Abortion: a word that is guaranteed to spark a tense debate. Throughout the years, Malta has been nudged into considering its introduction but has held firm against.

In 2013, the International Commission of Jurists told the UN that Malta’s blanket ban on abortion puts women at risk of torture and cruel, inhumane or degrading treatment. Nothing happened.

Three years later, the UNs Committee on the Rights of the Child recommended the decriminalisation of abortion “in all circumstances”, urging the government to ensure adolescent girls have “access to safe abortion and post-abortion care services”. Several international appeals persisted, including from the Council of Europe’s Commissioner for Human Rights. Nothing happened.

And in 2021, a private members’ bill presented by former independent MP Marlene Farrugia called for the decriminalisation of abortion. It was never debated and expired the moment the general election was called.

Then last June an American couple’s trip to Gozo to celebrate their pregnancy created a seismic shift in the debate.

Andrea Prudente began to suffer the symptoms of a miscarriage while 16 weeks pregnant and was told there was no hope for the baby. But a foetal heartbeat meant doctors at Mater Dei Hospital could not intervene to end the pregnancy because of the country’s complete ban on abortion.

Concerned about the risks to his wife’s life and health, her husband Jay Weeldreyer spoke publicly from her hospital bedside and their ordeal made international headlines. After their travel insurance provider deemed the situation life-threatening, Prudente was medically evacuated to Spain for the procedure. 

Within a month, Health Minister Chris Fearne had ordered a review of legislation and the US couple went on to sue the state for a breach to their human rights.

Not a unique case

The case was widely publicised but it is not unique. One Maltese woman, who went through the same ordeal while the Prudente case was unfolding, did so in silence because she feared judgement.

“I would have never guessed in a million years that we would be a couple looking at abortion options when we got to know that we were pregnant with our dream baby, our very well-planned second child,” she told Times of Malta.

“But nature decided otherwise for us when at 14 weeks pregnancy we got to know that our baby was dying slowly each day that was passing… You have to be carrying a dying baby yourself to know what it really feels like, to feel your belly grow and the kicks slowly decreasing instead of increasing, while your body is in a constant struggle unable to understand what is going on.”

Like the much-publicised case of Prudente, doctors could not terminate the Maltese woman’s pregnancy and she also travelled to end her ordeal.

She asked why a mother should risk “losing her sanity and possibly life just because society and law expects you to stay in one of the most horrendous situations ever when we would all know the outcome of this pregnancy can never be positive”.

Life or health

Nudged by Prudente’s legal suit, Prime Minister Robert Abela announced that the country would amend the law to free doctors and pregnant women from the threat of criminal prosecution if a pregnancy is terminated to protect a woman “suffering from a medical complication which may put her life at risk or her health in grave jeopardy”.

But the wording of the amendment went further than many people expected.

At the core of the debate was the word ‘health’.

It initially appeared that the legal amendment would merely bring into law a long-standing practice at Mater Dei known as the principle of ‘double effect’. According to this principle, it is sometimes acceptable to cause harm as a side effect of bringing about a good result.

So, a doctor would intervene with the sole intention of saving the mother’s life and the death of the unborn foetus or embryo is considered an undesired consequence of the intervention to save the mother.

However, critics, including the Catholic Church and the Nationalist Party, argued that allowing doctors to carry out a termination to safeguard the woman’s health is introducing abortion by stealth.

Thousands of people marched through Valletta early in December holding placards of swaddled babies to demonstrate their anti-abortion views and the issue threatens to spark a constitutional crisis.

President George Vella, a staunch anti-abortion advocate, has indicated he is prepared to resign over the matter and broke tradition in his Republic Day speech to call for a solution.

A recent survey commissioned by the Archdiocese of Malta found that almost 80% of people agreed with abortion when the pregnancy endangers the life of the mother compared to almost 25% agreeing when the woman’s life is not at risk.

You have to be carrying a dying baby yourself to know what it really feels like

Abortion on request

Mark Formosa, consultant gynaecologist at Mater Dei Hospital and lecturer in Obstetrics and Gynaecology at the University of Malta, shares the concerns about the current wording.

He fears the law could be open to a wider interpretation than intended, and the hospital would have to deal with a rise in requests to terminate pregnancies.

“What I think needs to be looked at seriously to prevent this from occurring is to implement a strict guardianship on the application of the law and this will require strong legal backing for the doctors on the ground of a 24/7 nature which unfortunately is presently lacking,” he said.

Formosa said he was taught during training to protect a woman by terminating a pregnancy when she has ruptured membranes and develops signs of sepsis.

“The few cases I remember where this happened, I do not recall any debate or hesitancy about what needed to be done. Was there ever any instance of the mother or her caring gynaecologist being threatened with court action for carrying through with this?

Not to my knowledge, so that begs the question as to whether this amendment was needed.

“From an academic point of view, legally speaking, the amendment will prevent this possibility from ever occurring but that leads us to the contention that has sparked serious concern from the medical community. It is, in fact, the wording of the amendment that can be construed to lead to a flurry of requests for abortion on mental health grounds,” he said, adding that data from the UK shows that 80% of requests for termination are made on mental health grounds.

“Another important issue to keep in mind is that the structure of our society has changed radically over the last few years with expats forming a substantial part of the patient population at Mater Dei Hospital.

Many of these expats have grown used to a society where abortion on request is a reality and will naturally feel they are now entitled to this in Malta as well.  Though some may argue that this is abusing the intention of the law, the risk I see is that the hospital will need to deal with an ever-increasing pressure to carry out terminations on mental health grounds,” he said.

The way forward

The prime minister has said the government is willing to consider different wording to the amendment, as long as the principles of the bill remain untouched.

After passing a second reading earlier this month, it will go to the committee stage, when amendments can be made, before a final vote. 

What is certain is that it will not end the abortion debate.

For some people, the amendment goes too far, while others are determined to push for more.

Marlene Farrugia, for example, sticks to what she requested in the bill she presented in 2021.

“The current amendment is but scratching the surface of the changes required in our national attitude and legislation to seriously address the humiliating, denigrating predicament Maltese and Gozitan women are in,” she said.

She wants abortion decriminalised and laws that introduce abortion as healthcare “within parameters that entice women to seek help free of taboo and indictment and which will lead to more lives of women and children being saved and lived better”.