Issue link: https://maltatoday.uberflip.com/i/1395902
13 maltatoday | SUNDAY • 25 JULY 2021 OPINION Urgent: an updated sexual health policy IN December of 2016, the morning-after pill (MAP) be- came available for purchase in Malta, after a judicial protest was filed by the Women's Rights Foundation earlier that year. It seems incredible that the MAP - a medicine that could make a world of difference to a wom- an's life – has been available to women in Malta for just four and a half years. The debate started in 2016 and continues to this day, with anti-choicers insisting that the MAP is abortive. However, it's easy to understand how the MAP could not possibly inter- rupt a pregnancy. The hormone inside the MAP delays the de- tachment of the egg from the ovary (ovulation). If ovulation has happened already, then it's too late for the MAP to work. Once the egg becomes fertilised, it remains unharmed and the pregnancy proceeds as normal. Before a medicine is launched on the market, it needs to go through several tests and checks by various authorities. The medicine is studied and researched thoroughly and a document called the Summa- ry of Product Characteristics (SmPC) is drawn up. The SmPC must contain all details about the medicine, including any side effects it might give, as well as its mode of action. Then, the medicine is submit- ted for close scrutiny by the Eu- ropean Medicine Agency, and later, if approved, by the Malta Medicines Authority. All three types of MAP available in Mal- ta have had to go through this rigorous process. Their SmPC specifically states that the MAP is not abortive. Yet, the MAP is not available for purchase from all pharma- cies because of conscientiously objecting pharmacists. To make matters even worse, the MAP is not on the government formu- lary which means that women cannot buy it from the hospital pharmacy after hours. When it comes to improving the chances of the MAP working, it's a race against time and nature since the pill must be taken before ovulation happens and within three to five days of intercourse, depending on the brand. Through the Family Planning Advisory Service (FPAS) help- line and our Doctors for Choice Facebook page, we are frequent- ly asked where women could re- liably find the MAP, dispensed in a non-judgemental manner. It is good to know that no pre- scription is needed to buy the MAP, although pharmacists can and should ask the woman some relevant questions. We've had several women com- plain that sometimes this is done in an insensitive manner and lacking in privacy. There have also been young people telling us that they've been refused the MAP because they're under 18 in spite of the fact that it's perfectly legal to dispense to 16-year girls and older, even though younger girls might need it too. This is why Doctors for Choice have launched an online ser- vice where women can answer a few questions and request a prescription for the MAP which they can present to a pharma- cy that stocks it – https://www. d o c t o r s f o r c h o i c e . m t / m o r n - ing-after-pill-prescription. The MAP is also called "emer- gency contraception" and nick- named "Plan B" because it is used when a couple's best attempt at contraception has failed for some reason. This could be due to a torn condom, a missed con- traceptive pill or delay in re-in- serting the vaginal ring. It's also used by women who have been unfortunately raped. Contracep- tion allows women to have con- trol over their reproductive lives. They can plan when to focus on their studies or work to progress in their career, as well as decide when it's time to have a baby. Thanks to the dismal state of sexual health education in Malta and the firm grip of the Roman Catholic Church on the coun- try, contraception is not used in a consistent manner among most couples. Young people are leaving school believing in myths such as that condoms in- terfere with pleasure during in- tercourse or that one could get cleaned in hospital after a rape. Studies have repeatedly shown that Malta has the highest rates of teenage pregnancies in the EU, coupled with low rates of contraceptive use. If we want to protect our children from having their lives derailed by an unexpected pregnancy, we must make sure that contraception is available widely and freely, and that a consistent and compre- hensive sexual health curricu- lum is taught across all schools. The number of women who contact Doctors for Choice ask- ing for information about abor- tion pills and saying they are close to suicide if the pregnancy continues is heartbreaking. We must get at least one per week expressing these depressingly sad thoughts. It's particular- ly poignant knowing that with better sexual health education or improved availability of con- traception, there's the possibili- ty that these women would not have needed an abortion. In fact, research shows that countries that offer freely available contra- ception and provide sound sex- ual health education have lower abortion rates. It is time for Malta to have a robust sexual health framework and protect its population from sexually transmitted infections and unexpected pregnancies with all their associated seque- lae. This country is begging for an updated sexual health programme to be taught in all schools, the availability of dif- ferent forms of contraception on the government formulary for free, and family planning clinics in different areas. It's al- so high time to remove barriers to the availability of emergency contraception and provide ac- cess to abortion healthcare as needed. Doctors for Choice is willing to help out wherever necessary and invites the government to discussions on the way forward. Dr Natalie Psaila is Specialist in Family Medicine, GP and a member of Doctors for Choice Nathalie Psaila