Dr. Abigail Aiken:

The Deputy's first question was whether the decline in the number travelling and the increase in the number accessing pills through Women on Web are related. If we look at the graph, exhibit 2, we could not put all of the years on the axis, so 2002 is the first year in the graph, which is the first year of the decline. This decline has been quite steady to 2016. Committee members will notice there is some compression on the axis between 2002 and 2009 so it looks steeper than it should be in the first part. The first years on the graph were prior to Women on Web becoming available in 2007. Of course, it took a little while for the service to get known and for people to start using it.

What we can say is there was a decline in people travelling even before Women on Web came along, but we see from the graph, exhibit 1, there was a tripling over the past six years. It could certainly be that some women are making a decision that it is better for them to use the online service than to travel. What could also be happening is there is a group of women for whom travel was never a possibility, that it was simply out of reach because it was too expensive or they could not get away from home or tell anyone. For these women it is possible the online service has allowed them a way to access abortion that was not there for them before, if that makes sense. Although the decline could be linked, we cannot attribute it to one replacing the other.

The Deputy's next question was on contraceptive access in Ireland. It is the case, no matter whether one is privately or publicly insured in Ireland, that one will have a co-pay for prescription medication, and this includes contraception. If we look at the figures released by the Irish Family Planning Association, someone could be looking at €30 a packet of contraceptive pills times 12 times however many years they will be used for, so there are co-pay problems with access to contraception for most people. People looking to get an intrauterine device, IUD, such as Mirena, could be looking at an upfront payment of €350 to €400. There are still some access problems, and this is reflected in the unmet needs statistic, where the unmet need for contraception in Ireland is double that of Great Britain where those medications are free of cost to everyone.

As my colleague pointed out, even with better contraceptive services, and absolutely that is something to focus on, the need for abortion still does not completely go away. It can certainly help with reducing abortion rates, but the two things really are hand-in-hand services that both need to be encompassed.

The Deputy's final question was about criminalisation and safety. We do see from the exhibits that the outcomes in terms of safety from Women on Web and other online services are good. One thing that is not in the charts is that among the about 9% of women who experience the symptom of what could have been a complication that was serious, 95% of those women did report going to a hospital and seeking care. Those who did not, which was about two people, were okay; nothing bad happened to them so from the data we have, people do go when it is necessary. However, this does not mean that it is easy for them to go and it does not mean that they might go when something is not an absolute emergency but they still might need some care. They might need some follow up, they might need to talk to someone, they might need counselling or they might need to go for something that is not necessary going to cause mortality but could cause morbidity so criminalisation still stops people from talking to health care professionals, interrupts that doctor-patient relationship that should be happening and stigmatises even if it is does not always stop people seeking emergency care. When one stigmatises something and makes it seem wrong, one puts it behind a door so it is no longer in the open.