Dáil Éireann debate -
Thursday, 25 Apr 1996

Vol. 464 No. 5

Developing a Policy for Women's Health: Statements (Resumed).

Miss Flaherty

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 relatively ad 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.

Mr. R. Burke

I welcome the opportunity to make a contribution to the debate on this report. I will not repeat the points that have been made on child care and other areas touched on by the previous speaker. I will restrict myself to a number of points including the need for proper, well equipped and professionally manned health centres available to women in local areas. These would provide the best quality health service at local level.

We have a greying population and, consequently, there will be an increasing need for proper geriatric care in our society. The absence of such care is a burden that falls in most cases on the daughters or wives of the elderly, and it is a burden which damages the health of wives and daughters. A concentrated effort should be made to provide adequate geriatric care within our communities.

In my own area of Fingal in north County Dublin there is an ageing population — as is the case in every other part of the country — and there is no care facility for geriatrics outside the private sector. In St. Ita's Hospital in Portrane, where I was born and where my father nursed, we have a fine facility with well trained, caring staff who are capable of providing geriatric facilities for the local population.

The numbers of psychiatric patients in that hospital are, thankfully, dropping as we have more and more care in the community, including St. Joseph's mental handicap service. We have available, however, a core of well qualified and well trained staff who have provided care for generations — the sons and daughters of those who previously nursed in the hospital.

While the number of psychiatric patients is falling, we have an increasing potential to use that site and the expertise of staff for the development of proper geriatric services for Fingal residents. We have a ludicrous situation where, within St. Ita's Hospital, health board policy dictates that older residential patients are being moved out to private nursing homes in County Meath and elsewhere while well trained staff are available who are capable of providing geriatric services for the hospital's resident patients. What is going on is totally contradictory because at the same time we have an ageing population in north County Dublin.

With the trained staff that are available, and using few resources, we should be able to provide geriatric care for the region. There is a tradition of care involving tained staff in the peninsula of Portrane and Donabate, and I call on the Minister to examine that matter urgently.

There appeared to be a policy within the Eastern Health Board of trying to close the St. Ita's facility. Rather than closing it we should examine the matter with a view to opening geriatric care facilities there for local people and for residential patients who are already in the hospital. It would make more sense than demolishing the existing buildings. We are celebrating the centenary of that facility and should have a long-term policy for it. This issue affects women's health not just because women live longer than men but because the task of caring for elderly relatives usually falls on them.

I know a number of women who were infected with hepatitis C and the affect it has on them physically and mentally. It is a scandal that merits the closest examination and action. The matter has been debated in the House on a number of occasions. Neither the Government, agencies such as the Blood Transfusion Service Board or specialists should try to defend what happened, obscure records and so on. This affects the health and peace of mind of many thousands of women. We should be open in our approach and err on the side of generosity of spirit rather than go into a defensive mode, which apparently is how matters are being treated at present.

Delays in orthodontic treatment are shameful. It may not be politically correct to say so but teenage girls are conscious of their appearance if they need orthodontic treatment. Many parents have come to me as a public representatives stating that their 12 year old daughter who needs orthodontic treatment was placed on a waiting list and would not receive treatment for four or five years. Not only is the damage done by that time but there is psychological damage as the girl grows up realising she needs orthodontic treatment which is not available to her. This can leave mental scars in later years. This area must be addressed. Young boys also need orthodontic treatment. There is no reason orthodontic treatment cannot be carried out privately and that proper contracts cannot be negotiated with orthodontists who charge ludicrous prices for treatment.

There is need for proper geriatric services nationally but I emphasise the need in north County Dublin. St. Ita's in Portrane is the ideal facility for such a service as it has sufficient space and a trained and caring staff. Two units have been set out for geriatric care. What is needed is a change in the health board's philosophy of "close everything down". There is undoubted need for such a service and, rather than depend on private nursing homes, we should adapt the existing facilities and make them available not just for psychiatric and handicapped services but for that one also. Not a week goes by without people telling me about their experience of trying to get an aged parent or relative into geriatric care. It is a dreadful burden for any daughter or niece to bear and that matter should be looked at in any policy which purports to deal with women's health.

Ms Shortall

I welcome the publication of this document. There is a commitment in A Government of Renewal to publish a plan for the development of health services for women. This discussion document, published in the middle of last year, is the first step. It was proposed that the issues in the document would be debated at as local a level as possible, there would be widespread consultation and that consumers of women's health services would be involved in devising the Government's policy. That happened as planned. There was widespread consultation and a great deal of involvement by women in developing the policy. My experience in the Eastern Health Board bears that out. It was exemplary in its approach to developing the policy and drew many lessons from Shaping a Healthier Future. The National Women's Council of Ireland was very much part of the launch of the document and had a big input in the consultative process.

As a member of the Eastern Health Board I am aware that that whole process has been extremely successful. Since last June 6,000 to 8,000 women in that area were consulted about the services they believe are needed in the women's health area. Notices appeared in newspapers, submissions were invited and questionnaires circulated throughout the health board area. A large number of completed questionnaires were returned and submissions were received from a number of organisations and individuals. Workshops were held on a wide range of issues relating to women's health, covering such items as women and violence, mental health, lifestyle and health behaviour, reproductive health and the health of different age groups of women, young, middle-aged and elderly. Lesbian health issues were also considered as well as consultation and the representation of women in the health services.

