The Perceptions of Pregnancy blog, like the Researchers’ Network, aims to reach beyond boundaries and borders, and to facilitate an international and interdisciplinary conversation on pregnancy and its associated bodily and emotional experiences from the medieval to the modern. Today’s post from Cara Delay and Beth Sundstrom employs the term ‘obstetric violence’ to understand Ireland’s reproductive history.

In October 2012, 31-year-old Savita Halappanavar, 17 weeks pregnant, sought treatment at a Galway hospital when she began to miscarry. Although there was no hope for a successful pregnancy, staff at the hospital allegedly told Halappanavar that they could not legally assist her with a medical abortion. When Halappanavar died of septicemia several days later, her tragic personal story spurred an unprecedented dialogue on women’s reproductive and health care rights in Ireland.

Halappanavar’s case is only one in a series of controversies surrounding reproduction in recent Irish history. Ireland’s abortion “problem,” as well as scandals over the abuse of women in Magdalen laundries and mother-and-baby homes, have dominated headlines for decades. Most recently, the government’s plan to compensate survivors of symphysiotomy has come under criticism. Each of these scandals also fits within a larger national and postcolonial pattern of systemized obstetric violence. Throughout the twentieth century and into the new millennium, all parturient Irish women and women of childbearing age sometimes were categorized as potential threats to the nation. With independence in the 1920s and 30s, Irish women’s reproductive capacities and roles as mothers were politicized as never before, coming to the center of public attention and coming under the purview of legislation. A Church-State coalition ruled Ireland by the early twentieth century, and it ensured that a Catholic ethos dominated virtually every sphere. Irish women, as a result, were categorized primarily as mothers and defined by their reproductive capabilities. As Clara Fischer notes, “…the moral purity at stake in the project of Irish identity formation was essentially a sexual purity enacted and problematized through women’s bodies.”[1]

Although usually used in the Latin American context, the term “obstetric violence” applies to the Irish case. Carlos Herrera Vacaflor defines obstetric violence as “the violence exercised by health personnel on the body and reproductive processes of pregnant women, as expressed through dehumanizing treatment, medicalization abuse, and the conversion of natural processes of reproduction into pathological ones.”[2] Similarly, Diaz-Tello argues that obstetric violence consists of the “bullying and coercion of pregnant women during birth by health care personnel...”[3] Obstetric violence can take many forms, and at its root are cultural norms that deny women access to adequate reproductive health care.

Perhaps the clearest example of this phenomenon in Irish history is symphysiotomy. In this outmoded medical practice, physicians expand a pregnant woman’s pelvis through the cutting of surrounding cartilage and ligaments, with the goal of assisting in obstructed births. Abandoned in favor of Cesarean sections by the early twentieth century in most places other than Ireland, symphysiotomy has been associated with long-term detrimental physical and emotional effects in women. In the 1940s, however, the Irish state’s overtly Catholic worldview complicated the practice of Cesarean sections, which were thought at the time to be tantamount to contraception—popular medical opinion asserted that a woman could only undergo three C-sections in a lifetime before sterilization would become necessary. Vehemently opposed to any limitation to women’s childbearing capabilities, some Irish political, religious, and medical authorities viewed the Cesarean section as an unsatisfactory and even untenable option. Symphysiotomies, then, continued in Ireland through the 1980s in some hospitals.

The persistence of symphysiotomy in Ireland is a clear example of obstetric violence. It also illuminates Ireland’s sometimes complex responses to the legacy of colonialism: while the former colonizer, Britain, adopted advanced medical technology (including Cesarean sections) and secular world-views, Ireland combatted its colonial history by privileging cultural and religious approaches to childbirth and maternal fertility. This world-view would affect not only symphysiotomies but also access to contraception and abortion, harsh attitudes to unwed mothers, and secret adoptions.

Symphysiotomy thus reminds us how religious, national, and medical power has been mapped on Irish women’s reproductive bodies. In the case of symphysiotomy, women were denied choice and autonomy, and women’s childbearing responsibilities and religious norms were placed above current medical practice.

Responses by Irish government, religious, and medical authorities to reproduction and motherhood in the twentieth century, and in recent decades, were replete with national meaning and representative of cultural power. As Orla O’Connor of the National Women’s Council of Ireland argues, “…one day, Ireland must accept and understand the extent and prevalence of institutional abuse of women and children.”[4] Understanding Ireland’s complex history of obstetric violence, as well as the potential for reproductive justice to provide solutions for moving forward, are essential in this process. A reproductive justice (as opposed to a reproductive rights) movement is directly relevant to the Irish case; such an approach promises to advance not only academic debates over women’s rights and status but also to encourage activism that will change women’s lives. Organizations like Survivors of Symphysiotomy and the Repeal the Eighth movement have begun this important work. For survivors of symphysiotomy and mother-and-baby homes; women whose children were adopted out without their consent; and the thousands of Irish women who still take the “abortion trail” to Britain every year, reproductive justice is long overdue.

Cara Delay, Associate Professor of History and Director of the Women’s and Gender Studies Program at the College of Charleston, holds degrees from Boston College and Brandeis University. Her research analyzes women, gender, and culture in nineteenth- and twentieth-century Ireland, with a particular focus on the history of reproduction, pregnancy, and childbirth. At the College of Charleston, she teaches courses on British and Irish women’s history and the history of birth and bodies.

Beth Sundstrom, Assistant Professor of Communication and Director of the Women’s Health Research Team at the College of Charleston, holds degrees from Brown University, Tulane University, and the University of Maryland. Her research interests include health communication, social marketing, and women’s health. She teaches undergraduate and graduate courses on such topics as strategic communication, social marketing, and health communication.

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[1] Fischer, Clara. 2016. “Gender, Nation, and the Politics of Shame: Magdalen Laundries and the Institutionalization of Feminine Transgression in Modern Ireland.” Signs, no. 4: 822.

[2] Vacaflor, Carlos Herrera. 2016. “Obstetric Violence: A New Framework for Identifying Challenges to Maternal Healthcare in Argentina.” Reproductive Health Matters, May. doi:10.1016/j.rhm.2016.05.001.

[3] Diaz-Tello, Farah. 2016. “Invisible Wounds: Obstetric Violence in the United States.” Reproductive Health Matters, June 2016. Abstract.

[4] “Return the Records to Survivors of Symphysiotomy.” The National Women’s Council of Ireland. Accessed 18 August 2016. http://www.nwci.ie/index.php/learn/article/return_the_records_to_survivors_of_symphysiotomy.