I welcome to the meeting Ms Olive Braiden, chairperson, and Ms Caroline Spillane, acting director of the Crisis Pregnancy Agency. Before asking the representatives to commence their presentation on sexual awareness issues, I would like to apologise for the delay which was due to a vigorous debate here earlier.
Sexual Awareness: Presentation.
Ms Olive Braiden
I thank the Vice Chairman and members of the committee for inviting us here. Despite having to wait for a while, we are very happy to be here to make a presentation on sexual awareness issues in Ireland, which are central to the work we do in the Crisis Pregnancy Agency. Over the past three years, we have accumulated a considerable amount of research in the whole area. I will make a few opening remarks, Ms Spillane will make a PowerPoint presentation and then we will take questions. I will be brief because of the time constraints.
As many members may recall, the fifth progress report of the All-Party Oireachtas Committee on the Constitution concluded there was an urgent need to take measures to reduce the number of crisis pregnancies in Ireland and to provide real and positive alternatives to women who were experiencing a crisis pregnancy.
The Crisis Pregnancy Agency was established by the Minister for Health and Children at the end of 2002. Our main work was to develop a strategy which would address the issue and ensure that supports and services were provided to women at risk of or experiencing a crisis pregnancy, or for women who had experienced a crisis pregnancy in the past. Over the past few years, the agency has made good progress. It has been implementing its strategy since last year. We do this in many different ways, through financial supports for organisations, through public communication and campaigns and through research, which helps us to understand people's behaviour. We also need to assess all the needs and, more important, we do this by promoting good practice in counselling.
Our mandate as set out in the establishment order includes first, a reduction in the number of crisis pregnancies; second, a reduction in the number of women with crisis pregnancy who opt for abortion, by offering them services and supports which make other options more attractive, which is quite a challenge; and, third, the provision of counselling and medical services after a crisis pregnancy. We have an independent board of nine, which is advised by a consultative committee of 20 professionals right across the board.
The agency has cross-functional programmes, the most important of which is the expansion of the counselling services.
In the past year we have expanded counselling services by 50%. When the agency was originally set up, there were just six agencies working in the area, all voluntary. These included the Well Woman centre, the IFPA, Pact, Cherish, which is now called One Family, CURA and Life. Senator Henry was president of Cherish for many years. Although these agencies were underfunded, they did amazing work over the years. It was important that the State took over funding of these services and expanded them.
Women who find themselves in a crisis pregnancy situation need to know there are good services on offer for them. They also need to know there is consistency between the services available in each part of the country and need not to have to worry about where they will go or whether they need to go to another town, city or county for a good service. The Crisis Pregnancy Agency believes that all these services should be available to all citizens.
The State and professionals working for it, whether doctors, social workers or other health professionals, have an important part to play in delivering good services. In some areas the State already plays a good part. We have developed four new services for women with crisis pregnancies in partnership with the HSE. These services are available in the former Midland Health Board area, Portiuncula Hospital in Galway and in Mayo General Hospital. They are a good cost effective model and an important State service. We have two new services starting in conjunction with the HSE in Cork and Kerry, one in the Beara Peninsula and the other in Tralee. The Positive Options leaflet lists all the services but these two are not included because they are new.
We call our model the Midland Health Board model because that board was the first to put it in place. It is an innovative service and operates in six locations across the midland region. It meets geographical needs well and at the low cost of only €80,000. This model of good practice should be provided by the State and implemented in all the other under serviced areas around the country. Women with a crisis deserve this State-provided counselling service and it should be provided as a right.
The Crisis Pregnancy Agency will publish the contraceptive framework next year. This is a model of how contraceptive services might be provided around the country in a manner that ensures that regardless of geographical location, women and men have access to contraceptive services and are given a choice of methods. This model will inform policy makers and the HSE on how best to develop these services in Ireland. We are working closely with the HSE on completing that model. Over 40% of the agency's €7 million budget is channelled through the funding programme to services. The majority of the money is for crisis pregnancy counselling and its related support services.
