Dalli left baffled as doctors propose further studies on morning-after pill

Civil liberties minister Helena Dalli lambasted as “illogical” a call by doctors to set up a committee to analyze whether to green light the importation of the morning-after pill.

“The contraceptive coil is already allowed in Malta and has the same effect as the pill, why should we ban the pill?” she asked family medicine professor Pierre Mallia. “This isn’t a question of opinion, but of fact, as much as the boiling point of water is. It’s a fact that doctors in Malta already prescribe the coil, so why should we even debate something that has the same effect? Our opinions are irrelevant here; setting up a committee would simply be a case of us running on the spot.”

Dalli was addressing a joint family, health and social affairs committee that has been convened for MPs to hear the view of experts on the morning-after pill. The topic was thrown onto the national agenda after the Women’s Rights Foundation filed a judicial protest to ensure the availability of emergency contraception in case of unprotected sexual intercourse.

However, Pierre Mallia as well as family doctors Jason Bonnici and Anthony Azzopardi said that a committee of experts should be convened to analyze the scientific literature on the morning-after pill and come up with recommendations to government.

Malta Medical Association (MAM) general secretary Martin Balzan also said that conflicting scientific literature exists on whether the pill is an abortifacient or not, with the latest studies indicating that it isn’t.

“No expert is going to stick his head out and say with absolute certainty that the pill doesn’t prevent implantation,” Jason Bonnici said. “Until we are certain that it can prevent implantation, it can be considered a contraceptive. However, there are some scenarios in which this may not be the case, and in this context a committee such as the bioethics advisory committee should evaluate the scientific evidence so as to avoid any future decision being based on personal opinion.”

Similarly, Pierre Vella said that a committee should evaluate the scientific evidence on the morning-after pill to weed out all the speculation, and hence cover doctors’ backs from being sued in court.

“I cannot understand how this small country makes a big fuss over a pill that has less of an effect than a coil that is already being marketed,” he admitted.

When Opposition MP Paula Mifsud Bonnici argued that scientific literature on the topic is conflicting, Mallia said that no double blind control studies have been carried out. Indeed, a study indicated that women in ovulation have identical pregnancy rates, regardless of whether they had taken emergency contraception or not.

“It would be easy to play it safe and stick with the current prohibition, but this study casts serious doubts on whether the pill can prevent implantation or not,” he said.

He sympathized with Helena Dalli’s logic but said that doctors need to feel more secure that a patient won’t be able to sue them for prescribing an abortifacient drug.

“The coil is based on preventive contraception, whereas the whole controversy about the pill is that it can prevent implantation.”

‘Don’t safeguard womens’ rights at the expense of the unborn’ – theology dean

Helena Dalli also appeared exasperated at arguments posed by the university’s dean Emmanuel Agius, who based his opposition to the pill on the “scientific fact” that life begins at conception.

“Life starts at fertilization and not at implantation, and we cannot safeguard womens’ rights at the expense of the most vulnerable [the unborn],” he said.

He dismissed an argument posed last week by Medicines Authority chief Prof. Anthony Serracino Inglott, that the product description for the Levonelle no longer includes a clause that states that it could prevent implantation of the egg in the womb.

That particular clause was used by Malta in 2006 to block the importation of Levonelle, despite its go-ahead by the medicines regulator.

However, Agius – who also has a seat on Malta’s National Bioethics Committee - said that Levonelle’s product description now states that it “acts mainly on ovulation”, hence not excluding the possibility that it could prevent implantation.

When quizzed by Opposition MP Michael Gonzi on how he joined the dots together, Agius urged the Maltese authorities to seek more information on the phrase.

“When an element of scientific doubt exists, we must always take our decisions in favour of life. If you shoot a gun at something moving behind a tree, you can’t then go to court and claim innocence because you had doubts that the moving object was a person.”

He insisted that the contraceptive coil is far less likely to prevent implantation than the morning-after pill, a comment that was instantly challenged by Dalli.

“No, no, no, that’s not true. The Medicines Authority chairman came here and stated otherwise. Who are you representing here? The bioethics committee? The Archbishop? Yourself?”

Agius responded that he was representing himself, but that the Church had a similar position on the pill.

Don’t forget the time factor, equality commissioner urges

Equality commissioner Renee Laiviera urged MPs to take into account the importance for women of taking the pill as quickly as possible, when deciding where the pill will be available from.

“The more time passes, the larger the element of doubt [that you could be getting pregnant] grows. What if the queues at health centres are long or a doctor isn’t immediately available?”

Here, Michael Gonzi – a doctor by profession – insisted that the importance of the personal relationship between doctor and patient cannot be underplayed, arguing that the MAP “is not a Panadol”.

Labour MP Deo Debattista questioned Laiviera whether the Equality Commission considers “women still in wombs as equal to women”, to which she retorted that it was not in her office’s remit to discuss the unborn.

The debate will continue on Wednesday evening, after which the MPs will draw up a formal report that they will present to Parliament.