Sometimes, living in Malta feels like existing in an alternative reality. A reality where legal professors interpret human rights in an alternative way, where medical professionals interpret medical research in an alternative way and where an amendment to criminal law that would still leave Malta with the most restrictive abortion legislation in all the EU, and even more restrictive legislation than Iran and Saudi Arabia, is (mis)-interpreted as the most liberal abortion law in the world.

The latest Maltese alternative truth being bandied about is based on the witness statement of Yves Muscat Baron, consultant and head of obstetrics and gynaecology at Mater Dei Hospital during the first sitting of Andrea Prudente’s case.

According to reporting by this paper, he stated that “today, there was a 79.2 per cent survival rate of the unborn baby when the mother’s waters raptured before 20 weeks of pregnancy’’.

This study was interpreted by columnist Ranier Fsadni as a statistic that suggests an 80 per cent fetal survival rate in cases like Prudente’s, whose waters raptured at 15 weeks of pregnancy. In fact, rightly so, Fsadni pointed out that this contradicts what I claimed (in a Times of Malta debate with Peppi Azzopardi).

Doctors for Choice have already debunked this ‘statistic’ by showing that this same study (Herzlich et al, 2022) was quoted incorrectly, since not even one fetus survived in cases where PPROM occurred prior to 19 weeks.

The study of Linehan et al, 2016, set in Cork, Ireland, a context very similar to that in Malta, acknowledged that there is a paucity of literature on cases like that of Prudente because, in most other countries, women presenting with PPROM at such an early stage of pregnancy are offered termination of pregnancy.

However, prior to 2018 in Ireland, abortion was only allowed if the woman’s life was in danger. Not surprisingly, out of 42 cases of mid-trimester PPROM over a period of five years (14 to 23+6 weeks gestation), the infants’ survival rate upon discharge was less than five per cent (two out of 42) and in none of these cases did PPROM occur prior to 17 weeks gestation.

What Andrea Prudente needed was a legal framework that would have allowed her doctors to treat her as a person with dignity, rights, and autonomy- Andrea Dibben

And while I am acutely aware that one study does not a body of evidence make; that medical advances might have occurred since the data collection period cited in the study; and that it is specialists who should be interpreting these studies and challenging the court testimony, I will reiterate that it is a pity that our medical professionals have never published similar studies, which would actually give us the true picture of the local situation.

If anything, the much better outcomes they claim to have achieved would be showcased internationally.

The first sitting of Prudente’s case reinforced the need for Bill 28 to pass without it being watered down. The importance of including “grave risk to health” was highlighted through the caring consultant’s witness statement that, unless the patient was in danger of dying, they could not terminate the pregnancy, despite her wishes and despite the very real risk of developing further medical complications that could be life threatening.

(Out of the 42 women mentioned above, one developed sepsis and five others experienced severe haemorrhage, some needing blood transfusion, while others had various complications.)

The importance of not excluding mental health from the medical assessment of a pregnant woman’s overall health was highlighted by the statement of the bereavement midwife, who stated:

“Their concern was her psychological relapse until they waited for the baby to die or infection to set in so that the pregnancy could be terminated.”

My takeaway from this first sitting is that, because the consultants did not think Prudente was in danger of dying and because they believed the fetus had a minimal chance of survival, she was going to be forced to wait, possibly for weeks, ignoring her wishes and totally disregarding her health and well-being, until either the baby died or infection or bleeding set in. In the context of her psychological condition, this was tantamount to inhumane and degrading treatment.

There are indeed questions to be asked, that every person who could get pregnant or anyone who loves someone that could get pregnant should ask:

Why is a pregnant woman not considered an autonomous person with the right to make her own decisions about her health in this country, even in such a precarious situation?

How can the state force a pregnant woman to suffer inhumane and degrading treatment for weeks or even months when a fetus has close to zero per cent chance of survival?

If Robert Abela was ever right about anything, he is right about one thing. This case should never be repeated in a civilised country and, for this reason, Bill 28 should pass in its current form without delay.

While I wholeheartedly agree with Fsadni that Prudente deserved our empathy, what she needed more was a legal framework that would have allowed her doctors to treat her as a person with dignity, rights and autonomy to make the best decision for herself and her health, as did the doctors in Spain after she was airlifted from the country.

This is the only way that young women observing this spectacle will be reassured that they can count on Malta should they ever be in a similar situation.

Andrea Dibben is a sociologist.