‘We are here, and we are not going away’ | Andrea Dibben

On Saturday, Malta’s emerging pro-choice lobby group held its first-ever rally to mark ‘International Safe Abortion Day’. ANDREA DIBBEN, of ‘Voice For Choice’ outlines why Malta’s total abortion ban, in all circumstances, poses a health risk to women

andrea dibben
andrea dibben

When Voice For Choice announced that it would be holding a pro-choice rally in Valletta, the response by one pro-life organisation was to organise a counter-protest in the same place, on the same day. It is widely known that their cause is more popular than your own. Isn’t there a danger, then, that Saturday’s rally will only expose the pro-choice lobby as a microscopic community that can be easily ignored?

When we launched Voice for Choice, it was in our manifesto that we would commemorate International Safe Abortion Day every year. This is an occasion where pro-choice rallies, activities and marches take place in countries all over the world. In Malta, it has never been commemorated. So… if the turn-out is one person, 20 people or 30 people… it doesn’t really matter. The message remains the same. ‘We are here, and we are not going away’. In any case, we have always said that this is not about the opinion of the majority. This is about rights; it’s about health; it’s about experiences woman go through in difficult circumstances. In fact, the main aim of the rally is to raise awareness of the challenges that women in Malta face; and to try to challenge the stigma and the taboo surrounding this issue, so that these women will know that we are supporting them…

When you say ‘these women’… do you mean Maltese women who have had abortions overseas?

Yes, but also women who have had harrowing experiences because of the lack of safe abortion in Malta. And in theory, that can apply to all Maltese women… because all women can find themselves in these circumstances.

According to statistics released by Voices for Choice, around 300-400 Maltese women seek abortions overseas each year. That is considerably higher than any previous estimate I’ve seen. How accurate are those figures?

It is an estimate based on official statistics that we have, and also online statistics for medical abortificients in other countries. In the last five years, 600 Maltese women have bought medical abortion pills online in teh past five years from just one website, and the number is increasing to around 200 a year in the past year. An average of 60 go to the UK every yer and we know that many others go to other countries where we don't have specific numbers. We do know, however, that hundreds more have gone to other countries for the same reason. We also receive stories from people saying, ‘I went to the Netherlands’… or to Italy, Spain, Greece, Portugal. Belgium… even to Poland, of all places. So, our estimate is conservative 300-400 women travelling for abortions every year, based on all these indicators; but that doesn’t take into account the cases we do not know about. Like the case that emerged this week, of a Maltese-Canadian woman who, five years ago, was denied emergency termination of her pregnancy by the local hospital, even though there was a risk to her life…

Before turning to the details of that case: how typical is it of the local situation? Is this something your organisation hears of often?

The worrying thing is that… we don’t know, and we can’t know, because there are no official statistics. In fact, that was our immediate reaction. We want to know what is happening at Mater Dei. We need answers. Actually, we are hoping that journalists investigate further, because we are limited as to how far we can investigate ourselves. I, for one, was expecting Mater Dei to come out with a statement… that the authorities would comment officially on the matter. But, as for how widespread this sort of thing is… ever since Doctors For Choice came out in public, there have been similar cases reported.  So I suspect that this one is actually the tip of an iceberg…

Let’s talk about that case itself.  What actually happened?

I didn’t speak to the woman in question myself, nor did I work on the story. But from what was reported… and also from the comments by her family, who are now speaking out publicly… my understanding is that she was here on holiday, to visit her Maltese relatives; she was 17 weeks pregnant, with every intention to have the baby… but her waters broke while she was on a bus. Obviously, she went to hospital; first they thought they could potentially save the pregnancy… but then, infection set in. Apparently – because this is all according to her story – the hospital staff withheld information from her until her husband flew in from Canada. Meanwhile, the situation kept deteriorating; she developed high fever; she did not respond to antibiotics… and at some point, she was told that the foetus was not viable, the way things were developing. But the foetal heartbeat was still there… although getting weaker. And as long as there was a foetal heartbeat, and she herself was not on the brink of death… legally, the doctors could not do anything.

My understanding is that the Canadian consulate got involved, and she was eventually airlifted to a hospital in Paris…

The Canadian consulate got involved, and the family even wrote to the Prime Minister, the health minister, etc. But it was her travel insurance policy that got her evacuated. She was lucky enough to have a good insurance policy that covered such cases. Otherwise, she could very easily have died here… like Savita Halappanavar, who died in almost identical circumstances in Ireland in 2012. In fact, the only difference between the two cases is that one – Savita – developed sepsis, and died. The other didn’t… but bear in mind that she had dual nationality, and the means to procure alternative medical help. Other women in the same circumstances might not be so lucky.

The Savita Halappanavar case also prompted a change in the Irish Constitution to allow for emergency terminations. This is something Malta’s pro-choice has been lobbying for from the start: access to safe abortions in four specific circumstances, including health-risks to the mother. But it has been argued that Malta’s actual legal framework does allow for emergency terminations in such cases. Would you say this incident proves that argument wrong?

