Dáil Éireann debate -
Wednesday, 5 Jul 2023

Vol. 1041 No. 4

Health (Termination of Pregnancy Services) (Safe Access Zones) Bill 2023: Second Stage

Minister for Health (Deputy Stephen Donnelly)

I move: "That the Bill be now read a Second Time."

As colleagues will be aware, when the Government was formed, I made it clear that we needed a revolution in women's healthcare. This Bill is another important step on that journey. It delivers on the commitment in the programme for Government and the long-standing commitment, first made in 2018, to provide for safe access zones. At its core, the Bill is about making sure women can access legally provided services safely and with privacy and dignity. It is about making sure our healthcare providers and workers can safely provide those legal healthcare services.

I realise this is a much anticipated Bill and that it has taken time to get to this point. However, this is a complex area of law. We are seeking to balance important competing constitutional rights. Therefore, it is important that any legislative provisions introduced are implementable, enforceable and capable of standing up to any legal challenges that might be brought against them. With that in mind and following Cabinet approval last year, officials from my Department have worked extensively with the Office of the Attorney General and other relevant stakeholders to draft the text of the Bill before us today.

I take this opportunity to thank all who have played a part in the development of the Bill. I particularly express my appreciation to the Office of the Attorney General, the Department of Justice and An Garda Síochána for their considerable input into the process. I thank the Oireachtas Joint Committee on Health for its work on the pre-legislative scrutiny, its thoughtful report following that work and its proposal for a provision in the legislation. I confirm that the health committee's proposal has been incorporated into the Bill. I look forward to engaging with members of the committee today and on Committee Stage. I also take the opportunity to acknowledge the considerable contribution of the Together for Safety team. In many respects, the Bill before us today builds on its innovative work and ideas in this area. Last but not least, I thank the officials in my Department, who have done Trojan work in making sure the Bill was ready to come before us today, that it is legally and constitutionally robust and that it does what we all need it to do, which is to keep women safe in accessing services and our healthcare workers safe in providing them.

Safe access zones or buffer zones have long been a feature of the legislative framework in Canada, Australia and certain states in the United States. More recently and much closer to home, the Isle of Man introduced legislation providing for such measures in 2019. Both Scotland and Northern Ireland either have followed suit or are in the process of following suit. Furthermore, the introduction of safe access zones here in Ireland is supported by clinicians providing the service in the HSE and by the Irish Medical Organisation, IMO.

The main purpose of the Bill is to address and mitigate, in so far as possible, the potential for a person's access to a termination of pregnancy to be impacted or influenced at the point of access. It will also provide additional assurance to healthcare providers that they will be afforded protections, should their services be the target of specified conduct that could interfere with their service provision and with their staff otherwise supporting the delivery of what is a lawful service.

I will go through the Bill section by section to clarify its provisions. There are seven sections. Section 1 is a standard provision containing definitions of the key terms of the Bill. As colleagues are aware, the Government decided to provide termination of pregnancy services within existing mainstream health services. This was done both to embed the provision of termination of pregnancy into primary, community and acute services and to ensure services could be provided to those needing them in relative anonymity. In line with this policy, the safe access zone legislation will not highlight the specific sites at which termination of pregnancy services are provided. Rather, it will create safe access zones 100 m from the entrance or exit to a premises where obstetricians, gynaecologists and general practitioners provide services. This will include such facilities as consulting rooms, family planning clinics and women's health clinics. The zones will also apply to hospitals that provide acute inpatient services within the meaning of section 51 of the Health Act 1970. The zones will apply in certain circumstances to shared properties and to private property.

Section 2 prohibits certain conduct in the vicinity of healthcare premises that may provide termination of pregnancy services which intentionally or recklessly impedes access or influences the decision of a person in relation to availing of, or providing, termination of pregnancy services. It is not intended to be a general prohibition on expression, assembly or protest in relation to termination of pregnancy services. The overarching aim of this provision is to protect a person's access to a lawfully available healthcare service and protect their decision to access termination of pregnancy services from unsolicited influence. Likewise, this also protects healthcare providers in their provision of termination of pregnancy services and their decision to provide termination of pregnancy services to ensure the availability of service.

Section 3 sets out exemptions that may apply in the context of prohibited conduct within safe access zones and the corresponding offences. In doing so, it further acknowledges and promotes, on a proportionate basis, the balancing of various human and constitutional rights. The section makes it clear that this Bill does not impede, impact on, prohibit or criminalise anything done by healthcare workers and other staff of the healthcare provider in the normal function of the health service.

With regard to the right to protest, the proposed legislation does not interfere with the right to advocate in favour of or against abortion, apart from in the limited areas covered by safe access zones and in the limited fashion covered by the concept of "prohibited conduct" as set out in section 2. As such, the prohibition is not on the right to protest but on exercising that right of protest within a safe access zone in a manner aimed at interfering with a person's access to a facility for the purpose of availing of or providing termination of pregnancy services.

The section clearly outlines that lawful protest outside the Houses of the Oireachtas is not prohibited by this legislative proposal, provided it is not aimed at a specific healthcare facility. The section also ensures that conduct which would otherwise be lawful, which occurs within a public place, meaning a building of worship, is not prohibited. This is to protect, for example, sermons that may be given during church services. It should be noted that this exception would not apply to, for example, grounds outside of a church within a safe access zone to avoid a situation where protestors use the grounds of a church or other similar location to circumvent the prohibited activities. The aim of this overarching approach is to ensure the effect of the proposed legislation on the rights of those affected is proportional to the objective sought to be achieved.

