Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I move: "That the Bill be now read a Second Time."

Today marks the fifth anniversary of the magnificent repeal referendum vote. Thankfully, the situation for pregnant people in this country has improved massively since people voted overwhelmingly to trust women and repeal the eighth amendment. Abortion is available on request up to 12 weeks of pregnancy and, beyond that, in very limited circumstances. The numbers travelling abroad or obtaining abortion pills illegally have dropped significantly. That said, we find that more than 200 people per year are still being forced to travel to access abortion services. According to the National Women's Council, many more are taking abortion pills illegally without proper medical supervision and accessing abortion in other countries. The question is why this is still happening. The answer lies in the restrictions contained in the Act itself, restrictions like the patronising, compulsory three-day wait for women to access abortion care. This, by the way, does not exist for any other medical procedure and certainly not for any procedure needed by men. There are restrictions like the criminalisation of doctors with a 14-year prison sentence if they interpret the law incorrectly and cannot 100% guarantee that the pregnancy would prove fatal within 28 days of birth, rather than 29 or 30, on the grounds of health risks and that they cannot prove are serious enough and restrictions like the effective ban on abortions post-12 weeks, where people are forced over the limit by all-too-common delays in accessing health services or facing risks to their mental or physical health.

We should not forget that successive Fianna Fáil and Fine Gael Governments were dragged, kicking and screaming, into this debate on abortion and were forced to call the referendum following a litany of predictable tragedies and, importantly, sustained pressure from a mass movement from below. I move our amendment to the Health (Regulation of Termination of Pregnancy) Act 2018. This Bill would amend that Act to provide for abortion on request by lifting the 12-week limit. It would abolish the three-day waiting period and allow for abortion on the grounds of fatal foetal anomaly that is likely to lead to the death of a foetus within one year of birth and it would, importantly, decriminalise the provision of abortion.

We bring this Bill to the Dáil in order to update Ireland's abortion law. Despite the historic and categoric victory of repeal, we still have at least 200 people travelling every year. This is utterly unacceptable. Women and girls cannot wait any longer for proper access to modern abortion care, free from the risk of prosecution for the medical profession. Despite this Government's conservatism, the Minister must realise that the people of Ireland spoke in the repeal victory five years ago. A recent National Women's Council poll showed that 80% agree that no woman should have to travel abroad and 71% agree that abortion should not be criminalised. Why are they going? It is because women's health is being harmed by continuing their pregnancy if they stay in this country. Currently the numbers accessing abortion care under the health grounds are similar to those who are able to access the care on health grounds under the previous regime. Two out of every five who need care because of fatal foetal anomaly cannot access the care they need here because doctors cannot say for certain that a foetus will die within 28 days. Doctors work under the chill of the veil of criminalisation that could lead to a 14-year sentence. The three-day wait is utterly insulting and patronising. I have spoken previously about the rigid 12-week limit which impacts mostly on women who find that their health has deteriorated beyond 12 weeks, on teenagers who do not discover they are pregnant until then, on undocumented migrants, on disabled people, on people living in domestic and coercive abuse relationships and crucially, on many who live in far-flung regions of rural Ireland.

I want to talk about Ms Marie O'Shea's report which, albeit late, is very welcome. The report is informed entirely by the experiences of women and girls and of medical practitioners. Ms O'Shea has put women's experience front and centre. The review that was ordered by the Minister for Health is provided for in the legislation that we passed. It is contained in the legislation because it was said at the time by the then Minister for Health, Simon Harris, that we have to ensure that the law is working. Now we have politicians claiming that they are uncomfortable with the review but for too long women's health has been dictated to by politicians and clerics. The law does not reflect the spirit of repeal. We cannot claim that people voted Yes because of the heads of the Bill because this is just not the case. The only evidence we have are the exit polls which comprehensively prove that the vote for Yes was on the grounds of giving women a choice and not forcing them to travel.

By trying to put off any change until after the next election, Fianna Fáil, Fine Gael and pro-Government Independents, who rely disproportionately on the older, anti-choice vote are being absolutely disingenuous and are increasingly leaving women and girls in dangerous situations and forcing them to travel.

Paul Murphy (Dublin South West, RISE)
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It is very obvious from the response of the Government to our Bill that those in the political establishment have not learned a whole lot from repeal. They should be taking the overwhelming vote for choice that the people gave us five years ago and running with it. Instead, they are hiding behind the sops put into the heads of the Bill before the referendum, designed to appease the Catholic Church, to allow conservative politicians to complete their so-called journeys and to appease what they thought were their own conservative voters. Even now, five years on, when things have moved on even more, when the Government has a report that very clearly says that the three-day wait has to go, that criminalisation of doctors has to go, that women still cannot access abortion on health grounds, and that the 12-week limit is too restrictive, politicians in this Dáil are lagging way behind the people. We should not be surprised. It took them 16 years to legislate for the X-case and 35 years to get the eighth amendment out of the Constitution. Then, when they finally did legislate for abortion, they put a completely unnecessary three-day wait into the law just to make sure that every woman has to wait a little bit longer before accessing the care that she needs. We know the impact that has on accessibility of care. The review of the abortion legislation was delayed until the last possible moment and then they delayed publishing it. Now, they are delaying legislating for the review. It is the same old story. They do not want to go near the issue of abortion because they are afraid it might lose them votes. Let me warn the politicians in Fine Gael, Fianna Fáil and the Green Party and the Independents and everyone else who clings to the fence on this issue.

If they fail to support legislation on this before the next election, they will lose votes from the two thirds of the population who supported repeal and the tens of thousands of young people who have become eligible to vote in the past five years. Women and pregnant people have waited long enough for their basic rights to bodily autonomy and to access the healthcare they need.

We have seen with the row-back of Roe v. Wade in the US what can happen if rights once won are not defended and a reactionary minority succeeds in rolling back progressive gains on equality. We must ensure that never happens here. Who would have thought that only eight years after the marriage equality referendum, we would be seeing a significant and horrifying rise in homophobic attacks? Who would have thought that eight years after the Gender Recognition Act, mainstream media outlets would be exploiting transphobia for clickbait and Fine Gael politicians would be scapegoating trans people to divert attention from the housing crisis? Who would have thought that five years after repeal, half of people faced with fatal foetal anomalies would still be forced to travel to England to access the care they need, that women facing risk to their health after 12 weeks would still be forced to travel and that women and girls would be forced over the 12-week limit by delays in accessing medical appointments?

