says: “We developed this project gave its last remaining 30,000 Assyrians a young Syrian recalled being “totally from Uppsala University says: “When at the start of the crisis. The number of three days to convert to Islam, leave or broken” because “I wanted to bring my faced with mass migration, governments migrants coming to Europe has fallen but be killed. The vast majority fled, as did parents, and I knew that repeating fall back on a tired repertoire of failed the region’s displaced people are more around 200,000 more Assyrian everything would take a year”. A Libyan, solutions. They put aside concerns about vulnerable than ever. As Europe reflects Christians from Qaraqosh and the who went to court to remove an interview human rights and reach for quick fixes. on its actions, we are determined to villages of the Nineveh Plain. from their record, said: “The translator The securitisation of migration has give voice to the millions of people who Coming amid preparations to was deceitful. It put words in my mouth blocked the search for better solutions continue to be denied a home and basic commemorate the centenary of the I never said.” And a Syrian struggling to societal problems.” human rights.” 1915 genocide of Christians in Ottoman to reunite his family in Germany In Cambridge, Atto’s work focuses on • Turkey, this new existential threat complained: “That’s the worst thing… the experiences of Assyrian Christians → respondmigration.com sent shockwaves across the Assyrian They keep you on hold”. Eighteen months and Yazidis, populations indigenous to → exhibition.respondmigration.com diaspora. Beyond it, however, the after receiving his residence permit, the ancient Mesopotamia, and today mainly Credit plight of an entire society forced man’s teenage brother was granted the concentrated in northern Iraq refugee from their ancient homeland went same. Later still, their mother was camps. At least 400,000 Yazidis have Narin Ezidi largely unnoticed. allowed to join them, but their father and been displaced by ISIS, and thousands Three years on, a Syrian woman other siblings had to stay in Turkey. more have been killed and abducted. awaiting an asylum decision in Germany RESPOND’s researchers, from 14 “There needs to be more strategic told RESPOND: “Some friends told us to partner organisations, have interviewed intervention in conflict zones to prevent go to another European country like more than 550 refugees in 66 cities, as the mass displacement and persecution LIVES 20 21

temperatures rise, the vast terrains of ice breakup of the George VI Ice Shelf on provides us with, perhaps, the most The world’s ice sheets are undergoing dramatic, Dr Poul Christoffersen locked around the poles melt faster and the Antarctic Peninsula. detailed understanding of Greenland’s Scott Polar Research Institute faster. The ice sheets of Antarctica and The team has set out instruments fast-flowing glaciers to date, and more potentially irreversible change with catastrophic [email protected] Greenland are already major contributors to measure melting, lake filling and accurate predictions in the longer term,” consequences for our planet. Building on a to sea level rise, and there is a real risk draining, as well as the bending of the says Christoffersen. “Not many groups Dr Ian Willis that the West Antarctic ice sheet will ice shelf produced by these phenomena. are linking modelling and observations 100-year history, researchers at the Scott Polar Scott Polar Research Institute collapse. Over the coming century, rising Using satellite imagery and numerical like we are. We want to make the models Research Institute are studying the changing [email protected] sea levels will mean towns, cities and models, they hope to gain a better the best they can be, based on real even entire nations will be at increasing understanding of the processes that can observations and real physics. If not, ice conditions, and using their results to predict Words Sarah Collins risk from flooding and some may have to lead to ice shelf fracture and to predict they won’t have any real powers of what the future might hold for our polar regions be abandoned completely. where, when and how the ice shelf, and prediction.” For the researchers at SPRI, the polar others like it, may break in the future. Although the conditions at both and for global sea level rise. regions are a laboratory, vital to The consequences of ice shelves polar regions are extreme, in the understanding our changing planet and breaking up are already being seen in the Antarctic, SPRI researchers have the planning for an uncertain future. West Antarctic ice sheet further south, benefit of working with logistics Glaciologist Dr Ian Willis is currently where Dr Poul Christoffersen is leading provided by the United States Antarctic focused on the stability of the massive one of eight large science projects in the Program and the British Antarctic floating sections of ice that skirt about International Thwaites Glacier Survey, both of which have bases on the 75% of the Antarctic coastline, where Collaboration. Involving over 60 continent. But in the Arctic, SPRI they act as a buttress against ice flow scientists and students, it is one of the researchers are on their own, managing from inland. most ambitious scientific partnerships logistics and camping in tents. Like the rest of the ice in the polar ever to take place in the polar regions Christoffersen says the effects of regions, these buttresses are weakening, and aims to understand why the glacier climate change are most easily felt as witnessed most dramatically in 2002. is retreating and what the long-term through talking to the local communities Scientists monitoring NASA satellite consequences of a continued and he works with in Greenland. The Inuit of images of the Larsen B Ice Shelf watched prolonged retreat may be. the high Arctic have relied on the sea in astonishment when roughly 1,250 At the other end of the planet, ice for transport and hunting for square miles of ice fragmented and Christoffersen has also been observing centuries but, over the past few collapsed in little over a month. another lake filling and draining decades, long-established routes over “These shelves are thinning because phenomenon. With funding from the the ice have disappeared. As the world warm water currents are eating away European Research Council, his continues to warm, and with the Arctic from below as the oceans heat up, and RESPONDER project studies the warming twice as fast as the rest of the from the top as summer air temperatures dynamics of the world’s second-largest world, traditional ways of life are

The polar regions are places of mystery, rise,” says Willis, whose research is ice sheet in Greenland, and how it’s increasingly being lost. myth and adventure. The names funded by the Natural Environment affected by meltwater lakes. “The continued melting of the world’s associated with the ‘heroic era’ of polar Research Council and the US National This section of the Greenland ice ice masses will impact us all – no one is exploration are part of this country’s Science Foundation. sheet moves up to 3 metres per day: going to be immune; all countries, collective memory, and none looms Before the Larsen B breakup, satellite much faster than other parts of the ice regions and continents will be affected larger than Captain Robert Falcon Scott images showed the buildup of small sheet. His team uses numerical models somehow,” says Willis. who, along with his crew, perished lakes on the surface followed by their combined with field observations in the “You really feel the importance of the returning from the South Pole in 1912. sudden disappearance. The assumption sometimes ‘wild west’ conditions of polar regions in your bones here at The Scott Polar Research Institute is that the lakes added stress to the ice northern Greenland using drones, SPRI. There are items here that take you (SPRI), which was founded in 1920 shelf, causing cracks to form, draining sensors and fibre-optic cables to right back to that heroic age – I walk by as a memorial to Scott, has celebrated the water, and then collapse. determine how and why glaciers in Captain Oates’ sleeping bag and its centenary this year. As well as its “We are seeing more and more water Greenland move especially fast. They are scientific instruments from Scott and Polar Museum and archive, SPRI houses forming on ice shelves, which is the only team to drill boreholes to the Shackleton’s expeditions on most days a world-leading polar research centre worrying,” says Willis who, with base of the deeply crevassed and in our Museum, and they never fail to that, since the 1930s, has been the colleagues from the University of fractured glaciers, which contribute stop me in my tracks. It’s the links to the base for numerous scientific expeditions Colorado Boulder, Columbia University directly to sea level rise because of their past that make this such a unique and to the Arctic and Antarctic. and the University of Chicago, is fast flow. interesting place to work, but it’s the Credit Tom Chudley / RESPONDER project Today, our polar regions are investigating the effects of surface water “Our model, combined with the research that’s being done right now like a ticking time-bomb. As global on the flexing, fracturing and possible measurements we’ve made in the field, that has implications for the future.” • 22 23

