The Bill before the Seanad makes two specific amendments to the Health (Family Planning) Act, 1979. The amendments are significant and arise from the need to provide an appropriate legal framework for the provision of a comprehensive family planning service for all those who require such service.
The Bill arises directly from the Programme for Government which included "a review of the operation of the present family planning legislation with a view to providing full family planning advice and facilities in all cases, where needed". A detailed review of the operation of the 1979 Act which had been brought into operation on 1 November 1980 was initiated by me more than two years ago. The 1979 Act provided that contraceptives might be sold only in accordance with ministerial regulations, by chemists selling them in their shops to persons who had obtained a prescription or authorisation from a doctor. That prescription or authorisation was to be issued where the doctor considered that the contraceptives were sought bona fide, for family planning purposes or for adequate medical reasons and in appropriate circumstances.
The review of the operation of the Act conducted by my Department showed that under licences issued by successive Fianna Fáil and Coalition Ministers for Health, including myself, approximately 30 million condoms have in fact been imported into this country in the period since November 1980. Many more have been imported on a personal basis. The review also indicated that they are being sold in just over one quarter of chemist shops and in family planning clinics of which there are few. Of great significance in the course of the review was the finding that there are large areas of the country where there were no outlets selling contraceptives. This means that the ability of couples to plan their families in the way they choose, as is their right, was severely curtailed in many instances through the absence of appropriate sources of supply.
While information and advice on family planning matters are integral elements of general practice, not all doctors are willing or able to provide a comprehensive family planning service to their patients. This extends in some cases to a refusal to provide authorisation for non-medical contraceptives under the Act. The net effect of the present situation is that every year a large number of patients travel long distances to attend the family planning clinics which have received consents to operate under the Act. I might add that information would indicate that anything from 14 per cent to 40 per cent of patients attending family planning clinics come from other counties outside the county where the clinic is situated.
The unsatisfactory nature of the present position is even greater when regard is had to the extent to which the present law is openly flouted. Sales of contraceptives at outlets other than those provided for in the 1979 Act are commonplace, while the provision in relation to bona fide family planning, if it ever had a meaning, has been ignored by the general public in their use of family planning services.
Arising from this review, the Government were convinced that certain changes in the legislation would be necessary to provide a responsible degree of access to family planning services and contraceptives in particular, while confining the rigours of the criminal law to areas where enforcement would be practicable in keeping with normal patterns of social behaviour.
I was also aware of widespread dissatisfaction within the medical profession at the provisions of the existing legislation requiring doctors to issue prescriptions for non-medical contraceptives. This requirement is an abuse of the doctor's professional role by dragging him into the field of moral monitor of his patient's personal life. The requirement for medical prescriptions was introduced in order to avoid a direct and honest approach to family planning in 1979. In July 1983 I received representations from the Irish Medical Association that the present Act be amended as a matter of urgency.
At their annual general meeting on 9 November 1983 the Medical Union passed two motions demanding that the Government revise the Family Planning Act and make family planning available to those who need it through their general practitioners and that the Government introduce a comprehensive Family Planning Bill without delay.
In considering the question of amendments to this Act, the Government have had regard to a number of general issues which have a bearing on the availability of contraceptives:
there has been a significant increase in extra-marital sexual activity to the point where illegitimate births, so-called in that statutory context, account for 6.8 per cent of all births in 1983;
studies show that young adults enter into sexual relations generally without using contraception and there is a particularly irresponsible attitude among young males in this regard;
abortion has become the chosen solution for a growing number of single women becoming pregnant, with 3,700 women having abortions in England giving Irish addresses. The majority of these are between 20 and 30 years of age and did not use any form of contraception prior to becoming pregnant.
I might add that the figure available for the first two quarters of 1984 indicates that the out-turn final figure for 1984 would probably be in the region of 4,000, 300 in addition to the 3,700. I would also point out that it is evident that many hundreds of women — how many we do not know — would not give an address in Ireland, in terms of the statutory return from the UK, and therefore the figure is probably nearer to 5,000.
Sexual activity outside marriage is not illegal and clearly has become more common for a variety of complex reasons. The reasonable availability of contraceptives on a legal basis should be part of the response of a caring society which wishes to avoid the horrors of abortion and the tragedy which can accompany unwanted pregnancies among the most vulnerable groups in society. I believe that education to assist young people to form mature relationships is of great importance and at any request the Health Education Bureau are co-operating fully with the Minister for Education in devising a programme of this kind for use in our schools. For 1985 I have increased the budget of the Health Education Bureau by 40 per cent, from £1.2 million to £1.75 million.
