With the volume of work in the health field, I think the Minister would agree that there should be a health warning given to anybody taking up the health portfolio on either side of the House.
Health (Family Planning) (Amendment) Bill, 1993: Committee Stage (Resumed.)
Debate resumed on amendment No. 3:
In page 2, before section 3, to insert the following new section:
"3.—The Principal Act is hereby amended by the insertion of the following section after section 2:
`2A—The Minister for Health shall provide in conjunction with the Department of Education, a Health and Lifeskills programme for education with the objective of promoting an understanding and appreciation of responsible sexuality.'.".
—(Deputy Flanagan)
Hear, hear.
We were discussing this very good amendment by Deputy Flanagan to the effect that we should have a health and life skills programme of education in our schools with, generally, the objective of promoting understanding and appreciation of responsible sexuality. On Second Stage I spoke of the real need to have an evaluation of the quality of that educational response. This amendment goes to the core of that. The Minister is aware that the stay safe programme, which is an example of such an educational response in our primary schools to make children of primary school age more aware of the dangers of sexual abuse and general bullying, has been enormously successful and welcomed right around the country by parents. There is some opposition to it but that is to be expected, given the innate conservatism of Irish life.
There is a need, and the Minister has said he is in agreement with this, to extend the stay safe programme in amended form to secondary schools. It may be necessary to put it on a statutory footing to give it impetus and introduce a standard of quality so that it will not develop in an ad hoc way, depending on the response of individual boards of management, the ethos of the school and the perspective that is put on a good healthy sexual programme in schools.
The vocational education committees in particular should have a very targeted response. They are dealing with adolescents just at the right age who are a captive audience in schools and colleges during the day. It would be a good extension of the welfare role of teachers to go into this area of life skills and relationship skills.
I referred earlier to the great worry I have about the escalation in the number of live births to single mothers in the State. Figures from the Central Statistics Office show the number of births outside marriage as a percentage of total births. In 1980 it was 5 per cent; in 1984 it was 8 per cent; in 1988 it was 11.9 per cent and in 1992 it was 18 per cent. That means that one in five children is born outside marriage and this is particularly marked in the 15 to 24 age group. The great majority of those births, two thirds, are the woman's first child.
This points to the real need to get the message across to young women and men of the need to take the necessary precautions. Too often in the past it has been left to the women to bear the responsibility and the subsequent guilt of an unwanted pregnancy.
I wholeheartedly support this amendment and hope that the Minister will respond by taking it on board. I am not sure whether it will involve a charge on the Exchequer but that may well be necessary in order to launch the stay safe programme in secondary schools in amended form. It may be necessary for the Department of Education to introduce legislation to do that.
I did not get an opportunity to speak on Second Stage. This morning the Minister said that we have moved a long way from the era of Irish solutions to Irish problems but, believe it or not, I believe that the 1979 legislation was progressive for the time. It was a time when AIDS had not been discovered. Irish society has changed dramatically since 1979. In these days of EC bureaucracy sometimes an Irish solution to an Irish problem might be better than imposing a doctrinaire, ideological continental solution to issues. In future perhaps we should have more Irish solutions to Irish problems.
I will bat for my father later.
He would have been surprised at Deputy Flanagan's comments this morning.
I suppose Deputy Flanagan and I are the next generation of Irish society in this House. Regarding the provision of condoms under medical cards, I understood that when the 1992 legislation was debated the only outstanding issue was the question of vending machines. The Minister is dealing with that issue in this legislation, but there appears to be another issue on the agenda — the provision of condoms through the medical cards system.
We are not discussing the amendment relating to that, it has been ruled out of order.
I appreciate that, although Deputy McManus made her contribution under subsequent amendments.
And rightly so.
The Deputy was entitled to that under the section. I thought I had better deal with it.
Special dispensation.
For a constituency colleague.
I appeal to the Minister to clarify this issue. Regardless of the legislation introduced by the Minister will new issues be raised by the Opposition? I am sure that will be the case.
Poverty is an old and a new issue.
Absolutely.
Deputy Haughey, without interruption.
