31 May 2021

Ireland, plus ça change – Yet again the Irish state is failing vulnerable pregnant women

By Jo Murphy-Lawless, via The Elephant Collective on Facebook. In June last year, in the midst of Covid times, Keith Adams published a piece on the Centre for Faith and Justice website entitled No Country for Poor Women (https://www.jcfj.ie/2020/06/18/poorwomen/) where he examined data from two reports on poverty and prison conditions, the Irish Prison Service Annual Report 2019 (https://www.irishprisons.ie/wp-content/uploads/documents_pdf/IPS-Annual-Report-2019-Web.pdf) and a report from the SVP entitled 'The Hidden Cost of Poverty' (https://www.svp.ie/getattachment/869467cb-2d60-4fe2-b612-a8c6e4357cdc/The-Hidden-Cost-of-Poverty.aspx). He argued that these reports challenge us as a society to think hard about the interconnections between gender and poverty and the stark consequences for women caught in poverty when things go badly wrong. Taken together, the reports lay out the following:
  • The rates of committal to prison for women are increasing overall
  • Even though women are more likely to be charged with non-violent crime - typically shop-lifting, receiving stolen goods and non-payment of fines - the rate of their being held in prison on remand is higher than for men
  • Committal to prison for non-payment of fines alone has been escalating dramatically
  • Women are commonly being sent to prison for very short sentences – 75% of women sent to prison in 2018 were serving three months or less
  • All three major categories of crime committed by women centre on the root problem of living in poverty
  • The SVP report estimates that the annual cost to the state of NOT dealing with the consequences of poverty ranges between €3bn and €7.2bn
When we look elsewhere at statistics on women and poverty (and a comprehensive database on poverty has been made far more difficult to put together since the independent statutory Combat Poverty Agency was abolished by the state in 2009), we learn that in 2019, single parent households with one or more children under the age of 18 had the highest at risk rate of poverty, 29.7 per cent compared with 6.1 per cent in two person households with one or more children under the age of 18 (CSO, 2020). And we know that single parent households, which comprise one in six of all household units in Ireland, are overwhelmingly headed by women and disproportionately at risk of being homeless. By 2017 rents, which had fallen back immediately following the 2008 economic collapse, rose to record levels and have kept rising. Adding to the relentless strains felt by those living in poverty. Adding to the weight carried by vulnerable households most often headed by women. And if women in poverty are then imprisoned, what happens for them and their dependents? As Keith Adams notes, prison sentences do not solve poverty, they make it worse, rendering lives which are already hanging by a thread, still more unsustainable, and which for women includes separation from their children. This week we have learned how much worse it can get if the woman in prison is pregnant and vulnerable, suffering from poor mental health. In a country where our general mental health services, such as they were, have fallen asunder with Covid, in a country where suicide amongst new mothers has become an appreciable factor in direct maternal deaths, in a country where perinatal mental health services are only beginning to be established, and where for a pregnant woman in prison, there is no continuity of care whatsoever despite this group needing specialised, skilled support, what was reported from the High Court last Friday by a quick-thinking Maria ni Fhlatharta on Twitter  (https://twitter.com/nifhla/status/1396775752411013127) was the situation of a pregnant woman in prison, with complex circumstances including her mental health needs, facing a court-ordered caesarean section. The woman’s case was being heard last Friday without her having her own legal representation about what she needed and wanted. As it happens, whatever else she may require from her pregnancy care, this woman at the mercy of our merciless system, had specifically requested not to have a caesarean section. In even the abnormal conditions of practice in our maternity hospitals, over-reliant as they are on rising rates of caesarean sections, women must give their consent. That is not an option for this woman prisoner. Instead she now faces a court-ordered caesarean: 'HSE secures order allowing doctors to carry out C-section on prisoner with mental illness' (https://www.irishexaminer.com/news/courtandcrime/arid-40297352.html) What the court has heard is that the woman was deemed uncooperative because she did not want to have any ultrasound and did not want a caesarean; in a previous birth, she had had a caesarean and did not wish to repeat that experience. She was also deemed unresponsive and lacking mental capacity to judge by two psychiatrists with apparently two obstetricians declaring in favour of an elective caesarean section – that is elected by them, not the woman. Four professional people who have never endured poverty, let alone the stressful prison setting