As a result of many months of consultation with various groups, the Eastern Health Board has drawn some conclusions and is making submissions to the Department of Health. The consultation process is proceeding as outlined by the Minister last year. During the course of consultation a number of recurrent themes were raised by individual women and women's groups. It is strongly believed that there are barriers to women becoming involved in the health services, particularly in terms of accessing services. Many of those barriers result from socio-economic factors. Concern was expressed about the current methods of dissemination of information and there was reference to the need to concentrate on preventive measures and promote a healthy lifestyle.

The need to involve women's organisations in planning, monitoring and evaluation of services was raised. The main barriers to a healthy lifestyle were considered financial, time factors and the lack of facilities — the biggest factor being cost. Concern was expressed by many people about the need to develop locally based services. It is believed that women should have an input to the planning and provision of services on an ongoing basis — the need to involve women's groups with expertise in this area was particularly underlined.

Another issue raised was the need to develop health services. The importance of friendliness and efficiency of professionals working in the field was stressed, as well as the need to develop sympathetic and sensitive listening skills. At the root of this issue is self-empowerment for women in terms of health and lifestyle in general. During the consultations an issue raised repeatedly was stress, which is believed to be one of the most powerfully destructive factors in women's health. That basic cause of ill health, which may result in psychiatric difficulties and general unhappiness for women, must be tackled.

The Eastern Health Board drew up a number of priorities, which will be submitted to the Department, covering a wide range of issues relating to women. It was stated that much work has been done in the maternity area by the Irish association for improvements in maternity services. Recommendations in that regard were taken on board by the various groups and individuals involved in the consultation. Another matter highlighted was the disappointingly low level of breast feeding — 30 per cent of women start breast feeding while in hospital but on return to the home that figure drops dramatically. It was felt that not enough is being done by the Department and health boards to promote and encourage breast feeding. There is a societal negative attitude to breast feeding and that problem must be tackled so that people perceive breast feeding as the optimun feeding for babies and are aware of the health benefits that accrue.

Concern was expressed about the lack of family planning services throughout the country, particularly in disadvantaged areas. There is need for greater access to information in this area and widespread promotion of family planning in schools and groups. Women who have their own income, particularly working women, are in a position to access and pay for these services, but concern was expressed that many women may not have access to information and do not have money to spend on family planning services. We must concentrate on making those services much more widely available in disadvantaged areas.

The question of hormone replacement therapy is a matter of concern to older women. There is a belief that there is a great lack of information on this matter. Given the importance of hormone therapy for older women, it should be widely available free of charge.

Throughout the consultation process the underlying theme was the need to include women in the development of services. The expertise of support groups for various aspects of health services should be availed of. Rather than making decisions at departmental or health board level and imposing services we should examine what is currently in existence. Despite working on shoestring budgets these groups have developed a great deal of expertise and built up the confidence of local women. We should use that as a base and increase resources. A bottom up approach should be adopted.

Another area dealt with in the document is the question of violence against women and the lack of adequate refuge places. While I recognise progress has been made in this area in the past number of years, including provision of additional funding, we have a long way to go before our services are at an adequate level, given the scale of the problem of domestic violence. In addition to providing more refuge places there is an ongoing need to provide proper training for people working in refuges. We need to develop refuges more as one-stop-shops offering a range of legal, health and social welfare expertise. In that way, they can respond to the urgent needs of women who face this problem.

There has been much talk recently about teenage pregnancies, an area of concern to many of us. Huge numbers of teenage girls either by accident or design end up in circumstances which are undesirable from a public policy point of view. Previous speakers referred to the difficulties faced by young girls, merely children, who become pregnant. I frequently come across cases in my constituency involving 15, 16 or 17 year old girls who are very much at risk because of their circumstances. If these girls are at risk, how much more at risk are their children? Such thoughts can make one feel a sense of gloom in regard to the future of many of these children.

These pregnancies should not occur but, where they do, there is a lack of support for young mothers and a lack of intervention on the part of the health services. It is important, however, to give credit to the new services that have been developed in this respect. One of the jewels in the crown is the community mothers scheme which has been successfully developed. This scheme is based on the principle of availing of the expertise of other mothers who have reared children successfully and who share that expertise with young mothers. That is an effective way of intervening with young teenage mothers without the barrier of the professional language so often used which can be off-putting. The scheme is also consumer friendly which has contributed to its success.

An issue that arose in the course of the consultations was the need to have specific services for lesbian women. It is quite disturbing that the priority area identified for them was the need for the provision of a Freefone line for life saving services. For that to be seen as the priority area is an indictment of society and an indication of the health issues involved for lesbian women and the psychological supports they need.

Other speakers referred to the problems of carers. There are generally two women involved, the person being cared for and the carer, and the needs of both must be recognised. This problem does not fall only to the Department of Health; there is significant input from the Department of Finance, as well as significant constraints. There is a need for specific focus on carers.

Another area highlighted related to female drug users and the need for specifically female services and support groups. It was indicated in the consultations that the preference of women with a drug abuse problem is to meet in an all female support group.

I do not intend to refer to all of the areas covered in the document which represents a comprehensive response from the Eastern Health Board. I have no doubt the responses from the other health boards were equally comprehensive. It was recognised by the Minister when he launched the document that the key note in approaching the question of developing a health policy for women is to listen. We have gone through that whole procedure. There has been a great deal of listening and input by individual women and by women's groups. I look forward to the Minister responding to that, as I am sure he will, and to having a comprehensive women's health policy document which the Government can follow in the coming years.

