Maria Byrne (Fine Gael)
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I welcome the Minister, Deputy Carroll MacNeill. She is very welcome and we look forward to hearing her contribution. She has ten minutes.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the ladies of the House so much for the invitation to speak on women's health, with International Women's Day this coming Saturday. It is wonderful. I also congratulate and thank Senator McDowell for coming into the Chamber. It was well commented on by the ladies present that there were quite a lot of men in the Chamber for the previous debate. There was not quite a stampede to the door but, my goodness, quite a rush to the door. It is wonderful to speak, yet again, with women, about women's health and women's issues in international women's week and women's health week. Senator McDowell is gloried among women. I thank him for being here.

It is sort of pointless to have to make these remarks continually but there we are. As a female Minister for Health and Member of the Oireachtas, I am more than ever struck and wonder why these weeks should be necessary. I really do have a sort of cranky difficulty with the continuous focus on women being different or having to be different - women for election, women in finance when I was in the Department of Finance, women's health - as though women are not half the population. I am the only female representative for the Dún Laoghaire constituency, not just in this Dáil but in the previous Dáil. For some reason, women have to go out of their way to highlight the different issues that have led to so many inequalities. Health is one of those. Perhaps just let us focus on a health service for everybody, recognising the basic dignity, human rights and respect that every person, male or female, deserves in the health system and right across the rest of society.

I would like to highlight, though, that some issues impact women more than men. One of those is maternity, naturally. I would like to highlight in particular, recognising that this is women's health week, that the maternity system's impact on women is very considerable. I want to recognise the women who have had difficult experiences in Portiuncula and Ballinasloe hospitals, where I have travelled twice in the past number of weeks to meet and sit with those women and spend time with them, whose babies' births and, in some cases, whose babies' deaths are the subject of review. The reason I highlight it is that time and time again in maternity services, there seems to be a systemic difficulty in actually listening to the voices of women, including heavily pregnant women in maternity units. That is not unique to this situation but across maternity hospitals and units. No matter what report I read into lack of care or adverse incidences, including the most recent report of the working group on medical negligence costs, I read about women highlighting that they did not feel they were listened to and how often that impacts on their care.

That is not just in the case of maternity issues. This morning I opened a women's health initiative in cardiovascular care, where it is not that women are not listened to, but because their symptoms present more subtly and in a more nuanced way, they are often not recognised or understood as a cardiovascular issue. The women's health fund in my Department has provided significant funding to address three specific projects between St. Vincent's, St. Michael's in Dún Laoghaire and UCD, to try to shine a light not just on the operation of bias in some of the diagnostics but also the tracking of particular risk factors in gestational diabetes and other markers in the maternity system that may lead to cardiovascular difficulties. There is so much to do in recognising that women may present differently. That is not a question of bias but simply different symptomatic presentation. Women have to be listened to, understood and respected in the most basic way. It seems ridiculous to have to say this out loud but nevertheless, women's experiences and symptoms can be different from men's. These wrong diagnoses and inadequate treatments lead to poorer results. It is a systemic issue that we have to recognise. I welcome Senator Clonan and the other Senator. I am sorry; I do not know his name. I am delighted to see them and thank them for coming to women's health week. Inequalities in health mirror inequalities that women face in other areas of life. I do not just want to focus on inequalities in women's health in Ireland. Next week I will attend the United Nations Commission on the Status of Women. I recognise the considerably greater difficulties that many women around the world are facing in terms of health inequalities more broadly. It is always important to recognise our own reasonably privileged, favourable position vis-à-vis many other women, and some of the intersectional issues that women in Ireland face in terms of their health.

A week like this, unnecessary as it should be, nevertheless enables all of us to shine a particular light on issues that were previously shrouded in some silence. In the past, we only heard something like menopause being mentioned in whispers. Thankfully, the silence around that, periods and endometriosis has begun to lift. That public conversation becoming louder has, thankfully, driven service delivery at a better level, although there is much to do. That work has been enabled through the women's health task force. I thank each member of the task force for their work, which, driven by the demands of women, has provided the foundation for the women's health action plans. Good progress has been made. I pay tribute to my predecessor, Stephen Donnelly, who drove much of that work with the women's health task force. It is a starting point, however. There is an awful lot to do. I am excited to work with all of the Senators to find the particular areas where we can do considerably better.

Let us recognise some progress. The State has invested an additional €180 million in women's health since 2020. That dedicated initiative has resulted in the beginning of new initiatives across the country, often the first of their kind. For example, there is the free contraception programme for women aged 17 to 35. There is much better investment in screening services and a commitment in the programme for Government to go further with that, based on clinical advice, not politicians' thoughts. We have expanded termination of pregnancy services. I think we are at 18 out of 19 maternity units now, and soon to be at 19. I will have an update for the House on that in a number of weeks. We have established a growing network of see-and-treat gynaecology clinics, which are working quite well. We have developed public services for fertility and, for the first time, limited funding for IVF for people whose fertility issues cannot be managed at primary or secondary care level. We recognise that these are many good starts, and there may be more to do and a need to examine how we might get better value, better outcomes or spread that particular fund in a more effective way. This year, we will see further work on the establishment of the Assisted Human Reproduction Authority, with the enactment of the amendment Bill and the establishment of the authority two key elements that will enable expanded eligibility for AHR. We are getting closer to the opening of the first public AHR centre in Cork.

We have established hubs for the treatment of endometriosis. Most endometriosis cases can be managed perfectly well with within a GP or primary care setting, but there is a need for complex intervention and complex services. We have hubs that have now treated about 1,100 of the more complex cases but there is quite a bit more to do in that area and to recognise the impact it has on people's lives.

Similarly, we started to meet women's long-overdue right to treatment for the management of menopause. While much of that can be done at primary care level and we have been working with GPs to improve awareness and training, we have also established six specialist clinics for the treatment of more complex cases. I appreciate that these clinics run at limited capacity but they are an example of a start and where we would like to go further with them.

As we continue to implement the national maternity strategy, we will open eight new postnatal hubs to improve the care provided to new mothers and their babies. I do not know if any of the Senators have spoken to new mothers who have had the opportunity to experience these postnatal hubs but the feedback I am getting is they have been quite positive and constructive. I am interested in Senators' feedback. The hubs have proven a good support to women with breastfeeding, physiotherapy and other emotional and physical supports for up to 14 days post birth, which is a very delicate time. There are four additional see and treat gynaecological clinics being put in place to complete the national network of 21 clinics for the fast and efficient management of gynaecological conditions. Those clinics have had a big impact on waiting times for those procedures. We are also working to improve breastfeeding rates, recruiting additional lactation consultants to support women on their breastfeeding journey and developing a new national breastfeeding strategy. All of that works while we continue to progress the tender process for the new national maternity hospital.

We are working hard to get to a place where everyone has access to quality tailored care that provides treatment and research appropriate to our physiology. Through the women's health action plan, my Department is also investing in such research that will expand the evidence base for women's health and lead to better healthcare. I mentioned this morning the cardiovascular project in Dún Laoghaire, which is an example.

Despite this focus on the women's health action plan, some voices are still not being heard quite loudly enough. Some groups are still left behind. We are trying to produce programmes that will target women who might for different reasons be harder to reach. For example, we have introduced a pilot programme to support Ireland's effort to eliminate cervical cancer by improving the HPV vaccination rate, not just among girls, but also boys, and in every community, including some healthcare underserved communities that may include Traveller, Roma and certain migrant groups living in Ireland. We have also supported a project to raise awareness among women and girls of the signs and symptoms of common types of cancer in different communities across Ireland. We continue to build on initiatives such as the provision of free period products, providing free tampons and pads women in every community and placing them in the bathrooms of public buildings. It might seem like a small step but it is a recognition that it is a natural part of life and that some women may be financially disadvantaged.

I would like to see a period where we do not have to have these weeks or specific task forces and women are just part of the national conversation in a completely normal way. I recognise that that is not yet so. On the other hand, women are living longer than men at 84 years compared to about 80 years. Nevertheless, our health outcomes in cardiovascular care and osteoporosis care are worse, and certain cancers are more prevalent among women. One would think lung cancer would operate equally between men and women but women get it much more often. There are certain outcomes, because of women's sex, that are more difficult. It is important that, while we shine a light on women's health action plans generally and the work to support women in their healthcare across the board, we make sure there are appropriate responses for the physiological differences in women, serious research is directed at improving women's health outcomes and we get to a point where women's health is treated as naturally as all health and there is no real differentiation. I welcome Senators' contributions.

Maria Byrne (Fine Gael)
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I will share my time with Senators Ní Chuilinn and Bradley.

Alison Comyn (Fianna Fail)
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Is that agreed? Agreed.

Maria Byrne (Fine Gael)
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I thank the Minister for coming to discuss this all-important issue of women's health to mark International Women's Day. There is nobody more committed than the Minister to resolving so many issues. I would like to raise a few issues with her. She referred to a few of them in her opening remarks. I campaigned on one of them during the previous Dáil and Seanad, which was the free HRT campaign. It was to be introduced in January but it has not happened to date. I know there was a shortage and there also have to be negotiations with pharmacies and the pharmacy union. From speaking to the pharmacy union, it is looking for engagement. Many women would benefit from the scheme once introduced. I am aware of the Government's commitment to its introduction.

I would also like to raise CervicalCheck and BreastCheck. CervicalCheck runs out between 60 and 65 years of age and BreastCheck between 60 and 69 years of age. These are preventatives. I would like the Minister to look at extending it.

The Minister referred to maternity issues in her speech. I wish to raise the maternity hospital in University Hospital Limerick. I believe the site was selected on the grounds of UHL about 15 years ago. There has been loads of talk of it moving but the conditions affect not only the staff, but also patients who avail of the hospital. It is on a very small site. There are many restrictions around visiting and supports for people attending it. Will the Minister look at this issue? There is also the area of perinatal health. Quite a high percentage of women end up with perinatal health issues but it is about going to meet the clinician, having that conversation and receiving that support. The last time I was at the maternity hospital in Limerick, there was a small box room and the waiting room was outside for every other area so everybody could see you in the room. It deserves more support and space.

