Mark Daly (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of State at the Department of the Environment, Climate and Communications, Deputy Hildegarde Naughton, to the Seanad Chamber. The first Commencement matter is Senator Rónán Mullen's.

Rónán Mullen (Independent)
Link to this: Individually | In context | Oireachtas source

Go raibh míle maith agat agus cuirim fáilte roimh an Aire Stáit. I welcome the Minister of State although it has to be said that the issue I am raising today has nothing to do with international road transport and logistics or with postal policy and Eircodes. That is not to take from the Minister of State's very fine contribution as a politician and as a Minister pf State. However, I requested that we postpone this until such time as there was a Minister from the actual Department dealing with the matter available but yet again the Seanad is not being treated with the respect that it deserves by the Government. I mean no disrespect to the Minister of State or to her commitment or indeed interest in the issue I am raising.

The concern I am raising today is about the remote consultation or so-called telemedicine abortion and specifically the suggestion that it will soon become permanent. It was reported in The Irish Timesin an article of 12 November that the Government intends to make remote consultation and at home abortion a permanent fixture of Irish abortion policy. We have been living with this policy since April 2020 when it was first introduced as a response of the outbreak of Covid-19. However, the suggestion that telemedicine should now become a permanent feature of Irish abortion law is very serious. This is a radical change to the operation of the law, particularly in contrast to how it was envisioned when the Bill was drafted. When the Health (Regulation of Termination of Pregnancy) Act 2018 was being drafted, the then Minister for Health, Deputy Simon Harris, assured members of the health committee that under the law, women would be seen physically for consultations and that absolutely termination of pregnancy services in Ireland would not be done by telemedicine. That was stated at a meeting of the health committee on 6 November 2018.

In a letter from March 2021, the Secretary General of the Department of Health confirmed that once the pandemic ended, temporary telemedicine provisions in relation to abortion would lapse. Unfortunately, when most Covid regulations were lifted at the start of this year, the policy of remote consultations continued. This was despite the absence of an independent investigation or study into the operation of telemedicine abortion in this country. Indeed, the HSE acknowledged that it is wholly reliant on secondary literature from Britain.

If the Government intends to make this radical change to Ireland's abortion law, surely it should be done in a transparent and open way by bringing forth amending legislation to the current abortion Act to explicitly provide for terminations by remote consultation. At least then there would be an opportunity for parliamentarians to scrutinise proposals, highlighting some of the issues that have already been raised in this Chamber by Senator Sharon Keogan and me. There are many concerns about safeguarding and physical risk to women's health associated with telemedicine abortion.

The HSE acknowledged in a letter of 3 March 2022 that meeting the woman in person increases the likelihood of the provider being able to identify any coercion or domestic abuse. With remote consultations it is more likely that the most vulnerable women will fall through the cracks. Removing in-built safeguards like a physical consultation and the privacy afforded by a GP surgery is sheer recklessness. As was reported in the Irish Examiner on 24 October, a teenage Irish girl was locked in a room and given abortion tablets in order to force a termination. That is not an isolated incident. A recent Savanta ComRes poll in the UK found that 15% of women aged between 18 and 44 said they experienced pressure to go through with an abortion that they did not want. Telemedicine enables coercive abortion and makes it more difficult to help the women who desperately need help.

The Government's first priority should be protecting women in abusive relationships and the victims of human trafficking. In the light of these developments, one would have to wonder about that and about the Government's priorities.

Hildegarde Naughton (Galway West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank Senator Mullen. I am taking this matter on behalf of the Minister for Health, Deputy Stephen Donnelly. He welcomes this opportunity to update the House on this important matter. I would like to thank Senator Mullen for raising the issue. 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 was provided across the health service, including the adoption of measures to facilitate social distancing and reduce personal contacts and footfall in medical facilities as appropriate. As part of the Government's ongoing efforts to protect public health and limit the spread of Covid-19, the Department of Health and the HSE worked together in 2020 to agree a revised model of care which put in place arrangements to allow termination-of-pregnancy services in early pregnancy to be provided remotely. For the duration of the Covid-19 public health emergency the need for social distancing, reducing personal contacts and reducing the burden on medical practitioners were paramount. It became possible for a woman to access a termination under section 12 of the Health (Regulation of the Termination of Pregnancy) Act 2018 before 12 weeks from her medical practitioner by telephone or via conference consultation. Engagement is ongoing between the Department of Health and the HSE to monitor service provision, to facilitate the smooth running of the termination-of-pregnancy service and to resolve any issues that may arise. However, as restrictions began to ease, it became timely to revisit the model of care, to review its operation and to consider whether remote consultation, as part of a blended approach to termination-of-pregnancy care, should be continued after the Covid-19 public health emergency period. At the request of the Department, the HSE conducted a review of the revised model of care of termination of pregnancy, taking into consideration the experiences of healthcare providers, service-users and international best practice. The review found that the majority of providers in primary care feel that a blend of remote and in-person care is optimal. In-person consultations allow provision of personalised care and allow potential problems to be identified and mitigated, while remote provision improves access for many women and addresses geographical and logistical barriers. It also alleviates some of the difficulties associated with the mandatory three-day waiting period. The review also found that the provision of a remote consultation as part of the termination-of-pregnancy services was safe, effective and acceptable to both service-users and providers.

Rónán Mullen (Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her reply. What is going on is that the Government is driven by the advice promoted by campaigning groups that prioritise ease of access over various threats to women's health and well-being. I mentioned the issue of safeguarding, but the physical risks to women's health associated with telemedicine abortion should be also addressed. If no physical consultation takes place and a women self-reports the gestational age of her pregnancy incorrectly and the stage of pregnancy is underestimated, having an at-home, do-it-yourself abortion, with the pills supplied via telemedicine could lead to disastrous health consequences. Ectopic pregnancies could go unidentified. If a medical self-abortion is attempted on that, the potential for a ruptured ectopic pregnancy is heightened and that could lead to severe health risks. I wonder whether the Government cares about any of that or is simply interested in listening to what abortion activist groups want.

Hildegarde Naughton (Galway West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Senator. The Government is committed to providing timely access to a high-quality safe termination-of-pregnancy service as close to home or the community as possible. With this in mind, the Department continues to engage with the HSE on the most appropriate model of care for termination-of-pregnancy services and the findings of this review forms part of that deliberative process.