Since it was established the agency has commissioned a great research programme. The information we supplied lists the research programmes we have carried out. Copies of the programmes are available if required, but they would make up an enormous pack. In all, some 19 major research projects have been carried out. This research has contributed greatly to informed debate and decision making. We are committed to the use of research as a basis for understanding behaviour, assessing needs , building on previous action and promoting the use of evidence-based best practice. Our conclusions and recommendations are based on research that has been undertaken by us over the past two years.
Sexual health awareness is a broad topic that covers a variety of issues. Our remit covers crisis pregnancy, contraception and education in those areas. Other areas, such as sexually transmitted infections, STIs, are not part of our mandate.
In the past year we have developed a video for parents, who are an important audience for the agency. We have provided the committee with a copy of this resource, a DVD, video and booklet. It aims to assist parents in communicating with their children about sexual health and relationships and supports them as primary educators of their children in this regard. One of our key aims is to ensure that this resource is used widely all over the country. So far, there has been great demand for the video which has been used in schools with groups of parents, in other community groups, and provided to parents to use at home. Ms Spillane will now explain our programme in detail.
Ms Caroline Spillane
Sexual activity is a broad area so I have tried to break it down into its different components. Last year the agency published the Irish Contraception and Crisis Pregnancy Study. This significant study involved men and women in the 18 to 45 age group. The study has provided much information in terms of sexual practice in Ireland.
A significant finding of the study was that the majority of those surveyed had experienced sex. The study confirmed that the age of first sex in Ireland has decreased and that the majority of young people between the ages of 18 and 25 are sexually active. However, the age of first sex in Ireland is higher than in many other countries, for example, the United Kingdom, the United States and Australia.
The study also confirmed that most people using contraception use either condoms or the contraceptive pill. Significantly, 10% of those in the study, despite being at risk of an unplanned pregnancy, did not use any contraception. If we extrapolate this finding to the general population, it means a significant number of people do not use any form of contraception.
The reasons for non use of contraception were in the following order. The primary cause was that sex was not planned or people were not prepared for having sex. Second, they were drinking alcohol or taking drugs. Interestingly, many women felt they were unlikely to conceive because of the menopause. When we remember that the study covered the 18 to 45 age group, it is interesting they believed that.
There are barriers to the use of contraception, some of which indicate the myths or misconceptions that abound. Two thirds of the study group felt that taking a break from the pill was a good idea. The contraceptive pill just did not appeal to some 38% of women and half of men and women said that they felt the pill had dangerous side effects.
There are also other types of barriers to using contraception. Although in Ireland attitudes to sex have become more liberal, we found that at least one quarter of those surveyed felt that if a woman was carrying condoms while not in a relationship, she gave the impression that she was looking for sex. This attitude transfers into how females feel about protecting themselves. Fear of being labelled as promiscuous leads some women to risk an unplanned pregnancy rather than carry condoms or use contraception. Again, the main reasons for not using contraception were unplanned sex, alcohol and drug use.
Another interesting finding is that the understanding of fertility among women and men is quite low, and decreasing among women. There are some charts in the packs we provided that show further details on this.
We also asked about the emergency contraceptive pill. The awareness of this is very high, with 96% of people knowing of its availability. Approximately 28% of the female respondents to the survey had used it and the figure was lower for male respondents who reported their partner using it. Specific knowledge relating to its use was rather lacking, with only 38% of people identifying the correct time period for its use and 44% underestimating the time limit. The emergency contraceptive pill has a specific time limit in which to use it. Approximately one third of the sample also felt they might encounter barriers if they were to access emergency contraception. These were perceived as the attitudes of professionals such as GPs or pharmacists towards its dispensing.
As Ms Braiden stated, even though sexually transmitted infections are not within the remit of the Crisis Pregnancy Agency, given the number of people who are risking unprotected sex, it is of significance. Between 2000 and 2003, 60% of STIs occurred in the age group 20-29 years. This age group is probably more likely to engage in high risk sexual practices. However, there are now better screening programmes and better numbers of people coming forward for screening. The specific areas of concern in terms of sexually transmitted infection would be genital warts, chlamydia and hepatitis B. I include a chart showing the rise in the period 1989 to 2003.
