Dr. Caitriona Henchion:

I thank the committee for the invitation to address it today. I am a medical doctor and have specialised in reproductive health for over 20 years. I have been the medical director of the Irish Family Planning Association, IFPA, since 2008. The IFPA is Ireland's leading sexual health charity. It promotes the right of all people to sexual and reproductive health information and to dedicated, confidential and affordable healthcare.

Access to a choice of contraceptive methods is critical to gender equality, to women’s ability to plan the number and spacing of any children they choose to have and to their participation in education, employment and public service, including voluntary work and politics. It is central to the achievement of the right to health and it is key to reducing the rate of unintended pregnancy and sexually transmitted infections.

The IFPA welcomes the working group report. The introduction of abortion care in January of this year has set a positive precedent for universal access to reproductive healthcare and policy on contraception should be consistent with this approach. We support universal access to all available methods of contraception without cost to the individual. This would enable people to choose the contraceptive most appropriate to their changing needs and preferences throughout their reproductive lives.

As a provider of abortion care and pregnancy counselling, we are acutely aware that many unintended pregnancies arise from poor or inadequate information and misinformation or because cost barriers force women who wish to avoid pregnancy to use unreliable methods or no method of contraception. In my daily practice, I have seen women present with unintended pregnancy who had chosen an effective LARC method but had deferred having it because of the cost involved. I have also seen women following a termination of pregnancy who are unable to afford their method of choice. This is completely unacceptable and I do not think this is what the public voted for in last year’s referendum.

Any contraceptive scheme must address the particular needs of young people. International research indicates that young people have higher rates of non-adherence and discontinuation of contraception than adults. We know from domestic research that adolescents identify cost as a barrier to access. Furthermore, the Irish Study of Sexual Health and Relationships identifies those who have sex before the age of 17 years as being significantly more likely to experience a crisis pregnancy. Given these risks and vulnerabilities, it would be unacceptable to exclude adolescents from a contraception scheme.

As the working group report acknowledges, the removal of the cost barrier alone is insufficient to ensure access to contraception for all who need it. Policy reform must address all barriers in a comprehensive and strategic approach. This includes legal restrictions, poor access to information about contraception, regional disparities in the quality and availability of services, gaps in provider training and capacity, stigma and lack of confidentiality.

The development of an implementation plan with clear goals and achievable actions will be key to the successful roll-out of a contraceptive scheme. This process must be undertaken in consultation with relevant stakeholders to ensure appropriate levels of planning and resourcing, as well as mechanisms for data collection, monitoring and evaluation. Specific measures must be introduced to address the contraceptive needs of vulnerable and underserved populations, namely, adolescents, refugees, asylum seekers and other vulnerable migrants, people with disabilities, homeless people, Travellers and other marginalised groups.

Members of the Oireachtas have a key role to play in supporting better access to contraception; political consensus and commitment on reproductive health policy will be crucial to full implementation, ensuring that these reforms can be progressed regardless of who is in government.