I was delighted to hear the Minister mention endometriosis.

The area of cardiovascular health is very close to my heart. It is important to encourage people to get checked and keep checking. People do not realise until it happens to them.

On the cancer strategy, the work happening and the treatment people are receiving are fantastic but there is an issue relating to medical cards. When somebody is given a terminal diagnosis, he or she should automatically qualify for a medical card while having treatment because of the stress and strain it puts not only on the patient, but on the patient's family, in applying, being refused and having to appeal it.

Those are some issues on this International Women's Day.

Nikki Bradley (Fine Gael)
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I thank the Minister for her time. I am conscious that she has covered some of the things I am going to mention but I will cover them anyway.

This week, we celebrate the strength, resilience and achievements of women across Ireland, but as we take pride in our progress, we must also confront the gaps that have a profound impact on women's lives. Today, I am addressing the gaps in women's healthcare. Women in Ireland are more likely than men to experience delays in diagnosis and longer waiting times for treatment. Conditions that predominantly affect women, such as endometriosis, autoimmune disorders and certain rare diseases, often receive less research funding and clinical attention. For women with disabilities, the barriers are even steeper with inaccessible clinics and a system that sometimes fails to understand their unique needs. Although the issue of rare diseases may seem abstract, the term is a misnomer.With thousands of diseases classified as rare, the total number of individuals - I say "individuals", as it is not just women - estimated to be afflicted with these conditions is one in 17. That is 300,000 men, women and children in Ireland, so not so rare after all. There is growing evidence that women with rare diseases are offered less comprehensive care than their male counterparts. Historical biases and a lack of gender-specific studies contribute to delays in diagnosis and fewer treatment options tailored to women. We must do better. We must ensure that healthcare providers are fully equipped to recognise and treat rare diseases in women just as effectively as in men.

As a Donegal woman – I always like to throw that in – the impact of an under-resourced healthcare system is especially clear in the north west. While Letterkenny University Hospital boasts dedicated and skilled professionals, resource limitations mean that women in the region face longer waiting times and fewer specialist services. Whether a woman lives in Donegal, Dublin or Kerry, her health should be prioritised equally without geographic bias.

Today, I call for a greater investment in women's health research to ensure that conditions affecting women receive the attention they deserve. I also call for stronger support for women with disabilities, by making healthcare facilities accessible and inclusive. In addition, I call for a commitment to rare disease care so that the roughly 150,000 Irish women affected are provided with timely expert treatment. Last, I call for equitable resource allocation across all regions so that no woman's quality of life is dictated by where she lives. Healthcare is not a privilege, it is a right. On this day, let us commit to building a system that truly works for all women because when women are healthy, our families communities and societies thrive.

Evanne Ní Chuilinn (Fine Gael)
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The Minister is very welcome. I thank her for her opening remarks. I echo her frustration - although that might be the wrong word, so "exasperation" - that we must have these weeks for women in sport, women in politics, and women for election. I hope we will get to a point where we do not have to have special weeks because, as the Minister says, we are half of the population.

I want to raise awareness today for a condition called hyperemesis gravidarum.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am aware of it.

Evanne Ní Chuilinn (Fine Gael)
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It was not in the Minister's opening remarks, which is okay, as those remarks were concise. It does not surprise me that some might not have heard of hyperemesis gravidarum because it is quite rare, which confirms the need to bring it up and to highlight it as well for women in this country. There is still a lot of shame, stigma and guilt attached to it. The condition is quite self-limiting for those who suffer from it. It is defined as a complication of pregnancy in which women experience extreme levels of nausea and vomiting. We know that many women experience nausea and vomiting in pregnancy – in fact, 70% to 80% of women do. It is awkward, uncomfortable and awful but it is very normal. However, it is not normal to experience that at extreme levels. Although only between 0.3% and 3.6% of pregnancies in Ireland are affected, it results in 3,000 hospitalisations.

I have notes but I do not really need them because I suffered from this three times. It is absolutely awful. You can imagine what it is like if, on waking in the morning, opening an eyelid or moving a big toe is enough to set you off. You have to run into the bathroom and vomit. Three hours later you might still be on the bathroom floor because you cannot move. Three days later you are probably in hospital on a drip replenishing the nutrients that your body has lost over the three days of cyclical vomiting that it is impossible to stop. Most of the time, it means you will be admitted to hospital.

I have experience of it but, thankfully, my experience in 2021 and 2022 was entirely different to what it was in 2011 and 2012 because of more education and awareness. The reason I bring it up now is because it will ensure that situation will only improve. One reason is due to the availability of the medication, Cariban. When I first suffered with hyperemesis in 2011, nobody knew what it was, including doctors and GPs. There was very little awareness or education. I was very lucky that a consultant in the Coombe had heard of the use of the drug, Cariban, in Canada previously, although it was not licensed in Ireland. Like me, thousands of women over the past decade paid €84 a fortnight each for the drug just to survive, be able to mind our other children or go to work, see family and function in the world.

Thankfully, Cariban was licensed in August 2024 and it is available on the DPS. It is important that GPs be made aware that they can prescribe Cariban. There is sometimes a little bit of doubt in that it used to be only available from consultants. It is important that GPs in communities all around the country realise that they can prescribe because there can sometimes be a delay in getting the drug for women when the GP they attend does not realise GPs can prescribe it.

That is just one piece. The other piece is that our communities, families, friends and, crucially, our employers need to understand that this is a very serious condition. Women are not being lazy by not going to work. They are not being irresponsible if they are not able to mind their other children. They are not being bad friends when they are not able to meet up. They need help, socially and in every other way. It is important to raise the issue. I want anybody suffering from hyperemesis in Ireland to know that we hear them and we feel for them. It is a really difficult thing, but they are so resilient and they will get through it.

Michael McDowell (Independent)
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With the permission of the House, I wish to share my time with Senators Clonan and Keogan.

Maria Byrne (Fine Gael)
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Is that agreed? Agreed.

Michael McDowell (Independent)
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I am very glad to have the opportunity to contribute to this debate. I welcome the Minister. The progress on women's health issues that she outlined in her statement is very encouraging material. I compliment the Government on all of the initiatives it is taking in this area. I want this to be understood.

Women's health is not only an issue for women. It is also an issue for men. Men and women together are affected by women's health issues dramatically and sometimes tragically. We cannot segregate the consideration of women's health into a small corner where only women are concerned.

Although this debate on International Women's Day is focusing on health issues relating to women, we should not forget what happened on International Women's Day last year. There was a referendum in which various proposals were put to the people that were rejected in the round. I do not want to reopen those issues here now, but I do want to say this: the women of Ireland overwhelmingly voted against the Government's proposals. In that context, I want to raise the fact that the National Women's Council took a very strong position on one side of that debate but women generally are entitled to be heard right across the board. NGOs do not always represent the real concerns of all women, which include such issues as we are discussing here today.

Misinformation was put out by Ministers at that time. I am glad to say it was not this Minister. People were told things that were untrue about the implications of what they were being asked to vote for. It is interesting to note today that the Government is coming forward with amendments to social welfare legislation to deal with the O'Meara decision. If we had passed the "durable relations" definition of family, it would have affected a range of issues right across the board. We were misled by Ministers at the time on the consequences of the votes. That issue has not gone away. Accountability for that misinformation should never be forgotten.

If we think about them, vaccination programmes such as the HPV one are both male and female issues. The fact is that women are the people who bear the consequences of male-female issues. We should not segregate or compartmentalise women's health into an area where only women are heard. If we are going to do that, we should remember that all women should be heard, not just activist NGOs that have a particular agenda.

Tom Clonan (Independent)
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Cuirim fáilte roimh an Aire go dtí an Teach. Déanaim comhghairdeas leí. I have not seen her since her appointment. I am delighted for her. I know she will be very good in the role.

I wish a happy International Women's Day to all of our colleagues and all those watching. I owe so much to the women in my life, including my mother for giving birth to me. "Thank you, mum". May she rest in peace.

I want to talk about a concern that has been raised with me specifically in the context of women's health by two paediatric surgeons. It relates to the urological waiting lists at Children's Health Ireland. This is an issue that impacts predominantly disabled girls and young women.People will be aware of the issues around the scoliosis waiting lists, and the fact that we have children, boys and girls, who are not getting the surgical interventions they need within the therapeutic window. There are hundreds of boys and girls on the urological waitlist list and 40% of the girls and young teenagers and, in fact, young women on that waitlist qualify for or need what is called the transitional urology programme because for certain disability issues and certain diagnoses like cerebral palsy, for example, although there are other issues, young women and girls experience congenital anatomical changes in their genitalia and reproductive organs. This is a cohort of young disabled girls and Irish teenagers who have to go through all the pathways of adolescence. Members all remember when they were teenagers and how difficult that can be, but to be a disabled girl, adolescent or young woman, it is even more difficult.

Compounding that is the lack of the transitional model of care that is commonplace in other jurisdictions. For example, it has been in the NHS for 23 years, since 2002, and it has been rolled out in the United States since 2005, so it is international best practice, and it is long recognised. It is not happening here. These girls and teenagers need to have a consult with a urological surgeon and then to have surgery within two and a half years at an absolute maximum to have vaginal reconstruction. If they do not get that, they will suffer from higher cancer risks - I am talking about multiples - of bowel, ovarian and bladder cancers, infertility, incontinence and all the psychosexual problems that go with not having these key interventions. Within the lifetime of this Government, this is an area in which the Minister could really make a difference with regard to our disabled women and girls.

Sharon Keogan (Independent)
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The Minister is very welcome. First, I extend my congratulations to all the women who were elected to both the Dáil and the Seanad in the recent election. I look forward to working with them all in the coming session and wish them all the best in their endeavours. In both Houses, we have the highest number of female Members elected in the history of the State. Here in the Seanad, nearly half of our Members are women, arguably making it the closest an Irish elected body has ever been to gender parity.

