Deputy Nealon was in possession but he indicated that he was sharing his time with Deputy Ring.
Policy for Women's Health: Statements (Resumed).
I welcome the opportunity to speak on this important issue. I congratulate the Minister on presenting this policy document. This is the first Government in Europe to consider a policy document on women's health.
This is the first opportunity I have had in the House to congratulate the Minister for arranging for the provision of an orthopaedic unit in Castlebar General Hospital. I understand that phase II of that project is due to commence next year. I am sure the Minister will be pleased that I will no longer knock on his door seeking his approval for that unit. On behalf of the people in County Mayo, I compliment him for the speed with which he sanctioned its provision.
Last week the Minister allocated £91,000 to the Western Health Board to provide lifts in a hospital. I compliment him for the speed with which his Department responded to that urgent request but I ask him to investigate why that health board had to request £91,000 to provide lifts given that the hospital concerned was opened during the last ten months. I want the public to be informed about it.
I am delighted to have an opportunity to speak on behalf of women. I compliment all the women who over the years have been treated as second class citizens. I come from a family of 13 children and I saw how hard my mother worked to raise her family. She looked after herself last as does every mother in this State. Women have been devalued here for far too long. That is why I compliment the Minister for bringing this important policy document on women's health before the Dáil. It is a major initiative on which we should build.
Breast cancer is a major concern and I welcome the breast screening programme set up in recent weeks. I am disappointed County Mayo has not been included and people must travel more than 100 miles from Belmullet to the nearest hospital for such screening. That is unacceptable. Services must be brought to communities and women's health must be given priority.
The issue of cancer is of great concern in the west. I may table questions on it in the coming weeks, but the Minister might consider investigating why there is such a high incidence of cancer in the west. I am sure other Deputies from the west will raise the issue of breast cancer about which a great number of constituents who visit my clinic are concerned. I ask the Minister to put in place a breast screening programme as a matter of urgency. Mayo is the third largest county in the country. If men were affected by breast cancer, millions of pounds would have been spent on research into it. I am asking the Minister to examine the matter.
A major problem in the west is that daughters who stay at home to look after an elderly parent and who may have some land are means-tested for the carer's allowance. That is wrong. Any person or household who looks after an elderly person should receive some State aid which should not be means-tested. As it costs the State hundreds of pounds per week to look after an elderly person in an old folks home I fail to understand why the State cannot make a contribution to those who care for old people in their houses. Some years ago this was a major election issue. I call on the Government to reconsider their attitude to this.
Women have never been recognised for their true value and for their contribution to society. In many cases women have to go out to work to provide for their families. In the evenings they return home to look after their families. I compliment them on that work which has not been recognised by the State. I call on the Government to make provision — similar to the children's allowance — in the next budget for women who stay at home to look after elderly people or their family. It is only right and proper that the major contribution women made to this country is recognised.
In my constituency there is concern about cystic fibrosis. It has been brought to my attention by a number of people in County Mayo that 1,200 people approximately in the State suffer from this condition, 150 of whom live in the Western Health Board region and over one third attend the Mayo General Hospital. As the Mayo General Hospital is at the planning stage of phase II an adult unit should be put in place for those patients. Patients in County Mayo have to travel long distances to St. Vincent's Hospital, Dublin, where the condition is dealt with. A doctor in County Mayo who had a particular interest in cystic fibrosis died recently and a replacement should be appointed to look after these people who have a serious illness.
It is important that a breast screening programme is put in place in County Mayo. I welcome the Minister's approval for the orthopaedic unit in Castlebar General Hospital. I am pleased I will not have to be knocking at this door any longer. I call on the Government to make provision in the forthcoming budget for some payment to the women who stay at home to care for an elderly relative. I am familiar with the way my mother struggled and worked hard. In the past women were not treated properly. I hope the Government will implement the recommendations of this document and that women get the respect they deserve. I wish to share time with Deputy Bradford.
Acting Chairman
Is that agreed? Agreed. The Deputy has five minutes at his disposal.
Obviously a five minute slot is not entirely appropriate if one is to address this document in a significant way. I concur with Deputy Ring on the inadequate way in which we have recognised the role of women in Irish society. We have not formally recognised that our country had founding mothers as well as founding fathers. It is only recently that we have tried to give women, the 50 per cent plus of the population, the recognition they deserve for the role they played in the development of this country.
