Bríd Smith says abortion services still deny women essential care

Thanks very much for the presentations. What really jumps out at me, I have to say, is the sense that we're almost back where we were when we started from the Eighth Amendment, like when you, somebody there, I think it was Katrina, said 90% of doctors don't provide care. I mean, rather than saying 10% do, when you say 90% don't, it actually really jumps out at you, the lack of services for women in this country. And then we also know that there's a lack of mandatory provision in maternity hospitals. So I think when we remind ourselves that the whole question of why we had a referendum on repeal the Eighth and why we need it to say to people, do you want to give women a choice? Shouldn't they have the right to have a say over their own health, over their own lives, over their own material futures, etc.? And we got a huge majority in favour of that. Then I think we need to look at the legislation in this review and address the issues that are really holding us back, half the population, women and girls, being held back by this legislation. And I want to ask a couple of questions. Maeve Taylor said earlier on that she didn't, she thought it was a good thing that socioeconomic reasons were not included in the reasons why women could, women or girls could seek an abortion. And yet when we were dealing with this on the committee before the referendum, this was one of the stickiest issues and it was put to a vote and was a very close vote and it was myself and some others who really pushed it because I would have thought that socioeconomic reasons would be very, very important. Because when you think about teenagers, migrants, women living with domestic abuse, disabled, pregnant people, all of that, it's disproportionately affecting the most vulnerable. So maybe Maeve could come in and address that for me please. I'm going to ask a few questions in a row and the reason I'm doing it is because I have to, once I hear the answers, I have to go down to the door to speak. My next question is really on the impact of the protests outside abortion providers. And do the panel of presenters here not think that the government is now presiding over a situation in this country where women are still being denied access to essential health care that people overwhelmingly voted for because of anti-choice zealots, religious zealots in the main. And how urgently do we think that that has to be addressed because I would have thought that that is one of the most urgent and important issues that we have to deal with, along with the question of conscientious objection being allowed to block women from accessing abortion care. Now, I know we've just had some discussion on conscientious objection, but do we know from the research carried out by the National Women's Council or the Family Planning Services how much the criminalisation of abortion acts as a chill factor rather than the conscientious objection? That if you, as a doctor or practitioner, thought, well, if I'm challenged on that, I could face 14 years in prison, potentially, how much that chill factor impacts on the non-delivery of services. And one other question about the scans and the delays that women are experiencing because of not being able to get a scan on time. Is there any evidence that that's connected with the fact that the scanning services have been outsourced by the HSE to a private company? And is there any evidence or am I just barking up the wrong tree to think that there's discrimination against women in maternity services on that grounds? Otherwise, I think that most of the questions have been dealt with. Oh yeah, the last and final one. There were two ancillary recommendations of the Citizens' Assembly that came out of the Joint Oire Actors Committee before repeal was voted on. And one of them has been partially acted on, the other hasn't been acted on at all. One is the provision of free contraception to all, you know, of active sexual activity ages. That's been partially acted on, but not fully. And the other is the introduction of a non-ethos based sex education programme at school. And the reason these were looked at and recommended is because they help if they were implemented, and we had evidence from all over Europe and from Britain and Holland and all the rest of it, to show that where these facilities exist, both free contraception and a non-ethos based sex education service, that the level of crisis pregnancies is reduced. So, could the panel please comment on those three or four questions? Thanks. I'm very happy to clarify my comments about socio-economic grounds. And I think my point was that what we would not want to see in law is a specific socio-economic grounds, so that you would have a 12-week gestation limit, and then women would have to make a case for abortion on the basis of socio-economic need. What we need to do, and the gestation limit, the gestation limit is the thing that excludes those in particular who have pressing socio-economic need for abortion care over 12 weeks. What we need to do is remove the 12-week limit. So, rather than having a situation where anybody would have to go and, you know, and sort of plead for an abortion on the basis of their particular case, that they would be able, the same as in the current situation before 12 weeks, to request abortion without having to justify their decision. And we know from the international data that most women present well before 12 weeks, but in those cases where a pregnancy becomes a crisis after 12 weeks, it is really important that women have access to care, but they should not need to justify that on socio-economic grounds. There simply should not be a gestation limit that makes it an issue. On the issue of safety zones, I would agree completely with you. I think the protests outside healthcare providers are instances of targeted harassment of women who need healthcare and of providers. I think those who carry out those protests know that the IFPA is not going to change our policy on delivering abortion care. They tend to target the hospitals and they tend to target smaller providers. And this is particularly difficult for providers who are living in, you know, close to their practices, living within a community, so outside Dublin, in smaller towns and areas. So, absolutely, there is a need for action on that. I will pass to Katrina to talk a little bit more about the chilling factor and access to scanning, but I want to thank you as well, Deputy, for raising the issue of the ancillary recommendations, because it brings us back to the issue of unintended