Call for full inquiry into use of symphysiotomy in Irish hospitals

Sinn Féin spokesperson on health Caoimhghín Ó Caoláin today called for a full inquiry into symphysiotomy, a practice he described as “a clinical scandal on a par with the clerical scandals we have seen exposed in the past two decades”.

Symphysiotomy is a procedure which involves breaking a woman's pelvis, resulting in its being permanently widened by up to 3.5 cms. It was used in Ireland between the 1940s and 1990s "as an alternative to caesarean section in cases of obstructed labour". Symphysiotomies were carried out on about 1,500 women in Ireland between 1944 and 1992. The Institute of Obstetricians and Gynaecologists say the procedure may give rise to walking difficulties, pelvic joint pain and urinary incontinence in those who undergo it.

One woman who underwent the procedure told

“I have spent 40 years locked up for having a baby. I kept having to give up jobs because of the pain. I have never been on a holiday and I never go out. I have to wear sanitary towels all the time because of bladder problems. I have been to a psychiatrist and I am eventually going to be left on my own in a wheelchair."

Speaking in the Dáil today, Ó Caoláin said: "Symphysiotomy was the imposition by clinicians in Irish hospitals of a certain Catholic ideology that saw the role of women solely as the bearers of Catholic children, a role to which their bodies and their rights were to be wholly subsumed.

Anyone who doubts the real motivation for the carrying out of symphysiotomy need only refer to the published writings of Dr. Arthur Barry and Dr. Alex Spain. The former referred to caesarean section as leading to the 'improper prevention of pregnancy'."

Says the group Survivors of Symphysiotomy:

“Symphysiotomy was a maverick practice, a barbarous procedure that should never have been performed except in the direst of emergencies.

“The surgery was exhumed at the National Maternity Hospital by doctors who were hostile to the idea of family planning and who were looking to replace Caesarean sections with an operation that would facilitate large families.”

In February, the Department of Health received a draft report from an academic researcher who was asked to review the practice in Ireland from the 1950s up to the 1980s.

According to the Irish Medical Times:

“The report considers under what conditions the practice of symphysiotomy was used in Ireland and also whether symphysiotomies were carried out longer in Ireland than best practice internationally would have indicated.”

Minister for Health James Reilly told the Dáil in February that, “I have little doubt that it was used very inappropriately.”

Read a full transcript of Ó Caoláin's speech to the Dáil on the issue below.

This is both a sad and an historic occasion - the first time that the Dáil has had statements on the use of symphysiotomy and pubiotomy, that barbaric practice which inflicted so much pain, distress and disability on so many Irish women.

Our debate today is tinged with sadness as we think of those women victims and survivors of symphysiotomy who are no longer with us - suaimhneas síoraí dá n-anamacha go léir. It is sad also to realise that it has taken so very long for this human rights issue to be acknowledged by the Dáil in a substantive manner.

I want to extend a very warm welcome to the women who are with us today in such significant numbers in the public gallery and who have survived symphysiotomy, living with the legacy for many years. We salute their courage in coming forward to tell their stories and to demand justice and truth.

The infliction of symphysiotomy on women in Ireland is one of the greatest medical scandals not only here but on an international scale.

Symphysiotomy is a clinical scandal on a par with the clerical scandals we have seen exposed in the past two decades. It may not be on a par in terms of scale but it is certainly equivalent in terms of the suffering inflicted on the women victims and on their families. And there is one very important and crucial parallel - that is the effort by the medical establishment and by Government to conceal the true nature and extent of this abuse of the bodies and of the rights of Irish women. I regret to say that this effort to conceal or deny the truth is continuing.

Exactly a month ago on 15 February here in this Dáil chamber I questioned the Minister for Health James Reilly on symphysiotomy. I asked the Minister if he agreed that this barbaric act should never have been carried out in the first place.

The Minister replied:
I reject the Deputy's contention that this was a barbaric act, although its use in certain circumstances may well transpire to have been utterly inappropriate.

That was a very regrettable statement on the part of the Minister. I challenge him to ask any of the surviving victims if they agree with his contention that sympysiotomy was not barbaric. A barbaric act is defined as something cruel and primitive. Symphysiotomy was both cruel in its infliction and its effect and because it was medically unnecessary. It was primitive because it arose out of an attempt to impose on the bodies of women an ultra-conservative version of Catholic teaching.

