John O'Mahony (Fine Gael)
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I welcome the Minister of State, Deputy John Paul Phelan.

Niall Ó Donnghaile (Sinn Fein)
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Cuirim fearadh na fáilte roimh an Aire Stáit. Gabhaim buíochas leis as ucht a chuid ama a thabhairt don cheist thábhachtach seo. The Minister of State is very welcome.

This straightforward Commencement matter does exactly what it says on the tin. I am looking for an update on the Government's plans for the proposed referendum to extend the franchise in presidential elections to citizens living outside the State, including the North. We hope a referendum on presidential voting rights will take place in 2019. It is important to note the work of Senator Billy Lawless on behalf of the diaspora community. There is growing consensus on the issue among people across a broad shade of political and civic nationalism in the Six Counties. I know that they have raised it directly during their engagements with the Taoiseach and his Government colleagues. The issue which is important in its own right has been highlighted particularly in the context of the jeopardy that hangs over us as citizens in the context of Brexit. I hope the Minister of State will be able to provide us with an update and appreciate his time.

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I thank the Senator for raising this issue which has been part of many discussions I have had in the Department in the past 12 months. It has been and will be more prominent in the next 12 months. Like a number of Members of both Houses, the Senator has been a strong advocate for extending the franchise in presidential elections to citizens resident outside the State. The Government decided on 7 March 2017 to accept in principle the main recommendation in the fifth report of the Constitutional Convention that citizens resident outside the State, including Northern Ireland, should have the right to vote in presidential elections and that a referendum should be held to amend the Constitution to give effect to that decision. When it was announced by the former Taoiseach in Philadelphia on 12 March 2017, it received a generally positive response from Irish citizens at home and abroad.

Following the announcement, an options paper which had been jointly prepared by the Departments of Housing, Planning and Local Government and Foreign Affairs and Trade, was published on 22 March 2017 to inform public debate on this significant policy change. The paper provided a focus for discussions at a dedicated session on voting rights held at the second Global Irish Civic Forum on 5 May 2017. The forum was attended by a wide range of representatives of Irish organisations abroad, including groups that had been campaigning actively on the issue for a number of years. Senator Billy Lawless has been mentioned in that context. The participants in the forum welcomed the opportunity to have their say and emphasised the positive role the Irish abroad would play in achieving progress on the issue. I understand those present at the forum seemed to have a broad understanding of the importance of due consideration and preparation being given to the option to be chosen and the wording of any amendment to the Constitution to be put to the people in a referendum.There was also a broad acceptance that the legislative and administrative change involved means it will not be possible to have voting from outside the State in place before a presidential election later this year even if a referendum was immediately held and passed .

There was also broad acceptance that the legislative and administrative change involved means that it will not be possible to have voting from outside the State in place before any presidential election later this year even if a referendum is held immediately and passed.

At the forum, the almost unanimous view of participants in regard to which citizens should have the right to vote at presidential elections was that the franchise should be extended to all citizens resident outside the State. There was also broad agreement that the extension of the franchise should not be limited to those who have left Ireland in recent years or within a certain time limit. There was a recognition among those in attendance that introducing a requirement to hold a valid Irish passport would be a reasonable criterion for eligibility. In light of the views expressed at the forum, my Department and the Department of Foreign Affairs and Trade are working methodically and carefully through some of the details that could arise in respect of the various options with a view to bringing a report to Government that will assist in identifying a preferred option to be put to the people in a referendum. Preliminary work has also commenced within the Department on the modernisation of the voter registration process, which will facilitate those eligible to vote to exercise their franchise from outside the State should a referendum be passed by the people in due course.

As the Senator may recall, the Government announced on 26 September 2017 that it has agreed indicative dates for the holding of referendums in 2018 and 2019, subject to the timely passage of constitutional amendment Bills by each House of the Oireachtas. It is intended to hold the proposed referendum on extending the franchise at presidential elections to Irish citizens resident outside the State on the date of the local and European elections in late May 2019. Against that background, my Department will, in consultation with the Department of Foreign Affairs and Trade, bring forward an appropriate constitutional amendment Bill on extending the franchise at presidential elections to Irish citizens resident outside the State in good time for the holding of the proposed referendum next year.

Niall Ó Donnghaile (Sinn Fein)
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I thank the Minister of State. He will not be surprised to hear that I believe his final two paragraphs are key-----

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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They usually are.

