Advocate, Campaigner, and Champion of Women’s Health and Social Justice
Dr Mary Favier MICGP FRCGP is a GP partner and trainer in a four-doctor practice in Cork, Ireland. She has been president of the Irish College of General Practitioners and a member of the Covid-19 National public health emergency team (Nphet). She has served two four-year terms on the board of the Medical Protection Society, the world’s largest medical indemnity organisation. As a founder of Doctors for Choice she is a long-time advocate for reproductive justice and campaigned successfully to change Ireland’s constitutional prohibition on abortion. She is a founder of Start, the Irish abortion providers support group. She works in an area of high urban deprivation in Cork city, is a member of Deep End Ireland, a GP and a particular interest in the health care needs of Travellers – Ireland’s indigenous ethnic minority. She teaches on the undergraduate medical programme in University College Cork and the Postgraduate General Practice training programme.
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“There was a sense for many years of feeling ‘other’ in medicine, being ‘other’ in general practice, and that was often a lonely path. But there were a number of us in Doctors for Choice who provided a lot to support to each other…But the law was always going to eventually change in Ireland because it was going to be a social movement, and it had to come from the grass up and that’s effectively what did happen.”
ICGP representatives, Dr Tony Cox and Dr Mary Favier attend the Oireachtas Joint Committee on Key Issues affecting the Traveller Community in2019. ICGP News
Today, I’m talking to Mary Favier, a pioneering leader in general practice. Tell us where it all began…
Mary Favier: Where did it begin? The trajectory of my career has been very much around advocacy and representing people and causes and trying to change things, trying to make them better, and sometimes taking on difficult ones. I had some fantastic teachers at school in Listowel, in Kerry, who really, broadened our minds and when I went to college, I got involved in almost every single society and project that I could, from the catering strike in first year, where somebody shoved a placard in my hand and said, stand there. And I didn’t even know what it was about, through to Comhlamh an overseas development society. And then I got involved in the women’s group in UCC (University College Cork), which was a feminist group, and that made me a feminist activist, I think. Later, I got involved in the junior doctors strike back in the late 80s, as an intern, and was on the IMO (Irish Medical Organisation) junior doctor committee. And I think that I became an activist advocate at that time. I think that’s really where I started to realize that, yes, I can do this, the more political, feminist, stuff.
But then I had the extraordinary good fortune to get a job working with Dr Michael Boland who was and always has been, the most eminent GP in Ireland, but also internationally. And for those involved in WONCA, he was President of World WONCA at one stage. I had been traveling and working in Australia and in the United States and when I came back, I couldn’t get a job. That will tell you how times have changed. I did a two week locum as an orthopaedic SHO, to fill in while I got a GP locum job.
A friend of mine rang me up and said, there is a job in the Irish Medical Times that might suit you and the closing date is tomorrow. So, I applied and I got this wonderful job as the first educational fellow of the Irish College of GP’s (ICGP), working half time in Michael’s practice in Skibbereen and then half time on educational projects with him in the ICGP.
He had the most wonderful mind and the most extraordinary intellect and an extraordinary diversity of interests and opinions. And he mentored me and he was a mentor throughout all my working days until he became unwell. And it was probably one of the most important things that happened to me. One of the interests I have now is around the role of mentoring and encouraging and just giving people a leg up to the places you are yourself.
From there, I went into the College (ICGP) and I wrote educational materials, and one of them has now come back full circle. When I worked in Australia, in an Aboriginal community, and for those of you who saw the film Rabbit Proof Fence, it was a place called Jigalong, I got an excellent insight into the health care of the Aboriginal people, the indigenous community, in Australia. And I was shocked. But, when I came home to Ireland, I realized that this was exactly the same situation with our indigenous Traveller Community and the health care of the Traveller people. So I asked Michael what he thought about writing an educational piece on Travellers for GP’s. And we did. And 25 years later I was giving a talk on the same subject at the WONCA Rural Conference in the University of Limerick last year and one of the lecturers there, Patrick O’Donnell asked if we could do this again, could we update it as it hadn’t been done in 25 years. So, we’re just about to publish it as an ICGP Quick Reference Guide for GPs. So there’s a lovely turn of history and I think Michael would have been proud of us.
Mary Favier features in the #BEAGP campaign by the Irish College of General Practitioners
Photo credit:KISTENMACHER
“But then I had the extraordinary good fortune to get a job working with Dr Michael Boland who was and always has been, the most eminent GP in Ireland, but also internationally. And for those involved in WONCA, he was President of World WONCA at one stage… And he mentored me and he was a mentor throughout all my working days until he became unwell. And it was probably one of the most important things that happened to me.”
In what free time she has she hikes the hills of Ireland and gardens (see top image).
DMacA: You’ve done terrific advocacy work for women’s health and dating way back to 2002. But, doing that work in Ireland must have been difficult.