In the area of crisis pregnancy, the study to which I referred earlier has shown that of women who have been pregnant, one in three have experienced a crisis pregnancy. The majority go on to have the baby, with 15% choosing abortion. It is interesting to note that 70% of those women were in relationships and that over 50% went on to raise the child with the partner. The lack of use of contraception is significant in that 60% of those with a crisis pregnancy said they did not use contraception at the time of conception.
There are three options which people in crisis pregnancy choose. The largest number of births happen to the 30-34 age group, followed by the 25-29 age group. The number of births outside marriage is approximately 31% at present and this is a similar trend to other European countries.
The choice in a crisis pregnancy for a lone parent appears to be between lone parenthood and abortion rather than adoption. A significant influencing factor for people choosing to parent alone would be the support of their families, friends and partners. Workplace and work circumstances are also hugely significant. A point to note is the risk of poverty and financial difficulty is a real concern for lone parents and they need ongoing support such as accommodation, child care and finance.
Adoption is now rarely seen as a solution to a crisis pregnancy because the number of children available for adoption has decreased dramatically, with 76 adoptions taking place in 2002 whereas at the end of the 1960s, the numbers were a couple of thousand children. Adoption is often not promoted because of the negative societal attitude. It is normally the preferred option between those who are absolutely opposed to abortion as a choice but still have negative associations with lone parenthood. They may believe the stigma of lone parenthood is too much for them. Antenatal accommodation and supported accommodation is extremely important for these women. Legislation to introduce open adoptions may be significant in making it a more realistic option for some women.
In 2004 the Irish abortion rate was 6,217. This figure has been decreasing during the past couple of years. One must look at the figures over a five-year period in order to map a trend in terms of abortion figures. When women opt for abortion, the decision is usually made very quickly. That is the reason crisis pregnancy counselling is so significant because it gives a woman an opportunity to have space and time in which to make an informed choice. People have barriers against accessing counselling and that is the reason the agency has worked so hard to try and expand crisis pregnancy counselling nationally.
What is that figure based upon?
Ms Spillane
It is based on the UK Department of Health and on Irish women providing Irish addresses at UK abortion clinics.
Not all Irish women having abortions would provide the correct details.
Ms Spillane
It is the best figure the agency has.
The real figure is obviously higher.
Ms Spillane
It could be.
I will speak about teenage births. There is a common misconception that teenage fertility in Ireland is increasing but there has, in fact, been a slight decline in teenage fertility rates. The Irish rate is 18.8 per one thousand births, which is a 2003 figure. The average rate in the UK is 27.34 per thousand births. A very small number of pregnancies happen among younger teenagers but these are governed by another set of factors. Births to very young teenagers are very difficult.
The Irish teenage abortion rate is low in comparison with other countries but it has climbed in the past three decades.
I thank both delegates for a concise and informative presentation. I have two questions. The agency obviously has a fund of research available to it. The condom and the pill seem to be the contraceptive methods most in use, accounting for 78% of methods used. Has the agency statistics on the use of other methods such as the diaphragm or the IUD?
Ms Spillane
The data is in the information pack provided to the committee.
My second question is on the attitude to sex and to women carrying condoms. Was that direct question put to women who participated in the survey?
Ms Spillane
Yes. I can read out the question asked. The statement was, "If a woman carries a condom while not in a relationship, it gives the message that she is looking for sex". Respondents were asked to agree or disagree or make a response stating neither. This is where the figure originates. Approximately one quarter of the 3,500 men and women in the survey agreed with that statement.
I congratulate the delegates on the impressive work. It is good to see a decline in the number of abortions, even though, as Senator Browne said, it does not show the total number. The decline is happening even though the total population of the country — as well as the population in that age group — has increased. It seems to be more hopeful.
I was involved in setting up the Crisis Pregnancy Agency and we were most anxious about the rate of abortions.
I am also delighted the delegation highlighted the situation regarding teenage births. The concentration is often on teenagers but it is the age group of 20-29 years where the real problems exist. The UK figure for teenage births is much higher than in Ireland and the US figure is about twice that again. We seem to be making some sort of progress and it is important to point this out.
