Why Malta desperately needs family planning clinics

A 17-year-old Junior College student walks into my clinic with her mother and says, “I would like to go on the pill.” After ensuring that she is comfortable having this conversation in the presence of her mother, I confirm she has no risk factors, is clinically normal and there are no contraindications to prescribing the oral contraceptive pill. We discuss the pros and cons of various types and finally agree on a particular pill. I explain how to take it and what side effects to look out for including the more serious but, thankfully, rare ones. She walks out with a one-year prescription and my telephone number so she can message if she has any concerns.

This is a typical scenario in any private gynaecological clinic. The personal situation may vary, the risk factors may change and the prescription may very well also be different, but in each case, a young person receives a professional consultation paid by her mother.

Imagine the same clinical scenario except this time, the 17 year-old is alone. She walks out with a prescription and a bill to pay, not only for the professional services but also the monthly cost of the contraceptive.

Consider further that she does very well on the pill prescribed, but after about three months when trying to buy another packet she’s told that the pill she is taking is out-of-stock. She desperately calls from one pharmacy to the next, only to be told the same. She then messages me and we agree on an alternative, which is hopefully available. This scenario happens regularly in Malta because there are no contraceptives on the essential medicines list. Contrast this situation with that in the UK for example, where the contraceptive pill is not only free, but in some cases available over-the-counter without a prescription at all.

Do GPs prescribe the oral contraceptive pill? Of course, they do. Women and girls in Malta do not need to see a private gynaecologist to obtain a prescription. They can visit their private GP, but many do not for a variety of reasons. If money is an issue, women and girls can visit the local health centre where they will always be able to speak to the GP available. Some may find it difficult to discuss these issues with a person they have never met before. Others are simply more comfortable discussing personal issues such as sexual and reproductive health with a female doctor. No health centre can guarantee the presence of a female GP at all hours of the day, but it’s good to note that the GP on-call changes from hour to hour.

Now contrast all of this with a setting where there are a number of dedicated family planning clinics in health centres across the island. These are staffed by trained GPs with access to speedy referral to gynaecologists as necessary. At the end of the consultation, women walk out with a prescription for the medication they need which they can obtain for free.

Of course, the contraceptive pill is not for everyone. Some women would prefer to consider an IUD such as the Mirena®/Jaydess® or a copper coil, or even a contraceptive implant. Again, the local family planning clinic should be able to advise women regarding the pros and cons of each contraceptive method, as well as inserting one of these so-called long-acting reversible contraceptive (LARC) devices. Yes, doctors need to be trained to insert these devices, but this should not be a problem.

So, what exactly are we waiting for? Why is it that we had such family planning clinics until the early 90s and now, 30 years later, women in Malta struggle to obtain reliable contraception which is easily and freely available? Contraception and testing for sexually transmitted infections (STIs) are essential reproductive and sexual healthcare services. Other than the cost involved, there should be no reason why they should not be made available to all, as needed and without barriers to care. Doctors for Choice believe that selected contraceptive pills and LARCs should be on the essential medicines list. This would mean that they would be available for free or at a heavily subsidised price, and they would never be out-of-stock.

Statistics from Eurostat show that over the past decade, when compared to Spain, Italy, Portugal, Cyprus, Greece and the EU as a whole, Malta has consistently reported the highest rate of teen births in proportion to its population. Each year, between 2015 and 2019, there were approximately 100 live births to girls between 15 and 19 years of age. This clearly indicates that our healthcare service is failing to protect children in Malta from the life-altering effects of pregnancy. Not only is the currently available sexual education programme failing us, but it is clear that the use and availability of contraception, including condoms, is regrettably low. It also stands to reason that the complete ban of abortions, even for young rape victims, contributes to our high teen birth rates.

Let us be clear about this: Maltese society is paying dearly for the absence of family planning clinics. Our taxes are used to provide healthcare which is free at the point of service, as well as subsidised housing, social services and other types of financial support such as children’s benefits etc. There is evidence from other countries in the world that providing free family planning services results in considerable cost savings in the long-term.

If we truly believe in equity, then that surely must also extend to young girls and boys who should be provided with the tools to protect themselves from pregnancy and STIs. Moreover, they should also have the knowledge and skills to engage in healthy sexual activity in the context of mutual consent.

We believe that our government has a duty to support the well-being and education of young (and not-so-young) women and men. It must ensure they have access to contraception which is freely available. This is the only way we will ever be able to keep the number of women who need abortions to an absolute minimum.