MF: It wasn’t always easy but I had some great support. When I was doing GP training, I did some work as a volunteer counsellor in the Rape Crisis Centre in Cork, for three years. This was in the days before the service was professionalized, as in the sense of psychotherapy, a change which was entirely appropriate. But we got wonderful training, and I saw a good number of clients there. It was my first exposure to the denial of abortion care in Ireland. So I developed an interest, but nothing more than the next person. And then with the referendum in 2002 which was around the role of suicide and trying to make sure that suicide couldn’t be used as a reason to access abortion in Ireland. We already had a constitutional ban, so it was a double lock. Myself and two other doctors were talking one day, complaining really, about how the only voice you heard in the media, from a medical point of view, was a conservative voice, a traditional voice, a Catholic voice, and almost always a male voice. And we knew there was more than this as for example we three were talking about it. And that’s how Doctors for Choice started. There were three of us to start and because we were the only medical voice, we developed quite a role in the media and we became a very important part of the growing advocacy movement to change the law on abortion. But it didn’t really go anywhere for a long time, and in the late 2000’s Doctors for Choice had become very small because there had been no political change happening.
Then one morning a BBC reporter rang me at seven in the morning asking me about the death of Savita Halappanavar. I didn’t know who she was but it had been on the front of the Irish Times that morning. From there, and for five years, it became very busy and it was a privilege to do it. I learned a huge amount and yes, some of it was challenging. There was a sense for many years of feeling ‘other’ in medicine, being ‘other’ in general practice, and that was often a lonely path. But there were a number of us in Doctors for Choice who provided a lot to support to each other. And we ploughed on, trying to put motions through the Irish College of GP’s to get things changed, the Irish Medical Organization, all of them effectively unsuccessful. I had been on the Medical Council many years earlier and knew some of the ways to addressthat. But the law was always going to eventually change in Ireland because it was going to be a social movement, and it had to come from the grass up and that’s effectively what did happen.
In the year before we came to the final campaign to repeal the Constitution in 2018, there was a decision made that the two central features of the national advocacy campaign should be the patient’s voice, the woman’s voice, with doctors amplifying that voice and providing background and context. And that became the pivotal role of Doctors for Choice, as it was then. And we were up and down the country at every meeting, every radio show, every TV show, right through until the launch of the national campaign of “Together for Yes”, a group that eventually had 70 organizations involved in it, on The Late Late Show (A national television show in Ireland), with myself and Peter Boylan (an obstetrician) as the two doctors.
It was a decision of the national campaign to run it with a medical voice which, in the end, was very effective and two thirds of the population voted in favour. And the funny thing about that was that doctors began to support the campaign very late, about six weeks out, but those that did became absolutely fantastic supporters of what became ‘Doctors for Repeal’, then ‘Doctors Together for Yes’ and then morphed afterwards into the ‘START’ providers group, which is the abortion providers group.
Everybody was exhausted after the referendum but we as doctors were the people who had to get up again and start describing what the service should look like. And that was the big role that I had. I had been involved, in the years before that, in Global Doctors for Choice. and they had asked me to join the board. It’s based in New York, and that gave me the most extraordinary opportunity to access academics, experts in the field of gynaecology, in the field of abortion provision all over the world, all the people doing all the latest research in the field of abortion provision, and I tapped into their most extraordinary network of up to date information and advocacy.
So, we described a service where the abortion service was going to be provided in primary care. It had been done in patches in places around the world, but had never been done as a national system. That’s what we designed and described and presented it for the year before the campaign to Repeal the Eighth Amendment to everybody who asked us. And in the end, that was the system adopted and that was because we had described it. If knew that if we had replicated the UK system of hospitals and clinics, there would be only 3 or 4 of them in Ireland because they wouldn’t have been financially viable, and they would run the gauntlet of protests and women would have an awful time having to travel to them. The government accepted the primary care concept and it became what the service is today.
‘Impossible to possible-abortion provision in Ireland’
You can link here to the full content of this TED Talk where Mary describes how she campaigned for many years to remove the Eight Amendment as it was harmful to Irish women’s health
“Often when writing reports I’m thinking, ‘oh boy, that could have been us and in our practice’ and it’s helped me introduce a significant safety culture in our own practice, very actively looking at how we can keep patient safety to the centre and core because, as we all know, it’s all about the small things. It’s the layering of small acts of safety that make the difference. “
Irish College of General Practitioners representatives attend Joint Oireachtas Committee on Health to discuss the preparation of clinical guidelines in light of the impending introduction of abortion services in Ireland. Dr Tony Cox ICGP Medical Director, Dr John O’Brien ICGP President and Dr Mary Favier ICGP Vice President. ICGP News
DMacA: Let me ask you about another area as you’ve been on the Medical Council and you’re on the board of one of the indemnity societies…so, doctors get a lot of criticism, and there’s quite a lot of litigation against doctors in Ireland. Is that justified?
MF: I would always try not to be afraid of criticism, or afraid of criticism of doctors. We have a lot to answer for. We are, in a sense, in extraordinarily responsible positions. And I think we need to be open to intense interest and interrogation, whether you call it criticism.