I know it is not the agency's brief to deal with sexually transmitted infections but the increase is truly dreadful and appalling, especially when one sees the effects of chlamydia, which can cause infertility if not diagnosed early. I am preaching to the converted. Genital warts are virtually impossible to get rid of on a long-term basis. Is there a need to organise an information campaign about sexually transmitted diseases?
In my view there are problems in obtaining the emergency contraceptive pill. People are embarrassed to go to their general practitioner and to their local chemist. A committee reporting to the FDA suggested that it should be available over the counter. It is not an abortifacient; it just prevents implantation of the fertilised ovum if it is fertilised and would not be discarded anyway. Does the Crisis Pregnancy Agency believe wider availability would be useful? We are talking about allowing nurses to write prescriptions before Christmas. Is this one of the areas we should address with nurses writing prescriptions? While people seem to know about it, its use is quite low and the knowledge for how long it is effective is also low. I congratulate the agency on all it has done.
I also welcome the delegation. The appearance of representatives of the Crisis Pregnancy Agency before the committee is long overdue and I am glad they are finally here. What did Ms Braiden mean when she spoke about consistency in services? The network is being developed locally. How local are the services? This point was mentioned by Senator Henry. Is Ms Braiden confident that people seeking contraceptives can get them in a non-judgmental way? Is contraception now a feature of the sexual health of a person?
Ms Braiden also spoke about counselling after a crisis pregnancy. I would like to hear more about that aspect. I am sure it is quite different depending on the nature of the crisis pregnancy and the ability of the person to deal with it. Presumably there is no single remedy. This morning I heard a radio advertisement by CURA about its services. I would like to hear an update on the controversy that happened last year. I am considering writing to the Advertising Standards Authority for Ireland about the matter as the advertisement does not specify that CURA is a Catholic agency. I understand the difficulty the Crisis Pregnancy Agency has had in identifying people and whether it is appropriate for an agency with a particular religious or moral belief to be in receipt of public moneys. I would be interested to hear how the agency is getting on because the issue died a death. I do not know what the story is with the decision the bishops made but certainly people need to know from whom they receive advice. I commend the stance the Crisis Pregnancy Agency took on this issue, which I support 100%. However, I would like to hear an update on the matter.
I join other members in welcoming the presentation of the Crisis Pregnancy Agency. I add my commendation of the work it has done since its inception. I am fortuitous to be here as a substitute to hear the presentation, which was most interesting. One of the most important issues in advance of the establishment of the agency was to ensure access to contraception. The data the agency presented to the committee showed that while only a small number cannot get access, it is still of some concern. Does the agency have any regional breakdown of those figures? Has the agency considered that the level of access would not be uniform throughout the country?
From a sociological point of view it is interesting that adoption used to be regarded as the mainstay of people who did not want to rear a child born to them and who would offer the child for adoption. There is a huge backlog of Irish couples looking for foreign adoptions. Does the agency have a view on how that issue is publicly discussed and how the Adoption Board deals with the matter? There is little public dialogue on the merits or demerits of adoption.
My final question relates to the use of condoms versus other forms of contraception. I concur with Senator Henry that the prevalence of sexually transmitted disease is a matter for concern. While it is probably not within the remit of the Crisis Pregnancy Agency, in addition to its use in preventing conception, should we consider the promotion of the use of condoms as a barrier against sexually transmitted disease, which obviously would not be achieved by other methods of contraception? Does the agency have a view on the matter?
Ms Braiden
I will answer Deputy Fiona O'Malley's question about CURA and Ms Spillane can answer the others. We have not had much communication with CURA since the problem last year when some members of CURA would not allow a referral system. I remind members of the issue. We worked with CURA, which has 36 centres throughout the country and gives an excellent service. However, to be able to give information, to which women are entitled by the State, on the three options, and because CURA is a Catholic agency, we worked with Bishop Fleming, who was the head of CURA at the time, to determine how the third option could be dealt with.
The agreement was that if a woman wanted information on abortion, the CURA counsellor would inform her that this was information CURA could not give directly but that there were six State-funded agencies — now 13 State-funded agencies — which could give such information. The CURA counsellors were to give women what we call the "positive options leaflet", which lists all the agencies and their services. This meant they did not need to deal with the subject directly which is against their ethos. However, they were happy to deal with it in this way and we were happy to accept that.