This coming International Women's Day will mark another anniversary, that is, the comprehensive defeat of the Government's attempt to eliminate women from the Constitution. This time last year, I and a few other Senators found we were low on voices in calling for the public to reject the Government's motion and thank God, the public answered. Luckily, while virtually the entire leadership of our political parties, nearly all of our Government sponsored NGO complex and the vast majority of the established media were gung ho to eliminate women from the Constitution, the Irish people themselves were not so easily fooled. However, now that the constitutional rights for women and carers are secured, we urgently need to move forward in making concrete improvements in their lives.

Some 90% of the carers in Ireland are women, and the current regulations on the carer's allowance are in many cases actively harming them. Recently, Meath County Council passed a motion from Councillor Carol Lennon for the 18.5 hour limit on work imposed on recipients of the carer's allowance to be disregarded for cases of study, education, training and volunteering. I call on the Government to heed this motion. The current work limits stop carers from being able to upskill by preventing them from pursuing continued education. This causes far too many women to miss out on years and even decades of professional development, meaning that by the time they return to the workforce, they do so at a considerably lower pay grade. The carer's allowance, while an invaluable lifeline, is not an adequate compensation for this. The Government must also finally deliver on its promise to abolish means testing for the carer's allowance as many carer's are married women who are already dependent on their spouse, and this means testing increases their dependency leaving them open to financial abuse. In short, when it comes to the position of women in Ireland, we can summarise today's situation with the adage - a lot done, and a lot more to do.

I understand the Minister had a meeting - I do not know if it was today or yesterday - with representatives from the Irish Pharmacy Union with regard to free hormone replacement therapy, HRT. All the women in the country were thinking this was going to be rolled out as part of the budget. It was all going to be free in January of this year. The perception was that women in Ireland would be getting this free. Could the Minister please let the women of Ireland know where that is at, the reason for the delay and when the roll-out will take place? I thank the Minister very much for joining us here today.

Lorraine Clifford-Lee (Fianna Fail)
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The Minister is very welcome on this day to mark International Women's Day. We are, of course, discussing a very important topic. It is one in which I know she will excel in her role as Minister for Health. The previous Minister, Stephen Donnelly, changed the landscape for women's health in Ireland during his term of office. I am sure she will continue that very good work and expand on the very many good schemes that were started. However, it is step-by-step, incremental change and, as was pointed out, this is a community issue rather than a women's issue. It impacts everybody in our community and the women in our lives - the women who are caring, teaching and working in our workplaces - and it is right and proper that proper investment is made because, unfortunately, like many things, we are fighting the patriarchy and it manifests in the lack of investment in women's healthcare over the years.

The free contraception scheme really changed the playing pitch for women in Ireland. Since the days of the contraception train going to Belfast, I did not think we thought we would see in a relatively short period of time free contraception for women in this country from the ages of 17 to 35. That was really ground-breaking. However, I would like to ask the Minister what the plans are to extend this to 16-year-olds. I know the previous Minister, Stephen Donnelly, had started working on that and was receiving advice from the Attorney General. Where is that body of work at? Will we be able to expand it upwards beyond the age of 35 because, of course, we know that women over the age of 35 still have a need for contraception? Oftentimes, when people are paying for a lot of things in their lives - expensive rent, mortgage payments, children, childcare and everything else - it can be very expensive for that age group. I would really appreciate if the Minister could give us an update in that regard.

Safe access zones were something many of us in this House worked upon in the last term. I am very glad safe access zones have been put in place to protect women who are availing of termination services and services in our maternity units. The gynaecology see and treat clinics have been a huge success and have really brought down gynaecology waiting lists. The menopause hubs have also been very well received. I know people who have accessed treatment there and they speak very positively. As people have mentioned, the roll-out of the HRT scheme is one thing but the HRT shortages is also something that is coming into sharp focus. There was a recent announcement that Estradot, one of the most widely used HRT patches, will be in short supply for much of 2025 and 2026. This has left women across Ireland feeling very anxious and abandoned. For many women, simply switching to another HRT product is not viable. HRT is not a one-size-fits-all treatment and many women have spent many years finding a product that works for them and coming up with a formula with their doctors to see what works for them. Therefore, the prospect of losing access to this very important drug is very concerning. The Minister might address what specific steps the Department of Health is taking to address these shortages. This then will ensure a long-term, stable supply of this really vital drug.

The free IVF scheme, again, was absolutely ground-breaking and many in this House worked very hard on that, but the expansion of the scheme is something that needs to be looked at. I would appreciate it if the Minister could address that. We know we needed to start with a limited form of free IVF. I am delighted that many couples who availed of the free IVF now have their bouncing babies in their arms, but we need to ensure that more people have access to this. We are facing a population crisis globally, but in the western world as well, and we need to help families to have as many children as they want to have. A lot of people might be able to have one child, but they are suffering from secondary infertility, and it is really important that those people can avail of the free IVF scheme.

Endometriosis was also referred to by a number of people here. One in ten Irish women, unfortunately, suffers from endometriosis. A national framework of endometriosis is currently in train. Could the Minister give us an update as to when this will be published? Education for GPs around endometriosis care needs to be mandatory.Many GPs have taken it upon themselves to upskill and engage in education in this area, but not all of them have done so. It is very difficult for people to switch GP if they find the doctor they are attending does not have skills, knowledge or interest in endometriosis. That applies particularly in Dublin but also in other parts of the country. Education and training should be mandatory. There also should be access to holistic care for patients suffering from endometriosis. Surgical treatment is one option but people might also need to avail of other, holistic therapies. Those therapies should be available to women without charge.

I am really glad the Minister mentioned bone health and cardiovascular health in her opening statement. I included a reminder in my notes to raise those issues and the importance of weight-bearing exercise for women as we age. That will mitigate against osteoporosis, brittle bones, falls, bumps and everything women experience as they move into the later years.

As the Minister noted, 18 out of 19 hospitals now provide termination of pregnancy services. That is very welcome. Cavan General Hospital is the one hospital still to begin providing the services. I understand they will become available at the end of March. Can the Minister indicate whether that is still the date?

There is an issue with women being gaslighted and not listened to when they access the health service. This is a particular issue for ethnic minorities and women of colour. We have seen that in other countries and it is becoming more prevalent in Ireland. There needs to be education and training through which biases within the health service are examined.

Shortages of public health nurses, particularly in areas of booming population such as my area of north County Dublin, are really impacting on women. When women are at home with small children, particularly their first child, it is a very vulnerable time of life. Women often have a toddler and a newborn at home and are unable to access the public health nurse service to which they are entitled. Other Members have raised this issue in the past. I hope the Minister can give us comfort that more public health nurses are being recruited, trained and deployed, particularly to areas of growing population.

The goal that was set of eliminating cervical cancer is achievable with access to the human papillomavirus, HPV, vaccine. I am glad the vaccination programme has been rolled out. The uptake is quite good but there are still some problems in that regard. There was a lot of vaccine hesitancy and there still is such hesitancy in regard to this particular vaccine. Much work is still needed in that area.

The lung cancer pilot screening project, in which north Dublin is included, is very welcome. I hope it will be rolled out to other parts of the country. As the Minister said, women suffer in particular from lung cancer.

A constituent contacted me recently regarding the repeated cancellation of vital surgery she is awaiting to correct very serious injuries she sustained while giving birth. Those injuries have been very impactful on her life and on the lives of her family. However, these surgeries are seen as non-urgent. This woman has repeatedly faced her surgery being cancelled. I ask that it be made a matter of priority to secure treatment for women who have suffered injuries during birth, which can be really horrific, wide-ranging and impactful on day-to-day life. Such surgeries must be seen as a priority and not something that can be cancelled and put on the long finger.

I suffered from hyperemesis during pregnancy. Those who have served with me here in the Seanad over the years know this is something on which I have campaigned. Mine was a lone voice for a long time. Cariban made a significant difference to my life and I am glad the medicine is now available on the general medical services, GMS, scheme. As my colleague pointed out, we need a public awareness campaign to inform people that this drug is available and is safe to use. Given the experience with other drugs in the past, many women are reluctant to take Cariban. It is a very safe drug and it can be life changing for women suffering from hyperemesis.

I have loads of other points to make but my time is up. We will have more time with the Minister in the future to discuss this really important topic. I thank her for coming to the House. I hope she will work with us to progress all these issues.

Maria Byrne (Fine Gael)
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I understand four Sinn Féin Senators are sharing time, with two-and-a-half minutes each. I call Senator Nicole Ryan.

Nicole Ryan (Sinn Fein)
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As a woman, I have experienced at first-hand the shortcomings of our medical system, as have so many female Members. One of the glaring issues is the overreliance on the contraceptive pill as a default treatment for women's health concerns. Instead of offering proper investigation, testing and a wide range of options for women, the pill is often handed out as a quick fix. Women are told to take it and see how they get on. If a woman has bleeding, she is offered the pill. It is all about the pill, not because it is the best option for us but because it is the easiest healthcare treatment.

The Minister spoke about all the supports for women that are available and are coming onstream. They cannot come fast enough. I highlight the issue of pregnancy loss and miscarriage and the lack of supports in that area. Statistically, one in four women will go through miscarriage. I stand here today as one of that number. While the process in maternity hospitals is very good, including in the excellent early pregnancy unit in Cork, after women go through that, they are left on their own. During the process, I found I received great medical advice in some places but that was not the case in others. I knew things were wrong. Had they been investigated sooner, it might not have stopped the loss but it could have helped me to deal with what was about to come my way. Three days before my 12-week scan, I miscarried. While the physical pain of going through a miscarriage is really hard, nothing could have prepared me for the emotional and mental pain I had to face over the coming weeks. It is still with me today and always will be with me. It takes three miscarriages before the problem is investigated. A woman has to go through this three times before anybody investigates any potential issues with various aspects of her health. I ask the Minister to consider that. It was not until I spoke to other women in my circle and my community that I realised they, too, had gone through miscarriages. There is stigma and shame attached to the issue. Every aspect of women's pregnancy journey must be supported, whether it is loss or aftercare.

