The pandemic brought abortion closer to home in Malta and thrust the issue on the national agenda. Before the pandemic, an estimated 400 women every year travelled abroad, mostly to the UK and Italy, for abortions in clinics. The pandemic shut down international travel, and Maltese women who sought abortion switched to procuring abortifacient pills online – and performing an abortion on themselves at home.
Women on Web said that it shipped 220 kits of abortifacient pills in the first year of the pandemic, and Abortion Support Network said all 110 Maltese women who sought its assistance got pills in 2020. Figures for the other organisation that sends pills to Malta, Women Help Women, is not available.
What these statistics seem to confirm is that abortion in Malta is more or less on a par with the range averages in the EU. The one, and perhaps only, thing that’s changed in the past year is that most abortions are now performed privately by women in their home.
This is not without its risks, either from potential prosecutions or medical emergencies, a scenario that might have prompted MP Marlene Farrugia’s attempt to lift the criminal sanction on abortion.
The PL and PN are set to thwart Farrugia’s private member’s bill from being put on the parliamentary agenda in the first place, which means that – no pun intended – Farrugia’s legislative initiative has turned into a stillborn.
So what’s the situation like out there irrespective of our parliamentarians’ determination to look the other way? What are these pills being posted to Malta? Will the police investigate and prosecute?
Lovin Malta has compiled this special report.
What is abortion and how is it done?
There are two types of abortion: surgical abortion or medical abortion. The former is a medical procedure performed under anaesthesia in a clinic; the latter by taking pills at home.
In the case of pills, the ingestion of two types of pills – Mifepristone and Misoprostol – causes a miscarriage in the first ten weeks of pregnancy.
Mifepristone is used in the treatment of high blood sugar in patients with complicated outlooks or certain conditions. It is also one of two types of pills that inhibit ovulation that are used as emergency contraceptive – popularly known as the morning-after pill – after unprotected sex. In Malta, it’s levonorgestrel that is available as a morning-after pill. Mifepristone is not available in Malta according to pharmacy sources.
Misoprostol is mostly used for gastro-intestinal conditions, and in Malta, it can only be prescribed by specialist consultants.
Are these pills safe and how do Maltese women procure such pills?
Maltese women buy these pills online and receive them in the post.
Self-administering these pills and causing a miscarriage up to the tenth week of pregnancy is generally considered to be safe and effective by regulatory medical bodies. However, in countries where abortion is legal, the procedure is usually preceded by a consultation with a doctor who also then conducts a follow-up medical examination afterwards.
Are there any possible medical complications?
Complications are described as rare, but the advice of Women on Web to women self-administer the pills is that they have to be within one hour’s reach of a hospital just in case complications develop. WebMD describes symptoms that call for immediate medical attention as severe abdominal pain, fainting, rapid heartbeat, fever, and sustained heavy bleeding – a sign of incomplete miscarriage.
Some studies suggest that around 7% of medical terminations fail, and this may lead to a deformed or harmed embryo.
The Guardian has reported that over the past year doctors at Mater Dei have reported a higher incidence of women turning up at hospital with ‘incomplete miscarriages’ – these are thought to be complications of abortion pills taken at home.
Can women in Malta be imprisoned if caught performing an abortion?
Abortion in Malta is punishable by up to three years imprisonment. Abortions performed abroad where abortion is legal cannot be prosecuted in Malta.
Lovin Malta asked the police whether they would prosecute any woman if information or report reaches them indicating that a woman would have carried out an abortion by taking pills within Malta. A police spokesperson said that the police would “investigate all reports, information or complaints it receives to the full extent possible.”
The spokesperson added: “It will then evaluate the evidence gathered to determine whether a criminal offence has been committed or not, as well as whether the offence, if any, is subject to criminal action. Each case is investigated according to its own particular circumstances and evidence available.”
The Times of Malta reported last week that the police investigated three women in the past five years, but none of the investigations led to charges.
Women on Web advise women on how to suck one of the pills so that no residue of the pill can be found in the event of having to go to hospital, and no proof can be had. This may mean that police would not be able to prove beyond a reasonable doubt whether a “miscarriage” was natural or chemically induced – over 10% of pregnancies end up in miscarriages anyway.
Moreover, the debate triggered by Farrugia’s attempt to remove criminal sanction of abortion has shown that, while a large majority is against changing the law, an even larger majority is against imprisoning women who perform or attempt to perform an abortion. This means that there is no appetite in the country, in general, to go after women who resort to abortions.
So does it make a difference if abortion is decriminalized or not?
Statistically speaking, the estimates suggest that the rate of abortion in Malta is more or less on a par with the European range, and this may indicate that criminalization may make no difference to the numbers. But it creates a climate of isolation and illicitness – any woman who takes pills to perform an abortion is likely to be wracked by feelings of anxiety and vulnerability.
Such women might not be able to access pre-and post-abortion counselling, something that, according to a paper authored this month by academics Claire Finkel and Liza Caruana-Finkel of the University of Liverpool, the World Health Organisation recommends.
This may create reluctance to make a run to the hospital if complications develop, thus increasing the risk to the woman and the embryo from failed or incomplete abortions.
Should abortion be decriminalised in Malta?