Hopefully this legislation will finally address the issue. Regarding education, there is no doubt that most children today learn the facts of life in the schoolyard. That is how it has always been and it is most unsatisfactory. The education children get in the schoolyard is incomplete, inadequate, often confusing and may cause problems. There is no doubt that something must be done in that area. Our education system is far too academic and it does not place enough emphasis on education in respect of relationships and the practical issues of life, for example, budget management and so on. This amendment should also be addressed to the Minister for Education. There is no doubt that education in relation to sexuality and relationships is inadequate at present. I have no doubt the Minister will say this is a matter for the Minister for Education and perhaps that is something we may pursue at a later stage.
(Carlow-Kilkenny): I find it somewhat disconcerting to stand here with no paternal claim to fame in the presence of Deputies Haughey and Flanagan. I will have to look to the future and perhaps a member of my family will look back in 40 years time and say, “I rememeber an old man one time”.
I welcome Deputy Flanagan's amendment. No matter how serious the question of AIDS and HIV infection is we must not lose sight of other aspects of this issue. We must face the dreadful scourge of AIDS, we cannot shy away from addressing that problem. It is important that we maintain a balance and uphold standards in sexual relationships. Regarding the introduction of a programme for schools which would encourage that, an appreciation of responsible sexuality is a sine quo non to use words of a forgotten language. I am somewhat concerned about Deputy McManus's amendment which proposes to provide information as to the safest and most effective use of contraceptive sheaths. I would be worried if you have just a lesson on how to use condoms you are suggesting, “this is what your life is about, this is what you should de doing”. If the lesson was geared towards responsible sexual behaviour it would be beneficial to students. It is important that standards are set and I do not subscribe to the argument that because condoms are available everybody should be promiscuous. However, there are standards and everybody need not be sexually active. I do not know if people are as sexually active as reported in the media. I cannot comment on that. We should uphold certain standards and by providing options students could make decisions in regard to their sexual behaviour. I did not appreciate the Minister laughing when Deputy Flanagan anticipated that his answer would be that this matter was not his responsibility. I suspect the Minister will say that despite everything that has been said and agreed, this is a matter for the Minister for Education. I am pleased this amendment was not ruled out for cost reasons. All teachers are burdened with extra work and costs do not enter the debate. I hope the Minister will treat this amendment seriously and that if he cannot deal with it now he will deal with it in the future.
On a point of order, Deputy Browne has not read my amendment. I wish to clarify that my amendment does not say that school children should be advised on how to use condoms. I want to have that point clear. My initial point was that the reason condoms fail is very often because people do not know how to use them. There was no question of my advising school children in this regard. That is not part of my amendment.
(Carlow-Kilkenny): The Deputy's amendment is clear. It states:
The Minister may by regulations provide for a programme of education and information as to the safest and most effective use of contraceptive sheaths.
It does not relate to school children.
(Interruptions.)
(Carlow-Kilkenny): Education is information.
Has the Deputy never heard of adult education?
I welcome this amendment which is far-seeing and enlightened. I do not wish to enter into the discussion that has ranged between Deputies Browne and McManus. Much of what Deputy Browne has said in relation to the wording in the amendment is accurate. I am convinced that there are more problems associated with the spread of AIDS, unwanted pregnancies and so on, than just the availability of condoms. Providing vending machines is not the answer to the problem. Deputy Flanagan's amendment goes a little further towards addressing the major problem. We have a spate of unwanted pregnancies here and it is a problem that must be addressed. However, supplying free condoms and providing vending machines is not the answer. There are more aspects of the issue to be addressed. We need an educational programme. We must educate our young people in responsible sexuality and an education for living should be brought into the equation as well. Parents are the primary educators of our young people. I have heard many people today refer to advertising programmes, the provision of information and so on, but we must not forget that the major responsibility for educating our young people in all facets of life lies with parents. They have the major responsibility and when children go to school much of that responsibility is passed to their teachers. Parents must be involved in the design and delivery of any programme for responsible sexuality or education for living. I commend this amendment to the House. I hope the Minister will accept it even though much of its scope lies outside his Department. I am sure he has an input in the Department of Education and he could initiate discussions to develop a programme for educating our young people.
I support much of what has been said regarding a programme for education and information. I have listened to much debate here on this issue as far back as 1979. I was in the Seanad when the then Minister, Charles Haughey, introduced the 1979 Act. I did not contribute to that debate but in a debate in 1985 I mentioned particularly the need for consultation, information and education. There was a need for consultation in 1985 but we have progressed since then. It is important that the question of education and information be addressed now. If the Minister says it is a matter for the Minister for Education I hope he will continue his discussions with her on this issue.
