Chapter 5      Reproductive Health

This Women’s Health Plan is the combination of months of work by members of the Advisory Committee on Women’s Health and by sub-committee members, and follows on from the work conducted during the consultation process in the South East and from the Department of Health’s document, A Plan for Women’s Health. I would like to thank all those who helped in this process and would like to commend their commitment to working in partnership.

In developing this document the committee took a holistic approach to women’s health, which incorporated physical, sexual, mental, social and spiritual dimensions to health. It emphasised that empowering women to promote and to maintain their own health was essential and that women who are disadvantaged (geographically, economically, physically or socially) need special attention.

The Advisory Committee on Women’s Health makes a number of recommendations to the South Eastern Health Board in relation to the health of women in the South East. In order to facilitate implementation, priority recommendations have been highlighted. From these, the priorities for 1999 and 2000 are documented.

It is envisaged that the Advisory Committee on Women’s Health, in consultation with Health Board personnel, will further prioritise recommendations and will review the implementation of previous recommendations on an annual basis.

This report will be made available on the Internet through the SEHB site, in public libraries and the SEHB libraries. The reports of the sub-committees to the Advisory Committee on Women’s Health will also be available in the main SEHB library in Lacken, Kilkenny.

Finally I thank the Board for supporting us in the process of consultation and co-operation and hope that this process will continue in the future.

Ms. Anne Kiely,

Chairperson,

Advisory Committee on Women’s Health,

Women’s health is an issue that affects more than women alone. Many women carry out several roles at the same time – as mothers, primary child carers, paid workers, carers of elderly people, spouses/partners. Because of this the health services tend to have a greater impact on women’s lives, either directly, as a result of their own personal experiences, or indirectly, as a result of mediating services on behalf of those they are caring for.

As part of the national strategy relating to women’s health services the South Eastern Health Board carried out a consultative process with women living in the South East on a variety of topics concerning their health in 1997.

The South Eastern Health Board established its Advisory Committee on Women’s Health in June 1998. Its terms of reference were to:

• examine the South Eastern Health Board’s consultative document on women’s health and the national strategy document A Plan for Women’s Health.
• prepare a women’s health plan for the South Eastern Health Board.
• advise the South Eastern Health Board Chief Executive on issues and priorities in terms of maximising health and social gain for women.

In preparing the women’s health plan, the Advisory Committee on Women’s Health set up six sub-committees each comprising health service providers as well as consumers and representatives of voluntary bodies and interested groups. The specific areas on which these six sub-committees focused attention were:

• information, health promotion, sensitivity training, representation and consultation.
• mental health.
• women as carers.
• reproductive health.
• physical health.
• sexual health.

Each sub-committee was asked to:

• identify and document current services.
• identify gaps in services.
• recommend and prioritise developments in women’s health services in the South East.

The Advisory Committee on Women’s Health makes a number of recommendations to the South Eastern Health Board in relation to the health of women in the South East. These are listed fully within the report ‘Women’s Health in the South East – 2000 and beyond’. The priority recommendations are listed below.

Overall

1. Seminars on women’s health to be held in a number of areas in the board region.
2. A designated SEHB officer to oversee the implementation of the Plan for Women’s Health.
3. The continuation of the Advisory Committee on Women’s Health.
4. Input into strategic planning groups who are looking at issues which have a bearing on women’s health.

1. The development of a consumer information pilot project based in Waterford.
2. To develop induction training for SEHB Staff.
3. To pursue the development of a Mobile Information Unit funded through EU sources.

Mental Health

1. To facilitate the development of lay and professional counselling services.
2. To expand the Mental Health Resource Officer service.

Women as Carers

1. To recognise the work of carers and voluntary groups.
2. To lobby for extra staff to support carers.
3. To provide dedicated space for parents of young children at design stage for hospitals and health centres.
4. To undertake a study of respite care needs and recommendations re development of respite care.
5. To facilitate the development of continuing education for young mothers.

Reproductive Health

1. Childbirth and home birth.

1. To lobby for the development of a national ante natal education programme be developed and then introduced in the South East.
2. To ensure privacy during childbirth.
3. To provide information on home births.
4. To investigate methods of providing additional support for mothers of newly born children.
5. To appoint a Midwifery Project Officer.
6. To provide additional information on pregnancy and childcare.