Section 4 sets out the powers of the Garda in respect of the enforcement of the legislation. The section contains a requirement for a Garda warning as a precursor to the commission of an offence. This mechanism was introduced to enhance legal certainty and protection of rights so that persons at risk of offending through commission of prohibited conduct are clearly made aware that they are engaging in prohibited conduct and that further conduct would amount to an offence. This provides the person concerned with the opportunity to avoid committing an offence. The criminal offence only occurs if the person engages in prohibited conduct after the warning is issued. In line with a recommendation from the Joint Committee on Health, there will also be a requirement to record the warning. The section also includes relatively standard powers of arrest and requirements to provide a member of the Garda with a name and address for the purposes of recording a warning.

Section 5 sets out the penalties arising for offences under the Bill, which may be prosecuted summarily. Penalties have been provided on an escalating basis where harsher penalties apply for repeat offences.

Section 6 is a standard provision regarding expenses incurred by the Minister in the administration of the Act.

Section 7 is a standard provision containing the Title and commencement date and will provide for commencement on a date prescribed by the Minister, by order.

Today affords us the opportunity to make a real difference in the lives of people in a very vulnerable position and to further protect healthcare workers providing legally mandated healthcare services. It is a milestone in ensuring that our friends, colleagues and family members are treated with consideration and empathy at a time when they most need our care and that they are afforded the dignity and privacy to make their own decisions. Essentially, it allows us to put safeguards in place so that women can access lawful healthcare services without intimidation, and service providers and their staff can provide them.

My own commitment to ensuring that termination of pregnancy services can be accessed quickly and easily by those who need them and without judgment or bias is a matter of public record. I believe that this Bill reflects that commitment. However, I am also aware that there are people in this House and across the country who have reservations and concerns in respect of the impact of this legislation. This is a sensitive issue and there are strongly held views on both sides. When we debated and voted for the repeal of the eighth amendment, and when we brought through the original legislation, the debate in the Houses of the Oireachtas was robust but was always respectful. The Members of the Houses conducted themselves in a fitting manner. I have no doubt but that the engagement and debate on this Bill will be robust because people have legitimately and passionately held views. I trust the debate will be equally respectful and professional.

This Bill is important. It is an important step in terms of the provision of these services, but it is only one step. There will be an increase in the number of maternity units in hospitals that are providing acute facilities. Several hospitals have been added during the lifetime of this Government. It is my intention that by early next year, all of the hospitals, all 19 maternity units, will provide those services. The latest update I have from the Department is that we are on track for 17 of the 19 to provide those services by the end of this year, with the remaining two to follow next year. These are legally provided and lawful services. While we must and do respect people's views, and while conscientious objection is rightly embedded in the legislation and any healthcare worker is free to exercise that right, we must ensure these services are provided around the country. We have a report. It is being implemented at an operational level. I know the legislative proposals will be looked at and are being looked at in detail by this House. My focus is on bringing through this Bill to ensure that the services required and provided for under law are provided around the country in community care or acute care settings, and to ensure that the various issues that have been raised around the provision of that care are addressed.

Deputy David Cullinane

I thank the Minister for his contribution. Women deserve safe and unhindered access to lawful services. This Bill is an important step towards providing that access and for that reason, we will fully support the Bill.

The Government has been slow in bringing forward this legislation. It has been apparent for many years that this legislation was needed and thanks to the tireless advocacy of many women, it is finally happening. I will caveat that assertion by saying that I accept the complexity involved in this legislation and that legal advice was needed from the Attorney General and others. I am not for one second suggesting this was easy because we discussed the matter in much detail on pre-legislative scrutiny and I appreciate the complexity involved.

I commend Sinn Féin Seanadóir Paul Gavan, who was the primary sponsor of a similar safe access zones Bill, which was drafted with Together for Safety. It passed every Stage in the Seanad. I thank Together for Safety and progressive Senators for their advocacy to keep this issue on the agenda.

In 2018, people voted for women to have access to services. Five years on, those services are still not properly or fully in place. Women should be able to access the services that were voted for and should feel safe when doing so. This Bill will address some of the concerns that have hindered the development of accessible termination of pregnancies but not all. The independent review highlighted significant geographical barriers to services, the underdevelopment of regional services and other barriers, such as the three-day wait. We want those issues to be addressed in a systematic way and we need to see a clear plan from the Government on how it will progress those recommendations. I hope this measure will diminish barriers which are preventing GPs from providing services by reducing the likelihood of protests but we know that GPs will need more than this to begin providing better access to services.

There are, however, some issues remaining with the Bill, particularly around enforceability. I would prefer to see a clear, practical and effective system of recording prior warnings included in the Bill. As it stands, it is unclear if warnings will carry over to different locations or if the Garda will be equipped to enable a tracking of warnings issued under this legislation. That means that a person can receive a warning at multiple locations without committing an offence which would undermine the purpose of the Bill. I would ask the Minister to work with the Garda, the Minister for Justice and the Opposition before Committee Stage to bring an effective agreed amendment forward which will ensure the enforceability of this legislation. In saying that, I am fully aware of the difficulties and the legal challenges that all of that entails but it is something that needs to be corrected on Committee Stage.

The Bill would create a 100 m safe access zone around any healthcare premises where termination of pregnancy services may be provided such as a GP or obstetrician's clinic or an acute hospital. Section 2 of the Bill prohibits certain conduct in safe access zones. It forbids a person from obstructing or impeding access to a relevant premises for people availing of or providing termination of pregnancy services; communicating material or otherwise engaging in conduct that is likely to influence the decision of another person in availing of or providing termination services, with intent to influence the decision of a person who may be availing of or providing services; engaging in conduct that is likely to threaten or intimidate a person who is accessing or attempting to access a relevant healthcare premises, or accompany, follow or repeatedly approach a person attempting to access said premises, with intent to influence the decision of such a person; and taking photos or videos of people attempting to access the relevant premises. These actions are also forbidden where a person is being reckless as to whether he or she influences or intimidates a person.

Section 3 of the Bill sets out exceptions to the prohibited conduct in section 2. There is misinformation coming from some sources in relation to the intention of this Bill and it is important for all of us to clarify what this Bill does but also what this Bill does not do.

