By Daiva Repečkaitė, Sabrina Zammit, Evy Coeckelbergs and Julian Bonnici

Over €1.15 billion has been distributed in direct orders under the Abela, Muscat and Gonzi administrations. Under Joseph Muscat, a single ministerial portfolio – Family – awarded €410.5 million in direct orders without a competitive tender. For Robert Abela’s government, the Environment & Energy Ministry has taken over, with €110 million.

A new Amphora Media analysis of all the direct orders & tenders published between 2010 and 2025 reveals that the Family, Health, Environment, Education, and Home Affairs ministries are the most lucrative portfolios for contractors to accumulate millions without a competitive process. 

Top spenders of direct orders according to ministerial portfolios under the last three administrations:

*Gonzi-era figures are based on disclosed amounts for 2011–2013 only; 2010 records largely lacked stated amounts

N.B: In Malta, ministerial portfolios, government agencies and other independent entities change over time– they can be merged and split between government terms as well as during reshuffles.

To address challenges with direct comparison across different administrations, Amphora Media looked at the first keyword in each ministry’s name (like “Transport” or “Justice”) to categorise the “portfolio item”.  We then tracked how much these entities spent on direct orders over time. 

The analysis does not cover portfolios that were merged with larger ministries (for example, when tourism was merged with foreign affairs in 2024).

Which contractors accumulated the largest sums under the different portfolios?

The Family Ministry, under different administrations and iterations, is where some of the eyewatering large direct orders are issued. 

The largest beneficiary during the period was the JCL and MHC Consortium, which received €273.6 million for Management Services of the New Hospital/ Residence. This was the largest single direct order issued over the fifteen-year period.

Another 11 beneficiaries of direct orders in this portfolio made over a million in direct orders over the period:

Care Malta Ltd (almost €61.8 million), Primecare Ltd (€10.1 million), Support Services Ltd (€8.5 million), Caring First Ltd ( €5.8 million), Age Concern Company Ltd ( €5.6 million), Healthmark Care Services Ltd ( €5.1 million), Malta Health Care Caterers (almost €4.8 million), X-Clean Ltd (over €3.6 million), Archdiocese of Malta Homes for the Elderly (€over €2.5 million), Villa San Francesco (nearly €2 million), and Falbra Ltd (€1 million).

The Environment Ministry is also among the highest spenders on direct orders. 

The United Equipment Co (UNEC) Ltd, part of Bonnici Group, was the top beneficiary, receiving over €32.2 million in direct orders for power generation, infrastructural works, industrial supplies, equipment procurement and more. 

More recently, the Shift News revealed that the government issued a €120 million direct order to a consortium led by the Bonnici Brothers.

Bonnici Bros Services was separately awarded early €3.5 million across direct orders for works on a shooting range under the Education, Sport, Youth, Research and Innovation Ministry. 

It was flagged by the National Audit Office for flawed management and weak internal controls,  including deficiencies in documentation and procurement record-keeping.. 

The official explanation was that the shooting range works were fast-tracked to ensure completion in time to host an international sporting event. In response to the unfavourable NAO conclusions, the government insisted it was still “proud” of whoever worked on the project.

Within the Environment Ministry, Ozo Malta received the second most, with €9.6 million in a single direct order for the “supply of administrative/operational services” to Wasteserv.

The Health Ministry is another major distributor of direct orders. Drugsales Ltd was the top beneficiary, with over €23.5 million in direct orders for various medical supplies and equipment.

Technoline, which has been accused of money laundering in connection with the Vitals hospital concession corruption case, is among the top 10 recipients of direct orders from the Health Ministry. Over the period, it received almost €4.7 million in direct orders for various hospital supplies.

The company was acquired by Ivan Vassallo with a loan from Vitals Global Healthcare. Prosecutors allege that Technoline Ltd was fraudulently acquired by Gateway Solutions Ltd using funds linked to the Vitals hospitals concession, allegedly structured through a loan arrangement. 

