2026-07-15

Amendments Nos. 1 and 2 are related will be discussed together.

I move amendment No. 1: In page 3, between lines 13 and 14, to insert the following: “(a) by the insertion of the following subsection after subsection (1): “(1A) The Minister shall, not later than 12 months after the coming into operation of this subsection, and every year thereafter, prepare and lay before each House of the Oireachtas a report on progress towards making contraception services available without charge to all women which shall include— (a) the number of women who availed of contraception services in the preceding year, by reference to age, (b) an assessment of the case for prescribing a further age or class or classes of ages under subsection (5), (c) an assessment of the case for making available under this section the contraception services referred to in subsections (1) and (4) by reference to an age that is under the age of 17 years, (d) an assessment of the barriers to accessing contraception services experienced by women who are unable to readily demonstrate that they are ordinarily resident in the State or to furnish a personal public service number, including women who are undocumented, women who are applicants for international protection, women experiencing homelessness and women who have experienced domestic, sexual or gender-based violence, and the measures taken or proposed to be taken to remove those barriers, and (e) the implementation of such commitments relating to contraception as are contained in any strategy or action plan relating to sexual health published by the Minister and for the time being in force.”,”. Amendment No. 1 seeks to ensure a report is prepared not later than 12 months after the coming into operation of the subsection and every year thereafter. It is effectively a report on the performance, of the provisions that we are currently legislating for. Last week, I warmly welcomed this Bill and talked about the huge benefit it will have for women. I also wanted to highlight that there were significant issues with access to our health services for certain women. A National Women's Council survey found that there are barriers particularly for women who do not have a PPS number, disabled women, Traveller women and LGBTQ+ women. There are cultural prejudices that they do not need contraception and of course geographical barriers. My call is to maintain data on the number of women who are availing of the services, understanding the profile of who is actually accessing the services and also understanding the barriers as set out in that survey and indeed those that we have picked up anecdotally. Many of us who have an interest in women's health have come to understand that in terms of dealing with any marginalised group. I appeal to the Minister to make sure that we have proper data collection to ensure that we get the most out of this legislation. Pointing to something else, we know there is a big gap in the uptake of the medical card and we have to understand why. The big issue we are trying to highlight here is that while it is fantastic that the legislation will provide for access to contraception via our pharmacies, we need to make sure that we look at who else should be able to access it. Effectively amendment No. 2 does not change anything but it gives the Minister the power to legislate to lower the age of access to the contraception scheme. It does two things. The scheme currently covers those aged 17 to 36. We in the Labour Party have spoken about the need to increase that upper age. We know that the Minister can do that by ministerial regulation. We know that women are fertile far beyond their 36th year. If they are able to access services such as termination services regardless of age, we do not see why there should be an age applied. It would cost relatively little. It would cost €5 million per year to increase the age threshold with regard to contraception services. We believe the Minister can do that by ministerial regulation. However, section 67E of the Health Act 1970 precludes the Minister from legislating for access to contraception services for those under the age of 17. The age of medical consent is 16 and we believe that the contraception scheme should be standardised to 16. Effectively we want to empower the Minister to be able to reduce the age to 16 for the contraception scheme.

I thank the Deputy for the amendments and the spirit in which they have been put forward. It is important to be able to have these discussions. I will deal with second one. The Deputy is quite right that ages of consent vary. Medical consent is 16, sexual activity is 17, consent under GDPR is 18, and that can lead to some complexity. It can lead to confusion on the part of young people seeking care and risk aversion on the part of the clinicians treating them. The HSE clinical experts recommend that healthcare professionals need a clear regulatory and legal framework to manage the complex needs of those aged under 17 who present independently away from parents or anything else. There is strong concern about the child protection elements of that. Though that framework should include training and education as well as child protection and legal protections, it should also provide access to contraception and sexual health services where clinically appropriate in line with international guidance on the rights of the child. However, they do not recommend lowering the age of consent, which I acknowledge is not necessarily what the Deputy is suggesting. They are suggesting that the linking of the two things is problematic and that it does not necessarily increase child protection. They are worried about different behaviours being adopted at earlier and earlier ages and having negative impacts for children. There was a very important piece of research done into sexual activity between children aged 15 to 17. It shows about 25% of 15- to 17-year-olds have had sex but the majority of those were 17 and therefore eligible for the free contraception scheme. I appreciate the point the Deputy is making. I will go with the clinical guidance on this because I do not want to rush something like that in legislation on this occasion with this amendment. I appreciate the importance of the point the Deputy is making but I also hear the case in relation to child protection more broadly and the protection of those more particularly vulnerable cases who may be presenting independent of parents. I am not in a position and I do not have research that enables me to take a position beyond the clinical expertise at this point in relation to it. I cannot put it any further than that at this time. On amendment No. 1, I understand exactly why the Deputy is raising it. I am not sure it is necessary in legislation. We can do so much of that through parliamentary questions, the health committee and other things, and we want to do that. It is very important that both the Deputy and the National Women's Council identify the particular barriers that exist for women in certain groups, whether it is, as the Deputy said, to do with PPS numbers, or Traveller, Roma or migrant groups. There are groups that have particular barriers to accessing health. That is one of the reasons we created the women's health task force, which has a funding stream specifically and additionally for that. When it came to funding the Health Research Board, HRB, this year, I asked it specifically to support women's research with a €2 million dedicated fund. This was in four areas: menstrual health, endometriosis, the mental health issues postpartum in traumatic birth cases, but in particular the issues around access to health generally for those much more marginalised groups. I say this as a measure of attempted reassurance about our concern for and awareness of those groups in trying to index as many different ways as possible to try to support those groups because I recognise the barriers they face in so many different ways whether it is language, culture, PPS numbers or customs and habits. There are so many different things and we want to provide healthcare for all. I am glad to have the opportunity to discuss it but I am not sure it is necessary for legislation. However, in any other context I will give the Deputy whatever information I can in relation to how we are doing with it.

