Ireland’s reproductive health history
History of Irish women’s struggle over their reproductive health is long and often tragic
This year marks the 50th anniversary of the Irish Institute of Obstetricians and Gynaecologists at the Royal College of Physicians of Ireland and, to mark the occasion, the college’s annual St Luke’s Day Symposium will include a special heritage event on Thursday which will reflect on the history of the specialty in Ireland.
According to Prof Mary Daly, professor emerita of modern history at UCD, who will address the meeting on “Contraception and the Irish Medical Profession”, the challenges and dilemmas Irish doctors have faced over the last 50 years in caring for women under the constraints of church and State have remained largely hidden.
Dr Michael Solomons, a consultant gynaecologist at the Rotunda Hospital in Dublin, ran one of the first family planning services in the country at Dr Steveens’ Hospital in the early 1960s, under the auspices of a gynaecology clinic.
It is reported that Dr Solomons, on seeing the detrimental impact multiple pregnancies and no access to any form of contraception had on women’s health in Ireland, wrote that, for them, pregnancy was “a death sentence”.
“He didn’t do it in the Rotunda because he claimed that respectable families might not send their daughters to train there if they heard there was a family planning clinic in the place,” Prof Daly said.
In 1963, consultant gynaecologists Dr Kieran O’Driscoll and Dr Declan Meagher established a clinic in the National Maternity Hospital in Holles Street in Dublin. “They were really targeting this appalling Irish phenomenon of women who had maybe eight, nine, 10 children, really huge families, generally poor, working class which were more common in Ireland than almost anywhere else at this stage,” Prof Daly explained.
The clinics targeted high-risk women with medical conditions who lived in very poor circumstances with very large families and soon after the other maternity hospitals began to follow their lead.
Doctors were also instrumental in establishing the Fertility Guidance Company Ltd in 1969, which later became the Irish Family Planning Association. “A lot of the early contraception however inadequate it was in Ireland, is actually medical led,” said Prof Daly.
The contraceptive pill arrived in Ireland in 1963, however contraception was not legalised here until 1980 with the introduction of the 1979 Health (Family Planning) Act.
Under the terms of the legislation, contraceptives could only be used “for the purpose of bona fide, of family planning or for adequate medical reasons” and were only available on prescription.
Under the 1979 Act, condoms were available on prescription. Some doctors refused to prescribe them on moral or religious grounds, and Prof Daly said some pharmacists also refused to stock condoms.
She said that, by the 1970s, there was a certain degree of acceptance that married couples would have to have access to contraception. However, it was widely believed that “the country would fall apart” if it became available to single people.
Sterilisation was another option of birth control that became available in Ireland by the 1970s. However, access to sterilisation was a “very gendered story”. Prof Daly explained that while it was relatively easy for men to get a vasectomy on an outpatient basis in the privacy of a GP’s surgery, it was not quite so easy for women, as tubal ligation required a hospital stay, an anaesthetist and theatre nurses etc. A woman’s husband would have to sign a consent form before she could get a tubal ligation.
Prof Daly said that in the late 1970s, under the direction of the then Archbishop of Dublin, Dermot Ryan, all the Dublin voluntary hospitals established ethics committees, which began to “police” all activities. As a result, she said that by the 1980s it became practically impossible for women to access sterilisation in Dublin.
“So you get this bizarre picture by the 80s. First of all it is quite hard to get tubal ligation in Ireland, there were women going to Britain to get it done but within Ireland . . . there were more done in Cork than anywhere else. They were done in
Women at the entrance to a tenement building in Dublin in the 1940s. Photograph: Hulton Archive/Getty Images Limerick, they were done in Galway, they were done in Portlaoise. It was almost impossible to get one in Dublin because the major maternity hospitals all had these ethics committees and the ethics committees, which were not just doctors, determined whether Mrs X could get a tubal ligation or not.”
She added that there are reports of nurses walking out and refusing to assist in a tubal ligation as well as gynaecologists being forced to wheel their own patients to theatre as porters also refused to co-operate on religious or moral grounds.
According to Prof Daly, the introduction of legislation on contraception in Ireland begged the question of who was going to police it, and doctors suddenly found themselves forced into the role of moral gatekeepers for the country.
Contraception Fifty years on and while thankfully access to contraception is no longer an issue for most women, doctors continue to find themselves central protagonists in Ireland’s reproductive and sexual health history.
Last month, the President Michael D Higgins signed the legislation that removed the Eighth Amendment to the constitution, allowing unrestricted abortion up to 12 weeks in Ireland for the very first time. However, as the dust settles, and the legislation is bedded down, it will once again fall to doctors to implement it in a clinical setting.