A victory for women’s autonomy

This week a judge in Malta dismissed a case filed back in 2017 by pro-life groups (Life Network Foundation and Save the Embryo Protection Act Malta) who opposed the introduction of the morning after pill aka Emergency contraception (EC).

Their claim was that EC is abortive and therefore in breach of Maltese criminal law. The judge upheld the Superintendent of Public Health’s argument that these groups did not have the juridical interest to file that type of case.

I am only a gynaecologist, so I will not get into the legal merits or otherwise of this decision. But I am also a scientist and I have studied the mechanism of action of EC and I can assure you that it does not cause abortion. It cannot.

There is extensive scientific literature published in respected peer reviewed mainstream journals showing unequivocally that EC does not, and indeed cannot work, once fertilisation has taken place. The fertilized egg takes about five days to travel down to the uterus and implant there. This means that there is not enough time for EC to make the lining of the uterus so thin as to prevent implantation. This is why EC cannot cause abortion. EC works by delaying ovulation and preventing fertilisation.

Life Network have a long history of misleading the Maltese public. Not only have they militated against EC, but they also receive government funding to promote unsafe medical procedures such as reversal of medical abortion. Their website proudly advertises their allegiance to Agenda Europe, a far right Christian-extremist network, committed to the ‘restoration of natural order’. Their goal is to remove the sexual and reproductive health human rights of women, young people, and the LGBTQI community in Europe.

This is so very dangerous and this is right here, right now. Life Network claim they are pro-life, but all the evidence suggests that they are actually pro-birth.

As a pro-choice gynaecologist, it is my duty to provide all those who seek my advice regarding an unplanned pregnancy with the full range of reproductive care available in Malta and/or abroad. These include continuing with the pregnancy and parenting the child when born, adoption and abortion, the latter being illegal on the island.

I am personally aware of one woman who was coerced by Life Network into continuing with her pregnancy against her will. She finally realised what their true intentions were and escaped abroad! This is what happens when extremists rule the roost. This is the true face of pro-life ideology in Malta: it opposes the availability of EC, reducing women to mere incubators while stripping them of their autonomy by denying them access to education, contraception and abortion.

If Life Network really cared about preventing abortion they would advocate to improve sexual education in schools and promote the availability of contraception. Failing to do so is hypocritical.

Before EC was available in Malta women resorted to taking overdoses of contraceptive pills to prevent pregnancy. Although the active ingredient was actually the progesterone in the contraceptive pills, the progesterone-only pill (a.k.a. minipill) did not exist in Malta at the time and therefore women would swallow massively high doses of oestrogen in order to obtain the minimum effective dose of progesterone. Thankfully those days are gone.

EC is available without a prescription because the Medicines Authority in Malta drew upon the analysis of research data of thousands of experts throughout the EU. This system is designed to protect consumers from incomplete information. Had there been even a shred of evidence that EC is abortive, the Medicines Authority would never have issued its marketing authorisation.

No one is forced to take EC. Yet those who may need to take it, especially out-of-hours, often have great difficulty obtaining it, because some pharmacists persist in hiding behind “conscientious objection” as justification for not stocking and/or dispensing this safe medicine. It is precisely because pharmacists are well trained, science-based professionals and respected, trusted experts in medicines, that one would expect them to base their conscientious objection to EC on science rather than opinion.

The crux of the matter is that when deciding to deny patients access to medicines to which they have a right, pharmacists should state the scientific rationale on which they are basing this decision. Conscientious objection must always be supported by rational argument.

Pharmacists also have a duty to care for individual persons in need of this medication. Indeed, some, but not all pharmacists do refer such patients to nearby pharmacies that will dispense EC. This, however, will not help the person who needs it after 12 noon on Sunday as very, very few pharmacies are open at this time.

There are also troubling reports of some pharmacists openly asking for identification as well as medical information without offering a private setting to do so. Anyone struggling to obtain EC, especially if under 18, should access our online service that offers a telemedicine consultation and an emailed prescription (https://www.doctorsforchoice.mt/morning-after-pill-prescription). Although a prescription is strictly unnecessary, it should reassure the pharmacist that a medical professional is taking responsibility for having asked all relevant questions.

One day, abortion in Malta will be freely, safely and legally available without shame or stigma. That day is soon. But until then, since abortion is still illegal under all circumstances, banning the morning after pill makes no sense at all. Thank you, Mr. Justice Micallef.