The Taoiseach notoriously claimed that repeal was "a quiet revolution". Anyone who roared themselves hoarse marching for choice knows it certainly was not a quiet revolution. But it is an unfinished revolution, and we now need to finish the work of repeal and never to forget that it was an active and very loud mass movement that forced a conservative political establishment to act. If the Government insists on kicking this legislation to touch and Opposition Deputies go along with that, then that movement will have to get active again to defend and to extend abortion rights and to ensure that no pregnant person is left behind.

Mick Barry (Cork North Central, Solidarity)
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A referendum had to be wrenched from Ireland's political establishment by a loud and boisterous movement of women, youth and LGBTQ and working-class people, in particular over the previous five years, 2013 to 2018. I agree with the words of my Socialist Party colleague, Ruth Coppinger, one of the foremost advocates for repeal and for abortion rights in this State: the political establishment had to be dragged kicking and screaming into granting a referendum it had resisted for many years.

Now the Government's conservatism is on display again as it attempts to put this Bill into the freezer for 12 months, a sign, in my view, that it intends to delay any progressive legislative change on this issue at least until after the next general election.

The Minister has sitting on his desk a report from Marie O'Shea, whom he commissioned to write a review five years after repeal on how the new arrangements are working out from the point of view of the health of women and pregnant people. She recommends, among other things, an end to the three-day waiting period and the decriminalisation of abortion. The Taoiseach, however, says he is "reluctant" and "uncomfortable" about such changes. I do not care about the Taoiseach's comfort; I care about what is in the best interests of women facing crisis pregnancies. The three-day wait is clearly not in the best interests of pregnant people. It is not a three-day wait to find out if you are pregnant; it is a three-day wait to have access to abortion pills after already deciding you want to terminate the pregnancy. No other group of people in Irish society are told to go away for three days and come back if they want healthcare. No other group of people are told to wait three days for a prescription. It is patronising. It treats women like children. It needs to be ended.

The current legislation provides for a jail sentence of up to 14 years for anyone who assists in the procurement of an abortion for a woman after 12 weeks. That provision creates a serious chill factor for doctors in deciding how to interpret the law. The law allows for an abortion after 12 weeks where the health of the mother is at risk. After all, that is the circumstance in which Savita Halappanavar died in an Irish hospital. The law also allows for abortion after 12 weeks on grounds of fatal foetal anomaly if the foetus were to go on to be unable to survive 28 days after birth. However, doctors are clearly fearful of prescribing abortions for women on either of those grounds. They face the possibility of having to prove in a court of law that the health of the woman was indeed in danger or that the foetus would not have been able to go on to survive 28 days after birth, with both those grounds coming with the threat of a 14-year sentence. Little wonder that the number of women procuring abortions in the Irish health service on health grounds, for example, is more or less similar to what it was before repeal.

As a result of policies such as these, hundreds of Irish women are still travelling to Britain for terminations every year. This is not what nearly 1.5 million people voted for when they voted to repeal the State's anti-abortion laws five years ago. Doctors should be trusted to act in the best interests of their patients. The 14-year jail sentence, that penalty, needs to be scrapped and abortion needs to be completely decriminalised.

It is not acceptable that there is only one GP in Monaghan and only one GP in Longford providing abortion services. The HSE needs to step up to the plate and actively recruit GPs in these areas who are prepared to offer the service. Nor is it acceptable that eight of the State's maternity hospitals do not offer abortion services. Conscientious objection by an individual GP is one thing; conscientious objection by an institution is quite another and is in no circumstances acceptable. The church and religious institutions have stood in the way of women's rights far too long. We need abortion services in every maternity hospital and we need a separation of church and State.

Winning abortion rights up to 12 weeks was a major victory by the repeal movement, but there are real issues with the 12-week cutoff point. In Argentina, where abortion rights were won by a mass social movement after 2018, women have abortion rights up to 14 weeks. In this country the citizens' assembly recommended provision of abortion up to 22 weeks on socio-economic grounds. I am going to be caught for time, but that is an issue I intend to come back to in future debate.

I have heard Government Deputies say they want abortion to be rare. Abortion will never be rare, in my opinion. One woman in three will have an abortion in the course of her lifetime. It is a right and one that will be availed of for a very wide variety of reasons. If, however, Government Deputies want to reduce or to have a chance of reducing the number of abortions in society, the Government should stop placing restrictions on this right and instead focus on the social issues that make many women consider abortion, such as lack of access to contraception, poverty and poor housing conditions. Women should accept no restrictions whatsoever on their rights, least of all from those who defend a social system which places these social burdens onto their backs.

Stephen Donnelly (Wicklow, Fianna Fail)
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I move amendment No. 1:

To delete all words after "That" and substitute the following: "Dáil Éireann resolves that the Health (Regulation of Termination of Pregnancy) (Amendment) Bill 2023 be deemed to be read a second time this day twelve months, to allow for consideration by the Joint Committee on Health of the legislative proposals contained in the Report of the Review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018."

I thank the Deputies for tabling the Health (Regulation of Termination of Pregnancy) (Amendment) Bill 2023. I note its publication and very much welcome the opportunity to speak to the issues raised. It is particularly appropriate, as has been said, that the debate this evening takes place on the fifth anniversary of the repeal of the eighth amendment, something I and many others here worked hard on.

As colleagues will be aware, when I was appointed Minister for Health I made it clear that we needed a revolution in women's healthcare. We were not looking for things to get a little better each year. Our ambition has been to move much faster than ever before to make up for the decades of underinvestment in and underprovision of healthcare services for women. Our aim is to provide new services and financial supports. Those cover important areas such as menopause, gynaecology, endometriosis, contraception, maternity services, breastfeeding, perinatal health, both physical and mental, and fertility.

To that end, this Government has invested in women's health services in a completely new way and at a completely new level. In the budget for last year I ring-fenced €31 million for new developments in women's healthcare, and the budget for this year saw an additional allocation of €70 million. By next year, the full-year impact of the last three budgets, before we add any new development funding for next year, will see an additional €150 million in the base for women's healthcare services. I know from talking to women and clinicians around the country that the impact of that is being felt. It is making a big difference.

