‘Women are treated like walking incubators’: Malta’s fight for abortion
Elle doesn’t find it easy to talk about her abortion, not because she regrets it – she would do the same again without any hesitation – but because the memory of the terrible, almost overwhelming, fear and isolation she experienced at the time still makes her feel so angry. “I’m privileged,” she says, twisting the ring on her index finger. “I could afford to travel. But what about those less fortunate than me? I know of a woman who felt so desperate when she found out she was pregnant again, she put her three children in front of some cartoons on the TV, and went straight upstairs to the bathroom to begin launching herself from the toilet on to the floor in the hope of inducing a miscarriage.” She’s fighting tears now. “That woman almost killed herself. What about her? Does anyone want to hear her story?”
Elle, who is 40, works in the culture sector, in a job that she loves. Three years ago, she found herself pregnant, something that came as a terrible surprise: “I’d always been told by my doctors that I couldn’t have children.” Had she ever wanted them? “To be honest, I never really did. I don’t need a child to define myself. But it wasn’t only this that made me afraid. I’m from a single-parent family – my father has a wife and children elsewhere who don’t know about me – and my relationship with my mother is complicated. When I found out I was pregnant, I felt strongly that I didn’t want history to repeat itself. My heart had only recently been broken, and now I was in an on-off relationship with this foreigner who was planning to leave soon. When I saw the result, I freaked out. I didn’t need to make a decision. I knew straight away that I wasn’t going to have a baby. It wasn’t something I felt I was able to do.”
She was, she admits, “very ignorant”. Of course she knew that in Malta, the country where she was born and has lived all her life, abortion is illegal. But until that day, this was not a law she’d ever had to consider breaking. Where could she get information? With whom could she even discuss her situation? Her gynaecologist, booked for a confirmatory scan, was in celebratory mode. Miracles like this didn’t happen every day, she told Elle, offering her congratulations, ignoring her patient’s tears. When Elle suggested that she didn’t want to be pregnant, a veiled threat was made: there would be paperwork; her pregnancy would be noted. Her GP was no better. “Oh, he’ll change his tune when you talk to him,” said this man, when Elle told him she wasn’t in a stable relationship. “At least now you’ll have someone to look after you when you’re older,” he insisted.
What was she to do? But if she was frightened, she was also determined. Somewhere in the back of her mind she remembered something she’d read, and this led her, eventually, to the Abortion Support Network, the charity that used to help Irish women to travel to London for terminations (abortion in Ireland was legalised in 2018). The ASN referred her to the British Pregnancy Advisory Service, but she also ordered abortion pills from abroad (a number of women’s organisations offer this service to those in the first trimester; it normally takes a fortnight for them to arrive). “I was clueless,” she says. “It was taking weeks to get everything sorted: to get an appointment, to arrange leave from work. The pills were my insurance policy.” This, for Elle, was the worst part. The waiting was unendurable. “I had to use my work address for the parcel. I was absolutely terrified. I was obsessed with the fact that someone would intercept it, and call me out.”
In the end, Elle didn’t have to have an illegal abortion in Malta. She travelled with her mother to the UK, and took her pills there, under the supervision of a British clinic – and in this sense, she feels she was lucky (most women dare not risk talking to their mothers, and go through the entire experience alone). But she was also extremely unlucky. The World Health Organization now believes that the safest way to terminate an early stage pregnancy is by using medicine rather than surgically (during the pandemic, it was the onlyway Maltese women who were less than 10 weeks pregnant could do so – and those further on had no options at all). However, in rare cases, there can be problems such as excessive pain and bleeding; on occasion, the pills may not be effective, and another dose must be taken.
Elle was one of these cases. Quite soon, she was in agony, her temperature rising rapidly. “I thought I was going to die,” she says. “I only managed to stay conscious by thinking about what it would be like for my mother to lose me, her only child. My God. I remember leaning on the side of the bed. My mother would put a cold towel to the back of my neck. The pain was blinding. It was like nothing I’ve ever experienced. I could hardly speak.” She had to take two lots of pills; after the first dose, she didn’t bleed. But eventually the clinic told her that she could now return to Malta: “They advise you to have a follow-up appointment. But this is impossible. You can’t tell anyone what you have done. You just have to take the risk.”