One could address the issues of the monetary value, the lack of financial resources, the lack of any formal recognition by the State of the important role played by women in the home but what we are talking about is developing a policy for women's health.
We must return to the adage of prevention being better than cure. While it is important to have the best medical care available — this is usually the most expensive — we often seek medical help too late. Whether we are discussing women's, men's or children's health prevention is an important issue. We should address problems before they require a solution, namely, we should do whatever we can to prevent the many illnesses which cause such difficulty and in many cases a high mortality rate. Much progress has been made in the past 30 to 50 years in health care for both men and women. Basic health care has improved significantly and as a result the mortality rate has decreased and life expectancy has increased.
In the Ireland of the 1990s we need a new approach because problems, diseases and illnesses which had not been recognised as late as the 1970s or the 1980s are commonplace and need to be addressed. In regard to women's health we have to concentrate on further research and on encouraging women to come forward for assessment and tests earlier.
Generally, women are slow to come forward when they have an illness. While they do not hesitate to have illnesses in their children investigated they put themselves at the end of the queue. That approach, laudable though it may be from a humanitarian point of view, has caused and continues to cause difficulties. The role of the Department and the health services must be to encourage women to come forward for assessment much earlier. We must allocate more resources to preventive measures. We must have sufficient support programmes available to encourage women to come forward in the initial stages of their illness to ensure we make further progress in increasing the life expectancy of women and deal with problems as they arise.
I would like more time to speak on this important matter but I welcome this type of debate and the approach of the Minister in this area. Obviously that approach will require further expenditure because we cannot solve any of these problems without the appropriate funding.
I am delighted to contribute to this debate on developing a policy for women's health. Women are living longer now than they did in the past because of a number of factors, including better nutrition, housing, sanitation, immunisation, the availability of antibiotics, earlier detection of inherited and acquired diseases and the capacity to treat them.
The expectation now is that women will live longer and healthier lives. Historically, the question of male and female health was examined jointly. In assessing health in the past we often looked at the causes of death. In 1840, the number of deaths among men in the 25 to 34 age group was 10.6 per thousand. The 1980 figure for the same age group is 0.5 per thousand. In 1840, the life expectancy of women was 42 years; in 1980 it was 76 years. The life expectancy of men in 1840 was 40 years; in 1980 it was 70 years.
In earlier years, the primary causes of death were TB and infections. Women faced the additional problem of puerperal sepsis during childbirth. The increase in the life expectancy of women is due to better nutrition, housing, public health measures, safer childbirth, the introduction of antibiotics, the treatment of anaemia and associated conditions and other medical advances, particularly immunisation.
Where do we go from here? Prevention is the way forward. We must also concentrate on areas we might have neglected in the past. We must also promote self-help and examine other areas where advancement has been made in the recent past. In regard to obstetrics, we should begin even before the child is born. Pregnant women should take folic acid which may prevent many neural tube and central nervous system defects. That is one area of preventive medicine requiring attention.
In regard to cancer of the cervix, Pap smear tests and screening is the way forward because this cancer is preventable if detected at an early stage. Women should be encouraged to have these type of examinations. When talking about cervical cancer, it must be remembered that if young girls engage in sexual practices it is not conducive to good health in later life.
A number of speakers referred to breast cancer and I welcome the Minister's special initiative in this area. It might be said that the Minister should have extended the initiative to include the entire country; he has selected a number of areas for investigation. Many women will be concerned that their areas were not included but this is a pilot programme and perhaps the Minister will be in a position to extend it in the future. Women must be assured that they are not being discriminated against in regard to their health and that all areas of the country will be treated equally.
I welcome the advances in breast screening which includes taking additional views of the breast, which has improved the detection rate. Cancer of the ovaries is a problem peculiar to women. With all the advances that have been made through screening, this form of cancer should be detected earlier and I hope that will be the case in the near future.
More emphasis must be placed on the promotion of breast-feeding which would not be a major cost to the Exchequer but of great benefit to women and infants. I urge the Minister to address this area with a view to further educating women through the distribution of leaflets, etc,. outlining the benefits of breast-feeding to various women's groups.
