Frank Feighan (Sligo-Leitrim, Fine Gael) | Oireachtas source

I thank Senators Pauline O'Reilly, Garvey and Martin, and the Minister of State, Senator Hackett, for tabling this important motion. I thank them for the opportunity to set out the commitment of the Government and my Department to expand access to free contraception to all women aged between 17 and 25 and, indeed, the commitment to promoting women's health more generally through the work of the women's health task force in the Department of Health.

Like Senator Martin, I am humbled and very thankful to attend this very reasoned, informed and welcome debate that included advocacy on behalf of women's groups. He rightly said that no one party has ownership of this issue. However, I would like to thank the Labour Party, as it has always been taken the lead on a very liberal agenda. In 1993, Deputy Brendan Howlin led the way in with the significant, landmark decision to legalise the sale of condoms. I agree that sometimes the Labour Party is not rewarded electorally. It has always led the way and brought parties, like my party of Fine Gael and many other parties, along a journey that we followed and I thank them.

I have listened to all of the individual contributions that were made with real passion and knowledge of the topic.I strongly agree with many of the points that have been well made by Senators.

Recent studies, such as that undertaken by the Dublin Well Woman Centre and the ERSI-HSE report, Talking about Sex and Sexual Behaviour among Young People in Ireland, have shown that some Irish women face real barriers in accessing contraception. Senators have reflected that research in this motion. It referred to rent, food, education and survival. Senators Garvey and O’Reilly outlined the challenges and barriers in rural areas, small villages and towns. It brought it home to me.

The results of this more recent research broadly reflect the findings of a working group report on access to contraception, published by the Department of Health in October 2019. This working group was established in April 2019, following recommendations from the Oireachtas Joint Committee on the Eighth Amendment of the Constitution. It was charged with considering the range of policy, regulatory and legislative arising issues in enhancing access to contraception. The group's high-level report provided a clear overview of the challenges associated with accessing contraception and outlined the potential for State intervention to address those barriers. The report highlighted the need for any new contraceptive scheme to provide women with the opportunity to choose the most effective and suitable type of contraception for them, based on their individual health and lifestyle needs and preferences.

As a result, there is rightly considerable focus on the existence of barriers to contraception. However, it is important to acknowledge that cost is only one such barrier. The working group report and the wider research literature show that local accessibility, embarrassment and lack of knowledge or information are also important factors that need to be considered. The interaction between contraceptive usage and cost is complex and should not be framed only in simple binary terms as to whether an individual can or cannot afford contraception. Rather, the question must also be whether cost factors may be influencing decision-making on the type of contraception used or how effectively or consistently a particular method of contraception is being used.

I say this not to dispute the points that were so well made earlier in this debate, but rather to caution against the view that simply making contraception free is enough to make contraception more widely available. We need to adopt an approach that targets all of the often interrelated barriers in a coherent and strategic manner to have the best impact on this problem. This is particularly the case if we are to encourage and enable the use of LARCs, which research has clearly shown can be the most effective form of contraception for many women. It is, therefore, essential that as well as rightly stepping up and tackling the cost issues, that we also ensure that services are readily accessible across the country, that policy initiatives are supported by educational and informational campaigns and that there is sufficient qualified capacity among healthcare professionals. A free contraceptive service is of little use if there is no local access to the service or if an individual is not informed about the different options that are available to them and about their potential benefits.

The Government's initial focus on those aged 17 to 25 is evidence of just such a strategic approach as we are prioritising that cohort of people who are most at risk for crisis pregnancy and are more likely to find cost a barrier to contraception. This does not mean that older age groups do not require supports. It is the Minister’s intention to consider an appropriate timeline for the roll-out of a universal State-funded contraceptive scheme, alongside the work that will be undertaken to develop and finalise the policy approach in respect of the 17 to 25 age group. However, further stakeholder consultation will be essential as we progress work in this area.

One of the strengths of the working group process was that it allowed an extensive public consultation process with more than 5,000 responses received, while also creating the opportunity for more extensive engagement with several key stakeholders, including both the Irish College of General Practitioners and the Irish Family Planning Association, IFPA, among others. There is a positive working relationship between State, voluntary and community groups working in the field of sexual health and well-being more generally. The Minister is looking forward to building on those relationships to help develop the best ways to improve access to contraception across the State.

I am sure Senators will join me in acknowledging and welcoming the fact that contraception use in Ireland is high and stable. It is important to recognise that Ireland is not an outlier in contraception policy. The European Contraception Atlas for 2019 ranked Ireland 12th of 46 countries with a rating of 65% for Government policies on access to contraceptive supplies, family planning counselling and the provision of online information on contraception. Senator Hoey mentioned she is in her 30s. I grew up in the early 1980s. It was a much different country back then. We have come a long way but we have much more to do.