Walking at ‘botanist pace’ on Mount Terror in Dr Ángela Cano RICHTERSVELD Cambridge University South Africa, Dr Ángela Cano likes to stop Botanic Garden LOCATION RICHTERSVELD [email protected] and smell the succulents. She then measures, 28° 36' 0" S, 17° 12' 14" E Sendelingsdrift photographs, presses specimens and gathers Words Louise Walsh STATUS Read more bit.ly/FN_wild seeds. Her work is helping to safeguard some UNESCO cultural and botanical World Heritage Site NAMIBIA of the rarest plants on Earth. RICHTERSVELD TRANSFRONTIER PARK LANDSCAPE Arid desert Kuboes RAINFALL NAMIBIA 5–200 mm / year

Oranjemund PLANT SPECIES RICHTERSVELD Alexander Bay Over 4,800 WORLD HERITAGE SITE

PLANT RARITY 40% endemic, mostly aloes SOUTH AFRICA Richtersveld Municipality and succulents Eksteensfontein

Richtersveld Fieldnotes SOUTH AFRICA Call of the wild collector An army of tiny seedlings has broken But climate change, poachers and The Garden is looking to double the surface behind the scenes at Cambridge over-grazing now threaten this unique percentage of their 14,000 plants to 40% University Botanic Garden (CUBG). ecosystem, and the South African wild origin as part of their new 10-year They are new arrivals, fresh from a year government had given the CUBG team strategy, helping to safeguard some of in quarantine. A regular visitor to check permission to collect seeds from the planet’s rich floral diversity for the on their progress is Assistant Curator around 200 species and take them future. Dr Ángela Cano. She is one of Cambridge back to Cambridge for research and As Cano looks over her seedlings, University’s ‘wild collectors’. conservation. she wonders what we will learn from Last year Cano travelled to Mount “We hiked all day to the top of the them: “on fieldtrips, you are inspired Terror in the ‘Succulent Karoo’ of South mountain carrying our tools, food and by nature and you have questions. Africa’s Richtersveld. This remote region water, and at night we slept outside in How did these plants evolve? What’s stretching between South Africa and a sleeping bag next to a fire,” she their ecology? If we let the time pass Namibia is a biodiversity hot spot with describes. “You wake very early because we will miss the opportunity to study over 4,800 plant species, 40% of which of the cold and you just want to collect and protect them. Who knows what are found nowhere else on Earth. and collect and collect. We record as we might need them for one day?” Succulents live in abundance here – their much information as we possibly can • fleshy water-storing leaves help them to because we don’t know what people will Expeditions are currently on hold survive in the tough arid conditions of need to know in a hundred, two hundred as a result of the pandemic but will this desert wilderness. years from now.” be resumed as soon as possible. 24 25

Spotlight From understanding ancient ideas of generation Reproduction to exploring new frontiers in fertility, Cambridge researchers are working across disciplines to study reproduction from multiple perspectives. Professor Kathy Niakan, new Chair of the University’s Strategic Research Initiative on Reproduction, introduces our Spotlight on some of this work – and explains how reproduction matters to us all.

Image Human embryo; Kathy Niakan

Every year, more than 130 million babies us for diseases later in life – and even Given the long-standing history of are born worldwide. Reproduction is vital across generations? cutting-edge reproductive studies in for the survival of our species, and, at a Do changing patterns of family Cambridge, including Sir Robert personal level, for our own families. It is relationships – adoption, single Edwards’ seminal Nobel Prize-winning little wonder, then, that debates around parenthood, same-sex parents, for work that led to IVF treatment, it is reproductive rights and reproductive example – influence child development? fitting that many of the challenges in technologies – around the very acts of How do we balance the risks and human reproduction will be investigated conceiving and giving birth – ignite such benefits of novel reproductive and debated here. passion and controversy. technologies in plants and animals? • Reproduction has relevance to every If there are ways to alleviate life- → repro.cam.ac.uk single one of us because of the way it limiting diseases like cystic fibrosis, is connects individuals, families and there a moral imperative to use any Professor Kathy Niakan is a biologist populations, and because it raises means necessary to avoid their working in human developmental and questions that reach in scope from transmission or is this opening a slippery stem cell biology. In 2016 she was the The intimate experiences through to global slope to design babies with specific first scientist globally to gain national policies. attributes? regulatory approval to edit the genomes big Why do three million babies and Major questions like these require of human embryos for research into 300,000 women still die globally each informed input from diverse disciplines. early human development and was year in childbirth, despite huge leaps in Finding new perspectives and offering named as one of the 100 most picture medicine and public health? practical solutions must take into influential people in the world by How have present reproductive account cultural, religious and societal Time Magazine. In October 2020 she practices like childbirth, infertility expectations – and often challenges became Director of Cambridge’s Centre treatment, abortion and population existing sociological, ethical and legal for Trophoblast Research and Chair policies been shaped by the past? frameworks. of the Cambridge Reproduction SRI. In what way does the environment In 2018, the University launched a experienced in the womb programme Strategic Research Initiative (SRI) on Reproduction led by Professors Graham Burton, Sarah Franklin, Anne Ferguson- Cambridge Reproduction SRI brings Smith and Nick Hopwood. Its vision is to together world-leading expertise from pool resources to address the most across the University, including from the: urgent, challenging and complex Centre for Trophoblast Research; questions about reproduction and the Centre for Family Research; Cambridge diverse ways that it has an impact on our Centre for Law, Medicine and Life Credit lives. Sciences; Cambridge Group for the

The Francis Crick Institute Crick Francis The The Cambridge Reproduction SRI History of Population and Social enables these issues to be approached Structure; Reproductive Sociology holistically – from historical, ethical, Research Group; Wellcome Trust– legal, cultural, gender-based, Cambridge Centre for Global Health sociological, psychological, Research; Wellcome-MRC Institute demographic, public health, policy, of Metabolic Science; and several biological and clinical perspectives – departments; as well as the nearby and through engagement with policy Babraham Institute and Wellcome teams and funding bodies. Sanger Institute. 26 27

A major research project sees sociologists situated at emerging hot spots of reproductive change, investigating the new ‘haves and have-nots’ in our fertility futures.