During the summer of last year some CURA counsellors decided they did not agree with giving out the leaflet and that they would not make referrals to another agency. This was not referral to England or anything like that; it was referral to one of our State agencies or to a GP who gave the service. This matter was very difficult for us and the bishops discussed it. They subsequently decided to give the order to CURA that the referral leaflet should not be given out. We got no direct communication by letter or otherwise from CURA. We were communicating with the head of CURA in Dublin who is a social worker and is very good at training the counsellors etc.
Nothing has happened since then. However, some letters have gone back and forward. To cover in the meanwhile until a real decision is reached, CURA counsellors will refer women seeking this information to one of its GPs. CURA has a list of GPs. While that can be a very good idea, it is an additional cost for the woman unless she has a medical card. Not all GPs will give information on abortion and we do not know whether it has specifically chosen particular GPs. While it is some sort of referral, we are not entirely happy with it because, for example, of the cost involved.
The Crisis Pregnancy Agency funds the other excellent services that are provided to women for free. The agency works with general practitioners, who can provide information and other good services. It is often the case that general practitioners do not have enough time to spend with women to go through their options with them. The agency is following up the cost issue with CURA. If CURA offers to pay for the general practitioner service, the agency will consider whether that would be satisfactory. I am adamant that there needs to be a separation between church and State, especially as there are many religions and faiths in this country. The State has decided to provide an information service to give women the data to which they are entitled. The Crisis Pregnancy Agency believes that all agencies funded by the State should offer all forms of information. The agency is not in communication with the bishops. I invite my colleague, Ms Spillane, to respond to Deputy Howlin's question about the level of access to contraception throughout the country.
Ms Spillane
The Crisis Pregnancy Agency is working on the development of a framework for contraceptive services. I have outlined to the joint committee a model of how such services might be developed throughout the country so that people can have access to, and a choice of, services and service providers. The framework that is being developed is under consideration in the Department of Health and Children at present. The agency intends to work with the Health Service Executive next year on the implementation of the framework. The basic model being proposed involves people being able to access a certain level of service by going to pharmacies and supermarkets where condoms can be purchased and a further level of service by going to their local general practitioner. The agency proposes that a more sophisticated contraceptive service will be provided to broader populations in larger towns. It is, as already stated, working on the model at present.
Does the agency propose that the advanced level of service will be provided at health clinics?
Ms Spillane
Yes. It will be provided at larger general practitioner clinics and family planning clinics.
Ms Braiden
A member also asked about post-abortion services.
Ms Spillane
Yes. The agency funds various organisations throughout the country, such as the Dublin Well Woman Centre, the Irish Family Planning Association and the Cork Sexual Health Centre, which provide post-abortion counselling services and medical check-ups to women free of charge. The 13 agencies which are funded by the Crisis Pregnancy Agency for counselling purposes provide free post-abortion counselling services. The agency intends to work with the various service providers to increase the current low level of take-up of post-abortion counselling and medical services. The disappointing level of use of such services is a phenomenon that is found in other countries as well as Ireland.
Do women have to visit general practitioners to access post-abortion counselling?
Ms Spillane
No. The agency does not give funds to general practitioners to provide free post-abortion counselling. Women can go to their general practitioners for post-abortion medical check-ups, although they have to pay for that. If they consulted their general practitioners when making their original decisions, it may be appropriate for such women to speak to them again afterwards.
Is there any reason the agency does not fund general practitioners who provide post-abortion counselling?
Ms Spillane
The agency has only recently started to fund post-abortion medical check-ups. It will consider giving funds to general practitioners to that end because not many women are availing of post-abortion medical check-ups at present.
Can the witnesses comment on the availability of emergency contraception?
Ms Braiden
The Crisis Pregnancy Agency has some concerns in that regard, not only because emergency contraception is not easily available but also because its cost can be quite prohibitive. There has not really been a debate about whether such forms of contraception should be available over the counter. When the agency made some queries in this regard, it was told that the company that provides the morning after pill has not applied for it to be available over the counter.