Importantly, the Bill is clear that it would not ban protest within 100 m of the Houses of the Oireachtas once it is not directed at a relevant healthcare premises or people accessing such a premise, and it does not prohibit otherwise lawful conduct occurring within a place of worship. The Bill strikes a balance between the rights of women to access services and the rights of others to have their views and opinions and to exercise those views and opinions in a way that does not interfere with the rights of women to access services. I respect that people have different opinions on this issue and there are deeply-held opinions, but I genuinely believe that this Bill strikes that balance where people, of course, can protest and can make those feelings known in a way that is appropriate but there should be no intimidation of women who are accessing service.

Under section 4, the Garda may issue a warning to any individual it believes is engaged, has engaged or will engage in prohibited conduct, which shall include a direction to cease. Section 4 establishes that, where a person receives a warning under that section relating to prohibited conduct yet continues to engage in that activity, he or she is committing an offence. It provides that where a garda believes a person has committed or is committing an offence under the Act, the garda may arrest that person. The Bill provides the Garda with discretion on whether and when to use these new powers and makes it clear that all existing powers will continue to be open to the Garda as appropriate. All of those are healthy balances which are being struck in the context of this Bill.

Section 5 of the Bill sets out offences and penalties. Section 5 establishes that it would only be an offence to engage in any prohibited conduct as set out in sections 2(1) to (4), inclusive, following a section 4 warning issued by a Garda. Section 5 creates an offence where a person fails or refuses to provide his or her name and address to the Garda when he or she is being issued a warning as set out in section 4. It also creates an offence where a person provides a false or misleading name or address.

The penalties for offences are set out in section 5(3). The Bill sets out a tiered approach to penalties. The Bill sets the penalty for a first offence as a Class E fine, which would be a fine of up to €500, or a month imprisonment, or both. For a second offence, it is a Class D fine, a fine of up to €1,000, or up to three months imprisonment, or both. For a third or subsequent offence, the penalty is a Class C fine of up to €2,500 or up to six months imprisonment, or both.

The Bill, in the round, is well-balanced legislation following months of work by the Department and Committee on Health and, indeed, the Minister for Health, to get this right. However, as I mentioned earlier, there are concerns about the enforceability of the Bill, as drafted, without specific provision for how the Garda will record warnings and whether it will be able to track warnings across different locations.

According to Garda testimony when the Bill was undergoing pre-legislative scrutiny, the Garda does not have an appropriate facility for recording the warnings as set out in the Bill. That is a major concern for the effectiveness of the Bill and the enforceability of safe access zones. As a consequence, a person may receive a warning at multiple locations, as I said earlier, without the Garda being aware of prior warnings, thus escaping penalties for repeated breaches of the Act. To complete this legislation, we need a clear, practical and effective system of recording prior warnings included in the Bill with a guarantee that prior warnings will be counted where a person commits an offence at a specific location.

I want to address the other ongoing difficulties which women face when attempting to access lawful abortion services. The Minister mentioned some of them. There is a clear regional disparity and inequality in service provision. The independent review identified the south east, where I come from, the north west, the midlands and Border counties as particularly under-served by primary care abortion services. There are also several maternity hospitals which are not yet providing full and accessible services. There needs to be real engagement with service providers and the report sets out some commonsense steps that should be taken. Services need to be mapped, and the longest travel distances need to be identified. A geospatial analysis of services is recommended and this makes perfect sense.

The Government needs to identify clearly where there are significant service gaps and put in place local and regional solutions for that. The idea of centralising some services in community-based regional or sub-regional women's health centres would allow us to bring together doctors, nurses and allied healthcare professionals to provide services in areas where localised service provision is unviable or unsupported. It is important that these centres remain distinct from maternity hospitals, and should focus on care which can be delivered outside of an acute hospital setting. They could provide a range of services for women’s healthcare which can be provided in the community, from medical terminations to access to hormone replacement therapy, HRT, health check-ups and menopause supports. What is clear from experience is that tinkering around the edges on this issue will not suddenly deliver enough consultants to deliver the full services.

We are not training or recruiting enough doctors and this all comes back to workforce planning. We need the Government to implement urgently a long-term workforce plan to train, recruit and retain the healthcare professionals that we need. We also need the Government to undertake the geospatial mapping of existing services, identify the deficits and deploy regional solutions to address service gaps and support those who are providing the service.

I warmly welcome this Bill as a step forward in making sure that we have fit-for-purpose abortion services for the women of this country but, as the Minister I hope would appreciate, a lot more still needs to be done.

Deputy Kathleen Funchion

I welcome the opportunity to speak on this.

I am delighted to see that we are at this stage. It is five years since we repealed the eight amendment and as I find myself often saying in this Chamber around issues that disproportionately affect women, everything seems to be a battle, and if it was not for the women and the advocacy groups that continue that battle, would we actually be here? I look forward to the day when we can be in here discussing issues that are not both long overdue and years in the making.

I particularly welcome this in relation to rural areas. My constituency is a good mix of urban and rural and there are many areas where there are no services being provided. I am not even necessarily talking about hospitals, but merely from a GP point of view. If one has a situation where it is known that there is only one GP or two providing this service in a rural county or in part of a rural constituency, that can become the target for protesters. It is very difficult for a woman in this situation.

I stress that any woman in that situation does not make that decision lightly. Sometimes people who have a very different view on this debate - they are entitled to that view - talk about it as if somehow people will be lining up for a termination and that is not the case. If one is going into a rural area and one is met with a bunch of protestors, that is extremely intimidating. It is totally unfair. We would not tolerate that in any other area of healthcare and it is totally and utterly unacceptable.

It is also unacceptable for the GPs. When this came out, this was new for GPs and practitioners, who are overrun and have a very high workload too.

