I thank the Leas-Cheann Comhairle. I was just making the point that, as the people's representatives, everybody has had ample opportunity, as is right and proper in this House, to give their views. I thank all Deputies for giving those views.
I also make the point that it is 146 days since the people voted to repeal the eighth amendment. It is important that we do not forget what has happened in that time. We know that, every day, about nine women leave our country to go abroad to access termination. These are women in crisis looking for help that they cannot get in Ireland today. In addition, every day about three women will take the abortion pill, obtained online without any medical supervision or advice. That is roughly 12 women every single day since the referendum passed who have continued to have to access termination in either dangerous circumstances or abroad. As we have the luxury of sitting in this House today, nine women are in our airports and ports heading off to the UK or other jurisdictions. That means that 1,752 Irish women - our mothers, sisters, wives, neighbours and friends - have had to access termination since the people voted to repeal the eighth amendment.
While we have an important job to do to make this, as Deputy Burton rightly said, the best possible Bill we can pass in this House, we must also be conscious that the reality of women in crisis pregnancy continues today. Until we pass the legislation, the instruction the people gave us to get on with and do our job is an instruction we have yet to fulfil fully.
Only this week I received a very heartbreaking email from a woman with fatal foetal abnormality in her pregnancy. This was a desperately wanted baby. She pleaded with me to see if I could do something to help her and her husband to ease what is already such tragedy and pain. The harsh reality is that until this legislation passes, we are not in a position to do that. Those sitting here need to realise that we cannot decouple the scrutinising we need to do from the reality facing women today. That woman is sitting at home today knowing that even though the people have voted to repeal, she will still have to travel abroad because doctors who really want to help her here cannot do it until we pass this legislation.
A number of Deputies rightly say that the people only voted on the question of whether to repeal the eighth amendment. That was the question. Of course, the chairperson of the referendum commission was right. I believe I, myself, said it on a number of occasions. The people voted either for or against repeal; that was their decision. However, they voted in the context of knowing what legislation I would introduce if they voted to repeal the eighth amendment. Those who campaigned against repeal highlighted elements of the Bill and quoted elements of the Bill on posters, in my view often distorted elements of the Bill. We had debates in television studios, radio stations and community halls. We had literature from both sides dealing with the content of that draft legislation. While it is accurate to say that the people's decision was to repeal or not to repeal, it is important to say that the people made that decision in the context of a very detailed debate, following the excellent work of a cross-party committee and the excellent work of the Citizens' Assembly.
Therefore the legislation we are introducing now is not a surprise. It is what we promised to do. There is an onus on me as Minister - I would argue there is an onus on all of us in this House - to legislate within those parameters. I am sure people on both sides of the argument will want to see changes. We should consider each and every amendment; that is our job. I will approach the debate feeling a huge responsibility to introduce a Bill along the lines of what we promised we would do. We told the people if they voted to repeal, this is the legislation I would introduce and that is the task we now have.
I sincerely recognise that there are deeply held views on all sides of the Oireachtas and throughout the country. In taking the next steps as an Oireachtas and as a Government, we must respect and hear them all. However, language is important and insightful. We have had many excellent contributions, including from speakers with a completely different view from mine. Deputy Butler gave a very eloquent and honest speech in this House last night. As a woman who had campaigned against repeal, she was very upfront about her views while also recognising the reality of the people's decision. She made a very important contribution last night.
Unfortunately, some people talking about the issue in this House are using language that gives an insight to a mindset that is worrying. I wrote down a few phrases I heard today. I heard reference to "those women". I have heard reference to "a cooling-off period". I heard an horrific and bizarre suggestion that termination will replace contraception. These sorts of views are offensive, but are also ignorant. They show a lack of understanding of the very difficult decision-making process a woman goes through before accessing termination. To equate in any way termination to contraception shows a fundamental lack of respect for women. It also shows a fundamental lack of understanding about termination and contraception.
As we go to the next Stage of the Bill, which I hope we will in the next few days, it is important that we all use language that is respectful.
They are not "those women". They are women from every town and every community in this country who are looking for help in a crisis. We need to be very careful we do not use language that stigmatises, and I ask that we reflect on that.
