Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I move: "That the Bill be now read a Second Time."

I am pleased to introduce the Health (Provision of Contraception Prescribing Service in Retail Pharmacy Businesses) Bill 2026 to the Dáil on behalf of the Minister, Jennifer Carroll MacNeill. The main purpose of the Bill is to make provision for the inclusion of retail pharmacy businesses as scheme providers and to provide a subset of contraception services referred to in section 67E of the Health Act 1970, the primary framework for the free contraception scheme. The Bill proposes to include pharmacists as prescribers of contraception in clearly defined clinical circumstances, in addition to their existing role in dispensing contraceptive medicines and devices. The plans for this were published in 2025, with an outline of the service fully agreed with our stakeholders in the pharmacy sector and included in the community pharmacy agreement. To enable pharmacy prescription, the Bill will amend the Health Act 1970, the Irish Medicines Board Act 1995 and the Pharmacy Act 2007 and will provide for related matters. The clinical basis for pharmacist prescribing is provided by the Health (Miscellaneous Provisions) Act 2024 and regulations made under it.

Clinical provisions for this service, like those that support the common conditions service, will be finalised by secondary legislation once this Bill is enacted. The Bill and the secondary legislation, training and clinical protocols that will follow it will support the terms and conditions for this service, as laid out in the community pharmacy agreement. All secondary legislation will be in place before commencement and launch of this measure.

The Bill will enable the prescription of certain forms of contraception, such as the pill, the patch and the ring, by pharmacists. However, as new contraceptive options come onto the market, there is some flexibility to include those also.

The Bill will make this service available under the free contraception scheme for people aged 17 to 35. It will also be available to private patients, with pharmacies setting their own fees locally. This option may be cheaper and more convenient than returning to the GP for every prescription for those private patients. Pharmacists already supply emergency contraception. Furthermore, we do not envisage that contraceptive devices such as coils or implants, which require minor procedures to insert and remove, would be suitable for pharmacy prescription.

At this point I would like to mention the national condom distribution scheme, which provides free condoms through a separate service. In line with introducing pharmacy prescription, we are also bringing the national condom distribution service into pharmacy consulting rooms on a phased basis. Efforts are also being made to make this service more accessible to GPs. Condoms are the only form of contraception that protects against HIV and STIs as well as unplanned pregnancy, so we aim to support everyone's health by making them more accessible.

The pharmacy service is a core part of our efforts to further support women's health services in the community, as laid out in our programme for Government and the national sexual health strategy. The report of the working group on contraception, published in 2019, was clear about the need to expand the range and capacity of services, as well as addressing cost barriers. This measure is a significant step in that direction, delivering convenience and savings in both time and costs for patients, taxpayers and the State. This service will increase capacity within primary care.

I also want to mention the GP training programmes that we have been supporting since 2022. This will enable more GPs and primary care centres to provide coils and implants, another measure that will add to capacity and contributes to the wider expansion of women's health that we have promised in the programme for Government.

The Minister and the Government have prioritised raising awareness and building treatment services for women who may be experiencing endometriosis; early detection and treatment are key elements of prevention and care. In addition to its primary function, hormonal contraception is an essential treatment for adverse symptoms associated with the menstrual cycle. Such symptoms range from heavy bleeding or period pain and mood disorders such as pre-menstrual syndrome and endometriosis. Despite periods being a normal biological process, our Healthy Ireland and health behaviour in school-aged children surveys tell us that 50% to 60% of women and girls miss school, college, work, social events or sport on occasion because of period symptoms. Endometriosis and similar conditions are at the more severe end of the scale and are estimated to affect 5% to 12% of women. Better access to hormonal contraception is part of the solution to this.

Yesterday we launched the women's health action plan in Tallaght Hospital and it was wonderful to visit the endometriosis hub there. It was great to meet the staff, and I was delighted to be there with the Minister, Jennifer Carroll MacNeill. We could see the progress. We can see those changes now start to happen, which is really good. It is making a wonderful contribution to women's health, and that is so important. This Bill is another key element in widening our support for women's health.

I will now take the House through the Bill to outline the content of each section. The Bill makes provision to enable registered pharmacists to issue prescriptions for certain contraceptive drugs, medicines, products and devices. For that purpose, and to provide for related matters, the Bill amends the Health Act 1970, the Irish Medicines Board Act 1995 and the Pharmacy Act 2007.