Words Fred Lewsey Image ‘The Instruments of Life’ by artist Gina Glover

Fertility futures

Fast Facts

Exploration of changing Researchers track the commercial Inequalities in reproduction perceptions and practices of explosion in ARTs since IVF was opportunities revealed reproduction reveals social pioneered by Cambridge Nobel for migrant women in British drivers behind fertility statistics scientist Sir Robert Edwards healthcare 28 29

eproduction doesn’t just happen something under threat, says Franklin. circumvent this problem, followed by younger. And the marketing pitch isn’t a also the business structures you’re by itself, says Professor Sarah However, the reasons behind these the more successful flash-freezing newborn babe, but rather freedom and participating in.” Snapshot R Franklin, Head of the Sociology fluctuations are elusive. ‘vitrification’ that transformed the egg reproductive control. The regulatory expert Department. “Reproduction is organised, The research team is getting under into a glass-like stasis, after which “Look at Prelude, founded by an IT Birth debt Access to ARTs relies on and the way people organise the skin of modern reproduction success rates for post-thaw conception entrepreneur,” says Van de Wiel. “Within access to capital: money makes many reproduction tells you so much about through what Franklin calls “indicative jumped. two years they had bought dozens of babies in the 21st century. But poor When it comes to implementing how they organise everything else. anecdotes”: case studies that reveal the What became apparent was the clinics across the USA, and now claim to women in rich nations still want children, human rights, the devil lies in the “Right now, I’d describe fertility underlying social drivers behind fertility potential egg-freezing client base be the country’s largest fertility company. still become pregnant, and still need detail, says Jinal Dadiya, a PhD as a condensed signifier of precarity. statistics. outstripped that of IVF alone, as it Much of their marketing depicts single maternal care. In the UK, we might like to student at the Faculty of Law, It represents a sense of imperilment. “Resurgent fertility politics needs to included not just women who want a young women, not families with babies. think this is a basic right afforded to all “particularly for rights administered It’s considered ‘something that needs be closely watched. It carries ideas about baby, but also all those who might want “Their pitch to women is: freeze your women regardless of status or bank with the help of many stakeholders help’, you know?” who should have reproduction assisted a baby in the future. young eggs, use our extra testing, so you account. We’d be wrong. and fast-evolving technology”. She Franklin is Principal Investigator or curtailed. We want our gallery of “Egg freezing is both an infertility have the best genetic material for making “The 2017 introduction of healthcare is investigating how states can best of Changing (In)Fertilities, a major situated projects to help show the ways treatment for the fertile and a fertility a baby when the time is right for you. charges for migrants in Britain for make good on their commitment to interdisciplinary research project funded reproduction is deeply implicated in all treatment for the infertile,” says Feel reassured that you can live free from everything except a GP and A&E means the right to reproductive health by by the Wellcome Trust that is ongoing in aspects of life,” she says, “and why the Franklin’s colleague Dr Lucy van de Wiel, your body clock, because meeting the it now costs to have a baby,” says Dr regulating fertility clinics well. the Reproductive Sociology Research question of causality is so very complex.” whose research focuses on the explosion right partner at the right age and Kathryn Medien, who has recently moved “Rapid advances in reproductive Group she leads. The project explores “Policymakers like broad sweeps of in the popularity of this ART. conceiving through sex is too from the Sociology Department to the technologies such as IVF, gamete how everything from technology to applicability, the ‘nudge’, but if there’s “Increasingly younger women are unpredictable. Open University. She argues that these preservation and surrogacy, along politics is changing the perceptions going to be meaningful social change, encouraged to freeze their eggs in “Their pitch to investors is: with our charges mark a financial transition in with a high demand for assisted and practices of reproduction. telling people to go on holiday and make preparation for future infertility, and treatments, people can have children British healthcare, a “privatisation of the reproduction, make fertility markets For the past eight years, Franklin has more children for grandma will only get those frozen eggs promise an extension when they are ready, even if that is at a underclass”. diverse and flexible,” she explains. been working with a global network of you so far.” to fertile life.” time when they are no longer fertile. “It’s easy to become a visa overstayer. “Each technological change Combined with fertility demands for Visas cost thousands of pounds, and few throws up a whole range of legal same-sex couples, it’s a market set to people have that. Certainly not a woman issues. Governments worldwide increase – and one likely to stay strong in who arrives to marry a man who becomes work with medical and other Timeline of egg freezing economic downturns. Children are abusive, or abandons them, when experts to respond to them. priceless; people are willing to spend a pregnant. Or soon-to-be-mothers with While each state evolves its own Source Human Fertilisation and Embryology Authority (bit.ly/3559PEk) lot to have them.” failed asylum claims, or yet to be approaches to these issues, when it She adds: “While the average age of a processed claims.” comes to devising regulation, they woman freezing eggs in the UK is still 37, She has been unpicking some of have a lot to learn from each other.” there is an idea increasingly sold that the the mechanisms behind these charging Dadiya compares different younger you do it the better. I’ve heard systems, and building a dataset of regulatory approaches to see which about fertility preservation stalls at charging for maternity care across the are best at furthering the right to 2013 2014 graduate fairs.” NHS using Freedom of Information reproductive health. She also looks 1983 1986 1999 2000 ‘Experimental’ label lifted by the Facebook and Apple announce Freezing can lock women into a requests, starting in London. She has at softer forms of governance, such First pregnancy from First pregnancy from frozen First birth from frozen HFEA allows the use of frozen American Society for Reproductive egg freezing as a benefit for frozen embryo eggs using slow-freeze method eggs using vitrification eggs in fertility treatment in the UK Medicine female US employees financial cycle. Eggs need to be stored, also been conducting interviews with the as advertisement regulation. which means regular payment, ranging doulas, or birthing companions, who work “There isn’t one correct from upwards of £200 annually in the with migrant women: “One of the first approach to maximising UK to over $1,000 in the USA. The more questions a doula is often asked is ‘can reproductive health in all contexts,” eggs, and the more cycles, the higher the you help me with a hospital payment she says. “But some solutions are chances of conception down the line. plan?’ such is the fear of debt collectors translatable. For instance, where social scientists looking at a wide range Beat the clock Louise Brown, the world’s By 2013, many of the world’s Some countries impose a shelf life – eggs or deportation.” one jurisdiction has worked out of fertility issues – from Western in vitro first IVF baby, was born in 1978, the professional fertility bodies had stopped are destroyed after 10 years in the UK. “A lot of practitioners are very principles for the price regulation of fertilisation (IVF) clinics to reproductive culmination of decades of research by labelling the treatment as ‘experimental’, The new industry has got this covered. concerned that this is eroding principles reproductive services, others can health in rural Nepal. One key finding is Cambridge Nobel scientist Sir Robert triggering a gold rush in egg-freezing Some start-ups specialise in fertility of universal healthcare in Britain,” says consider these principles in their both highly paradoxical and yet somehow Edwards. Since then, an estimated eight investment and marketing. Van de Wiel’s loans or subscription plans. In the USA, Medien. “Vulnerable women with own circumstances.” intuitive: the more you plan for children, million babies have been born globally book Freezing Fertility, published by fertility insurance packages that include newborns, who are living in hostels or Dadiya is currently exploring the fewer you have. following IVF and other assisted New York University Press, tracks this egg freezing are used by employers to sofa-surfing, are being chased for standard setting by fertility “We’re very familiar with the narrative reproductive technologies (ARTs). rapidly expanding offshoot of the attract the best female graduates or maternity payment running to thousands. professionals and scientists: “A lot of women having more reproductive While many different personal fertility industry, and the people it executives. Bailiffs are appearing on doorsteps.” can get lost in translation when options these days,” she says. “But journeys have led to these births, there aims to attract. The expansion of ARTs can create She argues that, while this case study scientific standards directly enter how does that translate into actual has typically been one unifying rationale: “We’ve always had commercialisation “new forms of dependency,” says Van de is UK based, it’s part of a global trend. the legal frameworks of countries experience? I want a baby, preferably as soon as of IVF, but there’s a large amount of Wiel, as well as reproductive anxieties in “The proliferation of ARTs means an as binding regulation.” “IVF, for example, is expensive and possible. That’s all changing. private equity and venture capital women from younger ages. “Certain increased ability to reproduce for difficult and nerve-racking. A much- The fastest-growing tech in the investment pouring into egg freezing – demanding careers may come to be seen populations who couldn’t before – Jinal Dadiya wanted child may result in a desire to reproductive marketplace is ‘oocyte often coming from places with no links to as contingent on ARTs such as egg whether that’s LGBTQ people, or single or provide a sibling, then it’s back on the IVF cryopreservation’, or egg freezing. In its the fertility industry,” says Van de Wiel. freezing if women entering them want the older women – so long as they are wealthy track, more time, more money. What’s early days, it was a resort for women with Start-ups focusing on clinical freezing option of children. To have a healthy child enough.” seen as a solution often creates further cancer diagnoses, but very low success services are seeing such an influx of at the best time, women can become “At the same time, there is a closing problems. We need a better account of rates often led to little more than false capital that they are acquiring many reliant on companies to test their fertility, down of reproduction opportunities for the problems the technology is supposed promise. established independent IVF clinics, or preserve and store their eggs, or poorer migrant populations – those fleeing to be solving.” The technology has improved creating corporate fertility franchises implant a healthy, tested embryo.” war or economic hardship.” For many While the 20th century saw fears of dramatically. An egg is the largest cell in unlike anything previously seen. Van de Wiel says she’s all for women, reproducing means incurring overpopulation, birth rates have the human body and freezing can cause The target customers for these new technologies such as egg freezing, “but debt, whether to extend fertility or get plummeted in many wealthy nations, and crystal formation in the cell. Slow- conglomerates are not just women in it’s important to stay well informed, and maternity care. “It raises the question: fertility is on government agendas as freezing techniques were initially used to their mid-thirties but those a decade not just about the biological facts, but who gets to access reproduction?” • 30 31