This is not to say that there is not room for improvement. There is always space to do more but it indicates the measures and supports that we already have in place through the HSE's sexual health and crisis pregnancy programme, and through the sexual health strategy, are having a positive effect. It also proves that we have a strong foundation and solid base in place to go forward together and take that next step of widening access to contraceptive services as set out in the Fine Gael, Fianna Fáil and Green Party programme for Government commitments.

For instance, the national condom distribution scheme, which is administered by the health and well-being unit of the Department of Health and falls under my remit as Minister of State, was established to promote condom use among individuals and groups who may be at increased risk of negative sexual health outcomes. It freely distributed in excess of 730,000 condoms and almost 450,000 lubricant sachets in 2019. This scheme has been expanded to include third-level colleges with the roll-out of condom dispensary services to over 23 third-level colleges to increase the opportunities for younger people to make safer-sex choices. It is envisioned that this service will be further expanded in the future. Senator Clifford-Lee felt that this might not be enough. This service includes migrants, young people, gay, bisexual and other MSM, sex workers, those with addiction issues and those with HIV. Take-up of the service has doubled. Senator Clifford-Lee is correct that we need to do more in this respect. She also wanted this prioritised. I will bring that back to the Government. Choices around contraception can be expanded too.

Embarrassment and lack of information have been identified as important barriers to contraception. With this in mind, a key goal of the national sexual health strategy is to ensure that everyone receives not only a comprehensive, age-appropriate sexual health education but has access to equitable high-quality sexual health services and robust information. In this regard, Senators may be interested to note that in partnership with the Irish Pharmacy Union, the HSE launched Play it Safe in August, a major new information campaign encouraging young adults to consider their sexual health and well-being during the current pandemic.This campaign involves making sexual health protection packs available in pharmacies nationwide, offering valuable information and supports to young adults, who we know from public health data are most affected by crisis pregnancies and sexually transmitted infections.

Beyond these initiatives, which seek to address the issue of access to contraception within the wider framework of sexual health, we must not lose sight of the fact that those individuals who hold a medical card already have access to most types of contraception free of charge. Almost 125,000 people have availed of contraceptive drugs and special services through the general medical services, GMS, scheme in 2019, while others who hold a GP visit card are also supported by reducing the clinical cost element of contraception. At the same time, the Minister for Health is acutely aware that for those who fall slightly short of qualification for the medical card, cost can be a real barrier to accessing the preferred or most appropriate form of contraception. Again, this can be a particular issue in respect of LARCs, which have a high upfront cost.

Although contraception is not solely a woman's issue, the ability to decide whether and when to have children has a direct impact on the physical, psychological and social well-being of women. It is in this wider context of women's health that the Government wishes to further expand access to contraception, and I wish to take this opportunity to briefly highlight the work underway on this wider agenda. Budget 2021 provided for a dedicated €5 million for a women's health fund to progress a programme of actions arising from the work of the women's health task force, which was established to improve women's health outcomes and experiences of healthcare. This funding complements the additional investment delivered across women's health services as part of budget 2021, including the €12 million investment in delivering the national maternity strategy and improving gynaecology and fertility services, and the €10 million investment in screening services, including BreastCheck and CervicalCheck. In sum, there should be no doubt about the commitment of the Minister of Health and that of the Government as a whole to promote women's health and that includes providing access to free contraception for all women aged 17 to 25. Nonetheless, it must also be accepted that this is not a straightforward issue, and a sizable body of work needs to be addressed to develop and finalise the policy approach, bring forward the necessary legislative proposals and to finally ensure the implementation of service delivery arrangements.

Regrettably, as with most areas in my Department, work on this issue has been disrupted significantly by the need to prioritise the response to Covid-19. This was unavoidable due to the significant scale of the public health emergency we have faced, but it does not mean the issue of access to contraception has been forgotten. Indeed, as I have outlined, the opposite is the case. There has been considerable financial investment and a lot of valuable work undertaken to alleviate the barriers to contraception. The next step is to address the issue of cost on a wider scale. The Minister for Health recently met with the IFPA to discuss this particular issue and to help chart a path forward. I spoke to him briefly prior to this debate about this issue, and it is clear that he is looking forward to working with the IFPA and other stakeholders to deliver on the Government's commitment in this regard. As a result, the Government will not oppose the motion, and I thank the Senators and the Minister of State present for raising this very important issue and for the opportunity to reaffirm our commitment to the issue.

As Senator Higgins said, we must provide the most effective, long-acting contraception free of charge, and I note her point. We also must prioritise this issue in government and I have heard the message loud and clear. Senator Martin summed it up perfectly when he said that the debate was both informed and robust. I thank Senators for bringing many of the relevant issues to the floor of the House. I look forward to working with them in the coming weeks and months in prioritising this agenda.