When Andrea Prudente was sitting in a Maltese hospital waiting for her foetus’s heart to stop beating, she was offered grief counselling. Prudente, an American photographer, began to miscarry her pregnancy at 16 weeks during a holiday with her partner on the Mediterranean island, and had been told there was no hope for it.
But because of the heartbeat – and despite Prudente’s own life-threatening risk of haemorrhage and infection – doctors at the Mater Dei hospital in Msida would not intervene to end her very wanted pregnancy. Malta’s ban on abortion in all circumstances – the only EU country to do so – prevented it.
Prudente sent the grief counsellor away. “It’s like sending in a PTSD counsellor when the battle is still going on,” she says.
It took a widely publicised medical evacuation by air ambulance to the Spanish island of Mallorca to bring Prudente’s two-week ordeal to an end, and for her and her partner, Jay Weeldreyer, to begin to truly grieve for their loss.
Only in Spain were they able to deliver their daughter, hold her and say goodbye. Staff gave the couple a blanket for the body, and a star to hang on a tree alongside those representing all the other births that had taken place at the hospital.
As soon as she arrived at the hospital in Mallorca, Prudente was approached by a sympathetic staff member. “She said, ‘I saw you on the news.’ And she hugged me,” Prudente says.
She was discharged this weekend and is recuperating before the long journey back to Seattle. She says she feels weak but is slowly recovering.
It was only thanks to their travel insurance that the couple was able to get out of Malta at all: the insurer considered Prudente’s risk to be significant enough to send a private jet with a surgeon on board from Belgium to transfer her safely to Mallorca.
“We were extraordinarily privileged to be American citizens who had the ability to purchase that kind of insurance, because absent a third-party insurance company, and absent us being foreigners, there’s no way we were getting off that island,” says Weeldreyer.
He says he is staggered by the lengths they had to go for what could have been a straightforward, if distressing, procedure.
The couple were contacted by anti-abortion activists on social media, who urged them not to intervene to complete the miscarriage and telling them miracles could happen.
“We have a relationship with medicine, not with miracles,” says Weeldreyer.
Prof Isabel Stabile, a gynaecologist with Doctors for Choice Malta, has seen two other cases like Prudente’s so far this year. But for those local women, waiting for the heartbeat to stop was the only option.
“Luckily, in those cases, the women were fine physically,” she says, adding however that they were “mentally distraught”.
On Monday, Doctors for Choice submitted a “judicial protest”, a legal petition to Malta’s civil courts signed by 135 doctors demanding a review of the abortion ban. The doctors say the law ties their hands in cases such as Prudente’s, where medical professionals must weigh the care they provide to a patient against the risk of being prosecuted for terminating a pregnancy.
Under Malta’s abortion law, which dates from the 1850s, women who have abortions face up to three years in prison, and doctors who perform them can be imprisoned for up to four years, as well as losing their medical licence.
“The current law does not protect them when they try to protect the lives of women,” says Stabile.
She says many of the signatories would not consider themselves pro-choice, but simply want to put an end to the threat of losing their medical licence for providing care to their pregnant patients. A 2019 study found that more than 60% of doctors in Malta supported legalising abortion in cases of risk to the patient’s life and foetal non-viability.
Anti-abortion groups point to Malta’s low maternal mortality rate as evidence that the abortion ban does not put patients at risk, and say doctors will intervene in cases of risk to life.
But Stabile says maternal mortality is “a very, very low bar to set” for measuring whether medical care is adequate.
Weeldreyer and Prudente say that as they were preparing to leave Malta, a doctor at Mater Dei who also practised in London told them that if Prudente had been in the UK, he would have intervened as soon as he saw her ultrasound results.
Mater Dei hospital has been approached for comment.
In a dark irony, Prudente’s nightmare is likely to become a reality for many women back home in the US. On the day she was evacuated from Malta to Mallorca, the US supreme court removed the right for women in the US to terminate a pregnancy, leading to a swathe of US states enacting bans on abortion. Though these states have included exceptions to save the life of the patient, experts warn the terms are so vague as to risk having a chilling effect on doctors, who, like those in Malta, could be reluctant to perform terminations after incomplete miscarriages for fear of falling on the wrong side of the law.
“The timing is nuts,” Prudente says of the ruling overturning Roe v Wade, noting that women in her position will soon have to travel between US states for the care they need. “It’s so regressive.”
She is now preparing to get home and sort through the “emotional wreckage” of a holiday that began as a “babymoon” but became a medical emergency, and then an international incident.
But she wants to use her experience to continue to advocate against abortion bans around the world. “We see ourselves as accidentally in this position to influence – just by being honest and sharing our story.”
In the meantime, Weeldreyer has a warning: “If you know a woman, if you love a woman, if you ever plan on knowing or loving a woman, or if you are a woman – don’t go to Malta.”
• This article was amended on 28 June 2022. An earlier version referred to “a swathe of states enacting outright bans on abortion with no exceptions for rape, incest or to save the life of the patient” in the wake of the US supreme court decision. While it is correct that some US states, including those that had laws in place ready to be “triggered” by the court’s decision, do not have exceptions in rape and/or incest cases, they do have exemptions where the life of the patient is in danger.