I wish to talk about the central nervous system. Stress, anxiety, depression and psychiatric disorders cause major problems in society. We are making progress in this regard, however, particularly in the psychiatric area with the sectorisation of psychiatric services. I hope this will be a way forward and that there will no longer be a stigma attached to people with psychiatric disorders.
Women may not be the head of the family but they take full responsibility for the care of the children. Great stress is placed on women with handicapped children and we must examine the services available to them. The Minister should consider making more places available for young children with a mental handicap including day services, respite care, etc. The provision of such services will have a favourable effect on women's health, in some cases in a specific way. This is an area where improvements can be made and we must constantly be mindful not only of the woman's health but also that of their offspring.
In recent times there has been an increase in the number of suicides and eating disorders. Early intervention is the way forward, particularly in relation to depression which can lead to suicide. Today psychiatrists in the Southern Health Board region referred to the importance of the early detection of depression in reducing the number of suicides. When talking about women's health consideration must be given to self-help.
One of the preventative measures people can take is to give up smoking. It is very important for women to take cognisance of this point as there has been a decrease in the number of men who smoke but, unfortunately, there has been an increase in the number of women who smoke. I stress the importance of prevention which costs very little and one of the ways to ensure prevention is through education.
There is inadequate representation of women on health boards and other bodies where decisions are made in regard to health. I am not a great supporter of gender balance on all boards but women should have an input to decisions which affect them. I ask the Minister to give consideration to the appointment of competent women to such boards.
I thank my colleague for sharing his time with me. I welcome the Minister's initiative in allowing further discussion on this document. There is grave concern about the causes of death among women. Approximately 20 per cent of women die from breast cancer while many others die from cardio-coronary heart disease. I strongly welcome the Minister's decision to introduce a national breast screening service and urge him to ensure that it is established as a matter of urgency. Women who are afraid that they may have breast cancer should be encouraged to undergo an examination. In addition, there should be an immediate follow through from the GP to the consultant.
It is important to provide adequate services in each region. I ask the Minister to follow up on his recommendation that we should work in conjunction with the Northern Ireland authorities. This would be of particular benefit to Donegal women, some of whom are in very bad health, who have to travel to Dublin at great expense. Greater emphasis should be placed on the need to carry out proper research on the causes of cancer. Given the concerns of all families about cancer, particularly as it affects women, the amount of money available for research is totally inadequate.
Cervical cancer accounts for 2 per cent of all cancers in women. It is important, therefore, for the screening to be simple, quick and inexpensive. I ask the Minister to give consideration to the promotion of screening for women and to undertake proper promotional campaigns at regular intervals. I commend the North-Western Health Board for its innovative response to the document and concur with many of its recommendations.
One of the main problems experienced by women in rural areas is a lack of access to many of the services provided by health boards. A centre along the lines of the Well Woman Centre should be set up in every region to complement the community care services provided by GPs. I am not criticising GPs who provide an excellent service but an alternative should be available to encourage women to take the initiative in regard to family planning and screening. This service should be made available in particular to young women in their late teens and early 20s.
The document refers to the criticisms about the lack of privacy for patients and the lack of respect shown to many of them, particularly women. In my constituency there has been severe criticism of the outpatient facilities. The hospital in Donegal town is totally inadequate and uncomfortable and affords no privacy to patients. I accept that there is a resource problem but it is necessary to have proper out-patient services and proper play facilities for children. These facilities should be the norm in all out-patient departments.
I welcome the White Paper on mental illness. In the case of women, issues such as depression, alcohol abuse and eating disorders need to be addressed as a matter of urgency. Many people complain that their GPs treat depression and stress with a tablet and by telling them to pull themselves together. Tablets should be a last resort and not the first treatment. There is a need for a national support service for women and their families in cases involving stress and depression. There is much stress attached to parenting and there should be easy access to counselling services, particularly for families with problems. A 24 hour helpline would help prevent much of the stress suffered by women. This problem may be linked to the increase in violence in the home. It is important to establish in each region a centre along the lines of the Rape Crisis Centre and to provide adequate resources for refuges. Prior to the opening of the refuge in Donegal people had to attend centres in Northern Ireland.