Back at home, Elle had a new respect for her body; she felt superhuman, she says. She was also radicalised. “Afterwards, I suffered from a lot of anxiety,” she tells me. “It wasn’t to do with the abortion. I only felt relieved about that. It was to do with the situation. To have to go through that so far from home. I wanted so much to talk to someone. But I didn’t find anyone, not for a long time.” A veil of silence prevails in Malta on the subject of abortion. No one knows who to trust. Three years on, she dreams of going public: of talking about her experience, the better to shame a government that makes criminals of women; that discriminates openly against half of its citizens, forcing them to take such risks with their health. But right now, she doesn’t dare.
The openly pro-choice regularly receive death threats in Malta; they are murderers and butchers and baby-killers, and should be lined up and shot. Those who have had abortions are sluts who should learn to “keep their legs closed”; if they’re unable to do this, it’s their sacred duty to become mothers, irrespective of their circumstances. Not so long ago, an anti-abortion government minister was informed of the numbers of Maltese women who each year travel to have a termination. “He said that in his opinion, they needed to be hunted down and prosecuted, even if they’d had the procedure abroad. Eventually, someone put him straight. You can’t prosecute someone for something they did in another jurisdiction. But for three or four days, I was absolutely petrified.” Across the table, Elle takes my hand and squeezes it hard.
Malta, which joined the EU in 2004, likes to boast of its liberal credentials. After the (long overdue) legalisation of divorce in the country in 2011, it has since become possible for gay couples to marry, and for transgender people easily to update their birth records to reflect their chosen gender. But this is not, by any means, the whole story.“The LGBTQ community has more rights than women, and I say that as someone who used to be in a same-sex relationship herself,” says Elle. Malta is the only country in the EU where abortion is illegal for any reason, including rape and incest (even in Poland, where restrictions on abortion have been dramatically tightened, a woman who has been raped is still, in theory, entitled to an abortion). If a foetus is found to be unviable, or the baby likely to die at birth or soon afterwards, the pregnancy must continue. If the health of the mother is threatened – as in the case of an ectopic pregnancy – doctors will act, if at all, only when it may already be too late.
Campaigners often cite the example of a Maltese Canadian, Marion Mifsud Mora, whose waters broke prematurely – she was only 17 weeks pregnant at time – while she was on holiday on the island in 2014. Mora begged doctors to abort her foetus, but they refused. Her temperature began to rise dangerously. Believing that her life was in danger, again she asked them to end the pregnancy. Again, they refused. She was saved only by her Canadian health insurance, which paid for her to be airlifted to France for the procedure. Had she not been in possession of such insurance, she would, according to Prof Isabel Stabile, the only gynaecologist in Malta who is openly pro-choice, almost certainly have gone down in history as Malta’s Savita (Savita Halappanavar died of sepsis in 2012, doctors in Ireland having refused to perform an abortion after her waters broke at 17 weeks).
Mora’s doctors may have been anti-abortion. But even if they weren’t – some pro-choice doctors keep their views private – they would have known they were practising in a grey area; they may have been unwilling to take the risk. In Malta, a person who supports a woman who is having an abortion is also deemed to be breaking the law, which makes it extremely difficult for doctors properly to treat their patients (there have been successful prosecutions). “I feel very angry,” says Stabile, when we meet for coffee at my hotel. “Some of my colleagues have tried to argue that even providing information is aiding and abetting.”
Women who use abortion pills in Malta are advised to take them orally rather than vaginally, even though this is widely considered to be less effective, the idea being that should anything go wrong, they are not detectable by doctors. “What do I tell a patient if she tells me she’s taken the pills, and that she’s bleeding too heavily? I have to tell them to lie,” says Stabile. “I must tell them to go to casualty and to tell the doctors there that they are having a miscarriage. Can you imagine having to tell a patient to lie like that? It’s immoral.”