1. Breastfeeding

1. To provide breastfeeding seminars across the region.

1. Family Planning

1. To facilitate the provision of non-directive Family Planning clinics.
2. Improve the availability of male and female sterilisation services.
3. To undertake an advertising campaign to raise awareness of Family Planning Services.

1. Crisis pregnancy

1. To support schools in implementing the RSE programme.
2. To work with Youth Leaders in providing RSE for early school leavers and at risk groups.
3. To provide comprehensive contraceptive service for all women.
4. To provide comprehensive non directive counselling service.
5. To facilitate continuing education for young pregnant women and mothers.
6. To provide information on preventative, counselling and support services for young people.

1. Incontinence

1. To provide information on continence care.

1. To implement the positive health promotion project for young women.

Sexual Health

The genesis of the South Eastern Health Board’s (SEHB) Plan for Women’s Health was a discussion document entitled Developing a Policy for Women’s Health published by the Department of Health in 1995. In that document the Department of Health invited each Health board, in conjunction with the National Women’s Council of Ireland, to engage in a consultative process with women on a variety of topics concerning women’s health.

Following receipt of reports from each of the eight Health Boards, the Department of Health formulated A Plan for Women’s Health, which was published in May 1997. That plan represented the fulfilment of commitments made in the health strategy document Shaping a Healthier Future. It, in turn, followed on from recommendations made in a report published in 1993 by the Second Commission on the Status of Women.

The reason for the emphasis on women’s health was the fact that many women carry out several roles at the same time – as mothers, primary child carers, paid workers, carers of elderly people, spouses and partners. As such, the health services tend to have a greater impact on women’s lives, either directly, as a result of their own personal experiences, or indirectly, as a result of mediating services on behalf of those they are caring for.

Traditionally, however, the structure and organisation of the health services has not taken women’s higher than average level of interaction into account. They have not been represented equally on decision-making boards. Neither have their views been solicited on a regular basis.

A Plan for Women’s Health is a national strategic framework for developing women’s health services. As such, it requires each Health Board to prepare a regional plan for women’s health. In addition each Health Board was required to establish an Advisory Committee on Women’s Health comprising Health Board service providers, women health service consumers as well as at least two representatives from the National Women’s Council of Ireland.

The South Eastern Health Board established its Advisory Committee on Women’s Health in June 1998. Its terms of reference are to:

• examine the South Eastern Health Board’s consultative document on
• women’s health as well as the national strategy document A Plan for Women’s Health.
• prepare a women’s health plan for the South Eastern Health Board.
• advise the South Eastern Health Board Chief Executive on issues and priorities in terms of maximising health and social gain for women.

The members of the Advisory Committee on Women’s Health are listed in

In preparing the women’s health plan, the Advisory Committee on Women’s Health set up six sub-committees each comprising health service providers as well as consumers and representatives of voluntary bodies and interested groups. The resulting synergy ensured that the concerns of women consumers and relevant Health Board constraints could be jointly shared and any ensuing recommendations jointly agreed.

Each sub-committee was asked to:

• identify and document current services.
• identify gaps in services.
• recommend and prioritise developments in women’s health services in the South East.

The specific areas on which these six sub-committee focused attention were:

• information, health promotion, sensitivity training, representation and consultation.
• mental health.
• women as carers.
• reproductive health.
• physical health.
• sexual health.

While violence against women was identified as a priority item in A Plan for Women’s’ Health, a separate regional committee, the South Eastern Regional Planning Committee for Violence Against Women, was subsequently set up by the SEHB, following a recommendation from the Department of Health, and is dealing with this issue. A report from this committee is included in Appendix 3. It was considered unnecessary to duplicate that committee’s work.

The South Eastern Health Board’s over riding concern is that it should deliver a women friendly health service and empower women to take control of their own health. Consultation and representation, health promotion and health information would be the hallmarks of a service which would also incorporate a holistic approach to women’s health. Specifically, it would take physical, sexual, mental, social and spiritual dimensions into account.

In addition women who are disadvantaged, whether it is geographical, economic, physical or social, should particularly have their concerns addressed.

The values and principles which have influenced and informed the Advisory Committee on Women’s Health in prioritising their recommendations are best summarised as follows:

• Matching both the concerns identified by women and the priorities identified by health service providers.