I assure Deputies I have listened carefully to the contributions made so far. I am pleased to note that, in general, there is very significant support for the Bill in the House, although I recognise there is far from unanimous support. I am mindful, however, that issues have been raised around certain provisions in the legislation and I look forward to Committee Stage, when we will be able to discuss and address these concerns in much greater depth. I am aware, for example, that some Deputies expressed a concern that the term "abortion" is not used in the Bill. I want to address that issue because I think it important. The reason is that this is the result of the wording inserted into the Constitution by the Thirty-sixth Amendment of the Constitution Act 2018. That amendment inserted a new Article 40.3.3° into the Constitution which states: "Provision may be made by law for the regulation of termination of pregnancy". Therefore, this Health (Regulation of Termination of Pregnancy) Bill is the means by which the Oireachtas will exercise its new constitutional authority under the new provision. In this way, the Oireachtas is carrying out the will of the people as expressed in the result of the referendum. Using the language of the new Article 40.3.3° in the legislation that seeks to give effect to this provides necessary consistency and clarity in law. What I am doing in the Bill is mirroring the language used in the new constitutional article. That is why we use the terminology in regard to "termination of pregnancy" rather than "abortion". It ensures that the Bill is consistent with the wording in the Constitution and avoids any potential doubts or unintended consequences which could potentially flow from departing from that language. It is for that reason, rather than for any other reason.
I am aware some disquiet was expressed around the positioning of the offences provision in the Bill. Again, I get this: people pick up the legislation and one of the first things they see are the offences. I have heard the sincere views of Deputies that this could create a chilling effect. The general scheme of the Bill published in July provided for offences in head 19 but the Office of the Parliamentary Counsel, when it drafted the Bill in three parts, decided that under this arrangement offences are in the first part of the Bill. I want to clarify that this section is based on Part 1 of the Bill for purely technical consideration by drafters, as opposed to any policy or political decision. There was no other reason for placing it there and certainly no symbolic consideration behind it. It is something I am happy to look at with Deputies as we move forward.
Several Deputies raised the issue of safe access to services and I thank them for doing so. As they are aware, it is my intention that, following the passage of this Bill, services for termination of pregnancy will be a normal and lawful part of the Irish public health service for women. I recognise, however, that these services carry a significant likelihood of demonstrations taking place, demonstrations which may be distressing and upsetting both for service users and for healthcare professionals. I am concerned we have already had maternity hospitals like the Rotunda having to take to their social media channels to alert women to this very upsetting situation happening outside the hospital. When a woman is accessing a maternity service, and going into a maternity hospital either to have a baby or to deal with a crisis pregnancy situation, that woman and her family deserve to be able to access those services in a way that does not further add to their distress or pain.
I believe we need to act in this regard. Many countries providing abortion services have included provision for safe access to those services in their legislation. In July I sought and received Government approval to draft legislative proposals to ensure safe access to premises in which termination of services may be provided. This would allow patients, service providers, healthcare staff and members of the public to enter the premises without fear of intimidation or harassment, and without being subject to unwanted communications about termination of pregnancy by any means. This would include oral, written or visual displays like the ones we were subjected to during the referendum campaign. While it was my original intention to provide for such safe access in this Bill, a number of issues were identified during the drafting process. In order to allow for full consideration, I decided we could not delay this Bill and that the best way to proceed would be a separate companion piece of legislation. I, therefore, requested and was granted Government approval to draft a separate general scheme of a Bill to provide for safe access to services which may provide termination of pregnancy procedures. Work on this companion legislation will be concluded without delay and, I hope, will be in place by early next year.
Another issue that has been the subject of concern by some Deputies is that of conscientious objection and the drafting of section 23 of the Bill. Some Deputies have suggested the Bill should not require doctors or midwives to refer a woman on for care where they have a conscientious objection to providing termination of pregnancy services. I would like to point out very clearly, because, frankly, there has been a lot of misinformation in this regard, that section 23 of the Bill as it is drafted is absolutely in line with the current section 49 of the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners 2016. This obliges doctors to enable patients to transfer to another doctor for treatment in cases of conscientious objection. It is also in line with the Nursing and Midwifery Board of Ireland's Code of Professional Conduct and Ethics 2014. Let me be very clear. This legislation does not require medical practitioners, nurses or midwives to do anything new or, indeed, to do anything more than they are already ethically required to do under their own professional guidance.
I am somewhat concerned that, while everyone has raised conscientious objection, nobody has raised it with regard to the impact on the woman. We cannot have a situation where a woman finds herself going from GP practice to GP practice in search of a doctor. I have asked Professor Boylan and stakeholders in medical colleges, when I met them in the last month, to consider the conscientious objection from a woman's perspective to ascertain how the woman can find out the information in a way that is safe for the woman and safe for the doctor. I cannot imagine how awful is the extra distress that arises when a woman has to go before a doctor in such a situation, and while that doctor has an absolute right to conscientiously object, this will add to the woman's distress. While we talk a lot about this from the healthcare professionals' point of view, and that is fine and is a legitimate issue, and conscientious objection will be provided for in this Bill, we should perhaps look at this more from the perspective of a woman in distress seeking help from the Irish health service. The question is how we help that woman navigate the situation to find the services she needs. I believe there is something that can be done in that space, as Professor Boylan and others work on implementation from a practical and operational point of view. I am sure we will be discussing this further on Committee Stage.
