The number of pregnant women in Malta who sought an at-home abortion by using a specific online telemedicine site to procure pills increased from 78 in 2017 to 509 in 2021, a study has shown.

Out of the 1,090 requests for medical abortions made over the five years, medication was shipped to 658 women (60% of requests). The remainder were cancelled either because the women chose to continue the pregnancy, experienced a miscarriage, or decided to travel to access abortion.

Most women (69%) sought an abortion because they claimed they could not have a child at that point in their life or because of financial issues (34%). Women could answer with more than one option.

Seventeen per cent said they were too young and 14% said their family was complete. Some said they wanted to finish school, their partner did not want the child, or they felt too old.

The vast majority - 92% - were under seven weeks pregnant.

The research was carried out by Andrea Dibben, Isabel Stabile, Rebecca Gomperts and James Kohout in collaboration with Women on Web (WoW), a Canadian non-profit organisation that aims to increase access to safe abortion.

The study was published in the British Medical Journal Sexual and Reproductive Health.

“Abortion care by women in Malta seems to be shifting from travelling abroad to countries where abortion is legal to self-managing medical abortion after purchasing abortion pills online…  These changes might have been accentuated by travel restrictions during the COVID-19 pandemic and by the local provision of voluntary services providing information and support," the report says. 

"Although at-home medical abortion is medically safe, pregnant people in Malta who access WoW services risk criminal prosecution, drawing attention to the urgent need to decriminalise abortion… This study further highlights the need for better family planning services and the promotion of more reliable methods of contraception,” the research says.

Malta is the only EU country with a blanket ban on abortion. The government is currently in the process of introducing legal amendments that will allow the termination of a pregnancy when the mother’s health or life are at risk.

Methodology

Researchers retrieved all requests to WoW from women in Malta who completed an online consultation between January 2017 and December 2021. Women had consented to anonymised use of their data for research purposes. As nationality was not included, researchers could not distinguish between citizens and non-citizens, although it is estimated that 20% of the population constitutes non-Maltese citizens.

The consultation forms reviewed included information about demographics, medical and pregnancy history, and health status. Women also selected the circumstances of their pregnancy, the reasons for needing an abortion, and their reasons to order medical abortion pills online.  

Women’s ages

The mean age was 29.3 years, but the cohort included women from all reproductive age groups. Just over half (53.3%) were between 25 and 34 years old, nearly a quarter (22%) were women 35 years and over, and another quarter (24.3%) were under 25. The majority (52%) were mothers with a mean number of 1.72 children, while almost a quarter (24%) had two or more children. 

Reason for seeking an abortion

The most common reasons for accessing telemedicine were legal restrictions (73%) and the unavailability of medical abortion pills (46%). 

2% said they were raped.

When describing the circumstances of their pregnancy, most women said they were either not using contraception (63%) or had experienced failure of contraception (30%). 3% had planned the pregnancy but the situation changed and 2% said they were raped.

Women who were mothers were less likely to be using contraception than those without children (70% compared with 60%), and women without children were more likely to experience contraception failure than those who were mothers (36% compared with 25%).

The most common reasons cited for accessing abortion care were not being able to have a child at this point in their life (69%) and having no money to raise a child (34%). 

"Having children seems to influence the reasons for seeking an abortion since mothers were significantly more likely to select ‘I am too old’ and ‘My family is complete’ than women without children. Those without children and those younger than 20 were more likely to want to finish school or select ‘I have no money to raise a child’ as a reason," the study found.

Vulnerable teens

Teenagers constituted nearly 5% of women receiving abortion pills. Although Malta has the lowest fertility rate in the EU, it has a higher-than-average teenage birth rate (11.9 births per 1000 girls aged 15 to 19 in 2019, compared with the EU average of 8.9).

Teenagers more frequently selected the need to keep abortion a secret, the cost, and school and work commitments, and fewer reported having a partner or friend with them during the process. 

“This high rate is partly due to the total ban on abortion, given that teenagers face more barriers to accessing abortion services. Indeed, the findings highlight how teenagers are more vulnerable since they often face economic and social difficulties and lack the support of a family member or partner,” the study found.

The full study may be accessed here.