• Equity

• Cost effective

• Empowerment

• Integration and partnership

The Advisory Committee on Women’s Health makes a number of recommendations to the South Eastern Health Board in relation to the health of women in the South East. These are listed after each chapter. The priority recommendations are listed after the general recommendations for each chapter and, in addition, are highlighted in the Executive Summary.

For the purposes of this report, and to aid in service planning, the Committee has pulled from the priority recommendations those recommendations which are being implemented in 1999 and which it feels should be implemented in 2000.

The Advisory Committee on Women’s Health, in addition to the recommendations made by the sub-committees, has a number of overall recommendations. These are all priority recommendations.

1. Designated Officer to Oversee Implementation.

The Health Board should appoint a designated officer in the SEHB to oversee the implementation of the SEHB Women’s Health Plan.

2. Continuation of Advisory Committee on Women’s Health.

The Advisory Committee on Women’s Health should continue in existence. The Heath Board should make a decision in relation to the desired composition of the committee and length of office of members. The present Committee feels that the current composition, with a mixture of health board and non-health board members, worked well during the preparation of this report.

3. Input into strategic groups which have a bearing on women’s health.

The Advisory Committee valued the liaison role it had with other committees during the preparation of this report. It recommends that this interaction with, and input into, current and future strategic groups within the SEHB, which have a bearing on women’s health, would continue.

4. Seminars on Women’s Health.

Framework

Under its terms of reference, this Sub-Committee set out to make recommendations on how to improve:

• information,
• health promotion,
• sensitivity training,
• representation and
• consultation for women.

Having identified these recommendations, it then set out to prioritise them accordingly.

In order to feel empowered to take control of their own lives and make decisions about improving their own health status, women need to make informed choices.

However, one of the major findings which arose from the women’s health consultation process undertaken in the South East region was the view held by the majority of participants that women do not possess the requisite information and education. In addition, because they do not perceive their own health and well-being as important and because they regard the health needs of their children, spouses and extended families as having far greater significance than their own, they need to be further educated to a point where they accept that their health is as important as everyone else’s.

Women are under-represented as policy makers and decision makers in many sections of the health services. Furthermore, certain groups of women, (for example, those who are economically or educationally disadvantaged; those who live in remote rural or deprived urban areas; women who are members of the Travelling Community, or who have a physical or mental disability) may all suffer a double handicap in that they are not likely to be vocal about their specific needs and they are even less likely to be involved in the decision making surrounding the meeting of those needs.

Among other tasks, this sub-committee focused particular attention on developing recommendations which would cater for potentially marginalised groups of women.

Overall recommendation

Priority recommendations

Summaries of the top three immediate priorities identified by this Sub-Committee are set out below.

However, it is important to stress that if we are to improve information, health promotion, sensitivity training, consultation and representation throughout the South East region, it will be essential to respond to all of the recommendations set out on the preceding pages. This Sub-Committee is also anxious to stress the importance of ensuring that the timescale involved is not unnecessarily protracted.

Finally, the Sub-Committee accepts that considerable effort and additional funding may be required in order to achieve these aims.

Consumer Information Pilot Project, Waterford

Induction Training for SEHB Staff

Mobile Information Unit

Framework

The work of the sub-committee on Mental Health focused on a range of issues, specifically:

• access to counselling.
• mental health promotion.
• information in relation to mental health services.
• destigmatisation of mental illness.
• training for health and support professionals as well as mental health voluntary and self-help groups.
• information and support for families caring for those who are mentally ill.
• access to alternative therapies.

The sub-committee proposed that there should be a comprehensive range of mental health services available to people in the South East. In particular, these services should include:

• mental health promotion by schools, youth services, adult education services, women’s groups and voluntary groups.
• the promotion and facilitation of self-help groups for individuals suffering from mental health problems and for their families.
• low threshold access to lay counselling and support services.
• easy and defined access to professional counselling services.
• easy and defined access to adult psychological services.

It is not envisaged that all of these services would be provided by the Health Board. Indeed, many voluntary groups might be in a better position to provide a number of these services in a ‘non-medicalised’ environment. The key issue from the clients’ perspective is that a comprehensive service should be available to them and that the service should operate within a structure of well developed links and easy referral paths between and within the voluntary and statutory services.

