Patricia Stephenson (Social Democrats)
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I thank the Minister of State for coming to the House today. A few weeks ago, during a discussion on women's health in this Chamber, I spoke about women not being believed in the healthcare system. Following that, I received hundreds of messages from women speaking about their own experiences of medical gaslighting. Reading those experiences that women chose to openly share on social media was particularly difficult, as I know the scale of those impacted by medical gaslighting is in fact much higher.

I am requesting an update on the implementation of the women's healthcare action plan, particularly as it relates to the recognition of structural inequality and health outcomes for women, and the need to address what is increasingly recognised as medical gaslighting. I acknowledge that the Department has publicly committed to listening to women as per the action plan, but the failure to believe women's symptoms and pain continues to be endemic in our healthcare system.

Medical gaslighting often strips women of the control they should have over their healthcare choices. Too often, women are not consulted about essential medical decisions until it is far too late to intervene. This is particularly prevalent in maternity care, where many women do not realise they have the power to question medical advice and seek alternative treatment before it is too late.

Women's experiences are invalidated. It is leaving them to question their reality and to shoulder unjust blame for what has happened to them, rather than questioning the shortcomings in their care. I have heard stories from women about being forced to travel overseas for endometriosis care, women being told that their excruciating physical pain is simply anxiety and women crying through IUD insertions without any painkillers or pain relief. Women in Ireland continue to report being told their pain is normal, in their heads or anxiety related. These brush-offs are not just anecdotal; they are supported by international and national studies which show that women wait longer for diagnoses, particularly for conditions such as endometriosis, different autoimmune disorders, cardiovascular disease and even cancers. In addition, gaslighting disproportionately affects women from marginalised backgrounds and those who might have chronic or invisible illnesses.

The radical listening report, commissioned by the Department and delivered by the National Women's Council and Community Work Ireland, lays bare the daily experiences of women when it comes to equitable treatment within the healthcare system. This is particularly true for marginalised women such as Travellers, Roma, disabled women, migrant women and women who are surviving different forms of trauma. They repeatedly describe not being believed, not being heard and being subject to dismissive, harmful or even prejudiced medical treatment.

I reinforce the point that these are not isolated incidents. These are systematic continuous failures. Women report being given sedatives rather than mental health care, being told their pain is imagined or being dismissed because they have a pre-existing disability. This is medical gaslighting, where a person's symptoms are concerned, minimised, misattributed or denied outright. It is not historical; it is happening today. It is happening now and has happened to me. I am sure it has happened to many other women in this Chamber.

Despite the radical listening report's clear findings from 2021, and the health system performance assessment platform now being operational, there is still no systematic collection of disaggregated data on the health outcomes for marginalised women. I would like to know how we can fix something when we are not even measuring the issue.

The Women's Health Action Plan 2024-25 also includes a key pillar on listening to women, including steps to initiate a new "'radical listening' exercise", as it is described, during this year. Will the Minister of State please provide an update on what this means in practice? When will it be conducted? Who will be consulted? What different groups will be brought in on it? How will it lead to women being heard and believed within medical settings? Will the Minister of State also update the Chamber not only on the roll-out of the strategy, but also on what actions are being taken to eliminate medical gaslighting? How are services being adapted to reflect the experiences outlined in the radical listening report? What progress has been made on integrating intersectional, measurable targets into the implementation of the women's action plan? To finish, I am not sure about my time-----

Maria Byrne (Fine Gael)
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The Senator has gone over time.

Patricia Stephenson (Social Democrats)
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Women in Ireland deserve better. They deserve to be heard. In addition, they deserve to be believed and treated with dignity in the healthcare system. That is not happening right now.

Jerry Buttimer (Cork South-Central, Fine Gael)
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I am taking this matter this morning on behalf of the Minister, Deputy Carroll MacNeill. I thank Senator Stephenson for raising it as it gives me an opportunity to update the House on the ongoing work to improve women’s health outcomes and experiences. The Senator is correct that women deserve to be heard, respected and believed. The Minister for Health has previously said, and I will repeat it, that we cannot be satisfied with anything less than a health service that provides true equality of care and treatment and where gender is not a barrier or a disadvantage. Unfortunately, until we get to that place, this conversation must continue. The Senator very eloquently highlighted some of the issues this morning. The women’s health action plan phase 2 and our continued commitment in the programme for Government is part of this conversation. Many of the actions contained within the second action plan are completed, for example: free contraception is now available to all women aged 17 to 35; termination of pregnancy services are available in all 19 of our maternity hospitals in line with legislation; there are increased period poverty supports for some of the most vulnerable women and girls in the country; and earlier this month, the Department of Health completed a women’s health listening forum which brought women into the Department of Health to share their experiences with our healthcare services - both positive and negative - so we can work to make changes that women want to see.

