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Category Archives: Reproduction

The political and personal landscape of choice in Ireland

This piece has been previously published in print by the Workers Solidarity Movement in the magazine Common Threads. Since its publication one of the pending prosecutions in the north referenced in the piece has resulted in a conviction for a young woman for having a safe though illegal abortion using the abortion pills.1383342_332492296896551_364124772_n.jpg

 

It is all but impossible, both in theory and in practice, to legally obtain an abortion on the island of Ireland, both north and south of the imaginary border that divides this island. It is completely impossible to safely and legally obtain an abortion anywhere in Ireland;  the legal framework in the south specifically requires that in order to obtain an abortion without being criminalised for so doing, the woman who needs it must be ill enough to die; thus it is rendered impossible for her to be safe in access to legal abortion.

 

In the north, the Offences Against the Person Act dating from 1861 – over a century and a half ago – is what renders women taking control of whether or not they give birth and remain pregnant illegal. It describes abortion as ‘procuring miscarriage’, a description which is very apt for what those who need abortions in the north of Ireland today are forced to do by this archaic piece of legislation; obtain the abortion pill illegally online via organisations like Women on Web, Women Help Women, or less reputable means. It states that anyone who does this “shall be guilty of felony, and being convicted thereof shall be liable [..] to be kept in penal servitude for life”. However there was an exception made to this under the Criminal Justices Act of 1945. This Act, while it created the offence of “child destruction”, defining it as “any wilful act [that] causes a child to die before it has an existence independent of its mother” allowed that such a “destruction” could be carried out without legal penalty if one is acting in good faith to preserve the life of the “mother”.

 

Unlike in the south, this has been interpreted by subsequent judgements to mean not only that the woman must be on the brink of death, but also that the woman’s health was important as well. (In the south, the Supreme Court ruling on X in 1992 specifically excludes the woman’s or girl’s health from being in any way relevant to whether she is permitted to access an abortion.) In 1994 a court in the north found that this “does not relate only to some life-threatening situation. Life in this context means that physical or mental health or well-being of the mother and the doctor’s act is lawful where the continuance of the pregnancy would adversely affect the mental or physical health of the mother. The adverse effect must however be a real and serious one and there will always be a question of fact and degree whether the perceived effect of non-termination is sufficiently grave to warrant terminating the unborn child.” However it is very difficult to establish clearly the criteria under which this is deemed to be the case; on the 26th of March of this year the Northern Ireland Executive finally agreed to publish guidelines for healthcare professionals on when it is legal for women to access abortion. This was following enormous pressure on the Executive owing to a ruling from Belfast High Court in November 2015 which found that to deny abortions to women carrying pregnancies that will not survive to term, or beyond birth, or pregnant as a result of “sexual crime” was a breach of their human rights. Again, as in the south, this legislative framework ensures that a woman cannot be safe if she is unwell and endangered enough to fit the criteria of being ‘permitted’ to access a legal abortion.

Despite the obvious outdatedness of the Offences Against the Person Act of 1861, there are nonetheless not one, but two pending prosecutions in Belfast at the moment under it. One is of a woman who procured the abortion pill for her teenage daughter; subsequent to its administration they presented at a hospital in search of medical treatment, worried for the daughter’s well-being. Though details of the case are as yet unclear, it seems that a (presumably anti-choice) medical professional they encountered there felt the need to report them to the police for something that would render them open to life imprisonment. The second pending prosecution is of a woman in her twenties who obtained the abortion pill for herself and apparently for others. Again, details of her situation are unclear, but given that there is no prosecution or pursuit of any of the over 200 women from the north who have openly and deliberately incriminated themselves under their full names in repeated open letters and publications in various media as people who have needed access to the abortion pill, it seems likely that this prosecution too came about under pressure from another party.

 

The legal structure in the south of Ireland is the 8th amendment to the Irish constitution. It states that “The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.” The obvious afterthought of the right to life of the carrier of the foetus granted was only included in the wording after a vigorous campaign from feminist groups of the time. The referendum for its inclusion in the constitution of southern Ireland was passed in 1983 after a vitriolic debate in a referendum in which only 53% of the electorate voted. 67% of those who voted, voted for it. This means that a decision made by a mere 35% of the electorate of southern Ireland 32 years ago, none of whom are likely to be women of reproductive age today (the youngest a voter in that referendum would be now is 50), is deemed relevant and appropriate to force every person capable of becoming pregnant in the south of this island to remain that way regardless of that person’s own opinion on the matter.

 

The 8th amendment also strips from any pregnant woman or other person the right to consent or refuse any treatment a higher power than herself(!) may deem necessary for the foetus she carries in pregnancy. It also means that it is at the whim of a medical treating power to deny a pregnant woman potentially lifesaving medical treatment if they consider it may damage the foetus she carries, as was seen in the case of Michelle Harte. Michelle Harte was a cancer sufferer who was receiving treatment denied to her by Cork University Hospital’s “board of ethics” (what a misnomer) when she became accidentally pregnant. The same ethics board denied her, a dying woman, access to an abortion and forced her to travel to the UK while incredibly ill with cancer to obtain the healthcare she needed – an abortion. She subsequently died. A Catholic bishop sits on that ‘ethics’ board.

 

Since the context of choice and bodily autonomy in most public discussions, even most leftist public discussions, seems only to be understood as the choice to continue or to end a pregnancy, it is imperative to highlight that the 8th amendment is used also as a tool of coercion against women and others in continued pregnancy and during birth. The 8th amendment is regularly cited to pregnant women wishing to go against what their doctor deems to be the best for them; the phrase, “I could bring you to court if I have to, you know” is one used against pregnant and birthing women in Ireland far too often. This is explicitly stated in the HSE’s National Consent Policy, which cites the High Courts as the appropriate place to determine what can be perpetrated upon the body of a pregnant woman without her consent. Doctors, midwives and social workers are more often those doing the coercing in this scenario; it rarely goes as far as the courts, as most women when told by the social workers who arrive on their doorstep (as has happened in more than one instance) that their existing children will be taken from them into care if they continue to refuse to comply with their doctor’s vision of what is best for them, do not feel capable of struggling back when in all likelihood they will lose anyway. However there is one instance in which the High Court has been invoked, in Waterford in 2013 in the Mother A case.