For any client who wishes to promote, maintain or restore their own mental health, access to appropriate information is paramount. Once first contact has been made with any statutory or voluntary service (e.g. self-help group, voluntary support group, General Practitioner, or Community Welfare Officer), clients should be provided with information and helped to access the range of services likely to be of most benefit to them.

Against that background, the sub-committee believes that the different levels of service, as well as the benefits and limitations of each level of service, should be defined. Each service would require ongoing audit. Greater levels of interdisciplinary and team working would also be required.

Additionally, the Health Board should link with, as well as provide support for, both voluntary self-help groups and lay and professional counselling service providers. Health Board support could take the form of providing extra funding; providing a resource centre or premises, and/or providing clinical back for voluntary workers who may need supervision, and/or who may need to access a different level of service for particular clients.

The sub-committee recognises that the Health Board must be accountable at all times for funds allocated to voluntary groups. It felt that the Health Board would have to be satisfied that the service delivery actually meets community needs; that the access is appropriate, and that the training and supervision of service providers is adequate for the level of service being provided.

Each service area should also have its own resource centre or premises.

Priority Recommendations

While the Sub-Committee believes that the existing spectrum of services supplied by the voluntary sector and the Health Board should be developed further, it has identified two issues in particular which it would regard as having over-riding priority.

Lay and Professional Counselling Services

The Health Board should facilitate the setting up of, or set up, lay and/or professional counselling services in locations and for client groups, where there is currently no service.

Mental Health Resource Officer

The Health Board should continue to fund the post of a Mental Health Resource Officer who would be responsible for promoting mental health and self-help in each of the four areas within the region.

Framework

The work of the sub-committee on Women as Carers focused on a range of issues.

In documenting the present services, the group would like to acknowledge the work being done by women who are caring for another person. This work often goes unrecognised and unrewarded. Yet without this work our society would be very different and our health services would grind to a halt under the burden of care.

The sub-committee would also like to acknowledge the work of individuals, self-help groups and voluntary agencies who are supporting these carers.

The following groups were identified as those most commonly requiring care in the home:

• the elderly infirm
• people who are terminally ill
• people with progressive neurological disorders
• people with learning disabilities
• people with physical disabilities
• children

(xi) The SEHB should ensure that the care systems become more consumer oriented.

The Carers

Childcare

(iv) It should make financial provision for the training of volunteers.

The Professionals

Recognition of the work of carers and voluntary groups

Extra staff to support carers

Dedicated space at design stage

Study of respite care

Continuing education for young mothers

Framework

The work of the Sub-Committee on Reproductive Health focused on a wide range of issues, including:

• Childbirth (including Home Births)
• Breastfeeding
• Family planning
• Crisis pregnancy
• Menopause
• Incontinence

The South Eastern Health Board is committed to providing the best possible maternity care for the women of the south east.

a) Ante Natal Care

b) Labour and Birth

9. Obstetric intervention should only be undertaken following full discussion about the pros and cons with the mother and her partner or companion, where this is appropriate.

c) Hospital Facilities

(ii) A greater choice of accommodation should be on offer.

(vii) Obstetric units should be renamed ‘maternity units’.

e) Post-natal care

(iii) A survey of women’s needs in relation to childbirth should be undertaken immediately.

6. Women from farming or rural backgrounds need to be made aware of the range and level of risks caused by coming into contact with animal diseases when pregnant.

Breastfeeding

1. Public Health Nurses should continue to record rate of breastfeeding initiation, rate at three months and explore the reasons for ceasing to breastfeed.

Family Planning

(v) Consideration should be given to developing peer education with these groups.

(xviii) The Health Board should look at what supports should be developed for young fathers.

(xix) Support should also be given to the parents of young mothers.

Menopause

Incontinence

Ante Natal Education

Privacy during Childbirth

Information on Home Births

Support for Mothers of Newly Born Children

Midwifery Project Officer

Information on Pregnancy and Childcare

Breastfeeding Seminars

Non-directive Family Planning Clinic

Improving the Availability of Male and Female Sterilisation Services

The Health Board should ensure that male and female sterilisation services are available in each community care area, are free to medical card holders and that the service meets the demand.

Information on Family Planning Services

Support schools in implementing the RSE programme

Work with Youth Leaders in providing RSE for Early School Leavers and At Risk Groups.

