An affront to women’s rights

The outcome of the parliamentary debate on emergency contraception – up to this point unavailable in Malta – was unsatisfactory on many levels.

After months of discussion with various experts and stakeholders, who gave conflicting advice and opinions on the effects of the morning-after pill (MAP), MPs sitting on the social affairs, health and family committees decided to recommend that the emergency contraceptive pill can only be dispensed against a doctor’s prescription.

They said the Medicines Authority must assess and process each individual application in respect of the Criminal Code and the Embryo Protection Act. “Any decision taken by the Medicines Authority must be based on the present laws, without hindering the fundamental human rights as listed in Malta’s constitution,” their recommendations read. 

Considering the arguments brought forward during the debate itself, this appears to be an entirely pointless compromise. Time and again during the discussion, all the relevant experts in the field – including the Medicines Authority – all concurred that the morning-after pill is not abortifacient. All clinical studies cited clearly indicate that the pill does not prevent implantation of a fertilised ovum (and hence interrupt a real pregnancy). As such, its effects as a contraceptive are no different from those of the inter-uterine diaphragm, or for that matter the condom: which can be purchased over the counter in any pharmacy, and even from dispensers in public toilets.

In the words of Professor Mark Brincat, an eminent local scientific obstetrician and gynaecologist, “there is not a single peer-reviewed publication that demonstrates that emergency contraception leads to a fertilized egg (oocyte) failing to implant, let alone cause an abortion. Expressing doubt is not enough, one has to demonstrate scientifically and actively that such a mode of action takes place. [...] one has to demonstrate that an action has happened in order to allege a crime.”

 The only difference is that emergency contraception is designed for use at a point when it would be manifestly too late to resort to other methods. But this, in itself, is absolutely no reason to demand that the pill be subject to prescription. 

One can only conclude that in taking this illogical decision, the parliamentary committee was only concerned with placating a small but very vociferous lobby, in a way that appears reasonable on the surface.

It is not, however, reasonable to place additional hurdles and obstacles in the path of women who would already be in a state of anxiety and stress. Nor is it reasonable to make a necessary medicinal product harder to obtain, just to placate a section of the public.

It is also a counter-productive resolution to the issue. Members of the same parliamentary committee had (unwisely) pronounced themselves against the morning-after pill before the debate even started. Apart from raising questions about the possibility of a biased committee, these MPs – including former minister of health Godfrey Farrugia – later withdrew their objections after Malta’s medical authorities finally set the record straight regarding the non-existent connection to abortion.

Under those circumstances, the only objection had been quashed. Why, therefore, did the committee feel the need to impose an extra bureaucratic layer, on what is essentially a fundamental women’s right? In order to exercise this right, Maltese women – alone in Europe – have to ask for ‘permission’ to access a very basic emergency medical service. It bears mentioning also that the direction taken by Malta’s parliament is at loggerheads with the European Commission on this issue.

In January 2015, the EC upheld a European Medicines Agency’s (EMA) proposal to recommend classifying emergency contraception as an over-the-counter product. Even if the recommendation is non-binding (Malta appears to be the only member state to have ignored it) one would expect valid argumentation to justify our rejection of this recommendation. 

There doesn’t seem to be any form of scientific or medical justification. Political justifications are not good enough.  

Politically, this compromise may be convenient for a political class that doesn’t seem interested in the plight of the people affected by their decisions. But for women, it is yet another attempt to wrest control of their bodies away from them, and place it in the hands of institutions. 

It is also a system that invites a clear abuse of such rules: willing doctors might allow women to use the same prescription for numerous purchases; pharmacists who know their clients might even be willing to sell the MAP without needing to see a prescription.

Far more probably, however, it will result in fewer women attempting to avail of the service. It is common knowledge that on sensitive, private issues such as this, unnecessary medical intervention is a serious deterrent. Ironically, this could even increase the backroom (or overseas) abortion rate.

Ultimately, it boils down to the question of whether this country really has women’s rights at heart. A heroin addict is (rightly) given dozens of syringes, no questions asked, from a clinic because it is a health concern in the battle against HIV and other blood-transmitted diseases. 

On the same principle: why should a woman require permission to use the morning-after pill? This was the question parliament was meant to answer. It failed to do so.