 

The Mother A case involved Waterford Regional Hospital taking a woman, known as ‘Mother A’ by the court, to the High Court in an attempt to secure an order coercing her into a caesarean section. They took this action despite the fact that Mother A was not utterly refusing to consent to a c section; she specifically said that despite her desire to have a vaginal birth, should an emergency arise, she would consent to a section. It was not an emergency situation; the spur for the coerced c section was a foetal trace which was categorised by the person interpreting it as “non-reassuring” rather than emergency. She also wanted to delay the birth by at least 24 hours, because her partner was out of the country until then and she wanted him to not only be present at the birth but also to be able to be there to care for their older child during the period she was in hospital. Further, while the hospital insisted she was 41 weeks and 6 days pregnant, she deeply disagreed with their assessment. (It is worth highlighting at this point a similar case in Our Lady of Lourdes Hospital in Drogheda in 2003 where a woman, Therese Darcy-Lampf, was coerced into a section at 34 weeks owing to the hospital having wrongly noted her gestation after a scan, despite the fact that she pointed this out to them repeatedly. Her baby, Jessica, died shortly after being born far too early.) All very reasonable things to want; yet all things that were utterly denied her at the apparently capricious behest of an obstetrician and a hospital that stripped her of her voice and her autonomy. No judgement was handed down in this case as the woman “consented” to the caesarean section before one became necessary.

 

The nightmarish reality of forced caesarean sections has now been publicly enshrined not only in Irish practice by the Mother A case, but also in law and in practice by the passing of the Protection of Life During Pregnancy Act of 2013. The first draft of this bill was called the Protection of Maternal Life During Pregnancy Bill; but clearly this concept, that women should not die because we are pregnant, was deemed far too radical by the Labour-Fine Gael coalition government to pass into law and thus it was renamed to ensure that nobody reading it should become confused and think perhaps that women’s lives matter. Such confusion is however highly unlikely given the content of the Act, which requires that a suicidal woman must prove that she is suicidal to up to 6 doctors before eventually being granted a lifesaving abortion. This despite the fact that suicide is a leading cause of death during pregnancy in Ireland, and despite the fact that we are constantly being reassured through ad campaigns telling us to ‘please talk’ (talk to whom is never made clear) that mental health is in fact real health. It is only real health until it comes to pregnant women, as was made obvious by the atrocities perpetrated on Ms. Y by the medical establishment and the state in the south in 2014.

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Ms. Y arrived in the south of Ireland on March 28th, 2014 as a refugee. At what is described as a “health screening”, six days later she found out she was pregnant; she made known to those performing the screening on behalf of the state that she had been raped and that she could not possibly under any circumstances have a child. She was very distressed. A nurse made an appointment for her two days later with the IFPA who informed Ms. Y that abortion is not accessible in Ireland and that travel for her “may” be difficult – as an asylum seeker travel documents and visas into and out of Ireland are time consuming, costly and difficult to obtain. The IFPA made an appointment for Ms. Y to have a dating scan and referred her to the Immigrant Council of Ireland for advice and support on travelling as a migrant. Four days later, Ms. Y had a dating scan performed and it was discovered she was 8 weeks pregnant.

 

At this point it would have been possible to hand her three pills and for her to have ended her own pregnancy as she wished, with minimal impact on her, minimal further violation of her bodily autonomy and integrity, and minimal pain and suffering. Three pills.

 

Instead, she was handed about from pillar to post, having contact with three separate NGOs as well as the HSE staff she initially encountered, and her situation appears to have slipped between the cracks of these, unnoticed by anyone except herself as with the continuation of her pregnancy her despair and hopelessness deepened. A doctor from Spirasi, one of the NGOs she had contact with, wrote to the GP of the direct provision centre she was consigned to, describing her as “having a death wish”. The GP of this centre says that the letter was not received. A co-ordinator at the ICI formed the opinion that Ms. Y might change her mind about needing an abortion based on apparently nothing whatsoever. A counsellor at the IFPA suggested adoption to her. For a further 16 weeks she was handed around and around until eventually, on the 23rd of July (almost four months after her pregnancy was first discovered and she initially declared herself utterly unable to contemplate going through with it) she had an assessment with a consultant psychiatrist who told her it was too late to have an abortion and then coerced her into being detained in a maternity hospital under constant surveillance, where she refused all food and fluids for several days.

 

By that time she had met a consultant obstetrician who was of the opinion, despite the fact that Ms. Y was so despairing and suicidal that she was even refusing water,  “that Ms Y could be maintained on the ward for as long as possible and hopefully to 30 weeks so that the baby could be delivered appropriately.” This would have meant another 6 weeks of detention against her will; another 6 weeks of sedation against her will in order to forcibly feed and hydrate her against her will in order that her body and autonomy undergo repeated violations in order to host a pregnancy she loathed so much she would rather have died than have it in her body any longer. Instead however, as Ms. Y continued in her determination to refuse fluids, a caesarean section was carried out on her several days later; enforced major abdominal surgery also against her will.

 

This horrifying and traumatic ordeal inflicted upon Ms. Y was torture; state-sanctioned, state-inflicted torture, state-legalised torture. And were another Ms. Y to arrive in the south tomorrow, in the same harrowing circumstances, the state would more than likely torture her in precisely the same manner.