Well, what this case tells us is that… yes, the law can allow for emergency terminations, but only when the mother is on the very brink of death. If the woman did reach that critical stage at Mater Dei – as she very well might have, had she remained a patient there – then yes, the doctors would have eventually been able to intervene. But not before. Now: if I were a patient in those circumstances, and had been just been told that my pregnancy was unviable anyway… I wouldn’t want to risk it. I wouldn’t want to have to wait until infection sets in, or until I was at the point of death, for doctors to try and save my life. So, what this case also shows us, is the urgency for a legal reform to allow for interventions much sooner in such cases. And this is what we – and also Doctors for Choice, among others – have been arguing from day one. At the launch of Voices for Choice, for instance, we held a panel discussion. One of the speakers was a gynaecologist, and he was asked specifically if there were cases where the ‘double effect’ principle does not apply. He said there was one specific instance – i.e., where the membrane gets ruptured: which is exactly what happened in this case – where it doesn’t work. In such cases, he said, a team of consultants would be called in to decide when, or to what extent, to intervene.  And the decision very much depends on whoever leads this team of consultants: some take a very direct approach, others are more conservative, etc. But when asked how often this happens, he replied: ‘Oh, not very often. It’s quite rare. We have around three or four cases a year’… [Pause] For me, that’s not ‘very rare’ at all. Not in a country the size of Malta, anyway…

What that also suggests is that there must be other cases where women’s lives are put at risk by unviable pregnancies… but we don’t know about them, because they don’t speak up, and neither do doctors…

[Nodding] At this point, I am questioning everything. I’m not saying ‘there have been deaths’… but I don’t know for sure. There are, after all, maternal deaths in Malta… are they properly investigated, to determine whether the death could have been prevented through emergency abortion? Because what we have also found out through this case is that, unless the family knows exactly what’s going on, and are ready to speak up about it… nobody else is going to. We would never know. So this, for me, is a big question mark right now…

Coming back to Saturday’s rally: as you said, it’s the first of its kind, in a country where the stigma associated with abortion is still quite strong. Realistically, how many people are you expecting to show up?

On the Facebook event page, there are around 180 marked as ‘going’, and some 418 marked ‘interested’. But we shall have to wait and see. I think that there is an element of fear that may hold people back…

Because of the counter-rally, you mean?

Yes. We’ve been receiving messages and comments asking whether it would be ‘safe’ to attend… warnings to ‘be careful’… or ‘not to take children’… and on the other side of the coin, we have also seen and received intimidating messages and comments. This is part of what the whole rally is about: we cannot have a civil discussion on the issue, in an atmosphere of fear and intimidation…

Do you consider the counter-rally itself to be a form of intimidation?

Let me put it this way: I can’t be sure of their motivations. I don’t know if they planned it to be an act of intimidation. But personally, I do not interpret it that way myself. To be honest, I expected there to be a counter-march: there was one even with the LGBTiQ pride march last week… and this [abortion] is the most controversial issue there is. So obviously, there was going to be a reaction. And they have a right to voice their opinion, just like we do. I do, however, think it was unwise for them to organise their march on the same day, at the same place and time. But the authorities granted them a permit, according to an article I read in the papers yesterday…

Well, it would difficult to justify granting a permit to one group, but not the other…

But usually, precautions are taken to avoid possible confrontations. In fact, according to the same article, there were ‘conditions’ attached to the permit. I haven’t seen these conditions yet, but I imagine they will be along the lines that, ‘you keep to your space, they keep to theirs’. Another thing to bear in mind is that this counter-rally is not organised by the ‘official’ pro-life organisations: like Life Network Malta, or the Gift of Life Foundation. Those organise their one annual rally, around December… but we haven’t seen any statements or comments from their end. The counter-rally is basically being organised by Ivan Grech Mintoff, and the Facebook group, ‘Abortion, Not In My Name’… and… let’s face it, the last rally he organised attracted just 30 people. For this one, the Facebook event page so far has just three people marked ‘going’, and around 11 ‘interested’…

But that is surely not a reflection of the actual lie of the land. People might not flock to a rally organised by Ivan Grech Mintoff… but it doesn’t mean they’ve changed their opinion about abortion…

No, and in fact that is another reason why numbers are not necessarily against us in this equation. If our rally is attended by 50 people, and they get 5,000… we would still be more successful. Because in a country that Is 95% pro-life, the 50 who attended the pro-choice rally are proportionally more than those 5,000 who attended the pro-life rally. And besides: how long have pro-life organisations been holding rallies, in a country that already has a total ban on abortion? Over a decade, at least. Our rally, on the other hand, is the first of its kind. We are making history here…

One other interpretation for the counter-rally is, in fact, as a measure of the pro-choice movement’s success so far. Clearly, the pro-life majority is feeling threatened… and there are indications – a University student survey here, a small pro-choice protest in Valletta there – that attitudes towards this topic really are changing.  Do you get that impression, too? Has there really been a groundswell shift in popular opinion?

I do get that impression, yes; but it is not easy to be sure. Social media, for instance, is not a reliable indicator. It creates echo-chambers that can be deceptive. So instead, I try and look at what is happening all around me. Tonight [Thursday], for instance, there’s ‘Science in the City’: a major national event, that has been happening for some time. Doctors For Choice have a stand. They will be distributing information. And at the same event, the University Law Students’ Association is organising a debate on abortion. So that’s two initiatives, at a national event with which we had nothing to do whatsoever, from our end. That is something in itself: there is a local discussion happening, and it’s not just coming from us. That is also what I meant earlier, when I said that ‘we are here, and we are not going away’. 

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