Investigators alleged that the company was “destined to be owned by former chief of staff Keith Schembri and ex-minister Konrad Mizzi, among others”, according to court reporting. 

In 2024, the court upheld an asset freeze against the company. Technoline received direct orders worth over € 226,000 from the Health Ministry post the asset freeze.

Technoline was also among the top contractors for the Agriculture Ministry, receiving over € 215,000 for animal health supplies. These were issued before the charges. 

In response to the findings, a lawyer representing Technoline wrote asking “to ensure that you differentiate between a direct order sic et simpliciter and a purchase order because of and as a result of, contractual obligations.” Procurement from Technoline was classified as direct orders in the government gazette

“My client is fully operational according to law and is administered by a Court-appointed administrator,” the lawyer representing Technoline explained, adding that the company’s representatives are not “ allowed to reply to any question put to them, which question might somehow directly or indirectly refer to, or be linked with, or referenced to the pending proceedings in Court.”

Beyond Technoline, Smart Care Pinto received more than €22 million in a single direct order for long-term care beds. Infrastructure Malta, a government agency, received direct orders worth over €7.7 million.

In Home Affairs, the largest beneficiary was GO, the telecommunications company.  Gold Guard Security is also among the top providers, with one direct order worth €1.3 million. Amphora Media has previously reported on the concentration of security contracts among several providers, Gold Guard Security being one of them.

The Ministry of Gozo, which added planning to its portfolio in 2024, also issued direct orders in the millions. 

Cassar Fuel was the top beneficiary, with €6.7 million, including a single direct order worth €2.5 million, an extension of a previous marine gas oil supply contract won by tender.

Manoel Island Yacht Yard, which is not part of MIDI’s Manoel Island concession, received €2.26 million for vessel servicing, among other purposes.

In the Transport portfolio, the largest beneficiary was Link-2018 JV (reportedly a consortium between V&C Contractors, Schembri Barbros and Schembri Holdings), which received almost €2.7 million direct order, in addition to the €28 million tender it was awarded.  

Direct orders were also awarded to Enemalta – €3.9 million in total.

The ministries did not comment.

Consultancies & IT Providers

When ranking suppliers by the amount received under each portfolio, the analysis showed that consultants, including IT providers, lawyers and others, were often the largest beneficiaries of direct orders.

Notably, Mifsud Bonnici Advocates made nearly €346,000 in direct orders for legal services between 2016 and 2022. Amphora Media has reported on how Aron Mifsud Bonnici’s tax evasion and money laundering charges were extinguished after he reached an out-of-court settlement under a new legal mechanism, while he continues to face separate charges in connection with the Vitals case

Asked about this, Aron Mifsud Bonnici replied, “My firm was not the authorities’ preferred choice. The longstanding and dominant pattern of direct procurement of legal services by Maltese public entities has always centred on larger, traditional commercial law firms, which have received direct instructions from government consistently across successive administrations — before, during, and after the period your questions reference. My firm’s engagements during that period represented a temporary broadening of the pool of firms instructed, not a displacement of the established pattern.”

“It is the norm, not the exception, for legal work involving specialist expertise or urgency,” he wrote, adding about the Vitals case that “A conflict of interest requires competing interests that compromise the integrity or independence of a decision or of a professional’s conduct. No such competing interests are identified. The question simply juxtaposes two separate and unrelated matters — the Vitals case and direct orders for legal services — and invites the reader to infer a connection. None exists, and none has been established in any forum.”

A breakdown of ministry spend in these areas is below:

• Finance Ministry: FTI Consulting, a US-headquartered company, emerged as the top supplier for the Ministry of Finance, with €3.4 million in direct orders. A direct order of over €2 million was also issued to Oliver Wyman, an American consultancy. Aside from foreign consultancies, the ministry and entities under it spent €1.2 million on Tal-Lira.
  
• Justice Ministry: Directed multi-million sums to Calamatta Cuschieri & Co, a financial advisory (including €3.2 million in a single direct order) and a number of security companies: Signal 8 Security, Kerber Security and G4S Community Services were among the top 20 beneficiaries.
  