 

It is important to note here the degree to which the maternity hospitals in the south are complicit in, and even the driving forces behind the denial of basic bodily autonomy to pregnant women; both in abortion and in continued pregnancy. It is for these reasons that those of us who are involved in the pro-choice movement should be deeply wary of embracing the “masters” (the word alone should be warning) of the Dublin maternity hospitals such as Rhona Mahoney and Peter Boylan when they declare themselves to be opposed to the 8th amendment. At least one of those ‘masters’ has been known to invoke the courts in order to coerce pregnant women into interventions during their pregnancies, labour and births, and both of them are opposed to women’s choice of type of care (midwife-led or obstetrician-led) and the choice even of birth position in the case of Peter Boylan. Furthermore Peter Boylan in 2015 testified in the High Court in defence of the barbaric practice of symphysiotomies. Tempting though it is to reach for a “higher authority” in defence of our stance, these are not our allies in the struggle for women’s bodily autonomy.

 

However those who are our allies in this struggle are, in fact, the majority of the voting public in the south. An exit poll carried out at the general election in February of this year found that 64% of people support the repeal of the 8th amendment. This number is all the more invigorating for those of us in the trenches of this fight given the increasing vehemence of the well-funded anti-choicers over the last number of years. It’s also all the more inspiring because there’s a general misunderstanding of what the pro-choice position is in the public discourse around abortion in the south; the case is constructed as “Would you agree with and support her decision in this case?” rather than “Would you personally stop her?”, a much truer reflection of what the pro-choice stance is and means.

 

As the fight continues, it becomes more and more important to avoid the slippery slope of only publicly advocating and arguing for abortion access in terms of the “hard cases”, such as where the pregnancy will not survive outside the womb or in the case of survivors of rape. The majority of those who seek abortions do not fall into these categories and would be left by the wayside. Only allowing abortion access for pregnancies conceived by rape and incest would not only be impossible to legislate safely for but also makes clear that the enforcement of continuation of unwanted pregnancy because the woman chose to have sex is outright misogyny; either one believes that an embryo or foetus has rights overriding that of the person carrying it or one does not.

 

We own our own bodies. We are not property of any state. We can and will birth where, how, and if we choose.

 

After #ge16, where to now for #Repealthe8th?

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The results from count centres across the state are slowly trickling in as I write this, and Labour activists and supporters are shouting that #Repealthe8th is dead as quickly as their candidates are dropping out of the race. They need to stop.

I presume they genuinely believe what they’re saying, just as they believe that we wouldn’t have marriage equality were it not for the Labour Party, but peddling that view damages the pro-choice movement.

Labour might have been confident that they could deliver a referendum on the eighth amendment, but pro-choice activists of all political stripes and none haven’t forgotten that they delivered legislation on X to allow for abortion where a woman would be a risk of dying that contained a 14 year jail sentence penalty for inducing a miscarriage, and the horrifying case of teenage refugee pregnant as a result of rape enduring what was ostensibly a forced c-section at 25 weeks, despite medical professionals acknowledging that she was suicidal. The #Repealthe8th campaign exists in spite of Labour, not because of it. Perhaps Labour in government after #ge16 would have delivered a referendum, but what would that have looked like?

Besides, Labour aren’t in government now, and unless there’s some kind of divine intervention over the next twelve hours it doesn’t look like they will be. They had five years to work to hold a referendum and didn’t. We can acknowledge that Labour were in government when the Marriage Equality referendum happened but it was won because people mobilised and worked their rocks off to get it passed; People who were never involved in politics before came out alongside grassroots groups and got Ireland to a place where it said yes to valuing people as equals. So instead of throwing the toys out of the pram and acting all hard done by, Labour activists would do better to channel their energies into the pro-choice campaign and work for a repeal of these laws. There is nothing to be gained by trying to undermine the positivity of pro-choice campaigners by getting in a huff, throwing hands in the air and saying we should all just forget it now.

That said, it is difficult to ascertain just how much of a deciding factor abortion was in this general election given the number of Fianna Fail TDs that have been returned and their unwillingness to commit to a referendum – but there have been huge returns for independents and political parties who are very much in favour of holding a referendum. The people of Dublin Bay South waved goodbye to Lucinda Creighton, one of the most staunch anti-abortion voices in the Dáil and while this is to be welcomed, this is not a time for pro-choice activists to rest on our laurels. Clare Daly has championed reproductive justice and been returned to the Dáil alongside Joan Collins. Ruth Coppinger, Paul Murphy, Richard Boyd Barrett and Gino Kenny are all pro-choice. Sinn Féin have a policy in favour of repeal the eighth. There is a recognition, even amongst conservatives such as Leo Varadkar and Frances Fitzgerald that a referendum is inevitable. It is easier now to be pro-choice than it ever has been before and thanks to the work of pro-choice activists and an increase in public support, the stigma surrounding the subject is ebbing away. Now is the time to send a clear message to the returned members of the new Dáil that a commitment to repeal the eighth amendment must form a part of any new Programme for Government. Women must no longer be blocked from accessing appropriate healthcare. Public opinion on the need to repeal the law and provide legal abortion for women is far more progressive than what is represented in the Dáil now, even with the addition of the large range of socialist, republican and left of centre voices. This public opinion needs to be converted into action on the ground.

We must make no mistake, the anti-choice groups that are happy to see women die for want of medical care, will consolidate their efforts in order to keep the eighth amendment in place. They will continue with their bitter newspaper columns full of demonisation and blame, and their shaming billboards and they will continue their misrepresentation and campaigns of outright lies against people who provide women’s healthcare in Ireland. Their attacks on the IFPA and others are not about women’s healthcare, they are about muddying the waters so that they can portray themselves as being something other than religious fundamentalists who want to keep women in the dark ages. They have no intention of stopping so we have an onus to build our movement, to keep up the pressure no TDs and tell them in their clinics, in the streets, in the courts, and in their media streams that they must fight to repeal the eighth. We can’t only depend only on TDs to argue these points in the confines of the Dáil chamber; there is an onus on us to keep speaking to our families and friends to reduce the stigma, to help women accessing abortion care, to publicise information and to counter the outrageous propaganda and lies bandied about by anti-choice activists. We must organise and march in the streets and stand shoulder to shoulder with others campaigning for free, safe and legal abortion.