Section 1 amends the definition of "scheme provider", which was previously limited to medical practitioners for the provision of prescriptions. The Bill expands the definition to include retail pharmacy businesses entering into an agreement with the HSE for the provision of pharmacy prescription services to women. The service will be provided by a registered pharmacist in accordance with relevant pharmacy legislation, including this Bill.

Section 2 amends section 32(2)(1) of the Irish Medicines Board Act 1995, and section 3 amends section 11 of the Pharmacy Act 2007, to support the clinical service and associated training requirements. These amendments ensure that the scheme is clearly enabled and cross-referenced through a refreshed legislative framework.

Section 4 is the final section and provides the Short Title and provisions for commencement.

Sections 1 to 3, inclusive, along with the clinical SIs to be drafted subsequently, align the relevant Acts to accurately define the new service. These sections also provide for clinical protocols, rules, codes of conduct and training provision for pharmacists who wish to provide the new service.

To sum up, the Bill will improve access to hormonal contraception; widen the range of services that can be delivered in the convenience of a local pharmacy; improve patient choice and convenience; save money for private patients and, separately, for the State by reducing costs under the free contraception scheme; and provide essential additional capacity for additional women's health measures, as promised in our programme for Government, the national sexual health strategy and women's health action plans.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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This Bill, which is overdue, is a small step in the expansion of community pharmacy and women's healthcare services. Sinn Féin will support the Bill. It is a sensible measure that recognises the expertise of community pharmacists and reduces unnecessary barriers for women who need repeat prescriptions for contraception.

Community pharmacists are among the most accessible healthcare professionals in the country. They are embedded in each of our communities. They are trusted and are often more accessible than a GP. Allowing appropriately trained pharmacists to prescribe repeat contraception following the initial GP consultation will make life easier for women. It will reduce unnecessary GP appointments and ease pressure on primary care.

While this Bill is welcome, it also exposes limits that exist in the Government's ambition for women's healthcare. Time and again we see individual announcements presented as major reforms while broader inequalities remain untouched. The clearest example of this is the free contraception scheme itself. Today if you are 35 years of age you qualify. Tomorrow when you turn 36 you do not. Nothing has changed about your healthcare needs overnight, yet suddenly you are expected to pay the full cost yourself. To me that makes absolutely no sense. Women do not stop needing contraception because they have reached an arbitrary birthday. Nor is every form of contraception solely used to prevent pregnancy anymore. Many women continue to rely on contraception throughout their late 30s and into their 40s. Others use hormonal medication not only for contraception but to manage heavy menstrual bleeding, endometriosis, polycystic ovary syndrome and a range of other medical conditions, yet these women are excluded. Women experiencing perimenopause and menopause are in the same situation. In some situations, they are paying significant costs for hormone treatments that are essential to their health, their quality of life and, most importantly, that work for them and have been recommended by their doctor. Women's healthcare cannot continue to be designated around arbitrary age limits. It should be based on clinical need.

Research published earlier this year found that almost one in three women still experience barriers to accessing the free contraception scheme. Those barriers include eligibility restrictions, awareness, availability and access. This tells us that among some of those women who technically qualify, the system is still falling short. The Bill also provides the rest of the House an opportunity to ask a much bigger question of Government. Why do we continue to treat women's health as a collection of separate initiatives instead of building a comprehensive service? Women's health does not begin at 17 and it does not end at 35. It begins in adolescence. It continues through the reproductive years, pregnancy, postnatal care, potential fertility challenges, perimenopause, menopause and into older age. Yet, women are too often expected to navigate a fragmented system paying for consultation after consultation and moving between different professionals without a structured co-ordinated approach.