Mr. Browne

(Carlow-Kilkenny): Tá sean-fhocal againn a deir “is fearr an tsláinte ná na táinte”. Bhí sé sin fíor fadó agus tá sé fós fíor sa lá atá inniu ann. Muna bhfuil an tsláinte agat is cuma cé mhéid airgid atá agat.

I slí amháin, ar ndóigh, tá an t-airgead tabhachtach mar leis an airgead is féidir aire a fháil go tapaidh agus níos tapúla ná mar is féidir leis an ngnáth-dhuine é a fháil. Ar an láimh eile, áfach, ní dhéanann sé maitheas ar bith duit muna bhfuil an tsláinte go maith agat. Tá an tsláinte fíor-thábhachtach do dhaoine ar fad na tíre agus táimid ag caint faoi shláinte na mban anseo inniu. Níl fhios agam cén fáth a bhfuilimidne, na fir, fágtha ar leath-taobh ar fad.

It is a sign of the times that equality has been accepted and that we can discuss these matters without the objections of men. Such debates can be a boost for men also. Perhaps we will all live to be 100 years old but if we highlight women's health issues, the health problems of men may also be focused upon in the future.

Over the years women did a great deal of hard work in bad conditions. Mothers without the benefit of mod cons, did great work in looking after large families, often sacrificing their own lives for the sake of their children. We cannot pay a sufficiently high tribute to mothers who I am sure were waved into heaven by St. Peter because of the sacrifices they made. When it came to sharing the food on the table, they were the people who got the leftovers. Many a big strapping son decided he deserved his share of the food more than his mother.

Mr. Geoghegan-Quinn

And many a strapping husband.

Mr. Browne

(Carlow-Kilkenny): The mother of the family worked the hardest to ensure that the rest of the family did well in life. Previous speakers referred to teenage pregnancies. It is difficult for teenagers to look after their babies. Anyone who is married, has a mature and responsible partner and lives in good housing knows it is not easy to rear children. Teenagers who may want to go out and enjoy themselves with their colleagues but who have to stay at home to look after a baby 24 hours a day have a difficult role to play. When they come to my clinic looking for a house my heart goes out to them in view of the responsibility they have to take on. Babies cannot be clocked in and out at certain times. They need all kinds of attention every hour of the day and night.

It would be nice to think we could do something to lower the number of teenage pregnancies because we certainly have far too many. For their own sakes and for the sake of the babies who have to grow into children and adults, they have to get a chance in life. We should do all we can for those who have babies to ensure they have the opportunity to look after them properly. There is no point in being moralistic about it: the babies are born and we have to look after them. This has put a big strain on housing. Children cannot grow up healthy if they are living in poor housing conditions. Often teenage mothers get the worst flats because people are not inclined to let flats to them. Frequently young girls have to rent substandard flats which are bad for themselves and their babies. If there is any way in which we can get across the message that teenage pregnancies are not advisable we should do so but it is not easy to moralise on this issue.

We should pay tribute today to a former colleague, Mrs. Monica Barnes, who in the days before equality was the in-thing and before women's problems had been highlighted, set about drawing attention to women. This was followed by the report of the Second Commission on the Status of Women, which suggested there should be discussion documents on women's health. These discussions are not confined to the Dáil. It is important that women can meet and express their views because they know their problems at first-hand. They are expert in child birth, yet it is amazing the amount of advice they receive from males. They have to listen to all kinds of advice when in fact they are the experts. The one advantage in this type of discussion document is that they can offer their views. They should be listened to much more than at present. It is important that their experiences, awareness and concerns are expressed. Frequently there are theories on certain topics which are far removed from the practicalities. The way in which the medical services are arranged and the inconvenience for women and mothers are issues that should be highlighted. Any discussion is an opportunity for women to express their views. They know better than most men exactly what they want.

The Minister referred to the role of health boards and said some were setting up new systems. This is important because the health boards are becoming more local. The reports are in the local newspapers and on local radio which is more effective than advertising on national bodies in the daily newspapers or on national radio. Many of the people who need this type of help do not read the daily newspapers or pay much attention to national radio but they listen to local radio. If statements from the local health board about medical treatment or plans for the future are read out on local radio or published in the local newspapers there is a greater chance of people hearing or reading them and, therefore, they will have more effect. The local health boards can provide facilities at local level. There is no point in having exclusive screening schemes in Dublin if people cannot avail of them. I am aware one cannot have expensive top rate facilities in every village but the more available they are the more they will be used and the better they will be for those who wish to avail of them.

It has been highlighted in the report that people suffering from depression may not go out and that the radio is their only lifeline. They may never read a newspaper. Local radio has filled a void in the lives of many people. It should be used to get across the message to the ordinary person who may never buy a daily newspaper or listen to national radio.

I was amazed to read in the Minister's speech of the prevalence of heart disease among Irish women. He said: "Mortality from heart disease in Irish women is among the highest of any of the countries of the European Union and is currently 70 per cent above the EU average". If the rate is 70 per cent above the EU average, something must be seriously wrong in Ireland and there should be a focus on that disadvantage. Smoking has been mentioned as a contributing factor but I shall deal with it later. Something must be drastically wrong that should be easily identifiable. Seventy per cent above the EU average is shocking. Depression has been referred to as being a serious contributor. It may be that housing conditions, financial considerations and so on, apart from any medical problem, are major factors. Obviously the more discussion there is on this topic the more advances will be made.

