Criminalising abortion creates ‘chilling effect’ on healthcare providers

It is about safe medical practice, because abortion is healthcare. This issue demands empathy and solutions that are grounded in respect. Beliefs should not jeopardise patient care

The National Patient’s Charter, launched in 2016, sets out the key rights and responsibilities of people receiving care within the Maltese health care system for the provision of safe, high quality care. It is structured around eight principles that form the foundation for an equitable healthcare service.

These rights and responsibilities explicitly define what users and healthcare providers within the Public Health Service can expect. For example, the Charter gives each of us the right “to receive all the information about his/her medical condition”; “to get support and enough information to participate in the management of one’s condition”; “to participate and discuss ethical matters that may arise in the course of one’s care”; “to be treated as an individual, one should expect that healthcare providers demonstrate dignity, patience, empathy, tolerance and courtesy”. Nothing could be further from the truth when it comes to the way some doctors and pharmacists respond when women try to access contraception or the morning-after pill in Malta.

Although the Charter focuses on a patient-centred approach and promotes patient participation in decision-making, it is also completely at odds with what is currently happening in Malta when it comes to women seeking help for an unexpected pregnancy. Some of my colleagues refuse to provide any information about the healthcare options available to women who do not wish to continue with their pregnancy. Not informing women that medical abortion at home is a safe procedure until 12 weeks of pregnancy is a dereliction of duty. Equally negligent is failing to provide information about parenting and adoption as options in these circumstances.

Women need their doctors to respect their wishes, and if that includes a decision to end a pregnancy, then we are obliged to provide all the necessary information to do so. Sadly, medical students in Malta are still being told not to mention the A word as it is illegal to do so. This is nonsense. The way the law stands at the moment, it is perfectly legal for doctors to provide information about abortion. We do this at the Family Planning Advisory Service (27780037; 20341686) almost daily through calls, chats and messages with women in Malta who are desperate for unbiased information about all their options. My pro-choice colleagues and I do the same in our clinics. Our own Patient Charter demands that we do so.

As expected, the law criminalising women who have abortions does the same for doctors who carry them out. Presumably this is meant to be a deterrent: do not open surgical abortion clinics in Malta! To the best of my knowledge, there are none, so this may not sound like an issue at all. But in reality it is, because approximately 300-400 women each year order medical abortion pills online, and take them at home.

Many doctors in Malta are worried about providing abortion-related information, even when it is legal to do so. This leads to delays in receiving accurate information and can lead to the ‘chilling effect’ in women who may worry about medical abortion-related complications as well as potential legal repercussions, such as being reported to the police if they seek post-abortion care.

Let’s be perfectly clear about this. Not providing women having an abortion with any medical guidance, if needed, is poor medical practice. Fortunately, abortion with pills is a very safe procedure. Nevertheless, problems such as heavy bleeding requiring medical assistance are possible. In these cases, we suggest women go to hospital to be assessed. But women in Malta are terrified of this. They fear being reported, so they will not disclose they have taken abortion pills. This means that the doctors taking care of them are not given the full clinical picture that they need to provide effective health care.

It is not widely known that reporting to the police is at the discretion of the medical practitioner. Doctors are not obliged to report but to provide information if so requested to by the court. But most women do not know this, and in any case, since reporting is at the discretion of the doctor, there is no guarantee that any particular doctor might not pick up the phone and make the report.

This is why decriminalisation of abortion is so important. People who need and have abortions must be able to have open discussions with family, friends, and their doctor without the fear of criminal punishment.

Regardless of the risk of imprisonment, women in Malta are deliberately breaking the law, making them criminals for accessing health services available to practically any other woman in Europe. In case you are wondering whether this actually happens, yes it does. In 2006, a 23-year-old Maltese woman was sentenced to three years’ probation, and in 2014, a 30-year-old woman received two years’ jail, suspended for four years. Another 28-year-old woman was sentenced to 18 months, suspended for two years. These women now have a criminal record.

It is encouraging that in the recent survey published in this paper, a majority of people in Malta, and around two-thirds of those under 35, are against criminalising women who have abortions. However, the reality is that the fear of being criminally charged will make some women very reluctant to seek the medical help or psychosocial support they might need.

The law as it currently stands also prevents doctors from providing the best possible care for their patients. Indeed, the recent survey published in this paper showed that when it comes to abortion, the Maltese public are less lenient with professionals than they are with women. Only 30% disagreed that doctors should be imprisoned for assisting women to have an abortion. This figure doubles from 22% to 48% between those with secondary and tertiary education, and is highest among 18-35 year-olds (52%) and those who did not vote in the last election (45%).

All women, and especially the most vulnerable ones, need their doctors to provide safe, compassionate care, whether they intend to continue with their pregnancy or not. Decriminalising doctors who support women having abortions has absolutely nothing to do with being pro-life or pro-choice. It is about safe medical practice, because abortion is healthcare. This issue demands empathy and solutions that are grounded in respect. Beliefs should not jeopardise patient care.