Dr. Mary Short:

I thank the committee for affording me the opportunity to address it. I am a medical doctor, a general practitioner and the director of sexual and reproductive health at the Irish College of General Practitioners, ICGP. I am also president of the European Society of Contraception and Reproductive Health and chair of the Irish Society of Health Care Professionals.

In light of a free termination of pregnancy service, the ICGP fully supports the principle of free contraception that is appropriate, available, accessible and free to those who wish to avail of it. Put simply, giving access to a free contraceptive service is the logical next step following the implementation of the community-provided medical abortion service.

The ICGP commends Mr. Conlon and his team on their comprehensive report but we cannot support the proposed phased roll-out of the service. His statement that contraception has potential health benefits that impact on people, and women in particular, when the opportunity to choose the most effective and suitable type of contraception based on their lifestyles, health needs and preferences is afforded to them is fully supported by the college. Reliable and appropriate use of contraception allows a couple to plan, space and limit their family size when they are ready and prepared for parenthood. In these different phases of a reproductive life, the choice of contraception will change depending on the needs of a couple. However, there are parts of the report that do not reflect the experience of GPs and I would welcome the opportunity to discuss this today.

Dr. Henchion and Mr. Conlon raised good points – lack of knowledge, fear of stigma and perceived lack of understanding from service providers may make contraception inaccessible. This raises the fundamental issues of information, education and knowledge, all of which impact on making the right choice at the right time. While Mr. Conlon makes a case for prioritising free contraception for the vulnerable and the marginalised, he also points out that these groups may for the most part have free contraception available to them through the GMS scheme.

The parts missing here are fundamental knowledge of reproduction, that is, sex education; information regarding the different methods of contraception; and empowerment to make informed choices appropriate to the particular need.

In addition, I make a case for those who have the educational knowledge but are at risk of making poor choices due to the initial cost outlay. A pack of condoms may seem an inexpensive option in the short term while a long-acting reversible method of contraception would be a better option. There is, again, a case for information and education for women in their mid to late 40s who erroneously believe that age, infrequent intercourse, etc., precludes them from a pregnancy. The ICGP, therefore, supports full and free contraception for all groups.

GPs are ideally placed to provide a full range of contraceptive services in the community. We are an education and training body and the college provides training in all methods of contraception and runs designated courses in the training of LARC. The college would like to expand the training and upskilling of our colleagues. The provision of LARC requires a specialised skill set of technical expertise. The training is time consuming and demands up to five sessions or two and a half days, although probably more in real time, to gain the necessary expertise, meaning GPs require funding and support for upskilling but, in economic terms, this is an upfront investment with long-term benefits.

I hope that we are all agreed that providing free abortion without contraception is not a healthy option. There is a strong case to be made for the normalising of attitudes to sexual and reproductive health, to rid ourselves of the stigma around our sexuality and to approach our reproductive lives through education and information appropriate to the age cohort. Free contraception on its own has not been shown to work, for which I gave the example of the UK but this has happened in other jurisdictions. Free contraception, acknowledgement of our sexual lives and needs over time, and a proper structural information and education programme will work to reduce the need for abortion, which is, I presume, the purpose of this exercise and would be a rewarding outcome for the provision of access to a free contraceptive service in the community.