Smoking has been referred to by several people and has been mentioned by the Minister. In this day and age when people are educated and young people are probably better educated than any previous generation, there are more young people smoking than in the past. One has only to drive past any secondary school at lunch time to see this. I am convinced — I do not think I am biased — that more young girls are smoking than ever before. They are standing around corners, sitting on walls puffing smoke. I cannot understand why they begin at such a young age. If they started to smoke at the age of 45, when they are more stabilised, I am sure they would not be able to continue the art of smoking. The number of teenagers smoking at lunchtime is unbelievable. What can one do for young people who are intelligent, who understand and who take no notice?

The statistics on breast cancer are more encouraging. The Minister said we could reduce the number of deaths from breast cancer in women over 50 years of age by one-third by screening women aged 50 to 64 for the disease. If the number of deaths could be reduced by one-third it would be a major achievement. The Minister introduced new plans for breast screening facilities throughout the country. Surely such screening should be encouraged if it results in a one-third reduction in deaths from breast cancer. He also stated that 40 of every 75 deaths — a reduction of more than 50 per cent — from cervical cancer could be prevented by a screening programme for women between the ages of 30 and 50. While I am sure the Minister will provide additional facilities for such screening, that does not mean people will avail of them. Women's organisations, in particular, should advise their colleagues to avail of those facilities. I hope the publication of this document will encourage more discussion on women's health and that women will listen to advice.

In disagreeing with raising the minimum age at which a person may marry a theologian from St. Patrick's College in Thurles stated that the Church should allow people at 14 to marry. I do not wish to get involved in a discussion on moral theology but anyone who suggests that a person is ready for marriage at the age of 14 must believe more in theory than in practice. Perhaps celibacy has something to do with his comments. It is outrageous that anyone should encourage teenagers to marry. The Government should be commended for raising the age at which people can marry. Marriage is difficult and requires maturity, commonsense and patience which children of 14 years do not possess. I am not sure if age brings maturity in all people, but it is outrageous to suggest that because people have reached the age of puberty and are sexually curious they are ready for marriage. If marriage at 14 merely allows them enjoy a sex life, the marriage would not last long. I am amazed that a person in a key position would adopt that position. Although some cope well, most teenagers of 17 and 18 find it difficult to cope with pregnancy.

I hope discussion on women's health will improve their lives. Everybody should be as healthy as possible and anything that gives rise to that should be encouraged by the Department of Health.

Mr. Creed

I welcome the opportunity to contribute to the debate on this document. Given our finite resources we should examine how we can spend money to deliver services that will provide tangible results.

I welcome the document with some reservations. A document on women's health excludes 50 per cent of the population. The statement that there are twice as many women as men over the age of 75 raises fundamental questions about the health of 50 per cent of our population. While it is important to dwell on the document before us, I await with interest the final chapter from the Department of Health, a policy document on men's health. There are a number of issues relating to men's health on which we should also focus. A banner headline in one of today's newspapers stated that we have the highest rate of male suicides in Europe. Those two statistics alone make a case for the publication of a document on men's health.

Apart from ensuring that services are delivered in a more focused, customer friendly and value for money fashion, the raison d'étre for the document must be that we score badly on the league table in regard to women's health. The life expectancy of women here is lower than that in any other EU country. To arrive at a consensus on future policy in this area there have been ongoing consultations since the document was published.

It is important that women are included in decisions on their health. As a member of the Southern Health Board for the past 11 years I have observed with interest the valuable contributions of professional and non-professional female members of the board. Some of their alternative views do not appear to cross the minds of male members of the board. It is vital that politicians encourage greater female participation in the decision-making process particularly on issues relating to women's health.

I congratulate the two new Members of the House, I am delighted we have a new female Member. I have no doubt both will make valuable contributions to all debates, including those on women's health.

The question of women's health is a cause of grave concern and the role of the GP is crucial in this regard. The general practitioner in the front line of service delivery offers a holistic approach to patient care that is very often separate and differs significantly from the centralised specialised treatment delivery on which hospital care tends to focus. General practitioners offer a particular advantage in that, by virtue of the medical card system, they deal with approximately one third of the population. As access to a medical card is largely financially determined, they deal with the lower socio-economic groups, including the unemployed and elderly, whom research indicates are the least amenable to the national preventive schemes on which the Department has embarked. They are also the people who most need to be included in the delivery of services so that we can redress inadequacies in certain areas of women's health.

In concentrating improvements in this area through the GP service, it has to be acknowledged that they cannot be delivered without significant investment of resources. It would, therefore, be worthwhile for the Department to look at the capitation fee which is available to GPs for each patient they have under the general medical scheme, the availability of proper back-up services such as practice nurses and secretaries, encouraging the setting up of group practices where resources can be pooled and the provision of ongoing education for GPs. All these areas should be looked at more carefully if GPS are to be to the forefront in delivering an improved service. A good example of how GPs can play a positive role is the child vaccination programmes which they have embraced as agents of the Department of Health and on which they have delivered effectively.

