The need to travel to access safe abortion has always been a barrier to women in Malta. The current travel restrictions, required to control the COVID-19 pandemic, further highlight the fact that Malta's reproductive health care is lacking in this regard. Unfortunately, during this difficult time women in Malta are less able to access abortion abroad, which is the only means to legally get an abortion. The longer the travel restrictions last, the more likely and the greater the number of women affected. It is very well known that denying women safe abortion services does not reduce the number of abortions but rather results in higher rates of unsafe abortions. Therefore, we are deeply concerned since the current situation puts pregnant people in Malta in an even more vulnerable situation. We are aware of a woman who couldn’t travel from Belfast to England for an abortion because of the COVID-19 situation, and subsequently attempted suicide. Women in Malta are no different to women elsewhere and have the same needs to essential health care.
Previous estimates already suggest that around 200 women in Malta purchase abortion pills online every year. The current status of affairs will result in an even greater number of women ordering and using medical abortion pills to get an abortion. Some of those who can financially afford travelling and would have otherwise travelled to get an abortion to get the procedure done within legal remits, will now resort to ordering the pills as their hands are tied; even more so than they were previously. So the distinction between the rich and the poor in this regard is now somewhat blurred. Except for those who are very poor and will always inevitably suffer without the support of the state.
Ordering pills always causes a delay, but now there is likely to be an even bigger delay in post due to the current situation. It is important to point out that although the medical abortion pills are generally medically safe to be used by most women, there are those who cannot use this method of termination and rely on the services of abortion clinics abroad (which are now inaccessible), either because of specific health contraindications (such as blood disorders, etc.) or because of the stage of the pregnancy.
The situation is further exacerbated as the COVID-19 measures have led to women locked-down and trapped with abusive partners. Women who are stuck in this situation are ending up with unwanted pregnancies as a result of rape within their own homes. A particular case involved a woman who was unable to buy her usual contraception, was raped by her abusive partner and ended up pregnant. Faced with such cases, doctors in Malta can refer these women to Abortion Support Network (ASN) for guidance, but feel somewhat helpless and worry that these women could self-harm.
As Doctors for Choice Malta we have had an increase in the number of women seeking help and we do refer to ASN. ASN has already revealed that the number of women contacting them for help from Malta has markedly increased during the COVID-19 pandemic.
Our position as Doctors for Choice Malta is in line with that of the Royal College of Obstetricians and Gynaecologists (RCOG): “Abortion care is an essential part of healthcare for women, and services must be available even where non-urgent or elective services are suspended. Abortion is time-sensitive, and services should be organised to provide care as early as possible.”
The RCOG in the UK published information for women who are seeking abortion and guidelines for health care professionals who need to care for women seeking abortion during the pandemic (published 21 March 2020). The UK government made urgent considerations to address reproductive health needs and approved home-use of medical abortion pills which can be taken following telemedicine consultations. Meanwhile, not only does Malta's government and health authorities remain oblivious to the difficulties and negative consequences of lack of abortion access, but the reaction by many to advocacy such as our own remains hostile.
We recognise that there are many different challenges during this time, including health and socio-economic issues. At Doctors for Choice Malta we are all practicing doctors experiencing the global strain on the healthcare system. However, this matter demands attention. If Malta’s medical and government authorities continue to ignore the fact that lack of abortion access leads to poor public health outcomes, then the repercussion can be devastating.
By Dr Gilbert Gravino - Doctor for Choice Malta