Niall Ó Donnghaile (Sinn Fein)
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Indeed they are. The detail therein is very important. The Minister of State is correct to acknowledge Senator Lawless and his work with various organisations on the matter. I also have majored on this issue since I was elected to the Seanad. Our experience and that of the Minister of State is that there is a willingness to work collaboratively and try to ensure this is done speedily and correctly. Many contributions on the matter have referenced the work being done by officials and I wish them well in those endeavours because we need to get this right. As we come to the stage where we hope to bring the legislation to the Houses, it is important to have a last round of engagement with the civic and representative organisations in regard to people in the North and the diaspora. I hope that Senator Lawless and I will have the opportunity to discuss the matter with the Minister of State and his officials over the summer recess or shortly thereafter.

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I have no problem taking the Senator up on that offer. This issue has rumbled on for several years and there have been many meetings on it. I met the Minister of State, Deputy Cannon, last week on the matter. This Commencement Matter is very timely and there is a general acceptance of the need for change. In the considerations prior to and at the forum, the possibility of a time limit such that citizens would have the right to vote if they had lived in the State within the previous five years or similar was raised but it was decided that that was too messy and that it would be difficult to agree upon a timeframe. Irish citizens with an Irish passport should be allowed to vote. There are other complicating factors. I have met with several groups, in particular in London and elsewhere in the United Kingdom, over the past few years. There is also the issue of where voting centres will be held. In many countries, they are held in consulates or embassies but postal voting is also a possibility. Much work has yet to be completed. The Minister of State, Deputy Cannon, and I will meet with any Member of this House, including Senator Ó Donnghaile, on this issue because the Government intends for the matter to go to a referendum of the people next year.

Anthony Lawlor (Fine Gael)
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I thank the Cathaoirleach for allowing me to bring forward this Commencement Matter. I thank the Minister of State for her attendance. I know the Minister, Deputy Harris, is also quite interested in this subject. I raise the national roll-out of a free contraceptive scheme. Ready access to effective contraceptive care is a key part of good reproductive and sexual health for many citizens. Known barriers to effective access to contraceptive care currently contribute to the levels of unplanned and crisis pregnancies. These barriers include cost, particularly for women who are just above the threshold for primary care reimbursement service, PCRS, eligibility, younger women and adolescents. The latter group includes adolescents who may be eligible for services under the medical card scheme but who, for reasons of cost of attendance, confidentiality, particularly when they are on a family medical card, or ignorance - they may be unaware that they are eligible under a medical card scheme or can discuss the matter with their GP, practice nurse or pharmacist - are currently apprehensive about attending a general practitioner, GP, or family planning clinic. There is strong evidence that young people positively view GPs as reliable sources of health-related information but there are also deterrents to their accessing necessary advice and essential services.

The Government should cost and closely consider an improved and integrated primary care contraceptive scheme to provide better access to this key service which is highly relevant in reducing rates of abortion, the risk of unplanned pregnancies, the transmission of STIs and related anxiety among many women and some men of reproductive age in many Irish communities. There should be funding for an integrated primary care contraceptive scheme to increase the capacity of the primary care sector to deliver this essential service. An educational component to ensure that those who would benefit from an improvement in these services are aware and knowledgeable about when and how to access the services is also required. Such scheme would bring us into line with many European Union countries where such such services are largely free at the point of delivery to most EU citizens. It would also be consistent with long-standing Government policy on extending many free primary care services to many of our citizens. Reducing the number of abortions by means of an enhanced and expanded contraceptive scheme is particularly attractive at a time when medical abortions will become available through a process of constitutional change.

Schemes in regard to medical contraception and education should be considered. There are several problems relating to the knowledge and understanding of the population in terms of how and when to access and use these services. As part of the maternity scheme, participating GPs should be required to confirm that they have consulted with expectant mothers in regard to post-partum contraception. Adolescents should be advised that they are eligible to consult with their local pharmacist, practice nurse or GP for relevant services. As part of an integrated primary care contraceptive scheme, we should provide a related message service for secondary schools, as well as public health messages. The latter should include information on how to access relevant services, as well as clear messages that highlight high risk sexual behaviour, similar to the effective campaigns run by the Road Safety Authority. This aspect of the initiative would build on experience already gained, but it would be more powerful and sustained than previous campaigns on the topic.