At present there are well intentioned but fragmented approaches to improving specific areas — cholesterol testing, breast and cervical screening. Many of these services could be given greater focus if they were delivered through the GP service. That cannot be achieved cheaply or easily; it will require a significant investment of resources. If we are serious about dealing with the problems set out in this document, we should face up to the question of resources. If we do not proceed by involving GPs to the maximum degree possible, we run the risk of developing parallel services by way of a series of regional clinics to deal with various areas on the one hand, with GPs simultaneously offering similar services which, through no fault of the GPs, are underfunded and inadequate.

My party colleague, Deputy Browne, referred to a number of preventive measures that could be adopted. Some of the statistics are worth repeating to show the extent of the problems and what could be achieved with proper policies. In 1993 there were 647 deaths from breast cancer. Apparently these could be reduced by 30 per cent if we had a national screening service in place. I welcome the Department's intention to move in that regard, but progress is too slow, and we will continue to have unnecessarily high mortality rates from breast cancer unless we accelerate the rate at which a national screening service is available. There are reservations about the provision of such a service because of the high incidence of false positive results, but it would be better to have a safety net in place, albeit with the trauma associated with false positive results, than not to have a service. The aim of significantly reducing the number of deaths in that regard is a laudable objective.

In 1993 there were 509 deaths from lung cancer. Newspaper headlines never cease to amaze me. During the week one newspaper published a headline to the effect that there had been a falloff in the numbers attending bingo nights because of the new regulations on smoking in public buildings. Surely responsible reporting would have highlighted the high incidence of deaths directly linked to smoking rather than bemoaning the declining attendance because of the new regulations. We should get the message home to people that their health would be enhanced if they would give up or reduce smoking.

I do not have figures regarding fatalities from cervical cancer, but it is estimated that we could achieve a 60 per cent reduction in fatalities nation-wide. It is regrettable that cervical smears are not available as a service to medical card holders as making them available would be an indication of the Minister's serious intent in delivering real improvements in this area.

The Minister also mentioned maternity services and the setting up of a specialist working group to investigate the delivery of ante and postnatal services. I want to move the debate on to a more parochial level by discussing maternity services in the Southern Health Board area, specifically in Cork city and county. Maternity services in Cork city are fragmented in a number of locations for various reasons, chiefly the infrastructural arrangements and the fact that certain "fiefdoms" had been established by those delivering the service at various levels which made it difficult to achieve a consensus on how best to improve it. I am glad that has been resolved and that there is now a consensus approach, that a new centre of excellence for the delivery of maternity services in Cork city and county will be located in the grounds of Cork University Hospital. I implore the Minister to give the green light to the stages the process must now go through as quickly as possible because, not to be alarmist, what exists in the absence of the new facility is not what would be considered adequate by expectant mothers, their relatives and the people delivering the service.

I want to touch on two other subjects. The choice of doctor is one of the foundation stones of the general medical scheme, and that means choice in its widest context in that medical card patients have a choice of doctors of different ages and attitudes. By and large it works. However, choice of doctor has not been tackled under present arrangements, particularly in rural areas where female patients predominantly want access to a female general practitioner. I am aware that well in excess of 50 per cent of places on medical courses in universities are being taken up by female students, a trend which will eventually be reflected in general practice. Nonetheless, in many rural areas there is not really a choice between male and female general practitioners. The Department should instruct all health boards to facilitate patients wishing to have a choice of general practitioner. That may often necessitate allowing medical card patients access to a female general practitioner who may not hold a GMS contract. If we are serious about choice of doctor and women's health issues, that is a fundamental need that must be addressed.

Deputy Browne touched on the general issue of smoking, the increasing incidence of which among young people, specifically young girls in secondary schools, is to be lamented. Given media concentration on other addictions such as alcohol and, even more alarmingly, ecstasy and other drugs, some parents may tend to turn a blind eye to their children smoking. The statistics to which I referred earlier, in particular the incidence of curable cancer to which smoking significantly contributes, should never be omitted from the equation, bearing in mind the serious impact on public health generally.

Our educational system has many questions to answer in regard to this practice of smoking. Much emphasis is placed on sporting activities in secondary schools. Recent research points to much greater numbers of young girls than young boys smoking, no doubt directly attributable to the influence of sport and outdoor activities in the case of boys. This imbalance needs to be redressed.

Given the emphasis placed on the inherent dangers of smoking over many years, regulations introduced by the Department of Health and the continued taxation of cigarettes, it is most disappointing that we have such a significant smoking problem. This will continue to be an enormous contributory factor in the ill health of a significant proportion of our population. I must reiterate that sport for all, boys and girls attending school, would be one method of tackling that problem.

Mr. Boylan

I want to contribute briefly to this important debate and comment on the statement of the Minister of State at the Department of Health, Deputy Brian O'Shea, when he introduced this policy document in the House on 9 November, 1995. Reading through his contribution I was startled to read that the average life expectancy of Irish women is among the lowest in the European Union, with death from heart disease being 70 per cent above the European Union average. That trend cannot be allowed to continue without some positive identification of its causes and immediate remedial action.

I agree with much that Deputy Creed had to say on the overall attitude to and the role of women in Irish society. There is no doubt that heavy smoking has been identified as a major cause of heart disease, with increasing evidence that many more young girls are smoking than their male counterparts. I am convinced this stems from lack of education as to its consequences. Whenever one attends a social function invariably one sees nine out of ten young girls smoking, if not cigarettes, some other substances, whereas among a corresponding group of ten boys one will see one, if any at all, smoking.

