Urgent: an updated sexual health policy | Nathalie Psaila

It is time for Malta to have a robust sexual health framework and protect its population from sexually transmitted infections and unexpected pregnancies with all their associated sequelae

In December of 2016, the morning-after pill (MAP) became available for purchase in Malta, after a judicial protest was filed by the Women’s Rights Foundation earlier that year. It seems incredible that the MAP - a medicine that could make a world of difference to a woman’s life – has been available to women in Malta for just four and a half years.

The debate started in 2016 and continues to this day, with anti-choicers insisting that the MAP is abortive. However, it’s easy to understand how the MAP could not possibly interrupt a pregnancy. The hormone inside the MAP delays the detachment of the egg from the ovary (ovulation). If ovulation has happened already, then it’s too late for the MAP to work. Once the egg becomes fertilised, it remains unharmed and the pregnancy proceeds as normal.

Before a medicine is launched on the market, it needs to go through several tests and checks by various authorities. The medicine is studied and researched thoroughly and a document called the Summary of Product Characteristics (SmPC) is drawn up. The SmPC must contain all details about the medicine, including any side effects it might give, as well as its mode of action.

Then, the medicine is submitted for close scrutiny by the European Medicine Agency, and later, if approved, by the Malta Medicines Authority. All three types of MAP available in Malta have had to go through this rigorous process. Their SmPC specifically states that the MAP is not abortive.

Yet, the MAP is not available for purchase from all pharmacies because of conscientiously objecting pharmacists. To make matters even worse, the MAP is not on the government formulary which means that women cannot buy it from the hospital pharmacy after hours. When it comes to improving the chances of the MAP working, it’s a race against time and nature since the pill must be taken before ovulation happens and within three to five days of intercourse, depending on the brand.

Through the Family Planning Advisory Service (FPAS) helpline and our Doctors for Choice Facebook page, we are frequently asked where women could reliably find the MAP, dispensed in a non-judgemental manner. It is good to know that no prescription is needed to buy the MAP, although pharmacists can and should ask the woman some relevant questions.

We’ve had several women complain that sometimes this is done in an insensitive manner and lacking in privacy. There have also been young people telling us that they’ve been refused the MAP because they’re under 18 in spite of the fact that it’s perfectly legal to dispense to 16-year girls and older, even though younger girls might need it too.

This is why Doctors for Choice have launched an online service where women can answer a few questions and request a prescription for the MAP which they can present to a pharmacy that stocks it – https://www.doctorsforchoice.mt/morning-after-pill-prescription.

The MAP is also called “emergency contraception” and nicknamed “Plan B” because it is used when a couple’s best attempt at contraception has failed for some reason. This could be due to a torn condom, a missed contraceptive pill or delay in re-inserting the vaginal ring. It’s also used by women who have been unfortunately raped. Contraception allows women to have control over their reproductive lives. They can plan when to focus on their studies or work to progress in their career, as well as decide when it’s time to have a baby.

Thanks to the dismal state of sexual health education in Malta and the firm grip of the Roman Catholic Church on the country, contraception is not used in a consistent manner among most couples. Young people are leaving school believing in myths such as that condoms interfere with pleasure during intercourse or that one could get cleaned in hospital after a rape. Studies have repeatedly shown that Malta has the highest rates of teenage pregnancies in the EU, coupled with low rates of contraceptive use. If we want to protect our children from having their lives derailed by an unexpected pregnancy, we must make sure that contraception is available widely and freely, and that a consistent and comprehensive sexual health curriculum is taught across all schools.

The number of women who contact Doctors for Choice asking for information about abortion pills and saying they are close to suicide if the pregnancy continues is heartbreaking. We must get at least one per week expressing these depressingly sad thoughts. It’s particularly poignant knowing that with better sexual health education or improved availability of contraception, there’s the possibility that these women would not have needed an abortion. In fact, research shows that countries that offer freely available contraception and provide sound sexual health education have lower abortion rates.

It is time for Malta to have a robust sexual health framework and protect its population from sexually transmitted infections and unexpected pregnancies with all their associated sequelae. This country is begging for an updated sexual health programme to be taught in all schools, the availability of different forms of contraception on the government formulary for free, and family planning clinics in different areas. It’s also high time to remove barriers to the availability of emergency contraception and provide access to abortion healthcare as needed.

Doctors for Choice is willing to help out wherever necessary and invites the government to discussions on the way forward.