If accessing abortion in countries where it’s criminalised wasn’t hard enough before the pandemic, lockdowns and COVID-19 travel restrictions have made the process that much more difficult.
In fact, the issue became so pronounced at the start of the pandemic that the European parliament and the Council of Europe’s Commissioner for Human Rights called on member states to guarantee safe and timely access to abortion.
The European parliament has also just passed a non-binding resolution calling for countries to ensure the right to legal and safe abortion. This resolution has been viewed as a challenge to the restrictive abortion laws of Poland and Malta in particular.
Though Poland’s introduction of a near-total ban on abortion in 2021 was a huge blow for reproductive rights, Malta’s laws are among the strictest in the world. Indeed, Malta is the only EU country with a total ban on abortion, with abortion laws dating back to the 1800s. Given Malta’s long history with such oppressive laws, our research with health and social care professionals in Malta and international abortion care providers shows the effect that criminalisation has on even legal abortion care.
Abortion laws in Malta
The law criminalises both the pregnant person and the abortion provider with the potential for up to four years in prison and has been criticised by a range of human rights bodies for its total restriction on bodily autonomy. Wider provision of sexual and reproductive health services is also severely lacking in Malta. Emergency contraception was only introduced in 2016 (pharmacists can still “conscientiously object” to providing it), and there are no state run family planning clinics.
Criminalising abortion of course doesn’t stop it happening. But what it does do is place it outside formal healthcare settings either through abortion travel or procuring abortion pills online illegally.
Abortion provision during the pandemic
Since the beginning of the pandemic, travel restrictions have made abortion-seeking journeys more difficult. While the provision of telemedicine (the distribution of health services and information via technology) in many countries has allowed women to access abortion at home, in countries where abortion is illegal, the risk of prosecution remains.
The Abortion Support Network (a UK charity providing practical information and funding for abortion seekers) told us it had received calls from 121 people in Malta between March 2020 and February 2021, up from 90 people who contacted the organisation from Malta the previous year.
Organisations like Women on Web and Women Help Women, which provide the abortion pills to those in countries where abortion is illegal or inaccessible, also recorded increased inquiries from Malta since the beginning of the pandemic. FPAS Malta – a volunteer-run family planning advisory service that launched in 2020 – was contacted by 203 people in the first six months, with most queries relating to abortion.
The effects of COVID-19 continue to be felt by people seeking abortion. The costs of testing, flight prices and quarantines were all noted as continued travel barriers. Disruptions to international postage were also obstacles to accessing abortion pills.
Fears of prosecution
Our interviews with health and social care professionals in Malta revealed that many are unclear as to what information they can legally provide about abortion. They’re also fearful of prosecution.
While abortion is illegal, providing pre and post-abortion care through counselling, information or follow-up sessions isn’t. These worries about potential legal repercussions have the potential to jeopardise access to accurate information and care, potentially endangering people’s health and lives. In fact, the stigma associated with abortion means that many women make journeys or procure pills alone without health advice or support.
Some participants working in health and social care also believed they had a duty to report to child protection services if someone intended to have or already had an abortion, even if conducted where it’s legal to do so, such as abroad. A new piece of legislation in Malta, The Minor Protection (Alternative Care) Act, is partly responsible. Introduced in 2020, it was intended to protect children against harm, but was interpreted to include foetuses within the definition of “child”, despite no mention of the foetus in the legislation itself.
A number of social care participants in our research indicated that this “duty to report” was imposed on them by superiors, presenting an additional chill factor in the provision of care. Pressure on practitioners to report those believed to want or who have had abortions also presents an increased risk of prosecution for both professionals and women seeking abortion. Unfortunately, this meant that participants felt that they had to balance caring for their patients and clients with protecting themselves from the risk of potential repercussions.
There is a strong anti-abortion sentiment in Malta, both in politics and society. In 2020, Malta’s Ministry for Social Justice and Solidarity, the Family and Children’s Rights donated €130,000 to a shelter for pregnant women administered by the anti-abortion organisation Life Network. A number of participants in our study also mentioned that the Life Network has operated as a rogue crisis pregnancy centre in Malta, impersonating abortion services and misleading women. It has political ties too. The Life Network takes part in Agenda Europe summits, a network of conservative and religious campaigners from the US and Europe that aim to reverse sexual and reproductive health rights in Europe.
The criminalisation of abortion affects all aspects of abortion care and fear of prosecution silences abortion seekers from seeking support from health and social care professionals. The pandemic has highlighted the limitations of accessing abortions in legally restrictive countries and underscored the urgent need for abortion to be decriminalised. If we’re to ensure that people can access and provide reproductive health services without fear of judgement, stigma, legal prosecution, or any other negative repercussions, the global decriminalisation of abortion is vital.