We will have to address the problem of our ageing population and re-evaluate the services provided in the community. It is important to provide proper services for the elderly but it is equally important to look after carers. Carers, 80 per cent of whom are women, should be supported in every way possible and I ask the Minister to provide an allowance to all of them, irrespective of their means. This would give recognition to their work which, while being fulfilling, involves much stress.
Because of the role they play in society, women have different expectations from the health services and want to be informed and to be involved in their own health care. There is a need to involve more women in the decision making process at health board level. This would ensure a flexible and more co-ordinated approach to health services and to women's needs.
Women are concerned about the way the hepatitis C issue is being handled. Although we responded in the best way we could when the crisis developed there is a need for a statutory tribunal. It does not matter how much this would cost. The women affected and people who have had transfusions are frightened. Who is to say what will happen to them 20 years down the line? I ask the Minister to reconsider setting up a statutory tribunal.
There have been hiccups in the provision of counselling services. It is imperative that women are counselled to help them cope with this disease. Problems have also been encountered in obtaining overnight allowances. The bureaucracy should be eliminated and these should be paid automatically.
I commend all those involved in the formulation of this discussion document. The Minister is awaiting response from the health boards and from public meetings. Certainly there is a need to involve women in setting up a health policy plan. Funding will have to be made available if women are to make progress. With 20 female Members in the House the Minister is no doubt aware that he will have to address the document in its entirety as a matter of urgency.
I feel strongly that I should take part in this important debate. I am delighted the Department of Health has given a commitment in this discussion document to improve women's health, to engage in a consultation process and to implement a strategy in this regard. This is in line with the commitment given in Beijing to plan for women's health.
Emphasis on good health promotion is very important. By and large, our health services have concentrated on tackling disease rather than promoting the well woman concept. A number of years ago I served on a health promotion committee in the Department of Health. A positive attitude has been adopted in this document and the idea of involving healthy women in designing health services is a good one.
The key to successful health promotion is to ensure that the healthy choices should be the easy and natural choices to make, but very often they are the more difficult choices. It was not an easy choice for me to decide to battle to lose weight.
The major killers of women are smoking and heart disease. As an asthmatic, I am aware of the importance of getting that message across. We will talk about Sellafield and the need to breathe clean air, yet we will pour smoke into each other's lungs. I suffer from occupational asthma as a result of working in smoke filled rooms.
I am horrified at the number of young women taking up smoking. I am delighted, therefore, that the new programme is based on peer pressure as peer pressure is the reason many 12, 13 and 14 year olds puff away behind the toilets on the way to and from school. We should tell women that they can relieve stress in many other ways, that they should not destroy their lungs or their chances of having a healthy child by smoking during pregnancy and that they should avoid ageing prematurely due to smoking. That is an important health message.
Breast cancer is also a major woman killer. When my mother was my age she was dying from cancer and left a family of eight children behind. I am delighted that the breast cancer screening programme is to be extended and targeted at a specific age group to ensure the maximum reduction in the number of deaths. A cervical cancer screening programme should produce results.
Women tend to visit their doctors during pregnancy only. Once they reach their early forties they are less likely to visit the doctor or undergo routine checks. There is a need, therefore, to put systems in place for those who do not visit their doctors regularly.
The causes of morbidity among women include the menopause and associated problems such as osteoporosis as well as hysterectomies. This is a major operation, both psychologically and physically.
A number of speakers referred to the importance of treating women with respect. I am glad I do not suffer from a skin disease and live in Cork. It is important that women are treated with respect when they present with an illness. Often when one visits one's doctor, particularly a male doctor, there is a male-female relationship. Women can feel disempowered when stripped of their garments. They have to talk to a fully dressed doctor while in their night attire. In such circumstances many women find it hard to speak up for themselves.
When I had my babies the maternity services were not family or women friendly when it came to respect. While the standard of health care was excellent one's partner was not allowed to attend the birth: one was processed through a production line. It is important to be called by one's name rather than being called "mother" as if one were a Reverend Mother, and to be treated as a human being so that people may be able to say what is important and ask the questions they want to ask rather than leave the clinic and half an hour later feel furious that they had not been able to ask relevant questions. The role of women in seeing that balance in relationship between the dressed-up predominantly male establishment and the disempowered woman in her nightie or pyjamas is a perspective we need by having a gender balance in the planning of our health services.
