What price for women's health?

The state must raise the status of pregnant women to a level commensurate with a modern nation

Dr Juliet Bressan, GP, Inner City, Dublin

March 12, 2024

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  • Article 41.2 of the Constitution of Ireland states: “...by her life within the home, woman gives to the State a support without which the common good cannot be achieved.” At the time of writing, this article was expected to be removed.1

    It could be said that the modern expectation of the role of the state is to provide for the common good, rather than to outsource it to women. The state, in other words, should protect women, not the other way around. 

    Dr Noel Browne was Health Minister from 1948-1951. How difficult must life have been for women in Ireland during those years. Dire poverty, endemic tuberculosis coupled with a lack of birth control, abortion and antenatal care led to tragic maternal and perinatal deaths. Dr Browne proposed a free medical care scheme for all mothers and children. The Irish Medical Association, clergymen and fellow cabinet politicians all objected vigorously and the Mother and Child Scheme failed,2 forcing the resignation of Dr Browne. 

    In 2024, as we vote on reforming the Constitution in favour of women, women in Ireland live in a wealthy country,3 albeit with limited access to free antenatal care, limited free contraception, limited free abortion. 

    Globally, almost 300,000 women die each year during pregnancy and childbirth. Most of these deaths can be prevented by access to affordable antenatal and maternity care.4 Despite our relative wealth, antenatal care in Ireland remains grossly under-funded in general practice.5 An antenatal appointment with a GP is currently funded to less than half the rate for a regular GPs appointment. A routine flu jab is valued more. It is difficult to accept that this is the true value, to the State, of a pregnant woman’s life. 

    There are at every antenatal appointment and for the duration of pregnancy, usually two patients to consider. Antenatal care involves training, practice, experience, attention to detail, repeated investigations, laboratory data collection, ultrasonography, foetal monitoring, and availability at very short notice for all of the concerns of the (often very vulnerable) patient. For women for whom English is not their first language, or who have grown up in cultures other than Ireland, it can require an extra amount of time and effort. If a doctor is to spend any time at all promoting and supporting breastfeeding, a thorough antenatal or post-natal consultation could last up to an hour. 

    Consultations for any additional illness during pregnancy such as infectious disease, back pain, haemorrhoids, vomiting, varicose veins, mental health, laboratory tests, UTI or any social care is not funded, and in many doctors’ experience, applications for reimbursement of extra visits for blood pressure, UTI etc, can be refused by the PCRS.5 This means the doctor is providing this enormously important and essential medical care at a great loss.  

    Antenatal and perinatal consultations are complex and should not be provided on the cheap. No GP should feel that this is a worthless, thankless task. Failure to properly fund vital GP work during antenatal care is a dereliction of duty by the State in its responsibilities to the women and people of Ireland. 

    Having addressed the constitutional issue, the State needs to address the status of pregnant women to a level appropriate to a modern nation. It must modernise the funding of all woman’s healthcare with their GP, during pregnancy, childbirth and postnatal life.6

    © Medmedia Publications/Forum, Journal of the ICGP 2024