What makes this situation all the more vexatious is the fact that contraception is neither free nor easily available in Malta – and there is widespread ignorance about conception (sex education in schools tends to focus on abstinence and marriage). “Some doctors are still very uncomfortable about prescribing contraception,” says Stabile. “What do you think is the most common form of contraception here? I’ll tell you. It’s withdrawal, because it’s free.” During the Covid pandemic, the Maltese government deemed contraception to be “non-essential” and supplies, which came from abroad, at one point ran out entirely.
How many Maltese women are currently having abortions? In terms of unsupervised illegal abortions using pills taken in Malta, some data exists. In 2021, for instance, 350 packets were shipped to the island. But these numbers do not include pills already in Malta, passed on by friends or wellwishers, or those who want or need to travel (either those who do not want to break the law, or whose pregnancies are too advanced). “On average, 55 women travel to Britain every year,” says Stabile. “But this is the only country we have data for.” Thanks to its booming economy, Malta’s population now comprises a high number (about 20% of the total population) of immigrants and expats. These women may return to their home countries for treatment. Others, particularly those whose papers are not in order, may be completely stuck.
Many women are known to travel to Sicily, which is close to Malta, where a small tourist industry has sprung up around the procedure (“packages” include a driver to pick you up at the airport and, if you require it, a villa). Not all of the operations performed there are, however, fully safe, or performed in professional settings. “We have heard of botched abortions in Sicily,” says Dr Lara Dimitrijevic of the Women’s Rights Foundation. “Some women have had serious medical issues afterwards.” In 2020, an organisation called Doctors for Choice set up a 24-hour helpline for women in need of medical advice. “Four people have called just today,” Dr Natalie Psaila, a GP, tells me, when I meet her one Sunday at her home. Put
all these things together and, Stabile estimates, it seems likely that at least 400 women have an abortion every year, and probably many more. “One happens every day,” she says. This isn’t an insignificant number. Malta’s population is only about 500,000.
Those who seek help are of all ages and social backgrounds. The mean age of those ordering pills online is 29.3. Fifty-two per cent are mothers; 24% have two or more children. While I’m in Malta, I meet several women who have had abortions, either on the island or off it. Mary is 26, single, and a teacher, and took pills she ordered to Malta when she fell pregnant. Sophia is 38, an entrepreneur and a single parent to her daughter. She was lucky enough to have a friend who had pills to hand. Clare, a secretary, is a 43-year-old married mother of two who had an abortion in Amsterdam 20 years ago (long before she met her husband).
But however different their situations, they have the same things in common: a fierce sense of outrage at the risks that they and others have had to take; a shared determination that things must change. “The government is exporting a problem,” says Sophia. “It’s always saying we’re No 1 for human rights, but we’re not at all. How can we be when women are treated like walking incubators?” Mary agrees: “The least we deserve is decriminalisation, because women will go on doing this. If you really, really need something, you will find a way of getting it. We’re talking about healthcare, not recreational drugs.”
Malta is a patriarchy, they tell me, one that silences women, and which always “knows best”. There is no equality, they say, not while the influence of the Catholic church remains so powerful. It begins in schools (where the controversial discredited 1984 anti-abortion film The Silent Scream is still sometimes shown to children), and continues from there. Those under-16s who get pregnant are described as “young mums”, not children. In cases of domestic violence and femicide, women almost always take the blame in the court of public opinion (Malta was obsessed by the Johnny Depp/ Amber Heard libel case, which confirmed many people’s ideas about victims). In one recent study, 20% of respondents said that rape can be provoked. Women continue to be largely absent from public life. Even after the implementation of a mechanism to enable political parties to appoint women directly to parliament, only 27.8% of Maltese MPs are female.
