Unveiling the truth: Evaluating Ireland's progress in investigating maternal deaths
Tatenda Mukwata died on April 21, 2022, at University Hospital Kerry, after giving birth to a healthy baby.
This June, inquests will be held into the deaths of Geraldine Yankeu and Tatenda Mukwata — two women who died in 2021 and 2022, respectively, in Irish maternity services after giving birth.
Their inquests are mandatory. Following the adoption of the 2019 Coroners (Amendment) Act, coroners are held to conduct inquests into all maternal deaths, leaving no leeway for a verdict of natural causes without an impartial investigation.
The 2019 Coroners (Amendment) Act was a milestone. Not only did it promise us that families would no longer have to fight for years to find out what caused the death of their loved ones, but it also provided an opportunity to uncover systemic and structural failures within Irish maternity services.
In adopting the 2019 act, Ireland also set an important example for other countries in which maternal deaths are still not fully or independently investigated.
The adoption of the 2019 act showed Ireland’s commitment, on paper, to uphold its international legal obligations under Article 2 of the European Convention on Human Rights. This provision lays down the right to life of all, which includes an obligation for states to ensure timely, independent, effective investigations into all unnatural deaths.
These investigations need to be public and involve the next of kin. It is a procedural obligation, meaning that although a state may not directly or indirectly be responsible for the death or deaths in question itself (a substantive matter), it can still be held accountable for a violation of the right to life if it does not take the necessary procedural steps after the death has occurred, such as doing all that it can reasonably be expected to do to find out how that person has died.
The mandatory inquests should provide the bereaved families with answers and, importantly, give insight into any systemic and structural flaws in the maternal healthcare system. It is these innate shortcomings that should, in turn, be addressed by the state as part of its substantive obligations under the right to life. Hence the new law is vital in ensuring compliance with both types of obligations under the European Convention on Human Rights.
Most importantly, the new law should lead to safer maternal healthcare for all.
But adopting a law is, in itself, not enough. What matters is whether Ireland took the necessary measures to ensure effective implementation of its 2019 act and whether all maternal deaths are now subjected to an effective and impartial investigation in a timely manner.
The delayed inquests into Geraldine Yankeu's and Tatenda Mukwata’s cases and the initial dismissal by the Cork coroner of the case of Geraldine Yankeu raise concerns about the effectiveness of the act in practice.
During a discussion on the effectiveness of the 2019 act in Europe House, Dublin, last March, it emerged that there are structural and systemic shortcomings in the act’s implementation.
Crucially, a panel of legal experts and an audience consisting of midwives, scholars, family members directly affected by maternal deaths, a member of the European Parliament, and a coroner, highlighted that no general oversight mechanism was established and that no funding had been dedicated to those bodies which must put the law into practice. This includes the coroners’ offices that must carry out these inquests and who, as sociologist Dr Jo Murphy-Lawless pointed out, are "totally under-resourced".
In terms of the inquest proceedings itself, problems have surfaced with its adversarial nature and the lack of a duty of care towards the affected families. Rather than the inquisitorial procedures which should be at the heart of all inquests, in which parties are looking to establish the facts so that future incidents can be prevented, State or private institutional care providers have come to maternal death inquests legally represented to defend their ‘cases’.
This has required bereaved families to seek experienced legal counsel. As barrister Doireann O’Mahony put it, the families are often left feeling "like furniture". A lack of any enforcement or oversight mechanisms, lawyers have also pointed out, results in a lack of consistency in the inquest proceedings, leading to subjectivity rather than objectivity.
It appears that although a beautiful law exists on paper, its effectiveness in practice remains elusive. And this is to be regretted for more than one reason.
Last January, the Elephant Collective travelled to Brussels with their Picking up the Threads exhibition, creating awareness of the persisting numbers of maternal deaths, the disproportionate number of women of colour affected, and the 2019 act that was adopted by Ireland to address this problem. Hosted by Irish MEP Clare Daly, it was officially launched by Robert Biedron, chairman of the Women’s Rights and Gender Equality Committee of the European Parliament and attended by politicians and parliamentarians from all ends of the political spectrum.
The event was very successful. As Daly noted during the discussion in Europe House last March, parliamentarians are still coming up to her about the exhibition, and a petition on the rising number of maternal deaths is under way.
By prioritising the effective implementation of the 2019 Coroners (Amendment) Act, Ireland can fulfil its international legal obligations and lead the way in ensuring timely and impartial investigations into all maternal deaths.
The 2019 act has the potential to serve as a model for Europe. But in order to do so, Ireland must step up its game and show that it is truly committed to protecting the rights and lives of women in childbirth. Effective implementation requires action and funding.
With the eyes of Brussels upon Ireland, the time for action is now.
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