Pro-choice groups are ready for this fight. Are you?

#Repealthe8th

@stephie08

Breda O’Brien, clickbait and being devoid of empathy

Breda O’Brien, clickbait and being devoid of empathy

Breda O’Brien has a regular, offensive clickbait column in the Irish Times where she gets paid actual money to peddle her narrow, bigoted view of the world that doesn’t tally in any way with actual evidence of what happens in real life. She goes to great lengths to portray women who’ve had abortions as being at best cold and indifferent about their experiences and at worst, callous, unless they are members of Women Hurt. For Breda, the only time it’s acceptable for a woman to talk about her experience of abortion, is if it is in the context of being a negative experience in your life. Ideally, the more torment connected to it, the better – because it will be the only time that your experience has any value at all. It doesn’t matter for her or even the Irish Times, that her stories are possibly not actually true, it just matters that some people will believe them. If you throw enough stones, eventually you’ll hit something.  Today’s offering is no different.

O’Brien opens today’s drivel by saying that Irish women talk about their abortions all the time with her. Maybe there are women who talk to O’Brien about their experiences but she is hardly the most likely of people you would confide in;

“Breda, you are a well known anti-abortion activist so I need to tell you, I was raped at 14 and had an abortion at 6 weeks.”

“That choice was morally wrong and is exactly the same as drowning a three year old child. ”

“Um, thanks Breda. I’m glad I got that off my chest by talking to you.”  

Given the exposure Tara Flynn and Roisin Ingle’s stories got in the Irish Times last week, it’s hard not to read O’Brien’s piece as a direct retaliation towards these courageous women. It’s basically an eight hundred word fuck-you to Roisin and Tara.

She also says that women have told her of going for post-abortion counselling in a pro-choice organisation only to be told, “you did what was right for you at the time. Put it behind you and move on.” But I find it a stretch that any pro-choice organisation would simply tell a woman “move on” after she said she found her experience difficult to deal with or that she had regrets. Because that is not how pro-choice people or organisations operate. That is a fiction. Unlike O’Brien, we recognise that women have different experiences while noting that the vast majority of women who have terminations do not regret them.

O’Brien says that these women feel dismissed and diminished, while not for a second noticing the irony that women who do *not* regret their decision are dismissed and diminished by O’Brien and her Iona cronies who are given a national media platform on which to do so. No person’s experience should be diminished, but the women who allegedly seek comfort from O’Brien should not be taken as representative of the sum total of women who have had terminations – just as the women who do not regret them are not the sum total, we merely note that they are the overwhelming majority. O’Brien goes to great lengths to couch her language in terms of pseudo comfort and “common humanity” and then denies to other women the capacity to make decisions for themselves believing that she knows better.

She  decries those of us who speak of cells and the right to choose and implies that we are the same as Roman men who left babies to die on the side of a hill as we dehumanise the “victim.” At no point does it register with her how she dehumanises women who make the decision to abort without regret; women who terminated because of the suffering that continuing the pregnancy might bring, or the risk to their health or wellbeing, or because they were in a violent relationship, or because they simply did not want to be pregnant.  If pro-choice feminists who advocate a woman’s right to choose are for O’Brien, like the Roman men who leave babies to die of exposure on the hillside then what does that make the women who actually choose to abort? This of course is the woman who is a spokesperson for the people that carry signs at their rallies saying “Abortion is Witchcraft” (forward to 2:52 of this video). Does that sound like empathy to you?  

Anti-choice ideology ignores that fact that legal and medical structures that deprive a woman of full control over her own reproductive system condemn women to being second class citizens. O’Brien attempts to portray herself as being understanding, attempting to make us believe she empathises with women in crisis pregnancies by saying if she had become pregnant as a teenager, she is “not sure what (she) would have done.” Perhaps that’s true. She wouldn’t be the first woman to be against abortion until faced with a crisis pregnancy and had she accessed a termination, she certainly wouldn’t even be the first anti-choice woman to terminate and subsequently stand outside that very same clinic and denounce the women who enter it.

But you are not empathising with a woman in a crisis pregnancy when you actively campaign in favour of laws that compel women to endure a forced pregnancy, a court ordered c-section, and then tell us that she should have been made to carry that pregnancy to term. Being empathetic does not mean heaping judgment on women who had abortions and telling them their decisions was morally wrong. Since when did empathy extend to stigmatising and criminalising women and advocating that they go to jail? You cannot attest to empathise with women in crisis pregnancies when you deny them a choice in their medical care that will literally result in their death.

O’Brien also carefully adds a sentence about Aylan Kurdi so that there is to be no misunderstanding as to where she stands –  comparing the drowned three year old to the terminated weeks old foetus. She could have written a column about how Europe should open its borders to the refugees, or about how Hungary is treating the thousands walking through their land, tired, cold, and hungry, searching for a better life. She could have even spoken about the reasons why women choose abortion and acknowledged that if you want less abortions, you need to make it easier for women to have children. That would be the logical thing, but this is not about logic, this is about curtailing women’s choices because Breda O’Brien views them as vessels and nothing more.

