Deputy Nuala Fennell gave me notice of her intention to raise on the Adjournment the need for action to provide information for the medical profession on the likely consequences for daughters whose mothers were prescribed DES, diethylstilboestrol, in line with European Resolution of May 1989.
Adjournment Debate. - Effects of Pregnancy-Related Drug.
I thank you for allowing me to raise this important issue this evening and thank the Minister for coming into the House to reply. Diethylstilboestrol, or DES, is a hormone drug which was widely used in Ireland in the forties, fifties and sixties to prevent miscarriages. Indeed, the use of DES was accepted medical practice until 1970. In 1971, it was discovered that DES could cause a rare type of vaginal cancer in young women whose mothers had taken the drug during pregnancy. It is now known that approximately one out of every 1,000 DES daughters will develop this rare form of cancer. As well as this, up to half of all DES daughters will have some kind of fertility problem, for example, ectopic pregnancy, miscarriage or premature labour and delivery. Many have malformed uteri and Fallopian tubes. In speaking about diethylstilboestrol I want to make quite sure that people understand that it is different from stilboestrol which was used by many women during that period to suppress breast milk.
Because of the known risks, DES daughters need special screening examinations. These women should be made aware of this fact. More importantly, members of the medical profession, in particular GPs and gynaecologists, should be informed and alerted to likely problems and treatments.
At present, only the Council for the Status of Women are taking action to provide information in this area. More recently, positive action was taken by the National Maternity Hospital, Holles Street, which has now opened a DES clinic under the direction of Dr. Mary Wingfield specifically to provide specialist care for women referred to it. Health departments and governments in other countries have dealt comprehensively with the information and medical needs of women but I regret to say that the Department of Health here are silent. Government and departmental action is vital on this issue because (a) doctors need to be alerted now to the problems and (b) women at risk need to be informed of the facts. This should be done in order to spare women, who may be DES daughters and are not aware of this fact, having to go through unnecessary treatment and pointless investigations for unknown factors related to fertility and pregnancy. They may have to undergo these investigations because the doctor dealing with them may not be aware of outstanding issues.
We do not know how many women are involved because no statistics on DES daughters are available. From inquiries the Council for the Status of Women have established that the prescribing of diethylstiboestrol was widespread in the fifties and sixties and this is in conflict with the claim of the Department of Health that DES was not widely used here. I do not want to cause alarm but if the issue was taken seriously and the matter did not have to be raised in the House, there would not be alarm. I now call on the Minister, in line with the European Resolution of May 1989, to identify women exposed to DES, to provide resources to inform and educate health care professionals about DES, to recognise the need for further research on DES exposure and to provide realistic funding for the programme I have described.
This matter was raised by Deputy Fennell in a question on Thursday last, 29 November 1990. In my reply to that question I indicated that the health promotion unit of my Department have had consultations with the Institute of Obstetricians and Gynaecologists of the Royal College of Physicians of Ireland with a view to preparing suitable material for distribution in relation to DES. This material, which will be circulated to the medical profession, should be available for distribution within the next few weeks.
However, no information is available on the extent of prescribing of DES in Ireland during the forties, fifties and sixties. I would be very interested to hearing from Deputy Fennell if she has information to the contrary because the expert bodies which should have the information do not have it available to them at present. We should contrast the position in the United States, where DES was widely advertised and widely used, with the position here where in the early sixties, the then Master of the National Maternity Hospital decided that when looking after women, in the areas of gynaecology and obstetrics, there should be the minimum use of drugs. This would seem to suggest that DES was not widely prescribed in this country.
However, I am very conscious of the concern in relation to the possible development of cancers related to DES in the daughters of women who may have been prescribed diethylstilboestrol. At the same time it is important that we approach this issue in a cautious and controlled manner to ensure we do not raise unnecessary fears and anxieties among women about possibility of developing cancer, because these vaginal cancers are extremely rare and, as I said, we have had consultations with the Institute of Obstetricians and Gynaecologists, through the Health Promotion Unit, and the decision made was to prepare literature for distribution to the medical profession.
Both my Department and the medical profession are very much aware of the problems associated with DES. Indeed, as far back as 1975, the National Drugs Advisory Board drew attention to this matter. In more recent times, my colleague, the Minister of State at my Department, Deputy Noel Treacy, had a meeting with members of the Council for the Status of Women to discuss a number of issues relating to women's health, including DES. As Deputy Fennell pointed out, a special unit has recently been established at the National Maternity Hospital and this will play a critical role in establishing the extent of DES related problems in this country.
As the hospital campaign develops there may well be a role for my Department, through the Health Promotion Unit, in augmenting and supporting the professional and medical expertise which the Deputy will accept is of fundamental importance. I do not consider it would be proper to carry out a mass information or screening programme at this time because of the fears and anxieties this would create, particularly since I have indicated that prescribing DES in this country would appear to have been very limited. It is my view that at this time the most appropriate way in which to continue to deal with this matter would be to ensure that all the information available is channelled through the medical profession with whatever assistance my Department can render. We keep this matter under review and if action is necessary we will take it as appropriate, but the correct way to proceed is to keep in contact with the experts, the Institute of Obstetricians and Gynaecologists.
Deputy Fennell also referred to the resolution adopted by the European Parliament which requested the Commission to undertake certain investigations on this issue and to report back to the Parliament. If such investigations or anything that might be contained in the Commission's report warrant further or different action on our part, that is something I would be prepared to consider. In the meantime I am satisfied that the approach we have taken is the proper one in all the circumstances. This will ensure that women who may be affected as a result of DES will be provided with proper medical care and treatment in the appropriate context and setting.
I thank the Minister for his reply. I will liaise further with him on points I want clarified.