As colleagues will be aware, as part of this work, later this year we will extend free contraception to women aged 16 to 30 and introduce State funding for IVF for the very first time.

In the context of this evening's debate, I take this opportunity to reiterate my commitment to ensuring that termination of pregnancy services can be accessed quickly and easily by those who need them and, critically, that they can be accessed without judgment or bias. This includes introducing legislation this year establishing safe access zones around termination of pregnancy services.

As Deputies are aware, the Health (Regulation of Termination of Pregnancy) Bill 2018 was signed into law on 20 December 2018. Expanded termination of pregnancy services have been available since 1 January 2019. The Act allows terminations to be carried out where: there is a risk to the life, or of serious harm to the health, of the pregnant woman; there is a condition present that is likely to lead to the death of the foetus either before or within 28 days of birth; and without restriction up to 12 weeks of pregnancy. This is in line with the recommendations of the Joint Committee on the Eighth Amendment of the Constitution, which published its report and recommendations in December 2017. Prior to the referendum to repeal the eighth amendment in May 2018, the general scheme of the Bill was published. The final legislation enacted is consistent with the published proposals, such that it reflects the will of the people who voted for repeal.

Initially, it is important to acknowledge the progress made in the roll-out of the service to date. As the report quite clearly lays out, there is much more work to be done, but it must be remembered that the service is relatively new, having been in operation for just over four years. For much of that time, it has been functioning under the constraints associated with the Covid pandemic. Notwithstanding these difficulties, it has embedded well into the wider health sector. The report acknowledges that much progress has been made in rolling out the services, but it is recognised that challenges remain. I acknowledged before the report was completed that there are challenges. However, the report is a really thorough, detailed and useful piece of work in pointing out many of the operational challenges. My Department is aware of these and is working with the HSE and other relevant stakeholders to expand access to services.

To ensure that the service is performing as it should be, and in line with statutory and Government commitments, I commenced the review of the 2018 Act at the end of 2021. The review was based on independent research and comprised two phases. The first was an evidence and information gathering exercise that consisted of public consultation and research into the operation of the Act from the perspectives of both services users and service providers. The public consultation provided organisations, stakeholders and advocacy groups working in the area, and all other interested parties, with the opportunity to have their say on the operation of the legislation. Believe it or not, nearly 7,000 submissions were received as part of the consultation process, which was very thorough.

Research to inform the service-user strand was carried out by Dr. Catherine Conlon, who has completed a large qualitative study investigating unplanned pregnancy and abortion care. The study, which was commissioned by the HSE's sexual health and crisis pregnancy programme, has generated an in-depth understanding of the experiences of women who have accessed abortion care services since the commencement of the Act. The study was published in July of last year.

Research into the views and experiences of service providers was carried out, following a tendering process, by Manchester Metropolitan University. That was the first phase. The second was led by an independent chairperson, Ms Marie O'Shea, who assessed the extent to which the objectives of the 2018 Act have been achieved, analysing the findings of the three strands of work from the first phase. She drew on the findings of other relevant peer-reviewed research and consulted further with stakeholders as necessary before providing conclusions. The final report of the review was submitted to me on 28 February 2023. I thank Ms O'Shea, and all those who contributed to the review for their dedication to and input into this important work.

There will be a debate on the various measures, the debate tonight being a good example, and there will be a lot of discussion, but I imagine that we can all agree the work was very detailed and thorough. Certainly from my perspective, there is a lot of useful detail and feedback from service users and providers in respect of improving the services.

The report makes a range of recommendations, most of which are operational in nature, with a relatively small number proposing legislative change. The review was comprehensive and included a wide range of perspectives on termination-of-pregnancy services. Consequently, it is important that we accord the recommendations in the final report due consideration and deliberation.

The report was considered by the Cabinet on 25 April. I recommended to the Government that the HSE establish an implementation group to progress the operational recommendations and that the report, particularly the legislative proposals, be referred to the Joint Committee on Health for its consideration. The Government agreed. The HSE group is being established and the report is now with the Joint Committee on Health. I am particularly interested in the health committee's views on the legislative recommendations but it is of course free to consider anything it wants, including all the operational recommendations. It may well have views on these.

It is recognised that the proposed legislative changes require careful consideration and discussion. These matters are not just for the Government; they are for the entire Oireachtas. Given the committee's cross-party composition and oversight role regarding the health service, it represents an effective and, critically, appropriate forum in which to consider the changes proposed. It is important to allow the Joint Committee on Health members the time and space they need to complete their deliberations before proceeding with any potential legislative change.

In the meantime, regardless of the health committee's recommendations, the debates we have here in the Dáil and Seanad and any Government recommendations or decisions, I will be absolutely focused on continuing to improve the services. There is an awful lot that can be done in parallel with any legislative change, regardless of its extent. As colleagues will be aware, 19 hospitals in the country have maternity units but only 11 of these are currently providing termination of pregnancy services. That is not acceptable to me and I do not believe it is acceptable to many here. The very clear goal is to have all 19 hospitals providing the services required. There is a lot of very useful detail in the report on making this happen. I assure colleagues that I am working directly with the HSE and the national women and infants health programme, which is leading on this, to ensure all the barriers to implementation across all 19 hospitals are identified and addressed. Colleagues will also be aware from the report that there are over 400 GPs providing services. That is a large number, particularly given the number was zero when the legislation was passed. Nonetheless, the report quite rightly points out – colleagues have already alluded to this – that there are parts of the country where there is very sparse provision. I am working with the Department, the HSE, the national women and infants health programme, GP representative bodies and GPs themselves to ensure we understand what is required to increase the number of GPs providing the services.

I fully respect the debate happening tonight and that there will be an ongoing debate on legislation and operational matters. I assure colleagues that, regardless of the debate, there is a health service already provided for under law. It needs to be available right across the country. Much progress has been made and there is much more that we need to make, so, in parallel with the debates we will be having here in the Oireachtas, I will continue to work closely with the HSE and Department to ensure the services already provided for under law will be provided to the greatest extent possible. I will also be making progress on the legislation on safe access zones for the reasons we all understand.

Joan Collins (Dublin South Central, Independents 4 Change)
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I thank Deputy Bríd Smith for introducing this Bill. It is very timely, this being the fifth anniversary of the significant referendum on the right to access abortion. The important point is that abortion is a healthcare issue. The review was initiated to determine where we were and how the legislation allowed women access to healthcare. We have to say that, in some areas, it is falling short. These are the areas we have to discuss. Several areas in the Bill before us deal with this. Section 2 would delete the foetal viability clause where there is a risk to the pregnant woman's life or a serious risk to her health.