To whom would the company in question have to make such an application?
Ms Braiden
It would have to apply to the Irish Medicines Board.
Ms Spillane
The Crisis Pregnancy Agency believes that emergency contraception is an important secondary method of contraception. It tries to encourage people to use contraception on a consistent basis. It is interesting that when one asks people about contraception, they accept that they need to use it to avoid crisis pregnancy. Condoms need to be used specifically to avoid sexually transmitted infections. Many people do not use contraception on a consistent basis. Emergency contraception, which is not always effective, should be used only as a secondary method of contraception.
Ms Braiden
That emergency contraception is not easily available is a serious problem. People find it difficult to make appointments to see their doctors at times when they need to access emergency contraception, which must be used within a 72-hour period. The cost of emergency contraception is another significant issue.
What percentage of the Crisis Pregnancy Agency's clients are couples? If a woman with a crisis pregnancy contacts the agency, is it required to inform her partner that she is pregnant? Can a woman make a decision in consultation with the agency without making her boyfriend aware of the situation? While she might not be willing to raise a child on her own, her partner might be willing to do so in some cases. The role of men has changed dramatically in recent years. Men may have had a secondary role in rearing children in the past but it is now accepted that men can be as good parents as women. Has the agency taken account of that?
Ms Braiden
The Crisis Pregnancy Agency is a policy making organisation that funds other agencies which provide counselling services. I do not believe it is the responsibility of a counsellor to inform anybody of the circumstances of a particular woman. She can decide what to do.
As a policy maker, I am sure Ms Braiden will agree that while it is obvious that two people are needed for a baby to be conceived, men are at a great disadvantage thereafter. I know a lady who became pregnant and had an abortion without her boyfriend of the time knowing anything about it. He continues to be totally unaware that he could have become a father ten years ago and that he could have a ten year old son or daughter now. I am sure that if he had known, he would have been more than willing to raise the child on his own. There can be an information deficit in such awkward and difficult cases. Men should be entitled to information in such circumstances.
Ms Braiden
I agree. The Crisis Pregnancy Agency has conducted research on the extent of men's knowledge of and attitudes to sexuality. The research, which has not yet been published, highlights the serious problem of insufficient information being shared within couples when the female partner discovers that she is pregnant. Women have to be trusted to make such decisions. The role of counsellors is to discuss a woman's options with her, for example, by giving her details of the support and assistance available to her. If a woman decides not to continue her relationship with her partner, that is her decision.
In general, would a counsellor advise a woman to speak to her partner, who is the father of her child? Is that the official line? I understand that it would be difficult to enforce a rule stating that a pregnant woman must tell the father of her child about her pregnancy if she has made up her mind that she does not want to speak to anyone about the matter. In the case of a married couple, a husband would not be allowed to sell the house without telling his wife. Surely the same logic should apply in the more serious circumstances to which I refer.
Ms Braiden
In such circumstances, the role of a counsellor is to outline to the woman with the crisis pregnancy the supports which are available to her, to remind her of the important people in her life and to impress on her the importance of discussing the matter with her partner. It is ultimately a matter for the woman in question to decide what she should do. The importance of counselling for a woman with a crisis pregnancy is that it gives her an opportunity to talk through all her problems and difficulties and address how the crisis pregnancy can be dealt with, a major problem for a woman in this position.
It is also a problem for a man.
Ms Braiden
Yes, but it is the woman who comes to the agency with the problem. The counsellor will impress on her how important it is to work with her partner, if she is not doing so already. While the woman will be aware of this, a person cannot be forced to do something.
That is correct. How many of the women who are given advice at Crisis Pregnancy Agency centres on, for example, abortion, decide to have an abortion without first consulting their partners or even informing them that they are pregnant?
Ms Braiden
We do not have figures on that.
Ms Spillane
We know from the study cited in my presentation that one in three women who had been pregnant indicated it was a crisis pregnancy. The vast majority of this group had the baby, while 15% chose abortion. Most of the women in question — 70% — were in relationships and more than half of them later raised their children with the fathers. Many of those who experience crisis pregnancy do not become pregnant as a result of a one night stand but are more likely to be in a stable, long-term relationship such as marriage. As I noted, more than half of these women later raise the children with the fathers.