They signed up for this in good faith but have suddenly become the target. Again, that is more acute and more difficult in our rural areas. I will mention the hospital in Carlow-Kilkenny. It is based in Kilkenny but it services the counties of Carlow and Kilkenny. It does not provide abortion services at present, although I believe that is changing, hopefully by the end of this year. I believe somebody will come on board in September who is willing to provide the service, which is welcome. I look forward to that for women in those counties who need to access that service.

I will briefly mention a matter that is not directly part of this debate - it is all linked - namely, the three-day waiting period. We had another Bill in respect of that issue a few weeks ago that I was glad to see was passed. I mention that and link it to this Bill because the waiting period is also a deterrent to some GPs, particularly where they are under pressure. Many people will tell you that when they ring a GP for any service, they nearly have to try to schedule their illness in advance. That is not the fault of GPs. It is, unfortunately, just the way things have gone due to the GP shortage. However, if there is a situation where somebody comes in and there has to be a three-day waiting period, that is a deterrent for the GP to potentially sign up. That is one part of the argument. My main issue and difficulty with the waiting period is its total distrust of women and the suggestion that they somehow need extra time to consider or think about this. I just do not believe we would see this if it related to an area of men's healthcare. It goes back to the same mindset of distrust all the time. I look forward to the legislation on the removal of the three-day waiting period also progressing.

I welcome the Bill. It is positive and I am glad the Minister is bringing it forward. It is long overdue but at least we are at this Stage. Hopefully, it will progress rapidly through the rest of the Stages so we can actually see it up and running, in practice, and being of benefit to women in those vulnerable situations, in addition to medical professionals, who deserve to be able to go about their business. On the reference to protests, as someone who has been on several protests over the years on various issues, I always welcome people's right to do that. However, I believe that outside the House is the appropriate place for that because the vast majority of protests are somewhat linked to legislation and policy. People have no business and no place intimidating those outside GP or other medical services. Protests need to take place where decisions are being made. People who want to protest should do so outside Leinster House and not where they would intimidate women.

Deputy Pauline Tully

In 2018, people voted for access to lawful termination of pregnancy services. It is five years on and these services are still not properly in place. Women deserve safe and unhindered access to these services. I want to see safe access zones introduced as soon as possible to ensure that women can get safe access to these services as quickly as possible. Senator Gavan of Sinn Féin was the primary sponsor of a similar safe access zones Bill introduced in the Seanad in 2021. It was drafted with the assistance of Together for Safety. I thank its members for their advocacy in keeping this on the agenda and each of the other progressive Senators who co-sponsored that Bill.

The Bill before us would create 100 m safe access zones around any healthcare premises where termination of pregnancy services may be provided. It would prohibit a person from obstructing or impeding access to a relevant premises for people availing of, or providing, termination of pregnancy services. It would also make it illegal for a person to communicate material or otherwise engage in conduct with the intent to influence the decision of a person who is availing of, or providing, termination of pregnancy services. It would also give the Garda the power to issue a warning to any individual it believes is or has engaged, or will engage, in such conduct. Where a person receives a warning, yet continues to engage in that activity, he or she may be arrested without a warrant. This would undoubtedly aid in ensuring that women can gain safe and unhindered access to lawful termination of pregnancy services. It is also important to clarify that the Bill does not aim to do a number of things. It does not, rightfully, seek to ban protests within 100 m of the Houses of the Oireachtas and does not prohibit the provision of information regarding termination of pregnancy services whether provided by, or on behalf of, the relevant healthcare provider.

However, there are a number of issues with the Bill as it stands. While it will address some concerns that have hindered the development of accessible termination of pregnancy services, it will not address all concerns. Every effort must be taken to attend to these issues as soon as possible. The independent review of the operation of Health (Regulation of Termination of Pregnancy) Act 2018 highlighted a number of issues this Bill does not deal with. For example, the report identified that there are clear regional disparities between services. It also highlighted that we are not training or recruiting enough doctors. It identified the south east, north west, midlands and Border counties as particularly underserved. We want to see services maps in order to identify significant service gaps so that local and regional solutions can be put in place.

The mandatory three-day waiting period is identified in the report as a contentious issue. The report informs us that the position of the World Health Organization is that a mandatory waiting period should not be required and the evidence does not establish any benefit to mandatory waiting periods for women. The report cites the Unplanned Pregnancy and Abortion Care Study commissioned by the HSE, which showed that respondents wish to access care as quickly as possible and do not perceive any benefit to having a three-day waiting period for reflection on their decision. Respondents stated that they felt certain of their decision, had not taken their decision lightly, and had reflected upon it prior to arranging an appointment with a GP or community provider. Researchers found that the respondents were almost universally consistent in their portrayal of the three-day wait as having had next to no impact on their personal decision-making process regardless of the length of time it took to make the decision.

We would like to see the issue of the three-day wait addressed quickly. The Minister could and should immediately progress amendments to the Act to remove barriers to abortion services, such as the three-day wait, rather than waiting to implement all legislative changes through this Bill. Testimony from gardaí during pre-legislative scrutiny also highlighted that they currently do not have an appropriate facility to record warnings given to those who do not respect safe access zones. As a consequence, a person may receive a warning at multiple locations without the Garda being aware of prior warnings, thus escaping penalties for repeated breaches of the Act. We want to see a clear, practical and effective system of recording prior warnings included in the Bill, with a guarantee that prior warnings will be counted where a person recommits an offence at a different location.

We want to see these issues addressed in a systematic way. We need to see a clear plan from the Government on how it will progress the recommendations in the independent report and we would like to see some of the recommendations, including some legislative changes, implemented very quickly, such as the removal of the mandatory three-day wait.

