Forty, pregnant, and seeking an abortion

A trend is emerging in Malta among women aged 40 and over, who already have children and who experience unintended pregnancies despite using contraception. The Journal catches up with Doctors for Choice - Malta’s Dr Natalie Psaila.

If you think that unwanted pregnancies are exclusive to teenagers, think again.

“An emerging trend that we’re observing is among individuals aged 40 and over, who already have children, who say that they have used contraception, but still experience unintended pregnancies,” reveals Dr Natalie Psaila, a Maltese doctor who make it to the BBC’s top 100 inspirational women in 2023.  

These women confirm using CE certified condoms but, despite these precautions, they still get pregnant, she pointed out. “These condoms shouldn’t fail easily but no contraceptive is fail-proof. This is why these couples are getting pregnant. Condoms have about 10% failure rate. Something like the pull-out method – a favourite with the Maltese – has a 40% failure rate.”

This situation is disheartening, and she even describes it as “heart-breaking”, especially considering that many of them have teenage children and are actively trying to educate them on reproductive health. She believes that women in Malta, especially those who are middle-aged, did not receive adequate sexual education in their younger years.

“This is happening very often. Out of all the people who spoke to me this week, for example, I would say that half of them were over 40,” said Dr Psaila.

As a co-founder of a non-profit organisation called ‘Doctors for Choice Malta’, she fervently supports the decriminalisation and legalisation of abortion, along with advocating for improved access to contraception.

Dr Natalie Psaila

Why are we still resisting pro-choice principles?

Dr Psaila believes that the Church holds significant influence. It appears that individuals, even those who were once devoted Catholics, may shift their perspectives on various matters. However, the notion that abortion is akin to murder seems deeply ingrained and challenging to shake off.

Yet, she tells us that there’s a discernible shift among the younger generation toward a more pro-choice stance. A recent survey reveals that, despite Malta maintaining a strong anti-abortion sentiment – with 61.8% staunchly opposed – there’s a notable shift in attitudes, particularly among the younger demographic. This suggests a discernible trend of changing perspectives, especially among the youth.

Dr Psaila notes a slow shift even among older citizens, and she attributes this evolving mindset to personal experiences. Older people, she explains, might have children or grandchildren who underwent abortion.

“I need to hang up.”

Another common occurrence that Dr Psaila encounters a lot is women who speak to her in secrecy, because they don’t want their partner to know that they are in contact with her. It’s not uncommon to have women suddenly hang up when on the phone with her, for this same reason.

“I had a foreign woman recently who was seeking advice. Her husband is Maltese. She seemed terrified, and I’m sure a pregnancy is the very last thing she needs,” tells the doctor.

We ask Dr Psaila whether she is ever afraid for her own safety and security, since she sometimes must provide refuge to women behind their partners’ back.

“I’m not intimidated by abusive men because I wouldn’t have been groomed like their victims would have been. Therefore, I have a different perspective of them. I can also spot an abusive man from a mile away and such men are usually cowards. I understand why women end up being victims and actually, it’s very difficult for anyone not to end up being a victim unless they’re really careful,” said the doctor.

What information do Doctors for Choice communicate?

They provide information to women who have decided to have an abortion.

Their website explains that Mifepristone and Misoprostol, the abortion pills, can be safely administered at home up to 12 weeks into the pregnancy, providing women have clear instructions on their usage and can seek medical assistance if necessary. These pills are highly effective, successfully concluding the pregnancy in over 95% of cases.

Organisations like ‘Women on Web’ and ‘Women Help Women’ dispatch abortion pills to women in Malta. They request a donation of between €75 to €100 to cover the pills’ cost and postage, but some women who don’t afford that are still assisted, depending on the case. These abortion pills are sent from abroad and may take approximately two weeks to arrive. Dr Psaila specifies that the pills themselves are not illegal in Malta. However, it is illegal to have them if a woman is pregnant.

European countries maintain varying gestational limits for on-demand abortions. Notably, the UK and the Netherlands have relatively progressive abortion laws that permit procedures into the second trimester.

In the UK, the British Pregnancy Advisory Service (BPAS), which is a non-profit organisation, and Marie Stopes International (MSI), a global non-profit organisation are prominent abortion providers, extending services to women from Malta.

If private care is financially feasible, direct contact with these providers is an option. Second-trimester abortions typically incur higher costs than those performed earlier. For assistance with travel planning or financial support, there is a charity called ‘Abortion Support Network’ that Maltese women can contact.

When it comes to the third-trimester, abortions in the UK are permitted under specific circumstances, primarily when the woman’s life is at risk or the foetus is affected by a deformity. These procedures necessitate specialised centres and can be associated with high costs.

It’s still not that easy.

Dr Psaila tells us of a particular instance in which a woman’s friend called her in panic. The pregnant friend ordered the pills online, but they were taking their time to arrive. This is something that ‘Doctors for Choice’ cannot possibly control. The friend sought Dr Psaila’s advice, because the pregnant woman was drinking high amounts of alcohol, crossing roads carelessly, and punching her stomach in a distraught state due to the situation she was in.

Things are calming down, but there’s still “horrendous” treatment.

Dr Psaila is often faced with adversity. In the past, individuals would approach her expressing disapproval for her work. Other colleagues in the medical field encountered obstacles in their career progression due to similar concerns.

However, the situation has slightly improved for her and now, working in private practice without an employer, she is better off and is even observing a pattern among fellow doctors calling ‘Doctors for Choice’’s helpline. More doctors are inquiring about the helpline’s services and seeking advice to be able to address woman seeking assistance.

“At least, women are being directed to us,” she tells The Journal. But it’s not always the case.

Dr Psaila believes that these needs to be free, unhindered access to rape victims and women who are carrying foetal anomalies.

“These women are still being treated horrendously. Everyone shuns them, and this makes me angry. Gynaecologists tell them that they know how the pregnancy will end, but there is nothing to be done. They tell them that they can’t help them. They tell these women that, in civilised countries, abortion is possible, but in Malta it is not,” said Dr Psaila.

“It’s not illegal to refer these women to us or to organisations like the ‘Abortion Support Network’ (ASN). There’s full support in the UK,” explains the doctor.  

Will abortion ever be legal in Malta?

‘Doctors for Choice’’s overarching goal is decriminalisation. Currently, women who have abortions – except if the pregnant woman has a complication that may lead to death – could face a maximum of three years in prison. Doctors who help women have abortions outside the instances allowed by law, face a maximum of four years in jail and a permanent revocation of their licence.

Dr Psaila believes that things will change once Maltese Members of Parliament feel comfortable that they have the people in their favour, and they see that there is a discussion about it at the grassroots.

Dr Psaila’s work recognised by the BBC

When the BBC unveiled its compilation of 100 women who were sources of global inspiration and influence in 2023, Dr Psaila made the list. Her name was listed together with notable individuals such as former US First Lady and attorney Michelle Obama, human rights lawyer Amal Clooney, footballer Aitana Bonmatí, AI expert Timnit Gebru, feminist icon Gloria Steinem, Hollywood personality America Ferrera, and beauty entrepreneur Huda Kattan.

“This came as quite a surprise,” admitted Dr Psaila. “I received an email from them telling me that they would like to nominate me. But they never told me whether I was accepted or not.”

It’s quite evident, by her words and demeanour, that Dr Psaila is the humble type. She concludes that the recognition was received with great gratitude. She quickly adds, though, that there are many other women who have been doing important activism work.

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