In addition, the Minister, Deputy Carroll MacNeill, is committed to the full implementation of the second action plan, and this work is ongoing. Major improvements are happening across services, including: the development of additional post-natal hubs to support women in the weeks after birth, with funding now available to bring a total of 13 hubs on stream nationally; the national maternity experience survey will be conducted in July this year, whereby women who recently gave birth will be invited to share their experiences of our maternity services, which will inform and improve the safety and quality of care provided to women and their babies; increased hours within the specialist menopause clinics will see capacity increase in this valued service; and funding has been allocated to allow for more staff in the two specialised centres for endometriosis care in Tallaght and Cork and the five regional hubs to support the important care provided to women experiencing endometriosis. If she has not been there previously, I invite the Senator to come to Cork, where we just opened a phenomenal facility. It goes back to what she said about women being listened to and supported. It is a fantastic facility. I am very proud of it as a Cork person.

Six HSE-run regional fertility hubs are in operation and referrals for publicly funded, privately provided AHR treatment commenced in September 2023. There has been continued expansion in the network of “see and treat” ambulatory gynaecology clinics to provide necessary care across 21 sites. A total of 18 clinics are now operational and will offer 24,000 appointments to women next year. Last year, the Department of Health published Ireland’s cervical cancer elimination plan with an aim of eliminating cervical cancer by 2040. A breastfeeding steering group has been established to design and develop a new whole-of-government breastfeeding policy for Ireland and the folic acid steering group has also been established to address instances of neural tube defects in newborns. Crucially, the Minister for Health is passionate about increasing the research available to us in the area of women’s health to build a robust evidence base in a long-underrepresented area.

As the Senator knows, most recently, the Minister announced a hormone replacement therapy arrangement for menopause treatment, as announced in budget 2025, will be progressing but with the addition of professional fees being paid to pharmacists, which will make the HRT completely free in respect of participating pharmacies for women who rely on it to treat their menopause symptoms. This will see the cost burden of this period of a woman’s life reduce significantly. The Minister has also written to all community pharmacists, asking them to sign up to this arrangement, which will commence on 1 June this year.

Too often we hear talk about women being dismissed or not listened to in our health service. Again, the Senator has very eloquently raised that matter, and I thank her for that. The voice of women is paramount. The Minister, Deputy Carroll MacNeill, is committed to hearing those voices, progressing the action plan and advancing women’s health in Ireland. I thank the Senator most sincerely for raising the matter. I look forward to working with her and the Minister, Deputy Carroll MacNeill, in delivering the outcomes we all want.

Patricia Stephenson (Social Democrats)
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I appreciate all of the different actions and steps and I know that women’s health is coming along in Ireland.

I have questions around things like gender sensitivity training. Are all staff receiving that in the new systems and units that we are opening up? Will there be a subsequent plan? This might not be something the Minister of State can answer today but the Minister for Health can come back to me on it. How will the learnings from this plan be integrated into that?

How are we measuring the real-world impact of these changes to women’s healthcare? I speak to women all the time who are still travelling to Romania and other countries for basic women’s healthcare. We need to be measuring the reduction in that regard and using it as a metric to measure the success in our own systems. It is about feedback because even if these units exist, we need feedback from woman accessing those units and healthcare professionals if they are not being treated with equality and respected in that space. Part of it is probably due to the fact our healthcare system is overstretched. Many doctors do not have the time, perhaps, to give the level of care they would like to give.What is happening then is that women are falling by the wayside within that space. We have had this long-term existing issue that our understanding of health comes from the default of men's health because that is how our research has always been. I would like to see what steps we will be taking coming into the next year.

Jerry Buttimer (Cork South-Central, Fine Gael)
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I again thank the Senator. I will bring her concerns and questions back to the Minister. The Government and the Minister share her commitment to providing women in Ireland with a healthcare system that is agile and responsive to the needs of the women of Ireland today. With regard to the women's healthcare questions the Senator has posed, I do not have the answers, as she will appreciate, but I will take them back to the Minister and ask the Department to engage with her. Women are 51% of our population. It is about all of us getting to a point in the conversation where this will no longer be necessary and we can have appropriate and timely care for women across all aspects of healthcare. I think the Senator and I have a similar view on that.

It is important that the framework of the women's health action plan protects our ambitions. It is about a commitment to listening, investing and delivering, and about consistently raising the issue of women's health in the Department of Health. It is about ensuring that the focus remains on the matters that the Senator has addressed this morning regarding women's health. It is a commitment backed up by €180 million in additional funding for targeted women's health supports in a five-year period. That has allowed for a good start to the genuine lasting change that is being delivered for women in our healthcare system.

I assure Senator Stephenson that the Minister, Deputy Carroll MacNeill, wants to ensure that the voices of women are not just heard but amplified and understood, and that their asks, including the asks made by Senator Stephenson this morning, are acted upon. It is about ensuring that we deliver a healthcare system that is better, more agile and supports women and girls to enjoy a healthier and equal life.