Symphysiotomy: state sanctioned butchering of young women

7 August 2021

A “mass medical experiment” that butchered young women, permanently maiming them in the name of Catholic doctrine, the surgical procedure of symphysiotomy was practised in Ireland from 1944-1984.

In a symphysiotomy, doctors sliced through the cartilage and ligaments of the pelvic joints to widen the pelvis for vaginal birth. The women then, in excruciating pain, had to deliver their babies.

The pelvic bone itself was also sawn through in more extreme cases, known as a pubiotomy.

Symphysiotomies were even carried out without the woman’s consent after she gave birth to widen the pelvis for vaginal births in future.

Symphysiotomies were introduced to Ireland in 1944 despite having been widely shunned by the international medical profession for many years.

They were carried out in some hospitals in Ireland instead of Caesarean sections up until the 1980s.

It was believed at the time that no more than four Caesarean surgeries could be performed safely. Contraception may then be needed to limit family size which was broadly opposed by the Catholic church, so some Irish hospitals used symphysiotomies as a way of avoiding the much safer Caesarean section.

Marie O’Connor, health correspondent and chairperson of support group Survivors of Symphysiotomy (SoS) who wrote the book  Bodily Harm on the subject said that the practice was “impelled by religious fundamentalism and it couldn’t be justified.” “It was a mass medical experiment,” she said.

“We have the writings of those doctors who first of all began to practice it out of the blue with the National Maternity Hospital in the 1940s, 1944 they started.

“It probably reached its height in the 1950s and then gradually the numbers began to go down slightly. But it actually persisted at the Lourdes hospital [in Drogheda] until 1984, so we’re looking at four decades here. “ Doctors had refused to perform the surgery in the past because from the first procedure on a woman in Paris in 1777, it was known that the procedure could cause life-long mobility problems and incontinence.

“From the very beginning, these issues were there, they were known and doctors refused to perform the surgery,” Ms O’Connor said.

“And symphysiotomies also carried a 10% death rate for babies.

“I have spoken to mothers who were left with a host of serious side effects and who lost their baby as well.” Some 1,500 symphysiotomies were carried out between 1944-1984 in Ireland.

Following a call from the United Nations for a major investigation into the practice and two government-funded Irish reports into the health scandal, a redress scheme was introduced for survivors in 2014.

The UN said that a redress scheme should hold offenders accountable and must offer “adequate compensation and rehabilitation on an individualised basis”.

The redress scheme gave survivors just 20 days to apply, a period critics said was much too short to allow women to access old medical records. This could either lock these women out of the scheme or could make them only eligible for a lower payment, critics said.

‘Completely inadequate’

The fund totalled €34m and women could apply for one of three levels of compensation – €50,000, €100,000 and €150,000, depending on the proven severity of their injuries. These payments, critics said, were completely inadequate for the pain they had suffered. Women who successfully took their case to the courts were awarded more than €300,000.

The payments were also to be strictly ex-gratia — without any admission of liability by the State, hospitals, individual medics or the Church.

To avail of the scheme, every applicant had to waive their right to pursue any civil claims regarding their alleged injuries following symphysiotomy.

This directly contravened the UN Human Rights Committee’s call for an independent investigation that would “prosecute and punish” the perpetrators.

Some women chose not to pursue the scheme for this reason.

“The scheme was the first of its kind, as far as I am aware, to protect private bodies, such as religious congregations, from legal action,” Ms O’Connor said. “As a condition of payment, applicants were forced to sign a waiver ‘holding harmless’ those responsible for their abuse. This breach of women’s legal and constitutional rights was widely censured.” The survivor groups Patient Focus and Survivors of Symphysiotomy Ltd broadly welcomed the scheme, saying that some women would benefit from a less adversarial process than pursuing their claims through the courts. Getting something was better than nothing and the average age of claimants was 75 years.

But the group chaired by Ms O’Connor, Survivors of Symphysiotomy (SOS) criticised the scheme for not going far enough to help these women who had been injured unnecessarily by the State.

