Ire­land’s re­pro­duc­tive health his­tory

His­tory of Ir­ish women’s strug­gle over their re­pro­duc­tive health is long and of­ten tragic

The Irish Times - Tuesday - Health - - Lifestyle - June Shan­non

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.

In­stru­men­tal

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.

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