Aborting misconceptions | Lara Dimitrijevic

Perceptions can be dangerously misleading at times. And there can be little doubt that popular perceptions surrounding the ‘morning-after pill’ – and emergency contraception in general – are somewhat on the negative side in Malta.

This can be attested by public reactions to the fact that a women’s rights organisation this week filed a judicial protest to overturn an apparent ‘ban’. Inevitably, the sternest resistance to this proposal comes from the pro-life lobby. The Gift of Life Foundation lost no time in branding the judicial protest as part of a conspiracy to ‘introduce abortion by stealth’; whereas another pro-life group, ‘Women For Life’ added that Malta would be ‘promoting rape’ by making emergency contraception available to women. 

This is to an extent consistent with the same lobby’s very vocal views on all areas touching on female reproductive rights. But on this occasion, similar doubts were expressed also by former Health Minister Godfrey Farrugia: who likewise insisted in parliament that the morning-after pill is ‘abortifacient’.

This view is hotly contested by the WRF, which argues that this is an issue about basic women’s rights, and has nothing to do with abortion.

Clearly, there are a good deal of conceptions and misconceptions flying about here. As chairperson of the group, Lara Dimitrijevic both signed and presented the protest on behalf of another 102 Maltese women… and therefore may be able to clarify at least one side of the argument for us.

Is the morning-after pill abortifacient, or not? And what, exactly, is the purpose of the judicial protest to begin with?

“Let’s start off with the fact that we are not talking about a ‘ban’ here,” she begins in her legal office in Valletta. “There is no ban on the morning-after pill in Malta. The situation is simply that the pill has not been licensed by the health authorities. It was an administrative decision not to issue a licence for emergency contraception… and as such, not the result of any prohibition at law. The point of our judicial protest was to challenge this decision, which we feel breaches women’s most basic rights…”

Why a judicial protest, though? Why not an outright court case to overturn the decision? And for that matter: why go directly to court, and not (as other voluntary groups often do when lobbying for change) approach the government with a view to convincing it to change policy?

“Given that we are bringing to attention a breach of human rights, we considered a judicial protest to be more appropriate than taking to the streets, or lobbying with the government. It was an administrative decision, and we are challenging it administratively. We believe this decision breaches the fundamental rights of women, enshrined by a number of international treaties that Malta has itself signed and ratified. Namely, the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)….”

On closer scrutiny, the convention cited by Dimitrijevic turns out to be rather specific on the issue of emergency contraception… and especially the obligation of all signatory governments (Malta included) to make it available in their respective countries.

Article 10h even states that: “It is discriminatory for a State party to refuse to legally provide for the performance of certain reproductive health services for women”

Of arguably greater relevance to the local issue is the fact that the UN Committee overseeing the implementation of this convention has separately condemned the Philippines for disallowing the morning-after pill. Its ruling observed that that Filipino women “bore the consequences of and were disproportionately disadvantaged by the inability to access and use the full range of reproductive health services, including modern methods of contraception.” 

“Yes, that is why this is ultimately an issue of human rights, Dimitrijevic continues. “And we feel that, in order to protect one’s rights, one has to go to the law-courts. We did this by filing a judicial protest… not a court case, as some have mistakenly described it. We are not asking for a ruling from the courts. This is simply an administrative procedure to make our request known. The protest was separately addressed to the Ministry of Health, the Ministry for Social Dialogue, and the Attorney General… who naturally has to be copied in to any request concerning any legislative changes. 

Now that the protest has been filed, what sort of response – if any – is she expecting? And has any been received to date?

“So far, no. We haven’t heard anything in the way of official feedback yet. Technically the government entities we addressed all have the right to reply if they wish. But there is no legal obligation for them to do so. This is more a case of us standing firm on the point that we feel our rights are being breached. Through the judicial protest, we are both asserting our own position, and placing the authorities ‘in mora’ [that is to say, in a position where the onus of reply lies with them].”

Fair enough, but that doesn’t give any indication of what WRF’s expectations are on a realistic level… 

“Ideally, we expect the change to happen. The ball is now in the government’s court; it is up to the government to see what it wants to do about the situation. We will wait and see what its response is, before deciding to take the matter any further…”

At the same time, the request itself is to overturn a (seemingly arbitrary) decision not to license a single pharmaceutical product. Is it really as simple as that, though? Does the requested change necessitate any change to Malta’s legislation?

“No, the law does not come into the equation, because the morning-after pill itself is not illegal. Nor is it abortifacient, which would be the only reason for any law against it in the first place…”

Yet there seem to be contrasting views on that point. The pro-life lobby clearly disagrees, and enjoys the support of a former health minister…. 

“Yes, but in matters such as this decisions shouldn’t be taken on the basis of individual views. This is a scientific issue, and should be based on what science says on the subject. The simple truth is that emergency contraception does not induce abortion…”

How does she account for the controversy, then?

“It all boils down to what you consider a pregnancy. That is the crux of the matter. The scientific definition is clear, but what causes the controversy is the amount of misinformation and scaremongering surrounding the issue. Some people are creating their own definitions. Naturally, everyone has a right to their own moral definitions, and base their own personal decisions on those convictions. That’s perfectly fine. But we are talking about scientific definitions here. Our point is that decisions such as licensing a contraceptive pill should be taken on the basis of fact, not moral opinions…”

But if science is so clear on this point, why is there so much resistance to licensing this pill in the first place?

“A lot of it has to do with misconceptions regarding what the morning-after pill really is, and what it does. It is partly based on outdated information going back to the 1970s, when the morning-after pill was first introduced. At the time, the oral contraceptive pill contained very high hormonal content, which proved harmful to women. The dose was reduced, and this gave rise to what became known as the ‘third way’ (of a three-way action): the thinning of the uterus lining, which prevented fertilised eggs from being implanted…”

Some 40 years ago, then, there may have been some truth to the claim that MAP was ‘abortifacient’. But the pill itself has been modified over years of clinical testing since then, she adds.

“The most recent research, carried out by Princeton University (March 2016) shows that there is no evidence that the morning-after pill has any effect at all post-fertilisation. It does not thin the uterus lining, or prevent implantation from taking place. These findings have been endorsed by the World Health Organisation, the International Federation of Gynaecology and Obstetrics, and the European Health Authority. Ironically, other forms of hormonal contraception that are freely available in Malta have more of a chance of inducing an abortion than the morning-after pill…”

Interestingly, the same ‘abortifacient’ effect can even be induced by entirely natural activities. “Such as breastfeeding, for instance. That can thin the uterus lining, too. So what do we do? Ban breastfeeding, because it might be ‘abortifacient’…?”

Dimitrijevic also hints that there may be an ideological driving force behind the authorities’ insistence on maintaining such an outdated view.

“On the government’s sexual health promotion website, until yesterday it stated that emergency contraception was unlicensed in Malta, and the reason it gave was because, ‘according to the Catholic Church’ – or words to that effect – the morning-after pill is abortifacient. Strangely, that has been removed since yesterday; and there is now a new version which does not refer to the Church, but which echoes the same line that it is ‘abortifacient’ from an ‘ethical’ point of view. And also that it is ‘illegal’…”

Both statements, she adds, are highly problematic.

“When discussing people’s rights, you cannot impose morality. Human rights cannot be made subject to personal ethical interpretations. And I think people are ready for this. We saw this, up to a point, with the divorce referendum. People are tired of having moral choices imposed on them. They want to move on.   

It is the second assertion, however, that Dimitrijevic finds more objectionable.

“I invite the health department to tell us where, exactly, it transpires that emergency contraception is illegal in Malta. We contest that view.”