Thursday, 11 July 2019
Nithe i dtosach suíonna - Commencement Matters
Medicinal Products Availability
I thank the Minister of State for coming to the House. This matter speaks for itself. There was a lot of talk about this area well in advance of last year's referendum to remove the prohibition on abortion. A working group has been set up by the Minister to see how we will go about providing contraception to women in this country. A public consultation was also launched and is closing on 5 August. I urge the public to partake in that and to give their feedback. That is a prudent way to do business, when making policy, but there is an urgency that needs to be observed.
During the Joint Committee on the Eighth Amendment of the Constitution, there was little public discussion of the ancillary recommendations which, to my mind, are extremely important, namely, sex education and contraception, which are fundamental to preventing unwanted pregnancies. That is the crux of this issue, as far as I am concerned. It comes to a point where we have to accept that we have heard all the expert evidence. The Minister has indicated that this is his intention. The October budget is looming. I sincerely hope that, once the public consultation has concluded, the Minister would hear from the working group he has set up in very early course, so this matter can be seriously considered for this budget and for implementation in January.
We cannot have a health service in which termination services are provided freely and contraceptives are not. This goes to the crux of a progressive health system. LARCs, long acting reversible contraceptives, such as coils and implants, are the most effective method of preventing unintended pregnancy and have a high satisfaction rating. A contraceptive programme which excludes LARCs may incentivise women to opt for less effective methods, such as condoms or oral contraceptives. This exposes them to an increased risk of unintended pregnancy. The availability of a wide range of methods is important because each woman's medical history and risk factors are unique and there is no one-size-fits-all contraceptive method that works for everyone. Furthermore, women's contraceptive needs change throughout their lives and there needs to be that adaptability in the system.
It is complicated enough but we are in danger of over-complicating it. This is something that needs to happen. If we are serious about gender equality, access to contraception is fundamental to women's empowerment. Political commitments were made in this area and I would like to see them realised in this budget. I look forward to hearing from the Minister of State.
I am taking this matter on behalf of the Minister for Health, Deputy Harris. I commend Senator Noone on the wonderful work she did as Chair of the Joint Committee on the Eighth Amendment of the Constitution, where her direction was incisive and very progressive.
As I am sure the Senator is aware, the issue of access to contraception has been the subject of particular attention in recent months following on from the recommendations of the Citizens' Assembly to improve women’s access to reproductive health services and the recommendation of Joint Committee on the Eighth Amendment of the Constitution to introduce a scheme to provide “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.” Following on from these recommendations, the Minister, Deputy Harris, established a working group within the Department of Health to examine the range of policy, regulatory and legislative issues arising in regard to improving access to contraception. The group has been working since 30 April and launched a public consultation earlier this week. The Minister would encourage everyone to have their say in what will be a fundamental policy change. It is intended that this group will report back to the Minister at the end of September with recommendations on policy options and next steps.
More generally, the HSE sexual health and crisis pregnancy programme has responsibility for the implementation of the national sexual health strategy 2015-20. The programme is supportive of initiatives that facilitate access to contraception for women, including long acting reversible contraception, LARC, such as intra-uterine devices, subdermal implants and so on. The high efficacy rates associated with LARC in preventing crisis pregnancies are well-recognised. Crucially, there is no potential for user error with LARC, which makes it more effective than other methods of contraception, given that many crisis pregnancies occur due to failure of the contraceptive method or incorrect use on the part of some people.
With regard to use of LARC among women in Ireland, the last Irish contraception and crisis pregnancy study suggested that uptake is at a low level but increasing across all age groups. This study found that the proportion of women aged between 18 and 45 using LARC rose from 5.7% in 2003 to 10.9% in 2010, although I do not know the statistics after that date. We know there are barriers to accessing contraception, and cost certainly appears to be an issue for some women in regard to LARC. Data suggest that among women who had considered using LARC, 27% said the costs associated with this type of contraception prevented them from choosing this method. However, we must also remember that hormonal LARC devices are provided free of charge to those with medical cards, which is an important measure in terms of addressing access to contraception. It is also important to acknowledge there can be other barriers to contraception aside from cost, such as difficulty accessing services in a particular locality or feelings of embarrassment.For example, in the United Kingdom, where contraceptive services and supplies are free of charge, a high proportion of pregnancies are still deemed unwanted or unintended. These are fair statistics. Clearly, this is a complex area and the working group has been established to inform the development of the most appropriate policy response. That is reasonable. The group will forward to the Minister whatever it sees as the most appropriate response.
I am aware of much of what the Minister of State has said. I just wish to emphasise again the urgency of this matter. The country in which we live has made huge progress in recent years. We should all be very grateful for that but it is not that long ago that a woman needed a man's consent to get contraception in this country. It is not that long ago that it was illegal. It was only legalised in 1979 and then only in restricted circumstances where a person was married. We have come a long way but, if we are to be a progressive society, termination services cannot be freely available to women while contraceptive services are not. This is about gender equality. I want to live a country in which women are empowered in this area. I hope the Minister will hear from his working group in the middle of September rather than at the end. We know the information. The Minister has indicated that he wants his policy to follow along these lines. There is political momentum at the moment and I do not want it to be lost. I hope this will be included in the budget with a plan for implementation from next January. I thank the Minister of State for his response.
I would like to make three points very briefly. The level of use of long-acting reversible contraception is still quite low, despite the advantages I know it has. There are different reasons for that. There is no question but that cost is a factor. At the same time, we should not lose sight of the fact that the Irish contraception and crisis pregnancy study showed that 88% of respondents did not report difficulty in accessing contraception. The data also show that 78% of sexually active heterosexual adults who did not wish to conceive used contraception at all times. The facts bear out the idea that the use of contraceptives in Ireland is high and stable. That should be welcomed.