Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael) | Oireachtas source

I thank the ladies of the House so much for the invitation to speak on women's health, with International Women's Day this coming Saturday. It is wonderful. I also congratulate and thank Senator McDowell for coming into the Chamber. It was well commented on by the ladies present that there were quite a lot of men in the Chamber for the previous debate. There was not quite a stampede to the door but, my goodness, quite a rush to the door. It is wonderful to speak, yet again, with women, about women's health and women's issues in international women's week and women's health week. Senator McDowell is gloried among women. I thank him for being here.

It is sort of pointless to have to make these remarks continually but there we are. As a female Minister for Health and Member of the Oireachtas, I am more than ever struck and wonder why these weeks should be necessary. I really do have a sort of cranky difficulty with the continuous focus on women being different or having to be different - women for election, women in finance when I was in the Department of Finance, women's health - as though women are not half the population. I am the only female representative for the Dún Laoghaire constituency, not just in this Dáil but in the previous Dáil. For some reason, women have to go out of their way to highlight the different issues that have led to so many inequalities. Health is one of those. Perhaps just let us focus on a health service for everybody, recognising the basic dignity, human rights and respect that every person, male or female, deserves in the health system and right across the rest of society.

I would like to highlight, though, that some issues impact women more than men. One of those is maternity, naturally. I would like to highlight in particular, recognising that this is women's health week, that the maternity system's impact on women is very considerable. I want to recognise the women who have had difficult experiences in Portiuncula and Ballinasloe hospitals, where I have travelled twice in the past number of weeks to meet and sit with those women and spend time with them, whose babies' births and, in some cases, whose babies' deaths are the subject of review. The reason I highlight it is that time and time again in maternity services, there seems to be a systemic difficulty in actually listening to the voices of women, including heavily pregnant women in maternity units. That is not unique to this situation but across maternity hospitals and units. No matter what report I read into lack of care or adverse incidences, including the most recent report of the working group on medical negligence costs, I read about women highlighting that they did not feel they were listened to and how often that impacts on their care.

That is not just in the case of maternity issues. This morning I opened a women's health initiative in cardiovascular care, where it is not that women are not listened to, but because their symptoms present more subtly and in a more nuanced way, they are often not recognised or understood as a cardiovascular issue. The women's health fund in my Department has provided significant funding to address three specific projects between St. Vincent's, St. Michael's in Dún Laoghaire and UCD, to try to shine a light not just on the operation of bias in some of the diagnostics but also the tracking of particular risk factors in gestational diabetes and other markers in the maternity system that may lead to cardiovascular difficulties. There is so much to do in recognising that women may present differently. That is not a question of bias but simply different symptomatic presentation. Women have to be listened to, understood and respected in the most basic way. It seems ridiculous to have to say this out loud but nevertheless, women's experiences and symptoms can be different from men's. These wrong diagnoses and inadequate treatments lead to poorer results. It is a systemic issue that we have to recognise. I welcome Senator Clonan and the other Senator. I am sorry; I do not know his name. I am delighted to see them and thank them for coming to women's health week. Inequalities in health mirror inequalities that women face in other areas of life. I do not just want to focus on inequalities in women's health in Ireland. Next week I will attend the United Nations Commission on the Status of Women. I recognise the considerably greater difficulties that many women around the world are facing in terms of health inequalities more broadly. It is always important to recognise our own reasonably privileged, favourable position vis-à-vis many other women, and some of the intersectional issues that women in Ireland face in terms of their health.

A week like this, unnecessary as it should be, nevertheless enables all of us to shine a particular light on issues that were previously shrouded in some silence. In the past, we only heard something like menopause being mentioned in whispers. Thankfully, the silence around that, periods and endometriosis has begun to lift. That public conversation becoming louder has, thankfully, driven service delivery at a better level, although there is much to do. That work has been enabled through the women's health task force. I thank each member of the task force for their work, which, driven by the demands of women, has provided the foundation for the women's health action plans. Good progress has been made. I pay tribute to my predecessor, Stephen Donnelly, who drove much of that work with the women's health task force. It is a starting point, however. There is an awful lot to do. I am excited to work with all of the Senators to find the particular areas where we can do considerably better.

