It has now been over a year since we started our unique pro-choice advisory service in Malta. Prior to the Family Planning Advisory Service (FPAS) coming into existence, women in Malta did not have a source of reliable information on reproductive healthcare, particularly on abortion. FPAS sought to change the status quo and we now have a team of pro-choice volunteers who are ready to help anyone who needs information on anything related to sexual and reproductive health.
There is no other service like FPAS in Malta. There is no other service that is run by people who are pro-choice and does not hesitate to give accurate information on abortion options and services. It is for this reason that FPAS provides unique insights into the reproductive care needs of women and girls in Malta.
This is what we learnt from our first year of running the Family Planning Advisory Service:
There is a great need for information on reproductive healthcare, and a great need for reproductive healthcare services. During the first twelve months, we were contacted by no less than 479 different individuals. This is likely to be a significant underestimation of the true number of clients, since we sometimes delete contacts before they can be included in statistics. To put this into perspective, in Malta - a country of around half a million people - more than one person a day needed to contact FPAS for advice and help, usually because they cannot find what they need through the national health service. And this is not the total number of people who have benefitted from FPAS. We have a lot of information online and in our knowledge base which people can browse and use to help themselves, without ever having to contact us.
Many people contact us for information on abortion. But that is not all. We have recently audited the last 100 consecutive chats with clients, which is the most commonly used method people use to contact us, and sorted them into the main reasons for contacting us. As expected, the most common request was for information on abortion providers, and this accounted for 40% of contacts. This high proportion is because the illegal status of abortion in Malta has not only prohibited actual abortion services, but has also had a chilling effect on the provision of information on abortion services. For this reason, FPAS is unique in the country for being the only service that makes no secret of the fact that it gives accurate information on abortion providers to women in Malta, and it is therefore no surprise that a relative majority of our contacts are requests for such information. Around 10% of contacts were from women who have used abortion pills and have queries about the process, and a further 12% of contacts were from women who suspect they might be pregnant and are distressed because they would not want to be pregnant. 38% of contacts to FPAS were unrelated to abortion. People have been contacting FPAS for information on all types of contraception, including implants (8% of contacts), IUDs (9% of contacts), contraceptive pills (4% of all contacts), the vaginal ring (1% of all contacts), and morning after pills (8% of all contacts).
Abortion is happening in Malta, but the law makes it less safe. The number of people contacting FPAS for information on how to access abortion is similar to the number of abortion pill kits sent by the main provider of such medicine to Malta - Women on Web - which shipped 227 abortion pill kits in a 12 month period from March 2020 to March 2021. This means that hundreds of women in Malta manage their own abortions at home every year, a practice that is illegal although rarely prosecuted. Using abortion pills by oneself can be a frightening process, and these women in Malta cannot rely on the national health service to obtain guidance and advice. The roughly 3% who will need medical assistance after using abortion pills would have to present to hospital and hide the fact that they used abortion pills. This is the situation women self-managing their abortion in Malta face, and it is clearly not good enough. FPAS tries to help these women by providing information on what is normal and what may need further medical care, and such calls account for 10% of all our contacts. However, this can never be an adequate substitute for an abortion help service provided by the national health service.
People from all walks of life need abortions. FPAS takes calls from people in a wide variety of circumstances who need abortion for various reasons. These include mothers who recently gave birth and cannot afford another child, girls who are in education and are pregnant, women in abusive relationships who want to be free of their partners, and women with very much wanted pregnancies but have been given an adverse antenatal diagnosis. We have heard from all of these people and have learnt that there is not one reason to have an abortion that is more valid than others; all reasons are valid.
There is an unmet need for information on contraception and access to contraception. People in Malta should not have to rely on a helpline run by unpaid volunteers to get information on contraception and how to access it. This includes access to the morning after pill, which is still patchy in Malta due to conscientious objection by pharmacists. The state has a duty to ensure all people can access contraception, including emergency contraception, and there should be subsidy schemes to make contraception affordable or free. In Malta there are no subsidies and no government help to access contraception. This is clearly not good enough, and it is why around a third of all contacts with FPAS are about how to access contraception. Unfortunately, FPAS cannot fund contraception for those who cannot afford it, but we can signpost to other voluntary organisations that may be able to help.
For us and our Family Planning Advisory Service, this is only the beginning. We will continue to serve women in Malta who need information and access to reproductive services, and we will continue doing so until such a time the state decides to take responsibility for women's healthcare and makes us obsolete.
by Christopher Barbara
chris.barbara@doctorsforchoice.mt