Pauline O'Reilly (Green Party) | Oireachtas source

I move:

“That Seanad Eireann:

acknowledges that:

- our nation has taken a significant step forward by repealing the Eighth Amendment to Bunreacht na hÉireann, thereby enabling people in this State to access abortion care;

- the Programme for Government commits to the rolling out on a phased basis of free contraceptive care, commencing with women and girls aged between 17 and 25;

notes that:

- a key recommendation of the Report of the Joint Committee on the Eighth Amendment of the Constitution is that free contraception be rolled out in Ireland. In its final report, the Report of the Joint Committee on the Eighth Amendment of the Constitution recommended ‘the introduction of a scheme for the provision of the most effective method of contraception, free of charge and having regard to personal circumstances, to all people who wish to avail of them within the State’;

recalls that:

- the Joint Committee on the Eighth Amendment of the Constitution heard evidence of a survey of women who had contacted an online abortion provider before access to abortion was made available in Ireland; the survey found that 44 per cent had not used contraceptives, while a worrying 56 per cent used a form of contraception that failed;

- this finding has now been further supported by a recent report from the Dublin Well Woman Centre which demonstrated that 51 per cent of women aged 17 to 45 have had sexual intercourse without using contraception;

- while contraceptives are free under the medical card the Joint Oireachtas Committee on the Eighth Amendment of the Constitution reported that for those who fell slightly short of qualification for the medical card the costs were prohibitive;

- 18 per cent of those surveyed by the Central Statistics Office in 2010 reported that the cost of contraception is an issue;

- the Irish Contraception and Crisis Pregnancy Study (2010) found that 11 per cent of study participants reported difficulties with access to contraception;

- the Growing Up in Ireland study (Child Cohort 2016), reported that at age 17 to 18, those from more socially disadvantaged backgrounds were less likely to report using contraception (73 per cent), compared to those from more advantaged families (83 per cent), demonstrating a clear cost barrier;

- the Report of the Working Group on Access to Contraception noted that in formulating policy on contraception a number of factors which are not related to cost benefit should be taken into account: - health;

- policy context following the enactment of the Health (Regulation of Termination of Pregnancy) Act 2018;

- women’s rights; - the Report of the Joint Committee on the Eighth Amendment of the Constitution found that Irish women availing of abortion services in the United Kingdom did not benefit from post-abortion contraceptive services, which were standard to women in the United Kingdom;

- the introduction of State-funded abortion services in January 2019 did not include the provision of post-abortion contraceptive methods free of charge and the majority of women continue to pay out of pocket for contraception;

- the costs associated with the provision of free access to contraceptives are low; for 17 to 24 year olds the cost is €18-22 million per annum according to the Working Group on Access to Contraception;

believes that:

- if we are truly a progressive country, we must expand care to all of those who do not wish to become pregnant, as well as supports for those who do, and to all children in the State;

- access to contraception is a matter not only of public health but of women’s rights;

- access to contraception is also a matter of human rights;

- contraceptives have the benefit of enabling individuals to plan the number and spacing of any children they choose to have, reducing unplanned pregnancies, and sexually transmitted diseases, increasing the uptake of smear tests, and helping in the management of menstrual health conditions;

- cost is a barrier to contraceptive use in Ireland, as laid out by the research;

- not every contraceptive suits every person and, in order to ensure choice, all methods of contraception should be available freely;

- the inclusion of stakeholder engagement in the development of any scheme for access to contraceptives is essential to the success of the initiative;

notes that:

- the Irish Council for General Practitioners advocates for free and universal access to contraception as a matter of priority for public health;

- the National Women’s Council supports access to free contraception for overall reproductive health;

- the Irish Family Planning Association in advocating for a universal State-funded contraceptive scheme points to the importance of the removal of all barriers, including cost, lack of local access to contraceptive services and poor access to information;

calls on the Government:

- to implement the Programme for Government commitment to roll out free access to contraception to women and girls aged 17 to 25, as a matter of priority;

- to set out a timeline for the development of a scheme for universal free contraception in the lifetime of this Government, in consultation with stakeholders.”

Given the history of the State with regard to women, women are now owed proper healthcare and I am asking that we take the next step today. A huge leap forward was made when we, as a nation, repealed the eighth amendment of the Constitution but if we are truly a progressive country it is time to deal with other aspects of reproductive care and care for children.

I note more announcements today from the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman, on additional supports with regard to childcare, which are incredibly welcome and go to the heart of this motion, but we are also looking for supports for those who do not wish to become pregnant.

The history of this issue is that in 2016 we had a Citizens’ Assembly and it found that reproductive healthcare included a right to free access to contraceptives. In 2017, in its final report, the Joint Committee on the Eighth Amendment of the Constitution recommended the introduction of a scheme for the provision of the most effective method of contraception, free of charge, and having regard to the personal circumstances of all people who wish to avail of it within the State.

In 2018, the then Minister for Health, Deputy Simon Harris, committed to the introduction of universal free contraception and commissioned the Working Group on Access to Contraception.

In 2020, in our programme for Government, Our Shared Future, we committed to, and we, the Green Party, pushed for, the provision of free contraception over a phased period starting with women aged 17 to 25. I commend many of those Senators, particularly women Senators, who have raised this issue since we took our seats in this House. In particular, Senator Clifford-Lee, who I hope will speak in the debate, has raised it with the Minister. What we are looking for is movement on that commitment and on outlining what will now be this phased universal healthcare.

