I welcome the opportunity to debate the shortcomings in abortion services in Ireland. My priority is access for women to the services which were voted for and endorsed by the people in 2018 and the too many barriers which remain. One of those barriers is the three-day wait. Sinn Féin supports removing the three-day wait. We never supported the three-day wait in the first place. We have tabled legislation to remove the three-day wait and have always been clear that this waiting period does not provide care or support or make the service safer. Rather, it simply makes access harder. We do, however, have significant concerns about the proposed new definition of a condition likely to lead to the death of the foetus, which is not grounded in the recommendations of the review of the Act and ignore the intention of a clear and tight definition. We are also concerned by proposals to decriminalise medical practitioners who knowingly and wilfully act illegally beyond the scope of the Act. We have a long history in this country of scandals in women's healthcare. The law is the law and medical practitioners should not be given carte blanche to act outside of the law. I want to address each of these points and the other provisions in the Bill in turn. 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. The Act was put in place with a clear understanding that the legislation underpinning these services would continue to be reviewed for operational effectiveness. The review of the operation of the Act was published three years ago. It highlighted serious imbalances in access to care, significant geographic variation in access to services, the underdevelopment of regional services and barriers such as the three-day wait. My priority is that the services which were voted for and endorsed by the people in 2018 are fully operational and accessible to all women. Women should be able to access the services which were voted for democratically, yet there are still barriers for access for many, as identified in the review. There is a postcode lottery in access to care. One of the biggest barriers identified in the review was a lack of GPs providing access to early medical terminations and the fact that regional centres and multidisciplinary teams are not fully operational. This creates a postcode lottery in access to care. Only 10% to 15% of GPs provide early medical termination services, which means fewer than ten GPs in some counties as of early last year. The review recommended a geospatial analysis of services to identify the biggest gaps. I am not aware of the Department ever conducting or publishing such a review. Maybe it exists and the Minister might come back to me on that. The review provided 75 recommendations to be worked through. Most do not require legislative change. It is important that the House receives an update on the steps the Minister is taking to improve services, to ensure access to services through community providers and to ensure hospital-based services are accessible in a timely manner. The Oireachtas did not intend for the Government to carry out a review and leave it on a shelf. The Minister for Health and the Taoiseach need to step up and implement the findings of the review. The Minister should bring forward a progress report on the consideration and implementation of the recommendations of the review. Moving to the Bill before us, I note it proposes to remove the three-day wait, instead obliging doctors to inform a woman of her right to a reflection period, to be exercised at the woman's discretion, and I support that. The Bill proposes to replace the death within 28 days prognosis-based definition for a condition likely to lead to the death of the foetus, otherwise known as fatal foetal abnormality, with an open to interpretation, circular and untested definition, namely "that there is present a fatal condition affecting the foetus". That is not grounded in the O'Shea report and the review of the Health (Regulation of Termination of Pregnancy) Act. The Bill further proposes to remove clinical provisions for medical practitioners who knowingly and wilfully provide abortions, access to terminations or advice on terminations which are outside the scope of the Act and which are, and would remain, illegal in this State. The Bill proposes to require practitioners or health professionals who are conscientious objectors to ensure access to abortions in an emergency. This is already provided for in the Act where there is an emergency threat to the life of the mother. This amendment, at best, seems to be redundant. The Bill seeks to remove the requirement for two medical opinions for access to a termination on risk to life or health grounds, to allow access following consultation with a single practitioner and to require the Minister to, within six months, issue guidelines to provide clarity to medical professionals in carrying out procedures under risk to life or health in an emergency and a condition likely to lead to the death of a foetus grounds. Finally, the Bill seeks to require a further operational review of the Act within three years. As I have set out, Sinn Féin supports removing the three-day wait for access to abortion services and replacing it with a right to a reflection period. We never supported the three-day wait. This waiting period does not provide care. It simply makes access harder, especially for women in difficult circumstances, whether they are victims of coercive control or domestic violence, rape or sexual assault or simply find out about their pregnancy too late and face timing out of access to care due to the mandatory wait. It particularly puts women who are subject to controlling or abusive partners and are from marginalised backgrounds in a difficult position because the first appointment may be the only appointment they get. The clear feedback from women and the review of the Act was that some women were also being pushed beyond the 12-week threshold by the three-day wait, which denied them their choice to end the pregnancy. We have always said that when it comes to personal decisions such as abortion, we need to trust and support women when they are making these decisions. We have all recognised in law and policy that women should have access to abortion services in the first trimester on the basis of their own free choice. This is the compassionate position put before the people in 2018 and it is the basis on which services have been provided since. Sinn Féin has tabled a targeted Bill to remove the mandatory three-day wait. We think that this Bill strikes the right balance. It is the right change to make. It respects women's decisions. It removes an unnecessary barrier to care. Removing the mandatory three-day wait does not provide remove a woman's ability to take more time if she wants to. That option will always remain open to her, and rightly so. Our Bill removes the requirement that the State must force every woman to wait, regardless of her circumstances, decision, health or needs. This is something that can be done quickly and should be done during the course of this Dáil term. We fully agree with the need for robust clinically sound statutory guidelines to protect and direct clinicians in providing lawfully permissible services. The absence of guidelines was identified as a serious barrier to many clinicians providing care. Guidelines are essential to address issues identified with the operation of terminations under sections 9 and 10 relating to risk the life of the mother and section 11 of the Act where a condition is likely to lead to the death of the