• Culture Ministry: with €1.8 million in a single direct order, the top beneficiary was software supplier European Dynamics Consortium, a multinational company.
  
• Economy Ministry:
  • Gauff Consultants received €1.4 million in direct orders;
  • Wyzer Ltd – a software consultancy co-founded by the government’s AI taskforce member Abdalla Kablan, was contracted to provide services to Malta Business Registry for over €1.2 million.
    
• The Office of the Prime Minister: Exigy Ltd was the largest beneficiary, with nearly €1.2 million. Moreover, PTL Ltd received a single direct order worth €557,272.
  
• Agriculture Ministry: Loqus Services was the top beneficiary, receiving €773,135. Separately, Loqus Business Intelligence, not registered as a company on MBR but appearing as the group’s brand, received €137,875. The group provides IT services;
  
• Energy Ministry: This portfolio’s top contractor was Darttek, with €378,704.

• Tourism Ministry: Although most top-20 contractors are corporate, there is one individual name, Marika Micallef. She received a total of €105,000 in direct orders;
  
• Social inclusion/ equality Ministry: In 2021, KPMG received a €138,000 direct order in this policy area; Labour politician and activist Desiree Attard was contracted for over €49,000 via direct order to serve as legal advisor to the Human Rights and Integration Directorate..
  

The Public Works Ministry: Awarded JF Group, which provides staffing with over €128,000 in direct orders received over 2024.

In tendering by portfolio, over three-quarters of tenders are concentrated in the hands of the Department of Contracts, making comparison with the distribution of direct orders difficult. Infrastructure Malta is the runner-up with under 9% of tender volume.

Over the period spanning 2011-2025, construction work benefited from more spending than any other tendering area, with €1.6 billion. It was followed by medical equipment, pharmaceuticals and personal care products (over €724 million) and health and social work services (over €676 million).

The Government and the National Audit Office did not reply to the questions sent.

• Tax revenues in Malta more than doubled between 2013 and 2023, rising from €2.5 billion to €5.6 billion, largely due to population and migration growth.
• Personal income tax and social security contributions both nearly doubled over the decade, yet local council funding remains below 0.8% of total tax revenues.
• Despite the population growth, investment in public services has lagged, particularly in healthcare, childcare, and local infrastructure.
• Foreign patients account for over one in eight hospital users, yet legal and administrative barriers persist.
• Childcare services are unevenly distributed, with areas such as St. Paul’s Bay, Sliema, and Marsa underserved, despite having large migrant populations.
• Government funding for after-school programs was reduced by half in 2024.
• NGOs fill widening service gaps by offering healthcare, legal, and integration support, but they face unstable funding and limited government backing.

Taking benefits, using free public services, exploiting tax breaks – a 2023 study shows these are the accusations most often levelled at migrants on social media in Malta.

A cross-border investigation by Amphora Media and our partner Público in Spain reveals that weak government investment in public services – for both citizens and foreigners – fuels tensions over quality and accessibility, rather than migration itself or the tax revenue migrants contribute.

Amphora Media examined key services in localities, many of which border each other, that have experienced significant increases in their foreign population. 

Check out all the numbers behind migration and population in Malta over here.

Malta’s Tax Revenues Soar Amid Population Boom

Malta is one of the EU’s fastest-growing economies, with the second-highest employment rate and the lowest unemployment rate in the EU. Still, a 2021 survey showed that nearly half of Maltese respondents viewed migrants as a greater burden than a benefit, and a quarter attributed low wages to migrants.

Malta’s tax revenues have increased significantly over the past decade, coinciding with population growth and migration. Between 2013 and 2023, revenues more than doubled from around €2.5 billion to €5.6 billion.

Between 2013 and 2023, revenue from personal income tax — paid by both Maltese and foreign residents — increased by nearly €1 billion, a rise of approximately 190%.

In 2023 alone, households contributed €1.5 billion, or almost two-thirds of all income tax collected.

Employee social security contributions, which cover pensions and other benefits, also more than doubled, climbing from €200 million in 2013 to more than €447 million in 2023.

