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How an Abortion Ban Trapped a Tourist on Malta

Andrea Prudente, a 38-year-old photographer living near Seattle, and her partner, Jay Weeldreyer, expected their trip to Malta to be a “babymoon” where they could interact while enjoying the Mediterranean. sun and local attractions.

But a few 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 release, 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.

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

A scan revealed that her cervix was open and the umbilical cord was sticking out, putting her at risk for a fatal infection, as well as bleeding from the detaching placenta, said Dr. stable. The best way to protect Ms. Prudente from those potentially deadly complications would be for a doctor to remove the placenta and fetus from her uterus. Ms. Prudente called the midwives she had seen at home and they urged her to undergo that procedure immediately.

But she was soon faced with a major obstacle: because the fetus’s heart had not yet stopped, the procedure would be illegal in Malta, where abortion is a crime.

Unless she could find a way out of the country, her only option would be to wait, possibly weeks, for the fetus to die — and hope the pregnancy wouldn’t kill her in the meantime. But due to her fragile medical condition, it was difficult to find a way out of Malta.

She was supposed to fly to Spain on Thursday evening, but nothing is certain about her condition.

Ms. Prudente’s crisis was the latest in a series of incidents that have shown how abortion restrictions can put women in mortal danger — and how travel to a more permissive jurisdiction can be difficult or impossible.

It is a danger that women already live in Malta, Poland and other jurisdictions where all or almost all abortions are banned. And it’s one that some women could soon face in the United States if, as is widely expected, the Supreme Court overthrows Roe v. Wade. While state abortion bans are likely to include exceptions to protect women’s life, recent cases in other countries suggest that doctors often still refuse to perform abortions in such circumstances, fearing they could face prosecution.

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

Mr Weeldreyer said the couple eventually understood they couldn’t even count on surgery if Ms Prudente developed a life-threatening infection. He said doctors told them that in that situation they would increase Ms. Prudente’s antibiotics to protect her without harming the fetus.

Deaths of other women after similar complications provide chilling evidence of how dangerous those kinds of schemes can be.

In 2012, the ordeal of Savita Halappanavar, a young woman in Ireland, began in much the same way as Mrs. Prudente’s. Mrs. Halappanavar’s amniotic sac ruptured prematurely, but the heart of the fetus inside her continued to beat. At the time, abortion was illegal in Ireland, so doctors refused to remove the fetus. Six days later, Mrs. Halappanavar developed sepsis, went into cardiac arrest and died. Her case became a rallying cry for abortion rights activists and helped to hold a referendum in 2018 that legalized abortion in Ireland.

The same grim streak played out in Poland last year, where a 2020 legal decision removed nearly all exceptions to the country’s abortion ban, when a young woman named Izabela Sajbor was hospitalized after her water broke at 22 weeks of pregnancy. Doctors refused to remove the fetus while a heartbeat was detectable. By the time they did, Ms. Sajbor already had a serious infection. She too died.

When Mrs. 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 her hospital room, the couple frantically searched online for someone to help. Finally they 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 proved difficult to find. Ms. Prudente’s condition makes travel risky: If she bled, she could bleed to death mid-flight unless she received immediate medical attention.

“You can’t just put her on a commercial flight to the nearest European capital,” said Dr. stable. “Nobody, myself included, would give her the chance to fly.” She couldn’t reach a more lenient jurisdiction unless she travels on an air ambulance that can provide emergency care along the way — but even that has created major bureaucratic and logistical problems.

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

Before Ms Sajbor died in Poland, she had told a friend she wanted to have an abortion abroad after discovering that her fetus had serious abnormalities, including a dysfunctional ventricle. But then her waters broke, setting in motion the chain of events that led to her death.

That’s the reality some American women could also face if, as is widely expected, the Supreme Court overturns Roe v. Wade, allowing states to criminalize abortion. While abortion is expected to remain legal in some states, women who find themselves in medical emergencies may not have the means to travel by ambulance between states, which is often prohibitively expensive.

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

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

The hospital in Malta initially took more than 24 hours to provide copies of its medical records needed to arrange the transfer, Mr. Weeldreyer. And then, he said, he was told by the insurance company that the hospital had incorrectly said that Ms. Prudente had already left against medical advice, leading to the false impression that she no longer needed to be evacuated, and causing further delays. .

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

IMG, its insurance company, initially hoped to evacuate her to London, but dropped that plan when the medical team determined the three-hour flight would be too risky, Mr Weeldreyer said they were told by IMG’s medical team .

Italy, Malta’s closest neighbor, was banned because so many of its doctors refuse to perform abortions that they couldn’t be sure she would get the care she would need.

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

IMG now hopes to evacuate her on Thursday evening.

And the clock is ticking. Ms. Prudente’s seven-day course of powerful 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 stuck in grief and fear.

“It feels like torture,” said Mrs. Prudente. “Assuming I survive this,” she said, “I want this to change.”

“This is wrong and it should not happen to anyone else.”

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