A systematic review and meta-analysis study published in the British Journal of Obstetrics and Gynaecology as recently as April 2016 concluded that there was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section. One of the principal reasons for use of symphysiotomy in rare circumstances was the dangers associated with caesarean section, which were very real in the 1950s and 1960s. This is supported by data from Irish hospitals which shows the rates of maternal and infant mortality were higher for caesarean section than for symphysiotomy.
In summary, it is important to note that Irish and international studies indicate that symphysiotomy is not a banned procedure but has a place in obstetrics in certain limited circumstances. For example, it may still be used in the western world in the delivery of a trapped head in breech delivery, or in emergency obstetric situations. The health of women affected by symphysiotomy has continued to be a priority. Medical services, including medical cards, are facilitated for the women by HSE-nominated symphysiotomy liaison officers based around the country, whether or not a woman has availed of the scheme.
In regard to human rights issues, one of the advocacy groups made representations to the UN Committee on Human Rights concerning symphysiotomy in July 2014. This year, submissions were also made to the UN Committee on the Elimination of Discrimination against Women. Ireland takes its membership of international organisations extremely seriously and is committed to human rights, which is why we always engage with these processes in a meaningful way, through providing information and updates, responding to recommendations and attending reviews held by these organisations. While the Government notes the comments made in 2014 by the UN Committee on Human Rights on symphysiotomy, the Government believes that there has been a comprehensive response to symphysiotomy with the provision of the following: the independent ex gratia scheme; the comprehensive independent reports on symphysiotomy, which included national consultation with the women; and the ongoing provision of medical services by the HSE.
I would urge anyone who wishes to get a fair and balanced view on the issue of symphysiotomy to read Judge Harding Clark's report. She was unfettered by Government in completing her work. She used her judicial skills and experience, and the skills of her clinical team, to examine all aspects of symphysiotomy and review the evidence collected during the two years of her work.
In conclusion, the brief given to Judge Harding Clark in November 2014 was not an easy one. At that time the advice to the Department of Health was that many women would face an uphill struggle in proving their claims in the courts. Each woman would face an uncertain outcome, as each case would be adjudicated by the courts on its individual merits. We now know that this is true. For example, in one of the small number of cases that have gone through the courts, the judge in that case found that even though the woman had a symphysiotomy 12 days before her baby was born in 1963, this procedure was not a practice without justification at that time. In her independent report, Judge Harding Clark has set out in detail how assessments were made and confirms that she personally reviewed and assessed every woman’s case. Judge Clark has also provided a comprehensive overview of the historical and medical context of symphysiotomy.
The Government hopes the scheme has helped to bring closure to women who underwent surgical symphysiotomy and their families.