Average monthly salaries rose from about €1,335 in 2013 to €2,125 in 2025.

Yet, investment in local councils, which are often on the front lines of population transformation and the tensions that come with it, remains limited.

The 2024 budget for local councils was slightly above €48 million across 68 localities. That’s around 0.8% of the total tax revenues generated.

Healthcare: who pays?

A survey found that most Maltese people see a high concentration of immigrants as an obstacle to integration. Yet only a third, the lowest share in the EU, viewed limited access to healthcare, education, and social services in the same way.

Approximately €73 million is allocated for primary health care and community services. At the same time, hospitals such as Mater Dei, Mount Carmel, Gozo General, Karin Grech, and St. Vincent de Paul collectively receive €265 million. 

Combined, this represents roughly a quarter of the Health Ministry’s budget and 6% of total tax revenues. 

Data shows that the number of Maltese citizens visiting Mater Dei has grown, and visits to health centres have fluctuated since 2020.

Malta has one of the highest out-of-pocket spending rates in the EU. In 2024, Researchers say that despite this, the share of unmet needs is low. 

This includes the migrant population. An EU dashboard shows that Maltese citizens are more likely to consider their health bad or report a long-standing illness. 

The latest Migrant Integration Policy Index states that “healthcare entitlements remain discretionary, and documentation and administrative barriers continue to pose challenges”, making the system “halfway favourable” to migrants. 

According to a 2024 report by the European Observatory for Health Systems and Policies, Malta has fewer acute care beds and less specialised equipment than several other Mediterranean countries and fewer than in 2022. At the beginning of 2023, the pain clinic had a waiting list of over 200 people.

Foreign residents constituted more than one in eight patients at the main hospital in 2023 and one in six users of the health centre.

Their number has more than doubled since 2020, but is still below the share of the foreign population in Malta, which was 29% in 2024.  A report warns that mental healthcare for migrant and refugee populations is “a major concern”.

Legal changes introduced in 2024 require many non-EU nationals applying for employment, family reunification, or studying outside recognised public institutions to obtain private health insurance with at least €100,000 coverage. However, students at Malta’s public universities and institutes are exempt from this requirement.

Between 2022 and 2023, hospital revenues from paid fees increased by more than 100%. In 2024, the hospital received €1,323,284.36 from third-country nationals.

“What we find with healthcare, and particularly in the last couple of years, is that things have really kind of stepped up in terms of payments, cracking down on making sure that people are charged and people’s documents are checked very thoroughly,” says Beth Cachia, research and advocacy coordinator at Jesuit Refugee Service, which helps refugees and asylum seekers navigate bureaucracy.

In 2024, the NGO helped 53 individuals with healthcare needs. Cachia warns of “ instances of people, even with a refugee status, turned away” despite healthcare falling under the protection of asylum seekers.

Umayma Elamin Amer Elamin, the founder and president of Migrant Women Association Malta, detailed how migrant women face similar challenges:

“Sometimes they get all the medicine, sometimes she will need to buy it herself. Sometimes, if they have an operation or an illness, they may need to wait. When it comes to communication, I feel translation is also a big issue,” she said, making particular reference to STD screening.

Gaps in Primary Care

Although the government claims that primary health centres are strategically located, St Paul’s Bay, with a total population of 35,000 (almost 60% foreign), does not have one.

Neither do Sliema and St Julian’s, which, with a combined population of more than 34,000, must use Gżira’s. Marsa (part of the Southern Harbour, where most migrants are non-European) also lacks a healthcare centre. 

2024 data shows that Mosta Healthcare Centre, which has a large catchment area, handled the largest number of emergency visits.

Paola, which had the second-highest number of emergency visits and covers several southern localities, including Marsaskala and Birżebbuġa, topped the list by the total number of patients. 

Caring for the youngest

Free childcare is provided to working or studying parents not on parental leave. Foreigners working in Malta are eligible too.