There is a disproportionate amount of litigation, and people litigate for all types of reasons. We are second only to the state of California in the US in terms of actual numbers. Some of it is to do with the size of settlements but some of it is because there isn’t a robust complaints procedure in Ireland. Every other country in Europe, for instance, has robust multi-layered complaints procedures, whether it’s from practice level to local area authority level, up to national level. But in Ireland we don’t have that.
A lot of work I’ve done with the MPS (Medical Protection Society- an insurance indemnity company) is about trying to address that gap, which requires changes in the Medical Practitioners Act. You see quite a lot of cases, and I think solicitors in Ireland would agree, that what is interesting from my point of view, as I write ‘breach of duty’ reports for the indemnity organizations and the state claims agency, and sometimes for plaintiffs, is that people rarely take cases for no reason. It’s always because something bad has happened in terms of a problematic outcome. What’s in dispute, of course, is whether there was a breach of duty or an avoidable error, and often there isn’t, but people litigate anyway. But to be fair to people, usually there have been very difficult outcomes. It’s a very interesting area to work in and I don’t do a huge amount, I do one day each week but I’ve learnt an extraordinary amount.
Often when writing reports I’m thinking, ‘oh boy, that could have been us and in our practice’ and it’s helped me introduce a significant safety culture in our own practice, very actively looking at how we can keep patient safety to the centre and core because, as we all know, it’s all about the small things. It’s the layering of small acts of safety that make the difference. Its been a very interesting, completely different sideline to everything else I do.
And, of course, I work in an area of high urban deprivation, which is another area of interest.
DMacA: As a former President of the Irish College of GPs, on the Medical Council, on the board of the MPS, on the national advisory board for Covid, ( NPHET ) what do you think is the position of women in medicine in Ireland?
MF: Mixed. As we know, more than half of all medical school entrants are women, and then graduates. However, we also know that they don’t maintain that significant number through the training years, and particularly into consultant posts. It’s different in general practice and it’s the flat structure, the lack of hierarchy in general practice, that is very appealing to women. It’s a specialty that I think is well suited to women and their style and way of thinking. There’s a lot of evidence that women practice safer medicine. But I think there’s a significant amount more to be done, which, again, comes to the mentoring issue. I think that, historically, men have had much better networking opportunities, collegiate opportunities, opportunities to be guided. They are encouraged- why don’t you apply for that, or why don’t you, you know, review this or sit on that board. There is a lot more work to be done but I don’t think it’s just about women. I think the social class divide in medicine is really significant. And having come from a family that had no previous attendance in university, from either parents or a wider extended family, and being something of a fish out of water when in college and recognizing that it takes years in a way to gain back that traction.
There’s a lot of work to be done in terms of enabling those from less advantaged families. For example I have two young adult daughters, young women now, and I recognize the privilege they have in their lives from the mentoring they can get from the likes of me, from understanding how the system works, and in giving them guidance and direction. It’s not unfair advantage, it’s not pull, it’s not nepotism, but it’s coaching. And so many young women in particular, from areas of disadvantage, don’t have that. And that would be the biggest area I would seek to address.
“… more than half of all medical school entrants are women, and then graduates. However, we also know that they don’t maintain that significant number through the training years, and particularly into consultant posts. It’s different in general practice and it’s the flat structure, the lack of hierarchy in general practice, that is very appealing to women. It’s a specialty that I think is well suited to women and their style and way of thinking. There’s a lot of evidence that women practice safer medicine.”
DMacA: My final question, bearing in mind your most recent recognition as one of “100 women for 2024”
MF: There’s a very funny story about that. My daughter, who’s working in London at the moment, sent me a screenshot and she couldn’t get over that her mother and CMAT, that fantastic young Irish musician were on the cover at the same time. She was so chuffed. So what’s next? I’ve become more interested in the area of social deprivation, and urban deprivation in particular, and through the Irish Deep End group which began in Scotland, looking at the social demography of medicine, the classic Tudor Hart ‘Inverse Care Law’, which is writ large in my practice, and that’s where I can see my interests going.
I’ve had a lot of national roles which occurred mostly by happenstance; being President of the ICGP at the time of Covid and ending up on at the national public health emergency team (NPHET) and representing general practice, was such an extraordinary pivot from having been a doctor who was always ‘other’ in abortion politics, to now leading the College and leading Irish general practice. It was a privilege and a position I was really mindful of and always wanted to make sure I did the right thing and represented general practice appropriately. But always with an eye to representing my patients and those who didn’t otherwise have a voice. I did a lot of media interviews and radio and television at the time, and the feedback I get all the time was that I was all so reassuring and relieved anxiety, which I just think is so funny considering my background… Relieving anxiety… Reassuring…
DMacA: Mary, it’s been wonderful talking to. As you know, I have huge admiration for your work. Thank you very much for everything you’ve done. And thank you very much for talking to us today. Thank you.