I was interested in the discussion here last year when the Minister, Deputy Howlin, quoted me during his contribution, in which he attacked the Fianna Fáil/Progressive Democrat Government at the time. It seems that I said in the debate on the 1985 Act that that Bill was "likely to undermine the values of young people". Deputy Howlin said at that time that my comments, and those of other Fianna Fáil Members, were cynical and disgraceful. I will let others decide on that issue. I may have changed my view on other issues but I do believe that the wrong message is being put across to young people. The message of responsibility for their actions has not been made clear except by a few Deputies. Along with other Members, I was hoping to speak earlier in this debate but through my own fault I was unable to attend.
The Minister and the Departments of Health and Education must emphasise the need for a programme of education and information. The question of responsibility on the part of both males and females must be emphasised also. I hope the Minister can accept some part of this amendment or, if not, discuss with the Minister for Education the important need for information and an education programme.
I wish to support Deputy Flanagan's amendment. I anticipate, along with other Deputies, that the Minister will, as it were, wash his hands of this by acknowledging that while it is a good amendment it falls within the responsibility of the Minister for Education. The Minister's Department is the appropriate Department to make available the necessary qualified and skilled personnel, albeit perhaps through the schools, but also, as other Deputies have said, through the holding of night classes. Many people who have left school would benefit from an understanding and appreciation of responsible sexuality. There is a case for the Department of Health to take a "hands on" approach to this issue and not to wash its hands of it. The Minister, very effectively, referred to another initiative by the Department of Health, the Stay Safe Programme.
That is education.
The Minister referred to this programme extensively when dealing with the Kilkenny incest case, in other words, he was piggy-backing on the Department of Education. The Minister has introduced this Bill, which I welcome, but he should not now adopt a "hands off" approach to the issue. There is a need for education and for young and not so young people to avail of the use of condoms if they so wish. As other Deputies have said, the use of condoms is not being made compulsory, but condoms are being made available. It is now up to people who wish to practice safe sex to avail of this form of contraception if they so choose.
I ask the Minister not to reject this amendment out of hand. He should give a commitment here today to do more than just discuss the matter with the Minister for Education. He should initiate programmes in our schools and, indeed, in our communities generally. He should utilise the skilled staff and the trained nurses available in our health clinics to extend the programme of education. It must not be left to our school teachers because many of them may not be sufficiently qualified to discuss these issues and to give the type of advice that young people require. I hope the Minister will accept the spirit of this amendment and incorporate it in the Bill.
We have had a long discussion in relation to the two amendments that have been taken together and, indeed, the third amendment which is not in order but which was referred to by many Deputies. I would like to deal with each of them because they merit careful analysis and consideration. May I impose on the good nature of the Ceann Comhairle and indicate in relation to the amendment not in order——
It is not his good nature. They are the rules of the House.
——that with the adoption of this Bill there will be no legal prohibition on health boards to provide condoms free of charge to any person? In fact, the free distribution of condoms is already an integral part of our HIV prevention programmes and services in many areas. There is a difficulty in relation to the GMS. Non-prescribed products are not currently included and there are a number of products that would properly be considered if I were to go down the road of non-pharmaceutical products. However, I am unwilling to do that because a range of issues would be raised in that regard. I will give an undertaking to the Deputy and to the House that I will monitor the difficulties in uptake for vulnerable people, particularly medical card holders, in relation to the enactment of this legislation.
Deputy McManus referred to finding useful documentation in public conveniences. That is part of the Department of Health's information campaign and these leaflets are present in many public buildings. They are a positive information medium. Not all Government Departments wish to become involved in this campaign. I am aware of this because I have requested other Government Departments to fund these and not all of them wish to take part in the scheme. I hope the message will go out to all Government Departments. Deputies opposite, I am sure, will have occasion to visit each Government Department and will, perhaps, raise the issue by way of parliamentary question to my colleagues who have not availed of this service. These leaflets are available also in entertainment centres around the country. This medium of information is a particularly effective one and I am pleased Deputy McManus concurs with that view.
