My interview this week on Morning Ireland, calling for a restorative justice approach to the Mother and Baby Homes Commission, and for more research

https://www.rte.ie/radio1/morning-ireland/programmes/2017/0308/858040-morning-ireland-wednesday-8-march-2017/?clipid=2423088#2423088

Article I published in the Irish Examiner newspaper: 

Symphysiotomy report begets more questions

50

Tuesday, November 29, 2016

Prof Linda Connolly 

Judge Maureen Harding Clark’s findings downplay physical toll of procedure and fail to recognise women’s right to consent in childbirth, says Prof Linda Connolly

Picture: PA

SYMPHYSIOTOMIES were carried out on 1,500 women in Ireland up to the 1980s, long after it was discontinued in other jurisdictions.

The controversial procedure cut the cartilage of a pregnant woman’s pelvic bone (breaking the bone in extreme cases) to widen the birth canal.

Three hundred and ninety-nine women have received €50,000, €100,000, or €150,000 sums under the symphysiotomy grant payment scheme, which paid out €34m.

The women’s medical records were checked by experts and a judge awarded the payments to those who could prove they had undergone the procedure. Of the 590 applications, 185 women were unable to establish their claim, as per the terms of the scheme. The majority of women who applied were over 75 years of age. The oldest was 96.

Until last week, it was presumed that Irish women subjected to symphysiotomies, often without their consent or knowledge of what was to be done to them, were left with long-term medical difficulties, including incontinence and chronic pain.

In 2014, the UN Human Rights Committee said the perpetrators of symphysiotomy should be prosecuted. Ireland’s compliance with the International Covenant on Civil and Political Rights was monitored. However, the findings of the report, by Judge Maureen Harding Clark, published last week, paint a radically different view. The report suggests:

• Symphysiotomy was (still is) a normal obstetric medicine. It is not an example of what childbirth experts in other research domains call ‘obstetric violence’ or a fundamental human rights violation. Literature supporting the case for this procedure was cited;
• Doctors performed symphysiotomies in the best interests of the women giving birth. That contraceptives were not freely available because of Catholicism explains why a symphysiotomy might have been chosen over a caesarean section;
• Some women who applied to the scheme had false memory about symphysiotomy in childbirth. They didn’t have a symphysiotomy, just had a traumatic birth;
• Some women who did not have a symphysiotomy applied to the scheme with the strong encouragement of sons/daughters/family members and/or with the help of GPs and third parties;
• Survivor groups and media sensationalised the long-term impact of the procedure (few women suffered life-long disability and the vast majority recovered);
• Many applicants saw the word “episiotomy” on their medical records and equated it with “symphysiotomy”. They confused symphysiotomy with the after-effects of other childbirth procedures, based on what they were reading and hearing in the media. Extreme pain, incontinence, difficulty walking, etc, are not uncommon after childbirth;
• Medical experts commenting on potential medical injustices in their own hospitals are unquestionably right in the assessment in the report. (And no international or independent experts were necessary). Medical records only noted clinical reasons for symphysiotomies. No notes citing any religious reasons are evident;
• Oonagh Walsh’s “scholarly report” on symphysiotomy has been ignored by sections of the media, “who appear to prefer the more lurid and unfounded accounts projected by some activists and bloggers”.
• Money is the ultimate mode of restorative justice. The women who had symphysiotomies (but who obviously recovered quickly) have been rewarded and are happy.

A large number of issues arising from this report need to be carefully addressed. Oonagh Walsh’s report, for instance, is widely cited in academic writing (by legal scholars, women’s historians, and social scientists). It is hardly ignored.

Some of the absences/silences in the report, as well as underlying assumptions, are as notable as some of the astonishing claims in it.

The term “obstetric violence” has caused division in medical, legal, and social science scholarship — ranging from positions that advocate the superiority of midwife-led care over modern obstetrics to those who uphold the principles of modern medicine as a necessary form of power over women’s own agency and choice, in the best interests of safe childbirth.

International human rights instruments contain guidelines on safe child birth. The Harding Clarke report reflects a view that women give birth because men help them and intervene to save their lives.

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.

International literature on active versus hyper-managed childbirth, and on obstetric violence, is not referenced. Huge swaths of international research, in the field of obstetric law and women’s human rights, have also been ignored.

The reality that all medical procedures (historical or contemporary) always take place within a rights framework, and not purely within a rational, clinical ‘expert’ framework, is unexplored.

Even if women had symphysiotomies at a time when women had little or no power or say in childbirth does not negate basic rights. The full range of historical interpretations of symphysiotomy is far more complex than the report suggests.

The report emphasises evidence of symphysiotomy inscribed on the women’s bodies, and in their medical files, more than it does the question of consent.

THE prevailing cultural view of pregnancy and birth stems from a patriarchal attitude that women must be submissive and passive, and let the experts who know better do the work.

To presume that medical maternity care is an infallible authority over women, or to maintain that a live baby and/or live mother is the singular benchmark for birth, is misguided.

