Holly Cairns (Cork South West, Social Democrats)
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I thank the Ceann Comhairle for including this Topical Issue matter. Before I get into it, I would like to say that for anyone who needs an abortion, the HSE's MyOptions service will help them find their nearest provider. People can phone 1800-828010 or go to myoptions.ie.

Last week, the news broke that the US Supreme Court had overturned Roe v. Wade, the case permitting termination of pregnancies across that jurisdiction. It was a shocking reminder that rights established for decades can quickly be removed. Equally worrying was the scale of celebration and pace at which lawmakers, primarily men, moved to restrict healthcare for girls and women. These events are a sobering warning. Some people in Ireland, including politicians, joyfully welcomed the news that the lives of girls and women were being put at risk, and we know this is especially the case in disadvantaged and minority communities.

While the right to bodily autonomy and healthcare, including termination - because abortion is healthcare - has been established by popular vote here, we know nothing is guaranteed. Some groups are still actively working to deny the will of the Irish people and threaten hard-won rights. However, we also know that the work is not completed to ensure that all people who need it have access to free, safe, and legal abortions in Ireland.

Recent UK Department of Health and Social Care figures show that 367 people from the island of Ireland were forced to travel to Britain for an abortion in 2021 - 206 from the Republic and 161 from the North. These are just the UK figures of people giving Irish addresses. In reality, there are many more.

For those travelling from the Republic, the vast majority were more than 12 weeks pregnant, with fatal foetal anomaly cases being the leading reason. This is an indictment of our current abortion laws. These are not abstract numbers; each one is a person being forced to leave the State for healthcare. In many cases, it is women and their partners enduring the pain of complicated pregnancies and foetal anomalies. These are heart-breaking and clinically complex situations. It is beyond disgraceful that our laws after repeal are still forcing hundreds of girls and women to travel for healthcare.

They are in the midst of the most difficult and emotional decisions they will ever have to make. They then need to navigate travelling to another jurisdiction, going through the chaos of Dublin Airport, or being fearful if they can afford it in a cost-of-living crisis. People living in rural areas, working-class people, disabled people, migrants and people living in direct provision all face additional barriers. It is important to note that the Abortion Support Network is a UK charity which provides financial assistance, accommodation and consultation to people from Ireland and other jurisdictions to access care in Britain.

Our laws are forcing suffering onto people already going through one of the worst events of their lives. The incredible work of Termination for Medical Reasons and all the courageous women and families who told their stories reveal the lived reality of this oppressive legislation. The current review of the Health (Regulation of Termination of Pregnancy) Act 2018 must remove these cruel restrictions. Other restrictions need to also be addressed, such as the three-day waiting period, which has no basis in medical science, and the absence of abortion services in large parts of the country.

Recent events in the US have brought this situation back into the headlines, but it has been the lived experience for many since repeal. It is now up to the Government to help them.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this matter, which is very timely in light of everything that has gone on in US. The Minister, Deputy Stephen Donnelly, sends his apologies. I am taking the matter on his behalf and I will read out his exact script if that is okay.

It is important that we acknowledge the very upsetting situations faced and difficult decisions made by the people behind these statistics, and the very sad circumstances that surround these terminations of pregnancy. As the Deputy will be aware, the Health (Regulation of Termination of Pregnancy) Act permits terminations to be carried out in cases where there is a risk to the life, or of serious harm to the health, of a pregnant woman; where there is a condition present likely to lead to the death of the foetus either before or within 28 days of birth; and without restriction up to 12 weeks of pregnancy.

Expanded termination of pregnancy services commenced on 1 January 2019 and are provided through participating doctors and hospitals throughout the country. However, I am aware that statistics reported by the Department of Health and Social Care in the UK showed that women with Irish addresses continued to access termination of pregnancy services in that jurisdiction in 2021.

11 o’clock

I assure the Deputy that it is a priority for my Department that the Health (Regulation of Termination of Pregnancy) Act 2018 is fully implemented and is performing as it should be to enable all women in Ireland to access services quickly and easily without bias or judgment. There has been a substantial reduction in the number of people with Irish resident addresses availing of termination of pregnancy services in the UK since the enactment of the Health (Regulation of Termination of Pregnancy) Act 2018 and the commencement of services. There is regular ongoing engagement between the Department of Health and the HSE to facilitate the operation of the service and to resolve any issues that may arise. We will continue to ensure the positive rolling out and enhancement of these healthcare services.

Four years ago, the Irish people voted decisively to change the Constitution and give the Legislature responsibility to regulate termination of pregnancy services. The people voted in the knowledge of the legislative proposals that would be progressed to deliver on this outcome. In line with the statutory and Government commitments, the Minister, Deputy Donnelly, has commenced this review of the operation of Act. The review will assess the effectiveness of the operation of the legislation and will be conducted in a fair and transparent manner.

The review is being led by an independent chair and comprises two main phases. As part of the first phase of the review, information and evidence on the operation of the Act is being collected from women who use the service and from health professionals who provide the service, along with the views of the public through a public consultation, which closed on 1 April. In the second phase of the review, the chair will assess the extent to which the objectives have and have not been achieved and will make recommendations to address any barriers identified. The chair is expected to conclude her report and provide a report to the Minister at the end of the year. This process will provide an important examination of how our termination services are operating and will give us a chance, where necessary, to identify improvements to the operation of the Act.

Holly Cairns (Cork South West, Social Democrats)
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The Minister of State has said that current legislation enables all women to access abortion services but it does not. There were 367 women who travelled to the UK that we know of but clearly there are many more, and they did not have access to that healthcare in Ireland. It is deeply disappointing and concerning that the Government is determined to review only the operation of the Act rather than providing the changes necessary to prevent further suffering. Could we honestly say we are happy with the fact that women and families who received the worst possible news are being forced to travel to another country for healthcare?

The review of the legislation is a missed opportunity to update our laws in line with best medical practice and the lived experience of families. Regrettably, the lack of action and resolve on this and related issues is clear. The Government has failed to bring forward promised legislation on safe access zones around GP surgeries and hospitals. Instead, the Together for Safety group has, in co-ordination with Senators, sought to progress a Bill where the Government has failed to do so.

There is also the larger context of maternal healthcare in Ireland. We are years, if not decades, away from a patient-centred system in which midwives have a leading role. We have shockingly low rates of home births in Ireland, with an institutional culture of forcing women into maternity hospitals. The Community Midwives Association and the Midwives Association of Ireland have called the HSE ban on water births "non-evidence based, unethical and inequitable". More than 3,000 women annually are hospitalised because of severe pregnancy sickness when a medication that could assist in many cases is unavailable on the drugs payment scheme or medical card. There is also a vastly disproportionate over-representation of ethnic minority women among maternal deaths in Ireland.

All of these matters are connected to how maternal and abortion healthcare are treated in Ireland. An unwillingness to provide the full range of abortion care needed by girls and women is the same unwillingness to provide the full range of properly resourced maternal healthcare. We need change.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy and I take on board everything she has said. I will bring back her comments to the Minister, Deputy Donnelly. The Deputy mentioned medication that might stop women being hospitalised because of sickness and I will bring it up again. My understanding is that it was to progress. I believe it is called Cariban and I will get the Deputy an update on its availability in the drugs scheme. We all believe it should be included.