Malta’s abortion reform will endanger women’s lives

Natalie Psaila is a family medicine specialist and founding member of Doctors for Choice, which advocates for reproductive health and rights. Isabel Stabile is Malta’s only openly pro-choice gynaecologist and a member of Doctors for Choice.

Malta is one of the few countries in the world with a blanket ban on abortion. Yet despite this, the organisation Women on Web received requests for abortion pills from 424 women in Malta in 2022, an increase of almost 20% over the previous year. All these women were willing to risk a three-year prison sentence because they were desperate. Doctors assisting them risk a four-year sentence and loss of their medical licence.

Medical abortion pills (mifepristone and misoprostol) are safe to be used at home. However, people are often scared of seeking medical attention while having an abortion. They are also wary of having family and friends know what they are going through, for fear of being reported to the police. They are left bereft of medical and social support.

Last month, a woman in Malta was prosecuted for procuring abortion pills after being reported by her abusive partner. She was given a conditional discharge for three years.

A year ago, Malta failed Andrea Prudente, when she developed pregnancy complications with no reasonable hope that the foetus would survive, placing her at risk of a life-threatening infection. She was evacuated to Spain for essential care after doctors in Malta refused to terminate her pregnancy.

Soon after the Prudente case broke, 135 doctors felt so aggrieved by their inability to provide medical care, that they signed a judicial protest asking for a review of the blanket ban on abortion. The protest compelled the government to review the law.

Despite promises that the new law, Bill 28, would allow a pregnancy to be legally terminated if the woman’s health is in grave jeopardy, we have been presented with a severely watered down version of the law where women must be at death’s door before doctors are allowed to intervene.

Women facing medical emergencies like Andrea Prudente – Malta has a handful of similar cases every year - will continue to risk the fate of Ireland’s Savita and Poland’s Dorota, who were both far too sick to be saved.

Bill 28 requires three specialist doctors to agree to authorise an abortion when a woman's health is “in grave jeopardy that can lead to death”. It also specifies that it can only be legally carried out in a licensed hospital. These conditions will undoubtedly introduce delays, possibly resulting in loss of life.

The new law presents a more dangerous environment for pregnant women in Malta than ever before, because it introduces further barriers to lifesaving care. It only seeks to safeguard doctors’ interests, as opposed to their patients’.

It also does nothing for those who need abortions in cases of fatal and severe foetal anomalies, rape, child pregnancies, because of socioeconomic problems, or for any other reason. These people must either procure their own illegal abortion in Malta, or find ways to travel abroad, or see their pregnancy to term.

This is a discriminatory and inequitable law. Those with the least resources face the greatest barriers. They often come from highly restrictive and religious family environments, or are in abusive relationships. Some cannot afford €120 for abortion pills, let alone travel overseas, while others lack access to the internet or even a phone. Indeed, abortion bans punish the most vulnerable in our society.

Doctors for Choice has teamed up with two other NGOs to set up a sexual and reproductive health information helpline, as well as an abortion support service to fill this glaring gap within Malta’s healthcare system. Many callers reveal a lack of basic reproductive health knowledge, including effective contraception use, reflecting the poor sex education delivered in our schools. We offer objective, unbiased and non-judgemental advice to those who call. It is a shame that our country ignores their needs and our volunteers have to make up for the failure of the state.

We call upon our politicians and policy makers to urgently decriminalise abortion so that women and girls can take autonomous decisions regarding their bodies, health and lives. As doctors, we will continue to speak up for all those silenced by stigma until Malta carries out full reforms in line with international standards.