A woman has a right to informed consent or refusal. Moreover, she should not expect to end up in severe pain after childbirth. Whether or not the women in this report were able to ride a bike after any invasive procedure, or go on to have another child within a year, is separate from the fundamental principle of informed consent in childbirth.

Some researchers suggest that performing a procedure on a woman without her informed consent, or by coercing her to give consent, can be physical abuse.

Women have reported being held down, screaming, while birth procedures were performed on them. Doctors in the 1940s to the 1980s might have presumed they were doing the right thing for women, but there are alternative interpretations.

The report does not name the obstetricians who performed symphysiotomies, nor does it examine their rate of symphysiotomy, relative to other doctors.

Based on the evidence submitted to the scheme, is it apparent that some doctors were more likely to perform symphysiotomies? If so, why? Should the obstetricians who performed the symphysiotomies approved by the scheme not be named, in the interests of transparency and further historical research?

The Harding Clark report raises as many questions about the history of childbirth as it answers. Until it is accepted that women historically were purely vessels in childbirth changes, they will remain powerless in the face of ongoing childbirth questions and experts will remain powerful.

Compensation will now be paid out to the women whose reproductive histories and bodily parts were retrospectively judged for this scheme, but fundamental questions remain.

The €34m in compensation is a clear admittance of wrongdoing on the part of the State, despite what the report intimates about ‘victims,’ bloggers, misguided applications and advocacy groups.

This story is far from over and it remains yet another example of Irish women’s bodies on trial.

• Prof Linda Connolly is a sociologist. She is the director of the Social Sciences Institute at Maynooth University and has authored a number of books and articles on Irish women’s social and political rights

I published this article in the Irish Times on February 22nd 2017:

Why it’s time for a woman to become president of an Irish university

‘The HEA’s expert group has called for the final pool of candidates for the appointment of new presidents to be comprised, in so far as possible, equally of men and women’ 

Wed, Feb 22, 2017, 07:00 Updated: Wed, Feb 22, 2017, 11:28

Linda Connolly

Prof Linda Connolly: While 52 per cent of entry-level academic positions are filled by women, they represent only 19 per cent of professorships

The review carried out last year by the Higher Education Authority(HEA) confirmed what many commentators had observed for years: women are “vastly under-represented in top positions within the higher education sector.” 

While 52 per cent of entry-level academic positions are filled by women, they represent only 19 per cent of professorships (NUIG was cited at having the lowest proportion of women professors at 13 per cent while UL had the highest at 31* per cent). This disparity is all the more glaring when we consider non-academic positions: women occupy 72 per cent of the lowest paid positions in universities while men occupy the exact same percentage of the highest paid positions.

Although there are disparities between the universities, the issue of inequality in senior appointments cannot be said to be an isolated one pertaining to a small group of lecturers, one university, or a couple of seemingly skewed selection processes. It must be seen as an embedded feature of the culture of universities in Ireland. 

Since the establishment of the very first Irish university 425 years ago, a woman has never been appointed as president of a university. Until that glass ceiling is broken, the implicit message for female academics is to curb your aspirations and find your place on the middle rung of the ladder.

Whatever the reality of the factors that influence the promotion process, the widespread perception among women is that the deck is stacked against them, with 64 per cent believing gender bias is prevalent in the sector. This discourages many from applying for senior positions in the first place or leads to the “leaky pipeline” phenomenon in some areas where it is difficult to retain female talent.

A new approach is clearly required – one which will appear to many as radical. The HEA’s expert group has called for the final pool of candidates for the appointment of new presidents to be comprised, in so far as possible, equally of men and women. They also call for all candidates for presidential appointments to be able to demonstrate experienced leadership in advancing gender equality as a key recruitment criterion. The introduction of mandatory quotas for academic promotion, based on the flexible cascade model where the proportion of women and men to be promoted is based on the proportion of each gender at the grade immediately below, would guarantee that many more women progressed to professorships and senior management roles.

At Maynooth University, we are currently taking several steps to respond to the HEA report and fundamentally address gender across the board. Maynooth has led the way in addressing gender inequality for many years, and we rank among the top performers in the sector in appointing women to senior roles; however, the urgency of this issue requires even more proactive change and leadership. 

There is also much more to be done in transforming how we define “excellence”, the impact of motherhood on female academics, unconscious bias in research practices and equality training. Research funding bodies, such as SFI and the IRC, are set to introduce funding penalties if gender inequality is not addressed. There is much at stake.

Maynooth University recently committed to applying for accreditation in the next round of Athena Swan, the leading international award scheme for positive gender practice in higher education. 

Achieving this will require the design and implementation of a comprehensive three-year gender equality action plan. 

Irish universities should welcome this challenge and not duck away from asking hard questions of our academic institutions. Extensive international research shows that gender equality is good for academic institutions and can only enhance the performance of the sector in Ireland, significantly. A change more than 425 years in the offing will require absolute commitment. 

Prof Linda Connolly is Director of Maynooth University Social Sciences Institute (MUSSI). On Wednesday, February 22nd, Maynooth is hosting an event, “Gender Equality Initiatives in Irish Universities: Prospects and Possibilities”