It allows for abortion on grounds of fatal foetal abnormality that is likely to lead to the death of the foetus, either before or within a year of birth. Section 4 allows for abortion on request prior to foetal viability and removes the three-day waiting period for abortion on request. Section 5 removes all clauses relating to the criminalisation of abortion.

In his introduction the Minister made the point that it was the recommendations of the Oireachtas Joint Committee on the Eighth Amendment of the Constitution that put forward the 12-week term and so on. That committee also said there should be no criminalisation of health providers in relation to abortion services and yet that was put into the legislation. There are areas where there were conflicts between the Oireachtas and the legislation as well. We are here to try to tease out where we can look at areas that allow women to access more.

We know that one in ten GPs offers abortion care but 50% of counties have fewer than ten GPs offering abortion care. There is a strong urban-rural divide, with services centred around Dublin, Cork and Galway. Just 10% of GPs are delivering abortion services, as the threat of criminal sanctions hangs over those offering them. The Minister mentioned that 11 out of 19 maternity hospitals are offering the services. I had a map of where those hospitals are and if you look at it there are huge gaps in the north, the midlands and Kerry. Women are finding it difficult to access hospitals to get an abortion.

We know the statistics, which show that in 2019 some 365 women travelled abroad for abortions. That is still one woman every day, after the legislation has been passed. That is an area we have to scrutinise and we have to say that is wrong. We should be able to progress abortion for women who have fatal foetal abnormalities. The 24-day restriction on when a baby born would live is too restrictive. That has been dealt with in the Bill and the limit should be up to a year. That is much more viable and that would take huge pressure off medics and consultants looking at where the fatal foetal abnormality is. They are the women who have to go Britain and the Netherlands to access abortions and that is just not on. It is not on after us having the referendum, particularly for women in those situations of a loved birth or pregnancy that turns into an issue of the parents facing the potential that their child will be born and then die within a couple of hours, six months or eight months or whatever. We need to do right by those women and couples. We have an obligation to look at that and this Bill covers it.

I mention how many people are travelling to Britain. Some 775 people have done so since the referendum. This increased from 194 in 2020 to 206 in 2022. Some 50% of those travelled for medical reasons. The number of those travelling for medical reasons increased from 32% in 2020 to 50% in 2021. This suggests there are significant problems with access to abortion care in Ireland post 12 weeks on the grounds of fatal foetal abnormality laid out in section 11 due to the 28-day mortality clause.

I do not understand why the Minister is pushing this back for a year and saying he will review it. Marie O'Shea will be attending the committee in the coming weeks and I cannot see why this cannot be agreed, brought in and be part of the discussion over the coming period of time. The Bill can be amended accordingly when it comes to other areas we have to look at.

David Cullinane (Waterford, Sinn Fein)
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It is important that we have time to debate and discuss the provision of abortion services in the State following the publication of the independent review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018 that was published last month. In 2018 people voted for women to have access to services. The provision of termination of pregnancy services was endorsed by the Irish people by referendum, with a clear picture of what those services would look like and with an understanding that the legislation underpinning these services would continue to be reviewed. Some five years on and the services are still not properly in place. Women should be able to access the services which were voted for.

We welcome the fact that the report has been completed and published. Much work went into it and I want to commend the author and all of those involved. The review has provided 75 recommendations for us to consider as legislators. Most of these are operational, as the Minister said, and can be passed directly to the health service to implement. Others are legislative and policy changes which need to be afforded due process and consideration by the Oireachtas.

We will have an opportunity to engage with the author, Marie O'Shea, at the Joint Committee on Health next week. I want to say - and I am speaking for myself as a member of the Joint Committee on Health - that the committee will examine the report with the author, which is what we should do. We will tease out the review process and the conclusion and recommendations in terms of how they were arrived at and the rationale that underpins them. It is not the role of the Joint Committee on Health to review the process and to repeat the review process. That is not our role and nor is it a role for the Joint Committee on Health to make recommendations on recommendations. The report's recommendations stand on their own two feet and on their own merit. It is for Government and Cabinet to decide whether or not they will implement those recommendations. We cannot kick the can down the road and expect the Joint Committee on Health to repeat a process which has already happened. That would undermine the work of the independent review, which has already been done. The recommendations stand on their own merit. Different groups and parties will have their views on each of the different policy and legislative recommendations, as my party does, but ultimately it is for Government to act and it should do so. The Government must make decisions on these recommendations and act on the expert and medical advice. The committee will tease out the detail but the ultimate decision rests with Government. That work on the recommendations to improve access to services which do not require legislative changes should start immediately.

The report has identified significant barriers in the provision and accessing of services which are pushing women close to and over the 12-week limitation period. The first glaring deficit in services is the low availability. Only 413 GPs, less than 10%, are providing services. Only half of the maternity hospitals are providing services and the review concludes that only 15, at most, will be providing services by the end of this year. The report identifies the lack of staff and support structures as a major reason more providers are not engaged in the service, as well as the levels of conscientious objection.

There is a clear regional disparity of services. The report identifies the south east, the north west, the midlands and Border counties as particularly under-serviced. A geospatial analysis of services is recommended by the review and this makes perfect sense. For the life of me I do not understand why that has not been done already. The Government needs to clearly identify where there are significant service gaps and put in place local and regional solutions for that. There needs to be real engagement with service providers and the report sets out common-sense steps that should be taken. Services need to be mapped and the longest travel distances need to be identified. The report has identified significant barriers to services, the underdevelopment of regional services and barriers such as the three-day wait. The three-day wait should be removed. We want to see these issues addressed in a systematic way and we need to see a clear plan from Government on how it will progress those recommendations.

In light of this ongoing work across the Oireachtas, we will not be supporting the amendment from the Minister. It is appropriate that we work through the process, allow the Oireachtas to complete its examination of the review and then consider the amendments to the existing legislation

Peadar Tóibín (Meath West, Aontú)
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The number of abortions has jumped a devastating 25% just in the last year. Some 8,500 unborn children were aborted last year and this figure is nearly triple the rate it was in 2017. That proves the predictions made by human rights campaigners in 2018, that the legislation, if implemented, would see a massive increase in lost lives. In the four years since the law was put in place, 31,000 babies have been aborted. This is equivalent to the population of Kilkenny city and for most people this is truly heartbreaking. Some 98% of those abortions were carried out on healthy mothers and healthy children, according to information from the Department of Health.