The majority of people in this state are pro-choice despite all of us of child-bearing age having never had our say on the Eighth Amendment. My own mother wasn’t even old enough to vote when the Eighth Amendment was passed. Prochoice activists acknowledge that abortion can often be a difficult decision for a woman. We also acknowledge that the decision to terminate can be a source of great relief to many. The difficulty for anti-choice activists is that they cannot contemplate, due to being completely devoid of empathy, why it would be a relief  for many women and why not every woman struggles with it, so in order for them to understand it they must portray these women as uncaring monsters like the Roman patriarchs or of course, witches.

Anti-choice activists do not understand, much less care, that when a woman is pregnant, she is more than a receptacle to carry a foetus to term, with thoughts, feelings, financial pressures and very often, other children to take care of. Just as it would be wrong for a woman to be compelled to terminate against her wishes, it is wrong to compel her to carry a pregnancy against her wishes. Women are more than the contents of their wombs and their existence has more reason than bearing children, and if we want to talk about moral value, then we must acknowledge that an embryo does not have the same moral value as a living, breathing woman who bears it, simply because it has the potential to become a human being. The inability to empathise at the very core of anti-choice beliefs is the reason why there is a woman on trial in Belfast for supplying her daughter with abortion pills, and it is the reason that a woman who has an illegal abortion in this state will get 14 years in prison. Reducing a woman’s humanity and placing it on a par with a week old embryo is not empathy, it is stomach-churning fanaticism. Perhaps had O’Brien actually been faced with a crisis teenage pregnancy, she may believe that had she taken certain decisions that she should have faced 14 years in prison, although at that time it would have been a life sentence (presumably for her own good), but that is not empathy.

Believing that because you never had an abortion that nobody else should have one either is about as far away from empathy as you can possibly get.

#Repealthe8th

@stephie08

Neural Tube Defects: Systemic Problems and Individualised Answers.

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Yesterday in the Irish Times, Dr Rhona Mahony, Master of the National Maternity Hospital, had something to say about folic acid. Up till now, you see, women people planning to become pregnant have been advised to take folic acid supplements daily. Ireland has a high rate of neural tube defects– which cause everything from spina bifida to anencephaly- the majority of which can be prevented with folic acid.

As of yesterday, this advice has changed:

“Up to 50 per cent of all pregnancies are unplanned, but a baby’s crucial neural tube develops in the first few weeks of pregnancy when many women may be unaware they are pregnant,” Dr Mahony said. …“Women who are sexually active should start taking the vitamin daily even if a baby is the last thing on their mind”

Taken at face value, this seems like good advice. If you’re at risk of getting pregnant, then taking a simple step to prevent painful or fatal birth defects seems sensible. And from a purely medical standpoint, I can see her point. Unplanned pregnancies happen! If I were at risk of getting pregnant and thought there was a reasonable chance I’d keep any pregnancy that resulted, I would seriously consider adding some folic acid to my daily routine. And I’m sure that, as a medical practitioner, Dr Mahony sees more of the suffering that neural tube defects can cause than most.

However, this doesn’t mean that Dr Mahony’s perspective- while important- is complete, or that she fully understands the context in which she speaks. Because medical advice is never given in a vacuum, and in this context Dr Mahony’s well-intentioned advice is ill thought-out, ignorant of context and in certain cases may be actively harmful.

Let me explain. Let’s go to the beginning.

Check out the rest, over at the original post in the Tea Cosy

Island of no consent – maternity care and bodily autonomy in Ireland

This piece was previously published in the print version of the Irish Anarchist Review

On the last day of August 2014, in a ruling the country and the media barely noticed, Mr Justice Ryan in the High Court in Kerry found against Ciara Hamilton and for the HSE in an utterly terrifying moment for every person pregnant or giving birth in Ireland from here on out. Ciara Hamilton had taken a case against the Health Service Executive after the birth of her second child, during which a midwife had, without obtaining consent, broken her waters, leading to an umbilical cord prolapse and an emergency caesarean section.

 

The breaking of waters during labour, in medical terms amniotomy or Artificial Rupture of Membranes (ARM), is not recommended best practice precisely because it can lead to a cord prolapse, which is a serious emergency when giving birth as it cuts off the blood flow and air supply to the baby. If the person giving birth is a Strep B carrier (as Ciara Hamilton was) it can also carry an increased risk of Strep B transferring to the newborn and causing serious damage to the baby (as happened to Ciara Hamilton’s child). It is listed as a Do Not Do under NICE recommendations. Despite this, and despite ARM being known to carry dangers and risks to both birthing woman and baby, it is still a widely carried out procedure in many Irish maternity hospitals. In the case of Ciara Hamilton’s birth, it was a procedure carried out by a midwife without seeking consent to do so.

 

This, too, despite being obviously grossly unethical and a fundamental violation of both human rights and bodily autonomy, is something which routinely occurs in Irish maternity hospitals. In the spring of 2014, AIMS Ireland carried out a survey of those who had given birth in Ireland between 2010 and 2014. The survey was available to be filled out online, and was spread through various social media channels, as well as through media coverage. The pool of respondents was a self-selecting one, and numbered 2,836. It found that only half of all those giving birth – 50.2% of respondents – were given an opportunity to refuse tests, procedures or treatments being carried out on them. This is a truly frightening figure. What is, however, more frightening, was the wording of Mr Justice Ryan’s finding against Ciara Hamilton.

 

“Mrs Hamilton would have seen the hook and would have known what was going to happen because of the sheet that was put under her in bed. Since, on the evidence, this was a routine procedure that Ms Kelliher was carrying out for the purpose of diagnosis to see if her fear of foetal distress was justified or not, it does seem strange that she would not have mentioned to the patient what she was going to do and have obtained her consent. The very fact that it was so routine suggests that the midwife would have done so. I am satisfied that the probability is that Midwife Kelliher obtained the plaintiff’s consent and informed her about the ARM that she was going to perform.”