Maria McCormack (Sinn Fein)
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I congratulate the Minister on her appointment. I am delighted she is here and to hear all her plans. I was really delighted to hear her mention endometriosis, which is what I will talk about today. It was great to hear other Senators discuss it. As Senator Clifford-Lee mentioned, it is a disease that affects one in ten women in Ireland, yet it remains widely misunderstood, underfunded and inadequately treated. These women are not just statistics; they are our sisters, daughters, friends and colleagues, many of whom have been left to suffer in silence. Endometriosis is not just a bad period. It is a chronic, inflammatory and whole body disease that causes extreme pain, infertility and, in severe cases, damage to vital organs. It takes an average of nine years to receive a diagnosis in Ireland. Women go through nine years of pain, missed opportunities and of being dismissed. For many, by the time they are diagnosed, the disease has spread beyond the reproductive system, affecting the bladder, bowels, diaphragm and even the lungs.

At present, treatments for endometriosis are outdated and mismanaged and there is a complete lack of specialised care. Instead of receiving gold standard excision surgery, which is the only proven treatment, women in Ireland are being prescribed hormone therapy, chemical menopause or, worse, unnecessary hysterectomies. These are not cures. They are stopgaps, leaving women to deteriorate further. The HSE has promised to provide public clinics but they are oversubscribed and lack trained specialists. Women are left with no option but to travel abroad to London, Romania or the US at enormous personal cost.This is not a choice; it is a failure of our system. We must act now. I am calling for the plans the Minister talked about to be acted upon. We could introduce specialised centres for endometriosis that would be staffed properly with suitably trained experts; not just gynaecologists, but multidisciplinary teams comprising urologists and colorectal and pain management specialists. There could also be a nationwide awareness campaign in order that young girls, parents, teachers and all healthcare professionals might recognise the symptoms early. Women with endometriosis are missing from our society. They are absent from work, from education and from their own lives. This is not just a health issue; it is a human rights issue.

Joanne Collins (Sinn Fein)
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I welcome the Minister. The first issue I want to raise is early breast screening. Breast cancer remains the most common cancer among women in Ireland. Despite medical advances, we still lose too many lives because early detection is not prioritised. Our current screening is for over-50s. We would like to see 40 as the cut-off. We need targeted awareness campaigns to encourage younger women to check for symptoms and access medical advice early. We also need investment in genetic testing for those with a family history of breast cancer, thereby allowing for early intervention. We cannot put a price on women's lives, and delayed screening is costing lives. Early detection is what will save lives. Last year, I had a scare. Thankfully, I got the all-clear, but a friend of mine had the same issue at the same time. We were referred to the same by two different GPs. My GP over-exaggerated the position slightly because she wanted me to get a mammogram. My friend's diagnosis was not over-exaggerated. She came out and was fine too, but at least I got the test. I knew 100% that I was okay. She did not know, and just had to play a guessing game all along. Different doctors will do different things. Referred to the same clinic by two different GPs, we had different experiences. It would be nice to bring the age threshold down just to save on that happening.

Pauline Tully (Sinn Fein)
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I welcome the Minister and congratulate her on her appointment. I am delighted for her.

I intend to raise a number of issues about women's is going to will provide clarity. Will she also provide clarity on whether GP costs will be included in the scheme? I know they are for the contraception scheme.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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They are not included.

Pauline Tully (Sinn Fein)
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That will be a barrier for some women because it can sometimes cost €50 or €60 to visit a GP in order to get a prescription. That is unfortunate. Can it be looked at again?

The contraception scheme is currently for those aged between 17 and 35. Are there plans to extend the scheme? Many women who get pregnant are over 35. I know one woman who was 49 when she found out, much to her surprise - let me put it that way - she was pregnant. She blamed a certain victory that the Cavan team had and the celebrations afterwards for this happening. Can the scheme be extended and can we look at younger girls who under their GP's care having access to contraception?

Does the Minister have plans to update and review the maternity strategy? I would love to see improvements in maternity care. There have been many such improvements, from fertility treatment right through to breast screening. There is an idea of Ireland being the safest country in which to have a baby. Unfortunately, that is not yet the case. There are a number of investigations going on, which I will not reference, about the loss of children at birth. The latter should not be happening in this day and age. The assisted human reproduction Act was passed last year, so the legislative framework is in place to develop publicly funded access to assisted reproductive services such as IVF. Are there plans to roll out access to IVF?

I would also love to see more investment in community midwifery services. Some women would love a home birth. There should be more support for home-based care for women who choose to have their babies at home. There also be more support for midwifery-led units. There is an excellent unit in Cavan General Hospital and another in Drogheda. They are only two such units in the State. I would love to see that type of care invested in and rolled out to more women across the State. There was a scare approximately five years ago that the midwifery-led unit in Cavan was going to be downgraded or closed. Thankfully, that did not happen. I want to make sure that cannot happen going forward because it is a service that many women value and choose to use over a consultant-led service.

I also want to see more investment in health and social care supports for survivors of abuse and domestic violence.

Maria Byrne (Fine Gael)
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We are running short on time, and we still have a lot of speakers. Will people be as brief as they can? We will move to the cross-party group and Senators Harmon, Stephenson, Cosgrove and Noonan. The Senators will have two and a half minutes each. Is that agreed? Agreed.

Laura Harmon (Labour)
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I welcome the Minister and congratulate her. It is clear she has hit the ground running in her brief. I wish her well.

The first issue I wish to raise is that we will always need to have stand-alone discussions on women's health because it is a specific subject, just as we must also have stand-alone discussions on Traveller women's health or LGBTQ women's health.

There are so many different areas within health. Even within postcodes, it is probable that there are variations. Will the Minister comment on BreastCheck screening and if there are plans to extend that based on age to younger women in the between 20 and 49 age group.

Endometriosis was mentioned by a number of Senators. It is concerning that we were promised a national framework on that in April of last year and that such a framework has not been fully published. The regional hubs are welcome, but they need to be resourced.

I would welcome an update on how the roll-out of free HRT is progressing. It is great to see the roll-out of free period products. That matter was not really talked about until a number of years ago. It is good to see the progress there in destigmatising periods and the issue of women's health in general. A challenge on healthcare generally is tackling misinformation and disinformation, particularly in relation to vaccines. It is concerning when we hear of decreases in the uptake of the HPV vaccine. It is encouraging to hear the Minister speaking about plans in that regard.

One matter the Minister mentioned is that, in general, women live longer than men. From my experience in the community when I was canvassing, you would see a lot of loneliness and isolation among older women. Sometimes they outlive their partners, and loneliness is a huge contributor to a number of different health issues, be it cardiovascular problems, depression or anxiety. There is probably an initiative needed with other Departments in the context of how we tackle loneliness. We will be having a debate on aspects of this matter later.

Patricia Stephenson (Social Democrats)
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I thank the Minister for coming to the House for this debate. We have already heard about medical gaslighting this afternoon. I suspect most, it not all, of the women in the Chamber can speak about experiences they have had when they have not been believed. Perhaps they have had really severe migraines and been told to try yoga or drink herbal tea. I once turned up in such severe pain to see a doctor that I was vomiting. I was given diazepam for stress. It turned out I had appendicitis. From what I have heard from colleagues today, this is a really common issue. It is so normal that women have this experience. The Minister said that women's symptoms are different. However, the answer has to be about what practitioners do about that, whether it is by means of gender-sensitive training or more research into how women's symptoms are different. We have heard about endometriosis already. So many women have their symptoms completely dismissed for up to eight years, leaving them in debilitating pain. That cannot be the way we do health.

Last week, I attended a presentation by Cared Ireland. I suspect some of those Members present also attended. I put on record my thanks to those who spoke and shared their harrowing experiences. Eating disorders disproportionately affect women. In 2022, a report from the HSE highlighted that most people seeking treatment were young women, particularly those in their teenage years and in their 20s. Disgracefully, as of April last year there were only three beds in Ireland. There were 20 promised in 2018, but no funding has been allocated for these additional beds. Women with eating disorders report their condition being dismissed by healthcare providers as stress related or as them being concerned about their physical appearance. It is not being treated as the mental condition it is.

Many women are expected to endure painful medical procedures with minimal pain relief. They are told to take paracetamol for highly traumatic gynaecological procedures, and they are not given appropriate anaesthetics.This should be routinely offered.

I also want to touch on some of the issues affecting women with intersecting identities. We have women of colour, Traveller women, Roma women, trans women, queer women, and refugee and migrant women and they have intersecting barriers to getting the proper healthcare they need, including structural barriers. We need to move beyond that and recognise the barriers within our systems that stop people from getting the healthcare they deserve. We need more investment in healthcare that prioritises the intersectional needs of diverse women.

Nessa Cosgrove (Labour)
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The Minister is very welcome. It is great to see a woman in the role and I have no doubt she will excel at it.

I will speak about poverty and women’s health. Poverty affects the health of men and women but there is the feminisation of poverty, by which I mean, women experience poverty at a higher level and more severely than men. This is caused by discrimination, breaks in periods of working life and, particularly, low wages in what are seen as female professions, including the caring professions in the areas of home care, healthcare and early years. Up to 98% of people working in the early years sector are women and 79% of people working in social care are women. The current minimum wage is €13.50 per hour but the lowest rate for childcare workers through the employment regulation order for the early years sector is €13.65, which is just 15 cent more than the minimum wage. This is an absolute scandal when we think we could not go out to work if it was not for these early years workers who are looking after our children. The lower hourly rate for care assistants is €14.79 but, shockingly, there are still examples where, despite employment regulation orders, care assistant posts are being advertised for less, particularly in migrant communities, which we rely on so much. It really shows a disrespect to low-paid workers.

Low pay has consequences for women’s health. Low-paid workers are likely to have poorer working conditions with regard to sick pay, maternity pay and holidays. They have fewer collective bargaining rights. I will give a shout out to the Irish Women Workers Unions during the 1945 laundry strike. If it was not for them saying they needed two weeks holidays back to back to look after themselves and their children, getting such holidays would never have happened.