Women tend to put themselves last and do not visit the doctor with every ache and pain. They will always put their children first. About three or four years ago a survey on women and nutrition was carried out in Tallaght. It looked at nutrition among poor families. One frightening finding was that low income families particularly lone parents were feeding their children at their own expense and were not consuming enough calcium, protein and so on. They were going without, or eating a sandwich or a boiled egg while looking after the needs of the children. It is important that women look after their own health and retain a sense of self-esteem. They should take it seriously and give it the same attention as the more hypochondriac gender is prepared to give it.
There have been enormous changes for women. Family planning was bitterly fought for in this House over a quarter of a century and access to good family planning has probably been the single biggest contributor to women's health. Some groups of women, such as travellers, still do not have proper access to family planning and put their health at risk through having large families with children too close together. They are not able to cope with managing this aspect of their lives.
We also had a long battle over female sterilisation. Women had to go before a hospital ethics committee rather than being able to make decisions over their own bodies. If a women decides her family is complete, she is entitled to sterilisation, if that is the couple's choice. Male sterilisation is the better option because it is a lighter operation but some men regard it as unacceptable or equivalent to castration. These options must be available to women through our public health services.
I agree with Deputy Coughlan about the importance of créche and play facilities at women's and children's health centres. I brought my children to places like the Eye and Ear Hospital, where they would have had drops in their eyes and be unable to read. There would be no toys in the waiting area, nothing except pictures of damaged eyes. I had to try to keep my children quite because the blind, the infirm and the elderly were there also. This was unfair to everyone. It does not cost much to provide a box of second-hand toys, a book which a parent can read to her child, or a play facility. These are essential and mothers notice their absence when they bring their children but if males design the services they are often blind to these issues.
Deputy Coughlan's point about women as carers was important. Often in families it is the daughter or daughter-in-law who looks after an elderly parent. The caring role is usually stressful. Quite apart from the monetary aspect, which has been raised, the stress for the carer is neither appreciated nor relieved. We should stress the importance of respite breaks for carers, who are predominantly women. I recommend to the Deputy an excellent book called Who Cares? by Catherine McCann, which is a bible for carers. The issues it raises are crucial for our health services as a whole.
Issues which are important for women tend to concern their children. The reduction in infant mortality has been significant. Sudden infant death is still the biggest cause of unexplained mortality. If one goes through the process of having a child who then dies it is an appalling experience. I am delighted with the breakthrough in research in this area and we should continue to do everything we can to reduce the death toll and its effect on women.
Our image of the health service is of male doctors and female nurses. This must change. There are few women in obstetrics and gynaecology, which is a women's area. Women are treated by people who do not know what birth is like. It is important to have a positive action programme so that there will be more women in that area.
Dental health is another area where women are neglected. I served for five years on the Dental Council as a consumer representative. We dealt with dentists who wanted more money and greater throughput of patients. My concern was with the number of women who could not afford to fix their teeth and whose dental health was damaged through pregnancy and lactation, which reduced their calcium. A positive action programme is needed in that area also — we are not doing enough.
Members mentioned the importance of psychiatric and mental health for women. Female victims of rape, violence and depravation should receive counselling, as should women who were abused as children and may carry that burden through to later life.
Deputy Moffatt stressed the importance of breast-feeding, against which there is a huge cultural bias in Ireland. It is not made easy to breast-feed in pubs, etc. When I was in the Coombe the curtains were pulled around me when I breast-fed as if I was unclean rather than doing what was right for my children. If breast-feeding is regarded as unclean and sexual rather than natural, the implication is that women should bottle feed children because they can do that in company. We should send the message that breast is best for the baby, it is natural and not prurient. We should be able to do it in cafés, buses and within our families and not have to hide away. Who will breast-feed if they have to go upstairs to a cold bedroom, rather than in the company of the family?
These are personal comments on the subject. I am delighted the issue has been put on the Dáil agenda and that so many women Deputies contributed.
Debate adjourned.