The vast majority of people, no matter what way they voted in the referendum five years ago, will see this loss of human life as a real human tragedy.

This month saw the publication of the abortion review, which shocked most people in society. It was devoid of humanity, and it was devoid of compassion. In many ways, the review reads like a checklist for abortion campaigners and obviously has been welcomed wholeheartedly in this Chamber by pro-abortion political parties. The report has shocked a number of people in government as well. There is no real mention of unborn children within the review and there seems to be no consideration of the child whatsoever. It does not seem to ask why so many mothers are having abortions. The committee on the eighth amendment heard testimony from witnesses which stated that 85% of abortions happen because of socioeconomic reasons; and that mothers feel that they have no choice but to proceed with an abortion because of the economic pressures on them. Every year we see dozens of mothers who are homeless and pregnant in this State, but there is no analysis of any of that in the recommendations of the report, and no suggestion that any supports should be put in place for mothers to give them the economic confidence to be able to raise their child to their full potential. Throughout this whole process, if we do not grapple with this issue, heartbreakingly we are going to see thousands of austerity abortions continue in the years ahead. We see queues of mothers and their babies outside the homeless shelters and food kitchens throughout the country. It is a pity the review did not seek to interview those mothers about their particular circumstances.

Incredibly, neither did the review have anything to say about the 133 women who have sued the State as a result of adverse incidents that happened in their lives. I have spoken to the Minister about this before. In the National Maternity Hospital there was a false diagnosis in the case of baby Christopher. He was falsely diagnosed as having a fatal foetal abnormality or life-limiting condition, although he was a healthy baby. The hospital then proceeded to end that child's life in a late-term abortion. The law was broken in that situation because only one obstetrician examined Christopher's mother, but the review seeks to make this the norm in all cases. In many ways the review seeks to reduce the level and quality of care mothers receive.

The Bill we are discussing today seeks to delete the three-day consideration time. This decision is one of extraordinary magnitude. It is an irreversible decision. The baby cannot be brought back after an abortion happens. Given the enormity of that decision, we should allow some time for a person to think it through. The human condition is that we all make mistakes. There is nobody in this Chamber or anybody listening to this debate who has not made a significant mistake in their lives. We tend to make significant mistakes when we are in situations of crisis or pressure and a three-day wait time to allow for consideration is important.

I heard the proponents of the Bill say that abortion is healthcare, yet 90% of doctors refuse to carry out abortions, as do half of hospitals. I ask them to tell me of any other healthcare procedure where 90% of doctors refuse to deliver it and half of the hospitals also refuse to deliver it. The vast majority of doctors want to save lives, not end lives. I believe this Bill puts pressure on doctors and nurses in that regard.

The other issue is the deletion of all criminal sanctions. In many ways, this will leave no real sanction to prevent an abortion, thereby allowing for abortion up until birth. That is an issue that will shock many people.

A few short years ago the Government persuaded many people to vote for the abortion referendum by promising safeguards within the system. Now it seems that the Government is looking to get rid of those safeguards and to renege on those promises. The truth is that if we could not trust the Government on housing, the health service, evictions or the cost of living, why should we trust it on the right to life either?

Carol Nolan (Laois-Offaly, Independent)
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The measures in this Bill would see Irish abortion rates soar, as the most basic protections and safeguards are stripped away from the legislation. Meanwhile, there remains a chronic lack of supports available to women with unplanned pregnancies. We know the HSE's My Options service, which is touted by the Government, is nothing but a hotline to have an abortion. Women who ring it and ask for information about real, tangible supports, are met with a brick wall. Women who want pregnancy counselling, including a focus on how they could proceed with their pregnancy, are being let down by My Options. There are documented cases of My Options counsellors, when faced with a phone call from a pregnant woman who felt unsure about what to do, advising the woman to make an abortion appointment anyway, even if she later changed her mind. This flies in the face of being non-directive counselling.

There must be an urgent focus on reducing the abortion rate. The referendum which has been mythologised here today was achieved partly on the shallow promise that bringing abortion to Ireland would not see the abortion rate drastically increase. Safe, legal and rare: that was the catchphrase at the time uttered by the Taoiseach, Deputy Varadkar, among others. Even accounting for Irish women who had abortions in Britain and the IFPA's estimated annual total of abortion pills taken in Ireland pre-2019, there has been a 70% increase in the Irish abortion rate since the introduction of abortion services here. We have seen approximately 28,500 babies aborted in Ireland in just four years. This is not just a statistic, but in each case a personal tragedy and a life lost. Some of the pro-abortion groups in this country have shown their true colours from time to time, such as when the abortion rights campaign celebrated 6,700 abortions. Glorifying in the destruction of human life is not something any reasonable person in this country would find appropriate. Despite cloaking the nature of abortion in misleading language, the Act still defines a termination of pregnancy as ending the life of a foetus. Some people in this House have well and truly lost sight of that reality.

The report commissioned by the Government as part of a review into the operation of the Act made sweeping recommendations based on fundamentally flawed evidence and selective findings. For instance, it is the author's view that the three-day waiting period should be abolished in its entirety, as it is without merit. The review draws on a piece of research commissioned by the Government, which interviewed just 58 women, all of whom had abortions. It never crossed the mind of the researcher to interview any women who had availed of the three-day period for reflection, and who opted not to have an abortion. Would that not have occurred to the researcher, in the interest of fairness and balance? If a reviewer just interviews one side from a small sample, we will get a skewed answer. One does not need to be a genius to figure that one out. When it comes to statistics for women who made an initial appointment but did not proceed to the second appointment, the author of the report, inexcusably, ignored HSE evidence, which shows that between 2019 and 2021 approximately 17% of all first appointments made did not result in a second and final appointment. Instead, she cited a non-representative study provided by the pro-abortion group, Start Doctors. In its small sample, it found that just 2% of women did not proceed to a second appointment. How can we take this report seriously when its author ignores official HSE statistics, which were brought to her attention in nearly 3,000 submissions to the public consultation? In spite of that, she relies solely on a fringe study. It would not be unreasonable to suggest that one set of data was selectively emphasised, as it bolstered the outcome she wanted to see, while conflicting data were cast aside.