Only yesterday the Dáil passed the Criminal Justice (Female Genital Mutilation) Bill. This legislation - which we very much support - is to outlaw another barbaric attack on the bodies of women, arising out of a form of extremism which degrades women and girls and asserts male domination over them. Symphysiotomy shows that such mentalities are not confined to Africa and this State is in no position to look down on countries where such practices are common while we deny the full truth of symphysiotomy and deny justice to its victims.

In that exchange with me on 15 February the Minister went on to say:

It was a standard procedure at one time and it was reintroduced to certain Irish hospitals in the 1940s as a clinical response to the limitation imposed by specifically Catholic religious and ideological circumstances.

I contest that statement. The evidence shows that even in more remote times symphysiotomy was not a standard procedure. It was always controversial from the time it was initiated in Paris in 1777. It had been rejected in most countries at the time of its reintroduction in the Ireland of the 1940s. This reintroduction was not, as the Minister stated, a clinical 'response' to the limitation imposed by what he called “Catholic religious and ideological circumstances”.

Symphysiotomy was the imposition by clinicians in Irish hospitals of a certain Catholic ideology that saw the role of women solely as the bearers of Catholic children, a role to which their bodies and their rights were to be wholly subsumed. It was also imposed for reasons of clinical training and we have heard the testimony of women who suffered this procedure in the presence of large groups of medical students.

The Minister in that exchange of 15 February unfortunately repeated the mantras we have heard from those in the medical establishment who seek to defend symphysiotomy. For example, that "the safety of repeat Caesarean sections in the period was unproven". Remember we are talking here about the period from the 1940s to the 1980s. It was as if medical science had not moved on in 40 years.

In a letter to the Department of Health & Children in May 2001 the Institute of Obstetricians and Gynaecologists claimed that the danger of sepsis from caesarean sections was the main reason for the carrying out of symphysiotomy. Again, this was an attempt to muddy the waters.

Anyone who doubts the real motivation for the carrying out of symphysiotomy need only refer to the published writings of Dr. Arthur Barry and Dr. Alex Spain. The former referred to caesarean section as leading to the “improper prevention of pregnancy”.

Of course the most compelling condemnation of symphysiotomy is not in academic studies but in the testimony of the victims themselves. Not only was the operation cruel and unnecessary, its victims were kept in the dark about what was being done to them. They received no aftercare or support. They were effectively abandoned by the medical establishment and by the State.

When the victims spoke out it took a long time for them to be listened to. Some of us here in the Oireachtas, including former Louth Deputy Arthur Morgan and myself, as well as a number of Deputies from other parties and independents, raised the issue with successive Health Ministers. We helped to keep the plight of the victims on the agenda. But again it was the women themselves, speaking out bravely, who elevated the issue to national attention.

In February 2010 RTÉ's Prime Time carried out an investigation into symphysiotomy. I said at the time, when I secured a Dáil adjournment debate in the wake of the programme, that an inquiry into this practice should already have been held, reported and acted upon.

One of the most extraordinary pieces of evidence on that programme was one that did not take a great deal of research. It was on the number of symphysiotomies actually carried out.
The Department of Health & Children was asked for a figure and gave one which they said was incomplete because they did not have all the relevant health board reports. Yet a reporter from Prime Time was able to go to the National Library, which has the relevant reports, and find the correct figure. It was three times the Department's estimate. This was a very sorry and embarrassing state of affairs for the Department to find itself in.

In the wake of the Prime Time programme it was announced on behalf of Health Minister Mary Harney that she had asked the Institute of Obstetricians and Gynaecologists to prepare a report for her on the practice. That was unacceptable. She was asking the institution whose members were responsible for the abuse to investigate itself. It was not a proper inquiry, though its establishment came about as a result of pressure on the Minister to act.

Similarly, the report currently in the hands of the Minister was not the outcome of a transparent and public investigation. We will reserve judgement until we see its contents but whatever it concludes the need for a proper inquiry remains.

This is the key demand. We need a full and proper inquiry that is open and transparent and that gives the victims their proper place.

We also urge the Government to introduce legislation amending the Statute of Limitations as was done in the case of sexual abuse victims. This would allow the women to pursue legal action.

We also need to see a comprehensive package of supports for the surviving victims of symphysiotomy, including health amendment cards for all.

In conclusion I want to thank the members of the Oireachtas Support Group for Victims of Symphysiotomy and re-affirm that we will continue to work together on this issue. And, most especially I want to pay tribute to the women themselves. Their persistence has shone a light into a dark period of our history but it is also been a beacon of hope.

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