We’re used to the idea that as adults we have some control over our destiny: what we eat and drink and how much we exercise can affect our risk of poor health. But we now know that risks of heart disease and diabetes can be programmed much earlier – even before we were born.

Words Craig Brierley

Fast Facts

Diseases in later life can be programmed by the environment experienced in the womb

‘Memory’ of problems during pregnancy may be passed down to the next generation through sperm

Obesity during pregnancy can potentially programme offspring to overeat

A parent’s emotional state during pregnancy can play a role in outcomes for the baby 32 33

owards the end of World War II, shown that lower than normal levels of Erasing the past Epigenetic inheritance lead to the generation of eggs and during pregnancy. But surprisingly, this a German blockade coupled with a oxygen in the womb result in babies is an idea that has captured people’s sperm, and then again at fertilisation link was equally strong if the father had Snapshot T severe winter led to a devastating born with fewer of the cells needed to imagination. The effect has certainly (see panel). a ‘difficult pregnancy’ emotionally. The ‘father’ of famine in the Netherlands known as the build the heart, resulting in it being been observed in plants and nematode While there is evidence that Hongerwinter. Forced to live on fewer weaker. Their blood vessels are less worms, and evidence suggests that the epigenetic modifications in some genetic Healthy beginnings As researchers genomic imprinting than 800 calories a day, around 20,000 able to contract and relax, and there are daughters of mothers who experience regions escape erasure, these are continue to unpick how both the lived people are believed to have died. signs of damage in the developing heart adverse pregnancies not only have thought to be the exceptions and most experiences of our parents and We inherit one set of chromosomes At the same time, Leningrad was and blood vessels caused by excess increased risk of obesity and type 2 likely regions of the genome that are not grandparents affect us before we are each from our mother and father, coming to the end of a drawn out and ‘free radicals’. diabetes but also pass this risk on to responsive to the environment, she says. born, others are investigating how we but it wasn’t until a discovery in deadly siege. An estimated 800,000 “If we think of heart disease, the first their own children. So could there be another way of can counteract adverse outcomes. 1984 by Professor Azim Surani civilians died as a result of the ensuing thing that comes to mind is how your But there is a problem, says Professor explaining how problems during one Professor Sue Ozanne from the – after his PhD under IVF pioneer famine. genetic makeup interacts with lifestyle Anne Ferguson-Smith from the woman’s pregnancy are passed down Wellcome-MRC Institute of Metabolic Sir Robert Edwards – that it was Decades later, a startling difference factors like smoking, obesity or a Department of Genetics. to her grandchild that doesn’t require Science looks at the effects of over- known that we need chromosomes emerged between the children – now sedentary life to increase your risk,” “When I ask an undergraduate what inheriting epigenetic modifications? nutrition and obesity during pregnancy. from both parents for normal adults – born from women pregnant says Giussani. “But even more epigenetics is, some say ‘Isn’t that how Yes, says Ferguson-Smith. She has shown in mice that, if the mother development. His discovery was during these terrible conditions. The important may be how the environment the environment influences how our Take the situation where a mother is is obese during pregnancy, it programmes to provide the impetus for the field Dutch survivors experienced an in the womb interacts with the genetic genes work and gets transmitted across undernourished. This will affect her her offspring to overeat and become of epigenetics. increased risk of obesity, diabetes and makeup of the fetus.” generations?’ This particular perspective offspring, making them more susceptible obese, potentially programming her own “This suggested that the heart disease; those from Leningrad did Our genome has the potential to of epigenetics has become almost to obesity and metabolic disease. If a girl offspring to overeat. “It’s a vicious cycle,” chromosomes contained extra not. become ‘decorated’ with effects from textbook stuff. But the evidence doesn’t grows up with metabolic disease then, she says. information that was dependent on These very different outcomes tell us the environment through ‘epigenetic’ really stack up.” when she is pregnant, this will in turn Ozanne’s work suggests that one way a ‘memory of its origin’ from the something important about what modifications in which methyl In fact, her own research has thrown have an impact on her own child’s health. of breaking this cycle might be to get mother or the father,” says Surani, happens in the womb during pregnancy, molecules attach and turn genes on or a spanner in the works: changes resulting “So the grandmother caused the defect the mother exercising during pregnancy. now at the Gurdon Institute. says Professor Abby Fowden from the off. These modifications are also from our environment occur only in in the daughter, and the daughter caused “It’s difficult to lose weight once Surani named this ‘genomic Department of Physiology, Development essential for regulating normal cell certain regions of the genome, and the defect in her offspring.” you’re obese, but we’ve shown that with imprinting’, a form of epigenetic and Neuroscience. development and, as cells divide and they are not passed on indefinitely. But she adds: “That doesn’t mean that sufficient exercise, even if you don’t inheritance in which the regulation “The fetus is programmed for the replicate, they are passed on to other In mammals, there is a mechanism that transgenerational epigenetic inheritance lose weight, you can improve your of a gene is influenced by the sex of environment in which it expects to find cells. Could these epigenetic erases all the epigenetic marks, not once doesn’t exist, it’s just that there are other metabolic fitness and become more the transmitting parent without itself. Most of the time, if what it has modifications be inherited further, but twice, she explains. These erasures mechanisms to explain how the effects insulin sensitive.” altering the genetic sequence. predicted in the womb ends up being from generation to generation? occur early on in the process that will of the environment might appear to Another possible solution is drug “The imprints are first erased in what it experiences after birth, its future be perpetuated across generations. therapy. Ozanne is looking at whether germ cells (precursors of sperm and health is likely to reflect that of the To some extent, that’s why studying metformin, a common drug used to eggs), and then reintroduced as general population. But what if there’s effects transmitted via the father, who treat diabetes, might help. they develop. Another wave of a mismatch? That’s when more health is not directly influencing the baby in Giussani, meanwhile, is interested erasure occurs after fertilisation, problems than average can arise in pregnancy, is better at addressing this.” in whether specific antioxidants could but the imprints are protected at later life.” “If the mother doesn’t counter the oxidative stress seen in this time and inherited, playing a Babies from the famines would The father effect While there is a focus different organ systems in his vital role in the development of the have been undernourished; they would on the impact of the mother’s health experimental models. fetus and placenta, and are have been born smaller, their bodies and wellbeing on that of her offspring, Finding pharmaceutical solutions get a balanced diet, transmitted through to adulthood.” programmed for a world where food perhaps more surprising is the will not be easy, however. First is Surani also showed that germ was scarce. For the Leningrad babies, contribution that the father may the challenge of identifying those cells are among the first cells to food was scare: the famine lasted also play. pregnancies where it would be emerge after the embryo implants, several years. In the Netherlands, her stress hormones Ferguson-Smith has shown that the appropriate to intervene – and, if so, and identified the key genes and however, food supplies returned to ‘memory’ of problems during pregnancy when? Then there is the subtlety of mechanism involved in their normal much quicker. or early life can be passed down changing the course of a disease development. Just as diet, smoking and exercise to the next generation through sperm. process while maintaining normal can increase and He has now teamed up with a affect our health as adults, so too can Evidence from other groups has function – excess free radicals consortium of researchers from they affect the unborn baby while it suggested that this might be through may cause oxidative stress, but we need Cambridge University, the is in the womb. But it’s becoming molecules known as RNA. This supports some of them for our bodies to function. Babraham Institute and across the increasingly clear that the environment affect how tissues Giussani’s studies, which most recently Clinical trials in humans then raise a UK to build a ‘family tree’ of how of these earliest months of life can also have found that heart disease risk from whole other set of issues. cells divide and specialise following affect our long-term health, and even hypoxia in the womb can be passed “The problem is that you’re treating fertilisation. The £10m Human the health of our grandchildren. between generations, but only from two patients: you’re treating the mother in the fetus develop.” Developmental Biology Initiative father to child. In fact, there is evidence and the child, and that’s hugely difficult is funded by the Wellcome Trust. Heart of the matter “If the mother that the mother can pass on to her from an ethical as well as a scientific doesn’t get a balanced diet, her stress offspring a protective effect against this point of view,” says Giussani. “That’s Professor Azim Surani hormones can increase and affect transmission of heart disease risk via why there are very few clinical trials in how tissues in the fetus develop – the her mitochondria. pregnancy itself. It’s safer to treat the pancreas or the number of cells that Even a parent’s emotional state can baby once it’s born. That way, you’re become fat cells, for example,” explains play a role in outcomes for the baby. treating one individual, not two.” Fowden. “This will have consequences Professor Claire Hughes from the Centre For now, it seems, the way to give in later life.” for Family Research has looked at how a baby its best chance of a disease-free In the office next door to Fowden, the family’s emotional struggles during adulthood is to follow common-sense Professor Dino Giussani is looking at pregnancy affect their child’s behaviour. advice during pregnancy: don’t drink, how the environment in the womb Professor Abby Fowden She discovered that a very young child don’t smoke, avoid stress, do exercise programmes our cardiovascular health Department of Physiology, Development and Neuroscience was more likely to have emotional and eat well. And everything in in later life. Using animal models, he has problems if the mother was stressed moderation. • 34 35

Surviving birth Ugandan researchers are working with Cambridge colleagues in one of the busiest maternity hospitals in the world to help more women survive complications of birth. Their research in Kampala is vitally important: levels of maternal deaths are nearly 50 times higher for women in Sub-Saharan Africa and their babies are 10 times more likely to die in their first month of life compared with high-income countries.

Words Louise Walsh Photography Valente Inziku, whose wife died in childbirth in Arua, Uganda, photographed by Tadej Znidarcic