At a community level, pharmacists, practice nurses and GPs who are interested should be enabled, encouraged and modestly supported to engage with local secondary schools. I also suggest school boards of management periodically invite interested practitioners to outline the services available and answer questions and inquiries made by students and school staff on relevant aspects of sexual health. Healthcare professionals who are assisting on this aspect of an integrated primary care contraceptive scheme could be engaged, supported and have their activities co-ordinated through high level agreements with their postgraduate training bodies and representative organisations.

Overall, an integrated primary care contraceptive scheme would be very welcome. As I said, we should take on board what the people demonstrated in passing the referendum. Of course, there will be crisis and unplanned pregnancies. We should provide support and consider introducing a scheme that will assist all of the people.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister for Health, Deputy Simon Harris, I thank the Senator for raising this matter in the Seanad. The Minister is unavoidably absent as he in the Dáil Chamber dealing with Priority Questions and asked me to come in his place.

The cost of contraception has often been cited as a factor in unintended pregnancies. The Oireachtas Joint Committee on the Eighth Amendment of the Constitution recommended the following: "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". There are insufficient data for the significance of the cost of the use of contraception. We know from the Irish contraception and crisis pregnancy study 2010 that other important issues, besides cost, influence access and decisions on contraception. Almost half of the women surveyed for the study said contraception had been used at the time of their most recent crisis pregnancy. Aggregate population data for contraceptive use in Ireland are not available. However, the health Ireland survey 2016 indicated that 46% of respondents used no contraception. Usage was highest among the group of people aged between 17 and 24 years and declined with each age group, with significant numbers in each group using no contraception. Clearly, there are other important issues besides cost in whether people choose to use contraception when pregnancy is not desired. Work in the United Kingdom suggests access to reliable contraception is only one of the measures needed to achieve a reduction in the number of unintended pregnancies. They include relationships and sexuality education, timely access to contraception and information and engagement with appropriate health services.

Contraception is widely and easily accessible in Ireland. A comprehensive range of prescription hormonal contraception is available through the community drugs schemes, including long acting reversible contraceptives. Condoms are not reimbursed but are widely available in retail outlets. Additionally, post-coital contraception is available over the counter in pharmacies and free for medical card holders.

The main cost of obtaining contraception relates to medical care such as consultations, follow-up visits and the fitting and removal of devices. However, 44% of the population have free GP services, either through the medical card or the GP visit card.

I will come back to some of the other issues raised by the Senator.

John O'Mahony (Fine Gael)
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Does Senator Anthony Lawlor wish to ask a brief supplementary question? I remind him that I allowed him latitude when he made his initial statement.

Anthony Lawlor (Fine Gael)
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I thank the Acting Chairman. I probably spoke a little longer because this is my first Commencement matter.

The Minister of State spoke mostly about the cost of contraception. It is easy to discover how much it costs because many people a medical card. Therefore, one can easily analyse the cost per head by analysing how many avail of existing services.

I am disappointed that the Minister of State did not mention sexual health education. There are medical practitioners who are willing, if asked, to go into schools to provide such education. I suggest the Departments of Health and Education and Skills become involved in providing such education. The latter Department could issue directives to various school boards of management to encourage them to invite medical practitioners to their schools. Such education is really important, particularly as the referendum has been passed. It is known that free contraceptive care and increased knowledge reduce the number of crisis and unplanned pregnancies. I urge the Government to introduce an integrated scheme to provide free contraceptive care and the necessary education for all citizens. Let us be mindful of the fact that sexual health is an issue for both males and females.

Catherine Byrne (Dublin South Central, Fine Gael)
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I shall return to the recommendation made by the Oireachtas Joint Committee on the Eighth Amendment of the Constitution. On numerous occasions the Minister for Health has said he fully supports the recommendation made by the joint committee and its call for contraception to be made available free of charge. Work on the legislation is ongoing, particularly since the passing of the referendum. I do not have information from the Department of Health with me, but I assure the Senator that the Department is introducing a new health and well-being programme into all primary and secondary schools. Two new booklets, one of which is entitled, Tom's Flower Power: A gentle explanation of how babies are born, were launched a few weeks ago. Such education is provided for young people in primary school. I also assure the Senator that the Department of Education and Skills is doing a lot of work at primary, second and third levels, although I do not have a comprehensive reply for him from it. I promise, however, that I will ask the Minister to convey to him what the Department is doing. I shall reiterate what the Minister for Health has said. He has clearly said he will follow the recommendations made by the joint committee. However, it will take some time to put in place some of the measures recommended, some of which are legislative. We are at the beginning of the process which will continue for the next couple of months.