Student Knowledge, Behaviour and Attitudes towards Abortion in Malta

Isabel Stabile, Natalie Psaila Stabile

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Aim: To explore the views of students enrolled at the University of Malta (in collaboration with KSU) and MCAST regarding abortion in Malta. The study was approved by the respective institutions’ Research Ethics Committees.

Study Design and Participants: The anonymous questionnaire, along with a recruitment letter, explaining the aims and ethical approval for the study, were distributed between September 2021 and July 2022 to students above the age of 18 who were current University of Malta (UM) or MCAST students in academic year 2021/2022. Distribution took place electronically as a google form via the mailing list and in the case of UM also on the social media platforms of KSU. QR codes linked to the google form were also distributed manually on campus wherever students were gathered. 

The Questionnaire: In addition to demographic information, the questionnaire covered the faculty where the student was enrolled,  followed by questions about general knowledge of abortion, such as whether medical abortion using abortion pills can be carried out safely in the first 12 weeks of pregnancy. In the next section, respondents were asked about their personal beliefs regarding abortion, such as whether women who access abortion, whatever the circumstances, should face criminal proceedings. In the third section, respondents were asked for their opinions about circumstances in which abortion should be made legal. In each case, where participants agreed with legalisation, they were asked to specify up to which gestational age they thought this should be allowed. These gestational age limits were selected for the purpose of the survey on the basis that in EU countries, 12 weeks is the upper limit in most circumstances and 24 weeks is the highest limit. In other specific circumstances, abortion is legal at any stage in the pregnancy within some EU countries (e.g. to preserve physical health, in cases of fetal impairment). Ref: WHO (World Health Organisation). Global abortion policies database [Internet]. 2019. Available from: https://abortion-policies.srhr.org.

In the next section respondents were asked their opinion regarding education about abortion such as whether healthcare students should receive more training about abortion. In the final section respondents were asked whether they would provide abortion-related clinical services in their future practice if abortion were to be legal in Malta (applicable only to medical and healthcare students). 

Results

A.            Demographics

Gender	UM (n)	MCAST (n)	UM (%)	MCAST (%)	Total (n)	Total (%)
Female	556	166	68.4	63.6	722	67.2
Male	244	88	30.0	33.7	332	30.9
Other	8	2	1.0	0.8	10	0.9
Non binary	4	2	0.5	0.8	6	0.6
Would rather not say	1	3	0.1	1.1	4	0.4
Total	813	261	100	100	1074	100

Marital status	UM (n)	MCAST (n)	UM (%)	MCAST (%)
Single	466	131	57.3	50.2
Married	29	30	3.6	11.5
Relationship living apart	260	76	32.0	29.1
Live with partner	53	21	6.5	8.0
Would rather not say	5	3	0.6	1.1
Total	813	261	100	100

Religion	UM (n)	MCAST (n)	UM (%)	MCAST (%)
Catholic	424	109	52.2	41.8
Atheist/Agnostic	283	92	34.8	35.2
Other Christian	26	16	3.2	6.1
Islam	16	11	2.0	4.2
Other	23	11	2.8	4.2
Jewish	3	1	0.4	0.4
Hindu	3	2	0.4	0.8
Buddhist	1	0	0.1	0.0
Would rather not say	34	19	4.2	7.3
Total	813	261	100	100

How important is religion in your life?	UM (n)	MCAST (n)	UM (%)	MCAST (%)
Not applicable	135	48	16.6	18.4
Not important	412	119	50.7	45.6
Important	195	58	24.0	22.2
Very important	52	26	6.4	10.0
Would rather not say	19	10	2.3	3.8
Total	813	261	100	100

Are you working?	UM (n)	MCAST (n)	UM (%)	MCAST (%)
Part time	331	110	40.7	42.1
Full time	57	53	7.0	20.3
No	418	94	51.4	36.0
Would rather not say	7	4	0.9	1.5
Total	813	261	100	100

Are you a parent?	UM (n)	MCAST (n)	UM (%)	MCAST (%)
No	782	216	96.2	82.8
Yes	30	40	3.7	15.3
Would rather not say	1	4	0.1	1.5
Pregnant	0	1	0.0	0.4
Total	813	261	100	100

