Who can be trusted to provide services respecting women’s human rights?

Did anyone at the Department of Health anticipate the public outrage that ensued when it was announced that the Sisters of Charity were going to own the new National Maternity Hospital (NMH)?

Some media commentators have likened the mess to that made of Dr Noel Browne’s Mother and Child Scheme in the early 1950s. The chief medical adviser to the government at the time, Dr James Deeny, said “because of bloody-mindedness, folly, idiocy, scheming and religious obscurancy . . . they made a right mess of the Mother and Child Scheme”.

Now the negotiators for the NMH and St Vincent’s Hospital Group have made a right mess of the deal to locate the new hospital on St Vincent’s campus and give the building to the nuns. When it comes to maternity care for the women of Ireland, service providers cannot get it right.

Apart from dealing with the ownership of the new hospital, which has to be the taxpayer, Minister for Health Simon Harris must address the services that will be provided in the new NMH and the 18 other maternity hospitals and units in the country. Who can be trusted to provide services that respect women’s human rights?

Some of the obstetricians interviewed about the move to St Vincent’s campus sounded delusional. Dr Peter Boylan, chairman of the Institute of Obstetricians and Gynaecologists, spoke about “clinical outcomes that compare with the best in the world”. Dr Rhona Mahony, current Master of the NMH, referred to “world class medicine in a Dickensian building”. Are obstetricians oblivious to the fact that Ireland’s maternity services have been criticised by two international human rights bodies in the past few months?

Highly critical

In March, the UN Committee on the Elimination of Discrimination against Women (CEDAW) was highly critical of Ireland’s “over-medicalised” model of maternity care. “The State party has a policy of having three births per 24 hours for every bed in maternity wards, which does not respect the normal birth process.

The committee recommends that the State party revise its policy on medicalisation of child delivery and the use of maternity wards to ensure that women can have access to maternity and delivery services without time pressure or being exposed to artificial methods of accelerating births.”

In April, the Report of the Commissioner for Human Rights of the Council of Europe was also critical of the “over-medicalised model of childbirth”. While the commissioner welcomed the National Maternity Strategy 2016-2026, he expressed “concern at the current legislation and practice in Ireland which seriously hamper women’s access to sexual and reproductive health and rights”.

The commissioner stressed that “the Eighth Amendment of the Irish Constitution, protecting the right of the unborn on an equal basis with the right to life of the pregnant woman, departs from the position consistently held by human rights bodies that the right to life, as enshrined in relevant international treaties, does not apply to prenatal life”.

Yes, it is true that Irish maternity hospitals and units have good safety records. An analysis of the latest Maternity Patient Safety Statements shows that perinatal mortality rates are low, between zero and 9.6 per 1,000 births. Major obstetric events such as eclampsia and uterine rupture range between zero and 5.8 per 1,000 mothers delivered. Still, in 2017 women expect more from services than surviving childbirth.

Too much interference

The over-medicalised model of childbirth means there is too much interference in the birth process. Induction rates are increasing, particularly in first-time mothers. Nearly two-thirds of maternity hospitals and units have induction rates of more than 40 per cent. Caesarean section rates are more than 30 per cent, twice that recommended by the World Health Organisation. So, no, Ireland does not have “world class” maternity care.

The Minister for Health must ensure that women receive services that give them control over all aspects of pregnancy and birth in the new NMH and the other 18 hospitals and units. Can that happen under the current system? It seems unlikely. Obstetricians will cling onto power, as they have done since the Mother and Infant Care Scheme was established.

The vast majority of women need a midwife only. But other than acknowledging that pregnant women need “women-centred care”, the new National Strategy for Women and Girls 2017-2020 says little about how this might happen.

The Minister for Health must pay attention to what international bodies are saying. After 60 years, it is time for the interventionist model of childbirth to go.