Deputy Ivana Bacik

I am delighted to speak on behalf of the Labour Party on this important Bill and to express our warm welcome for it. I thank the Minister for introducing it in the House. As he said, it is in keeping with a long-standing commitment. It is long-awaited and long overdue. We have just marked the fifth anniversary of the repeal vote. The need for safe access zones and the introduction of such legislation was widely spoken about at the time. It was included in successive legislative programmes in 2019 and in the programme for Government in 2020. We are now in July 2023. It is unfortunate it has taken this long, particularly when a cross-party Private Members' Bill was introduced in the Seanad by Senator Gavan. The Labour Party was proud to co-sponsor that Bill with Senator Gavan and his colleagues because it was drafted by the fantastic activist organisation, Together for Safety, working with Senators. It received strong support. If we had been able to use that Bill, it would have been a swifter way to move to a space where we would have safe access zones in law.

I am conscious that members of the Together for Safety campaign in Limerick have joined us in the Gallery this afternoon, including Karen, Evie and their colleagues. I welcome them and pay tribute to their valiant campaigning and focus on this important issue. I will mention the work of Labour Party activists who have consistently supported Together for Yes in Limerick, including our former Deputy, Jan O'Sullivan, and our councillor, Conor Sheehan. They have been to the fore in calling for the swift introduction of this legislation.

We are all in agreement that the Bill is vitally important to those women seeking access to termination of pregnancy services. It is also very important for all healthcare workers, including doctors and nurses, who are seeking to provide such services. It is also important to our democracy in that it is a way in which we can see the will of the people being carried out. In 2018, five years ago, people voted by an overwhelming majority, more than two thirds, for women to have access to abortion services here. Where we see protests obstructing such access, that is really seeking to impede the carrying out of a service that has such an overwhelming democratic mandate.

There are other obstacles to accessing such services, and the Minister has alluded to them. I am very glad, as I think all of us will be, to hear the Minister’s remarks about the work that is being undertaken to improve access because we are all conscious of the geographic inconsistency in access to services. According to the recent review, there are currently 13 counties in which fewer than ten GPs are providing access to early abortion services and not yet all maternity hospitals are doing so. I very much welcome the Minister’s commitment today that we are on track to see 17 out of 19 hospitals providing such services by the end of 2023. The rest will do so next year. It is still the case, however, that we have seen a long delay in the roll-out of consistent services nationally. That is a real concern and it is a difficult and distressing experience for many women and girls who are seeking to access services in counties where they are not available.

I was glad to have been invited to give the opening address to a recent conference of abortion providers in Ireland - GPs, hospital doctors and others who are actively engaged in providing abortion services. They spoke with me about their anxiety to see more colleagues join them, particularly GPs. The more GPs who provide the service, the easier it will become and the fewer obstructions there will be for women who are accessing such services. Also, there will be a critical mass to stand up against the intimidation that some GPs are continuing to experience where they are providing services. If they feel isolated within their own local area in providing such services, clearly that is a difficulty. It does not help when we are seeking to ensure that more GPs provide such services.

The delay has not helped. This time last year, the Minister promised that this legislation would be in place before last Christmas. I acknowledge the huge progress in debating Second Stage today. I also acknowledge the complexity of drafting, and I will come to that in a minute. We need an assurance that the legislation will be passed without any further delays. We are conscious that this is the second last week of this Dáil term. Perhaps the Minister will indicate when he envisages the legislation will pass both Houses and be brought into effect. That is also a critical timeline for us.

As I said, five years ago people voted by an overwhelming majority. I commend all those involved in campaigning. It was a hugely important and compelling campaign run by organisations such as Together for Yes and groups such as Women’s Health Ireland. I was glad to play a part in those and the Minister was also part of the campaign. Our Labour Party slogan during the 2018 referendum campaign was “For Compassion in a Crisis”. That was the overwhelming feeling and emotion that arose in the referendum vote. People were voting for compassion and empathy. There was an understanding and appreciation of the huge difficulty and distress that so many women in crisis pregnancies were in because their crisis was being compounded by having to travel abroad for necessary healthcare.

The national conversation which took place in the run-up to the vote on 25 May 2018 and which was, as the Minister said, conducted in a respectful and dignified manner, for the most part, provided the space for those who were undecided in advance of the referendum to make a journey towards a position where they could vote "Yes". It was founded on empathy and compassion and it put an end to the chill that the eighth amendment had cast over my generation and so many women for so long.

In 2018, this country said we had enough of a lack of compassion and decades of secrecy, shame, exile and isolation for women in crisis pregnancy. It is remarkable, looking back on it, to think that almost 1.5 million people voted for the constitutional change. Therefore, it is incumbent on us all as legislators to ensure that where a woman seeks to access abortion care in line with that overwhelming vote, she may do so free of intimidation and harassment. That is why we have always pushed for the introduction of safe access zone laws. As the Minister has said and as we all know, these laws are in place across other jurisdictions. They are vital for the provision of accessible, safe abortion services in Ireland.

The Bill before us provides for the designation of such zones, within 100 m of healthcare premises, where conduct aimed at impeding or obstructing access or influencing decisions in relation to the termination of a pregnancy will be prohibited. We are very glad to support that provision. We do so noting that the intimidating protests that are regularly taking place outside hospitals and GPs serve as a barrier to accessing vital medical care. They also, as I have said, create a chilling effect on the provision of abortion services, particularly in areas where coverage is already low and GPs may already feel they are easily identifiable and therefore isolated.

We have heard from Marie O’Shea’s review and Catherine Conlon’s work about the huge distress that women remain in, despite the change in the law because they are forced to travel for care. They must make the journey twice due to the mandatory three-day waiting period requirement. That crisis is compounded further when women are faced with intimidation and protests on arriving at a clinic or hospital.

GPs from rural areas in particular have reported to my office that they, their front-line staff, often administrators and receptionists, and patients may be the subject of abuse and intimidation. Most of us have seen some of the posters, heard some of the chants and observed some of the behaviour of those who organise these so-called protests. Some of them gather very near here, outside the National Maternity Hospital, in my own constituency of Dublin Bay South. Of course, individuals are entitled to have different views and, under our Constitution, they are entitled to freedom of assembly and association, but they are not entitled to harass patients who are accessing healthcare or to harass medics and healthcare workers who are doing their jobs.