Sinn Féin believes there is a better way. We have proposed a structured women's health scheme delivered through primary care to bring together those GPs, pharmacists, practice nurses and allied health professionals in a co-ordinated model centred on women's needs throughout every stage of their lives. That would mean earlier intervention, better continuity of care, less duplication and ultimately better outcomes. It would also recognise what women have been saying for years. Our healthcare is not a niche issue. It is not an optional extra. It is not a specialist add-on. It is fundamental to our overall well-being and healthcare. While we support the legislation I challenge the Minister of State, the Minister, Deputy Carroll MacNeill, and the Government to go further and expand the free contraception scheme beyond the current age limits, ensure that hormone therapies are affordable and accessible to women who need them and embed women's health properly across primary and community care instead of relying on isolated initiatives. The women who fall outside of the current scheme, those aged over 35, those living with conditions that requiring hormone therapies, those navigating perimenopause and menopause and those who continue to face financial barriers deserve more than this small step, no matter how welcome it may be. They deserve a healthcare system that sees them and supports them throughout their life cycle and values them at each stage of all of them.

Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I welcome this legislation that progresses the free contraception available for those aged 17 to 35 and will allow pharmacists to prescribe contraceptive medicines and products. What annoys me is to see that the Government has said the pharmacies will set their fees locally. This is not good enough and this is not free contraception. There has to be something put in place to ensure that the contraceptive is actually free when somebody goes to the counter to purchase it. Pharmacists are entirely capable of providing enhanced care beyond that which they currently do. It is a positive step. Of course, when we ask more of our pharmacists it is incumbent upon them to ensure they are adequately supported, which is not happening at the moment and is not going to happen with this legislation. I hope that this measure does not become like the HRT and blister packs we have seen in the past. When the Minister fails to do the groundwork, the roll-out can be unnecessarily delayed.

A related issue is that the free contraceptive scheme is still limited to women aged 17 to 35. Did the Government forget about the women who can still get pregnant right into their menopausal years? It is a big failure that it did not recognise that and forgot the women from 35 to 50 years of age. Last August I described the pace at which it is being rolled out as woefully inadequate. That was in response to the Minister answering a parliamentary question I placed seeking information on the expansion of the scheme by alluding to pilot schemes and referencing the annual budget process. The scheme was first introduced in 2022 and limited to those aged between 17 and 32. The increase to 35 in 2024 was woefully inadequate. Now, in 2026 we are still in the same place. That suggests there is no political will.

I appeal to the Minister of State to make this a priority and let us dispense with the listless and lethargic pace we have seen to date. Women's health deserves to be embedded as a core service across pharmacy and community services. Not enough is being done for endometriosis. The Minister of State suggests that the pill is the solution; it is definitely not the solution. Endometriosis is a life-changing diagnosis and more needs to be done. Women with endometriosis are forced to go abroad. Ireland is nowhere near the point of providing vital care for women with endometriosis. The suggestion that free contraception is enough is a complete failure of this Government and I ask the Minister of State to rethink this and do more for women.

Sinéad Gibney (Dublin Rathdown, Social Democrats)
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I will make a few key points. While we welcome this Bill, we believe that oral contraceptives should be available prescription free. The action plan does not have enough solid commitments when it comes to contraception, and essentially the barriers still exist and exclusion from the scheme is still an issue for some women. The Social Democrats welcome this Bill, which provides for pharmacists to re-prescribe certain contraceptives. However, we stand firm in the belief that oral contraceptives should be available prescription free. They are some of the safest and most thoroughly researched medications available and we must listen to the World Health Organization, to the Irish Pharmacy Union and to our own Oireachtas health committee, which have all now recommended that they be available over the counter. We understand that some medicines should only be available by prescription but there is no clinical reason for this to be the case for oral contraceptives. They are safe. They have been thoroughly studied and they are effective. The biggest issue with contraception is access. An additional hurdle of having to go to their GP means that some women simply cannot or will not access oral contraceptives, despite their wants or needs. This Bill is a welcome step to widening access, but we must think much bigger if we truly want contraception to be easily and freely available to all who need it.

I also welcome the publication of the third women's health action plan yesterday, but I am concerned we are seeing a repackaging of previous announcements and little detail on the timelines or funding commitments attached to measures. We need commitment from Government that the age expansion of the free contraception scheme will happen in the lifetime of this plan. Furthermore, we need to see solid commitments on inclusive and women-centred healthcare to ensure everyone can access medications and care that meet their needs and that we are resourcing practitioners to provide that care. It is welcome that the Government has stated its intention to expand the age range for the free contraception scheme, but we need to know when that will happen. Women are delaying access to contraceptive care right now because they are anticipating being included in a public scheme. They are avoiding availing of long-term contraceptives because of high costs to get them privately and mixed messages about when they will be able to receive that care publicly.