I thank the Minister. I feel very strongly that in bringing forward amendment No. 2, and I have listened carefully to the Minister's response, that judgment should not be passed on why a 16-year-old girl might present to a pharmacy seeking contraception. It would be very worrying if the message were to go out that we are trying to control or dissuade behaviours. The history of our State has been trying to control and dissuade behaviours when we know that behaviours are happening. The intent behind this amendment in particular is for vulnerable girls out there who are in a situation where they do not have a supportive family environment but perhaps are being exploited in some other context and need access. I hear what the Minister is saying about child protection but at the end of the day we need to look at the health separate to child protection. It is part of child protection but it also has to be considered separately because it is an immediate need for a young woman who legally remains a child but who may be involved in sexual behaviour at the age of 16. Of course, we know there are other girls who access contraception not because of needing it for the original use but for other health conditions. We need to be very mindful that we want to create a health service that can afford access to those who are in difficult situations. The vast majority of those under the age of 18 will be going with the consent or knowledge of their parents, but there are definitely females out there, particularly in marginalised communities, who need to access contraception and who do not have the means to be making a doctor's appointment. We believe being able to access it through the caring environment of a pharmacy would be really appropriate. I ask the Minister to reconsider amendment No. 2. As I say, it does not change anything. It merely empowers the Minister to make a decision armed with greater research and evidence at a future date to legislate to lower the age. It is to standardise with the age of consent of 16 and it is important that the Minister should have that power because she is currently precluded from it as we read the 1970 Act.

I welcome the Bill. We spend a lot of time inside these Houses talking about other parts of reproductive healthcare and not enough about contraception, so it is really welcome that we are having a focus and discussion on it and are moving forward with changes. On the point in relation to the eligibility piece, it is important that we expand eligibility as much as possible, and at the older age groups as well. In a reply to a parliamentary question last month, the Minister said that expanding access for 36- for 40-year-olds only costs €5 million per year and that is something that should be considered in terms of increasing the age group upwards as well. The National Women's Council report found that 31% of women experienced barriers in accessing free contraception and age limit was one of the most cited barriers there as well. It is certainly something that should be considered. It is not a huge amount of money. It would increase access and we need to expand the eligibility more broadly.

If I had all of the money in the world, of course I would simply do these different things but I have to make choices between different things that the Oireachtas wants to spend money on. There are so many requests to spend money. There are never requests to find other things to do with them. Yes, if I had the money, of course, but that would also mean having to make choices around assisted human reproduction or putting more money into menopause clinics. There are so many different things for which we need more money and more positions. I do recognise the calls from the National Women's Council in relation to that. It really is a question of how much money we have for everything. I am struck by Deputy Sherlock's comments in relation to protection. I am trying to distinguish child protection from all other issues. I hope there would be no girl at this point in the Irish healthcare system who would experience any judgment for presenting to any healthcare professional. That is not the message we are trying to send in any sense whatsoever. I also recognise there are some girls who are in extremely vulnerable situations but those are exactly the girls who also need a child protection response to what is happening to them. Seventeen is the age of consent as legislated by the Oireachtas. It is the age of sexual consent. We have spent a long time with that and there is no proposal to revise that as such. It is not the case that a 15- or 16-year-old girl will be able to go into the pharmacy in the first instance. This Bill provides that the follow-up care and appointments would be in the pharmacy for the additional four and a half years but that she would still have to go to a GP in the first instance. If a 15-year-old presented to a GP for contraception that raises questions. Is it to manage a different condition, for example, for which there is evidence or concern? We have discussed endometriosis, for example. I do not know. I am not a clinician. I do not want to misrepresent that, but I can see scenarios as the Deputy describes in which that may be relevant. However, if there are broader child protection concerns that doctor also needs to be able to see and spend time with that girl. I am not happy to go against the clinical advice I have on this. The clinical advice I have is that earlier sexual debut is associated with adverse outcomes. It is not just about unplanned pregnancy; it is about other concerns and other protections. That is why we have chosen 17 and not 16. I was here for that debate some time ago. It is logical and aligned to have sexual activity consent age aligned with the age for accessing free contraception. Those things are logical. The Deputy might conversely say that it is logical around medical consent as well and I appreciate that point also. However, on the basis that I have the clinical advice, I do not have a reason to go against that at this point.