In relation to the two amendments being taken together, one in the name of Deputy Flanagan and the other in the name of Deputy McManus, the first states that the Minister for Health "shall provide in conjunction with the Department of Education, a Health and Lifeskills programme of education with the objective of promoting an understanding and appreciation of responsible sexuality". The second states that "the Minister may, by regulations, provide for a programme of education and information as to the safest and most effective use of contraceptive sheaths". Virtually all Deputies who spoke anticipated that I might indicate that this is outside the remit of the Department of Health.
Surprise us.
Different functions are ascribed by statute to various Departments and the education function is a statutory responsibility of my colleague, the Minister for Education, Deputy Bhreathnach. I have had discussions with her in relation to the Lifeskills programmes and I agree with the views expressed across the House that a new impetus is required now to stay safe programmes and Lifeskill programmes. These are important in educating young and not so young people in the need for responsible sexuality. There are people suffering from all forms of inhibitions due to the lack of this type of educational programme. Hopefully, we can provide for this but it is not appropriate to this legislation. It is not an education Bill and this amendment could not easily be encompassed in this legislation. However, I accept all the views expressed, and give a commitment to discuss the matter with the Minister for Education. I would say to Deputy Owen that I am not washing my hands in relation to this issue. I have a responsibility to see how we can collaboratively make progress on it.
Programmes are in existence already. I am aware of the importance of life skills programmes and of providing information to all people about HIV transmission and AIDS. The Department of Education has issued guidelines on sex and relationship education for use in secondary schools. A number of health boards has life skills programmes — for example, the north-west life skills programme is in operation in all primary and second level schools in that area. Another example is the Bí-Folláin programme of the Mid-Western Health Board which is targeted at primary schools in the mid-western region. The success of the Bí-Folláin programme has been such that other health boards have applied to have the programme introduced in their areas. Other health boards also have social and health programmes in schools in their areas.
My Department's health promotion unit has in place a number of initiatives which educate and inform the public about HIV and AIDS. For example, almost 500,000 copies of an information leaflet have been distributed. School materials produced by my Department in conjunction with the Department of Education have been disseminated to all second-level schools and in-service training in their use was provided for teachers. In addition we have produced a video for use in education settings, almost 400 copies of which have been distributed to youth leaders, teachers, health boards and community groups. I recommend to Deputies who have not seen this video to look at it because it is very valuable and I was extremely impressed with it.
Information regarding safe and effective use of condoms is included in these initiatives, as is the issue of relationships and sex education. Such information will continue to be part of the AIDS information programme. Consideration is currently being given to the needs of primary schools in the area of AIDS education. Much work is ongoing and much needs to be done. I will bring to the attention of my colleague, the Minister for Education, the views of Deputies, but I do not believe this amendment is appropriate in this context.
I thank the Minister for his sincere consideration of the amendment. It is unfortunate he is not prepared to accept it or to act on it. As the Minister's responsibilities extend to the public health arena he has a duty in this regard, particularly as he is the Minister responsible for family planning legislation. I see no reason that his responsibility should not include education and a programme of information on this matter. I would use the parallel of the present AIDS information campaign. The Minister has never said that the AIDS information programme or HIV preventative measures are not the responsibility of the Minister for Health. There was not involvement by the Minister for Education in the current information-education campaign being conducted on the television. I put it to the Minister that his responsibilities are a little more than those which he accepts in this regard.
Accepting the bona fides of what the Minister has said about health promotion in schools, health boards have a function not only in the dissemination of information but in the provision of a locally focused information facility on family planning matters. There are health centres in almost ever town and village in the community, many of which are closed for the greater part of the week. A programme of information and education for adults and young people alike could be undertaken in these areas for the benefit of the community. Perhaps we should think not just in terms of a schools programme — a reading of the amendment clearly shows we do not propose to confine such a programme to schools. We are engaged in the all-embracing task of making information available and pursuing a programme of awareness in the form of an education process. I am not going to press the amendment. Maybe I should but I am sure the Minister would use the substantial Government majority to ensure its failure.
It might be more substantial this evening.
I am not sure about that, judging from some of the earlier comments. I will not press the amendment. We have been debating this matter since 10.30 a.m. and no division has taken place yet. However there is still 20 minutes left of this debate and who knows what may happen on sections 6 and 7?