Let us recognise some progress. The State has invested an additional €180 million in women's health since 2020. That dedicated initiative has resulted in the beginning of new initiatives across the country, often the first of their kind. For example, there is the free contraception programme for women aged 17 to 35. There is much better investment in screening services and a commitment in the programme for Government to go further with that, based on clinical advice, not politicians' thoughts. We have expanded termination of pregnancy services. I think we are at 18 out of 19 maternity units now, and soon to be at 19. I will have an update for the House on that in a number of weeks. We have established a growing network of see-and-treat gynaecology clinics, which are working quite well. We have developed public services for fertility and, for the first time, limited funding for IVF for people whose fertility issues cannot be managed at primary or secondary care level. We recognise that these are many good starts, and there may be more to do and a need to examine how we might get better value, better outcomes or spread that particular fund in a more effective way. This year, we will see further work on the establishment of the Assisted Human Reproduction Authority, with the enactment of the amendment Bill and the establishment of the authority two key elements that will enable expanded eligibility for AHR. We are getting closer to the opening of the first public AHR centre in Cork.

We have established hubs for the treatment of endometriosis. Most endometriosis cases can be managed perfectly well with within a GP or primary care setting, but there is a need for complex intervention and complex services. We have hubs that have now treated about 1,100 of the more complex cases but there is quite a bit more to do in that area and to recognise the impact it has on people's lives.

Similarly, we started to meet women's long-overdue right to treatment for the management of menopause. While much of that can be done at primary care level and we have been working with GPs to improve awareness and training, we have also established six specialist clinics for the treatment of more complex cases. I appreciate that these clinics run at limited capacity but they are an example of a start and where we would like to go further with them.

As we continue to implement the national maternity strategy, we will open eight new postnatal hubs to improve the care provided to new mothers and their babies. I do not know if any of the Senators have spoken to new mothers who have had the opportunity to experience these postnatal hubs but the feedback I am getting is they have been quite positive and constructive. I am interested in Senators' feedback. The hubs have proven a good support to women with breastfeeding, physiotherapy and other emotional and physical supports for up to 14 days post birth, which is a very delicate time. There are four additional see and treat gynaecological clinics being put in place to complete the national network of 21 clinics for the fast and efficient management of gynaecological conditions. Those clinics have had a big impact on waiting times for those procedures. We are also working to improve breastfeeding rates, recruiting additional lactation consultants to support women on their breastfeeding journey and developing a new national breastfeeding strategy. All of that works while we continue to progress the tender process for the new national maternity hospital.

We are working hard to get to a place where everyone has access to quality tailored care that provides treatment and research appropriate to our physiology. Through the women's health action plan, my Department is also investing in such research that will expand the evidence base for women's health and lead to better healthcare. I mentioned this morning the cardiovascular project in Dún Laoghaire, which is an example.

Despite this focus on the women's health action plan, some voices are still not being heard quite loudly enough. Some groups are still left behind. We are trying to produce programmes that will target women who might for different reasons be harder to reach. For example, we have introduced a pilot programme to support Ireland's effort to eliminate cervical cancer by improving the HPV vaccination rate, not just among girls, but also boys, and in every community, including some healthcare underserved communities that may include Traveller, Roma and certain migrant groups living in Ireland. We have also supported a project to raise awareness among women and girls of the signs and symptoms of common types of cancer in different communities across Ireland. We continue to build on initiatives such as the provision of free period products, providing free tampons and pads women in every community and placing them in the bathrooms of public buildings. It might seem like a small step but it is a recognition that it is a natural part of life and that some women may be financially disadvantaged.

I would like to see a period where we do not have to have these weeks or specific task forces and women are just part of the national conversation in a completely normal way. I recognise that that is not yet so. On the other hand, women are living longer than men at 84 years compared to about 80 years. Nevertheless, our health outcomes in cardiovascular care and osteoporosis care are worse, and certain cancers are more prevalent among women. One would think lung cancer would operate equally between men and women but women get it much more often. There are certain outcomes, because of women's sex, that are more difficult. It is important that, while we shine a light on women's health action plans generally and the work to support women in their healthcare across the board, we make sure there are appropriate responses for the physiological differences in women, serious research is directed at improving women's health outcomes and we get to a point where women's health is treated as naturally as all health and there is no real differentiation. I welcome Senators' contributions.