Only half of Maltese women who participated in a local study said their pregnancy was planned, with the same research showing that just a third use the most reliable contraceptive methods.

The data was collected through a survey for a University of Malta Master’s degree in Gender, Society and Culture. It shows that condoms and the so-called withdrawal method are the predominant methods of contraception.

Both those methods have higher failure rates than contraception methods such as the pill, and both place the onus of contraception on male partners in a relationship.

Over 3,000 people took part in the online survey.

Overall, the respondents’ primary contraceptive choice is condoms at 30%. Nearly a fifth opt for the withdrawal method and 10% use natural family planning. The most reliable forms – oral contraceptives and intrauterine contraceptive devices – are used by 24% and 6% respectively.

The study by Francesca Fenech Conti, who was mentored by Marie Briguglio and Andrea Dibben, provides a 2022 “snapshot” of Maltese women’s contraception use and family planning practices.

It is the first research of the sort, and Fenech Conti hopes it encourages policymakers to look into why so few Maltese women are using hormonal contraception.

It comes just weeks after Health Minister Chris Fearne promised that the government will provide free contraception to the public from this year. While it is unclear what contraceptives will be made available, the Labour Party had pledged ahead of the last general election that it would distribute the pill and intrauterine devices for free if elected.

Fenech Conti told Times of Malta that according to international research, merely providing free contraception is not enough to ensure consistency of use. Provision must be accompanied by proper education, guidance and counselling by appropriately trained professionals in the field of family planning.

Fenech Conti, who founded the Women for Women NGO, notes in the write-up of her findings that she is a pro-choice activist who believes that robust family planning policies and the provision of contraception helps limit the number of illegal and unsafe abortions.

“The topic of family planning and use of contraception is very close to my heart. From personal experience, I know that unplanned pregnancies – even when wanted – can have an adverse impact on the life of women and their children,” she told Times of Malta.

“I am also very troubled by the experiences of women I meet through the NGO as unplanned pregnancies could lead to abortion or a descent into poverty. There could also be repercussions on the wellbeing of the foetus when a woman, unaware that she is pregnant, continues to consume food and drinks that could harm the baby.”

Fenech Conti added that the choice of contraception seems to be quite dependent on social, cultural and financial factors, including religion. She found a correlation between religious respondents and less reliable forms of contraceptives, such as natural family planning, condoms and the withdrawal method.

Unplanned pregnancies

The 58% of respondents who said they had experienced a pregnancy were asked a series of questions to determine, among others, whether they planned on getting pregnant.

“According to research, it is difficult for women who go through a successful pregnancy to later claim it was unplanned. I therefore asked multiple questions linked to intentions.

“This means I got a range of answers: at least 23% of respondents clearly admitted they did not intend on getting pregnant; however, contraception behaviour shows that up to 47% of pregnancies were not planned.”

When asked whether in the month before they became pregnant, they had planned on becoming pregnant, 8% said their intentions kept changing, and 23% did not plan on getting pregnant.

In answering a separate question, only 53% of respondents said they intended to get pregnant, while of the rest – 40% said they were using contraceptives and 7% opted not to provide an answer.

The replies also show that 18% of women using the withdrawal method still got pregnant while 12% of condom users got pregnant and 5% got pregnant while on the pill.

One in four reported a miscarriage

More than one in four participants who reported a pregnancy – 28% – suffered at least one miscarriage.

Fenech Conti notes that this large percentage of miscarriages reported by respondents must be further investigated, especially since research shows that there are long-lasting nega­tive effects on women experiencing this traumatic life event. She suggests reviewing local post-miscarriage mental health support services.

According to the UK NHS, one in eight pregnancies will end in miscarriage. Many more miscarriages happen before a person is even aware they are pregnant.

The Lancet reported in 2021 that miscarriage affects one in 10 women in their lifetime.

In numbers

• Only a fifth of those not using contraception are pregnant or trying to get pregnant;
• 18% said they were not using their preferred method of contraception as they cannot afford it;
• Only 10% of respondents get their prescriptions for artificial contraception from the public health services;
• 5.5% of the 1,483 respondents who had experienced a pregnancy have had at least one abortion.

The survey

Fenech Conti collected data from the replies of over 3,000 women who took a 10-minute online survey at the beginning of 2022. The platform she used for the survey ensured a limit of one respondent for each IP address.

Of these, 2,552 were Maltese women, including people assigned female at birth who may not identify as female. Further cleaning of the data left Fenech Conti with 2,192 female Maltese respondents of reproductive age between 18 and 49.

The number of respondents required for a confidence level of 99% with a 3% margin of error on a population of 113,200 women of reproductive age is 1,819, while a sample with a 95% confidence level and 5% margin of error would require 383 respondents.

Fenech Conti said that the survey excluded people under 18 since they would have needed the consent of their parents or guardians. Additionally, some 60% of respondents have followed tertiary studies, compared to the estimated 30% of the local female resident population who actually have this level of education.

Nearly 18% of respondents were aged between 33 and 37, while 16.8% were aged between 28 and 32, and another 16.8% between 38 and 42.

A total of 85% said they were in a stable relationship, 11% single, while 3% said they were in a casual relationship.

Although half of the respondents said they considered themselves religious, 61% said they never attend religious services.