People cannot make informed decisions about their care if they are left without a clear answer as to when the scheme will be rolled out to other age groups. Caithfidh an córas athrú más mian linn freastal ar gach bean a dhéanann an rogha frithghiniúint a úsáid. Má tá baic rompu sa chóras atá againn, caithfear dul i ngleic leo.

Barriers to accessing contraception remain and they are primarily shame, stigma and confidentiality. For many people, having to go to their GP and then to the pharmacy creates an insurmountable barrier. For those who lack access to transport, who live at home or who live in situations of coercive control, having to go to the GP triggers a world of questions in their lives that severely impact their right to privacy and their right to access this medication. This is doubly felt in rural areas. National Women's Council research indicated that those in cities, towns and villages were between 35% and 41% likely to use the free contraception scheme while the figure was only 26% in the countryside. The same research found rural women faced extra barriers around fear of judgment, stigma, lack of confidentiality and travel. This gap needs to be addressed. We know pharmacy prescribing and over-the-counter access is key to that.

Undocumented women, asylum seekers and those in the international protection system are still excluded, despite being among the most socioeconomically disadvantaged groups and much less likely to be able to afford contraception. The current age limitation also leaves many women out despite the fact that just because you are a certain age does not mean you want to have children. Every reduction in barriers to contraception is welcome, particularly in a country that not long ago banned it completely, but we have a long way to go to ensure everyone has access.

Jen Cummins (Dublin South Central, Social Democrats)
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I read with interest of this item on contraception. I cannot help noticing it is happening on the day the decision on Bessborough has been made. Considering the whole mother and baby scenario that happened in this country and the devastation faced by so many people born in Bessborough or who had children in Bessborough and do not know where their children are, it is poignant to have this conversation today.

It is fantastic that women aged 17 to 35 can get free contraception. That is excellent but I agree with those who have said it should be extended to whenever child-bearing age ends. If it is 40 for me or 50 for you - whatever it is - that is what it should be. It should be based on the individual.

I agree with the previous speaker that it is very disappointing to learn migrant women are not included in this. A vulnerable cohort of people come here to seek protection and to be helped. They are in a vulnerable situation with regard to contraception. I am sure it would not cost that much money to include them in the scheme, so I call for that to happen.

I read in a report there is low awareness among women with disabilities and Traveller women. Why is that? We need things to be accessible to people. We need the message to be out there among disabled people that this is available to them if they are in that age group.

I was concerned that condoms are not included. Many other things are included, which is fantastic, but condoms are often used. They are quick and easy, etc. I know from being around third level institutions that you can get them there but not everyone goes to third level institutions and they might not be in a youth service. I know if you go to the HSE sexual health clinic, you can get them there. That should be brought in. Condoms are priced around €5 or €6 for a packet of three - I did a quick search before I came in here. That is a lot if you are a student or are on a low income. If we include other things, we should include condoms as well.

It is important to expand the scheme to as many women and people who need it as possible.

Jennifer Whitmore (Wicklow, Social Democrats)
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I welcome the Bill. It is great to see progress in the area but an opportunity was missed to make the scheme accessible to everyone. Similar to my colleagues, one of the main issues I have is the age scope of the Bill. I am glad the national women's health action plan includes a commitment to expanding the age scope but this needs to be a firm commitment and it needs to happen sooner rather than later. We need free contraceptives to be offered to women of all ages.

The National Women's Council of Ireland undertook a survey of 500 women that was published this year. It found one in three still faces barriers to accessing the free contraceptive scheme - women in the Traveller community, women from migrant communities, women with disabilities. Reproductive health and contraception should be accessible to all; there should not be any barriers, particularly for women from marginalised or vulnerable communities. I hope the Minister of State, Deputy Collins, will continue to review the scheme to ensure that happens.

I want to talk more broadly about women's health. There is a huge problem with women's health, not just in Ireland but globally. There is insufficient funding, research and trust. It is not given the attention it needs. We are seeing some progress in women's health getting more attention but there is much more of a journey to go on that. Women are left suffering from invisible illnesses for years without diagnosis, treatment or even being believed.