Some Deputies also raised the issue of greater support in regard to pregnancy in general, but more specifically for women in crisis pregnancy situations. In this regard, several colleagues pointed to the need to implement the ancillary recommendations made by the joint Oireachtas committee on the eighth amendment. I hate that title "ancillary" and while it is only a word, I know the committee very much had these as central, key recommendations. While we sometimes talk about them as though they are merely add-ons, they are very much at the heart of what the committee, the Government and the people want to do. We have seen other jurisdictions like Portugal and Spain that have liberalised their laws on abortion also put in place better services in regard to sex education, counselling, perinatal hospice support and, crucially, contraception, and, as a result, the number of abortions declined. I looked at those figures not long ago, so I know that both Portugal and Spain have seen a very consistent downward trend regarding abortions as the supports have been increased for people in crisis pregnancies, but also in regard to trying to help people not find themselves in a crisis pregnancy situation. No woman wants to find herself in that situation.
I assure the House I am committed to working with the Oireachtas to reduce the number of crisis pregnancies and this is part of ongoing work in my Department. Work has been progressing on the development of more comprehensive sexual health and well-being education information and promotion. Recent progress includes the formal launch and ongoing development of a new website, sexualwellbeing.ie, which provides information on contraception, crisis pregnancy, consent, relationships and sexually transmitted infections. A new safer sex campaign targeted primarily at young people was also recently launched using the hashtag, #respectprotect, and there is ongoing extension of the provision of free condoms to target harder-to-reach groups, including, for example, people living in direct provision.
Regarding Deputies' concerns and legitimate issues on obstetric care in general, I am proud to be part of a Government working with an Oireachtas which is committed to the development of our maternity services. Over recent years there has been a very significant focus on the development of national maternity policy in order to ensure our maternity services are developed in a coherent and evidence-based way. It is hard to believe we did not have a national maternity strategy in Ireland until 2016, so it is clear all of those who talk about the need to do more in this space do not tend to talk about it outside of referendum campaigns, sadly. Nonetheless, we now have Ireland's first ever national maternity strategy, Creating a Better Future Together 2016-2026. It was developed by the current Taoiseach when he was Minister for Health. We also have the HSE's national standards for bereavement care following pregnancy loss and perinatal death, including in situations where somebody has experienced loss through abortion. In addition, HIQA has now finalised national standards for safer, better maternity services. When we take all of these developments together, they are clearly key building blocks which will enable us to provide a consistently safe, patient centred, high quality maternity service.
For my own part, I am fully committed to ensuring that all women accessing maternity services should receive the same standard of safe, high quality care, regardless of where they live in this country.
I am also aware some disquiet was expressed around the posititioning of the offences provision in the Bill. Again, I get this. People pick up the legislation and one of the first things they see are the offences. I have heard from Deputies their sincere views in this regard, and their view that this could create a chilling effect.
Every woman from every corner of Ireland should expect and be able to access the maternity services she needs. Deputy Joan Burton rightly raised the issue of access to anomaly scans. We are rolling out this capacity across maternity services and recruiting sonographers to ensure access to scans will be available in all maternity units. While it is quite an involved process to get through all of the recruitment, we are making good progress and I expect access to scans to be available nationally by the end of 2019.
Last October I launched the implementation plan for the phased roll-out of the maternity strategy which had been developed through the national women's and infants' health programme. While we have a great deal more work to do in this area, we have legislation before us to fulfil a commitment to the people which I made with many Deputies across the House that if they repealed the eighth amendment, we would bring forward legislative provisions largely in line with the all-party committee's report and very much in line with the general scheme published before the vote took place. I am pleased that the debate on Second Stage is concluding and look forward to progressing the Bill through Committee Stage. I continue to think of the nine women who will travel from the country today, the nine who will travel tomorrow and the nine who will travel the day after that. I think of the three women who will continue each and every day to access abortion pills online without any medical supervision. It is for them that we will put our shoulders to the wheel to pass the Bill and that the HSE will work with Dr. Boylan to ensure we will be ready to implement new services at the beginning of 2019.