of frequent overcrowding and lack of stable conditions, where a trusting relationship with a named midwife is non-existent, have given their opinion about this woman’s circumstances. Yet these conditions which they have never experienced are the very conditions which can accelerate mental ill-health during pregnancy and in the post-pregnancy period (Snowe and Ohaja, in press). To which can now be added the consequences of the violation of a woman’s bodily autonomy. We have been here before so many times in Ireland, in countless troubling contexts. What women need and want in pregnancy and birth coming up against the same intractable issue: professionals, generally male, from a generally male establishment go to court to seek a ruling that states a woman cannot exercise autonomy and must have the conditions of her labour and birth imposed upon her by the rigid diktats of the High Heidyins who oversee our woefully inadequate maternity care system. Solicitor Caoimhe Haughey who has challenged the maternity system head on for many women and families in similar circumstances commented yesterday: ‘There are serious legal and constitutional issues in this tragic case in particular in regard to Consent and Bodily Integrity’ (https://twitter.com/CMHaughey/status/1397100458137772032) Wendy Lyon, the feminist human rights solicitor, commented this week: ‘I happened to be in the virtual court myself when this application was made on Friday. Very concerned by what I heard’ (https://twitter.com/wendylyon/status/1396819425899188224) Wendy was the solicitor who represented Ms B in the 2017 case where the HSE sought a High Court order to enforce a caesarean against Ms B’s will ( “Judge refused to order woman to undergo Caesarean section” https://www.irishtimes.com/news/crime-and-law/judge-refused-to-order-woman-to-undergo-caesarean-section-1.2852130). That same genre of professional obstetric suits showed up in court to argue that a caesarean was the only possible mode of delivery. In a rare instance of Irish courts actually recognising women’s right to bodily autonomy, the High Court judge commented that it was a ‘step too far’ to order a caesarean to be imposed on Ms B, that it would in fact be constituted as a ‘grievous assault’ .. ‘to have her uterus opened against her will’. Katherine Wade in a 2017 article in the Medical Law Review about the Ms B case commented that the issue of ‘capacity’ has received relatively little judicial attention in Ireland and that an important element in ruling on capacity is whether or not a patient can believe in the treatment information being conveyed by doctors which then implies the duty of care that doctors have in presenting treatment options openly and honestly (Wade 2017: 497-498). Irish women have good reason to be cautious on this score. As it happens, Ms B was fortunate enough to be in circumstances which gave her scope to explore a range of resources, including having a doula, so that she could decide what she wanted in her fourth pregnancy, and she was able to pursue her defence of that decision with vigour. The woman prisoner has no such luxury. She is already completely marginalised. It was stated in court last Friday and noted by Maria ni Fhlatharta that the woman has ‘fluctuating capacity’. How badly affected will the woman be, how compromised her mental and emotional capacities to stabilise by a court decision that lies completely out of her hands and against her wishes when she is already severely affected by being in prison: where Ireland has no specific guidelines for pregnant women prisoners, no guaranteed antenatal classes, no named midwife. These last two are the elements that contribute to women’s sense of confidence in pregnancy and which could make a concrete difference to the outcomes for a pregnant woman prisoner, a more secure adjustment for herself and her baby when her prison sentence concludes and she resumes her life outside (Snowe and Ohaja, forthcoming). The case of this woman’s unsupported circumstances comes hard on the heels of the shocking instance reported last month in the Irish Mirror on 28 April of the homeless and heavily pregnant woman who was beaten so badly that she lost her baby and she herself sustained serious injuries (“Pregnant woman lost baby after brutal attack in Dublin city centre”: https://www.irishmirror.ie/news/irish-news/crime/pregnant-woman-lost-baby-after-23994463). But then we know that in the savage stakes of a brutally unequal Irish society where money, status and hierarchy mean all, the women who do their parenting at the bottom mean more or less – nothing.   Jo Murphy-Lawless 26th May, 2021.   Additional References   CSO (2020) Survey on Income and Living Conditions (SILC) 2019. Cork: CSO. Survey on Income and Living Conditions (SILC) 2019 - CSO - Central Statistics Office (https://www.cso.ie/en/releasesandpublications/ep/p-silc/surveyonincomeandlivingconditionssilc2019/)   Snowe, Caroline and Ohaja, Magda (forthcoming, MIDIRS) Pregnancy in Prison: An International Literature Review.   Wade, Katherine (2017) Commentary: Caesarean Section Refusal in the Irish Courts: Health Service Executive v B., Medical Law Review, Vol.25, No. 3, pp. 494-504.