B.            Knowledge About Abortion

Knowledge Questions	Correct	Incorrect	Incorrect & Don’t Know
	UM (%)	MCAST (%)	UM (%)	MCAST (%)	UM (%)	MCAST (%)
More than 90% of abortions in the UK occur within the first 13 weeks of pregnancy.	55.0	39.0	3.0	1.0	45.0	61
Medical abortion using abortion pills can be carried out safely in the first 12 weeks of pregnancy.	62	53	11	9	3	47
A fatal fetal anomaly means the fetus will die in the womb, during delivery or shortly after birth.	66	51	6	7	34	49
A Maltese woman who accesses abortion services abroad can be criminally prosecuted in Malta.	30	24	49	46	69	76
Women generally regret having an abortion and suffer psychological consequences.	49	31	28	38	52	69
It is illegal for any professionals in Malta to provide information about abortion services.	23	20	51	48	77	80
The current costs for a woman seeking an abortion abroad can be up to 2000 EUR.	47	35	6	6	53	65
Legalising abortion will increase the number of women seeking abortion.	62	40	28	43	38	60
In countries where effective contraceptive methods are available and widely used, the total abortion rate decreases.	8	9	7	64	93	91

C. Personal Beliefs About Abortion

Beliefs	UM SA+A (n)	MCAST SA+A (n)	UM Neither (n)	MCAST Neither (n)	UM D+SD (n)	MCAST D+SD (n)
The punishment of up to three years imprisonment for a woman who has an abortion should be removed from the criminal law	769	188	40	20	84	53
A total abortion ban leads to potentially unsafe abortion practices	718	208	45	31	50	22
A total abortion ban discriminates between those women who can access safe and legal abortion abroad, and those who cannot	654	181	85	43	74	37
Abortion is an affront to women who cannot have children or have suffered miscarriages	129	49	131	60	553	152
It is possible to be personally opposed to abortion and be pro-choice	594	158	121	53	98	50
Women who access abortion, whatever the circumstances, should face criminal proceedings	50	27	60	28	703	206
Abortion is like taking a life because life begins at conception	202	76	134	38	477	147
Comprehensive sexual education, including information about the availability of contraception, should be available in all secondary schools	789	232	18	15	6	14
Having or performing abortions under any circumstances goes against my personal religious beliefs	177	60	108	33	528	168
The punishment of up to four years imprisonment for healthcare professionals who assist a woman to have an abortion should be removed from the criminal law	645	179	68	23	100	59

SA – Strongly Agree

A – Agree

D – Disagree

SD – Strongly Disagree

D. Attitudes Towards Gestational Age Limits

Reasons for Abortion	All Stages UM (n)	All Stages MCAST (n)	Up to 24 wks UM (n)	Up to 24 wks MCAST (n)	Up to 12 wks UM (n)	Up to 12 wks MCAST (n)	Never UM (n)	Never MCAST (n)	Not Sure UM (n)	Not Sure MCAST (n)
If a woman’s life is in danger	642	170	40	13	40	30	26	18	65	30
In case of rape or incest	343	107	132	43	179	51	92	36	67	24
In case of non-viable fetal anomalies e.g., anencephaly	460	124	77	22	76	30	92	38	108	47
In case of viable fetal anomalies e.g. Down's Syndrome	156	59	107	32	135	38	290	96	125	36
To preserve a woman’s physical health e.g., serious heart disease or cancer	504	134	83	26	81	28	48	33	97	40
To preserve a woman’s mental health	293	81	111	33	156	48	138	57	115	42
For economic or social reasons	174	57	96	25	236	56	219	93	88	30
On request (no need for the pregnant person to register a reason)	144	52	97	22	229	54	272	93	71	40

E. Training & Service Provision

UM Students: Do you think healthcare students should receive more training in terms of:

	Strongly agree	Agree	Neither	Disagree	Strongly Disagree
General knowledge on abortion?	622	124	37	19	11
Medical abortion techniques and complications?	564	133	62	22	32
Surgical abortion techniques and complications?	535	129	74	30	45
Pre- and post-abortion medical counselling?	630	111	39	16	17

MCAST Students: Do you think healthcare students should receive more training in terms of:

	Strongly agree	Agree	Neither	Disagree	Strongly Disagree
General knowledge on abortion?	168	49	30	3	11
Medical abortion techniques and complications?	159	46	35	6	15
Surgical abortion techniques and complications?	150	46	41	10	14
Pre- and post-abortion medical counselling?	178	37	27	6	13