 

What the judge has here concluded is that the midwife obtained consent because she should have done so – and that a woman giving birth who had consented only to a vaginal examination, NOT an ARM, should have known that ARM would have happened because of the presence of an amnihook and a sheet. This is a truly bizarre conclusion. Why would a person giving birth be assumed to be able to identify an amnihook – a specialised piece of medical equipment – and further be assumed to know that it would mean an ARM would be carried out on them without having been consulted or informed about the risks and benefits of the procedure? Again, this judge with no evidence to prove this assumption – and indeed the more recently published evidence from AIMS shows that not giving women a chance to refuse procedures is a large part of normal practice – asserts that a health care provider would have obtained consent because they should have done so, with no onus on the healthcare provider to prove evidence of informed consent being obtained. The fact that Ciara Hamilton testified to the fact that she was not given an opportunity to consent to an amniotomy is not even mentioned by the judge in this decision. Even more disturbingly, he goes on to say:

 

“The patient’s co-operation was needed in terms of re-positioning on the bed, the procedure might take some time and the implement was quite long, so it is not something that a person would or could do without the knowledge of the patient. The plaintiff got into position, was co-operative and consented to the vaginal examination. Ms Kelliher used a hook and gel and of course surgical gloves. She put a sheet under the plaintiff and got her to move down in the bed and discussed with the plaintiff what she was going to do. Midwife Kelliher said that she “would have discussed”, but in my view that was a matter of usage and she clarified that she actually meant, not that she would have in the sense of describing a practice in a conditional sense, but that she did with Mrs Hamilton.”

 

Mr Justice Ryan is here saying that Ciara Hamilton positioned herself in such a way as to consent to an ARM. She consented to the vaginal examination and moved down the bed. Is this really so different from the “short skirt” argument put before courts in trials of other forms of violation of women’s bodies? Yet again, with no proof, he asserts that an ARM could not be carried out without the knowledge of the person giving birth, despite the evidence of a woman who had undergone it that indeed it had been. AIMS Ireland has heard from many, many more women around the country who have had nonconsensual amniotomies – and indeed many other procedures – performed without their knowledge. This is a far from rare occurrence; yet the voice of the woman upon whose body this was perpetrated is once again, in the arena she sought redress for her exclusion from the decisions being made about her body and her birth, being spoken over, ignored, and deemed uninformed, inconsequential, and irrelevant.

 

But by far the most frightening aspect of all in this case is that, despite clearly stating in his ruling that Ciara Hamilton had “underwent a frightening and disturbing experience that would leave long term troubling recollections”, Mr Justice Ryan punitively awarded the full costs of the HSE’s defence against her and her family. This was unarguably a move designed to discourage other women and people who have experienced violations of their consent during pregnancy and birth from pursuing legal action against those responsible. A move meant to punish a woman and her family who did dare to speak up against the unacceptable, indefensible treatment AIMS Ireland hear of in Irish maternity wards all too often, and whose experiences, as before during their birth, were once again ignored by the State and its enforcers, quite literally judged to be meaningless. The truth of what happened to Ciara Hamilton and her recounting of it and its consequences for her and her son was callously dismissed by a judge who simply refused to believe it because he thought it shouldn’t happen.

 

What this ruling means is that it is now legally not a requirement for any Irish maternity ward or healthcare provider to prove either that a procedure is necessary for the person giving birth or the baby they’re giving birth to, or that they obtained informed consent from the person giving birth to carry out that procedure. In a country in which pregnant women are specifically excluded from the HSE’s National Consent Policy as being the final arbiter of what happens to their own bodies, with the High Court cited instead as the appropriate decision maker for these cases, this ruling is a further reminder to anyone with a uterus that if they are, or if they should become pregnant, they are no longer in control of their own body. They are lesser; they do not own themselves. Instead the State owns them.

 

This, of course, is in part a consequence of the 8th amendment; but it’s also in part a consequence of a larger prevailing attitude in maternity care in Ireland, that women in general and specifically women who are pregnant and giving birth are not trustworthy decision makers and cannot be allowed to make choices around their pregnancies and births as they cannot be trusted to be concerned with a safe outcome for their baby. This is bizarrely at odds with the State and HSE attitude to those who have given birth; they become at once the only possible caretaker for that child, not in need of any support or care in so doing, left entirely alone to do so with no formalised system of support around them even when they look for the assistance of one. Again, Ciara Hamilton and her family are an example of this; a family who need specialised supports for their son, damaged due to the poor management of his birth, they live in a state that will do its utmost to avoid shouldering the cost of it and avoid recognising Ciara Hamilton’s son as a valued member of our society who should be provided with all that he needs in order to allow him to participate in that society in a just and equal way. Now both they and he have been further punished for their attempt to right that balance and address the wrong done to him and his mother during their birth. For a family to be faced with the crippling financial burden that is the HSE’s extravagant legal costs of defending a birth claim will further deepen the gap between what their child needs and what they can afford to give him. Their situation is a haunting and horrific one that should never have been allowed to happen, and in many other jurisdictions never would have.

Contrasting the judgement in the Hamilton vs HSE case with a recent UK Supreme Court judgement, Montgomery v Lanarkshire Health Board, is an exercise designed to induce both heartbreak for the Hamiltons and rage on behalf of all pregnant women in Ireland. In this ruling, the Supreme Court held there exists for those giving birth an explicit right to information  about ‘any material risk‘ in order for them to make fully informed decisions on the process; without this information being provided, informed consent cannot be said to have been given. In this instance, Nadine Montgomery was pregnant, diabetic, carrying a large foetus and was not informed by her doctor of her increased risk of shoulder dystocia, which is, in the words of an expert witness of the case, “a major obstetric emergency associated with a short and long term neonatal and maternal morbidity [and] an associated neonatal mortality”. She did indeed experience a shoulder dystocia during birth, which was a horrendously traumatic experience for her and caused severe long term brain damage to her son.

