What if our Family Planning Advisory Service did not exist?

Well, just one year ago it didn’t. Three NGOs, Doctors for Choice together with the Women’s Rights Foundation and Women For Women set out to redress a gaping void in the provision of information about sexual and reproductive health. Until a year ago, if women, girls, men or boys wanted information about contraception, sexual health, the morning after pill, or access to abortion services, they would have had to either show up at the local health centre and hope to find a listening ear, or pay for a private consultation with their trusted family doctor or gynaecologist. In the case of abortion, they would have been lucky not to be shown the door as soon as the word is uttered.

After months of increasing number of people contacting us for information on our Facebook pages, we decided to do something about it. We issued a call for volunteers, prepared a detailed handbook, organised training, set up the IT infrastructure and launched the Family Planning Advisory Service (FPAS) in August one year ago. In the past 12 months we have been contacted by 479 different people for information and support. FPAS is not a hotline, it’s a helpline, so people can either send us an email, chat with us online or make a call. We try to respond within a few hours. We answer all manner of questions and link callers with the services that they ask for, including if requested, abortion services.

We have recently completed an audit of the last 100 client chats relating to sexual and reproductive health. As expected, the majority of our callers requested information about the provision of abortion (40%), and a further 10% related to post abortion medical questions such as possible side-effects after Mifepristone or after having had a surgical abortion abroad. If FPAS did not exist, these questions would have remained mostly unanswered, as there are very few openly pro-choice doctors. That is 50 women and girls worrying unnecessarily about having an abortion when a quick chat with trained volunteers supported by medical doctors can put their mind at rest.

About one fifth of our chats related to contraception advice including the pill (4%), the intrauterine device (9%), implant (5%), or vaginal ring (1%). Perhaps this is not surprising considering the dismal state of our sexual and reproductive health care system.

But this is not right: your sister, niece, cousin, friend, possibly even your mother, is looking to FPAS for advice about contraception. This service should be readily available from any polyclinic, free of charge.

You may be thinking that these clients are simply trying to obtain a free service from FPAS. While there may be some truth to that, our health system already provides a free service led by specialists in Family Medicine at the local polyclinics. So, why are these persons not reaching out to the existing healthcare system? Is FPAS convenient, welcoming and fast? Yes it is, but so could be the public service.

A further 8% of our chats with clients concerned how to access the morning after pill. We find this surprising considering that this should be available without a prescription from any pharmacy. The fact that women and girls reach out to us for this information because they have difficulty buying emergency contraception would suggest that the community pharmacy system is not providing an adequate service to people who require timely access to morning after pills.

The next most common request for information (12%) is along the lines of “could I be pregnant?” These clients have no idea whether they could be pregnant and have not yet had a positive pregnancy test. This is truly an indictment of our school-based sexual education system. Surely every girl who leaves Year 12 in our school system should know that a urine pregnancy test can confirm a pregnancy a few days before the missed period, provided the menstrual cycle is regular. Women and girls should know that the length of pregnancy is calculated from the first day of the last period, and not as some of our clients seem to think, from when the pregnancy test is positive or from the day of the missed period.

The first 12 months of FPAS services has shown us that trained volunteers supported by a couple of medical doctors can respond to hundreds of messages covering a variety of concerns per year. Imagine what could be done with a few more volunteers!

We don’t charge for this service but donations are welcome. FPAS can be contacted for help through online chat at www.fpas.mt or by calling 27780037.

Prof. Isabel Stabile and Dr Chris Barbara are members of Doctors For Choice