Low pay can lead to stress, mental health difficulties, depression, anxiety and addiction. This is amplified by women having the majority of the unpaid care duties and domestic work in the home. There is not a cohabiting couple here that does not argue about the unequal division of unpaid work in the house.

Disadvantage is a consequence of poverty and exclusion and women living with economic disadvantage have shorter life expectancies. Traveller women have a life expectancy of 11.5 to 12 years fewer than other Irish women. Poverty and disadvantage will probably always exist but there is a way forward, and I would like the Minister to intervene in this regard and work across Departments. We could lift nearly 60,000 women out of poverty and disadvantage by recognising their key roles as carers and early years educators and paying them appropriately through very simple State mechanisms such as employment regulation orders and, crucially, by enforcing them.

Malcolm Noonan (Green Party)
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Cuirim fáilte roimh an Aire agus déanaim comhghairdeas léi. Ócáid thábhachtach is ea Lá Idirnáisiúnta na mBan. Tá sé níos tábhachtaí ná riamh de bharr go bhfuil an bonn á bhaint de chearta ban agus cailíní in an-chuid tíortha, bíodh sin i réimse an oideachais, fostaíochta nó in ábhair ghnéis. Tá ról suntasach againn i leith shábháilteacht na hÉireann mar thír ina gcuirtear rogha leathan deiseanna ar fáil do chailíní óga agus iad ag teacht in inmhe.

International Women’s Day is an important event and growing in importance as the education, employment and reproductive rights of women and girls in many countries continue to be undermined. We have a strong role as legislators to ensure Ireland is a safe country full of opportunity for young girls growing up.

I acknowledge the significant progress made during the previous Dáil and, in particular, the work done in the Seanad by colleagues, including my former colleague, Pauline O’Reilly, on issues such as the free contraception scheme, specialist clinics, menopause care, endometriosis centres, publicly funded fertility treatments and HRT, which we all appeal be progressed. There were also the safe access zones in terms of termination of pregnancy.

As for further improvements, the promised national maternity hospital must be progressed and delivered as a Government priority. The promise to provide a comprehensive women’s health programme in general practice advice on contraception, STIs, menopause, fertility and so on must be followed through. We need to go further than merely developing a plan of making free period products accessible in more locations. We need to expand the eligibility of State-funded IVF as promised, building on the success of the initial roll-out by the previous Government. We need to fully implement the recommendations contained in Ms Marie O’Shea’s statutory review of the termination of pregnancy Act.

I pay tribute to the women in developing countries who are fighting for reproductive rights against a tide of far-right activism. I pay tribute to those women’s grassroots movements. Cuts in development aid from the UK and US will seriously undermine this and be potentially devastating to the lives of women and girls in terms of their reproductive rights. It is a whole-of-government issue and important to raise today.

Mark Daly (Fianna Fail)
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Anois, an Seanadóir Higgins. Sorry, Senator Flynn. Are you sharing time?

Eileen Flynn (Independent)
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Yes.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Eileen Flynn (Independent)
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The Minister is very welcome to the House to discuss women’s health. I have heard many Senators speak about period products being available in toilets it, and it really annoys me. I have never in my whole life heard a poor woman give out about not having period products. It does not fix the health inequalities within Irish society. I welcome it of course, as do poor women, but this is not my first time to say in the House that we should stop being the do-gooders and saints of poor women within Irish society. Give us the opportunities to do it for ourselves. As Senator Ruane said when we were voting for the Leas-Chathaoirleach, put us women who have had fewer opportunities up front because we are well able to do the jobs.

Women in prison need healthcare. Women from the Traveller community need an awful lot of support when it comes to reproductive healthcare and postnatal healthcare so Traveller women can trust in the system. I know from being a member of the Traveller community when I was pregnant with both Billie and Lacey, I was just seen as the Traveller. I did not have any idea about what was going on with my own body and my child at the time. I have spoken about it in this House before, and know from many Traveller women. After I had Billie I had severe postnatal depression to the point where I once wanted to take my own life. I did not want to go to the health system because I did not trust it. I thought my child would be taken from me. Unfortunately, this is the case for many Traveller women today.

The number of women and children who are homeless in this country is absolutely appalling. It is important to have statements on women’s health but last week I called it an inaction. Why could we have not have gone out and visited women living in hotels, who are in refuges, who are really in the pits of Irish society and do not feel supported? These statements mean absolutely nothing and it is unfortunate to be a woman who is really struggling to feed a family of six or a big family. In the Ireland of 2025, we speak about women around the world who have less equality of opportunity, but it is also unfortunately the case for many women in working-class communities and women from the Traveller community.

I know we talk about the three Cs – childcare, confidence and cost – we need to add the fourth C as soon as possible, which is class. Working-class women do not have the same equality of opportunity as women from a richer class. I heard another Senator speak about going to a GP paying €50 to €70, depending on where the GP is based, for access to a medical service only to be told, “It is all in your head.” Women are very undermined in the healthcare system in Ireland and that should not be the case.

I know the Minister is well-placed in her role.I look forward to working with her in the future. I would love to be able to lower the CervicalCheck age limit, especially for Traveller women who get married younger than women from the general population, sometimes at age 15 or 16. The age for CervicalCheck should be lowered to 20. There should be more supports.

As I have said numerous times in this House, poor women and women from ethnic minority groups are not looking for handouts. What we are looking for are hand ups. We need wraparound support. Mental health is a major crisis in our community. I look forward to working alongside the Minister to tackle mental health issues. Traveller women carry the load in our community, which puts a lot of pressure on them. It would be brilliant to work with the Minister to support Traveller women in every way we can and ensure they can access health and have good quality healthcare in this country.

Alice-Mary Higgins (Independent)
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There is much in the Minister's speech that I welcome, including the focus on women being heard. That has come across again and again. Where endometriosis is concerned, our services are very far behind because there is a need for a culture shift in them. There is also the question of having a voice and choice in respect of maternal health. There is huge pressure on older women to have inductions, and the pressure around inductions in maternal health is an issue. The question of when women get listened to persists because we have a long legacy of women not being listened to, in particular when it comes to issues of their reproductive health. As others have said, that is amplified for those who come from a minority community or do not speak English as a first language. A huge cultural shift is needed. Regarding the National Maternity Hospital, I have always been clear on preferring that it be fully publicly owned but what will be vital is that the culture there is one that is fully public and accountable.

We are marking International Women's Day. We are in a context of a huge roll back in respect of women's rights across the world. It is a very dangerous time. I will focus primarily on areas related to health. Recently, the attempts to disappear women are quite sinister. Some complain about the word "women" disappearing, but what we are actually seeing is that those who are against LGBTQ rights are happy to sacrifice women's rights even when it comes to things like visibility in health research. In the United States, the Centers for Disease Control and Prevention, the National Science Foundation and the food and drug bodies are circulating lists of words that, if they appear in research, the research might need to be pulled. There are questions about whether the word "woman" appears on some of those lists, as well as the words "female", "bias" and "transition". Some of these are basic scientific terms. This is happening because priority has been given to attempts to trample on the rights of, for example, trans women. Of course, that leaves all other women by the wayside. There is a huge ideological issue affecting the scientific research we need in order to have good health outcomes.

The international health research world is a community. I suggest that this is an opportunity to see how Ireland can engage with some scientific researchers who find themselves silent in the United States. It may be a time for particular resources for our health institutions and universities in terms of partnering with those who find their research blocked.

Alongside this, we see cuts to the USAID's budget. A lot is made of UK Prime Minister Keir Starmer being a wonderful diplomat. The cut to the UK aid budget is something that is deeply damaging to international diplomacy, alongside what has happened in the United States. It is actually mirroring what the United States is doing, bizarrely. It has a massive impact on women across the world, bearing in mind that front-line health services - women tend to be on the front line - were hit unequally in terms of Covid. They are now being hit by massive cuts. There has been a 50% cut to the aid budget of the United Nations family planning body, for example. Some 11.7 million women in Africa will have limited access to contraceptive care. These are some of the massive things that have happened this year. How will Ireland step in and how will the Minister work with our partnerships in terms of overseas aid to help bridge some of those terrifying gaps in women's health?

Some of the greatest health threats to women come from conflict. Across the world, we have seen the use of sexual violence as a weapon in war. Crucially, we have seen the devastating impact of the disregard for civilian lives. Healthcare facilities have been made a target, which is never acceptable and is a war crime. To see all of the hospitals in Gaza that have been demolished is shocking. We have all seen the reports from those who have given birth without anaesthetic by caesarean section. Some 60% of preventable maternal deaths across the world are happening in conflict zones. I would like to address that as a health and women women's rights issue. I intended to raise other issues, but I will park them for now.

Mark Daly (Fianna Fail)
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Thank you, Senator. I have 12 Senators offering to speak and I have to call on the Minister at 4.20 p.m. I believe the Leader has a proposal.

Fiona O'Loughlin (Fianna Fail)
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I have a proposal that, notwithstanding the Order of the House today, statements to mark International Women's Day, shall conclude at 4.45 p.m., if not previously concluded.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed. I thank the Minister for staying for an extra 15 minutes. I ask Senators, given the fact that 12 Senators have offered, it will have to be a case of loaves and fishes, with about two minutes apiece. Is that possible?

Fiona O'Loughlin (Fianna Fail)
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Yes.

Teresa Costello (Fianna Fail)
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I thank the Minister for coming to the House. In the week that we celebrate International Women's Day, I am glad to say that we are witnessing a shift. Women are rising up and finding their voices, and no longer accept a substandard approach to their healthcare. We are demanding and achieving better services and care. Above all, we are demanding to be heard when it comes to our health.

