I am glad to have the opportunity to speak on the discussion document,Developing a Policy for Women's Health. It is welcome in that it mainlines and mainstreams women's health issues which, up to the time of this and the former Minister, tended to be solely the concerns of women's interest groups, such as the Oireachtas Joint Committee on Women's Rights. The Minister rightly gave credit to its former chairman, Ms Monica Barnes, on whose initiative the first steps towards developing this policy in its present form were commenced.
During the 1980s we discussed documents drafted by the UN, the Council for the Status of Women and the Commission for the Status of Women, which pointed out the need for a specific policy on women's health. They pointed out areas where women suffered, that women in Ireland were faring worse than women in other parts of the world and that there were women in some places who were a great deal worse off than women here. All the related issues were raised from time to time by specific women's groups.
This document is extremely welcome in that these issues are being taken on board in a comprehensive and committed way by the Department. Commitments are being given, albeit tentative and directional at this point in terms of resources, and services are being developed in response to particular areas of concern. I thank all the women who participated in various commissions, councils and committees. I have never been a member of the Joint Committee on Women's Rights but I thank all those who have worked on behalf of women to mainline what have too often dealt with as also ran issues outside the mainsteam of policy. I congratulate the Ministers involved for actively taking the report on board.
When reading the report one cannot but be taken aback by the major problems facing women, particularly with regard to risks of mortality. Irish women have a substantially shorter life expectancy than most of their European counterparts. The main causes of early death are heart disease and cancer. Specific services need to be developed, particularly in the area of cancer, and the Minister has given a strong commitment in this regard. I look forward to hearing in the near future details of the proposed programme for the development of services for cancer which the working group is to issue. Substantial funding has already been given to St. Luke's Hospital and to other services.
Services are needed by all sectors of society but particularly by women who are prone to risks of lung and breast cancer. Lung cancer is associated with smoking. It is disturbing that many young women are commencing and continuing to smoke. This indicates the need for an interested programme, starting with health promotion which, hopefully, would ultimately reduce the need for increased services later in life.
Because early detection of breast cancer can lead to successful treatment, and much less radical treatment than was the practice in the past, many of us would like to see the level of services, including screening, improved. Screening services are available on a relativelyad hoc basis. Until the recent past, they were mainly available only when voluntary groups provided them; they were provided in only a limited way by State services. The extension of screening services on a universal, countrywide basis, particularly to age cohorts at highest risk, should be an absolute priority.
For women the spread of services is critical. As a Dubliner it is easy for me to relax and say that whatever is available is bound to be available in Dublin. From my attendance at the Fine Gael women's conference, where we discussed this health policy, I know there are great concerns among rural women about access to a wide variety of services, particularly in the areas of pregnancy, fertility and cancer. Women who were infected with the hepatitis C virus as a result of the failures of the blood transfusion service identify with the problems of having to travel long distances for specialist services. People in Dublin and other urban centres must continue to make the case for women in isolated communities who may be less economically well off and reliant on public transport. The availability of accessible health services is critical for women who are confined to their homes and have the responsibility and burden of caring for children.
The report identifies heart disease as one of the other major causes of early death among women. This might surprise people because we tend to think of heart attacks as being associated more with stressed out businessmen rather than with the stereotype image of Irish women. This can be linked to diet and life practices.
It was announced during the week that a new committee would be set up to oversee the development of sports facilities. The Minister asked it to concentrate on the development of sports facilities for women. I very much welcome this as it is a critical issue for women.
Once they reach their teenage years, it is very easy for girls to be sidelined into sedentary activities, except perhaps for a short period when they go disco dancing. Almost all physical sporting activity models are male and almost all television coverage concentrates on male sports. Due to the successes in women's hockey and the emergence of female soccer teams, women are beginning to get their noses in, but one only has to contrast, for example, the attention given to the all-Ireland football and hurling finals with that given to the camogie final. I welcome the President's initiative to assist in giving a higher profile to women's sports.
Lifestyle is a critical issue for women as both good and bad practices are established during teenage years. If the situation was transformed and there were models and support from a wide range of State services, many women could avoid problems. There is no doubt that diet and exercise are of critical importance.
I know from experience that, with the best will in the world, it is extremely difficult for a mother of two, three or four children to find time for herself. Traditionally, 8.37 a.m. is the time the single woman, the businessman and perhaps the politician — Deputy Richard Bruton was seen jogging down Griffith Avenue at 8 a.m. recently — goes for a jog before work, but it is also the time a mother with children is under more pressure as babies have to be addressed and children sent to school. Likewise, in the evening, when others might find time for themselves, she catches up on work while the children are in bed. Opportunities are, therefore, limited, even for women with a desire to take exercise. If there were sufficient images of active women, to match the expectation that men and boys will be involved in sports, women could be much healthier and have a better quality of life, thereby reducing the demands on the health service.