Not many amendments have been accepted.
This is a matter that must be taken seriously. It was fudged on previous occasions by various ministers. We have liberalised the law in this area and by so doing we run the risk of sending out signals that may be misinterpreted by the community as regards making condoms available and to hell with education and training and engaging in a programme that will make people more aware of acting in a responsible manner in terms of sexual behaviour.
The Minister should arrange to report to the House on his deliberations with his colleague, the Minister for Education, so as to ensure that this matter is addressed as quickly as possible. Since our last discussion of similar legislation programme managers have been appointed to the political process. I suggest that the programme managers of the Minister for Health and the Minister for Education work together on this matter to ensure the introduction, with the sanction of Cabinet, of a proper system of education and training of the type envisaged in the amendment. I regret the Minister has not taken on board the content of an amendment which everybody, without dissent, has reckoned to be entirely plausible, reasonable and sensible.
I take it the amendment is withdrawn.
Yes, but reluctantly.
Amendment, by leave, withdrawn.
Question proposed: "That section 3 stand part of the Bill."
This debate has been very useful. I want to emphasise that I do not disagree with the impact of the Deputies' views. I am simply concerned about this legislation and it would serve no purpose to insert in it an inappropriate clause if, by common consent, we can achieve the objective of the amendment in another way. I have outlined to the House the work done to date by health boards. I intend to encourage all health boards to become involved in similar activities.
The word "balance" has been used as if the enactment of legislation to provide for freer availability of condoms must be balanced by education. Many people who traditionally object to the availability of condoms equally trenchantly oppose life skills education. Many of them oppose the stay safe programme and other initiatives in this regard. Deputies should not be under any illusion that people who are opposed to this legislation will be in any way placated or balanced by what is perceived to be an education programme. They would see that measure in the same light. That must be understood.
Is the Minister not playing into these people's hands by refusing this amendment?
I hope the educational programmes that are desirable can be put into place. I have already had discussions with the Minister for Education. We have jointly commented on the stay safe programme. We have had a number of collaborative ventures between my Department and the Department of Education. That will continue and will be expanded upon.
In relation to my amendment there is a certain misconception. I am concerned about the tone of the debate since Question Time. The message coming across to me is that somehow young people can be irresponsible and older people are not irresponsible. If my amendment was to relate to any group, it would not be to schoolchildren but to older people. I put down this amendment bearing in mind the type of person who is likely to avail of a condom vending machine. They may be schoolchildren but I presume the bulk of them will not be. The age group that presents as being at risk from HIV infection is from 18 to 40. Those are the people I am targeting in my amendment.
It is all very well to provide the opportunity to buy a device but a certain amount of basic information should be provided. I am not talking about an education programme in schools but about something else. The Minister has a responsibility in this area. Perhaps there is an automatic overestimation of the knowledge and responsibility of adults. There was a famous case in recent times where a woman became pregnant where one could say that an adult did not act responsibly. We are failing to see the point if we are concentrating only on young people or school going children and presuming that everybody else understands the mechanics of condoms and appreciates the responsibility attached to using them.
This amendment should be in the Bill. I will not push it to a vote but the point should be considered again. I am sure there will be opportunities in regulations to consider the point. It is not a matter for the Department of Education but for the Department who produced this Bill to enable people to be responsible. To enable people to be responsible requires the knowledge of how to be responsible.
I am glad of the opportunity to participate on Committee Stage. When we debated family planning legislation last I made my views well known.
I listened with interest to the Minister for Health on this section. He has given a fair and firm commitment on education programmes. As the Minister said, there are programmes initiated by the Department of Education and also programmes run by the health education unit of the Department of Health and by the health boards. The House should recognise the commitment of the Minister in this regard. We should also recognise that the people who oppose this legislation may not be happy with whatever type of educational programme is undertaken by the Departments of Health, Education or any other State Department. They have opposed the stay safe programme and other such programmes initiated by the Departments of Health and Education.
I support this legislation. It is pragmatic and much needed.