No doubt this trend has to do with overall attitudes to health matters. Most young boys and men are geared toward sporting activities and keeping fit but that is not the case with young girls. That phenomenon is indeed sad. Young girls may feel insecure or bored and that should be addressed. No doubt it is related to the high incidence of heart disease among Irish women which, with proper intent, could be substantially reduced.

While we here may be only catching up with trends elsewhere, soap operas portraying slender, fashionable female figures have developed a huge following, particularly among young girls. Some become obsessed with having a good figure and resort to a rigorous diet aimed at reducing weight, the fatty content of foods and so on. Manufacturers of alternatives to dairy produce have got away with murder. The Dairy Council has been very negligent in not counteracting the highly orchestrated campaign run by the many multinationals and blenders of alternative dairy products here and abroad over the past ten years or so. It prompted one esteemed heart surgeon, Mr. David Nelligan, to draw attention to the fact that what was happening was nothing short of criminal, pointing out that dairy produce was a good source of nutrition and that many alternative blends have a high risk of causing heart disease. Many alternatives like margarines and butter oils contain an ingredient comparable to a substance used for the repair of cars and household equipment, plastic padding and so on. It is unbelievable that many people consume such harmful products which can lead to heart disease.

Education has a major role to play. The Minister of State, Deputy Brian O'Shea, on 9 November 1995, at column 18 of the Official Report stated:

I stress that this document is not an excuse to hold up developments which will provide women's health or reduce illness among women. Even since the discussion document was published, decisions have been taken on some issues where there is general agreement that progress should be made. Funding has been allocated for counselling women with crisis pregnancies and research has been commissioned on the reasons women with crisis pregnancies seek terminations abroad.

The numbers of teenage pregnancies and others outside of marriage is a cause of serious concern. It is a very sad phenomenon that the lifestyles of many young women are totally disrupted. I cannot understand why there should be so many pregnancies among young girls when so much information and education is available to them. Is there a breakdown in our society? While I am a traditionalist, I see the role of the mother and father in marriage as extremely important, even stretching that concept to advocating that two people should make a joint commitment, whether in a church or elsewhere, to set up home and rear a family. There is a growing number of casual partners. When young girls become pregnant, their overall approach to life, of necessity changes totally and their future plans are disrupted, through unwanted pregnancies which are becoming ever more numerous. This leads one to believe that our educational system is lacking.

That takes me back to all the fashionable nonsense being portrayed on our television screens. Various imported programmes portray this type of casual lifestyle which seems to be the order of the day. It is also portrayed in many foreign magazines sold here. I am not against people having a broad outlook on life and seeing what happens but it is sad that young girls should think that is a good lifestyle, it comes back to the point I made about the role of parents. The role of the mother is extremely important. The attitude of society is that the mother who goes out to work is held in higher esteem than the mother who works at home. Marriage should not disrupt a girl's career but I do not think a career is the be-all and end-all. I do not think that the mother who works at home should feel less adequate than a mother who holds down a job. Rearing a family is a full-time job, now more than ever because of all the opportunities for people to get into trouble. It is a constant job to educate and advise young people because they can easily be misled.

The former Taoiseach, Dr. Garret FitzGerald, recognised the importance of the work of the mother who stays at home. He had the idea of introducing a payment of £9.50 per week in recognition of the role of the mother who works at home but it never came to anything. I believe it was his genuine intention to introduce it but it never became Government policy. Many women who work in the home were disillusioned when this financial recognition did not materalise. When we see all the problems that young families face I think it is time that the role of the mother in the home should be recognised by the State and that the mother who stays at home to look after her children should not feel less adequate than the mother who has a role outside the home. I fully recognise the need for both partners in a marriage to work outside the home but rearing a family is a big task. After a day in the office or working in business, the woman has to come home and deal with her children and all the problems that go with it — in case people think we in Cavan are not forward thinking people and are inclined to keep the women in the house let me congratulate the appointment of a married woman as chairperson of the county enterprise board. I have no doubt that if one spoke to her, she would say it is a big strain. Because any woman working outside the home has to face the household chores, the school lessons and getting the clothes ready——

Mrs. Geoghegan-Quinn

The husband could help.

Mr. Boylan

Unfortunately the husband will more or less say that the mother will do that. I fully accept that the husband has a role to play but at the end of the day who can iron the shirt or tie the bow better than the mother? It is expected that the mother will put the final touch.

The economy is going well, we have a good Government and an excellent Minister for Health who is very caring and has done marvellous work in extending the health services across the country. Nevertheless the hepatitis C figures are starting and nothing has changed very much since last November except that the issue of compensation for the unfortunate women who have hepatitis C as a result of the contaminated blood is being addressed. The Minister should look at the possibility of reintroducing Dr. Garret FitzGerald's idea of financial recognition for mothers who work at home. The £9.50 of a decade ago would be around £25-£30 now. It would take some of the pressure off a woman who, with her partner, has to earn a living to keep the household afloat. The money certainly would not go to loss and a great many of the problems of our young people would also be addressed.

I certainly appreciate the role of women and the marvellous work they do inside and outside the home. The startling figures need to be addressed and I know the Minister will do that.

Minister for Health (Mr. Noonan

, Limerick East): I am pleased to respond to this debate on the discussion document, Developing A Policy for Women's Health. It gives me an opportunity to express my commitment, the commitment of my Department and the commitment of Government to improving the health of Irish women. As the Minister of State, Deputy O'Shea, said when he opened the debate, the publication of the discussion document on women's health was the first step in a process which, I hope, will lead to significant improvements in women's health. The second stage of the process is now concluded. Women throughout Ireland have been consulted on the document and on their experience of the health services.