Deputy Stephen Donnelly

No.

Deputy Ivana Bacik

We have seen really despicable tactics being used in some of these protests, including the appalling practice of displaying small coffins. This is taking place outside maternity hospitals and in a context where they may cause obstruction and intimidation to patients who are accessing all sorts of different services, and their families. We should all reflect on that as we see these so-called protests taking place. These protests amount to an undermining of the democratic will of the people in requiring us to provide abortion services and access to abortion services for women.

We have unfortunately a long history of denying services to women. I am thinking of contraception services, which were denied to women and men until the 1990s, around the time when I was in college. We had a condom machine in the student union building at Trinity College Dublin in 1989 and 1990. It was being vandalised every week but it was also in huge demand because at the time it was one of the only places in Ireland where somebody could buy condoms. It is extraordinary to think that was in 1989. The other place was the Virgin Megastore on the quays. The Irish Family Planning Association was providing condoms at the time for a donation because it could not sell them. There was a huge amount of obstruction for so long and highly restrictive rules around access to contraception that would be unthinkable now. There was huge, similar obstruction around access to vasectomies, procedures that we now see as utterly routine and non-contentious. Family planning clinics were regularly vandalised and people were intimidated. Brave and courageous doctors were in some cases just defying cultural repression and Catholic teaching by providing services that we now take for granted. When we are debating the protests, protestors and safe access zones for abortion care, we have to reflect on the fact that, unfortunately, there has been a long history in this country of obstructing access to services around pregnancy, termination of pregnancy and even around contraception.

As I said, and as the Minister has also pointed out, there are complexities in drafting this legislation. We acknowledge that. There are particular complexities around the balancing act required to achieve a balance between the right of access to services and the rights of freedom of expression and assembly. I have reviewed some of the submissions to the pre-legislative scrutiny stage of this debate. Many submissions objecting to the concept of safe access zones cited concerns around freedom of expression. The constitutional provisions on freedom of expression, assembly and association are clearly framed in a way that is absolute. These are not absolutely protected rights. Women have the right to bodily integrity and the right to privacy. Therefore, the introduction of these zones, when narrowly defined and framed in such a way that provides safeguards, constitutes a constitutionally robust and proportionate restriction on the right to protest.

I know there has been some focus on section 4 and the provision of a warning from a member of the Garda, which is an extra and additional check on the framing of the offence. There is a valid concern around the evidential requirement about the recording of the warning. The Joint Committee on Health examined this matter in detail. Section 4(3) requires that a garda, when recording the warning, must also require that the person given the warning has to state his or her name and address. The fact that a name and address has been provided to a garda will give some comfort to those who are concerned about how it can be proven that the warning was recorded. The fact that the garda will have the name and address and can repeat that back will be important in practice.

We welcome this Bill. It is constitutionally robust and we are very committed to seeing it pass into law and to seeing safe access zones instituted in our law. We have looked for them for some time.

Before I conclude, I want to refer to the other barriers to women's access, not just the geographic issues or the numbers of GPs and hospitals providing such services but the barriers that still exist within the legislation and which were the subject of Marie O’Shea’s recent review. I pay tribute to Marie O'Shea, Dr. Catherine Conlon and those involved in carrying out the review because its recommendations are strong, evidence-based and focused on addressing unnecessary structural barriers to women's access to abortion services.

Along with many others, the Labour Party made a substantial submission to the review process. Among the changes we called for was the abolition of the three-day waiting period, a mandatory requirement which we believe is paternalistic and unnecessary and imposes an unnecessary and completely non-medically required barrier on women's access. We also called for an end to the criminalisation of doctors who do not conform with the legislation. It is not in keeping with our laws on healthcare, as the Minister for Health will be well aware. Again, that creates an unnecessary chilling effect on medical providers, particularly those who may be contemplating becoming a provider of services.

We have also called for review of definitions. In Dr. Conlon's research, and when we hear from our constituents and others, we hear about women still travelling to Britain because they cannot access abortion care at home. We hear about awful scenarios, including of women awaiting diagnosis as to whether a foetal anomaly is "fatal enough" to enable a termination within the terms of the legislation. Doctors tell us that the definition of fatal foetal anomaly is simply not aligned with medical practice and medical and healthcare understandings. I know the Joint Committee on Health is looking at the Marie O'Shea review recommendations but we need to see urgent movement on implementing those recommendations.

I welcome the statement by the Minister for Justice, Deputy McEntee, at the weekend that she personally is in support of removing the three-day waiting period imposed on women who have already resolved to seek a termination but who are forced to have a second visit or consultation with a doctor. I hope the Minister will be joined by more of her Government colleagues and that there will be a shift away from the rather disappointing commentary we have seen since the O'Shea report was published, including, for example, comments made by the Taoiseach which seemed to be less supportive of the recommendations than we might have hoped.

I am conscious that we debated Deputy Bríd Smith's Bill in this House and had a debate on some of the recommendations in the report. Let us move swiftly on this legislation and implement those strong recommendations that are evidence-based and seek to remove structural barriers to care. Without the removal of those barriers and without the necessary reform of the 2018 law, we are still going to see the sort of paternalism that characterised the eighth amendment and the case law under it. We are going to see that paternalistic shadow still cast over women and women in crisis pregnancy.

While I am glad the Government is tackling the clear and overt harassment and intimidation that unfortunately is still going on and being used against women seeking abortion care, I would also like to see the Government take on the structural barriers in our legislation which have the effect of frustrating, intimidating and restricting women who are seeking an abortion. These barriers are also creating this chilling effect upon doctors and medics who are trying to provide care.