What proportion of the 15% of the group who had abortions are in a relationship?
Ms Spillane
We do not know that figure.
To return to the issue of CURA, it is highly unsatisfactory that the organisation does not communicate with the Crisis Pregnancy Agency. I have forgotten how much funding the agency provides to CURA but it is substantial. I recall the Crisis Pregnancy Agency pointing out that CURA had entered into an agreement with it which it was expected to honour and that the agency had not heard anything to indicate that the contrary was the case. It is a matter of concern, however, that CURA does not communicate directly with the Crisis Pregnancy Agency.
While I accept the point that CURA has an interim arrangement in place for dealing with general practitioners, the current relationship with CURA is not satisfactory in that the Crisis Pregnancy Agency is mandated and funded to provide a service. It also funds other organisations to provide this service. When will this issue come to a head because it needs to be resolved? When is the Crisis Pregnancy Agency due to give CURA more money?
I reiterate my full support for the Crisis Pregnancy Agency's position on the separation of church and State. This must be total because we live in a republic which must honour all citizens equally and have no preference for any particular religion. No State agency should show any such preference. Will this matter come to a head soon?
Ms Braiden
CURA's contract with us runs until the end of 2006. At the end of next year, the organisation will enter into a new contract with the Crisis Pregnancy Agency. In the meantime, we will work with CURA to determine how its referrals take place before entering into a new contract.
I do not wish to press Ms Braiden on what may be a sensitive issue but does the Crisis Pregnancy Agency propose to continue with the referral system CURA uses until the current contract expires or will the agency try to find a more satisfactory solution?
Ms Braiden
We have written to CURA asking a series of questions requesting information on the general practitioners to which it makes referrals and on whether the referral service will be free. General practitioners give an excellent service and the arrangement may be good, provided that no costs are imposed on the woman. Many GPs also refer women to CURA which provides them with a very good counselling service. CURA cannot refer a woman back to a general practitioner because this is neither a good idea nor best practice. One of the reasons CURA agreed to the referral service was that it believed, as does the Crisis Pregnancy Agency, that the more opportunities a woman gets to talk about her crisis pregnancy and what she proposes to do about it, the greater the chance that she will decide to keep the baby following a few counselling sessions at which she has talked through all the difficulties.
As Ms Spillane stated, women who choose an abortion usually do so quickly and they seldom seek counselling. This group of women tend not to have had counselling, whereas the women who choose counselling face a dilemma which they then work through. With prolonged counselling, these women may decide that they can keep their babies. The latter is a difficult challenge for women who may not have money or a place to live. CURA's views on this issue are similar to those of the Crisis Pregnancy Agency.
The Deputy referred to a CURA advertisement she saw. It is important that CURA state it is a Catholic agency with a Catholic ethos to allow women seeking information on abortion to choose from the many other services.
I am grateful to Deputy Fiona O'Malley for raising the issue of CURA. As one who is not Roman Catholic, it is always difficult to be seen to criticise the Roman Catholic Church on these issues. We now know, however, that it is not appropriate to have bishops running any organisation of this nature. If the events of recent days and the words of Fr. McGinnity prove anything to us, it is this. While the onus of addressing the role of CURA may be on the Crisis Pregnancy Agency, Members of the Oireachtas also have a responsibility in this regard.
Deputy Fiona O'Malley is also correct to argue that CURA advertisements should explain that the agency provides limited advice. We had a serious problem a few years ago when several possibly bogus abortion referral clinics operating here placed advertisements in the Golden Pages, with the support, unfortunately, of some general practitioners. We cannot leave it to the Crisis Pregnancy Agency to deal with this issue. Unfortunately, by the end of 2006 many women will have become pregnant and perhaps had abortions due to inadequate counselling.
Ms Braiden
That is the concern. To give due recognition to CURA, it offers good services that are better spread around the country than those of other service providers. Many people use CURA because its services are nearby. It is important, however, that people who access its services are clear about what they will obtain.