Comprehensive Contraceptive Service for All Women

Comprehensive Non Directive Counselling Service

Continuing Education for Young Pregnant Women and Mothers

Support for new mothers, especially young mothers

Information on Continence Care

Framework

The Sub-Committee on Physical Health set out to examine a range of women’s health issues around topics such as:

• dental health.
• nutrition and exercise.
• breast cancer.
• alcohol and substances abuse.
• osteoporosis.
• the older woman.
• women members of the Travelling Community, as well as disadvantaged women.

At an early point in the Sub-Committee’s deliberations, it became obvious that, aside from breast cancer screening and cervical cancer screening, many of the factors affecting women’s health are very much influenced, if not actually determined, by individual behaviour.

The health challenge, as perceived by this committee, is that in addressing any issues which require alterations in personal behaviour, a multi-disciplinary approach is required. The committee takes the view that effecting any necessary changes would require the Health Board’s role to be seen in a partnership light, with emphasis placed on voluntary participation from communities combined with a non-judgmental approach from service providers, including the Health Board itself.

The key to developing a multi-disciplinary approach to lifestyle changes hinges on effective health promotion. In order for health promotion programmes to be effective, they must be innovative as well as positive in tone. They must make provision for individuals and communities to take the lead, and they must adopt a non-judgmental style.

Overall Recommendations

Dental Care

(iii) Designate specific dental clinics to treat women members of the Travelling Community.

Older Women

Nutrition

Breast Cancer Screening

Cervical Cancer Screening

Alcohol and Substance Abuse

Smoking

Osteoporosis

Positive Health Promotion Project for Young Women

Framework

In recent years, there has been growing recognition of the fact that sexuality plays a significant role in the quality of people’s lives, that sexual problems cause both emotional and physical distress, and that sexual enquiry, education and counselling are essential components of responsible and comprehensive health care.

The Canadian guidelines for sexual health education have adopted the World Health Organisation’s definition of sexual health because they encompass the life enhancement and problem-prevention dimensions of sexual health embodied in the philosophy and content of the guideline statements. Despite the optimistic appeal of such definitions, those involved in sexual health education should be aware of the problems inherent in any attempt to define sexual health.

The paucity of research and statistical information on the whole area of sexual health is an issue which needs to be addressed as a matter of urgency. One of the reasons why this health category has traditionally been neglected is, presumably, because it is regarded as complex, fragmented and conflicted. The combination of these factors leads the sub-committee to believe that there is a need to establish strong links between all the different groups which deal with sexual health.

Against this background, the sub-committee on Sexual Health specifically set out to:

• agree a definition of the term ‘sexual health’.
• assess current gaps in the health services, as they relate to sexual health, and then devise a list of priorities designed to improve services in that area.
• acknowledge, (as a medium term priority), the need to develop a strategic plan to improve health education and communication, and provide health service resources in the area of sexual health. In addition, encourage the Department of Health to recognise sexual health as a separate health category, with its own importance, respect and values.

Definition of sexual health

As of 1986 the World Health Organisation (WHO) defined sexual behaviour as:

The sub-committee on Sexual Health recommends that the WHO definition of sexual health be regarded as a template only. This is because ideas and norms about sexuality and health often emerge from an amalgam of influences such as social mores, science, medicine, religious beliefs and personal experiences. In the case of health professionals, for example, opinions on sexuality and sexual health are often shaped by factors such as their diverse forms of training and their social status or positioning. While the individuals or groups who propose a particular definition of sexuality or sexual health might indeed have sound reasons for their selection, these reasons themselves may be the result of intricate cultural processes, which produce a concept of sexuality that fits the existing social order. As a result, no one single definition of sexual health is likely to be able to represent this range of diversity satisfactorily.

To further complicate the picture, because the words ‘health and healthy’ carry an assumption of medical authority and objectivity, the term ‘sexual health’ can be misused, implying either approval or disapproval of specific behaviours. It can also be manipulated by lobbyists under the guise of disseminating medical truth. It is precisely that potential for multi-interpretations that makes some sex educators and therapists apprehensive about propagating a concept of sexual health - either explicitly, by defining it, or implicitly, by developing guidelines for promoting sexual health through education.

Researchers (M Barrett et al 1991) explored three different approaches to understanding and defining the term sexual health. These approaches were:

It is important to provide a template definition upon which we can all build – a definition that is mutually acceptable to everyone involved in the delivery of women’s health.