Reproductive healthcare should be a matter between a woman and her doctor. Without removing the unnecessary structural barriers to reproductive healthcare, the Government will still be failing in its duty to women, in particular the thousands of women who continue to experience crisis pregnancy each year and the many hundreds who are still having to travel abroad years after we voted to repeal the eighth amendment and so long after we voted for compassion in a crisis. This is something I feel strongly about, having been involved in pro-choice campaigning for as long as I have. If I had been told 30 years ago that it would take so long to achieve a position where women in crisis pregnancy could access healthcare rights here in Ireland, I would have been desperately frustrated, particularly at a time when we were being threatened with prison just for giving women a phone number of a clinic in England. Again, that was a time when we could not even access condoms legally. Clearly, huge strides have been made but that is 30 years ago. We are still debating a three-day waiting period that is clearly medically unwarranted and, as we all know, was simply put into the draft legislation at the last minute before the referendum took place. It was unwarranted. There were already enough restrictions in the legislation.

It seems extraordinary that we are still debating this issue when we have seen such a clear vote from the people and we are increasingly seeing doctors who are stepping up. I want to finish on that optimistic note. Doctors and healthcare providers are stepping up. It was incredibly powerful to see how many came to a conference that was explicitly for abortion providers and about abortion providers hearing from each other in Ireland about how they are providing services and how they can best meet the needs of their patients. It was incredibly powerful to see that happen in a country that, as recently as five years ago, still did not have legal abortion in place. We have made huge strides but it is time to up the pace and increase the momentum with which we are making the necessary changes. We all recognise that they must be made. They include the removal of the three-day wait period, the removal of the criminalisation of doctors and revisiting the definitions in law that are unnecessarily restrictive and mean that women are still having to travel for healthcare we should be getting here at home.

Deputy Éamon Ó Cuív

Tá áthas orm deis a fháil cúpla focal a rá ar an mBille seo, an Bille Sláinte (Seirbhísí Foirceanta Toirchis) (Criosanna Rochtana Sábháilte), 2023. Is ceist casta é seo mar téann sé ar ais go buncheist; cén uair a thosaíonn an beatha daonna? Tá sé deacair sainmhíniú a dhéanamh air sin ach má chreideann tú gur duine daonna atá ionat ón am go ngintear thú, bheadh dearcadh amháin agat. Má chreideann tú nach duine daonna, bheadh dearcadh eile agat. Téann sé sin go croí ceiste atá thar a bheith casta.

Is léir go bhfuil trí dhearcthaí sa bpobal. Ar dtús, tá iad siúd a chreideann ag am ar bith gur féidir ginmhilleadh a dhéanamh. Ansin tá iad siúd a chreideann, taobh istigh de théarmaí an Achta, nach é an cúis atá le ginmhilleadh máthair a shábháil - níor chreid mé riamh gur ginmhilleadh a bhí ansin - ach le beatha a shábháil. Sa gcás áirithe sin, creideann siadsan nár cheart ginmhilleadh a dhéanamh. Ansin tá daoine ann a chreideann - agus déarfainn go bhfuil siúd thart ar an tríú chuid freisin - go mba cheart, i gcásanna áirithe, ginmhilleadh a cheadú ach go mba cheart go mbeadh srianta ann. Abortion is a complex issue. As I said in Irish, you could divide the population into three thirds. First are those who believe that abortion is a legitimate and correct thing to do, with very little restriction whatsoever. I think they account for about one third of the population, according to opinion polls in The Irish Times.

Second, one third believe that abortion should be legal but with restrictions, and one third oppose abortion if its purpose is, as said in the Act, the killing of the foetus. In other words, the argument about the life of the mother does not arise in a case like that, because if the purpose is to save the mother it is not abortion, according to the Act. Each person to their own conscience and beliefs. It is important that I respect Deputy Bacik's beliefs, which would not be shared by me. I also hope that she can share my deep concern for what I consider to be human life.

We are not here to debate abortion in itself, but we are here to debate a Bill about safe access zones. There are a number of wider issues that arise here. I do not know if this is the first time that we have brought in legislation outlawing certain types of protests or actions, no matter how peaceful they are, but allowing any other actions of protest outside the same buildings. Perhaps the Minister can tell me. What happens if, for argument's sake, there is a pro-choice protest in Dublin in favour of amending the law to liberalise it, which is trying to persuade people to allow more abortion, and it marches past a number of medical clinics? Is that going to be a breach of the law? If there was a pro-life march down town, arguing for the opposite but arguing over the same subject, will that be legal? The whole idea of protest is trying to persuade people. What does the law say about protest marches going past baby hospitals and clinics, with protesters holding up banners telling people to protect human life and not to have an abortion? My second point, and it is a basic rule of law and nothing to do with the specific issue, is that you bring in law if you are advised that there is a need for the law. Is it correct that in September 2019, Garda Commissioner Drew Harris wrote to the then Minister for Health to advise that the existing public order legislation is adequate to deal with the kind of protests witnessed at hospitals and clinics to date, and that the introduction of exclusion zones would be redundant because of the existing current laws and the fact that no instance of criminality has been reported or observed? That is the second basic principle of law. A law should not be introduced if it is not necessary, because every law has unintended consequences and restrictions.

I absolutely agree that people should not be hassled when they are going to a doctor's clinic, a hospital or whatever. There is no question about that, but do we not already have the power to stop that? Taking doctor's clinics, for example, the reality is that nobody knows what patients are going into the clinic for. There was talk about rural clinics. Certainly, in my experience of the rural clinic, nobody knows your business. They might know you, but they do not know your business if you go to see the doctor. Therefore, the idea that people could be targeted does not add up. It seems to me that this law was written with abortion clinics in mind, à la the arrangement in Britain. I think that we need to tease this Bill out. I hope the Government does not try to rush it through the House. I have always had a fetish about rushed legislation of any type. I think it is a very bad habit. I hope we take a very detailed look at this and go through it line by line, now that we have the legislation. I hope the Minister brings it to the committee and that whatever time needs to be taken will be taken so that we do not have a whole lot of unintended consequences and bad precedents in relation to other forms of protest over other things that this might be used as a precedent for. I must say that I think that this Bill is more to satisfy a lobby group than to solve a real problem that exists in society. As I said, it would appear that the Garda does not think it needs this power, and it is always looking for power, as the Minister and I know.