There are many such faults in the report, too many to detail here. The supporters of this Bill clearly have no interest in respecting the promises that were made to voters in 2018 to encourage them to vote "Yes". They were on the fringe of the "Yes" campaign at the time. Senior Ministers, with whom the responsibility of government still rests, were responsible for persuading a majority to vote "Yes" on the basis of commitments to draft legislation being published well in advance of the referendum. After five years, when the people can no longer have a say over this contentious matter in the form of a referendum, it would be deceptive and undemocratic to tear up those promises and institute an even more extreme abortion regime.

Róisín Shortall (Dublin North West, Social Democrats)
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I welcome the opportunity to contribute to this debate. I thank Deputy Bríd Smith for her work on this legislation.

Today marks five years since the historic referendum to repeal the eighth amendment and this Bill provides us with a fitting opportunity to reflect on the legislation passed in December 2018.

Despite the largely positive implementation of the Act, a number of key issues have become apparent and these are laid bare in the review. They include the mandatory three-day waiting period, which has been described by GPs in the HSE inclusion service as problematic, especially for marginalised and vulnerable service users. The World Health Organization, WHO, also specifically recommends against mandatory waiting periods, stating that they serve no benefit. In my view, it is a somewhat paternalistic provision in the current legislation that fails to recognise that the majority of patients seeking an abortion have made their mind up before they visit a doctor. The waiting period can also act as another barrier to those seeking an early medical abortion, with some women timing out of care. The WHO also points out that mandatory waiting periods force some women to disclose their pregnancy so that they can get additional time off work or education or to arrange travel or childcare. This failure to provide a service that ensures privacy and confidentiality in all cases must be addressed.

The wide-ranging issues with the three-day waiting period are further compounded by the limited availability of abortion services in many parts of this country. The review by Marie O’Shea BL found that half of the counties in the Republic have fewer than ten GPs providing services, nine counties have fewer than five GPs providing the services, and six counties have two GPs or fewer providing services. To make matters worse, eight of the country’s 19 maternity units, which are publicly funded units, do not provide termination services.

Research carried out by Dr. Lorraine Grimes and the Abortion Rights Campaign found that 30% of survey respondents who have used the service since 2019 had to travel for four to six hours to access abortion services. This is completely unacceptable. This uneven geographical spread of services must be addressed.

There are also issues with abortion provision in the case of fatal foetal abnormalities. The current 28-day clause is not working in practice and has been described as arbitrary and rigid by the review chair. This section of the 2018 Act is forcing women, often in tragic circumstances, to go abroad to access care that should be available in Ireland. This clause, along with the prospect of criminalisation, is undoubtedly having a chilling effect on doctors providing terminations and is deterring others from engaging in service provision. The recommendation to remove criminal sanctions must be acted upon. Ultimately, our termination services should be guided by international best practice. It is clear from the review, however, that we are out of step with the WHO. Like all healthcare, termination services should be evidence based. To achieve this, our legislation needs to be in line with the WHO guidelines. We must remember that when Covid was raging through this country, the Government and the health authorities regularly told us that we must follow the WHO guidelines and that to do so was good practice. The same should happen here.

While the Oireachtas Joint Committee on Health will certainly play its part in examining the O’Shea report, referral to the committee should not be used as a means to delay the recommended legislative change. This is a Government commissioned review. It is underpinned by extensive research and in my view, it is a very good review. Under no circumstances should we have to wait a further 12 months for the recommended legislation to be produced. The recommendations are clear. It is now up to the Government to act.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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This is the fifth anniversary of an historic referendum that changed Ireland. It gave a generational view to a new Ireland. It is in that context, and also in the context of the review by Marie O'Shea BL and the proposed Bill, that we are talking about abortion services in Ireland. The current legislation, as Ms O'Shea has said, is not fit for purpose. Ms O'Shea is unequivocal in her review and critique that the legislation put together four or five years ago needs to be updated. Hundreds of women and girls are being let down by the State with the current legislation. The Minister has said, not in the Chamber but elsewhere, that there is an arbitrary nature to the provision of abortion services in Ireland. Eight publicly funded hospitals are not providing abortion services to women.

In the time this Government has left, it must implement the recommendations of the review. The issue here is not only the review but also the people of this country who voted overwhelmingly in 2018 to progress abortion services. It is clear from the review that the legal framework for the services needs to change. The Joint Committee on Health will critique Marie O'Shea's review but it is up to the Government to put forward a new framework for implementing the recommendations. That is not the job of the committee, as previous speakers have noted. It is up to the Government to implement those changes in the time remaining to it.

The people of this country have moved on, as has the report, but the women of Ireland are still being left behind under the current legislation. This is about trust. We trust women with regard to accessing abortion services in Ireland.

Ivana Bacik (Dublin Bay South, Labour)
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I commend Deputy Bríd Smith and her colleagues on bringing forward this Bill and giving us the opportunity to discuss and debate the issue of access to abortion services in Ireland five years on from the historic result in the repeal referendum when 66.4% of us voted "Yes" to repeal the eighth amendment and to ensure that women in Ireland would have access to the abortion healthcare we so clearly needed. For those of us who campaigned for many decades to see abortion law change, it was a momentous result. It showed the compassion and empathy people in Ireland had for the reality of crisis pregnancy and the real lived experiences of women and girls across Ireland. The key issue, reflecting on it five years on, is to ensure that abortion healthcare is available and accessible to all women and girls who need it. That is crucial.

In the years since we legislated to enable legal abortion to be carried out here, 775 women have travelled to England for abortion services there. This clearly illustrates that, as the O'Shea report so clearly puts it, there remain unnecessary barriers to access for women. We need to address those barriers.

I commend Marie O'Shea and her colleagues who carried out the very careful and comprehensive research and review into the operation of the legislation. Those colleagues include Dr. Catherine Conlon, who has a long track record of careful research on this issue. The recommendations and findings of the O'Shea review are sensible and clear and they would greatly enhance access to abortion care in Ireland. They are very much in keeping with the submission the Labour Party made to the review process. We called for a number of operational and legal changes to be made to ensure increased access. I note the Minister's comments about the operational changes that are needed and which he said will get under way. That is very welcome to hear. In particular, it is welcome to hear the Minister's commitment to ensuring that all maternity hospitals will provide abortion care services, as indeed they should.