For far too long, certain aspects of women's health were not discussed openly. This may have been due to embarrassment or an ingrained belief that such issues were private matters, topics to be whispered about or not spoken of at all. The more we speak out, though, the more we push back against the circle of silence and break the silence. For example, menopause was simply referred to as "the change" for generations, a term that barely captured the emotional and physical toll it takes on a woman. Many women suffered through this difficult phase of life without understanding what was happening to their bodies, without any resources and without anyone to talk to. They often felt alone, isolated and uncertain. Thankfully, things are changing. Conversations are happening. There is more information available now and the stigma is slowly being erased. The introduction of menopause hubs is a positive step, but we need more of these initiatives. We need to continue to ensure that women have the support and care they deserve during this stage of life.

In the previous Dáil term, under the former Minister, Stephen Donnelly, significant steps were taken towards improving women's healthcare. The introduction of the first ever women's health action plan, the delivery of essential services such as menopause clinics, free contraception, fertility hubs, same-day see and treat gynaecology clinics, specialist endometriosis centres and postnatal hubs. These are incredibly important steps, but they are just the beginning. More is needed and we must keep pushing for further improvements.

One area I am particularly passionate about is breast cancer care. I welcome the recent standardisation of access to post-mastectomy and hair loss products. Lowering the age for free breast cancer screening and improving diagnostic services for young women presenting with signs of breast cancer is something I will fight for and I will not stop until we achieve it. I do not want any more women in their 20s and 30s being diagnosed with stage 4 breast cancer because they had to wait for months on end for a simple scan, giving cancer the time to progress to a terminal illness.Every woman, regardless of her age, deserves timely and accurate diagnosis because early detection saves lives. Women are no longer silent. We are standing together demanding the changes we deserve and we will not settle for anything less. We also know that the work is not finished. Too many women have been let down by the lack of education, screening and diagnostic services and that must change.

As someone who has faced a serious illness that predominantly affects women, I want to share a piece of advice with you all. You only get one body. Mind it, know it and take care of it. Do not be embarrassed or shy about going to your GP if you notice that something is wrong. If you feel something is off and you are not being listened to, speak louder. Shout, if necessary. Never ever be afraid to seek a second opinion. Your health is too important to ignore.

We will continue to speak out, to advocate for the women who are often overlooked and to demand a healthcare system that serves us all equally and fairly.

Mark Daly (Fianna Fail)
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I know I am not sticking to time but I am conscious that Members are speaking not only for themselves. They are also speaking for the many women around the country who have never been listened to. It is important we hear those voices they are representing - the people they know in their communities - and that we hear their own stories as well. I call Senator Nelson Murray.

Linda Nelson Murray (Fine Gael)
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I thank the Minister for coming in. No doubt she will do a fantastic job. She already is doing so. There are many issues on women's health that have been brought up by all my esteemed colleagues here and I concur with many of them.

Knowing today was coming up, I spoke to a female doctor friend and I asked her what we can do in government to support women's health. I was surprised by the answer given. The answer simply was to support women, especially younger women, to work by providing childcare. I know it is not the Minister's brief but she will understand in a second. This, in turn, will change their health for the better. Access to childcare supports women to work, to exercise, to meet friends, to join groups and to play mothers and others football. It allows them to help their overall health by providing a means to do so. I recognise that it is a priority issue in the programme for Government, which I welcome.

That being said, I will add to that, taking a holistic approach to women's health in general. I am a mother to two beautiful girls. I became a mammy much later in life. I had my first daughter at 39 and my second at 40. Let us just say, it took me a while to get there with some medical help and losses. I share Senator Nicole Ryan's feelings there, but I am truly blessed. I like to think that I could be a role model for my girls, and it is one of the reasons I decided to run for politics. We all know it is not easy, particularly for women, to enter politics. Does the Minister know the questions I face on a daily basis? They are: "Who is looking after your kids while you are here? Are your kids missing you? and "Your kids are very young for you to be in politics?"? Yesterday, I got a spokesperson's role. I was delighted with myself. I got a text from a close friend, who I know meant well, but it read, "Delighted for you, make sure you still give time to your kids." While I was canvassing for the local elections, one person asked me who was minding my kids while I was canvassing. I hate that I am about to say this, because I do not want to separate us women from men, but would any of these people have asked the same question to men?

What I am putting forward for women's health is that we simply support women to be working mammies, if that is what they choose to be, do not judge them for it, try not to worry about their children, and instead tell them we are proud of them and we would imagine their kids are too. Trust me, their well-being will be much better for it.

To all my colleagues, whenever you find yourself doubting yourselves, remember how far you can go and how far you have come. Remember everything that you have faced, all the battles you have won and all the fears you have overcome. Sometimes you forget that you are awesome and this is simple a reminder.

Eileen Lynch (Fine Gael)
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I would like to take this opportunity to welcome the Minister to the House. We are speaking today on an issue that affects every family and every community. The Government has made significant strides in improving healthcare for women in Ireland but many women still struggle to access the care that they need when they need it. I know from experience in my area of Cork North-West that too many women, particularly in rural areas, face barriers when accessing essential services.

There are several areas where we can improve. First, we need to create a culture of listening and research when it comes to women's health. For too long, women's pain and symptoms have been dismissed or normalised - the gender pain gap. We need to change this. We need greater investment in female-focused medical research as, historically, women have been under-represented in clinical trials and our existing knowledge of women's health conditions is incomplete - it is actually woeful. I welcome the proposed further radical listening exercises which are to take place under the women's health action plan and I would appreciate it if the Minister could provide some further clarification on this.

I also believe that we can do more to support women when it comes to reproductive healthcare. I note that is an issue that has been mentioned today by many of my colleagues. I hope to see further roll-out of State-funded IVF treatment for those with difficulty conceiving, but also egg freezing. We need to ensure a wraparound service that supports women at every stage of the life-cycle and in each choice that they make.

Finally, it would be remiss to speak about women's health and not mention the number of women across the country providing care in the home - caring for children and adults with additional needs, their ageing relatives and partners. While 300,000 people across the country identify as unpaid carers, 61% of these carers are women. While caring is traditionally seen as more of a women's role, this mindset is embedded as a part of the fabric of our society. In reality, each and every one of us has been cared for at some point in our lives and however brief, we will likely have to care for somebody at some time. This is a hallmark of our society and it should be a hallmark of our aim to build a more equal society. We need to change our policies to provide greater support for our carers and I am glad that the phasing out of the carer's allowance means test during the course of this Government is included in the programme for Government.

I also believe that this is an area where we can adopt best practice sharing across the European Union where you see many excellent pilot projects and I would encourage the Minister to consider this topic for discussion as part of Ireland's upcoming EU Presidency in light of the European care strategy that was proposed by the Commission in 2022.

We need to ensure that every woman in Ireland receives the care and dignity she deserves and we need to commit to a healthcare system where women are heard, where their health is prioritised and where no woman is left behind.

Fiona O'Loughlin (Fianna Fail)
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I wish the Minister well in all the challenges that she faces. On this day, I also thank the former Minister, Stephen Donnelly, for all the tremendous work that he did in starting a revolution around women's healthcare.

I am conscious that this is about International Women's Day as well as about women's health. I am also conscious that women comprise 45% of Seanad Members, which is fantastic. I say well done to everybody who worked hard to get here, but we stand on the shoulders of all of those who went before us. You see four portraits as you enter here - the four first female Senators, namely, Eileen Costello, Ellen Cuffe, Alice Stopford Green and Jennie Wyse Power. As a practical suggestion, I ask that their names be put under each one. Let that be our action from today. It is important to know them by name.

I am conscious of the women whose voices are not heard - the women from Ukraine, the women from Gaza, and women who are displaced or tortured right around the world.

In terms of the health issues we are talking about, many colleagues have spoken about the really important aspects of women's health that we need to concentrate on. Many of them spoke about supporting cancer survivors, about trying to have more preventative screenings in place, about ensuring we have more IVF and that HRT products are sourced and are available, and about older women who develop dementia and younger women who develop eating disorders. However, something I would like to see an emphasis on also is preventative health measures around nutrition and around the use of alternative health methods, such as yoga, to be able to support us living healthily, living longer and living well.

One other aspect I feel should be addressed is the whole area around the pelvic floor and women who have given birth.This area is neglected at the moment.

Anne Rabbitte (Fianna Fail)
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I welcome the Minister to the Seanad and wish her all the best in the role. In the two minutes allocated to me, I am going to focus on two important issues relating to accident and emergency departments, training and this environment. We need to ensure that when a parent brings a child, a teenager, young adult or an older adult who is neurodiverse or has intellectual disabilities that there is a space there for a sick person to be seen. They need to feel safe and have their rights protected. I welcome the Minister's comment about listening to the mother, the aunt, the sister and the sibling. The sibling knows best, and the mum knows best. Some of our children who are neurodiverse or have intellectual disabilities need to be put in an environment where they are not actually over stimulated, where they get over-anxious, where the lights are too bright, the noise is too much and there are too many strange faces. Could we look at our emergency departments to ensure that there are nurses trained in intellectual disabilities and with autism training as part and parcel of the core team? I thank the Minister for that.

The next issue I want to focus on relates to diagnostic overshadowing again in the context of emergency departments. My ask on International Women's Day is that we listen to mothers, sisters and aunties in order that the staff in the emergency department listen to a child who is nonverbal. They must not assume that because a child is nonverbal or has a condition such as Down’s syndrome or other intellectual disability that he or she does not have a pain. As was mentioned earlier, everyone needs to have their markers checked, temperatures, bloods and have their scans taken. Mum might not want it but please do it because not taking those markers costs lives. Staff should not assume. Staff need training in this to work with people with intellectual disabilities and with children who are neurodiverse. On International Women's Day some mums are grieving for the loss of their child due to diagnostic overshadowing. My speech today was dedicated to a five-year-old whose name is, it is important to say, Kate Molly Colum, who suffered from diagnostic overshadowing. She had Down's syndrome.

