Seanad debates
Tuesday, 16 April 2024
Nithe i dtosach suíonna - Commencement Matters
Abortion Services
1:00 pm
Annie Hoey (Labour)
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I welcome the Minister of State to the House. I have a health topic for the Minister of State, as he peruses different topics here today.
Following on from the "RTÉ Investigates" programme broadcast last night - I hope the Minister of State has seen it and, if not, I would certainly recommend he take a look at it - I want to ask the Minister, or the Minister of State, Deputy Burke, on behalf of the Minister, when the recommendations of the O'Shea report will be enacted and what timeline the Government has put in place for examining those recommendations and enacting them. Anyone who saw the programme last night will surely agree that we are in urgent need of legislative action. The documentary shone a light on the harsh reality of the exclusionary and restrictive provisions of the law. I refer to the Marie O'Shea report. This review was published in April 2023, yet progress on many of the recommendations is awaited.
The call for immediate action is also reflected in the conclusions of the Oireachtas Joint Committee on Health, of which both Deputy Colm Burke and I have been members. Its December 2022 report supported the review's recommendations, describing them as necessary measures to ensure the 2018 Act meets the needs of women and pregnant people. The health committee report called on the Government to advance the implementation of the report without delay.
I acknowledge efforts to improve operational aspects of abortion services in the past year, including that 17 of the 19 maternity hospitals are now providing care, but we still have significant barriers to equitable and accessible abortion services. These barriers include ongoing criminalisation, the mandatory and patriarchal three-day wait, inadequate data collection, lack of safe access zones, uneven geographical coverage and the narrow rigid legal criteria for abortion access after 12 weeks, including the 28-day clause for fatal foetal anomalies. These obstacles have resulted in women and pregnant people being denied timely reproductive healthcare and, in many cases, being forced to travel abroad.
I do not believe that is what we voted for. I remember spending quite some time on that referendum campaign. We were putting women and their stories out - really hard, difficult stories of fatal foetal abnormalities discovered after 12 weeks, having to travel and having to live with the shame and secrecy. Those are the things that we went door-to-door talking to people about. I do not believe what we saw last night on that documentary is reflective of what people voted for.
On the documentary last night, we heard about a couple whose baby, Rose, had to be brought back on ice. The couple had to put their baby's body in the boot of the car and cover it with coats in order that they could get it through customs. I do not believe that is what people voted for. Another couple talked about having to leaving their son behind because they wanted to get a post mortem and coming back five weeks later to find their son's body decomposed. I do not believe that is what we voted for in May 2018. I do not believe that is what the people wanted to see continuing to happen to women.
It is estimated that 860 women have travelled from Ireland to the UK to access abortion services since the eighth amendment was repealed, with 85 suspected to have travelled in the first part of 2022. I personally know a number of women who still have to travel. I am stunned that I know people who have to travel. I do not believe that is what we voted for.
We need necessary legislative and operational steps. These include full decriminalisation of abortion in line with the WHO guidelines to remove the chilling effect on healthcare providers. We need to remove the mandatory three-day wait period. We need to review the 12-week gestation limit to ensure women and pregnant people are not timing out of care and forced to travel abroad. The citizens' assembly recommended a 22-week cut-off limit for fatal foetal abnormalities. This is not outside the realms of what was discussed during the process we got to ahead of 2018. We need to recruit a HSE primary care lead for termination of pregnancy to address gaps in training, guidance and data collection.We need to expedite the safe access zones legislation. We will be dealing with that in here later today. We also need to regulate rogue crisis pregnancy agencies, which are acting with impunity.
Colm Burke (Cork North Central, Fine Gael)
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I thank Senator Hoey for her contributions in the Joint Committee on Health. I enjoyed being on that committee with her. The Minister, Deputy Donnelly, has asked me to deal with this Commencement matter.