I move amendment No. 2: In page 3, between lines 17 and 18, to insert the following: “(b) in subsection (6), by the substitution of “16 years” for “17 years”,”.

Amendments Nos. 3 to 7, inclusive, and amendment No. 10 are related and may be discussed together.

I move amendment No. 3: In page 4, lines 26 and 27, to delete “or medical device”. We have a number of Government amendments to the Bill which collectively remove a reference to a medical device or devices from the Bill. Our pharmacy regulators, the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority, HPRA, have been able to confirm to me that none of the contraceptives to be included in the pharmacy scheme are classified as medical devices. Amendments Nos. 3 to 5, inclusive, essentially look to remove the reference to medical devices. Amendment No. 4 removes references to medical devices from the proposed amendments to the Pharmacy Act 2007. To recap, sections 2 and 3 amend the Irish Medicines Board Act 1995 and the Pharmacy Act 2007 in order to support the clinical service and associated training requirements that must be fulfilled to provide the contraception-prescribing service. Those sections ensure that the scheme is clearly enabled and cross-referenced through a refreshed legislative framework supporting pharmacy prescription of contraception. Amendments Nos. 6 and 7 are to delete the references to medical devices within the Long Title. As I said, both of our regulators have asked that references to medical devices be removed. As stated last week, the current forms of contraception that will be included in the pharmacy prescription services are the contraceptive pill, the patch and the ring. Those are medicinal products and not medical devices. I hope the House is happy with those changes, which are largely technical in nature.

I move amendment No. 4: In page 4, line 27, to delete “or medical devices”.

I move amendment No. 5: In page 4, line 32, to delete “or device or devices”.

I move amendment No. 6: In page 5, lines 8 to 10, to delete all words from and including “subsection (3A)—” in line 8 down to and including in line 10, and substitute “subsection (3A),”.

I move amendment No. 7: In page 5, lines 15 to 17, to delete all words from and including “subsection (3B)(a)—” in line 15 down to and including line 17, and substitute “subsection (3B)(a),”.

I move amendment No. 8: In page 5, between lines 20 and 21, to insert the following: “Report on prescription-free oral contraceptives 4.The Minister shall, within six months of the passing of this Act, prepare and lay before Dáil Éireann a report on a proposal to allow registered pharmacists to dispense prescription-free oral contraceptives.”. This is an amendment looking for a report on the provision of prescription-free oral contraceptives. It calls on the Minister, within six months of the passing of the Act, to lay before Dáil Éireann a report on the proposal to allow registered pharmacists to dispense prescription-free oral contraception. While the Bill as printed allows pharmacists to represcribe certain contraceptives, we believe that oral contraceptives should be available prescription-free. The oral contraceptive pill has been around for well over half a century and is one of the safest and most well-studied medicines available. In 2019, the World Health Organization publicly stated that oral contraception should be available without needing prescription. In 2023, the Irish Pharmacy Union, IPU, told the Oireachtas health committee that there is no clinical reason for oral contraceptives to be supplied only on foot of prescription, with proper protocols in place for a very safe and effective healthcare intervention. In 2023, the health committee endorsed the IPU's call and wrote to the previous Minister for Health urging him to allow direct access to oral contraceptives through community pharmacists. Community pharmacists had been providing emergency contraception prescription-free since 2011. There is no clinical reason this should not be extended to oral contraceptives. Pharmacists are highly trained healthcare professionals. They should be allowed to operate at the top of their licence. They are available in every community and are very accessible. They have private consulting rooms, already used for emergency contraception. If we find that a patient would benefit more from long-acting, reversible contraceptives, the patient can be referred to the GP by the pharmacist. Accepting this amendment would further alleviate pressures on already overstretched GPs. We know that the report published by the National Women's Council in April found that the survey respondents cited access to GPs as a significant barrier in accessing the free contraceptive scheme, particularly for migrants, people from rural areas and Travellers. It would also be particularly beneficial for those not eligible for the free contraception scheme. It would reduce the cost since they would not have to go to the GP. We are looking for the Minister to consider that issue and produce a report for the Dáil within six months.