Following long and careful consideration of all of the relevant factors the Government decided to bring forward the Bill which is now before the House. The substantive amendments are contained in section 2. In order to increase the availability of contraceptives, especially in areas where chemists choose not to stock them, I am adding a strictly limited number of other groups who will also be entitled to sell contraceptives:
(1) Doctors will in future be entitled, if they so desire, to sell contraceptives at the place where they ordinarily carry out their professional duties.
(2) Employees of health boards acting as such will be enabled to sell contraceptives at a health institution which would include such places as hospitals and health centres.
(3) Persons who have received my consent to provide a family planning service under subsection (3) of section 3 of the present legislation will in future be entitled to sell contraceptives at the place at which they are providing the service.
These are the current family planning clinics.
(4) I have made provision for designated employees of certain hospitals to sell contraceptives at these hospitals. It is obviously desirable that maternity hospitals, where advice on family planning is given on a routine basis to those who seek it, should be in a position to make available at the hospital contraceptives which may be required by patients. Similar arguments apply to permitting the sale of non-medical contraceptives in hospitals treating patients with sexually transmitted diseases.
I believe that the extended list of permitted sales outlets will go as far as is reasonably necessary to remedy the obvious inadequacies in present availability while maintaining a firm degree of statutory control on the possible outlets which most people would wish to see.
Clearly these provisions do not lend credence to the wild accusations that this Bill will lead to the widespread indiscriminate sale or distribution of non-medical contraceptives. The limited number of types of outlets for the sale of contraceptives will in fact restrict their provision to highly responsible individuals and institutions.
The second major change contained in section 2 is that any of the designated persons may sell contraceptive sheaths or spermicides to a person over 18 years without their having to produce a doctor's prescription for them. This is eminently reasonable since it has never been practicable or desirable to require medical practitioners to prescribe the use of devices of this nature to adults and I see no good reason for retaining such a requirement. It is an insult to the maturity and privacy of the ordinary citizen and it is offensive to patients and to doctors.
The Seanad will be aware of the statement by the chairman of the Ethics Committee of the Irish Medical Organisation, Dr. Meade, on 11 February that he believed that doctors generally would welcome this Bill. Similar sentiments have been expressed by the Irish College of General Practitioners. It is not unreasonable that we should adopt in this Bill 18 years as the legal minimum age to permit persons to buy these items in their own right. Eighteen has been accepted as the age at which it is appropriate for them for example, among other roles, to elect Members of Dáil Éireann. The Seanad recently passed the Age of Majority Bill and therefore it would be quite inconsistent to retain the prescription requirement for non-medical contraceptives for adults of 18 years and over.
Prescriptions will, of course, continue to be required for the supply of all other forms of contraceptives, because medical advice, assistance and monitoring is required in their use. The question of an age limit does not come in there at all because, as we know, persons under the age of 18, for example, in terms of cycle regulation, are prescribed medical contraceptives as such and the age limit does not apply in that context.
Section 3 provides for the short title, citation and its being construed as one with the other health Acts. This section also provides that the Act shall come into force on such day as the Minister may by order appoint. It would be my intention to make such an order within a reasonable period of the Bill becoming law. That would be during the course of this year. There will not be any undue delay in that regard.
It has been said that there is no demand for the measures contained in this Bill. In one sense this is true — there has not been a strong public campaign. The reason for this, of course, is that the law has been so widely ignored that the very large number of adults who have access to the family planning services they require have been prepared to flout the law. This must be a matter of concern to us as legislators as it gives rise to contempt for the law generally when inoperable provisions are adopted and maintained. It is time to remove the rather hypocritical sleights-of-hand from our legislative process in this area and this Bill is a response to a most glaring example of hypocritical legislation.
I would, however, reject the assertion that there is no demand for the Bill. On the contrary, there is strong evidence that in passing this Bill we will in fact be acting in accordance with the wishes of a sizeable majority of Irish adults.
I would draw the Seanad's attention to the results of a wide-ranging, scientific research project commissioned by the Health Education Bureau last year as part of their ongoing monitoring of public knowledge and attitudes on health matters. As part of the project, views on family planning were sought from a fully representative random sample of almost 700 adults aged 18 to 50 years.
The results of the survey, which have yet to be published, form a very useful basis for development of family planning services but in particular they show that:
50 per cent were dissatisfied with existing legislation due to restrictions on the availability of contraceptives.
64 per cent felt that condoms should be available without a doctor's prescription while doctors, health board clinics and family planning clinics were seen as acceptable outlets for contraceptives, in addition to chemists' shops.
89 per cent supported the establishment of family planning clinics by health boards.
