How an abortion ban trapped a tourist in Malta

Andrea Prudente, a 38-year-old photographer who lives near Seattle, and her partner, Jay Weeldreyer, expected their trip to Malta to be a “babymoon” where they could connect while soaking up the Mediterranean sun and the sights local.

But days after arriving in Malta on June 5, Ms Prudente, then 16 weeks pregnant, began to miscarry. A few days later, her waters broke and her placenta began to detach, making it impossible for the fetus to survive, according to Dr Isabel Stabile, a gynecologist who has worked with Doctors for Choice, a Maltese advocacy group.

Ms. Prudente and Mr. Weeldreyer were devastated. But then they discovered that the situation was even worse than they had imagined and that Ms. Prudente’s own life was also in danger.

A scan revealed that her cervix was open and the umbilical cord was protruding, leaving her at risk for a life-threatening infection, as well as bleeding from placental abruption, Dr Stabile said. The best way to protect Ms. Prudente from these life-threatening complications would be for a doctor to remove the placenta and fetus from her womb. Ms Prudente called the midwives she had seen at her home and they urged her to undergo the procedure immediately.

But she was soon faced with a major obstacle: the heart of the fetus had not yet stopped, the intervention would be illegal in Malta, where abortion is criminalized.

Unless she finds a way to leave the country, her only option would be to wait, potentially for weeks, for the fetus to die – and hope the pregnancy doesn’t kill her in the meantime. But due to his fragile medical condition, a way out of Malta was difficult to find.

She is now due to fly to Spain on Thursday evening, but in her condition, nothing is certain.

Ms Prudente’s crisis was the latest in a series of incidents that have shown how abortion restrictions can put women at risk of death – and how getting to a more permissive jurisdiction can be difficult, if not impossible.

It’s a danger women already live with in Malta, Poland and other jurisdictions where all or nearly all abortions are banned. And it’s a situation some women may soon face in the United States if, as commonly expected, the Supreme Court overturns Roe v. Wade. Although state abortion bans would likely include exceptions to protect the woman’s life, recent cases in other countries suggest that doctors often refuse to perform abortions in such circumstances, fearing prosecution.

Mr Weeldreyer and Ms Prudente had no idea abortion was illegal in Malta when they arrived at hospital last Sunday. And no one explained to them the legal restrictions, they said – only that their fetus would certainly not survive and that Ms Prudente was admitted to hospital for observation.

Mr Weeldreyer said the couple finally realized they could not even count on surgery if Ms Prudente developed a life-threatening infection. He said doctors told them that in this situation they would increase Ms Prudente’s antibiotics to protect her without interfering with the fetus.

The deaths of other women from similar complications offer chilling evidence of how dangerous these types of plans are.

In 2012, the test of Savita Halappanavar, a young woman in Ireland, started out very similarly to Ms Prudente. Ms Halappanavar’s amniotic sac ruptured prematurely, but the fetal heart inside her continued to beat. At the time, abortion was illegal in Ireland, so doctors refused to remove the foetus. Six days later, Ms. Halappanavar developed sepsis, went into cardiac arrest and died. Her case became a rallying cry for abortion rights activists and helped spur a Referendum 2018 who legalized abortion in Ireland.

The same dark sequence unfolded last year in Poland, where a 2020 court ruling removed nearly all exceptions to the country’s abortion ban, when a young woman named Izabela Sajbor was admitted to hospital after her waters broke at 22 weeks of gestation. Doctors refused to remove the fetus when a heartbeat was detectable. By the time they did, Ms. Sajbor already had a serious infection. She too is dead.

When Ms. Prudente realized how much danger she was in, she and Mr. Weeldreyer began to panic.

At one point, she wondered if she should ask Mr. Weeldreyer to punch her in the stomach to hasten the end of the pregnancy.

From their hospital room, the couple frantically searched online, trying to find someone who could help. They eventually found Dr. Stabile, the gynecologist, and Lara Dimitrijevic, a women’s rights lawyer.

Both had the same advice: Leave Malta.

But a safe way out of the Mediterranean island nation has proven difficult to find. Ms. Prudente’s medical condition makes traveling risky: if she were to hemorrhage, she could bleed to death mid-flight unless she receives immediate medical intervention.

“You can’t just put her on a commercial flight to the nearest European capital,” Dr Stabile said. “No one, including myself, would give him the ability to fly.” She can’t reach a more permissive jurisdiction unless she travels in an air ambulance that can provide emergency care en route – but even that posed significant bureaucratic and logistical challenges.

Her situation highlights a grim reality of abortion bans: women may not be able to travel to other jurisdictions to terminate a pregnancy when they urgently need it.

Before Mrs. Sajbor died in Poland, she had tell a friend she was considering having an abortion abroad after discovering that her fetus had serious abnormalities, including a dysfunctional heart chamber. But then his waters burst, setting off the chain of events that led to his death.

This is the reality that some American women could also face if, as commonly expected, the Supreme Court overturns Roe v. Wade, allowing states to criminalize abortion. Although abortion is expected to remain legal in some states, women who encounter medical emergencies may lack the resources to travel interstate by ambulance, which is often prohibitively expensive.

In Malta, women generally have no way of escaping the island if they have medical complications like Ms Prudente’s, Dr Stabile said. Air ambulances cost thousands of dollars and few residents have private medical insurance. “Of course, the situation for Maltese women is much worse,” said Dr Stabile. “The solution for this couple is to travel. But for a local person, this is not a viable option.

Ms. Prudente has private insurance that covers medical evacuations. But even that still wasn’t enough to bring her to safety.

Malta Hospital initially took more than 24 hours to provide copies of its medical records needed to arrange the transfer, Mr Weeldreyer said. And then, he said, the insurance company told him that the hospital had incorrectly said that Ms. Prudente had already left against medical advice, which gave the mistaken impression that she no longer needed to be evacuated and caused further delays.

The hospital did not respond to a request for comment and the insurer declined to comment.

IMG, his insurance company, initially hoped to evacuate him to London, only to abandon that plan when his medical team determined the three-hour flight would be too risky, Mr Weeldreyer told the IMG medical team.

Italy, Malta’s closest neighbour, was ruled out because so many of its doctors refuse to perform abortions that they could not be sure she would get the care she needed.

On Wednesday, IMG called with a new plan: They would evacuate Ms Prudente to a hospital in Mallorca, Spain. Although not as close as Italy, it was the closest destination they felt could provide reliable care.

IMG now hopes to evacuate him on Thursday evening.

And the clock is ticking. Ms Prudente’s seven-day course of strong antibiotics began last Thursday. Every hour she waits increases the risk of infection or other catastrophic complications, as well as the psychological pain of being trapped in grief and fear.

“It looks like torture,” Ms. Prudente said. “Assuming I survive this,” she said, “I want that to change.”

“It’s wrong, and it shouldn’t happen to anyone else.”