pregnancy as the critical factor here. And at the end of March, we supported the launch by the United Nations Agency for Reproductive Health, UNFPA, and the launch of this report actually called Seeing the Unseen, the case for action in the neglected crisis of unintended pregnancy. And absolutely empowering people to have the means of preventing pregnancy through education and information and through access to contraception care are absolutely critical. So, I might pass to Katrina now for more on contraception and the scanning issue and the chilling factor. Thank you. Well, I suppose just to come to the scanning issue first. So, overall, it is again, it is one of those things that depends on geography. So, it depends where you are in the country, what way your scans are going to actually be provided and who is going to provide them. In some parts of the country, it will be the maternity unit that will provide scans and the doctor will contact them. In Dublin and some other parts of the country, it is outsourced to a private company. And the contract that that company has is supposed to be that they provide those scans within that three-day waiting time, that it is not supposed to impose an additional delay. And whereas that might work a lot of the time, there will be delays some of the time. And whether this is due to, I mean, everywhere has had staffing issues in relation to the pandemic, so that may be part of it. It is definitely not something that I could say was clearly either discriminatory or certainly against the enactment or the accessibility or allowing access to abortion. It is set up specifically for allowing access to abortion. We have a dedicated referral pathway into this company, which is separate from the general referral pathway in order to get timely appointments. But it certainly does happen sometimes that there are delays, and that can be a delay of maybe up to a week, and that can very negatively impact on women in this very time-sensitive service. So, there are occasionally delays. That is definitely true. It is really difficult. We do not know. We are not given any information as to what the cause of the delay is. So, it can be a difficult experience for women when that happens. And in some cases, if we were to go along with that and wait for the scan, it could potentially put women over the legal limit. In cases where you would be very concerned in that situation, you might then contact your local hospital. But again, like an awful lot of things in relation to the operation of this service, it puts an undue amount of pressure on providers to go way above and beyond what they would normally be expected to do in order to actually try to make sure that the service works for women. So, you could have several calls in a day about one person, not based on medical need, not because that person is really sick, but based on the law, based on the fact that if you do not get on to somebody today, that person is going to miss a deadline. And that is actually taking up time that should not actually be needed to be taken up. Similarly, like the administrative burden completely falls on the providers. So, providers have to do additional certification documents, notification documents, and nobody would mind doing those things if they were going to give good data to anybody. But the only data they really seem to be interested in finding is the medical council number of the doctor who is doing the providing. There is no useful information about the demographic of women who are attending for abortion on the notification forms. So, I hope that answers the question in relation to scanning. I think I have talked about the chilling effect of the criminal sanctions probably enough at this stage, so I think I might pass on from there. Laura, do you want to go in? Yeah, just to go in on two or three of the questions Deputy Smith has. I think just firstly on the Safe Access Zones. I mean, this is a piece of legislation that has been promised, there is cross-party support on, and it is one that we think needs to be moved without delay. And we are concerned at the delay in bringing it forward. And I suppose, you know, in part answer to your question, it is hard to know, I suppose, the combination of factors that is leading to the poor coverage that we have. But we certainly believe, and we know from some evidence from START, for example, that GPs, particularly in rural areas, are concerned about opening and concerned about protests. So, that would remove that, and we believe would assist in terms of broadening out the coverage. Just to turn as well to the two issues that you raised in relation to the ancillary recommendations, which I think are really important. I will just maybe say something about the sex education one. And, you know, this has come up, I think, in many different places at the moment, in terms of discussions and debates within the Oireachtas. It is also part of what is going to be included in the third strategy on gender-based violence. And it is without doubt at this point that we need a comprehensive sex education programme within primary and secondary school that is obligatory for schools and is part of the core curriculum. And I think, you know, it is really unfortunate that it is one of the areas that is absolutely getting left behind. So, in our view, in the Women's Council, it is a key piece. It is a key piece for women's health. But it is also key as well in terms of wider issues concerning women's equality. And just to turn to Alana around the contraceptive piece. Yeah, essentially, this is a hugely welcome move, and it needs to be extended across the whole of the reproductive age range, as you say. But I also think we need to give focused attention to thinking about how the 17 to 25 rollout can be delivered in such a way that everyone can benefit from it. And I think part of that is thinking about the network of providers. So, yes to using GPs and women's health clinics, but also thinking about the potential role of pharmacies. In other jurisdictions, oral contraceptives are available without prescription via pharmacies. They are a trusted local community-based healthcare facility. I think it would be incumbent on us to consider is there a role for pharmacists to play if we are to reach all those who could benefit from this, particularly when they safely deliver the emergency contraceptive as it is. And it would be a good care pathway to be able to provide a regular contraception consultation, in the case of providing emergency contraception as it stands. Okay, I need to move on. Okay, I need to move on. Okay. Okay. Okay. We'll move on.