While 20 per cent felt that contraceptives should be available without any minimum age limit, only 14 per cent suggested that an age limit of more than 18 years should be set.
Fully 68 per cent considered that contraceptives should be available to single people.
This is clear evidence of a demand for the measures contained in this Bill.
I must emphasise that this survey was commissioned quite independently by the HEB from Irish Marketing Surveys as part of their own programme of activity. The results have become available to my Department very recently but they demonstrate that the measures contained in this Bill are in harmony with a significant public demand. These findings are in line with the results of the MRB public opinion survey published in The Irish Times on Tuesday, 12 February — which showed that among the 18-24 age group, 66 per cent were in favour of contraceptives being available to all.
I have already referred to the views of the medical profession which also constitute an authoritative demand for a change in the law on the lines proposed in this Bill.
Despite the evidence of a demand for change I would argue strongly that demand is in principle, a lesser consideration than need when considering changes in the law. There are, after all, many pieces of legislation adopted in this country year after year for which the level of public demand is at best limited.
It is a duty of legislators to provide a framework of legislation which corresponds to their assessment of the needs of the community in the interests of the common good. In the category of necessity I would place the difficulties experienced by couples in many parts of the country in obtaining contraceptives; the contrast between normal behaviour on the part of adults and the odious legal requirement to seek permission from doctors before buying a packet of condoms, and the changed sexual mores among young people.
With regard to the consequences of the passing of this Bill it is my firm belief that the apocalyptic predictions of the consequences of adopting this Bill are quite frankly incredible. The mere availability of contraceptives on a legal basis will not necessarily result in their more widespread use. In most instances it will be the legal position and not actual behaviour which will change as a result of this Bill.
The experience of the availability of contraceptives on a much more widespread basis than is envisaged in this legislation in other European countries shows the great variation which exists between them. This variation reflects the differing cultural values, social norms and religious characteristics of the various countries involved.
There is, therefore, no reason to believe the behaviour of the Irish population will even approximate to the levels of extra marital sexual activity and the social consequences thereof which have been recorded in some countries. Indeed, by contrast, the experience in Northern Ireland, which is much nearer to us in culture and outlook, is instructive. There, the availability on a legal basis of contraceptives in the way proposed through this Bill, has not resulted in any dramatic decline in moral standards. Indeed, and ironically, the abortion rate is now somewhat higher here in the Republic than in the North. Therefore, I believe that the House can proceed to pass this measure in confidence that the measure will not produce any significant change in social standards.
I would draw once again to the attention of the House the fact that there has been a significant change in sexual behaviour already in Irish society. There has also been an increase in the practice of contraception among married couples. This change in social reality has not been reflected in our legislative framework.
There is the widespread purchase of contraceptives by single people and their sale in ways other than that envisaged in the 1979 Act. I do not believe that it is possible to turn back the clock and to drive this form of behaviour underground. I believe that Senators realise that their neighbours and fellow-countrymen and women who in large numbers avail themselves of family planning services, sometimes in a way which is outside the law, would not wish to see the consequences of a strict enforcement of existing provisions.
They know as well as I do that the impracticable provisions of the 1979 Act were adopted in the full knowledge that they were unenforceable and would not, in fact, be enforced. I would argue that by providing, as this Bill does, a more realistic legal framework it now becomes possible to contemplate enforcement of the law. It will put an end to the farcical contrast between what we affirm in our statutes and what we accept as the norm in society.
In this regard, I have already stated in the other House that I propose to authorise appropriate medical officers to monitor the operation of this legislation, using the powers conferred by section 91 of the Health Act, 1947. I have no doubt that those who will be authorised to sell contraceptives will do so responsibly. Some have expressed fears that abortion referral activities may be increased by this measure. While the law in relation to abortion is a matter for my colleague, the Minister for Justice, I wish to assure the Seanad that I will not be prepared to give my consent to any family planning clinic which is known to be providing an abortion referral service. In that regard I have not issued any consent since I became Minister when any such information was available to me.
As I mentioned in passing there has clearly been, in recent years, a change in sexual practices in this country and, in particular, a change in the relationships entered into by many people. This Bill has regard to these changes and I shudder at the implications of some of the points which have been made against this Bill in the Dáil and elsewhere. I am precluded from commenting here about the Official Report of the other House in view of our appropriate separation, but it would appear that some would argue that we should outlaw virtually all sexual activity outside of marriage. We should perhaps go further, some may even argue, and cut off Irish society from the rest of the world. We have virtually reached the stage when we should restrict the right to travel abroad to those who are judged to be "sound"——