I thank the Senator for giving me this opportunity to address the House on the review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018. The Act was signed into law on 20 December 2018 and expanded termination of pregnancy services have been available since 1 January 2019. The Act allows termination to be carried out in cases where there is a risk to the life, or of serious harm to the health, of the pregnant woman where there is a condition present that is likely to lead to the death of the foetus either before or within 28 days of birth and without restriction up to 12 weeks of pregnancy. This is in line with the recommendations of the Oireachtas Joint Committee on the Eighth Amendment of the Constitution, which published its report and recommendations in December 2017. Prior to the May 2018 referendum on the eighth amendment, the general scheme of the Bill to regulate the termination of pregnancy was published. The final legislation enacted is consistent with the published proposals.
In line with statutory and Government commitments, the Minister for Health commenced the review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018 at the end of 2021. The final report of the review was submitted to the Minister at the end of February 2023. The report makes a range of recommendations, most of which are operational in nature with some proposing legislative change. The report was considered by the Cabinet on 25 April 2023. Following the meeting, the Government agreed that the HSE would establish an implementation group to progress the operational recommendations while the proposals recommending legislative changes were referred to the Joint Committee on Health for consideration. In December 2023, the Joint Committee on Health issued its report on the legislative recommendations. The Minister for Health has now asked for further consideration of this issue at the Cabinet committee on health.
The HSE established an implementation group and identified the recommendations that relate to the operation of the service. An action plan for the implementation of these recommendations has been developed and ten workstreams have been identified. The implementation group is chaired by the director of the HSE's national women and infants health programme. The national implementation group includes multidisciplinary representation comprising healthcare professionals across the termination of pregnancy pathway and service users with lived experience of TOP services. The first meeting of the implementation group took place in October 2023. This was followed by five subgroup meetings held in December 2023. Meetings of this group are ongoing.
An overriding message of the review centres on the need to increase access. Substantial strides have been made in this regard. For instance, six additional hospitals came on board in 2023, an increase of 55%. Termination services in early pregnancy, up to 12 weeks, are now provided in 17 of the 19 maternity hospitals, with the remaining two expected to come on board in 2024. There has also been a small but sustained increase in the number of community providers. Approximately 20 additional providers have come on board in the last 12 months alone. Furthermore, the revised model of care introduced in response to the Covid pandemic has now been approved as the enduring model of care. With this blended approach, it is possible for one of the two consultations required for termination in early pregnancy to take place remotely. This will alleviate the time and expense involved in travelling to the doctor's surgery twice and will be of particular benefit to those seeking to access services in remote areas or areas that are poorly served at present.
Safe access legislation is at an advanced stage. It is in progress through the Houses of the Oireachtas. The next Committee Stage session is to take place in this House this evening. It is the Government's priority to have this legislation enacted as soon as possible.It is hoped that the cumulative effect of these measures will substantially reduce the barriers and increase access to services for those who need it.
Annie Hoey (Labour)
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Many of the changes outlined by the Minister of State are not the required legislative changes that we need to see. That is what we want. The recommendations that emerged from the review have a robust evidence base and are rooted in qualitative research of the lived experience of women and pregnant people who have accessed abortion services since the commencement of the Act. This is a Government-commissioned review, so we need to immediately progress legislative amendments and service developments that accurately reflect the findings of the review, the research underpinning the recommendations that came out of the review and international best practice as set out by the World Health Organization.
The review clause was put in because we recognise that healthcare cannot remain frozen in time. I am aware that here are plans, but the Government cannot delay the legislative and operational changes any further. We need political leadership to ensure that Ireland's reproductive healthcare system is both equitable and is capable of responding to the emerging evidence and clinical best practice in order that it can meet the needs of women and pregnant people. We voted for care, compassion and dignity. Until we make legislative provision for the recommendations contained in the O'Shea report, we are simply not going to get what we for.
Colm Burke (Cork North Central, Fine Gael)
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It is worth noting that the Health (Regulation of Termination of Pregnancy) Act 2018 is of relatively recent provenance and has been in operation for just over five years. For much of that time its operation was affected by the challenges resulting from the Covid-19 pandemic. Nonetheless, it is recognised that the service has embedded well into the health sector, as outlined. We now have 17 of the 19 maternity units providing that service and the other two will come onboard in 2024. It is acknowledged, however, that some challenges remain. The Department of Health will continue to work with the HSE and other relevant stakeholders to address those challenges and ensure that the service is available to those who need it.