Navigating social and epistemic harms: the role of Facebook in women's health activism against essure

Abstract

This thesis explores the multi-dimensional harms experienced by women in the UK who sought sterilisation with the Essure device. The Essure device is a permanent birth control implant made of metal coils, designed to cause scarring in the fallopian tubes, effectively blocking them to prevent pregnancy. It was inserted non-surgically but later faced significant controversy due to reports of severe complications, leading to its removal in 2018. In addition to exploring the harm experienced by some women, the study considers women’s use of a private UK Facebook page as a response to harm. Grounded in a zemiological framework, which focuses on social harm, and integrating Miranda Fricker’s theory of epistemic injustice, the research develops the concept of epistemic social harm. This concept captures the impacts of the dismissal of women’s knowledge in healthcare and how this amplifies physical, psychological, financial, relational, and autonomous harms. Through qualitative methodology, including interviews and netnography, the study investigates how these harms are shaped by institutional and gendered power dynamics within healthcare. The findings reveal significant institutional failures, with healthcare providers often dismissing the women's suffering, resulting in delayed diagnoses and treatment. The research also highlights the potential and limitations of the Essure Facebook group as a site for epistemic resistance, where women could share their experiences and challenge the medical narratives that dismissed their suffering. However, despite this digital empowerment, systemic healthcare reform is necessary to address the entrenched epistemic hierarchies that continue to marginalise women's voices. The study contributes to the field of Zemiology by offering a novel framework for understanding how knowledge-based injustices intersect with broader social harms, and it provides recommendations for future research and healthcare policy reforms to create more inclusive and just systems for women’s health.

Date of Award	Jul 2025
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	UK ESRC NINE Doctoral Training Partnership
Supervisor	Teresa Degenhardt (Supervisor), Thérèse Murphy (Supervisor) & Lisa Smyth (Supervisor)