Having appraised and reviewed each of the individual reports submitted to it, the Sexual Health sub-committee notes the following general points:

• Historically, human sexuality has been regarded as a complex and difficult subject. Today, integrating opinions and ideas from a wide variety of disciplines and organisations continues to pose a formidable challenge.

• Sexual health is a profoundly important aspect of human existence.

• There is a general lack of knowledge, understanding and public awareness around sexual health issues.

• Sex can be viewed as a force working for both good and bad, with much of the good stemming from its potential for causing harm. There is no alternative to working out a moral position to suit the new situation. We can’t always get it right. There is a need for moral humility.

• Sexuality presents us with many challenges. It has evolved in the human species to serve more than a reproductive function – specifically, pair bonding; fostering intimacy; providing pleasure; bolstering self-esteem; asserting masculinity/femininity; reducing anxiety or tension; for material gain; as a way of expressing hostility.

• No debate on sexuality could be complete without considering the binding effects of sexual intimacy. That, in turn, depends on the vulnerability inherent in the sexual situation. Unlike animals, the key issue for human beings is their vulnerability to psychological and emotional insult/attack, rather than vulnerability to physical attack. Specifically, they run the risk of being exploited, rejected or humiliated.

• Emotional security is very important. In a sexual relationship, emotional security can be undermined if sex is used for purposes such as asserting masculinity/dominance, or bolstering self-esteem. Sexual behaviour may be perceived as immoral if it is used by one person to exploit the psychological or physical vulnerabilities of another.

• Homosexual intimacy can be as valid as heterosexual intimacy. Many homosexuals live in a society which rejects their sexuality, irrespective of how that sexuality may be expressed. They may regard any overt expression of homosexuality as sinful. Aspects of the evolution of homosexual behaviour may be interpreted as a reaction to society’s rejection of homosexual intimacy and, as a consequence of that, a rejection by homosexuals of the values of heterosexual society. If they were prepared to listen, members of the heterosexual community could learn much from the homosexual community.

• The reproductive consequence of sex confronts us with a balancing act between good and bad. That is one of the most important tasks facing us as sexually responsible individuals. The fact that another human being may be created as a result of such activity may leave us facing some extremely complex moral issues.

• Hypocrisy abounds in social attitudes to sexuality and can have very destructive effects. For example, there is a tendency to accept the prevalence of teenage pregnancies, rather than be seen to officially condone sexual activity and give teenagers access to contraception.

• It is important to take individual variability of sexual responsiveness into account when aiming to create a value system that is likely to be of general relevance.

• We need to consider the effects of ageing.

• Celibacy needs to be recognised and respected.

• We live in an era where sexual activity is threatened by physical hazards such as AIDS, cervical cancer and sexually transmitted infections. This is an area which urgently requires more education, research and funding.

• We need to develop a more responsible attitude to parenthood.

• We need to place more emphasis on helping those with sexual problems and difficulties.

• The needs of individual groups need to be addressed – specifically, people with mental and physical impairments; diabetics and others with chronic illness; members of the Travelling Community; older people; non-nationals – people with language barriers, emigrants and refugees; teenagers; sexual minorities; single people including widows and widowers; prostitutes.

Recommendations

(iii) In the area of sexual health, priority should be given at national and regional level to:

• improving existing education structures and developing new education modules designed specifically to address sexual health.

• asking the Health Boards to link with other agencies in identifying the health needs of people who work in prostitution in the region and working with these agencies in developing services for these people.

Training in psycho-sexual counselling

Providing services for People working in Prostitution

Members of the Advisory Committee on Women’s Health

Ms. Ann Kiely, Chairperson, Kilkenny.

Cllr. Deirdre Bolger, SEHB Member, Wexford.

Ms. Ann Boyle, Community Care SEHB, Kilkenny.

Ms. Patty Costigan, Primary Care Unit, SEHB, Kilkenny.

Ms. Theresa Hanrahan, SEHB Hospital Manager, Wexford.

Dr. Julie Heslin, Specialist in Public Health, SEHB, Kilkenny.

Ms. Audrey Lambourn, Communications Manager SEHB, Kilkenny.

Dr. Venie Martin, Head of Development, Waterford Institute of Technology.