I take this opportunity to thank the National Women's Council for their assistance to the consultative process on women's health. The council responded to my invitation to assist with the consultative process to ensure that consultation with women was as broadly based as possible. Representatives of the council have worked closely with the health boards and the Department to facilitate consultation and dialogue on the discussion document, Developing a Policy for Women's Health.

I acknowledge the commitment and enthusiasm of the health board staff who organised the consultative process. As one would expect, the process was handled differently in each health board, reflecting different priorities, perceptions and needs. This diversity has added colour and tone to the consultative process. It is all the more persuasive then that the women who participated in the consultative process are saying broadly the same kind of things. They want a health service that is women-friendly. They want to see women's health services improved and developed. They want information on health and social services that is accessible and relevant to their needs. They would like access to more complimentary health services. They are calling for ongoing consultation of women by the health services and greater representation of women generally in the health services. If we are to take seriously the idea of developing services which are perceived by the consumer to be of high quality, a goal set out in the health strategy, we must listen to what women say about their health and design services which they feel comfortable using. The consultative process on women's health has posed a challenge to the health services. It is a challenge to which the health services are well able to respond but it is one that calls for some fundamental thinking about the way in which we plan, organise and deliver services to women.

Now that the consultative process is completed, my officials have begun drafting a plan for women's health. It is my intention that the plan for women's health should grow from the discussion document and the consultative process. The plan must take on board the issues raised during the consultative process. It must address the issue of how to develop more user friendly services for women and how consultation with women can be built in to the operation of our health services. The plan should also heighten women's awareness of the risks to their health and the measures which are within their control to improve their health.

I hope to bring the plan to Government for approval in the early summer and to commence its implementation as soon as it has been approved. I cannot promise an overnight transformation of our health services into the kind of health service that many women would see as ideal. However, we can begin, perhaps we have already begun, the process of transformation to a health service that is woman friendly and that promotes the health of women generally.

I welcome the positive reception which the discussion document has received from speakers on both sides of the House. All Deputies who have spoken recognise the value of the document and of consulting women about the health issues which most concern them. I will respond to a number of issues raised by Deputies in the course of the debate.

Deputy Geoghegan-Quinn referred to the need for a comprehensive family planning service. I share the Deputy's concerns in this matter. Perhaps I could outline to her the steps I have taken so far to ensure that a comprehensive service is available.

Health boards are responsible under section 8 of the Health (Family Planning) (Amendment) Act, 1992 for providing and making available a family planning service. In March 1995, in response to the policy agreement for Government, my Department issued a set of guidelines to the health boards to enable them to evaluate and expand the current range and level of family planning services available in their areas. The purpose of the guidelines is to ensure that in each health board there is an equitable, accessible and comprehensive family planning service. In this service the key role of the general practitioner in providing family planning services is recognised. Health boards have been asked to ensure that a broadly-based programme involving family planning clinics and/or other service-providers is developed so that services are within easy reach of clients and choice of service-provider is available.

I have received preliminary reports from the health boards on the implementation of these guidelines. I am awaiting their final reports which should take account of the services being developed by voluntary organisations and have regard to the opportunities presented for pregnancy counselling by the development of comprehensive family planning services.

The range of services provided free of charge under the GMS has been extended to include spermicidal creams and contraceptive devices. A total of £730,000 in additional funding was provided to the health boards for the development during 1995 of their family planning services in accordance with the guidelines.

I was particularly interested in the reference by Deputy Geoghegan-Quinn to recent innovations in general practice, relating to provision of minor surgical services in one particular practice in the Western Health Board area. Since the establishment of the general practice development fund in 1992 and the introduction of the indicative drug target saving scheme, significant investment has been made by the newly established health board general practice units in improvement of general practice premises and in practice equipment. Rota and cover arrangements have been improved and practice support staff such as practice secretaries and practice nurses have been employed in increasing numbers. These measures have resulted in better services to patients, the majority of whom are women.

The improvements in the organisation of general practice and the operation of general practice units within health boards provide an effective base from which to address the health strategy commitment to provide additional services within general practice. My Department requested health boards to give priority to developing a range of services in general practice in 1995.

One of the priorities is to extend the range of women's health services in general practice. These services include those which require special expertise or support on the part of a general practitioner in women's health. They cover women's health services provided by health professionals other than general practitioners in a general practice setting. Health boards and general practitioners have begun to address these priorities. I look forward to seeing further development of women's health services in general practice in the near future.

Both Deputy Geoghegan-Quinn and Deputy O'Donnell asked for information in relation to counselling women with crisis pregnancies and about the research which my Department has commissioned on why women with crisis pregnancies seek terminations. Expert and sympathetic counselling is available to women facing a crisis pregnancy. The service is available from general practitioners, voluntary organisations and health boards.

In 1995 my Department provided funds to the Irish College of General Practitioners in respect of their training programme and information pack for general practitioners in response to the Termination of Pregnancy Information Act, 1995. I also provided £300,000 to agencies such as Cherish, CURA, Irish Family Planning Association, Life, Pact and the Well Woman Centre for the development of pregnancy counselling services. In addition all health boards have been asked to evaluate the need for pregnancy counselling services, taking account of the services being provided by voluntary organisations.