foetus. Terms such as "risk" and "serious harm" and the lack of reliable pathways were identified as problematic due to the lack of legal definition which asks clinicians to make philosophical judgments and puts them at risk of acting beyond the Act and illegally. This Bill makes the same mistake with its definition of a fatal condition. We do not support the proposed definition for a condition likely to lead the death of the foetus, otherwise known as fatal foetal abnormality. This amendment is not grounded in the statutory review of the Act, which recommended a review with stakeholders to consider alternative grounds that would be clear to apply in practice and in keeping with the spirit of the legislation. The proposed definition in the Bill is untested and circular. The term "fatal" is not defined. There are no limits on it. It leaves the philosophical question of life and the balance of probabilities entirely to clinicians, which is not right and an abdication of our duty in this House. Most problematically, the amendment ignores the intention of a clear and tight definition and the process recommended by the review is ignored. We should not insert untested and loosely drafted definitions into the Health (Regulation of Termination of Pregnancy) Act without having followed the right process. The review recommended the convening of stakeholders, including medical practitioners, other relevant healthcare professionals, patient representatives, lawyers and, of course, women, in order to obtain a better understanding of the challenges in section 11 and ensure that the multidisciplinary foetal medicine teams are properly resourced with the appropriate skills mix. In the context of late-term abortions for fatal anomalies we are talking about pregnancies a person wants to keep, and made the choice to keep during the 12-week period. For these pregnancies we need to work with clinicians on guidelines to give effect to the intentions of the current definition, to consider only minor amendments to that definition to improve its operation and not its scope, and to work together to improve health services for children to ensure that where a family elects to continue a pregnancy they are supported if their child is born with a condition. There are many conditions that can be recognised as fatal under the proposed definition, not because they have to be but because the services to save the child's life are not present or functioning. They are fatal because successive Governments have failed to put in place the health services those children need to survive. Many conditions are present at a higher level in Ireland than in other jurisdictions, because instead of providing families with the supports and services they need for their child to survive and thrive, they have the option of an abortion because the child has an anomaly. I do not support that. I support families who have chosen to keep the pregnancy to have the best chance for their child. I support those children being able to live a good and healthy life. We do not support any slip into the territory of abortion on possibly fatal grounds. We do not believe that disability is a ground for an abortion or that this is in any way a progressive position. I agree that no woman should be forced to carry an unviable pregnancy. I also agree that no woman should be forced to travel for services that should be lawfully available on this island, but it would be wrong to insert such an open-ended, untested and loosely drafted definition that puts families and children in a position where abortion is an option not because the child will not survive, but because the child might die because the State has not invested in the care the child needs. We are concerned by proposals to remove offences for medical practitioners who knowingly and willfully act illegally beyond the scope of the Act. Abortion services in Ireland are decriminalised for an early pregnancy and otherwise for risk to the life or health of the mother or in the case of a condition that is likely to be fatal. We have a long history in this country of scandals in women's healthcare and the treatment of women and children by some parts of the health service. The criminal provisions retained in the 2018 Act are there to ensure that medical practitioners do not knowingly and willfully act illegally outside or beyond the scope of the Act. The law is the law and the medical practitioners should not be given carte blanche to act outside of the law. That would be ludicrous. Criminal sanctions were included in the Act to ensure that only those services endorsed by the people and by the Oireachtas are made available in this State. The way to address issues of criminalisation is through the application of clear, robust statutory guidelines on the provision of services under each different ground. That is how we balance protections for clinicians, parents and children. We acknowledge people's right to conscientious objection and the importance of protecting that, while ensuring that in emergency cases the life and health of the mother must take priority. I am not convinced of the need for the proposed amendment on this issue. The point is already addressed in the existing law. The issue here again is a lack of statutory guidelines. We need to be very clear on this issue. When there is a risk to the life or health of the woman, there is an obligation on medical practitioners to try to save her life. We need to avoid any repeat of the tragedies that happened under the old system, like what happened to Savita Halappanavar. Her story is part of why we have the legislation we have today. In a repeat of those circumstances there should be no barriers or objections to saving a woman's life. It astounds me that the Bill clearly goes far beyond the recommendations of the review. It disrupts the consensus-based approach that brought about repeal and presumes to rip up many of the safeguards that were presented to the people in order to convince them to repeal the eighth amendment in the first place. A genuinely constructive approach to improving services for women would have involved engagement across the Opposition to support the targeted Bills that are on the Order Paper for removing the three-day wait, tabled by me, Deputy Coppinger, and others, who have been trying to be constructive in removing the three-day wait period. This Bill has no democratic legitimacy. It is not productive. It is not designed to become law. It proposes to significantly undermine the legal framework that was put before the people. Tremendous work was done by the committee on the eighth amendment and then by the health committee of the Thirty-second Dáil to bring this legislation together and to deliver services for the women of Ireland, which also addressed the concerns of people on safeguards and protections, in particular, for children with disabilities. We have approached this constructively. We will work constructively across this House on the recommendations of the review, which need to happen to ensure the services we voted for are fully operational and accessible so that women who choose to avail of an early-pregnancy abortion have access to GP-led services; that where there is a risk to life the mother is prioritised; and to ensure that where there is a fatal condition affecting the foetus that women are not forced to carry unviable pregnancies, but that where a child can live and the family has elected to keep the pregnancy during the 12-week period, that the child is given every chance to survive and indeed thrive.

Sentiment score: 0.02