Ruth Coppinger (Dublin West, Solidarity) | Oireachtas source

This is a report on the future of health care. We all know that Ireland has been in the dark ages for a long time in respect of reproductive health care. It is extremely disappointing that this report has practically no reference to reproductive health care at all, that is, to contraception and abortion. A total of 51% of the population are women who potentially may become pregnant and who would like to have control of their fertility. One would think that a report on the future of health care would take sufficient account of that. The only reference I can see that is made to it at all is on page 58, which states that the committee has agreed the following services should come under the remit of universal health care: public health preventative care, including health promotion activity, screening and family planning supports for self-management of health. The only reason family planning was added in there was because the Solidarity representative on the committee, Deputy Barry, put it forward. We put forward a much more extensive amendment and proposal on the issue but the committee saw fit to reject it. I will return to that point later.

What is the future of health care for women in this country and for those who can become pregnant? The report totally ignores reproductive health. The HSE reported to the Joint Committee on the Eighth Amendment of the Constitution yesterday that women on low incomes are having difficulty affording permanent contraception. Even with the so-called State subsidy, one still has to pay €148 for the Mirena coil. For many women finding that amount of money becomes a barrier to getting it and as a result, the HSE reported yesterday that many of those women will end up with crisis pregnancies because other forms of contraception are not reliable for them. The VHI and private health insurers do not provide any coverage at all for contraception. It seems that is allowed by the State. Are women to continue to be ignored in the future of health care in this country?

We are meant to be emerging - but have not emerged - from a situation whereby the church controls a huge number of hospitals that have direct control over women. Some of the major hospitals in the capital city do not supply contraception. The Government was going to hand over control of the national maternity hospital to a church-run charity and the Government had to back-track on it following a huge protest. Those are major issues and this really shows how the Dáil is far behind the needs of society and public opinion.

It was also reported at the Joint Committee on the Eighth Amendment of the Constitution yesterday that 536 packets of abortion pills were seized by the Customs and Excise under the direction of the Health Products Regulatory Authority, HPRA. That means the State directly obstructed at least 536 women from accessing a safe, early abortion and probably forced women to go abroad to have a later one. We do not know. What we do know is that whatever comes out of the Joint Committee on the Eighth Amendment of the Constitution will come back to the Dáil. Are we going to leave this entire issue in the shadows? There is a half-hearted effort by the HSE and the State to find out the extent of abortion in this country but it will have to be addressed in the health system. The alternative is for us to continue to have an Irish solution to an Irish problem.

Research has been done, which of course is always done outside the country. One could not expect the Government to do it. Two studies have been done on how widespread is the extent of the use of the abortion pill in Ireland. One was done in Texas by Dr. Abigail Aiken, who testified at the committee, and another more up-to-date study has been done in the University of Kent on access by Irish women to safe but illegal abortion. The results of the study are pertinent to the future of health care in Ireland. It showed that in one year, 3,000 requests for abortion pills were made from the North and South of Ireland to the websites of two organisations, namely, Women on Web and Women Help Women. Those pills are legal and used in every other health system in Europe bar Ireland and Malta. A total of 99% of people in Europe have access to that safe, essential medicine declared by the World Health Organization as being much safer than surgical abortion, for example. What will happen in that regard? Are we going to continue to let thousands of women from this State access illegal abortions or will it be catered for in the health service? If one breaks down the figure of 3,000 women seeking abortion pills between the North and South, more than 2,000 are from the South. I accept that not every woman will proceed to carry out a termination even if she gets the pills but it works out that five people a day are having home abortions in their bedroom in this country today. How will that be catered for in the health service whenever we do repeal the eighth amendment and legislate for abortion in this country?

The fact that the future of health care report does not even refer to it speaks volumes. Will another chapter be inserted? What does the Minister of State have to say about that? We should be planning to repeal the eighth amendment, which we all know is inevitable, but we should also be planning to legislate to allow women to access this in our own country rather than another one. This could be easily done. GPs could prescribe the pills, as they do in other countries. A woman could go to her own doctor and be prescribed a safe, early medical abortion, and she could ring up if she has any difficulty. That would be the end of the matter. We do not need huge clinics to the same extent as in the past given the availability of this pill.

It is extremely disappointing that the all-party committee rejected an amendment proposed by Solidarity-People Before Profit that there would be a new section on sexual reproductive health, which historically has been neglected by the Irish health system. The number of consultant obstetricians and gynaecologists is one of the lowest in the OECD and Ireland is one of the few developed countries without universal foetal anomaly screening. We keep hearing this mantra about it being the safest place in the world to have a child, but it clearly is not. More than one third of women attending antenatal services last year did not get a foetal anomaly ultrasound and we all know that women outside Dublin, in particular, would have real difficulty getting one. Ireland is almost alone in Europe in terms of the complete lack of access to abortion and free in vitro fertilisation, IVF, services. There is some assistance available, but it is not free.

We proposed that the committee would recommend free universal access to sexual and reproductive health services. These would include LGBT+ sex and health education; gender confirmation surgery and hormone therapy; contraception; screening, prevention and treatment for sexually transmitted diseases, including pre-exposure prophylaxis, PrEP; substantially expanded and properly resourced public gynaecology services; fertility treatments, including IVF; access to abortion services, along the lines of the Citizens' Assembly recommendations; and antenatal screening, including non-invasive prenatal testing and foetal anomaly scans. Consultants recently reported that these scans could now be done at eight and ten weeks, but they cost €150 to €300, so they are not carried out. We could be preventing so much difficulty for families who are expecting.

In addition, we also proposed pregnancy-related sick leave and an examination of extended paid maternity leave. It is extremely discriminatory that someone who has become pregnant uses up health benefits dealing with inevitable health issues. That is not equality. To achieve those goals, we also put forward that it would be necessary to separate church and State. The church should not have control of hospitals because these services will not be provided. It is extremely disappointing that none of this is catered for in the future of health care report, which raises the question whether women will have to come back, fight and demand that these things are provided in our own country.

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