My Department has also commissioned the University of Dublin, Trinity College, to carry out a major study to identify the factors which contribute to the incidence of unwanted pregnancy and those factors which result in the option of abortion. The research study commenced on 1 September 1995 and is being carried out by a multi-disciplinary team consisting of representatives from the departments of social studies, sociology and community health and general practice at the university.

In brief the study will consist of a comparison between pregnant women who proceed with their pregnancies and those who decide to opt for terminations. Pregnant women who proceed with their pregnancies will be selected through GPs, family planning clinics, Well Woman centres and maternity hospitals. In addition it is intended to interview Irish women who have decided to have abortions. These interviews will take place in the United Kingdom.

It is envisaged that this research will take 18 months to complete. Its results will help the Department of Health develop educational, counselling and other services designed to reduce the number of crisis pregnancies and the number of women who have recourse to abortion. The problem of teenage pregnancies will also be looked at in this context.

A number of speakers have referred to the need to ensure that there is greater representation of women at decision making level in the health services. The health strategy states that one of the objectives of Government policy is greater participation by women in the organisation of the health services both in the more senior positions and at representative levels.

A report completed last year on women's employment in the Midland and Mid-Western Health Boards suggests that the barriers that are holding women back from senior posts arise in areas such as training, interviews, promotional paths and organisational culture. With the encouragement of my Department, health boards are currently reviewing their employment practices to ensure that obstacles to gender equality are overcome. When this review is completed, the Department will consider what further joint action is necessary with employing agencies to ensure that women are fairly represented at senior levels in the health services.

Deputy Geoghegan-Quinn referred to the importance of the workplace for educating women about health. I agree with her. I was pleased that this issue was discussed during the consultative process on women's health at a seminar hosted by the Irish Congress of Trade Unions with support from my Department. That seminar emphasised the importance of the workplace as a source of health information and education for women in employment. Proposals made at the conference to develop workplace health for women are being followed up by the Department and the Irish Congress of Trade Unions.

All Deputies mentioned the threat that cancer, in its various forms, poses to the health of Irish women. The improvement of cancer services is one of my priorities as Minister for Health. I have appointed a working group in the Department to review our cancer services and, in consultation with experts in the field, to recommend a cancer strategy. This group is now finalising its report.

On 6 October last I announced the expansion of the breast cancer screening programme which has been piloted by the Eccles St. project. The first phase of the expanded programme will cover the Eastern, North-Eastern and Midland Health Board areas and will target 120,000 women in the age cohort 50-64. This will mean that about half of women in this country in that age group will be involved in the first phase. All the expert advice available suggests that we should proceed slowly to build up the screening programme to ensure that the highest standards are achieved in the detection of breast cancer.

A working party was appointed by the previous Minister for Health in October 1992 to review cervical screening. Their report was finalised in early 1995. The recommendations of this report have also been examined by the group established to prepare a strategy on cancer services.

Issues which are being considered in relation to implementing the report on cervical screening include the formation of a national database of the target group of women to be screened; an appropriate payment to GPs for smear testing; the training of cytoscreeners to ensure that there is expertise of a high quality in our laboratories to analyse the smears; the most appropriate way of informing women of the benefits of screening; how cervical screening services should be organised, centrally and locally, and the staffing implications of a screening programme. Given the complexities of the issues, time is needed to plan and develop a screening programme of high quality.

The House will be aware of the important Fourth UN Conference on Women which took place in September 1995 in Beijing. Despite some initial pessimism, the governmental conference was a most successful one. Representatives of 185 countries agreed a declaration and an important document, A Platform for Action, which commits Governments to take steps to address inequalities and oppression experienced by women.

There is general agreement that the platform is an important step beyond what was agreed at the Third UN Conference on Women in Nairobi ten years ago and will create a momentum in favour of women throughout the world. Not surprisingly, the platform identifies improving the health of women as one of the major priorities for action by UN member states. The platform calls on Governments to review health policy and legislation to ensure that they reflect a commitment to women's health.

They are asked to design health programmes, in co-operation with women's organisations, that address the health needs of women throughout their lives and that take into account their multiple roles and responsibilities. In particular, Governments are asked to strengthen preventive health programmes for women, to take measures to protect their reproductive health and to promote research and information on women's health. As you can see, the discussion document, the consultative process and the plan for women's health puts this country in good shape to implement the health commitments of the Beijing platform.

One cannot think of the Platform for Action agreed in Beijing without thinking of the many problems which women throughout the world face every day. The improvement of women's health in the developing world is one of the most important issues of our times. I am aware that consultation on this aspect of the discussion document is not yet complete. My Department with the co-operation of the Department of Foreign Affairs, will shortly be organising a forum in which groups concerned with the health of women in the developing world will have an opportunity of identifying steps which we could take in this country to strengthen our commitment to women's health in the Third World. Even the shortest visit to a developing country leaves one in no doubt as to the scale of the problems which undermine the health of women and children and the difference which assistance from even a small country such as ours can make.

I thank Deputies for their constructive contributions to this debate on developing a policy for women's health. It is clear that all parties in this House share the same objective of promoting the highest attainable standard of health for women. Although this has been the first debate in the history of this House on women's health, I am sure it will not be the last. I look forward to further constructive dialogue with members of the House following the publication of the Plan for Women's Health.

Sitting suspended at 2.15 p.m. and resumed at 2.30 p.m.