SYMPHYSIOTOMY

Below is my contribution last week in the Dail Symphysiotomy Debate:

Difficult and all as this discussion is, it is important that it is held. First, I again extend my sympathy to all of the women who were affected by this.

I have read the different reports, including the report of the socio-medical historian, Professor Oonagh Walsh, who goes into the history of it. This was in Ireland, where there was no legal access to contraception and where the question of the mother being subsequently perhaps able to deliver multiple babies successfully was a key element of socio-medical strategy. This was part of the background to what happened in maternity hospitals. Also, the great privacy attaching to pregnancy, which still pertains for instance in most of the developing world where there is very little discussion it is fairly secretive. Once women have a baby successfully delivered, very often what most people want is to forget as much as possible as quickly as possible. That pertains to this day. We have practices which in future years may be looked back upon where we have a lot of arrangements around very high numbers of Caesarian sections, which are running close to 30%, without a huge amount of discussion. It is true that while for some women delivering a baby is not only a happy and joyful event, it can also be relatively speedy and less painful than it is for a certain proportion of women on the other end of the spectrum for whom, even today, delivery can be extraordinarily and exceptionally painful.

When I was part of the then Government that discussed this, I was of the view that the redress approach should not be the same as an inquiry, that it should be a redress scheme which would be set up and which would invite women who were affected to go through the procedure to seek to get their redress. Let me say why I take that position. I have just heard Members suggesting there should have been a more court-based adversarial process. I personally knew many affected by the different inquiries into children who were held in institutions, in some cases as adult women in Magdalen institutions for the greater parts of their lives. While some are robust in going through procedures and telling their stories, for others, who are both fragile and damaged, it is an incredibly difficult experience where not only must they share with whatever the procedure is but then they must explain to their families and children something which, like this procedure, they may never have explained previously. Setting up a process that would allow women to be compensated was certainly uppermost in my mind and the Labour Party’s mind, given that we were coming off a long period. In 2003, as I recall, Deputy Michéal Martin was Minister for Health. The Deputy is a compassionate person but he did not do anything to address the stories that were coming forward then. That happened over a long period of time. It was put to one side. Really, it was not addressed until the various more detailed examinations which were undertaken, starting with Professor Walsh’s report, going on to the good report done by Judge Yvonne Murphy and then the redress scheme administered by Judge Harding Clark.

What is interesting about the scheme is that, initially, it was thought – this was following on two previous detailed expert reports – that approximately 350 women would apply. In fact, there were 950 applications. That is no one’s fault. Inevitably, when a scheme is advertised those who feel they were affected as well as those who perhaps had been involved in different groups over a long period of time campaigning on it would, of course, go forward. It is also interesting how many awards were made. Liability was established in over 400 cases. That is a shocking figure. In that sense, the scheme dealt with and made awards to far more women than were even anticipated would come forward when it was set up at the outset.

There have been comments here about the fact that awards were classified in groups by amounts awarded but that is often done internationally where one is making a scheme easy to access. It is quite a sensible approach to take because it lessens the trauma for most of those concerned. We need to be honest about that. We have had so many cases in here of women who have been accused of sexual abuse who have been thrashed on social media because of what they have said, and we have discussed that here. I entirely disagree with the idea that these most private matters would be entirely in the public domain and before a court-type procedure because of the cases of those of whom I am aware who either chose or did not choose to go before court-type procedures on previous occasions.

Three-hundred and thirty-nine applications received awards, 166 of which were awarded €100,000. I am not saying that in any way compensates for what the women suffered but it is a significant sum. Some 15 assessments involved awards of €150,000 because those women suffered potentially significant disability which, as the House will be aware from the women’s testimonies, affect their lives in profound ways.

What do we do as a consequence of learning this?

I suggest that we invite the authors of the various reports to make presentations to the Oireachtas health committee and to have a discussion with the members about the history, with due regard to the sensitivities of people who suffered in this way. That would be a valuable public exercise in terms of education.

We should consider this as well in today’s context. About three weeks ago I sat with over 20 women in a hospital and rehabilitation centre in Dar es Salaam in Tanzania in east Africa, where I worked in the 1980s. I wish to speak particularly to all the women who are present, because this is very much a women’s concern. In Africa and in most of the developing world, the follow-on and current day practices to which symphysiotomy relates is called fistula. This is where after a delivery, as a consequence of vaginal or rectal damage, a woman basically becomes incontinent in respect of urine and, in some dreadful cases, in respect of faeces as well. It is truly horrifying because in many countries and societies, women to whom that happens are ostracised and shunned as though they have done something wrong. We never had such a history in Ireland; we would never do that. When we are looking at the past through the prism of the present sometimes we do not sufficiently recall what Ireland was like and what the different forces of authority in Ireland were. In any event, we should point out here today that where parallel practices continue to be staple treatments for women who are being delivered of babies in the developing world, this country in its development programmes should help in trying to provide recovery for the women and girls affected.

Of the approximately 23 women I spoke to in Dar es Salaam, who had all had potentially life-saving operations to correct what had happened in a recent childbirth, about seven were teenagers. The youngest was around 15 years of age. As we in Ireland seek to address a dreadful wrong and what women here suffered in the past, we must also thank those women for telling us about it and for sharing what happened to them with later generations of women. The eldest of the women who received the awards was 91 years old while the youngest was 51. All of us would like to believe that the services in Ireland have moved on dramatically, but we should not forget that this type of dangerous event during pregnancy is still very prevalent in much of the developing world.

The other voices that are missing from the debate in Ireland are those of midwives. People who have watched the popular television programme “Call the Midwife”, which is based on Jennifer Worth’s memoir of being a midwife in the east end of London in the 1950s, will be aware that it was the development of the British National Health Service by Aneurin Bevan, the great Labour Party Minister, which brought an end to some of the terrible practices of that time, as outlined in the books and the television series.

I propose that the authors of these detailed reports be invited to appear before the committee. I am pleased that hundreds of women have received some redress. I hope it has helped them in their lives. It will not have cancelled out what happened to them but, hopefully, it will have given some comfort to them and their children. We should also be proud of the Irish development aid programme, which partly sponsors the hospital and facility I visited. Thousands of women’s lives are being saved every year partly through the development money that Irish taxpayers contribute through their taxes. In that way they are bringing an end to parallel sufferings that, unfortunately, women are still undergoing. The tragedy, both then and now, is that when these things happen in a maternity case the baby is often lost as well. The woman is not only physically damaged but her capacity to have children is also severely damaged. Again, that is an enormous heartache for people. It was in the past and it is now.