The best example of that is endometriosis. My inbox was flooded in the past couple of weeks with people suffering from endometriosis or adenomyosis, which I was not aware of but which is a similar and equally debilitating condition. Symptoms are being dismissed, treatment is inaccessible and life is being made unliveable. Roughly one in ten women in Ireland has endometriosis. Many of these women struggle to be seen and just to be diagnosed. Often, their disorder is dismissed as simply period pains. A study a few years ago found it takes a woman an average of nine years to be diagnosed with endometriosis in Ireland. That is nine years of not being believed, of being in pain and of essentially putting life on hold. These are often young women. It is really not acceptable. It is a horrific disorder and it has a huge impact on those living with it. It can take their independence, leave them with limited mobility and bind them to their homes. They miss out on work, on family events and, really, on life itself. It is a gruelling disorder and we need to start giving it the attention and funding it deserves and calls for. We cannot continue to fail women when it comes to women's health matters. I ask that the Government put a large focus on treatment of those conditions.

Marie Sherlock (Dublin Central, Labour)
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We welcome this Bill. The free contraception scheme launched in 2022 was ground-breaking at the time but access to it has been an issue. In that regard, it is most welcome that prescription rights have been extended to pharmacists by this legislation. The other critical thing is that for all those women not eligible for the free contraception scheme - and I will talk about that in a minute - it will lower the cost of renewing their prescription. I think we are all in agreement that when there is no medical need to attend a GP, it makes eminent sense to allow pharmacists operate to the top of their licence and to devolve greater care to them in the community. We welcome that.

There are cost barriers and geographical barriers, particularly for women in rural areas, to accessing their GP. An issue I have raised many times in this House is access to GPs in socially disadvantaged or fast-growing areas, where we know there is a lack of access or a long wait to access GPs. Empowering pharmacists to renew prescriptions is most welcome.

When the scheme was introduced, it was for 17-to-25-year-olds and then it was extended to women up to their 36th year.

The time has now come to extend the age range. We know the cost of extending it from 36- to 40-year-olds is just €5 million. It is not a big amount of money in the overall health budget but it would have a fundamental impact on women of this age. We know there are women well into their 40s who need access to contraception. We believe changing the age limit from 36 to 40, at a minimum, should happen now. As I said, it would be at not much cost.

The other key issue is access. We spent a bit of time during the week talking to the National Women's Council. The research it has conducted is very interesting, whereby 36% of survey participants spoke about very real barriers, particularly for those do not have a PPS number, which is a requirement to access the scheme. There is an issue with regard to women in IPAS centres who do not have a PPS number. There is also an issue with regard to cultural prejudices, particularly assumptions by some healthcare providers that disabled women or LGBTQ+ women do not need contraception. We need to send out the very clear message that this should not be the case. I have already mentioned the geographical barriers.

We need to look at the measures that can be taken to ensure greater access to this very important scheme and in this regard we will bring forward amendments when this comes before the Dáil next week. We believe the Bill is very positive but it is timely to look at expanding the scheme to women aged up to 40 years. We also need to look at the age of access. We know the medical age of consent in this country is 16 but the age of access to the scheme is 17. We need to standardise this imbalance and ensure the age of access is 16. We also need to deal with the very specific barriers for women in IPAS centres and undocumented migrants who do not have a PPS number but very much should be able to access the scheme like every other woman in the country. I welcome the Bill but we need to do more to ensure it reaches all of the women in the country it should reach.

Brian Stanley (Laois, Independent)
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I welcome the opportunity to speak on the Bill. It is a step in the right direction by improving access to contraception through pharmacies. I believe the proposed legislation will be another step forward for women's health, their control over their fertility and improving reproductive rights. It will add another building block to enhancing and developing a proper primary care system, which we are all supposed to be working towards in Sláintecare, but it is of course is limited.

The Bill will bring some benefit for women who have endometriosis and use contraception for this purpose, women in lower income groups and women in rural areas who may not have a medical card or access. To be able to obtain certain contraceptives directly through a local pharmacy will be a particular benefit in rural counties such as Laois and in rural localities where there are no family planning clinics. Crucially, this will take some of the excessive workload from GPs. We know it is becoming increasingly difficult to access a GP, and I have highlighted here many times the difficulties in County Laois. This scheme means contraception methods appropriate for safe administration by pharmacists, who are highly qualified to do so, will be administered in pharmacies and it is good day when we are doing it. Pharmacies open late in the evening and at weekends when GP surgeries are understandably closed. GP surgeries operate from 9 a.m. to 5 p.m. although some of them open in the evenings now. Pharmacies have longer opening hours and they are open on Saturdays. Some of them open on Sundays. This will improve access.

