Fiona O'Loughlin (Fianna Fail)
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I welcome the Minister of State, Deputy Feighan, to the Chamber.

Sharon Keogan (Independent)
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I thank the Minister of State for being here today. I would have like to have seen the Minister, Deputy Donnelly, here to discuss this very important matter and answer the questions I put down.

I raised the issue in March in this House about the state of telemedicine provisions for abortion in Ireland and the risk surrounding its operation. Telemedicine abortion was introduced in March 2020 as a temporary Covid-19 emergency measure. While virtually all emergency measures have been pulled back, telemedicine abortion remains in place, with no signs of the Minister for Health seriously committing to pulling it back. This is regrettable as there are serious acknowledged risks associated with telemedicine that must urgently be addressed. I raised some of these in my contribution on 1 March.

I am aware the Minister for Health ordered a review of the revised model of care for termination of pregnancy in quarter 4 of 2021, which took a largely positive view of telemedicine abortion and valued its convenience for women having an abortion.However, I must stress that there are considerations more important than convenience and ease of access, such as the physical and mental safety of women and girls in this country. As such, how can the Government stand over the acknowledgement from the HSE, in reply to a parliamentary question, that meeting the woman in person increases the likelihood of the provider identifying any coercion or domestic abuse, yet it continues to operate a policy that facilitates the abuse of vulnerable women? I understand the Minister is considering a blended approach for telemedicine, which would allow operational in-person consultations. Under this proposal, the most vulnerable women would inevitably fall through the cracks. Women suffering from domestic abuse, coercion and those trapped in human trafficking would not benefit from a blended approach. It cannot be seriously argued that abusers would permit their victims to opt for an in-person consultation over a remote, impersonal phone call. Moreover, a phone call is an inadequate substitute for an in-person consultation and examination. There is no way to guarantee a woman's privacy in a phone call scenario.

Recent findings from a BBC Four poll reveal that 15% of women between the ages of 18 and 44 in the UK have experienced pressure to go through with an abortion they did not want to have. Allowing telemedicine at-home abortions to continue without the requirement of a face-to-face consultation for such an important decision leaves open an extremely likely probability of women being coerced into having abortions by the malign influence of a partner or third party. How does the Minister for Health intend to address this alarming probability? Clearly his "whatever you are having yourself" attitude to a blended approach fails to adequately redress this alarming issue.

I fail to see how telemedicine abortion, including even a blended approach, could accurately verify a woman's gestational stage. If a pregnant woman were beyond nine weeks and six days and had inaccurately self-assessed her last menstrual period, she could receive and self-administer abortion pills, which could impose immense health risks. Moreover, there is no way to guarantee a woman would take the pills at home as soon as they are received. Situations like these could lead to complications like haemorrhaging, infection, incomplete abortions and ongoing pregnancy. I cannot see how telemedicine, either in full or in a blended approach, would adequately address these risks. I am calling on the Minister for Health to acknowledge the realities of the situation. People's lives are in danger here. Women in abusive situations are being utterly failed by telemedicine abortion. The Minister cannot continue to live in a bubble where the only issues around abortion relate to how easy and convenient it is to have one. The argument that this measure is a temporary Covid response is increasingly losing its relevance. The Minister needs to address these very serious matters and ensure a full return to mandatory in-person consultations for women seeking abortions.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising this issue, which I am taking on behalf of the Minister for Health. The model of care for the termination of pregnancy service became operational in January 2019, following the enactment and commencement of the Health (Regulation of Termination of Pregnancy) Act 2018. Termination up to nine weeks’ gestation is carried out in the community by GPs or doctors working in family planning and women's health clinics, providing clinical supervision and supporting women's self-management. Women with a pregnancy between nine and 12 weeks’ gestation are referred for hospital-based care.

The arrival of Covid-19 in 2020 required a substantial shift in how care is provided across the health service, including the adoption of measures to facilitate social distancing and reduce personal contacts and footfall within medical facilities, as appropriate. As part of the health system response, a temporary revised model of care for the termination of pregnancy service was agreed to facilitate remote consultation with a medical practitioner for the purposes of accessing termination in early pregnancy. The revised model of care stated that face-to-face consultations could be held if clinically necessary but that such consultations should be kept to a minimum. It is recognised that the current public health guidance, including guidance on managing risk of transmission of respiratory viruses including Covid-19 in general practice, continues to apply and advises limiting footfall through the practice by discouraging unnecessary attendance at the practice by people who can be dealt with equally well by telephone.

As wider public health restrictions began to ease in 2021, the Department requested the HSE's national women and infants health programme to undertake a review of the operation of the revised model of care for termination of pregnancy services from a clinical and patient safety perspective. The purpose of the review was to consider whether the revised model of care should be retained going forward. This review was completed and submitted to the Department. Having regard to the experiences during Covid-19 and the review work undertaken, consideration of the model of care is ongoing.

Sharon Keogan (Independent)
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I was not expecting anything else from the Department, to tell the truth. I am very disappointed. I understand the review is ongoing. I am unfamiliar with how long it will take to conclude the review or when the results will be published. There are safeguarding issues here, specifically with regard to coercive control and domestic violence, and there are also difficulties in identifying the gestational age with telemedicine. There are side-effects to these drugs and pills. Healthcare for abortion is not something that should be given through telemedicine. It is not something that can be ordered online like Amazon or fast food. That is not what abortions and healthcare for women are about. The sooner we get back to in-person consultations the better. It does not serve women well to have abortions available through telemedicine, particularly women who are in vulnerable or coercive relationships and subject to domestic abuse. I look forward to seeing that review. When will it be published? I will be back in September on this issue and hopefully the Minister will be free the next time. I thank the Minister of State for coming in this morning.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I again thank the Senator. I do not have a date for when the review will be announced but I will follow that up in the Department. Timely access to care, as close to home or the community as possible, is a key principle of the vision of Sláintecare. The review of the changes to the termination of pregnancy model of care adopted during the pandemic is an appropriate and timely initiative. The Department is continuing its engagements with the HSE regarding the final considerations related to this review and the next steps. The outcome of the review will be made available once this deliberative process concludes. In the meantime, it is important to reflect that the temporary model of care, along with the relevant public health advice, remains in place. The Senator has raised a few issues regarding her views. I will bring them to the Minister and the Department.