Accessing abortion in a highly restrictive legal regime: characteristics of women and pregnant people in Malta self-managing their abortion through online telemedicine

Abstract

AbstractObjectiveTo examine the numbers and characteristics of women and pregnant people in Malta seeking at-home medical abortion using online telemedicine from 2017 to 2021.DesignPopulation-based study.SettingRepublic of MaltaParticipantsBetween 1 January 2017 and 31 December 2021, 1090 women and pregnant people requested at-home medical abortion through one online telemedicine provider (Women on Web). Mifepristone and misoprostol were shipped to 658 women (60.4% of requests).Main Outcome MeasuresThe numbers and demographics of persons to which abortion pills were shipped, their reasons for termination of pregnancy, and reasons for requesting medical abortion between January 2017 and December 2021 were analysed. Selected data were compared across different groups.ResultsThe number of persons in Malta to whom medical abortion pills were shipped increased significantly during the COVID-19 pandemic. Women and pregnant people requesting medical abortion were diverse with respect to age, pregnancy circumstances and reasons for seeking termination. More than half were mothers and over 90% reached out to Women on Web at < 7 weeks. Among those completing a medical abortion, 63% did not use contraception (n=412), and in 30% (n=197) there was contraception failure. The most common reasons for ordering medical abortion pills online were difficulty accessing abortion because of legal restrictions (73%) and abortion pills not being available (45%) in the country.ConclusionsDespite a complete ban on abortion, the number of women and pregnant people residing in Malta completing at-home medical abortions is considerable and has increased since the COVID-19 pandemic.Summary BoxesWhat is already knownLegal restrictions do not impede women and pregnant people from accessing abortion care but make them liable to criminal prosecution.What this study addsSince abortion is criminalised in Malta, there are no official statistics related to abortion. This is the first study looking at the number and characteristics of women and pregnant people who access abortion care outside the formal healthcare system in this highly restrictive legal regime.Despite the abortion ban, women and pregnant people in Malta are increasingly accessing telemedicine and self-managing their abortions.