A woman has claimed her life was "needlessly put at risk" because of a two-day wait for authorisation before she could undergo treatment to end her ectopic pregnancy.

The anonymous woman's story was made available through NGO Doctors for Choice, who have long insisted that the management of ectopic pregnancies is compromised by Malta's total legal ban on abortion. 

According to the woman, she was initially denied a medicine called methotrexate because a board and senior hospital staff had to approve it first. 

“It took two and a half days for the medicine to be approved," she wrote in Break the Taboo - are pro-choice collection of abortion experiences from Malta.

"In the meantime, the embryo was growing and so with every hour that passed my fallopian tube was more at risk of scarring and perforating and the treatment itself was becoming less likely to work. My fertility and, indeed, my life were needlessly put at risk because of unnecessary procedural delays all stemming from this umbrella ban on abortion."

The incident happened within the last year and a half, she said.

In her account, she describes how and her partner started using the intra uterine device for contraception because it is known to be 99 per cent effective at preventing pregnancies. But some time ago they discovered she was pregnant.

“Within a few days we had a scan done and it confirmed my fear... it was ectopic. The pregnancy was not viable, the embryo could never survive; its existence threatened my fertility and my life,” she writes.

An ectopic pregnancy occurs when an egg implants itself outside of the womb, usually in a fallopian tube.

The scan and bloods showed she was a good candidate for the relatively new  methotrexate treatment that would treat the ectopic pregnancy without the need for surgery, and therefore would save her fallopian tube. 

Within a few days we had a scan done and it confirmed my fear... it was ectopic. The pregnancy was not viable, the embryo could never survive.

The couple applied for the procedure at Mater Dei Hospital but, since abortion is illegal in Malta, their case had to be brought to a board before it could be dispensed. Two and a half days later it was approved, she said. 

“Eventually, the treatment was made available," she said.

"The first dose did not work and the delay in treatment was partly to blame as this is a time-sensitive condition,” she wrote. “I had to be re-admitted for another dose which thankfully did work. It was a traumatic experience made even more traumatic by the whole methotrexate issue. I’m thankfully on the road to recovery now but still incredulous at the status quo."

A spokeswoman for the health ministry said that a "significant percentage of ectopic pregancies can be treated medically as long as a number of criteria are adhered to. 
"Once the case fits the criteria a request form for methotrexate is signed by the Consultant or his/her delegate and countersigned by the Chairman or his delegate of the Department of Obstetrics and Gynaecology," she said.
"The procedure usually takes few hours. There is no board whatsoever which oversees the process." 

However Professor Isabelle Stabile for Doctors for Choice said the law needed to be changed, claiming methotrexate is technically illegal because articles 241 and 243 criminalise all ways of inducing miscarriage.

She said: "The law must change so that access to this medication, which technically causes an abortion, can be provided in a timely fashion."

In the position paper on abortion Doctors for Choice explain that the criminal code has no provision for abortion under any circumstance, not even when a woman’s life is imminently at risk of death as a result of a pregnancy.

Current local medical practice generally applies the ethical ‘principle of double-effect’ in order to protect such women. The ethical principle stipulates that it is permissible to do something ‘morally good’ that has a ‘morally bad’ side-effect, providing the latter was not the intention, even if it was foreseen. 

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