The report highlights the problems of women suffering from depression and overweight, smoking and teenage pregnancies. A large European document, which I have not yet had time to read analyses child care services in European countries. I have no doubt it will confirm the findings of the last study that within this State there is a lack of child care services, such as the general availability of créches, child care and Government financial support for child care. Apart from the United Kingdom which is the only country with comparably poor service, a vastly better service is provided throughout the rest of Europe, in terms of maternity and paternity leave, parental leave and State provided child care services. This is critical in terms of the health of women.
While many women choose to be in the home, many others would choose to mix being in the home and at work, or being engaged in sporting and voluntary activities and having a healthier lifestyle if support was provided in terms of child care facilities. It is no accident that, despite the availability of choice, most men choose to remain in the active workforce where they can attend business lunches and go for a drink after work with their friends with the camaraderie and personal satisfaction that goes with it. Work in the home is extremely hard and demanding, although working with children and overseeing their development can be very satisfying. However, its remains unsupported with the result that many women, if they had a choice, would prefer a mix.
In the absence of well paid employment, State child care facilities are essential. The provision of a substantial impetus would lead to a marked improvement in the health of and morbidity rates among women with fewer suffering from depression and needing valium. The opportunity to work also offers women independence.
The issue of violence against women is dealt with in the report. The findings of recent reports and the campaigns organised by the various organisations which deal with women and children who have suffered abuse illustrate that there is an extraordinarily high incidence of violence. In this context the anlaysis in the most recent book by Roddy Doyle is revealing and shows how women can become trapped.
There is a lack of services for the victims of violence and this is not covered sufficiently in the report. The position in Dublin is unsatisfactory. Although there are one or two well supported refuge centres they cannot cope with the demand for places. Last year the Minister provided substantial finance to fund the development of a major new centre on the northside of the city, but this is only a tiny drop in the ocean. Elsewhere there is a dependence on voluntary groups to provide such centres.
I do not know of any location where the State decided to provide a service. It has responded to the demands of local active groups in our main cities, but there are many areas without a refuge. Until we offer women and their children a way out of violent situations, large numbers of women will continue to suffer from depression and their children will suffer other long-terms effects.
These are the gaps in the report that I would like to see filled in. If women are to be healthy and have a good quality of life, child care and other services, such as refuge centres, are of critical importance.
The issue of teenage pregnancies is dealt with briefly in the report. The Government has committed itself to a specific policy of targeting resources towards groups with low health status and giving them priority. Particular attention will be paid to teenage pregnancies. In other words, we will try to care for the young women concerned as well as we can, which is meritorious, but it is not enough for those who become parents at such an early age.
A deputation of members of the Select Committee on Social Affairs visited Sweden where a ban on the physical punishment of children has been successfully implemented for over 20 years. It met representatives of the social services from which it received much general information. Teenage pregnancies are virtually unheard of there. This raises the question of the way we order and organise our society. Apart from the problem of high levels of unemployment, there is the issue of why so many young women make that life choice. It is not enough to say we will try to look after them as best we can; we need to do something much more fundamental to offer young women choices comparable to those expected by young women in Northern Europe, such as the opportunity for personal development, to grow to maturity, to take up work and pursue education courses, before they enter into the demanding role of parenting. Something much more fundamental needs to be done to offer better choices to young women so they will have a life comparable with what other young north European women expect. Such a life would, at least, offer them personal development, an opportunity to reach adult maturity as well as having work and educational opportunities before entering into the demanding role of parenting. It would be better for them and for their children, as well as giving them a better quality of life.
While I welcome the concern about teenage pregnancy, we have to review fundamentally our acceptance of the high numbers of young women who become mothers by the time they are in there late teens when in physical, emotional or intellectural terms their own maturing process is not even complete. We should be able to do better for the next generation. The best group from whom we can learn are lone parents who have matured and coped with it. A substantial study should be done among them in relation to how we can offer the next generation, a better life choice with different health and welfare outcomes as a result.
This is a welcome and valuable document which faces up to the medical and health problems facing women. It identifies all the main categories of special medical problems associated with women and those that affect women a great deal more than men, as well as identifying strategies to tackle them.
I pointed out one or two gaps in this proposal which largely covers the Department of Health. When discussing women's health it is impossible to stay within that narrow area because issues, including employment, sport, recreation, education and social welfare, also impact directly on the quality of their lives. In the context of a health strategy it is an extremely welcome document which further expands the commitment, to the areas of child care and domestic violence. If, in reviewing this in five to ten years' time, we find that substantial sections of it have been implemented, we will see the results in improved health for women.