 

Despite the fact that Nadine Montgomery had repeatedly expressed concerns about giving birth vaginally, her doctor said that she as a matter of course chose not to explain the risk of shoulder dystocia to diabetic women because the risk of serious injury to the baby was very small and that if she did, “then everyone would ask for a caesarean section”. The doctor makes no mention of the risk to women’s health and wellbeing of shoulder dystocia in her decision making.

 

A key and obvious difference here between the Montgomery case and the Hamilton case already is that the very concept of explaining risk of interventions, or of not performing interventions, to women is discussed at all in the Montgomery case. It does not appear at all in the Hamilton vs. HSE judgement. Given Mr Justice Ryan’s discussion of how Ciara Hamilton was treated it is probably safe to assume that informed consent is completely outside his frame of reference – again, a terrible but unsurprising indictment of the Irish maternity system as well as the Irish court system. The idea of informed consent literally does not make any showing here. Extensive discussion of the idea of informing women and how that should best be performed by healthcare providers takes place in the Montgomery case and yet the Hamilton judgement does not mention this concept even once.

 

In stark contrast, not only was the concept of informed consent discussed at length during the hearing of the Montgomery case itself, but it is also given a strong legal definition and set of requirements in the ruling itself.

 

“An adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken. The doctor is therefore under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments. The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.”

The final and deepest cut of bitter envy from the Montgomery judgement to those of us in Ireland forced into the maternity system here, comes from Lady Hale’s part of the judgement, thus making it case law in the UK from the highest court in the land. It is as follows:

“In this day and age, we are not only concerned about risks to the baby. We are equally, if not more, concerned about risks to the mother. And those include the risks associated with giving birth, as well as any aftereffects. One of the problems in this case was that for too long the focus was on the risks to the baby, without also taking into account what the mother might face in the process of giving birth.”

Could any paragraph and context more succinctly highlight the appalling gap between the treatment of pregnant women in Ireland and the expected sheer basics of human rights of pregnant women elsewhere in the world?

For more on this see AIMS Ireland – www.aimsireland.ie, also on Facebook and Twitter.

A duty to reproduce: Modern Ireland is a sci-fi dystopia for women

In an episode of Battlestar Galactica called “The Farm”, Starbuck gets shot during a raid on Caprica and loses consciousness. She wakes up in a hospital, where it turns out that the cylons have a lot of human women hooked up to “baby-machines”, because they can’t reproduce themselves, so they’re trying to reproduce with humans. The human women are used as incubators and the cylons are of the view that they have a duty to reproduce. The cylon doctor tells Starbuck how women of reproductive age are very “precious commodities.” The agency of the individual does not matter – they are merely vessels. Vessels do not need to consent. The women hooked up to machines for the sole purpose of reproduction are, in this case, science fiction, and it’s pretty grim.

As I type this, there is a woman who is clinically brain dead but being kept alive on life support against her family’s wishes solely due to the fact that she is pregnant. The trauma that her family is going through now does not bear thinking about. I have lost a close family member in terrible circumstances, but I cannot imagine what it must be like to endure the heart-breaking pain of deciding to switch off a life-support machine. The trauma of it is surely enormous.

A next of kin is generally legally entitled to make a decision regarding treatment where a person can no longer consent. This family has concluded that the best course of action for this woman would be to withdraw life support. The medical staff cannot grant this request due to the constitutional right to life of the unborn: the right of an early stage foetus to be gestated potentially supersedes a woman’s right to dignity in death.

The state and the law of Ireland views women as vessels. In Ireland, once we are pregnant, we are no longer agents of ourselves. We do not get to decide whether we should or should not remain pregnant. Our thoughts, our feelings, our mental health does not matter. Our ability to parent does not matter. Our poverty does not matter. Our right to die a natural death does not matter. Our dignity does not matter. Our physical health does not matter, because you must be at risk of death to have an abortion. This is the outworking of the 8th Amendment. The state is unapologetic in this. The only time in which a pregnancy may be ended lawfully through termination is when there is a risk to a pregnant person’s life. The life of the foetus is what matters: continuing the pregnancy at all costs is what matters. If a pregnant woman is deemed to be suicidal, and like Ms. Y, wants an abortion, the pregnancy will be ended not through termination, but by an early caesarean once it is viable. To the state, ultimately, we are simply wombs with irrelevant thoughts attached.

The woman on life support in Mullingar, due to being clinically brain dead after suffering brain trauma, is being treated as an incubator for her foetus. There are people arguing for her to be kept alive for months so that her foetus may be born, and then turn the life support off – for them, she serves no purpose beyond this pregnancy. Her family now intend going to court to ask, in the name of compassion and human dignity, that her life support machine be switched off. There is no predicting what the courts will decide.

Will Article 40.3.3’s requirement to vindicate “the right to life of the unborn” in so far as is practicable require doctors to keep a clinically dead woman alive artificially in order to incubate it until it can be delivered? It is the crux of the case. It isn’t clear what stage the pregnancy is at (Reports have varied from 16 weeks to 20 weeks, with Joan Burton stating during Leader’s Questions today that it is at a “relatively early” stage), but while the 8th Amendment remains on the books every single case that presents such as this one will mean a trip to the courts for a family, because there will never be a clarity on what is practicable and what isn’t. Is one week practicable or twenty? You cannot legislate for every potential case.

We do not need another inquiry and report to tell us that the 8th Amendment still leaves medical practitioners with a lack of clarity as to what to do in these situations, or to tell us there is lack of clarity on whether it’s the pregnant woman’s rights or that of the foetus that will prevail. Leaving a pregnant woman hooked up to a machine for the sole purpose of incubating a pregnancy for possibly twenty weeks, in the absence of her next of kin’s consent where she has no capacity, does not uphold her dignity. It does not uphold her right to die a natural death. It does not allow for her family to consent when she cannot. It is inhumane, but her womb is a “precious commodity.” They wouldn’t do it to a dog.