I meet Sophia at an old hotel near the San Anton Gardens, a park that surrounds the official residence of the president of Malta, and after our meeting is over, I wander into it in search of peace and shade. What happens next is almost too perfect, given all that we discussed. A first communion has taken place nearby, and the paths are crammed with small girls dressed as miniature brides: Minnie Mouse shoes, bouncy white veils, pale posies in their hot little hands. The children’s parents look on proudly as professional photographers strain for the right shot, and I watch them, too, from a bench by a fountain. They look so innocent and adorable and happy, but it’s also very hard not to think of what might lie ahead for them, these girls who will form the next generation of Maltese women.
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Across Europe, there has been a tightening of abortion laws. “Any country is only one election away from losing abortion rights,” says Mara Clarke, the founder of Abortion Support Network. Poland controversially imposed a near-total ban in 2020; it is now so difficult to get an abortion in Hungary and Romania that ASN is to extend its services to both. There are also a number of places where paper and practice don’t match up. Italy, for instance, has abortion on request up to 12 weeks, but in 2016, Italian health ministry data showed that 70% of gynaecologists refuse to perform the procedure; the ASN doesn’t think the situation has improved since then. In Ireland, women achieved a great victory when abortion was legalised, but many are still travelling to London: there simply isn’t enough provision. Meanwhile, in the US, worry grows following the leaked revelation that the nation’s highest court had provisionally voted to overturn Roe v Wade, the 1973 ruling that effectively legalised abortion in the country.
Malta’s laws mean that campaigners at least have nothing to lose. “Things can’t get any worse,” says Dimitrijevic. “The status quo is the worst-case scenario.” But there are, she believes, tiny chinks of light. Women’s rights groups are increasingly organised. The word “abortion” is no longer so taboo (conversations like ours would, she says, have been unimaginable even five years ago). Activists take succour, too, from the fact that legislation has been passed that will allow foetuses that are the result of IVF to be tested for nine lifethreatening genetic diseases, including Huntingdon’s (though such embryos will not be destroyed). The language around this change has pushed the debate forwards.
But still, the fight ahead looks to be long and hard. Last Wednesday, the Women’s Rights Foundation filed a judicial protest on behalf of 188 women, a document that says the Maltese government’s blanket ban on abortion breaches their right to health, privacy and equality. This move replicates the approach the same group took six years ago, when it filed a judicial protest on behalf of 102 women who were campaigning for emergency contraception to be made legal on the island. In that instance, the activists were successful; within months, the government had acquiesced. This time, they do not expect the government to act. But if it doesn’t, they will be free to take their fight to the courts. Most believe the case will end up in the European court of human rights and that there, they will win.
On my last night in Valletta, Malta’s capital, I head out to meet Dr Andreana Dibben, an academic at the University of Malta, the chair of the Women’s Rights Foundation, and the person who passed me all the telephone numbers I needed to do this piece. It is Sunday, and every church I pass – there is a different church for every day of the year in tiny Malta – is full of people celebrating mass. At a bar by the harbour, we talk for a long time, and every word she says is interesting and vital.
A teenage mother herself, it was only when she became a social worker and met victims of domestic violence that she became pro-choice. Violent men use pregnancy as a control mechanism, she says; in Malta, they’ve also been known to use its abortion laws to prevent their partners travelling. Does she feel there is any political will to change? She isn’t sure. The ruling Labour party would, she says, win an election even if it lost the votes of older voters who are anti-abortion. However, politicians continue to speak one language in Malta, and another to their European counterparts, playing it both ways. (The human rights commissioner for the Council of Europe and the human rights committee of the UN have both told Malta the situation must change; some MEPs are also pushing for abortion to be included in the EU’s charter of rights.)
But she won’t be pessimistic. The first time she went on television to talk about abortion several years ago, she was trembling. Even to say the word in public felt momentous. Now, though, she feels strong. There is such solidarity among activists, and she knows how badly women want change, even if many are too frightened to make this public. Sometimes, it gets her down, hearing women’s stories: the suffering, the loneliness, the fear. To listen is to carry a heavy burden. “But then, someone will recognise me, and they’ll say thank you. And then they’ll say it again: No, I really mean it. Thank you.” Behind her fabulous glasses, her eyes narrow. She’s smiling now. “It happens all the time, and it makes all of it worthwhile.”
Some names have been changed