An official review of pelvic mesh and medicines in pregnancy reveals systemic sexism and abuse of power within the health care establishment over decades.
The Cumberlege Review ‘First Do No Harm’ was published in July after a two-year investigation into countless examples of avoidable harm done to women who were treated for Pelvic Organ Prolapse (POP) or Stress Urinary Incontinence (SUI). The review concluded that pelvic mesh implants have led to crippling life-changing complications and the unnecessary suffering of thousands of women. One patient quoted in the report said, “This is not a life. It is an existence. With potentially another 40 years ahead…this is a depressing prospect.”
Pelvic mesh, which is sometimes referred to as a sling implant, is a device used to treat POP and SUI. 92,000 women received a pelvic mesh implant in England between 2007 and 2015. But treatment was paused in 2018, and The Independent Medicines and Medical Devices Safety Review was ordered by Jeremy Hunt (then Secretary of State for Health) amid concerns surrounding the operations and their long-term effects.
Surgical mesh is nothing new. It has been used since the 1950s to carry out hernia and vascular repairs. Typically, each surgeon would cut flat mesh in the operating theatre to fit each patient. The significant difference with the pelvic sling is how it was developed as a one-size-fits-all device. From the early 2000s kits comprising pre-cut and pre-shaped mesh with custom applicators were marketed as a breakthrough in treatment for POP and SUI. Within a marketised health service, the pelvic sling was sold as a quick, cheap, and easy fix for SUI and POP. A bonus for health executives was the promise from manufactures such as Ethicon that the sling kit could be inserted by less experienced surgeons. The rapid uptake of mesh surgery calls into question just how many women underwent this procedure whose condition would not previously have been severe enough for surgical intervention. As the volume of mesh surgeries increased considerably, many women were told that the procedure was the new ‘gold standard’, a phrase that was used by surgeons across the country to justify surgery.
It is clear from the many stories told to the ‘First Do No Harm’ review the extent to which women’s lives have been affected: “This device took everything from me: my health, my life, my job, my dignity, my marriage, my freedom. There are a lot of us suffering.” Some of the adverse long term medical effects of the mesh include: severe and chronic pain, with many women permanently taking opioid painkillers in order to stand or walk; reduced mobility due to nerve damage caused by the mesh, with many women relying on crutches or a wheelchair; recurring or new prolapses or new incontinence; erosion of the mesh into the vagina, bladder, intestine and bowel; haemorrhage; sexual difficulties; psychological issues including PTSD, depression, anxiety and attempted suicide; autoimmune issues, and tragically, the death of at least one woman. The impact was felt far beyond the medical, however. Many women spoke about how they had lost their job, their home and experienced relationship and family breakdown.
A key theme emerging from the report is how the women had to fight to be heard. Women who raised concerns post-surgery were routinely ignored: “They would tell you there was nothing wrong with you and that you were just a hysterical woman,” said one witness. Many women were told their symptoms were ‘probably due to their menopause’. The general response from surgeons and consultants was dismissive, defensive, and arrogant. This is a clear demonstration of institutional misogyny, where the legitimate concerns of women have no status.
Faced with a seemingly impenetrable wall of power and institutional denial, women formed their own patient campaign groups. These groups have been instrumental in applying the pressure that eventually lead to the Cumberlege Review.
The review itself acknowledges the systemic failure to collect data and monitor patient outcomes, in effect handing a blank cheque to Ethicon and the medical profession. One shocking revelation is that there is no mechanism for tracking the long-term impact of a mesh implant, for example.
Amongst the nine recommendations the report makes are measures to set up an independent commissioner and a regulatory framework that will both monitor and provide a system for compensation when things go wrong. A network of specialist centres for mesh-injured women will be developed.
There is also a call for greater transparency of the payments made to clinicians and medical institutions, such as teaching hospitals and research establishments.
As socialists, we recognise that these demands do not go far enough. While they attempt to regulate and bring greater transparency to the existing system, they do nothing to combat the power and influence of big business interests withing the health sector. They also fail to address the fragmentation and chronic underfunding of the NHS.
We can have no confidence that these limited recommendations will address the fundamental problem of women’s inequality as patients, or women’s oppression within capitalist society.
A truly democratised and accountable health service would kick out the private sector wholesale, take into public ownership the companies responsible for new procedures and treatments and running them with democratic control by elected bodies of health workers and patients. This must include placing women’s voices and needs at the heart of developing a serious strategy for women’s health, which has always been underfunded and undervalued.