a bad month we can have up to 15 mothers dying. For Fast “IN babies, the number is usually double or three times that figure.” These are the words of Dr Annettee Facts Nakimuli, an obstetrician working in one of the world’s busiest maternity hospitals, in Kampala, Uganda. Looking after up to 28,000 deliveries Genes linked with risk and a year, she and the other doctors and protection in pre-eclampsia midwives work under intense pressure. discovered in African women Every day, 300 pregnant women visit the antenatal clinic. Up to 100 patients are in First contemporary textbook the labour ward, around 40 of whom will of obstetrics by African have complications – obstructed labour, doctors for African women haemorrhage, sepsis or pre-eclampsia to be published by Cambridge – and up to 25 emergency caesarean University Press sections will need to be carried out. “When women come to the labour Large-scale studies in the ward they hope to come out with the best UK and Uganda search of it – they hope to come out with a live for predictors of adverse baby, and come out alive themselves. pregnancy outcomes But women go to hospital with mixed → 36 37 feelings – they’ve seen others die before of Cambridge University Hospitals NHS occur in women with no known risk them, so there’s a tendency to think of Foundation Trust. She visits Kampala factors,” he explains. Smith’s unique Snapshot maternal death as something inevitable each year with a volunteer team of NHS data-rich approach looks for the rather than avoidable,” says Nakimuli. clinicians and midwives from the Rosie ‘biological signature’ of an unhealthy The placenta grower Part of the challenge is the sheer “What motivates me organised by Cambridge Global Health pregnancy using regular ultrasound scans Pregnancy complications are often number of patients compared with the Partnerships. and blood sampling, DNA sequencing, the result of defective placental number of doctors and midwives. “We “The staff in Kampala don’t need analysis of samples of placenta, fetal development and function. But how are a national referral hospital so we clinical expertise – they’re very good,” membranes and umbilical cord, and every day is the belief and why this should happen is a receive everybody... we can’t deny says Patient. “What they asked us for details of the delivery and outcome. ‘black box’. These are particularly admission because we are full,” says help with was in building clinical The huge volume of data is already human problems and it’s not Nakimuli. “In fact we’re not even sure guidelines that could be used everywhere providing health benefits: for instance, possible to study the organ inside what full means – we’ve always worked that, in my lifetime, and updated easily. They’d had no his team discovered that offering the mother. above 100% capacity.” breathing space to take a step back and universal late pregnancy ultrasounds So Dr Margherita Turco working But Nakimuli is convinced that, even develop standardised approaches.” at 36 weeks’ gestation eliminates with Professors Ashley Moffett with the difficulties of resourcing and As the Ugandan and Cambridge undiagnosed breech presentations of I will see preventable and Graham Burton came up with logistics, something can be done to teams worked together to develop babies, lowers the rate of emergency a transformative solution: she grew reduce the mortality rate. Despite an guidelines for the major causes of caesarean sections, improves the health a uterus and a placenta in a dish. astonishing workload, she and others maternal mortality, there were some of mothers and babies, and could “Without a reliable experimental have had the drive to question why so maternal death being unexpected successes, says Nakimuli: actually save the NHS money. “Practice model that mimics how placental many pregnant women die in Africa – “Our midwives gained confidence. We only changes when guidelines change, cells interact with the maternal and improve their chances of survival. saw, for example, Charlotte the doctor and guidelines only change when the tissues, it was impossible to ask and Kimberley the midwife discuss evidence to support change is strong,” talked about as a thing even basic questions,” says Turco, Silent killer Ten years ago, Nakimuli matters as equal partners. It showed us adds Smith. from the Department of Pathology arrived in Cambridge as part of the how interdisciplinary teams work well. Nakimuli’s goal is to look specifically and Centre for Trophoblast Cambridge-Africa Programme, a Around 80% of our deliveries are in the at the ‘signature’ for pre-eclampsia: Research. University-wide initiative to make its of the past, even within hands of midwives, and so the more “Until now we have been studying the “We can now grow miniature expertise and resources available to empowered they are, the better.” women who have developed the functional ‘organoids’ that so support ‘African researchers working in Back in the UK, Patient says she has disease,” she says. “We need to move a closely resemble first-trimester Africa on African priorities’. She was a new perspective on her own work: “You stage earlier and do prospective studies Sub-Saharan Africa.” placentas that the cells record embarking on a PhD with Professor come back with a completely different that will help us to understand which a positive response using a Ashley Moffett, an expert on the life- appreciation for the NHS. I really think women we should pay special attention pregnancy test, showing they are threatening condition pre-eclampsia that about use of resources and how we don’t to when they become pregnant. secreting hormones. results from the placenta developing always make best use of what we have. Because African women have more “Our mini-placentas will help abnormally. The experience has made me a better severe forms of the disease, we think to shed light on the mysteries Pre-eclampsia occurs more doctor.” this is an opportunity to understand surrounding the relationships commonly in women of African ancestry Another success is on the way to the disease as never before.” between the placenta, uterus and compared with Europeans, and happens being born: the first contemporary fetus. They could be used to earlier in pregnancy and is more severe, Dr Annettee Nakimuli textbook of obstetrics written by African Optimism Moffett believes that Nakimuli Obstetrician in Kampala, Uganda, and researcher at Makerere University understand the role of the placenta says Moffett: “What makes the disease doctors for African women. Nakimuli and has the passion and ability to make a to protect the baby and how a ‘silent killer’ is that it’s impossible to her Ugandan colleagues are currently difference: “She’s a leader. She’s not chromosomal abnormalities perturb predict or prevent. The only course of writing the contents planned for only established and maintained these normal development, as well as to action is careful monitoring and Nakimuli explains: “I’ve really worked on of systematic processing and reviewing publication in print and online by wonderful collaborations between screen the safety of drugs to be emergency delivery.” trying to understand pre-eclampsia and of reasons for maternal death is low. Cambridge University Press in 2021. Makerere University and Cambridge but used in early pregnancy. Over the past decade, Nakimuli has we’ve made discoveries that will help The first step is to identify the barriers Meanwhile, her Cambridge colleagues she’s been a role model for all the other “To me, one of the most exciting travelled back and forth between her us to understand the basic disease, but to this process, which she is doing are providing advice and have raised collaborations that now exist in areas aspects is that the events when research lab at Makerere University in sometimes the endpoint of being able for her PhD as part of the Cambridge- funds for the book to be available as like sepsis, placental malaria, a mother and her fetus first Kampala and Cambridge’s Department of to help the patients is not easy to reach. Africa Programme, co-supervised by open access. hypertension, anaesthesia and infection physically interact through the Pathology to learn techniques, analyse In the meantime, it’s very obvious that Nakimuli and Dr Catherine Aiken from control. For change to happen it needs to uterus and placenta have been samples and spend time with Moffett we need to find other ways of helping Cambridge’s Department of Obstetrics Predicting outcomes Nakimuli is also be led by Africans like Annettee.” impossible to capture. Now we can examining why this complex disease is so women right now.” and Gynaecology. starting a new study to understand how Nakimuli herself is optimistic that the see exactly what happens when the much more of a problem in Africa. Their “One of the things that makes an to predict a complicated pregnancy. Her small successes in reducing the rate of two sides ‘talk’ to each other, collaboration led to the discovery of Stories to books Ugandan obstetrician enormous difference to women surviving Pregnancy Outcome Prediction Study (or maternal mortality in Africa will become and if that dialogue is perturbed particular genes found only in women of Dr Imelda Namagembe is also trying is somebody systematically collecting POPs), funded by the Royal Society and bigger successes: “Globally, maternal in women who suffer an early African descent that are linked with risk to improve maternal health by, as she the reasons why mothers have died, the African Academy of Sciences, and and neonatal health has become a high pregnancy loss.” and protection in pre-eclampsia. explains, “learning from the stories of reviewing them, understanding what’s thought to be the first of its kind in priority among the international Moffett is now hopeful that recent the women who have died.” happening, and then learning from it,” Africa, is based on a model designed by community, and there is more awareness Dr Margherita Turco work on ‘mini-placentas’ with Cambridge In the UK, if a woman dies during or says Aiken. “And no one has done this Professor Gordon Smith in Cambridge’s in Africa that we should not accept that colleagues Dr Margherita Turco (see after pregnancy, the circumstances of in Uganda.” Department of Obstetrics and it is normal to die during childbirth. We panel) and Professor Graham Burton will her death are collected anonymously by She adds: “Given the pressure that Gynaecology. are seeing small successes so, when provide a much-needed experimental a national service called MBRRACE doctors like Imelda and Annettee are Smith’s study followed 4,212 UK they announce every few years there is a tool to understand this mysterious (Mothers and Babies; Reducing Risks under, it’s amazing that there’s also the women for five years from early bit of decline, I think: yes… we will finally disease – and the role of the placenta in through Audits & Confidential Enquiries will and the determination to say look we pregnancy through to delivery in order to get there. general. across the UK), which then makes can do something about this.” identify predictors of adverse pregnancy “What motivates me every day is But even with these major steps national recommendations to improve It’s a sentiment echoed by Aiken’s outcomes. “In the UK, although some the belief that, in my lifetime, I will see forward, the researchers know they are future care. colleague Dr Charlotte Patient, a women are identified as high risk for preventable maternal death being talked still a long way off being able to offer Namagembe would like to see a Consultant Obstetrician at the Rosie pregnancy complications from their about as a thing of the past, even within early diagnosis and treatment, as similar system in Uganda, where the level Maternity Hospital in Cambridge, part medical history, most complications Sub-Saharan Africa.” • 38 39

