C: Amal Women's Association

No, the Irish maternity system is not systemically racist

The Amal Association, which describes itself as a front-line provider of services to Muslim women and women with a connection to the Muslim community nationwide, including ethnic migrant women and refugees, recently presented a submission to The Joint Committee on Children, Equality, Disability and Integration on the experiences of migrant communities engaging with the Irish healthcare system. 

Its presentation focused mainly on the findings of a report on research that it conducted entitled A Mother is Born Too.  

The research was led by Dr. Camilla Fitzsimons from Maynooth University and supported by the Irish Human Rights and Equality Commission.  

It specifically explored the experience of Muslim womenin maternity care settings in Ireland. 

Before discussing the findings of the research, the representative from Amal, Ms Yara Alagha, prefaced her remarks by saying that Muslim and non-Muslim women have had positive experiences in Irish hospitals, with “individual acts of kindness that have made a huge difference in their lives and that this is especially so for first-time mothers who do not have family to support them.” 

Ms Alagha also paid her “respect and great gratitude to the healthcare workers who show heavenly care and patience, both during COVID and in ordinary times.” 

But for Ms Alagha, one of the very concerning findings that came out of its research was that 4% of the participants when pregnant only presented to the hospital, for the first time during their maternity, when they were in labour.  

The Amal Association also highlighted to the Committee the research finding that “31% of healthcare workers in the Irish health care system witnessed racism and discrimination towards Muslim women by other healthcare workers, while 74% of healthcare workers were unaware of any policies in respect of providing quality, culturally specific care for Muslim women.” 

These points were uncritically accepted by members of the Committee and taken as representative of systemic failings right across the Irish health care system. 

Indeed, for Committee member and Fianna Fáil Senator, Erin McGreehan, the statement made by Ms Alagha regarding “individual acts of kindness” “says a great deal about our system, namely, that kindness, decency and respect are not the default. I found much in what she said shocking and upsetting.” 

That is an understandable reaction when someone tells you that basically just under a third of workers in the Irish health care system are witnessed racism and discrimination towards Muslim women, and that the majority are ignorant of ‘culturally specific care.’

But let us take a closer at the research and the ‘A Mother is Born Too’ report in order to assess how accurate or reliable that representation really is, because there are a number of points that should have immediately raised concerns. 

The first thing to note is that the number of Muslim women who participated in the survey was just one hundred and six.  

They did so mostly through an anonymous, online survey questionnaire.  

Only eight in-depth interviews were conducted and just one focus-group was carried out.

Recruitment for the survey was mostly carried out by the Amal Women’s Association itself via outreach, networking and what are termed ‘snowballing methods.’  

This latter method of research is notoriously unreliable as “it is usually impossible to determine the sampling error or make inferences about populations based on the obtained sample.” 

The second alarm bell regarding the representative nature of the research is that only thirty-eight healthcare workers participated, also through a separate online survey questionnaire.  

The researchers themselves accept that even this level of participation “fell short of the research target of 50 practitioners.” Recruitment of health care workers was also via networked and snowballing methods. 

The third major issue is that the research “draws from the Irish Network Against Racism (INAR)’s description of racism, which is: 

“Any action, practice, policy, law, speech, or incident which has the effect (whether intentional or not) of undermining anyone’s enjoyment of their human rights, based on their actual or perceived ethnic or national origin or background.”

Based on this description if a nurse or health care worker unknowingly offered a Muslim woman anything but-halal-based food, they would be guilty of a ‘racist act.’

The fourth issue of concern is that the presentation to the Committee made absolutely no mention of the fact that when the 106 research participants were asked directly about their experiences of racism and discrimination through the following question: “During my maternity care I experienced racism/discrimination because of my skin colour and/or Muslim-Faith,” the vast majority (86%) reported not experiencing any forms of racism or discrimination whilst attending maternity services. 

Instead, the Committee’s entire focus was carefully directed to a vision of the Irish health care in which racism and discrimination are a “systematic issue.” 

None of this is to deny the difficult and insensitive treatment that a tiny proportion of the 106 women who participated in the survey experienced. There are obnoxious professionals in all areas of life. 

But it does remain true that the picture presented to the Committee was partial and lacking in perspective. If the Senators had read the Report before questioning the Committee’s guests, they might have known that and been more critical in their engagement.

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