It is disturbing to see that still, only 11 of 19 hospitals currently are providing these services. This is a real shortfall and again shows the serious barriers to access for many women. We also know that not enough GPs are providing access to early termination services and this again is a matter of genuine concern. We must see and I urge the Minister to ensure that we have stronger and quicker Government action in this regard. I also welcome the Minister's announcement regarding the safe access zones legislation. This is welcome and we have been looking for it for some time.

Two clear legislative changes are required to address what are serious barriers to access. One concerns the three-day waiting period. In our submission, we made the point that this aspect is medically unnecessary and creates significant barriers, especially for women living outside urban areas in places where there is limited access to providers and for those financially or socially vulnerable or disadvantaged. As Marie O'Shea has pointed out, this three-day waiting period can in practice be a wait of four days, five days or even longer. This is an unnecessary barrier and should be removed. The issue of decriminalisation is also urgent. Having spoken with doctors and abortion providers, this is still a serious chilling factor for medical practitioners. The criminalisation provision in the legislation is not necessary medically and it is certainly not the norm in other medical procedures. It should, therefore, be removed.

Regarding the Government's proposed amendment, I agree with all my colleagues on this side of the House who have pointed out that a year is too long to wait. We must see the Joint Committee on Health take on board the recommendations of the O'Shea review and we must move forward and debate this issue as an Oireachtas but we do not need a full year to do so. As we have the careful and well-reasoned recommendations from the O'Shea review, let us see the Government move swiftly on these to ensure women have access to the abortion healthcare we so badly need and to give full effect to the vote of the people five years ago today.

Stephen Donnelly (Wicklow, Fianna Fail)
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I again thank colleagues for their time and for tabling this debate. I start by acknowledging the work of healthcare workers providing these services. Many statements have been made here today about the services not being sufficiently accessible and being flawed. They are not sufficiently accessible and there are improvements we can make but I can tell colleagues that I talk directly to the people providing these services and they have fought very hard. They have dealt with some very difficult situations in their own workplaces, as the people who have provided these services, and some of this is alluded to in the report.

I want to do this as the Minister, but it is important for all of us in the Dáil to recognise we have healthcare workers right across the country, including GPs and those working in general practice and those working in the maternity hospitals, working very hard to provide these services. Colleagues who do not agree with the provision of these services made the point that the numbers have increased substantially. We do know these services are being accessed at significant levels. I wish to acknowledge the work of our healthcare providers in this context. This has not been an easy service to set up, as evidenced by the fact that it is still only available in 11 of the 19 hospitals concerned. I therefore acknowledge the work of our healthcare professionals in this regard.

To address some of the issues raised, it was repeatedly alleged that I or the Government somehow delayed this report. This is entirely false. The reviewer asked for more time to allow for a specific study to be completed in order that she could incorporate it into the final report. As I said, I got the report at the end of February, I think it was, and we moved on it very quickly. The debate tonight is an example of why we do need to take some time with this endeavour. There have been repeated references from those proposing this legislation to the will of the people and to the referendum. I campaigned hard for the repeal of the eighth amendment. When I knocked on doors in County Wicklow and other places, as many of us did, it was very much in the context of the heads of the Bill, flawed or not and whether we agreed with those proposals or not.

As we tease through any potential changes to the Bill, we have to keep these things in mind, namely what the right thing to do is in terms of the provision of health care and respecting the democratic wishes of the country. People did not vote to repeal the eighth in isolation. They voted to repeal the eighth in a very clear context of the heads of the Bill. I have spoken to people who voted to repeal the eighth with a very clear understanding of some of the measures in place that we are discussing. It is important that, as we debate this, as we must, that we keep those things in mind. We need to respect the democratic imperative, as well as the absolute need to provide the best possible services to women.

There have been several references to waiting 12 months to legislate. The Government has made no decisions in terms of timelines to legislate. There is a 12-month timed amendment in the Bill. In other words, the Bill, by the Government's amendment, would be deemed to have passed Second Stage 12 months from now. No decisions have been made in terms of Government legislation.

There has been a lot of talk, including by the proposers of the Bill, about the report from Marie O'Shea and that we have to implement what is in it. I studied the Bill in detail. It is not in line with the recommendations of the report. Perhaps one of the sections is in line with the report, in terms of decriminalisation. However, none of the other parts of the Bill would meet the recommendations in the report.

Stephen Donnelly (Wicklow, Fianna Fail)
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We have to bear that in mind. If we do a line-by-line comparison with the proposals in the Bill and the recommendations in the report, the Bill before us does not reflect the recommendations in the report.

The Committee on Health is the appropriate place to put this. Various members of the committee have raised questions about this. I am surprised at that. It was an Oireachtas committee that came up with the termination of pregnancy report. The health committee has dealt with surrogacy very well. It is dealing with safe access zones very well. It is exactly the right place for this to go.

I know I am out of time. I will reiterate one important thing. Regardless of any proposed legislative change or changing the parameters within which termination services are provided, which is a lot of the debate we are having, it is my absolute determination that we will continue to roll out the services as they exist under the current Act because that has not yet been done to the extent that it needs to be. By the end of this year, we are working towards moving from 11 to 17 of the 19 hospitals providing services, which will be a very significant improvement. Regardless of any proposed legislative changes, I will work very closely with the HSE and healthcare providers to increase the number of GPs providing abortion services in particular, as colleagues have quite rightly said, in the parts of the country where there is very sparse coverage.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I have to come back on a number of things the Minister said. To say that we are not acknowledging that there has been a service provided for women and girls to seek abortion in this country is not true. My opening remarks acknowledged that we have had massive change since the law was brought in and that abortion has been accessed here and is accessible to a certain cohort in limited circumstances.

It is quite coincidental, as the Minister knows, that the Bill has been brought before the House on the fifth anniversary of repeal because of the lottery system we have. Nevertheless the Minister is right to say that if we match this with Marie O'Shea's report the Bill goes further. That is true. That does not mean if the Bill was dealt with in a committee that people would not put forward amendments and all the rest. I note there are people in the House who are utterly opposed to the change. They are the same people who campaigned vigorously against repeal of the eighth amendment and were not going to change their minds. They are entitled to their opinion but, thankfully, we still live in a democracy and the vast majority of people voted to take us out of the dark ages in regard to abortion rights for women and girls in this country.