hen you have a child you’re The decision about if and when to making a decision about have children can be one of the most “W someone else’s entire existence. That’s a really, really big significant many people will ever make. decision,” says Dr Simon Beard at But – for those who have the choice – Cambridge’s Centre for the Study of Existential Risk. As a moral philosopher, what influences come into play, and Beard has thought deeply about the how have these changed over time? ethics of having children. He’s troubled by the simplistic way that many people Words Jacqueline Garget talk about such an important decision – or don’t talk about it at all. “People want to see it as a private decision, and believe they should be able to do whatever they want,” he says. “But throughout history, the decision to have children has always been strongly influenced by social and ethical values. A lot of people have children because they think it’s what other people want, whether parents or partners. They’re brought up with views about what good families look like. They’re influenced by their religious upbringing, or ideas about their career, or what stage they’re at in life.”

Taking control Today people spend more time preventing pregnancy than allowing it, until they actively decide (When) otherwise. But before the advent of reliable contraception, it was the other way around. “Until the middle of the 19th century, if you were engaged in a → are you Fast Facts

Researchers studying birth rates in Britain relate going declining fertility from 1850 onwards to the growing cost of children and the increased acceptability of deliberate fertility control

An uncertain economic climate relating to COVID-19 to have might be a short-term deterrent to childbearing