Alison Comyn (Fianna Fail)
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I thank the Minister for coming in today and affording us this really valuable opportunity to discuss women's health. I am loath to quote Tammy Wynette in the House but I do agree that "Sometimes it's hard to be a woman", especially in the context of women's health. I will not sing that. I applaud the fact that the Minister mentioned some of the fantastic initiatives that have happened over the years around period poverty, menopause in particular and free contraception. I have spoken at length in the Seanad about my personal issues and what has happened with the shortage of HRT products. It affects many women. I welcome the Minister's comments that she will engage with the pharmacists' unions and try to address those shortages. An update on that would be really valuable as well as the national framework for endometriosis that has been mentioned as well. I would like to see where we stand with that framework.

However, an area that I have been told is still falling short in Irish healthcare is the treatment of eating disorders, the most common being anorexia nervosa, bulimia and binge eating. Girls and women are at greater risk of eating disorders and the core symptoms that come with them such as body weight, body image, shape concerns and binge eating. In a presentation last week to Oireachtas Members, Paula Crotty from Caring about Recovery from Eating Disorders, CARED Ireland, said the lack of progress since the HSE's 2018 model of care for eating disorders is very disappointing. She said despite the plan's promise of 16 specialist and dedicated inpatient beds, the reality is only three inpatient beds are available. I am happy to be their advocate and call for action on this.

As we celebrate International Women's Day, it is encouraging to see such a leap in recent years on better healthcare for all women and a broad selection of women in positions of power here to lead the charge and implement the changes necessary.

Finally, I started with a quote from Tammy Wynette so I will finish with one from Dolly Parton, "If your actions create a legacy that inspires others to dream more, learn more, do more and become more, then you are an excellent leader."

Mark Daly (Fianna Fail)
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The Deputy Leader has a proposal.

Fiona O'Loughlin (Fianna Fail)
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With the permission of the Leader and with the kind support of the Minister I put forward to the House that notwithstanding the Order of the House today, the statements to mark International Women's Day shall now conclude at 5 p.m. if not previously concluded.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed. I thank the Minister for her assistance in that extension of the time again, which is great.

Margaret Murphy O'Mahony (Fianna Fail)
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I welcome the Minister to the House and thank her for giving her time and for extending it a few times. It is great to see a female Minister for Health. I wish her luck going forward.

International Women's Day is a global day celebrating the social, economic, cultural and political achievements of women. Today, to mark International Women's Day we are discussing women's health in the Seanad. Being a woman brings many joys but in life it is not physically easy being a woman. We have to deal with periods, pregnancy, childbirth, menopause, endometriosis and so on, all of which bring literally levels of physical pain. As a young girl and woman I myself suffered severely with endometriosis. I was often unable to go to school and later to work, so I am delighted to see that there is now so much being done for it and that it is being spoken about. It is no longer taboo and is being recognised for the very harsh condition that it is. I am proud to be an Oireachtas Member here today where the words "period", "menopause", "endometriosis" and so on are freely and openly used. We have come a very long way.

I am also proud to be a member of Fianna Fáil, which has been very instrumental in transforming women's health. Following our return to Government in 2020, Fianna Fáil transformed women's healthcare, underpinned by the country's first ever women's health action plan. We built a new national network of same day see-and-treat-gynaecology services, fertility hubs, specialist menopause clinics and endometriosis clinics, a cause very close to my heart. I could talk for a long time about what Fianna Fáil has done for women's healthcare but I am conscious of the time. Again I wish the Minister well and thank her for coming in on International Women's Day.

Rónán Mullen (Independent)
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I will strip it down. I welcome the Minister. I have no doubt of her ability and wish her the very best in the brief. I also thank Senator Stephenson for introducing me to the concept of medical gaslighting. There are several women in my life who like to accuse me from time to time of merely having man flu and I now have the perfect repose.

More seriously, I have three points. We should of course have a broader and indeed longer debate covering not just women's health but other issues. Since it is International Women's Day, we need to have that discussion about what did the public say when they said such a resounding "No" last year to the removal of the idea of the mother's particular role and gift to Irish society as set out in the Constitution. We cannot just ignore people's statements or decisions on these matters when it does not suit us. We should talk about how we can complement the needs of parents, women and men in the home because a clear message went to the Government at that time. Perhaps it needs to be clarified through debate as to what positive measures could be taken to give effect to the decision to maintain the status quo in that area?

In terms of women's health, there are positive and very negative and troubling legacies from the previous Government's endeavours. I welcome, as does everybody else did, the great progress being made in BreastCheck with the mobile screening units and of course the screening units in hospitals. Hopefully, that can be rolled out even more so that more women aged between 50 and 69 can be screened every two years. The outcome is more lives being saved. We must not lose sight of that.

I really regret though, the impact on women's mental health, particularly women abroad, as a result of the surrogacy legislation that was put through last year by the Minister for Health. When I consider the ruthlessness with which that was put through and the lack of attention to the mental health and other needs of women who are exploited through surrogacy, that is one of the great regrets I have from the previous term.

On the troubling issue of abortion, and I will conclude with this, like many other Irish women and men, I am troubled by the rise in Ireland's abortion rates. There needs to be a refocus to reduce abortion, specifically the dangers of basing abortion on a telemedicine model when the HSE has acknowledged that meeting a woman in person increases the likelihood of the provider identifying any coercion or domestic abuse. On maternal mortality, there was a case in a Limerick hospital of a woman who had an abortion via telemedicine, despite the existence of an undiagnosed ectopic pregnancy, and who nearly died because there was no ultrasound. As a matter of informed consent, every woman should be offered an ultrasound, whatever one’s views on the rights or wrongs of abortion. It is a matter of women’s health and the health of their unborn boys and girls.

I wish the Minister well. Whatever differences we may have from time to time, I know she engages seriously with people’s ideas. Those ideas are, I hope, proposed honourably and with integrity in respect of these important issues.

Sarah O'Reilly (Aontú)
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Fáilte and best of luck to the Minister in her new role.

I welcome the opportunity to contribute to this debate on women’s health. The Department of Health has released statistics to Aontú which show that there is a 12% difference in the five-year survival chances for women diagnosed with breast cancer in public hospitals versus those diagnosed in private hospitals. This is a very sad statistic. It is shocking to think that 12 more women out of every 100 will die after being diagnosed in a public hospital compared with those diagnosed in private hospitals. I hope those outcomes will improve during the Minister’s term in office.

On the subject of International Women’s Day, 8 March will mark the first anniversary of the resounding defeat of the family and care referendums, which, had they been passed, would not only have stripped Irish women of their special inclusion in our Constitution, they also would have diluted the already scant rights of family carers even further. It is hard to believe that the National Women’s Council pushed to delete the word “mother” from the Constitution. Aontú, along with a handful of others, took on the might of the entire establishment in live debates. A few good men and women boldly faced down Ministers who were insulated by a compliant Opposition and the weight of many highly paid but unelected NGOs, all willing to ram the referendums through. However, right prevailed over might. Principles, intelligent, critical thinking and genuine care for the electorate trumped Government virtue signalling.

On the topic of the referendum, most of the carers in our country are women. There have been many promises from the Government to end the cruel and unfair means test on carer’s allowance that discriminates against women. Many women provide care full time but are denied financial supports because they are judged on the basis of their husbands' or partners' incomes. When will the Government get rid of the means test for carers? The programme for Government states that the aim is to phase it out. That is simply not good enough.

Joe Flaherty (Fianna Fail)
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I appreciate the Cathaoirleach letting me in, particularly as we are over time.

I commend the Minister on her appointment. She will do outstanding work. I was delighted to see her appointed. She will bring a lot of energy to the job but, more importantly, as we see today, she brings an important dimension to a challenging office.

It was inspiring to hear so many heartfelt and personal contributions from many colleagues. Sometimes, as public representatives, we can feel powerless when people come to us. In one such situation, I am dealing with a mother and daughter who have Ehlers-Danlos syndrome, which is connected to hypermobility spectrum disorder. It is a degenerative, life-long condition which, unfortunately, is not covered under the long-term illness scheme. As the Minister will know, that scheme has not been reviewed since 1975. It covers 16 conditions. With the stroke of a pen, the Minister could make it an awful lot easier for countless thousands of women across this country if she reviewed the scheme in the context of conditions such as that to which I refer but also the many others to which previous speakers referred. Reviewing the scheme could prove to be innovative, ground-breaking and a seismic step forward for our health service. I hope the Minister will take what I am saying on board. I genuinely hope she can look at this scheme. In 1975, I was a small, fat six-year-old boy. That shows how long ago the scheme was introduced. Hopefully, the Minister can have a look at it and change it. Changing it would have a meaningful impact for many women.

Mark Daly (Fianna Fail)
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Before I call the Minister, I again thank her for twice accommodating the extension of the time allowed for the debate.

I welcome Councillor Claire Murray from Offaly and Liam to the Gallery. They are most welcome here for this debate.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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How much time do I have?

Mark Daly (Fianna Fail)
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Fifteen minutes. We are not due to finish until 5 p.m. The Minister has accommodated us and we will most certainly accommodate her.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I genuinely want to try to respond to everything I can. I will preface my remarks by saying that I do not know the answer to everything, but I will try to get better answers as I get further into the brief and things come more naturally to me. I will honestly try to give the best answers I possibly can. I will also try to give very honest answers because I do not think there is anybody in this room who does not want to see the health service improve over time. There is no disagreement on that. There is really no difference between us in wanting to see it improve. The only difference is that I am responsible for paying for it, so I have to be honest about how we can do that and by how much we can increase the budget.

Many of the issues that were raised involve a price tag. While I want to say "Yes" to everything, it is just not realistic or possible for me to do so. I want to be honest about my approach, which is that I want to extend everything as much as possible. However, I also want to try to get the best value for what we are doing. For example, many Senators referred to screening in general and to extending the age limits in respect of, for example, with BreastCheck. We looked at this in the development of the programme for Government in the context of wanting to broaden the age thresholds. We quickly realised we are not clinical experts and it is probably better, as we review these schemes - which is stated in the programme for Government - to take the advice of clinical experts on the best way of doing that. Do we, for example, simply extend BreastCheck in terms of ages? What would be the best ages? How would we capture that in the best way? What are we doing in respect of lung cancer? What is the position when it comes to bowel screening? How are the different cancers picked up at different stages?