I thank the Deputy. I confess that we were not exactly clear on the nature of the contraceptives overall. Can I just clarify whether the Deputy is referring to progesterone only or combined, or simply the initial access in the pharmacy?

We are talking about the prescription of oral contraceptives as called for by the World Health Organization, as set out by the Irish Pharmacy Union and as endorsed by the previous health committee. We are looking for a report on that with the detail of the various elements, if more detail is required. It was from that call from the IPU, endorsed by the health committee. The committee previously wrote to the Minister about access to oral contraceptives. There is a letter in the Department from the previous health committee, in 2023, setting out the detail on this. That is the call as endorsed by the IPU. Beyond that, the Minister may consider the report.

I have better clarity on that now. This Bill is the culmination of a couple of years of work begun by my predecessor on the provision of contraception through pharmacies. That work commenced with consideration of the matter by the expert clinical committee on contraception, which was convened by the HSE. The crucial thing about the recommendations is that we are so pleased to be able to extend the follow-up service to pharmacies but we are not in a position to remove it from the clinical judgment of the GP in the first instance. That initial prescription has to come from a GP because there are so many contraindications for contraception for so many different types of women. I am aware that in some other countries, some contraceptives are given out over the counter, such as a progesterone-only pill. Combined hormonal contraception is recognised as being much more effective than that but it carries additional risk, for example for women with a personal or strong family history of certain conditions like blood clotting, cardiovascular disease and cancer, those who have significantly high blood pressure, those who smoke, or those who are aged over 35. There is a link with a higher risk of adverse effects. There are other contraindications too. The clinical advice in the draft protocols, which was constructed with advice from our expert clinicians and pharmacy regulators, is looking to see that measurements such as blood pressure and other risk factors are evaluated in person and in the privacy of a consulting room. That is obviously initially with the GP but the follow-up is with the pharmacist. The more structured approach that we are trying to give is about making sure that those protections are in place, that there is the clinical judgment of the GP in the first instance, followed up by the pharmacist, and also that it is not a simple over-the-counter service and there is a consultation or appointment for it. I do not think this is the case, but the Deputy can imagine a situation where a person is asking for something over the counter and there is a stigma. I am not sure that is the case at all because people have the ability to ask for things in private in pharmacies generally. Having the consultation room set-up, which I know the Deputy is not suggesting we do not have, is important. It is important that we have constructed a scheme which is more dedicated to that privacy and confidentiality structure. We are not in a position to accept the amendment, again based on the substantial clinical advice which has gone into this from the HSE and the pharmacy regulator. I am and we are trying to expand so much of what our pharmacies can do. The Deputy has great belief in pharmacists and their technical expertise. Obviously, we have established the common condition service. We are now giving them this power too and we would very much like to extend that. When it comes to contraception, that first prescription-based structure followed by a structure that monitors how women are over time, recognising that their health may change in a five-year period, is a clinical structure that is important to maintain.

It is important that we allow pharmacists to operate at the top of their licence and give them as much power as possible, and alleviate pressures on GPs. As I said, this is recommended by the World Health Organization and endorsed by the previous health committee and the IPU. That is the background to this amendment. Many pharmacists have private spaces where they do consultations about emergency contraception. Those spaces exist. It is one that we can maybe think about and have dialogue and engagement about in future. We can think about how we make the most of pharmacists and take pressure off GPs, while doing so with the best health outcomes.

Like everything, it is better to start something and develop it rather than wait for something else. We are trying to start so much with pharmacists. It is important to remind everyone about the national condom distribution scheme too, which we are expanding to pharmacies on a phased basis. Obviously condoms are not prescription items and do not have to be covered by this legislation. Pharmacists do not have to prescribe them as such. Free condoms are being made available in pharmacy consulting rooms. Access is being phased into pharmacies in different regions. By the time we launch that scheme, participating pharmacies will be able to access a free condom supply for their consulting room so they can offer them to people who might need them, which is a good thing. For reasons of patient safety, it is better to begin a scheme like this in a structured way. The scheme expands access more broadly and it achieves the goal of trying to get pharmacies to do more while making life easier for women generally, which I am a big fan of. Let us start this and see how and where it goes. If the clinical advice changes on the operation of this scheme, we can come back to it. Let us start this well and move forward with it.

Amendment No. 9, in the name of Deputy Rice, has been ruled out of order.

I move amendment No. 10: In page 3, lines 8 and 9, to delete “medicines, products and devices” and substitute “medicines and products”.

Pursuant to Standing Order 194(3), I report specifically to the Dáil that the committee has amended the Title of the Bill.