Environmental issues are now part of the mix that influences reproductive children? decision-making 40 41 sexual relationship, particularly if you were more heavily involved in jobs like way to economise – don’t have six or says Dow. “Instead, the groups bring were married, you didn’t try to prevent textile weaving and cotton spinning,” says seven children, have three or four instead.” together people who are so worried about Snapshot pregnancy,” says Dr Alice Reid, a Reid. “Having one or two children didn’t Beard says this thinking persists “When you the impact of climate change and historical demographer in the Department stop them working, but having more today in driving demographic change. planetary health on their future children’s The geographer of of Geography. “So when a major fertility children did. There might have been an A report from the Child Action Poverty lives that they are pledging not to have reproductive rights decline does happen, it’s interesting to agreement between the husband and wife Group estimates the overall cost of a have a child children.” ask why.” not to have too many children too fast, child in 2019 up to age 18 in the UK was She adds: “BirthStrike 1 and No Future Having, or not having, a baby raises Reid’s research focuses on the UK otherwise she would have to leave the £185,000 for lone parents (up 19% since No Children are very strategic and you’re making a a multitude of considerations and it from 1850 to 1930, when the birth rate workforce and their income would drop.” 2012) and £151,000 for couples (up 5.5% thoughtful groups. Their aim is to put polarises emotions – not least in dropped from 4.5 children per woman to Simon Szreter, Professor of History since 2012). pressure on governments and relation to abortion. fewer than two. She thinks this is linked and Public Policy in the Faculty of “The big shift around the world has decision about corporations to do something about Dr Francesca Moore from the to the emergence of people’s ability to History, says that most societies been from ‘successful parents have lots climate change, and to try to make people Department of Geography and choose. throughout history have found ways to of children’ to ‘successful parents have care.” someone else’s Homerton College is exploring how “Perhaps women hadn’t wanted big control their reproduction. In 1798, successful children,’” he says. “People Dow recounts the story of one member legal frameworks affect access to families for a long time,” says Reid, “but it Thomas Malthus wrote his famous essay want money to invest in their children, who realised that while her mother abortion. Her current focus is on gradually became more acceptable to On the Principle of Population, arguing and it’s having a huge impact on their entire existence. wouldn’t vote differently because of anti-harassment buffer zones do something about it. Contraceptives that the Poor Laws of the time were reproductive decision-making.” ‘concerns about the weather’, she might around abortion clinics. She uses weren’t easily available or very effective encouraging people to have children by An uncertain economic climate change her mind if there was a threat of That’s a really, case studies to examine their effect at the time. We think people knew how handing out money according to how can also be a short-term deterrent not becoming a grandmother because her on patients, healthcare workers, to stop having children through sexual many they had. When the law changed to childbearing, and Reid says that daughter refused to have a baby under protesters and local residents. abstinence and withdrawal – but these – stopping payments and sending the COVID-19 and its economic effects may really big the current system. “Laws relating to abortion vary methods can only work with the poor to workhouses instead – there was a reduce numbers of births in the short “These groups are imagining pretty widely across regions and agreement of both parties within a corresponding rise in the age of marriage, term. Some couples may recoup delayed dystopian scenarios,” adds Dow. “Many decision.” countries,” she explains. “Women marriage. The growth in education and a drop in fertility. births later, but that will not be possible members are climate activists and have accessing healthcare clinics find benefited women. It led to more equal “Another societal factor influencing for everyone and some women will been involved in environmental anti-abortion protests extremely relationships, or at least more discussion reproductive choices was the rise of the end up with fewer children than they campaigning for some time. They are distressing and threatening. We’re about having children.” British professional middle classes in originally intended. talking about food shortages, water Dr Simon Beard seeing an alarming rise in extreme Fertility declines were recorded in the the late 19th century,” says Szreter. Cambridge Centre for the Study of Existential Risk shortages, civil unrest, forced mass protest tactics in the UK such as British working class towns of South “Such good jobs required an expensive Population concerns According to migration, pressure on resources, very clinic vigils, graphic imagery and, in Lancashire and West Yorkshire in the late education, and every child you had was the United Nations (UN), our global scary stuff. Their sense of urgency has some cases, violence. 19th century, where women had earning 18 years of rising expenditure stretching population is set to reach 10 billion by “That’s not an issue that we can solve been galvanised by the latest UN figures “In parts of London, anti- potential. “Married women in these places ahead of you. There’s one very obvious the year 2050. “Population growth is by reducing fertility – if anything that’s that we’ve only got 12 years left to prevent abortion protests around a product of three main components,” likely to make things worse,” adds Reid. catastrophic climate change.” healthcare clinics were prevented says Beard. “These are increasing life “A population with lots of old people and Dow says that these movements are using antisocial behaviour expectancy, population momentum not enough working-age people creates using the common desire to have children, legislation that created protest and fertility rate.” economic challenges, social care and common cultural associations Birth in decline exclusion zones. In 2018, the Home A fertility rate of 2.1 children per problems, and increases demands between children and the future, to raise Total fertility rate by region, estimates and projections, 1950–2100 Office ruled out the introduction of woman would ensure a broadly stable on healthcare services.” awareness of the fact that climate change Source United Nations Department of Economic and Social