Dr. Martine Millett-Johnson, Consultant Obstetrician/Gynaecologist, Kilkenny.

Mr. Seamus Moore, SEHB Community Care, Clonmel.

Ms. Maeve O’Grady, Access 2000, Waterford.

Ms. Angela O’Keeffe, ICA, Waterford.

Ms. Sheila Vereker, Rape Crisis Centre, Waterford.

Ms. Barbara Wallace, Public Relations Consultant, Wexford.

Members of the six sub-committees which were involved in preparing the aforementioned recommendations.

Membership:

• Ms. Audrey Lambourn, (Chair), Communications Manager, South Eastern Health Board, (SEHB).
• Ms. Corinne Alexander, Waterford.
• Ms. Fiona Brannigan (Secretary), CEO Department, SEHB.
• Ms. Brid Dowling, Ballybeg Community Development.
• Ms. Mairead Fennessy, Department of Public Health, SEHB.
• Ms. Marguerite Guidera, Waterford Community Care, SEHB.
• Ms. Ann McLoughlin, Health Information Officer, SEHB.
• Ms. Fran O’Grady, Regional Childcare Training Officer, SEHB.
• Ms. Joan Phelan, Continuing Nurse Education, SEHB.
• Ms. Marian Daly, South Tipperary Community Care, SEHB.
• Ms. Monica Ryan, Pre-School Services Officer, Waterford Community Care.
• Ms. Mary Ryan, Disabled Women’s Working Group, Disability Information Officer, SEHB.
• Ms. Ann Tierney, Librarian, SEHB.
• Ms. Marianne Tomkins, Public Health Nurse, Carlow Community Care.
• Ms. Barbara Wallace, Public Relations Consultant, Wexford.

2. Advisory Committee on Women’s Health: Sub-Committee on Mental Health

Membership:

• Ms. Angela O’Keeffe, Irish Countrywomen’s Association, (Chair), Waterford.
• Ms. Frances Whelan, Social Worker, Wexford.
• Mr. Michael Saunders, Money Advice and Budgeting Service, Kilkenny.
• Ms. Suzanne Fewer, Counsellor and Lecturer, Waterford Institute of Technology.
• Mr. John de Courcy, Senior Clinical Psychologist, SEHB, Waterford.
• Ms. Ann Mullins, Public Health Nurse, Kilkenny.
• Ms. Joan Power, Resource Officer, Waterford Mental Health Services, SEHB, Waterford.
• Dr Neville de Souza, Specialist in Public Health and member of the Mental Health Review Group, SEHB.
• Sr. Carmel Terry, Director, St Brigid’s Family and Community Centre, Waterford.
• Ms. Catherine Kavanagh, Regional office, GROW, Kilkenny.
• Ms. Norma Burke, Psychiatric Nurse SEHB and member of AWARE, Tipperary.
• Ms. Paula Kealy, Positive Action, Kilkenny.
• Dr Regina O’Kelly, General Practitioner, Carlow.
• Ms. Elaine O’Brien, Psychologist, Kilkenny.
• Dr Julie Heslin, Specialist in Public Health, SEHB, Kilkenny.

3. Advisory Committee on Women’s Health: Sub-Committee on Women as Carers

Membership:

• Ms. Ann Kiely (Co-chair), Solicitor, Kilkenny.
• Dr Venie Martin (Co-chair), Waterford Institute of Technology.
• Ms. Elaine Bradshaw, Alzheimer’s Association, Kilkenny Branch.
• Ms. Brona Tracey, Speech and Language Therapist, Community Care, Kilkenny.
• Ms. Margaret Lawlor, Public Health Nurse, Tullow, Co Carlow.
• Ms. Audrey Lonergan, Clinical Psychologist, SEHB, Clonmel, Co Tipperary.
• Ms. Gretta Power, Liaison Public Health Nurse for the Elderly, South Tipperary.
• Ms. Stella Crean, National Parents Council, Enniscorthy, Co Wexford.
• Ms. Peggie Finn, PRO, Alzheimer’s Association, County Wexford.
• Ms. Geraldine Tabb, Public Health Nurse, SEHB, Waterford.
• Ms. Suzanne Walsh, Waterford Institute of Technology, College Street Campus Waterford.
• Ms. Paula Lane, Research Officer, SEHB/Waterford Institute of Technology.
• Mr. Eddie Collins-Hughes, Director, National Carers Association.
• Ms. Caroline Ayers, Secretary to the Committee, SEHB.
• Ms. Corinne Alexander, Joint Secretary, Waterford Institute of Technology Women’s Health.