CURA advertises in every church and none of its advertisements indicates that it provides limited services. The House will have to examine the problem Deputy Fiona O'Malley has raised because it is not solely a matter for the Crisis Pregnancy Agency.
During a debate on child care in the Seanad last night, I noted the importance of trying to secure free child care for lone parents. As the research provided by the Crisis Pregnancy Agency showed, risk of poverty and financial difficulties are a major concern and key supports, including accommodation, child care and finance, are required. These issues must be addressed by legislators because they are not part of the agency's brief. As the delegation will be aware, I have worked in this area for all my adult life. If women are informed they will receive no support, which will be the case for most of those in question under the current system, it will not help to persuade them to continue with the pregnancy.
I apologise for contributing at such a late stage in this interesting discussion. What level of success can be achieved in this area? It is interesting to note that two thirds of those cited in the report did not use contraception. Is that correct?
Ms Braiden
Two thirds of those who had crisis pregnancies did not use contraception regularly.
Ms Spillane
Some of the other 40% cited contraceptive failure.
I hear a great deal on Saturday mornings about condoms bursting. Perhaps the proclaimed standards of condom companies should be called into question. Their products state that this does not happen. I receive numerous requests for emergency contraception on Saturday mornings due to burst condoms. As a GP, I wonder if a cause of contraception failure is due to people on the contraceptive pill being on antibiotics. What does contraception failure mean? We do not question patients too closely but, to be honest, I question if contraception was used in every case. According to the information supplied to us, 40% of people claimed to use some form of contraception, half of those said they were using condoms while a third of them claimed they were using oral contraceptive pills. In cases of unplanned sex in conjunction with alcohol, it may be the case that the heart was more in control than the head.
Ms Braiden
That is very often the case for us all.
Will we ever be able to do something about that?
Ms Braiden
It will be difficult. The important thing is that everybody has the message that if they do not wish to become pregnant, they must use contraception. We are running an extensive television advertising campaign at present. We also have people giving out information and free boxes of condoms at concerts. The contraceptive message is really important. The contraceptive framework will be a big part of our work next year. We will be working around the country with health services and GPs. As we all know, it was difficult to get condoms in the past in Ireland. They are available now but they are not used to the degree they should be.
Apparently many condom vending machines in pubs have never contained condoms. They work on the premise that very few people will go up to a barman to say that there are no condoms in the machine. I have heard anecdotal evidence that if a person does complain about a condom machine being empty, he or she will get his or her money back.
There will be a run on them on Monday.
What we are talking about is getting through to people. Barriers still exist to people making complaints if condom vending machines are empty. People are far more likely to buy a condom in a pub rather than in a chemist shop that is open between 9 a.m. and 5 p.m. because of the correlation between alcohol and sex. If we decide to go down that road, condoms should be made more available to people.
Ms Braiden
Sex education in schools is really important. The video for parents has been very successful. It is called "You Can Talk to Me." If people grow up with good sex education, which has not been the case in Ireland, it will reduce the number of unwanted pregnancies.
Is sex education in schools adequate and is it uniformly taught across the country?
Ms Braiden
It is not uniform. A study is currently being carried out by the Department of Education and Science on the RSE programme. When we have that report, we will make recommendations on it. There is clear evidence that in some schools there is very inadequate or no sex education. If members have time to look at the video, they will see young people aged 14 and 15 giving their views on this. The majority of them had no sex education in schools. Parents are the prime educators of their children. We would like parents to take a greater role in this. People have found the video very helpful. It is very difficult for parents to give good sex education to their children if they have not had some help in formulating it.
Is the DVD and video available to parents through the Crisis Pregnancy Agency?
Ms Spillane
It is available through libraries and citizens information centres. It is also available to the National Parent's Council, with which we are working. It has a programme called Team-Up, which is a parent training programme. We also give it to parents who contact the agency. Several thousand copies have been disseminated since its launch last March. It can also be downloaded from our website.
That is good.
It only remains for me to thank both delegates for coming before the committee and for their detailed presentation.
The joint committee adjourned at 11.56 a.m. until 11.30 a.m. on Thursday, 10 November 2005.