When we talk about free contraception we are talking about it in a number of different contexts. One of those is the one many people will know, that is, with regard to crisis pregnancies. We know that greater use of contraception lowers the rate of termination. That was a frequent point of discussion in the deliberations of both the working group and also the Joint Committee on the Eighth Amendment of the Constitution. France, Italy, Turkey and Portugal have reduced their termination rates by introducing post-abortion free contraceptives. We did not introduce such a measure and now is the opportunity to do that. As a Government, we have committed to that so I ask the Minister to outline his thoughts on that issue.

Crisis pregnancies happen for a number of reasons. One of those is that people are not using contraceptives, which I will address shortly. Another is because people do not have access to contraceptives. A further reason is that people may not feel that they are able to ask for contraceptives. I am thinking of one group in particular, that is, women in situations of domestic abuse, who may not have ready access to the financial provisions to be able to pay for them. In their deliberations on that matter, the members of the working group discussed the fact that the medical card provides access to free contraceptives but despite that, 18% of people said the cost was a barrier.

I spoke to the president of the Union of Students in Ireland today, Lorna Fitzgerald, who told me that there are free healthcare facilities on campus which provide prescriptions free of charge and that the only thing they do not provide free of charge is contraceptives. As a country we have to ask ourselves what the reason is for that. Is that because of our history and the way we have treated women, particularly the topic of sex and menstrual health, through the decades and indeed the centuries?

That brings me to the point of cost as a barrier. In that particular instance it may be that young people do not want to go home and ask their parents for money for reproductive healthcare of any form. Many people in this country do not want to talk about it with anyone, even their partners, but it is also true to say that cost is a barrier.I was on a Newstalk programme this morning and was challenged on that. The accusation put to me was why should everybody else have to pay for the contraceptives of another person. We know that over time it reduces the cost to the State. We are providing free abortion care so why would we not provide this service as well? In addition, with respect to the facts, A Growing Up in Ireland study from 2016 showed that 17 and 18-year-olds from a lower socioeconomic background reported using contraceptives less than those from a higher socioeconomic background. Clearly, cost is a barrier and we need to address that as a State if we are serous about the well-being of our citizens. It is simply not good enough to say "Just go out and buy it yourself".

Sometimes people say using a condom is very cheap. The roll-out of the national condom distribution service last year is to be commended. However, that is not always the best form of contraception. The pill is not always the best form of contraception. One could pay €300 upfront for some forms of contraceptives but they may be the ones that are the best in the circumstances for the particular women and it is usually women when we talking about that chunk of money. The Irish Family Planning Association has told me that it is incredibly difficult in that a woman may have had abortion care, which is free, and following that be given advice on what is the best contraceptive for her. Even though she may chose a form of contraception she may not want, either because she is prioritising other people within her family or does not have money, she does not want to spend €300 up-front. However, over the lifetime of that contraceptive choice it is a cheaper form of contraceptive. For us as a State, it is not a huge outlay. A spend of €300 over the lifetime of that form of contraception which could be ten years is not a huge outlay. Women often prioritise school books for their children, rent and putting food on the table over the purchase of contraception. They may not be eligible for a medical card but that still does not mean that cost is not a barrier to them. This is a human rights and a women’s rights issue but it is also a right for everyone, male, female and those of all genders. That is why I ask the Minister of State to lay out a plan for free contraceptive care for everyone.

Regarding women who reported they had used abortion care in the UK before we repealed the eighth amendment, the women with whom they had sat side by side in those clinics received free contraceptive care following their abortion. That reduced the chance they would have to come for a future termination or abortion but Irish women were not receiving that. One would expect that when we rolled out termination or abortion services we would also roll out that contraceptive care following it.

In referencing a form of contraception that may cost €300, not every contraception suits every person. That may be due to the different stages of life they are at or the cost involved. However, research shows that 44% of those who were using online abortion providers said they had not used contraceptives and 56% said they had used a form of contraception that had failed. What is behind those figures is the fact that people intend to use contraception, be it condoms or taking the pill every day, but that is not always the reality of people’s lives. Longer term contraceptive use can work better in those circumstances.

If we are providing free contraceptives we must consider providing all the care that is associated with that to help people to make the best choices. That comes down to education and also the education of the healthcare providers. A problem that has been identified to me is that it is not happening at the moment. General practitioners are not getting the access to education they need to be able to advise people on the best form of contraception. When the Department is coming up with a plan, I would like it to consider using the type of implementation group for contraceptive care that was used for abortion care and that it would be a bottom up approach involving engaging with the stakeholders. For example, what do GPs need in order to be able to provide this care? What do women accessing the service need to have to be able to access this care?

Education is also a key factor for people in society generally. I have said to the Minister for Education, Deputy Foley, previously and I reiterate it here that we need free contraception and when considering reproductive rights, there are three elements, that is, abortion care, free contraceptives and education. From speaking to those in third level institutions, I know they are trying their best with respect to the concept of consent, but we cannot have people arriving in an institution at the age of 17 or 18 not having received the proper education they need to have received in primary and second school. As a State, it is time to fess up and, essentially, provide proper sex education instead of the antiquated religious indoctrination type of approach we have had in the past. The ONE Study from the National University of Ireland, Galway, NUIG, earlier this year found one incident where a boy in secondary school was told the best form of contraception was going by a woman’s cycle. That person will go on to lead a sexual life when he goes to university or starts to work with no proper understanding of the contraceptive choices available. Let us also address that issue.

Honestly, we are a progressive country. It is extremely welcome that we have this commitment in the programme for Government. I thank the Minister of State for coming to the House today. Great work was done by many non-governmental organisations and ordinary people in repealing the eighth amendment. Let us now get that last barrier lifted. I ask everybody to support this motion and thank them for the time they have taken to consider it. I ask my colleague, Senator Garvey, to second the motion.