Let’s Talk About: Reproductive & Obstetric Violence (part 2)

Image of a uterus on a green background/sphere with two hands wresting on the edges of the background

Part 2 of 2

In our previous blog post for the 16 Days of Activism against Gender-Based Violence we outlined what ‘reproductive and obstetric violence’ means. Here we take a closer look at how reproductive and obstetric violence happens in Irish maternity services.

The Irish State has a long history of institutionalised gender-based abuse. Think about the horrors of state-sanctioned and state-funded Mother & Baby ‘homes’ where generations of unmarried women were sent to give birth and then had their children taken away. These coercive institutions have recently been in the news thanks to The Clann Project’s work to prevent a 30-year seal on the archive created by the Mother and Baby Homes Commission of Investigation. As RTÉ reports, “mother-and-baby homes is not an issue of the past, it is ongoing”. The speed at which the term ‘repeal’ re-emerged as “repeal the seal” shows there is still plenty of appetite to resist such attempts to carve away at the rights people have won. 

The healthcare system and especially pregnancy-related services can, at times, be places of gendered abuse. We see this in the appalling treatment of women who were subjected to symphysiotomy during childbirth who are still seeking compensation. We see this in the thousands who were forced to travel for abortion care, in the cases of Miss X, Miss Y, Miss C, and in what happened to Sheila Hodgers and Savita Halappanavar. We continue to see this when migrant women are treated poorly in labour and when disabled people have reproductive choices made for them by courts

Coercion in Irish Abortion Law & Clinical Guidance

Although the 8th Amendment—a harsh 35-year constitutional ban on abortion—was repealed two years ago, the Health (Regulation of Termination of Pregnancy) Act 2018 still falls short of guaranteeing pregnant people full reproductive freedom. The current abortion legislation exerts reproductive control by imposing barriers like the mandatory three-day wait. In addition to this explicit state control, the law makes it harder for those facing violence or coercion from their partner to assert their human rights by complicating their access to abortion. It can also create significant financial and care burdens on people forced to travel outside their own communities.  

This is not the only element of coercion in the abortion law. The possibility of arrest and a 14-year prison sentence still hangs over doctors’ heads. As a result, some doctors are overly cautious in how they interpret the legislation. Pregnant people suffer the consequences: they are still making the journey to obtain abortion care abroad, as highlighted by Ellen Coyne in the Irish Independent, on November 9th 2020: 

‘A woman had to travel to England for a termination for medical reasons after her baby was diagnosed with a significant chromosome disorder … Six weeks after coming back from England, she wrote a letter to a consultant explaining what had happened to her. A month later, he has not replied. “Nobody was going to own this, nobody was going to mind us. I don’t want this to happen to anybody else. As much as we like to think we would be safe and looked after in Ireland, we were not,” she said.’

At the other end of the spectrum of reproductive control, some women find themselves up against so many obstacles that they are forced to continue their pregnancy. This is because individuals whose medical abortions fail are still forced overseas to complete abortions they legally initiated at home if they find out they are still pregnant after 12 weeks. As Abortion Support Network (ASN) recently reported, an Irish woman who contacted them is in that situation now due to a failure in duty of care by the HSE:

‘A woman in Ireland had taken early medical abortion pills three times – and they’d failed. Why did they try pills three times? There was no provision of surgical abortion where she lived, and, by this point, it was too late for her to travel to Dublin for a surgical abortion. Unfortunately, due to caring responsibilities and other factors, this client is not able to travel abroad and will be forced to continue her pregnancy.’

At least 25 Irish residents have been forced to travel to the UK since March 2019 due to exceeding the 12-week threshold after their medical abortion failed. All of their abortions were completed in the UK at significant personal expense or via grants from ASN. ARC have been running an email-your-TD action on Care At Home After Failed Abortion since early September, prior to learning of the above forced pregnancy case. We have yet to receive any meaningful response to our communications from Health Minister Stephen Donnelly.  

Coercion in Pregnancy Care, Labour, and Childbirth

It took the HSE a year after the referendum to revise the national consent policy to recognise the rights of pregnant people to give or refuse consent to treatment. Much work remains to educate maternity hospitals about an individual’s right to make their own decisions about pregnancy and childbirth – and the Covid-19 pandemic is throwing a wrench into that process.

According to Midwives 4 Choice, many abuses against pregnant people are occuring in our maternity services under the guise of preventing Covid transmissions. Irish people are sharing similar experiences to those reported in the UK through forums like “In Our Shoes – Covid Pregnancy”. Maternity hospitals are limiting patients’ choice to have a partner or support person with them for antenatal visits, scans, labour and birth. This is also true of abortion care in hospital. People are forced to attend on their own, even when they would like to have someone with them.

The World Health Organization recognises the importance of each individual having a birthing companion of their choice. Some labouring people are being told at the moment of their caesarean that their birth partner cannot come into the operating theatre. Other birthing partners are being refused entry to the hospital altogether, and some people are being made to labour completely alone against their will. Not only is this traumatic in and of itself, but it also means that there is no one to witness any mistreatment or failure in duty of care that may occur.

Indeed, the abuses go beyond depriving people of support. They include invasive physical procedures like pressurised inductions of labour – which often lead to a cascade of interventions, including caesarean surgery – and coerced internal vaginal examinations to see that labouring people are ‘far enough’ along in their labour for partners to be ‘allowed’ to join them on the labour ward. One labouring person was told: “if you don’t like it, go somewhere else”. 

Just last month, in November, 2020, the home birth service run by self-employed community midwives who have an agreement with the HSE were instructed to cease attending at waterbirths. The Association for Improvement in Maternity Services Ireland (AIMSI) issued a statement criticising the HSE’s decision to ban home water births:

“The available international evidence indicates that any ban on waterbirth is not evidence-based … Furthermore, AIMS believes this strategy will result in more medicalised interventions such as the routine use of syntocinon [hormone injection], the routine use of episiotomies, or coached pushing and a poorer maternity experience overall.”

From all of these examples, we can see that reproductive and obstetric violence remains prevalent  in Irish maternity services. It is the job of the state to defend the human rights of its residents – Ireland has historically failed at this and has been the perpetrator of extensive reproductive violence against women and pregnant people. As campaigners, we must hold the State to account. We must demand an end to all forms of gender-based violence, and insist on our right to bodily autonomy; our right to choose if and when to start and grow our families; and our right to be heard and respected in childbirth.

Please see the 2019 report Human Rights in Childbirth (HRiC) by the UNHCR Special Rapporteur on Violence against Women for global context.