What do we know about abortions in Malta? | Aleksandar Dimitrijevic

If the Covid-19 pandemic has taught us anything, it is that our health decision-making processes and policies must be driven by data for the wellbeing of all.

It is a sad fact that when it comes to reproductive health in Malta, specifically the need for abortion care, a small group of volunteer activists who run FPAS* know more about the needs of women and pregnant persons in Malta than our health authorities.

Contrary to popular belief, abortion is a reality for women in Malta. Our stringent “pro-life” laws do not stop women from accessing the healthcare they need.

Historically, options were limited for those who were either poor or too young to seek help independently. Not so for affluent members of our society, who could afford a trip and the cost of an abortion in either UK or Sicily.

Having an abortion in Sicily is usually a secretive, yet relatively straight forward affair. The pregnant person acquires the phone number (often from a relative/friend who has had an abortion themselves) of a person referred to as a “tour guide”, who will meet her on arrival by ferry or plane, and taxi her to and from the abortion “clinic”. Everyone’s anonymity is preserved, and it costs around two to three thousand euro.

The word “clinic” is in inverted commas because according to Italian law, although free of charge, abortions can only be performed in public hospitals. It is highly likely that these abortions are illegal according to Italian law. Moreover, even if legal, there is no way of ascertaining how many women from Malta have abortions in Italy because these data are not collected by the Italian government.

This is not the case with respect to abortions in the UK as the government there records the nationality of all women having abortions. So, we know for certain that every year around 60 women from Malta have abortions there. Also, the UK is one of the countries with the longest cut off points for legal abortion and it is therefore often the only destination available for women with very much wanted pregnancies but whose fetus is diagnosed with one of several fatal diseases. From the testimonies we have heard, these are some of the most harrowing stories of the hard choices future parents in Malta had to make.

There are Maltese women who travel to other countries: Netherlands, Belgium, and Spain to name a few; foreign women that live and work in Malta and Maltese women with foreign partners who travel to either their own or their partner’s countries of origin to have abortions. How many of these take place every year is impossible to ascertain; but we know that they are happening.

Because having an abortion in a country where it is legal to do so (i.e., practically in the rest of the world) does not fall under Maltese jurisdiction, women travelling for abortions cannot be prosecuted by the Maltese government upon return. This fact has been confirmed by European courts long ago.

Not so with abortions taking place in Malta and which have now become the most numerous.

We are often asked by foreign journalists whether backstreet abortions (i.e., performed illegally by doctors or other unorthodox means) are happening in Malta. It is hard to tell. There are stories of women throwing themselves down the stairs, drinking bottles of gin or their partner kicking their stomach until they miscarry, but these are rare, although they do happen. Similarly, there are rumours going back to the 1980s of doctors performing abortions locally or prescribing an overdose of off-licence medicines to induce miscarriage. Again, we have not found any reliable evidence of this, although we are certain that this did happen in the past.

Most abortions taking place in Malta today are by means of telemedicine, which means receiving abortion pills by post after a telephone or an online consultation with a doctor. This is a very safe way of accessing abortion. Especially in times of Covid, research done in UK and USA has shown that telemedicine is a safer option than visiting a clinic. Indeed, both the CDC in USA and the NHS in UK have approved telemedicine as the safest way of accessing abortion during the pandemic.

For these abortions to be safe, the consultation and the sourcing of pills must be provided by a reliable provider, which in the case of Malta is either Women on Web (womenonweb.org) or Women Help Women (womenhelp.org). These are experienced organisations that give reliable medical advice and provide the pills from reputable sources. In 2020, Women on Web shipped 220 sets of abortion pills to Malta. Women Help Women does not provide data per country.

So how many abortions do women from Malta have every year?

Based on the confirmed data (from Women on Web and the UK), the number stands at around 300, but this excludes all the other situations listed above. To guestimate the real number we must make some assumptions: that the number of women travelling to Italy or to other countries is similar to the number travelling to UK and that the number of pills bought from Women Help Women and other sources is close, albeit possibly smaller, to the number that Women On Web ship to Malta every year. That puts the figure to just over 600 a year.

If you think that this is too high, think again. Netherlands, a country with great track record in prevention of unwanted pregnancies through excellent sex education and contraception availability has the third lowest abortion rate in Europe, at 156 abortions per 1000 live births. At roughly 4300 live births per year, if Malta had the same rate, it would translate to 670 abortions per annum and our prevention efforts pale in comparison to theirs.

These numbers are still a guessing game but what we do know is that by criminalising this important part of the healthcare of women, our country is burying its head deep in the sand to pretend that the issue does not exist, while women in Malta are paying the price every day.

Malta is criminalising women for being women and yet it achieves nothing, because our blanket ban on abortion does not prevent abortion from happening – as the figures above show. Just think about it: the biggest single crime in Malta is abortion, bigger than all other crimes combined. If Malta were to seriously pursue all these women as criminals and enforce the sentences of three years imprisonment for abortion, we would need to build two new Corradino’s just for women.

To create a comprehensive sexual and reproductive health policy, Malta must start by repealing its worthless 19th century laws, decriminalise abortion and stop treating women who decide to have an abortion as criminals.

Aleksandar Dimitrijevic is a pro choice activist for Men Against Violence

The Family Planning Advisory Service (FPAS) is run by trained volunteers and provides free information on reproductive choices to people in Malta. They can be contacted via phone 27782758 or chat on www.fpas.mt .