Put paternalism to bed in our health service

Female health scandals are almost two a penny. Health Correspondent Catherine Shanahan says it is high time for a health service chief keen to hear what women want

In 1999, an Oxford-based GP Ann McPherson addressed a conference in Dublin called ‘Women Taking Control of their Health’.

The conference was co-hosted by the Women’s Health Council, set up in 1997 on Michael Noonan’s watch, a health minister whose legacy will forever be tainted by the tragic fate of Bridget McCole.

Also, 1997 was the year of the hugely controversial C case , when a 13-year-old girl, pregnant and suicidal as the result of a brutal rape, was brought to Britain by social workers for an abortion, more accessible in Ireland now than it was then, but still with some way to go.

Dr McPherson is reported as telling the conference that patients who participate in decision-making might have improved health outcomes.

She pointed out that women, in general, have more contact with the medical profession than men: Through childbirth, contraception, taking children to the doctor, being carers, and through medicalisation of the menopause.

The conference also heard from Noreen Kearney, then chair of the Women’s Health Council, who said the consultation process that led to the setting up of the council showed women still lacked essential information about their health.

The council was established in a year when female health issues regularly dominated the political agenda, casting the State in a very poor light.

Fast forward to 2008 and that same council, set up by statutory instrument to advise the health minister on all aspects of women’s health, “disappeared” when a female health minister, Mary Harney, announced a major programme of agency rationalisation in the health sector.

“It is probably more accurate to refer to it as having been a ‘disappearance’ rather than a ‘merger’,” said Gabriel Scally in his just-published report on the CervicalCheck scandal.

The reason the establishment of the WHC makes it into the Scally report is to highlight “there was a period when women’s health was taken very seriously” in this country — albeit at the time when we were one of just two EU countries yet to licence emergency contraception and when we were in the crosshairs of the UN Human Rights Committee over our restrictive abortion laws and constitutional entrenchment of gender inequality.

Still an’ all, the council was a step forward, producing “authoritative reports on a wide range of issues pertaining to women’s health”.

Eight years after the demise of the WHC, another “authoritative” report on a women’s health issue, was produced: The Surgical Symphysiotomy ex-gratia payment scheme.

Compiled by Judge Maureen Harding Clark at the behest of the then health minister Leo Varadkar and presented to current Health Minister Simon Harris in 2016, it couldn’t be more different in tone to the Scally review.

Harding Clark writes: “Compassion did not overturn common sense when it was apparent that personal recollections were simply not corroborated by the contemporaneous medical records of the symphysiotomy delivery.”

Even though many women complained of lifelong disability as a result of what in hindsight can only be viewed as a barbaric procedure, where doctors cut through the fibrous cartilage of the pubic joint to widen the birth canal — their voices are absent in the report.

In contrast, the voices of doctors are very much in evidence. A chapter looking back at the clinical reports of the major maternity units for the latter half of the 20th century includes extensive commentary from consultant obstetricians explaining and justifying their use of symphysiotomy.

Linda Connolly, a sociologist and director of the Social Sciences Institute at Maynooth University, wrote in the Irish Examiner at the time that Harding Clark’s report “reflects a view that women gave birth because men help them and intervene to save their lives”.

She writes that the report “is informed by a group of male medical experts, with little attention to perspectives in childbirth studies that empower pregnant women and which prioritise women’s experience”.

The Scally review, conversely, is informed by the women whose health was not protected by the largely male consultant workforce in whom they had placed their trust.

Instead of patronising the victims, it takes the view that the medical experts have a case to answer.

At a press conference following the launch of the report last Wednesday, Scally described their behaviour as “verging on misogyny”.

“The point was made,” he said, “that many of the major controversies about maltreatment of patients or denial of reproductive rights in the Irish healthcare system have involved women being damaged.”

The number of women damaged by our health service is staggering. Yes, plenty of males have been damaged too, but who can recall a major health scandal involving men?

Women were the victims of the Anti D/Hep C scandal, given infected blood products by the State to supposedly safeguard the health of future babies.

Bridget McCole, who died fighting for compensation, is the unfortunate poster woman of that generation.

Numerous women were damaged by the dodgy obstetric practices of one Michael Neary, whose use of symphysiotomy left many with lifelong incontinence and pelvic pain.

The mental distress the State subjected single mothers to by placing them in mother and baby homes, taking their babies and putting them up for adoption, continues to traumatise families.

The failure here to legislate in any meaningful way for termination of pregnancy has led to repeated criticism by the United Nations human rights committee which only last year ruled that our abortion laws had subjected Siobhán Whelan, denied access to an abortion in 2010, despite being diagnosed with fatal foetal syndrome during her pregnancy, as “cruel, inhumane, and degrading treatment”.

The findings of the Scally review provide no reassurance that treatment of women has moved on in any meaningful way.

Indeed, it is Scally’s view that paternalism is an ongoing pervasive problem in the health service, particularly at hospital consultant level, which is male-dominated.

As Prof Connolly remarked when discussing the Harding-Clark report: “This story is far from over and it remains another example of Irish women’s bodies on trial.” 

Perhaps the only way to ensure that women’s voices are heard in the health service is to appoint someone who listens to them.

Gabriel Scally for director general of the HSE, anyone?

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