At present, women aged from 17 to 35 can get free contraception but I would like to see this being extended upwards to at least 40 years or possibly to the age of 45. Many couples are now leaving it longer to have children due to economic necessity. This is a story in itself. We talk a lot about reproductive rights for women and couples but, unfortunately, a lot of people, for reasons of housing, access to housing and economic necessity, delay having children longer than they would like to. This is an area we will come back to on another day. Will the Minister look at the benefits of moving the age upwards to at least 40 years? The Minister did say, or was certainly reported as saying a few months ago, that it was not on her priority list. It should be on the priority list because women are having children into their early 40s. If the scheme could be extended to the age of 40 it would be a big improvement, but I would like to see it going further than that.

A survey carried out four months ago by Trinity College found that the age limit was the most often cited barrier for women who want to access the scheme. One in three women face barriers accessing the free contraception scheme. It is good that two out of three are able to have it but one out of three is not and we must revisit this. I ask the Minister of State to take away this message.

While I am speaking on the issue, I want to mention BreastCheck, which has brought huge benefits in terms of early detection and has saved many lives. It has been a huge step forward in recent years but it needs to be extended further and I ask that the Minister considers this. Women aged between 50 and 69 can avail of it but several women have asked me to make the case for lowering eligibility from the age of 50 down to the age of 40 or 45. It would not break the bank to do so. I am raising this as serious issue because breast cancer is a huge issue in this country, as is ovarian cancer which I believe is harder to detect. BreastCheck has really been one of those game-changers and it would be a very positive health measure if we could lower the age at which women are eligible for BreastCheck.

The Bill is a step forward and I would like to see it going further. I would like to see the age of eligibility increasing to at least 40, which would only cost €5 million to €6 million as I understand it. It would be a huge change if we did this in the Bill and there is a budget coming up. I ask the Government to seriously consider this, along with lowering the age of eligibility for BreastCheck. I understand that both have a cost but it is not hundreds of millions of euro and is a relatively small figure. I hope this will be given serious consideration by the Government. It would save lives, improve women's health and save money.

Niall Collins (Limerick County, Fianna Fail)
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I thank all of the Members of the House for their contributions to the debate and I look forward to their support for the Bill as it is considered further on Committee Stage. All of the points raised by the various speakers will, of course, be considered in due course.

It is wonderful to have the potential to deliver a scheme that promises to widen the scope of what community pharmacies can deliver, add convenience for many patients and deliver cost savings. We also hope the scheme, along with the common conditions service, will pave the way for wider development of pharmacy services in the years to come. Given our growing and ageing population, continually delivering additional capacity is a key challenge that we, as a Government, are determined to meet. Our population has risen by more than 800,000 people since 2015, many of whom are in the key 17 to 55 age range most in need of reproductive healthcare. New schemes such as this will help us to meet demographic demand.

The Minister is determined to continue with her significant progress on supporting wider women's health in recent years. Since 2020, we have invested over €180 million in women's health; opened six specialist menopause clinics and a network of 18 see-and-treat ambulatory gynaecology clinics; opened regional and two supraregional endometriosis hubs and launched a national endometriosis framework; launched and expanded the free contraception scheme; launched the free HRT arrangement; launched a State-funded assisted human reproduction treatment scheme; provided period dignity grant schemes to support community measures; and delivered nine postnatal hubs and perinatal mental health teams in all maternity hospitals and units.

The Minister was honoured to launch phase 3 of the women's health action plan yesterday in Tallaght hospital. Our new plan includes commitments to broaden delivery of our existing women’s health supports, while deepening our research base, enhancing prevention and social inclusion, and, of course, prioritising care for more serious conditions, including endometriosis. It also includes further expansion of the free contraception scheme and its integration into wider sexual and reproductive health supports is a key element of the third action plan, and this Bill is a key part of its delivery. The Minister looks forward to further debate on Committee Stage and, ultimately, to enacting this very important legislation.