Deputy Donnchadh Ó Laoghaire

In 2018, people voted for women to have access to services. Five years on, and these services are still not in place and the protections that they ought to have are still not in place. I support this legislation and I commend the work of my colleague, Senator Gavan, in particular, who worked hard to put this in place and brought forward the legislation in the Seanad. This legislation is about striking the balance between free assembly and the rights of women and their partners attending maternity appointments and services to be free from harassment. There is scope for improvement, but I believe that broadly, it strikes that balance. It is proportionate to ensure that women who are having a termination can do so free from harassment. It is proportionate that where there is a fatal foetal abnormality, a pregnant woman should be able to get a termination without being confronted by people telling her she is doing the wrong thing and should go home. It is proportionate that a couple of going to an emergency maternity appointment, where they are worried that they might lose their baby or are worried for their health or the health of child, do not have to run the gauntlet of placards that might be highly visual or disturbing.

We are talking, in this legislation, about 100 m, and a few thousand metres across the State as a whole. It is also proportionate that it will still allow protest to take place. It allows places of worship to continue as heretofore, and it allows protests here at the Dáil and on most of the main thoroughfares of our cities and towns. Campaigning against access to abortion is legitimate. Many people disagree deeply with it, and are entitled to protest against it. Many decent people have conscientious objections. In most instances, they object reasonably. However, unfortunately, there are exceptions. We can see, from international experience, that services that provide terminations can be a focus for protest, sometimes of the most aggressive kind, that can attempt to put vulnerable women under pressure at a time that they deserve calm and peace more than ever.

I note the recent removal of posters from marches against abortion by members of the public. For the record, I think such behaviour is contemptible and stupid. I do not think it should be controversial for people who support access to termination to say so. People are entitled to protest and demonstrate that those protests are happening, and that should be protected. What they are not entitled to do is to crowd the entrances of services to intimidate, discourage and harass, to impede access and to record these women or their partners. It is not unreasonable or disproportionate to protect women in these circumstances and is not unreasonable or disproportionate to prevent such conduct. It is for that reason that I support this Bill.

Deputy Jennifer Whitmore

I welcome the debate on this long-overdue legislation which the Social Democrats will be supporting. I acknowledge the work done by abortion rights campaigners to get us to this point, particularly Together for Safety. Without their tireless campaigning for safe access zones, I believe this legislation would have fallen off this Government's agenda and would have been delayed even further than it has been already. Despite this Government's long-standing commitment to legislate for safe access zones and cross-party support in both Houses of the Oireachtas, progress has been painfully slow. It is now over five years since the then Minister for Health, Deputy Harris, received Cabinet approval for safe access zones. He said it was his intention to bring forward legislation by summer 2019. At the time, in 2018, the then Minister said that legislation was needed to ensure patients and staff were not subjected to intimidation or harassment.

Unfortunately, since then, too many patients and staff have suffered that exact fate. This Bill first appeared in the legislative programme in the spring of 2019 and campaigners hoped it would be expedited to deliver on the Minister's commitment. Instead, however, the Bill languished on legislative programmes for another two years with the note, "work under way". During that period, a new Government was formed and its programme for Government also committed to establishing exclusion zones around medical facilities.

In February 2019, as protests increased, councils began to take matters into their own hands. Louth County Council passed a by-law to prevent protests outside healthcare settings providing terminations. Other councils followed, including in Galway and Limerick. Unfortunately, these by-laws were ineffective and councils were advised that national legislation was, in fact, needed.

In October 2021, while the Government continued to stall, Senators took the lead and introduced a cross-party Private Members' Bill that sought to legislate for safe access zones. This Bill was commissioned and drafted by Together For Safety. Despite passing all Stages in the Seanad by April 2022, this Bill never reached Second Stage in the Dáil. However, it undoubtedly put a fire under the Government and provided officials in the Department of Health with a vital blueprint for the legislation before us today.

In August of last year, the Minister for Health finally published the general scheme of the Health (Termination of Pregnancy Services) (Safe Access Zones) Bill 2023, three years after it was supposed to be legislated for. This was followed by pre-legislative scrutiny at the Joint Committee on Health from October 2022 until April 2023. During pre-legislative scrutiny, it became clear that despite the length of time it had taken the Government to produce the general scheme, it still fell short of what was required in terms of enforcement. This is a matter to which we will return later in this debate.

It is clear from this timeline of events that there has been an absence of political will and courage to legislate in a timely manner. The Minister for Health dragged his heels while patients and staff dealt with the consequences of repeated delays. Between 2019 and 2021, the Abortion Rights Campaign conducted extensive research into patients' experiences of accessing termination services. Its report with Dr. Lorraine Grimes, "Too Many Barriers: Experiences of Abortion in Ireland After Repeal", found that 14% of patients had encountered anti-abortion activity when attending abortion services. Participants in this study recounted "people doing rosaries and saying hurtful things about going to hell and punishment" and "people with coffins outside praying". One respondent said, “There was an anti-choice sign (maybe a picture of a foetus) outside the private ultrasound clinic where I had to go to ensure I was within the 12 weeks.”

In the past five years, protests have been reported all around the country. On 3 January 2019, just two days after termination services were introduced, the first protest was reported outside a GP clinic in Galway. Since then, protests have continued regularly across a number of counties. In Together For Safety's submission to the review of the Health (Regulation of Termination of Pregnancy) Act 2018, it stated that there were sustained protests reported outside University Maternity Hospital Limerick and Holles Street hospital. Such protests have not abated. The Minister for Health will be aware of this having received multiple emails from Together For Safety about the situation in Limerick.

Debate adjourned.