It started with one area in Scotland.

This month, one of the 14 health boards in Scotland decided to ban the use of transvaginal mesh. Now the entire country has decided to do so.

This makes Scotland the first country to stop the sale and implantation of the controversial transvaginal mesh implants in women.

It all began with a dedicated group of mesh-injured women. Members of Scottish Mesh Survivors petitioned their government and had a hearing in front of a Parliamentary Committee in June.

The U.S. does not have a way of directly petitioning the government to request a hearing.

The women told their stories of chronic pain, infection, mesh migration, nerve injuries, organ perforation and a host of other complications.  The mesh is commonly used as a treatment to hold up prolapsing organs, but an unknown percentage of women have life-altering complications.

Compounding their frustration is the fact that transvaginal mesh implants are permanent and the manufacturers, largely U.S.-based companies, never studied how to remove the troubling polypropylene implant if it was needed.

Scottish Mesh Survivors asked the government for a registry of mesh injuries and asked that the procedures be suspended until there is an improved patient informed consent. Most women who testified didn’t even know doctors were implanting a mesh in them, much less that it would be nearly impossible to remove. The women also requested a registry be established along with mandatory reporting of complications by doctors and hospitals.

At the present time in Scotland, like the U.S., reporting of adverse events is voluntary. Many doctors choose not to report on a bad outcome for one of their own patients in case it casts an unfavorable light on the doctor.

Alex Neil, the Health Secretary, told BBC News, “I’ve personally met with women who’ve been adversely affected, and I was deeply troubled to hear how women affected have suffered, and they have my full sympathy and support and we’ll certainly do everything we can to improve the situation.”

“No one should have to experience the level of suffering that some of these women have had.”

Mr. Neil fears the actual number of mesh-injured is underreported.  He will ask the country’s chief medical officer to alert the 14 provincial health boards to stop the practice while the safety of mesh implants is studied. The European Commission review of transvaginal mesh implants should be released in January of next year.

In Scotland, about 1,800 women have received transvaginal mesh, delivered through so-called “minimally-invasive” surgery through the vagina, and about 350 women received the larger pieces of mesh to treat pelvic organ prolapes. They are all made of polypropylene, a plastic that is petroleum-based.

The actual number of women who suffer complications is not known because there is no follow-up and reporting of adverse events is not mandatory either in the U.S. or Scotland.

Meanwhile in the U.S. there are at least 75,000 product liability lawsuits filed around the country and mesh is still used as a treatment for prolapse . In fact the medical society, American Urogynecologic Society (AUGS), continues to call mesh the “gold standard” despite the high number of complications associated with its use.

What does Scotland know that the U.S. doesn’t?

Scotland is a country with a public health system, meaning medicine is geared to patients, not for profit.  Mesh manufacturers have less influence over doctors and citizens have a direct way to petition their government, as the Scottish women did.

These factors, no doubt, led to the country taking the precaution of giving the benefit of doubt to its citizens, not the mesh manufacturers.