I am not a clinician, so there is a process to be engaged with in that context. All those things cost additional money but, in many ways, they have saved us enormous hardship, most importantly, in terms of patient care, and saved us money in terms of treatment. We have to make sure that as we make choices – they are definitely choices – we get the best return for our extended investment in the healthcare system. I will be very honest about all of those things over time.

Many different points were raised, and I want to try to respond to them appropriately. I will deal with HRT first because many Senators raised that. There are two primary issues with HRT. The first is the shortages involved. Specifically, we are talking about HRT patches, in particular, Estradot, which is in short supply. That comes in four different versions or doses. There is a certain amount we can do, and then there is the reality as well. The issue is not access to this drug, as it is with other drugs, for example, where it has not been licensed or anything of that nature. The issue is demand, the growing demand across Europe and the manufacturer’s ability to produce it quickly enough to meet demand, not just here but across the Continent. I am getting updates about the availability of the different patches. The 37.5 mg, the 50 mg and the 100 mg patches should all be resupplied by 7 March. Regarding the authorisation holder, we cannot get an estimated date of return for the 75 mg patch. Senators can see how case by case it is. That is a difficulty. I do not wish to be dishonest in any way. Strictly speaking, the Government cannot override that shortage of supply. We can do everything we can to try, but, ultimately, we are suffering in the same way as the rest of Europe is in respect of the availability of certain medications and how that changes over time. I will always try to get updates and provide information. This is where the expertise of pharmacists is very important. They have - not in every case but in some - been able to find alternatives that have long since been licensed medications to try to support some, not all, women while shortages obtain. I just want to be honest about what is possible.

The second piece, correctly, relates to the cost of HRT. It is important to distinguish something. The former Minister, Stephen Donnelly, secured €20 million funding to cover the cost of the HRT products. That did not include - Senator Tully inquired about this - a GP scheme, nor did it include funding to cover pharmacists' dispensing fees. Those are different. The State has not done that before. I refer to these incremental initial steps. I think the former Minister wanted to pay for the medication as a contribution to reduce the cost. I spoke with a woman yesterday who is getting HRT, as we all do in our different areas, and who paid about €60 for two products. On her receipt, it just says €60 – or whatever the cost – and it names the medications, the number of pills and the dosage, whatever that happens to be.What it does not say is the cost of the medication or the dispensing fee charged by the pharmacist for each medication. For example, in a scenario where the cost is €60, perhaps the medication costs €10 for one product and €30 for another with a €10 dispensing fee for each product. This scheme has been available for implementation since 1 January to cover the cost of medication, not the dispensing fee. It is the first time this has happened but there was a reluctance to implement it.

I met the IPU on 11 February and have been engaging with it since then. There is a huge opportunity here and I would love to speak with the Senator further on this. Pharmacies are a bit like credit unions in that they are in every town in Ireland. Pharmacies could have a much greater and expanded role in healthcare in terms of diagnostics, prescriptions and common conditions. I am really excited about the opportunity for pharmacy and I met the IPU about this. There is a huge body of work to do to support pharmacists a little more than we have been - there is no question about that - to go further in our ambition on what pharmacy can do, as well as to resolve this. In fairness, this is the first time the question of a dispensing fee has come up.

It is not within my budget. I do not have a budget to cover a dispensing fee but I am genuinely trying to find a space in the middle that enables the implementation of this scheme as early as possible, which certainly will cover the cost for medication and then we will see what else is possible. I want to be transparent. The cost of the medication has always been available to be free since 1 January. I hope that answers the fair questions people have asked. It was never to cover all the cost; only the cost of medication. I have gone back to check this a few times but I appreciate how these things sometimes may get lost in translation.

Senator Flynn highlighted women in prison and some of the more intersectional issues. She is quite right and I will address this in terms of some of the issues of more marginalised communities. Women in the Dóchas Centre prison suffer in particular with addiction and mental health issues. I was on the penal reform committee of these Houses before I became a Minister and this is a serious issue. I have asked my officials to try to engage with Dóchas to find ways that I, as Minister for Health, can lean in and do better for women in the prison, particularly in recognising the impact very short sentences have and in respect of the inability to support and treat people over time. Women coming in and out of Dóchas - which they typically do based on the sentences they get - means it is very hard to get any further in terms of providing supports. Two years ago, I was in the new women's prison in Limerick- and we hear all sorts about Limerick Prison. What struck me was the dentist chair there. It really spoke to me about the violence many women had experienced before they ever got to Limerick's prison for women prison and how important dentistry was as an immediate support tool to women coming in. There is probably a no more marginalised group than Traveller women in prison. If you look at the statistics - and I have raised it again and again - Travellers are much more likely to be imprisoned, both the Traveller community in general but particularly Traveller women. It is important to recognise some of the sharp realities of life there.

Several Senators correctly raised eating disorders. I met Deputy Butterly, who was here last week and spoke so eloquently on the radio about her daughter - I think her name is Jennifer, forgive me if I am wrong. I also spoke at the Bodywhys conference, which was an international conference with speakers from London and the Netherlands who provided evidence-based research on early intervention initiatives. They have been doing very interesting research. I recognise, however, there is a need for more supports. I wish to highlight and recognise the Minister of State, Deputy Butler, is doing a lot work on both adult and children in this regard. It is important to recognise that. The new children's hospital - which I visited last week - will have 20 dedicated CAMHS beds, with eight of those beds dedicated to eating disorders. This will be an important step. There will also be 14 of the anticipated 16 multidisciplinary eating disorder teams in place around the country in 2025. We have another two to do there.

Regarding the pelvic floor issue raised by Senator O'Loughlin, I visited St. Michael's Hospital this morning, which has a dedicated unit that opened in December 2024. I am told it is working well in meeting some more of the need.

There is a balance around the issue of IVF and AHR. An amending Bill is needed to tidy up some of the necessary work but it is also important to get the authority established and do this all in one go within this calendar year. I should have said at the outset, however, that I really appreciate everyone's engagement and ideas because I have learned so much from all the Senators here today. There is a body of work to do that will extend eligibility a little more. Once the authority is established, it will enable same sex couples to begin accessing services. It is important when we consider where we go best on furthering eligibility, that we look to the scientific evidence of where we are likely to get the best outcomes first, rather than looking to our constituents or our hearts in the first instance.

Some Senators raised the issue of carers. It is really important to highlight carers. Senator Tully and I were co-chairs of the Oireachtas family carers group and during that period, the disregards for carer's allowance were extended considerably three times, for both the savings disregard and the incomes disregard. We must take this further. We all want to get to a point where there is no means test for that but we also need to look at priority. As the Senators are aware, in my own constituency and others, we deal with carers who are all doing very different things. Some are providing 24-7 care, while some are doing other things. Some carers are caring for one person and others are caring for two. There are very different measures of need in this and while the body of work is really for the Minister for Social Protection, I recognise people have very different experiences.

Cavan termination of pregnancy services will open on 31 March. Regarding pregnancy loss, we did a fair bit on this in the past Oireachtas in extending and making available statutory entitlement to leave and after 24 weeks, people are entitled to a full maternity leave. It is not much but it is some support to recognise the pregnancy. Many female Members of this House and the Dáil spoke on that. I am glad to hear the continuation of that being highlighted. It is such an important issue for - as the Senator said - one in four women. There are many in this room who share that experience and it is important to highlight that loss.

Senator Higgins raised the more international piece and she is quite right to do so. I had one line in my speech on this. Yesterday, I met Marcos Neto, UN assistant secretary-general. I have been meeting him over a long period as we are trying to get the United Nations Development Programme office for sustainable finance to be based in Dublin. We have been working on this for a long time with the former Minister, Eamon Ryan, in the past Government. I am sure the Minister for Finance, Deputy Donohoe, the Tánaiste and Minister for Foreign Affairs, Simon Harris, and the Minister of State, Deputy Richmond, will be supportive of it. Mr. Neto has said Ireland is one of very few countries around the world expanding its overseas development aid budget, in contrast with many European countries. We should all remember that. While we should of course be doing that, this is in contrast to many others who are making significant cuts.

As one of those countries, I am speaking next week to the United Nations Commission on the Status of Women. It has never been a more important time to highlight women in the United Nations, especially with all the changes currently happening in diversity, equality and inclusion all over the world. I want the Senators to know what I am doing on their behalf. I have a bilateral meeting with Sierra Leone. Botswana, Malawi and Ireland are trying, as a trio, to rejuvenate this whole process and to rejuvenate the Beijing Declaration and Platform for Action on genuine equality between men and women. I have a side event, called the "Socio-economic consequences of early Pregnancy in Latin America and the Caribbean; A Call for Policy Action", where I will speak with colleagues from Panama, Costa Rica and the Dominican Republic. We have another really important side event, called "Women in Gaza: Rising for Freedom and Dignity", organised by the League of Arab States together with UN Women. I thank the Senator for highlighting the war crimes happening in Gaza and Ukraine in respect of sexual violence and the targeting of medical facilities. I have a meeting with Karama, a network of civil society and activist groups from the Middle East, and with Concern and have a number of other events. To highlight to colleagues what is happening on an international basis, we are increasing our overseas development aid budget and we are engaged on a multilateral basis to try to lift the experience for women around the world and not just in Ireland, although, of course, our focus starts here. Have I forgotten anything?

Joe Flaherty (Fianna Fail)
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I also asked about long-term illness.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Senator is right that the scheme needs to be reviewed. Everything has a cost so we have to work out the broad need across the board. Not everything will be possible. I thank the Senator for highlighting that. He is right that the scheme needs to be reviewed. Was there anything else?

Rónán Mullen (Independent)
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I asked about a review of telemedicine.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not know enough about that. I will need to look at it.

Mark Daly (Fianna Fail)
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I thank the Minister and all the Senators who have contributed to the debate.