Paul Gavan (Sinn Fein)
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It is nice to see the Minister of State. She is very welcome. I want to raise the issue of the promised review of the Health (Regulation of Termination of Pregnancy) Act 2018. I begin by quoting what the then Minister for Health, Deputy Harris, said when that legislation was passed. He stated:

I am purposely seeking a review clause in the legislation as a result of looking at other jurisdictions where legislators thought all they needed to do was pass a Bill and that they had dealt with the issue forever. For us to do that would be a dereliction of our duty. It is appropriate that we return to the issue and make sure the legislation continues to be in line with best international practice.

During the Second Stage debate on the legislation in question, the then Minister also gave a very clear commitment that the there would be a full external review of its operation. It is crucial the this review be external.

I want to know where we stand in respect of this issue. We have heard that the current Minister for Health, Deputy Stephen Donnelly, apparently told the Cabinet in March that the review had started. We also know the Secretary General of the Department of Health, Mr. Robert Watt, said in March this year:

The Department will collate the findings of the three strands of the review. Upon completion a full report, with any necessary recommendations, will be submitted to the Minister for Health for consideration ...

My first concern is that the latter does not sound like an external review. It does not sound like the commitment that was given in the wake of the regulation of termination of pregnancy legislation being passed. I want to understand clearly from the Minister of State that the commitment will be upheld; that it will be an external review and that we will see a fully independent chairperson who is a specialist in reproductive rights and equality-based healthcare at the head of that review. I want to hear that the review will be expansive in scope, that it will be conducted in line with international human rights standards and the terms of reference and review process should be public and transparent. I am indebted to the National Women’s Council of Ireland, NWCI, which made these points in an excellent document it produced just a couple of months back.

We have some crucial issues. Having made so much progress in repealing the eighth amendment, we understand now that actually only one in ten GPs are actually providing abortion and termination services. I repeat it is only one in ten. We also know almost half of the maternity hospitals in the State are not providing services. That is not what the people of Ireland voted for. We need, therefore, to see action and to see an urgent review. There is a further issue, namely the ancillary recommendations of the Joint Committee on the Eight Amendment of the Constitution, of which I was a proud member. There was a great deal of agreement on the importance of these ancillary recommendations and, specifically, the need for free contraception. That was clear and is in the programme for Government. We have not seen progress yet and I want to understand from the Minister of State when that progress will be made because it is urgently needed. We know that contraception is linked directly to reduction in unwanted pregnancies so that is a key issue. Crucially, in those ancillary recommendations, we promised it would not matter where a woman lived and that regardless of where a woman lived all women would have access to the same standard of obstetrical care including early scanning and testing. That is clearly not the case. Women are being failed. I must be clear that this is not what people voted for, they voted for the provision of services and it is clear these services are not being provided as they should be.

I have one final point to raise with the Minister of State, that is, the need for safe access zone legislation. In my city of Limerick there was a protest each day during Lent outside the maternity hospital. There was a commitment in the programme for Government to enact safe access zone legislation. I am very fearful this Government is now trying to walk away from that commitment. Again, I am looking for a clear assurance that legislation will be enacted.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank Senator Gavan for raising this matter, which I am taking on behalf of the Minister for Health. The Health (Regulation of Termination of Pregnancy) Act 2018 was signed into law on 20 December 2018 and commenced on 1 January 2019. Section 7 states: "The Minister shall, not later than 3 years after the commencement of this section, carry out a review of the operation of this Act." This review clause, introduced by the Government on Committee Stage in the Dáil, was included in the Act in order to facilitate monitoring of the impact, operation and effectiveness of the legislation in practice, as well of the delivery of services in the area.

The Minister has asked me to confirm that the review will be led by an independent expert in line with similar reviews of legislation under the aegis of other Departments. The Minister expects the independent expert appointed may wish to have input on the methodology and may wish to undertake his or her own detailed consultation with particular individuals or groups. At this point, however, he anticipates that a three-part approach will be taken to the review of the operation of the Act. The three strands of this approach will focus on women who have used the service, service providers and public consultation.

Women who have used the service are clearly a crucial group to consult in reviewing how the Act has operated during its first two and a half years to date. For the review to be effective, it must find out whether the legislation provides access to termination of pregnancy services in practice to those who wish to avail of them. In this regard, independent research exploring women’s experiences of termination of pregnancy service and gathering their views of how the system has operated since January 2019 will it be essential.

Information from service providers we will provide the second key strand of the review. In this regard, we will need to gather the views of those involved in providing termination of pregnancy services in both community and acute settings in Ireland. This research will encompass input, for example, from hospitals and GP surgeries providing termination services, from individual medical practitioners in both settings, from the medical colleges and from the HSE.

In order to ensure that all those who wish to do so are given a chance to share their views on the operation of the Act, it will be important to include an opportunity for members of the public, special interest groups or any other interested parties to submit their views for consideration in the review. This will be achieved through a public consultation process.

Once the review has been completed, it is expected that a full report correlating the findings from all three strands, and including any necessary recommendations, will be submitted to the Minister for Health for his consideration. The Minister has held a number of meetings with stakeholder groups to discuss this approach to the review. Thus far, there appears to be broad agreement that it would be appropriate and effective. The process is continuing, however, and the approach will be finalised in due course. In the meantime, the Minister has asked me to assure the House that the Department continues to work with the HSE to ensure that all women can access this service quickly and easily and without bias or judgement, and that we continue to provide a compassionate and dignified termination of pregnancy service. The most important thing is that women accessing the service can do so with certainty of the quality and safety of the care they will receive.

Paul Gavan (Sinn Fein)
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I thank the Minister of State for her reply. It is good to hear that there will be an independent person appointed to lead the review. I would, however, appreciate a timeline for this because we are quite some way through the year at this point. I am also not clear about exactly how external the overall review will be so I am looking for some further reassurance in that regard. Fundamentally, the point I wish to make in the time available is that each day last year at least one woman had to leave this country to go to Britain for a termination.

There are a number of issues that arise in the context of the Act.There is no medical reason for the three-day waiting period and that is causing concerns. There are real concerns that women who are pregnant in circumstances where there are serious or fatal foetal abnormalities involved will run out of time in the context of the 12-week period.

There is also the major issue of access to services. We know that access is not there at present. I am an old-fashioned republican. I believe in a complete separation of church and State. We need to see full reproductive healthcare rights for women in this country. This review is urgently needed. It would be helpful if the Minister of State could provide a timeline.

Anne Rabbitte (Galway East, Fianna Fail)
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Regrettably, I cannot answer as to the specifics. I can only answer in the context of what is in the script provided by the Minister for Health. The Minister has asked me to assure the Senators that implementing the Health (Regulation of Termination of Pregnancy) Act 2018 and ensuring access to services under the Act remains a priority for the Department of Health. All the indications are these services are both operating and available. They are being delivered throughout the country in hospitals and community settings.

The review of the operation of the Act required under section 7 gives us an opportunity to examine the matter in more detail and hear the views of all those involved, particularly women who have used the service. The review is being progressed this year and will be led by an independent expert. It is anticipated that a three-stranded approach will be taken to review the operation of the Act and that these strands will focus on women who have used the service, service providers and public consultation. Research to inform the service users and service providers strands will be commissioned and carried out independently and a public consultation will be held. Reading from that, it seems that there will be movement on the matter before the end of the year. The Minister is confident the information gathered during the review of the operation of the 2018 Act will provide us with evidence as to how to proceed in future, to continue to ensure the service mandated by the people in May 2018 is operating effectively.