In his opening remarks, the Minister spoke about the Act allowing abortions to be carried out in cases where there is a risk to life, serious harm to health, a condition that might lead to the death of the foetus before 28 days and without restriction for up to 12 weeks of pregnancy, in line with the recommendations of the Joint Committee on the Eighth Amendment. This is not true. The committee did not recommend the 28-day limit on fatal foetal abnormalities and certainly did not recommend that women had to wait three days to think about the decision. That was inserted into the heads of the Bill as an appeasement towards certain senior members of Cabinet who, all of their political lives, were opposed to abortion rights in this country. One of them, the Minister, Deputy Simon Coveney, wrote an op-ed in theIrish Independentin late March 2018 - the referendum was held in May - in which he said he was appeased and would give in on the basis of the three-day wait. How utterly misogynistic and insulting is that? Thousands of women have found that to be the case in this country.

When we look at statistics on who did not turn up for the second visit following a first, we find many went abroad or got the pill illegally online because of the utterly patronising treatment they had to face. I have gone through the details. The reality is that the most marginalised women, as Marie O'Shea outlined, are the ones impacted the most by the three-day wait. That is something that could be lifted straight away.

Although the Minister said the heads of the Bill were what convinced people to vote "Yes" in the repeal referendum, as an activist who knocked on thousands of doors, along with hundreds of other people who knocked on thousands of doors, it never once came up that people were voting "Yes" based on the heads of the Bill. People voted "Yes" to give women a choice and to stop them travelling out of the country to access basic abortion health care. The truth is that the review shows us that they are still travelling – at least 200 a year – and by the time we get back to this another 200 or more women will have had to travel for all of the reasons outlined by Marie O'Shea.

In his testimony, Deputy Boyd Barrett put it very humanely when he said that almost half of those who travel will be people whose pregnancies are fatal foetal abnormalities. They have much wanted pregnancies and children, but they have discovered it will be impossible for that life to be compatible with life itself. Due to the restrictive 28-day limit and the criminalisation of abortion which, by the way, was not in the heads of the Bill, along with the 14-year sentence, that acts as a chill factor on doctors to the extent that almost half of those who had to travel did so in a lonely and isolated way.

I will not repeat the arguments that we heard in the years leading up to the referendum, but there were heart-wrenching and tragic stories. They are something that would make every decent human being in this country feel ashamed of the society we had. That is why we got an astounding "Yes" in the referendum.

The Minister said this debate shows we need to take our time. It has been five years since repeal and four years since the legislation was introduced. We have evidence in front of us that there are certain obstacles within the legislation that are forcing women to travel and a full abortion care service is not being delivered in this country. That is not me saying it; that is in a report commissioned by the HSE via the office of the Minister. It was a report that was insisted on in the legislation. It is as much a part of the legislation as any other measure.

We are required to review the law because it is brand new and we do not know how it will be enacted or play out. We have to see how it is playing out from the point of view of those who need to access the service and those who are providing it. It is very clear what is required and it does not require the Minister, Cabinet or even the Oireachtas to agonise over it for a whole year. It requires us to look at the scientific evidence. Neither the Minister nor I are as well as equipped as Marie O'Shea and her team to assess the needs of pregnant people and their health providers in this country. There is no grey area in that.

There are two measures in the recommendations that could be applied immediately and are also in this Bill. We can lift the three-day wait, decriminalise abortion for abortion providers and begin to deal with other issues, including limitations around the 12-week cap on the provision of abortion and how we deal with requests for abortion on the basis of risk to health, including mental health.

That is what our Bill is trying to do. The Minister has a problem with it, the whole Cabinet seems to have a problem with it and certain Members much more than others appear to have a difficulty with it. If the Minister is about to park this for a year, he is looking at hundreds more people being put out of this country and unable to access the healthcare to which they are entitled.

I have been through the experience of a Bill being parked for a whole year. That affected more than 500,000 retired workers. It was parked for a year in 2018. We are still waiting for the matter to which it relates to be dealt with in 2023. That is because the Government does not want to deal with it. The Government does not want to give retired workers the rights they deserve and the Cabinet and politicians on the Minister's side of the House do not want to deal with it before another election. Even if it goes to next autumn, we will be coming up on the last hurdles prior to a general election before we begin to look at the matter again. That is what the conservative elements of Fianna Fáil, Fine Gael and some of the Independents in this House are trying to avoid. They are trying to avoid the reality for women and girls who are being forced to travel and who do not have access to full abortion healthcare services.

I thank Marie O'Shea. The Minister should have been more robust in his defence of the critique of her report given from this side of the House because it was much more heavily critiqued than what we are trying to do here. I am here to support, defend and advocate for full access to healthcare for women and girls in this country. There is no other reason. I am not trying to stir it up. I am not trying to be controversial. That is why we brought these amendments and, thankfully, we got chosen to bring them before the House at an appropriate time, with Marie O'Shea's report telling us all that we need to know.

Those in medical practice and the people the Minister has to deal with on a daily basis would be in favour of him removing the criminalisation of doctors immediately, particularly as there is no other aspect of medical care that is criminalised. If people have a problem with the treatment they got or the operations or procedures they received, it comes under civil law. This is under criminal law and acts as a chill factor in the context of doctors being able to provide the care they want to provide. Despite what some people claim, doctors care about life. They care about the lives of women and girls, as well as unborn life. That is something the Minister could act on immediately. I know it would be hugely appreciated by the medical profession. I know when those who suffer fatal foetal abnormality have had to go to Britain. Some of these women are constituents of mine. They came to me and informed be about what was said to them by medical practitioners in Britain. They were asked whether the matter had not been resolved in their country. Those practitioners understood that the women were entitled to this service but that there is an anomaly in Ireland stopping the provision of care to those who most desperately need it.

Shame on the Government for tabling the amendment and trying to block the Bill. The Government will probably be successful, given the number of the votes it will get in this House. Unfortunately, the Government will probably not allow for a free vote of members of its own parties. That said, I echo what Deputy Boyd Barrett said. Take the amendment away; do not put it to a vote next Wednesday. If it is put to the House, the Minister will be doing a huge disservice to the people who need abortion care in this country.

Bernard Durkan (Kildare North, Fine Gael)
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The vote will take place at the usual time next week.