In section 3 the Minister is giving himself a negative power. He will not intervene in relation to where machines should be placed until he sees how the Act is working and then he might make regulations to prohibit them in some places. Does that mean that if a person or a group believe that the presence of a machine is offensive, they can mount a campaign and the Minister might find himself making a regulation prohibiting the placing of a machine in that place? In his speech the Minister says that section 3 might be required in the event of a proliferation of vending machines in places where very young people congregate. Young people often congregate in hotels and in other places of public resort. It would not be their normal place of congregation but they congregate in such places. I would like the Minister's assurance that he will not make the effect of this Bill null by giving in to objections to certain locations. I would have preferred had the Minister indicated what he thought would be an inappropriate place so that people would know where not to put them and everywhere else would be open. Will the Minister assure me that this section will not be used to return to the pre-1975 situation?
We have made a significant step forward by allowing vending machines. We are removing the regulations that govern the sale of condoms and the age barrier for the purchase of them. On balance, I decided to keep this power. Only two powers are left to the Minister for Health in relation to condoms. The Minister may prescribe certain locations, because it is possible, particularly in the case of outdoor vending machines which will probably become available here, that there would be inappropriate locations for such machines. I do not foresee, for instance, any school board or management installing a condom vending machine in a school. I would deem such location to be inappropriate and unsuitable. It is theoretically possible, and the argument was put to me, that outdoor condom vending machines could be sited in locations that would be deliberately offensive to people. I felt we would have to have some residual power to ensure that that did not happen——
Beside a banking machine.
I was thinking more of one being sited beside a church or place of worship, which would be inappropriate and might give offence to some people. We should be sensible about their location. The idea simply is that sexually active people would have ready and easy recourse to condoms. That is the import of this Bill. It is as simple as that. We can do that without giving offence to other people, who are entitled to have different views, whose sensitivities and sensibilities in this matter are entitled to be protected. That is the simple impact of this reserved power. I genuinely do not foresee it ever being used.
The only other provision with which we might deal in a few minutes is that in relation to the quality of condoms. If we are to have an effective prophylactic in preventing the transmission of disease we must have set, clear standards.
Those are the only two residual powers I reserve to the Minister of Health. I think both are needed.
I question the Minister's wisdom in this regard since, in section 3 (1) he has retained power to regulate in the negative. I would consider it to be of extreme importance that the Minister would issue guidelines on places that might be considered unsuitable for condom-vending machines. Since this debate began the Minister has mentioned two locations only, schools and churches. I would take it for granted that it would cause extreme offence to many members of the community were condom vending machines to be installed in either of those locations.
I am concerned about areas in which perhaps different companies might compete for prime space within a specific location. What about that? Has the Department drawn up guidelines or regulations to prohibit a multiplicity of machines in certain locations? The Minister mentioned in the course of his Second Stage remarks internal or external locations. I do believe that regulations should be laid down as to locations the Minister regards as being unsuitable. These should be outlined. If he is not going to do that, at least his Department should issue guidelines as to the unsuitability of certain areas. Otherwise, it might not be too long before the Minister would be forced into making regulations. The Minister should give a lead in this regard and issue guidelines for the benefit of everybody involved.
Notwithstanding what Deputy Flanagan says, I am afraid I must disagree with him. The wrong thing for me to do would be to introduce legislation containing a list of places where I think condom vending machines should not be sited. I do not foresee that being necessary. That would be the wrong signal to give. I believe that commercial companies involved in the production or distribution of condoms will find appropriate locations. They will not, on a commercial basis, give offence to anybody because they are in the business of satisfying consumers; that is what it is about. I have reserved this residual power in the event of its being necessary. It has been inserted as a safety net to ensure that power is vested in the Minister to take action if and when that should be appropriate. I do not foresee any commercial company causing people deliberate offence. If they do, certainly I will take action to ensure that such offence is eliminated. It would be the wrong tactic for me to gather round my advisers and rack my brains on all the places of installation that might give offence to somebody. I am sure any such list would be inexhaustive. Reserving residual power to take action, in the event of somebody acting irresponsibly, is by far the better avenue to travel.
Another grievance for the TDs clinic when we are lobbied.
That is democracy.
As it is now 4.45 p.m. I am required to put the following question in accordance with an order of the Dáil of this day: "That the sections undisposed of and the Title are hereby agreed to in Committee; that the Bill is accordingly reported to the House without amendment; that Fourth Stage is hereby completed and that the Bill is hereby passed".
Question put and agreed to.