4. Advisory Committee on Women’s Health: Sub-Committee on Reproductive Health

Membership

• Ms. Deirdre Bolger (Chair), Counsellor and Member of SEHB, Gorey, Co. Wexford.
• Ms. Ann Boyle, Staff Officer, Community Care (Secretary).
• Ms. Ann Scully, IFPA, Waterford (Unable to attend).
• Ms. Susie Long, Higginstown, Co Kilkenny (Resigned May 1999).
• Ms. Louise Graham, Community Services Centre, Station Road, Carlow.
• Ms. Joy Harper, La Leche League, Kilkenny.
• Ms. Bridget Farrell, Physiotherapist-in-charge, Regional Hospital, Waterford.
• Ms. Maura Murphy, Pre-School Services Officer, Community Care Centre, Grogan’s Road, Wexford.
• Ms. Breda Ryan, Public Health Nurse, Community Care Centre, Clonmel, Co Tipperary.
• Ms. Helen Mulcahy, Public Health Nurse, Community Care Centre, Cork Road, Waterford.
• Ms. E O’Keeffe, Ward Sister, Maternity Unit, St Luke’s General Hospital, Kilkenny.
• Ms. T Hanrahan, General Manager, General Hospital, Wexford.
• Dr Ray Howard, Consultant Obstetrician/Gynaecologist, St Joseph’s Hospital, Clonmel.
• Ms. Patricia McQuillan, Practice Nurse, John’s Street, Kilkenny.

5. Advisory Committee on Women’s Health: Sub-Committee on Physical Health

Membership:

• Mr. Seamus Moore (Chair), General Manager Community Care, SEHB, South Tipperary.
• Ms. Iris Checkett, Medical Ward Sister, General Hospital, Wexford.
• Ms. Anne Marie Curran, Senior Occupational Health Sister, Waterford Regional Hospital.
• Ms. Susan Higgins, Community Dietitian, Health Promotion Unit, SEHB.
• Ms. Phil Mahony, Public Health Nurse, Health Centre, Bagnelstown, Co Carlow.
• Ms. Niamh Murphy, Waterford Institute of Technology.
• Ms. Barbara O’Brien, Dentist, St Vincent’s Health Centre, Cashel.
• Ms. May O’Brien, Reach to Recovery.
• Ms. Una Ryan, Ballybeg Community Development Partnership.

6. Advisory Committee on Women’s Health: Sub-Committee on Sexual Health

Membership:

South Eastern Regional Planning Committee on Violence Against Women

The Regional Planning Committee was asked to undertake the following tasks by the National Steering Committee on Violence Against Women:

• An Audit of Services in the South East Region, with particular emphasis on identifying gaps and needs in the current service provision.
• Compile a Three Year Development Plan.
• Set up Local Networks.

In undertaking the above the Regional Planning Committee set up the following Working Groups:

1. Awareness/Education/Training Working Group - Identified need for in-house training Organised Training/Information Sessions.
2. Services Working Group - Undertook Audit of Services and preparation of Development Plan
3. Legal Working Group - Reviewed existing legal services highlighted the following: Lack of Accessibility to Victims. Need for standardisation of Reporting Practices and Policy. Need for increased resources – Premises, Staffing, Family Law Courts and Law Centres.
4. Policy Working Group - Drafted Mission Statement, Drafted Good Practice Principles.
5. Funding Working Group - Prepared Model for Staffing and Annual Costs for Rape Crisis Centres, Refugees and Outreach Services. Funding proposals and recommendations to the SEHB on the distribution of the extra allocation were agreed and submitted.

Objectives and Targets

In March 1999 the Committee held a Planning Session, professionally facilitated with the aim of setting agreed objectives and achievable targets for the coming year.

Objectives:

1. The setting up and development of Local Networks.
2. The development of policy and codes of good practice.
3. The development of a strategic plan to deal with the gaps in services as identified.
4. Provision of ongoing education, awareness raising and training about the issues related to Violence Against Women.
5. Liaison with the National Steering Committee, SEHB and relevant Government Department.