“The symphysiotomy payment scheme has been widely criticised by human rights defenders both in Ireland and internationally. The government ignored the calls made by UN human rights bodies for proper redress to be given to survivors for their injuries,” Ms O’Connor said.

“The scheme did not amount to an effective remedy for women, because it was an ex gratia or grace and favour scheme that was introduced without any admission of wrongdoing. A number of women decided not to apply for this reason. Women were generally given twenty days in which to apply, a time limit without precedent for schemes of this kind. This made it almost impossible for survivors living outside Ireland to access.

“The scheme breached the recommendations made by the UN Human Rights Committee and two other UN Treaty bodies by failing to provide for individualised assessment.

“It was a paper-based process. Women’s voices went unheard because the terms excluded oral evidence. A sole assessor was given unlimited discretion. There was no independent oversight, nor any right of appeal, as recommended internationally.

“The scheme routinely looked for proofs of disability, such as medical records, that in some cases went back half a century. Records held by deceased doctors and closed hospitals were generally impossible to access.

“The terms provided no mechanism for accepting independent medical reports, and when they were submitted, a significant number were rejected in favour of the opinions of the doctors engaged by the scheme.” Of the estimated 1,500 women subjected to the surgery, the State anticipated that some 350 who were still alive may apply.

But 590 women applied. Of these, 399 women were collectively awarded €30m under the scheme. More than €3m went on legal and administrative costs.

A majority of applicants received the minimum payment of €50,000 which was made to 216 applicants.

Some 168 applicants received €100,000 and 15 received the highest award of €150,000.

This last group was found to have suffered significant disability following an elective symphysiotomy carried out after they gave birth. One applicant received the maximum payment after suffering a pubiotomy, a report by the scheme’s assessor, Judge Maureen Harding Clark, said.

185 applicants were unable to establish their claim, according to that same report.

Some women died during the process and one chose to fight for justice through the courts instead.

Ms O’Connor said: “Damages under the scheme were payable only for significant disability which could be proven to be a direct consequence of the surgery. The biggest number of awards were made at the lowest level of €50,000. This was a small fraction of the court awards made in symphysiotomy cases.” Judge Harding Clark and the State were roundly criticised by SoS after her report, commissioned by the Department of Health, claimed that some women had applied for the scheme despite having no medical evidence of having had the procedure.

Wrongdoing

SoS said that many women were too embarrassed to report sexual problems or incontinence to their doctors and for older women, many medical records no longer existed.

The Irish Council of Civil Liberties criticised the scheme at the time, saying that it “falls short of meeting Ireland’s international human rights obligations to an ageing population” of symphysiotomy survivors.

The redress scheme was so flawed that Prof Conor O’Mahony, director of the Child Law Clinic at University College Cork (UCC) recently warned in this paper against repeating the mistakes made in this scheme when developing the mother and baby homes redress scheme.

He called for transparency in the development of the State’s mother and baby homes redress scheme to avoid repeating past mistakes that have “left a trail of anger and bitterness” amongst survivors.

Ms O’Connor agrees that lessons must be learned.

“The criticisms and recommendations made by the various UN human rights bodies suggest that all redress schemes need to be accompanied by an acknowledgement of wrongdoing”, she said.

“No ex gratia arrangement offers survivors an effective remedy.

“Women’s voices need to be heard, and this is particularly true of the scheme to be introduced for survivors of Ireland’s mother and baby homes.

“Given what we now know about the Commission’s report, the terms should provide for oral as well as written evidence to be taken from the women incarcerated in these institutions. The assessment of damages should be individualised, with independent medical reports and independent legal advice provided free of charge to survivors. There needs to be independent oversight, and a right of appeal, as recommended by successive UN bodies.

“Finally, the time allowed for applications to the scheme should be fair and reasonable. Ideally, the scheme should remain open, like the 1996 Hep C/HIV scheme, which was exemplary. We haven’t had a model scheme since.”

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