Seanad debates
Friday, 25 September 2020
Nithe i dtosach suíonna - Commencement Matters
Health Services Provision
10:30 am
Lorraine Clifford-Lee (Fianna Fail)
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The Minister of State is very welcome to the Chamber and I thank him for responding to this matter. It is fitting that we are here today to talk about access to contraception given that tomorrow, 26 September, is World Contraception Day.
As the Minister is aware, a working group on access to contraception was established in April 2019 by the then Minister for Health, Deputy Harris, to consider the policy, regulatory and legislative issues relating to enhancing access to contraception following the recommendation of the Joint Committee on the Eighth Amendment of the Constitution. That working group produced a report almost 12 months ago. The report identified various barriers to accessing contraception. In particular, there are significant barriers relating to choice of contraception and accessing the most effective form of contraception.
While the cost of delivering this universal free contraception was estimated by the group to be in the region of €80 million to €100 million a year, it emphasised that considerations which go beyond purely economic considerations needed to be taken into account when accessing this scheme.
Provision of universal free contraception in particular negates the harmful consequences of crisis pregnancies. Those harmful consequences would be avoided if universal free access to contraception was introduced in Ireland. However, the working group outlined three alternatives to full universal access if that was the concern of the Government of the day. First, a universal State-funded contraception scheme based on the GMS scheme but including the copper coil; second, the expansion of the GMS scheme as it relates to long-acting, reversible contraception, to be available to all women; and, third, a phased approach to the introduction of free contraception beginning with younger women in the 17 to 24 year age group. The group estimated that that would cost in the region of €18 million to €22 million a year.
The then Minister, Deputy Harris, told the Dáil in October 2019 that free contraception would be available at the beginning of 2021. The programme for Government commits to providing free contraception over a phased period starting with women in the 17 to 25 year age category. Can the Minister of State outline the work that has been undertaken to establish this State-funded contraception scheme to date? Can he give a clear timeline for the implementation of the programme in its entirety because it is urgently needed, although I am aware legislation will be required to introduce this contraception scheme?
Detail is also needed on how and when free contraception will be available to all women, not only those in the 17 to 25 year age category. Women's contraceptive needs do not stop in their mid-20s. Barriers to accessing contraception are not only experienced by younger women. We know from the UK abortion statistics relating to 2018 that 69% of Irish women who accessed abortion care in England and Wales that year were over the age of 25.
Choice of contraceptive methods is empowering for women and it will be critical to the success of any scheme. I hope the Minister of State will confirm that the State-funded contraception scheme will provide access to all methods of contraception.It is crucial that long-acting contraception methods, such as coils and implants, be accessible to all. It is important to remember that not every contraceptive works for, or is suitable for, every woman. Women's contraceptive needs change over time so it is important that the Minister of State confirm to us today that all methods of contraception will be included in the scheme.
Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising what is an important issue — increasing access to contraception. The Government understands the need to promote women's health and equality and, as such, the new programme for Government includes a commitment to expand access to free contraception for women aged between 17 and 25, as outlined by the Senator.
The Senator has made me aware of the recommendations of the Joint Committee on the Eighth Amendment of the Constitution. The working group was established in April 2019. This group was charged with examining the range of policy, regulatory and legislative issues in respect of improving access to contraception. The group's high-level report, published last October, identified the complexities associated with this issue and highlighted the need for any State-funded contraception scheme to provide women with the opportunity to choose the most effective and suitable types of contraception for them, based on their health and lifestyle needs and preferences.
Following the report, it was clear that a sizeable body of work would need to be addressed in order to develop and finalise the policy approach, bring forward the necessary legislative proposals and ensure the implementation of service-delivery arrangements. Unfortunately, work on this matter has been disrupted significantly by the need to prioritise the response to the COVID pandemic, although it will be considered further in the context of the Estimates process.
There are already several supports in place to facilitate individuals' access to contraception. For example, the national condom distribution scheme, which was established to promote condom use among individuals and groups who may be at increased risk of negative sexual health outcomes, distributed over 730,000 condoms and almost 450,000 lubricant sachets in 2019. This scheme has been expanded further, with the rolling out of condom dispensary services in November 2019 to over 23 third-level colleges.
The Senator may also be interested to know that, in partnership with the Irish Pharmacy Union, IPU, the HSE last month launched Play it Safe, 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, whom we know from public health data are most affected by crisis pregnancies and sexually transmitted infections.
In addition, it is important to remember that approximately 125,000 people accessed contraceptive services through the general medical services scheme in 2019. These individuals received their contraception free of charge. Those with a GP visit card are also supported in accessing contraception as they do not have to pay costs arising from GP visits.
The success of these initiatives is reflected in the fact that 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. There is, of course, scope for improvement, and it is clear that there are barriers to accessing contraception that must be addressed. At the same time, it is important to recognise the progress made and the measures already taken to address this complex issue.
Lorraine Clifford-Lee (Fianna Fail)
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I am very disappointed with the Minister of State's response. I understand the Covid pandemic is causing havoc, particularly for the Department. This issue existed long before Covid so I am very disappointed to hear that no progress at all has been made on it. It is a core issue in the programme for Government. I will be taking it up with the Minister, Deputy Donnelly, to determine whether we can make progress on it because life needs to go on alongside Covid.
The national condom distribution scheme, while welcome, is a male-focused form of contraception. It is not female centred.Women's lives are transformed by access to contraception and they can plan and control their lives and their own fertility. While the condom distribution scheme is welcome it is not at all sufficient. I appreciate the Minister of State saying Ireland is ranked 12th of the 46 countries on access to contraception but this does not mean women can access suitable contraception. By "suitable" I mean longer acting contraception such as coils and implants, which are vital. It is clear from the report that these methods of contraception are not readily accessible in Ireland. I am disappointed with the response but I want to work with the Minister of State and the other Ministers at the Department of Health to get this up and running and delivered.
Frank Feighan (Sligo-Leitrim, Fine Gael)
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I appreciate the Senator's concern about this very complex issue. The working group highlighted that the majority of people in Ireland can and do access contraception without difficulty. Contraception use in Ireland is high and stable. This is a fact that we welcome but there are issues we need to address. At the same time, the Government is supportive of the need to expand access to contraception even further and move towards the provision of a free contraception service over time. This is reflected in the commitment made in the programme for Government. It is not a straightforward process and a number of regulatory, legal and policy issues will need to be addressed before the final parameters of a State-funded scheme are determined. The issue of access to contraception has not been forgotten. As outlined, the opposite is the case and much valuable work has been undertaken to ensure effective supports and information are available to those who need them most.