This is the constitutional law, and while the law is designed to treat women as vessels we will always have the hard cases that fall outside of the scope of legislation. We will have more women in desperate situations. More Savita’s, Ms. Y’s. More A’s, B’s and C’s. More Ms. D’s. More Ms. X’s, and more women hooked up to machines because the state does not afford them or their next of kin the capacity to consent for themselves because their wombs are too precious a commodity to risk allowing them control over. This isn’t science fiction, for women, modern Ireland is dystopia enough, and there is no need for machine overlords, while catholic conservative values dominate policy on this issue.

#Repealthe8th

 

 

To them, we are nothing but vessels

A young non-Irish woman with limited English and precarious residency status, discovered she was eight weeks pregnant as a result of what the Sunday Times have reported as a “traumatic rape.” Due to her legal status in Ireland she could not freely travel abroad in order to access an abortion so immediately applied to have a termination in Ireland under the new legislation, stating that she was suicidal at the prospect of carrying the foetus to term. Like Savita Halappanavar and Bimbo Onanuga, she is another woman from outside of Ireland who has been completely failed by the Irish medical system.

Three doctors declared that the woman was suicidal under the panel formed under the Protection of Life During Pregnancy Act in January. The legislation states that medical practitioners may authorise an abortion where “there is a real and substantial risk of loss of the pregnant woman’s life from a physical illness or by way of suicide” but they must have “regard to the need to preserve unborn human life as far as practicable.” The Act does not set out timelines during which decisions should be made by these panels, or when abortions should be performed if granted under this law. To insert a timeline in that law, giving the applicant some clarity, would have been too generous a gift for the women of Ireland by the Irish government. The panel of three doctors said that despite the fact she was suicidal, it would be better to wait until the foetus was viable for delivery instead of performing an abortion. She went on hunger and liquid strike in response. People do not enter in to hunger strike lightly; It is a last resort attempt by people seeking redress when the politics of despair have left them with nothing else to fight with but their own bodies.

The HSE in turn, sought an emergency order at the High Court on the 2nd of August which would allow it to forcibly hydrate the woman on the grounds that they wanted to protect her life and the life of the foetus which she did not wish to carry. It further sought orders that would allow them to carry out other procedures related to her pregnancy. The woman was represented by her lawyers, and the foetus was also represented by its own legal team. The Irish courts have already stated that it is a medical practitioner who is entitled to make decisions concerning the pregnancy, and not the woman herself. The law goes far beyond preventing a pregnant woman from having an abortion in circumstances where her life is not at risk. The Irish law is designed so that a person who is pregnant no longer has any say over what happens their body whether it concerns continuing the pregnancy itself, the location in which you wish to give birth or whether you will hydrate yourself or not.

Last month in Geneva, the chair of the UN Human Rights Committee said that Irish law on abortion treats women as a “vessel and nothing more.” Once you are pregnant in Ireland, you become property of the state and your own wishes are irrelevant.

On the 3rd of August, this young, suicidal rape victim, having gone through two court hearings seeking an abortion and an unknown number of medical interrogations by a panel of three doctors, underwent a caesarean section in an Irish hospital at approximately 24-26 weeks gestation. Preserving human life as far as practicable in their eyes required performing a c-section on a woman while she was around six months pregnant, despite the fact that she had been raped, was suicidal, had gone on hunger and thirst strike and had asked for an abortion repeatedly from eight weeks on.

The implications of this are horrifying. It has sent a clear message to women in Ireland that if you are suicidal and seek an abortion which you are constitutionally entitled to, you run the risk of medical practitioners compelling you to wait until the foetus is viable and then having a c-section forcibly performed on you. This woman was in a very vulnerable position given the multiple traumas she had endured. It is the stuff of nightmares. There are other women who are suicidal as a result of pregnancy and access abortion services because they have the means and support to travel. Some contact Women on Web and some contract the Abortion Support Network. Some will borrow money from friends. Those who don’t have internet or phone access to make appointments or ability to leave the country, or money to pay, and will take other steps. Some will borrow from money-lenders, others might throw themselves down stairs. But those who are pregnant and suicidal will not go to these panels, the risk is too great.

We do not know the full facts of this particular case because the media are restricted from reporting in full. However, we do know that the Protection of Life During Pregnancy Act has not resolved the issue of not being able to access an abortion even if you are suicidal in Ireland. Three doctors said this woman was suicidal, but apparently this was not the right kind of suicidal for the purposes of the Act, and because a c-section was available then she could have that instead of a lawful termination.

It begs the question of what type of ‘suicidal’ will allow you to have a legal abortion in this jurisdiction and as long as the Eighth Amendment remains in the Constitution, there will be women travelling, dying and undergoing forced c-sections for want of an abortion within Ireland. There is no clarity as to what the scope of “practicable” actions are in order to prevent a woman from having an abortion under the cloak of “protecting the life of the unborn.”

Years ago, I had a conversation on facebook with someone who was anti-choice and was quite forthright in his views that women should be prevented from having abortions at all costs, even if they were suicidal and it required locking them up in specially designed pregnancy gulags under 24 hour suicide watch. It is a frightening vista but not totally unrealistic. Those on the anti-choice side will of course say the term “gulag” is hysterical, but if you were a pregnant suicidal rape victim, who wanted an abortion, and was in hospital on a court-ordered drip having an effectively forced c-section under threat of a court order, faced with the prospect of a 14 year jail sentence if you induce your own miscarriage, it just might feel pretty gulag-esque. You just might even etch “Nolite te bastardes carborundorum” on a wall.

To them, we are nothing but vessels.

Repeal the 8th.