Malta’s abortion reform: A step forward, but short?

Malta has one of the most restrictive abortion laws in Europe, and this is still the case after the recent law reform.

Malta has long been among the few countries where a total ban on abortion was in place with no exceptions even for circumstances where the termination of pregnancy is necessary to save a woman’s life or in cases of rape or incest. This has finally changed, but Malta’s abortion law still fall short.

The new legislation allows abortion when continuing the pregnancy endangers a pregnant woman’s life; indeed a step forward from the total-ban which was previously in effect. The law also allows abortions when a pregnant woman’s health is under grave jeopardy which may lead to death, upon the approval of a medical commission that consists of three doctors. The legislation excludes health conditions that are not life-threatening and, as such, assumes a very narrow definition of “health” that is solely concerned with the mere survival of women.

Abortion exceptionalism

Within the framework of this law, pregnant women and individuals facing health complications would only be granted the option of abortion if and when their conditions become life-threatening. This approach can be seen as reflective of a form of abortion exceptionalism, wherein the usual medical response to health concerns is distinctively altered. Ordinarily, when someone seeks medical attention for a health issue or complication unrelated to pregnancy, healthcare providers intervene promptly, even if the condition is not immediately serious or life-threatening. Often, such intervention is necessary to prevent the condition becoming life-threatening. By allowing abortion to preserve a woman’s health only when the condition is suspected to lead death, Maltese abortion law continues to risk women’s health and lives.

Such abortion exceptionalism may also create confusion among medical practitioners, given the challenge of reaching a consensus on which conditions might eventually result in death and whether this can be discerned in a timely manner to safeguard a woman’s life. Due to concerns about legal consequences, medical practitioners might be hesitant to provide abortion services, even if a woman’s health condition deteriorates. Indeed, instances of this nature have been documented in other contexts, with a recent example occurring in Poland, where several pregnant women with complications died due to inadequate medical attention. The confusion stemming from the intricacies of the abortion law played a role in denying these women access to timely interventions that could have potentially saved their lives.

Medical gatekeeping

The amendments in Malta also holds on to medical gatekeeping on abortion. Medical gatekeeping refers to the practice where medical professionals, often doctors, use their authority to restrict or control access to abortion services. Medical gatekeeping can create significant barriers for individuals seeking abortion care, potentially delaying or denying them access to safe and legal procedures.

The World Health Organization (WHO) recommends abortion to be available at women’s request, without any third-party authorization from any other individual, body or institution.