Affairs, Population Division (2019a), these zones across England but, in population but, despite the rise in overall will mean a very difficult future for World Population Prospects 2019 (bit.ly/3k8qjlG) June 2020, MPs voted in favour of a population, global fertility has actually Environmental anxiety The decision humanity. Bill that would create buffer zones been falling for a long time, and looks whether to have children now also comes “A focus on population numbers is outside all clinics in England and set to continue to fall. with an added dimension: concern for the very simplistic, and obscures the fact that Live births per woman Estimates Projections Wales. If successful, this legislation “If fertility was reduced to below state of the planet. A study published in the vast majority of global carbon would bring an end to the ‘postcode replacement everywhere in the world the journal Environmental Research emissions come from just a handful of 7 lottery’ of harassment that women right now, at least half or more of the Letters in 2017 by Swedish and Canadian corporations, not from people having accessing abortion clinics face. population growth in the next 60 or researchers found that four personal children. These groups are saying we 6 Legal frameworks have been 70 years would be due to population choices have a consistently high might not have a future at all.” regulating reproduction in a momentum: the existing large cohorts reduction in carbon emissions: eating a 5 geographically determined way.” of women of reproductive age who don’t plant-based diet, living car-free, avoiding Making a decision So what, armed with Moore is also exploring the have many children each, but collectively flying and having one fewer child. the correct information and a long-term 4 escalation of the anti-abortion produce fairly large numbers,” says Reid. Of these, having one fewer child had view, is the best decision for potential protest in England and the role of “In the longer term, people deciding not by far the greatest impact, saving around parents to make? Beard says there is no 3 American ideas of ‘free speech’ in to have children will reduce fertility and 58.6 tonnes of carbon per year. ‘one-size-fits-all’ policy on having this protest. reduce the population. But it will also However, Dr Katie Dow in the children that could ever work. He is keen 2 produce some very odd population Department of Sociology says that to see wider debate around population Dr Francesca Moore structures and create many problems not everyone agrees with the view that growth and reproduction, to help 1 along the way.” there is a simple relationship between individuals think more critically about the Japan and Italy offer a glimpse of a larger human population and advantages and disadvantages of having these problems – their fertility rates are greater environmental degradation. children before making their decision. But 1950 2100 so low that their populations are already In collaboration with Heather McMullen if there’s one indisputable fact, in decline. “As we talk about a global at Queen Mary University of London it’s that if everyone made the same population of 10 billion, we’re also talking she has been following the online reproductive choice, the results would Sub-Saharan Africa Latin America and the Caribbean about a situation where increasing discussions of climate activist groups to be disastrous. Northern Africa & Western Asia Australia & New Zealand proportions of people will be past understand how environmental issues • Central & Southern Asia Oceana (exc. Aus & NZ) retirement age. Over a quarter of Japan’s influence reproductive decision-making. Eastern & South-Eastern Asia Europe & North America 1 BirthStrike has since announced the end of its population is already over the age of 65,” “These groups are explicitly against campaign, citing reasons that include accusations says Reid. population control, or populationism,” of being populationists. 42 2 3 4 43

1. Divine aid, 4th–2nd century BC Terracotta model of a swaddled infant from Hellenistic Italy, offered to the gods to secure family success

2. Monstrous birth, 1559 The ‘monster of Cracow’, an unusual-looking human child in a manuscript discussing diabolical causation 1 3. Generative parts, 1672 Engraving of follicles, or ‘seed-preparing vessels’, that feed the female ‘balls, trumpets… womb and vagina’

4. Man-midwifery dissected, 1793 Satirical image, a weapon in debates over who should assist women in childbirth, medical men or midwives 7 6 5 5. Human embryos, 1799 The first connected series of pictures showing growth and increase in complexity through human development

8 9

6. Family pedigree, 1934 ‘Schizophrenic family’ pedigree from a book explaining the Nazi sterilisation law to doctors and administrators

7. Calendar wheel, 1960 Wheel marketed to help The histories of how living things Reproduction: Antiquity to the Present women use the rhythm procreate – from the banks of the Day (2018), published by Cambridge method to identify fertile ancient Nile to the fertility clinics of University Press and now out in and non-fertile days today – have been brought together in an paperback, is edited by Professors Nick 8. Family planning, 1967 astonishing book covering 4,000 years Hopwood and Lauren Kassell from the Indian stamps advocating a two-child family, shown of making (and not making) babies. Department of History and Philosophy of here standing on the red The volume represents decades of Science, and Dr Rebecca Flemming from triangle, a symbol of scholarship by 70 leading researchers the Faculty of Classics. contraception and follows a five-year project funded by 9. Room of ribbons, 2017 the Wellcome Trust. This is the brief Read more Photographs and ribbons, offerings for divine aid to version, told through a selection of the → bit.ly/reproductionbook Credits (1, 2, 4) Wellcome Collection; (3, 5, 6) Cambridge University Library; have healthy children, in a book’s images. → bit.ly/reproductionblog (7) T. S. Welton, Rhythm Birth Control (Grosset & Dunlap, 1960); (9) Jessica Hughes Catholic shrine in Italy HISTORY A BRIEF OF REPRODUCTION Editorial office University of Cambridge Office of External Affairs and Communications, The Old Schools, Trinity Lane, Cambridge, CB2 1TN T +44 (0) 1223 765 443 E [email protected] cam.ac.uk/research facebook.com/cambridge.university instagram.com/cambridgeuniversity twitter.com/cambridge_uni youtube.com/cambridgeuniversity linkedin.com/school/university-of-cambridge weibo.com/CambridgeUniv

Council for Advancement and Support of Education (CASE) Circle of Excellence Winner 2020 Gold Award: Publications (Institutional Relations)

Horizons 39 Pioneering research from the University of Cambridge

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