The distribution of these vital facilities did not mirror the population:

• In Gozo, only Victoria had childcare centres available from the localities included in this analysis.
• In the South, Birzebbuga had two childcare centres and Marsaskala had four.
• The much less populous Pieta’ and Gżira had five and six, respectively.
• The populous St Paul’s Bay only had two.
• In Sliema, where the majority of pupils at schools are foreign, there are only two childcare centres for younger children.
• St Julian’s is a smaller locality than Sliema, but there are three childcare centres.

Parents in full-time employment can place their children in after-school centres. The government considers that the introduction of free childcare, including for school-aged children, is behind Malta’s success in raising female employment rates.

As of early 2024, the 3–16 centres in Sliema and St Paul’s Bay had waiting lists of 25 and 28 children, respectively.

According to the 2024 financial estimates, the government reduced funding for after-school clubs by almost half, from €9 million to an estimated €4.8 million, between 2023 and 2024.

For migrant mothers without established family networks, access to childcare can significantly impact their employment prospects.

“I can confirm this is the big challenge for a woman, to have access to the labour market and to get enough funds to live easily in Malta. I can see the majority of our beneficiaries have this problem,” says Elamin. “Sometimes they can’t work, for example, because of their situation or maybe because they are married and they have children, or they don’t have access to services that can help them to work with their children.”

The Expats Malta Facebook community also guides its members who seek better schooling for their children.

“If you’re a typical family, it’s fine, no problem. You move to a village, you’re in the catchment area for a school, and that’s where your child goes. But if you come as a single parent, they’ll ask: do you have a letter of authorisation from the other parent? Even if you have full custody. It’s all these small things where the right information is just missing,” one of its administrators, Tom Erik Skjønsberg, says.

NGOs stepping up without public investment 

NGOs, such as the Migrant Women Association Malta, and communities attempt to fill the gaps left by state authorities. The association has begun incorporating social services into its training and entrepreneurship portfolio. 

 “We have become like one of the organisations that have a social service directly to the asylum seeker, refugee, and migrant woman. But specifically those affected by poverty and sexual gender based violence,” says its founder, Umayma Elamin Amer Elamin.

Since last year, JRS Malta, where Beth Cachia works, is partnering with aditus Foundation and Migrant Women Association Malta to jointly provide legal, psychological and social work services, cultural mediation, and basic integration support services to vulnerable individuals.

However, without sustained funding, it can be difficult to maintain.

“We had something before. We used to study Maltese, English and some arts as well. Computers too. But because of COVID-19, we closed and we didn’t open it again,” Mohamed Ibrahim from the Sudanese community told Amphora Media.

“Unfortunately, we didn’t [find government support]. We used to collect money to pay the rent and we had to close it. We didn’t even try find a place for us because the support there once was lost.”

This investigation was developed with the support of Journalismfund Europe.

The United Kingdom is no longer the primary destination for Maltese residents seeking abortions abroad. Official data analysed by Amphora Media, as part of the European cross-border investigation Exporting Abortion, coordinated by Público (Spain), reveals that Spain has now surpassed the UK in the number of women from Malta travelling there for the procedure.

Public records and freedom of information requests show that Spain has seen a rise in numbers from Malta over the past few years, despite the UK historically being the ‘classic’ choice.

According to experts, the Netherlands is also a common destination among Maltese women, though Dutch authorities do not document specific figures for Malta, among other countries.

Why Are More Women Choosing Spain?

The number of Maltese residents travelling to the UK for abortions began to decline in 2020, coinciding with the COVID-19 pandemic. However, the shift in abortion travel patterns appears to have been influenced by multiple factors.

According to abortion researcher and Abortion Support Network volunteer Liza Caruana Finkel, this trend may also have been influenced by Brexit, which could be complicating visa requirements for non-EU nationals residing in Malta. 

One other significant factor is the increased awareness and use of abortion pills for early pregnancy terminations (up to 12 weeks). However, for women seeking abortions after this period, travelling abroad is the only option.

Malta has the strictest abortion laws in the EU – allowing a legal abortion only in cases where  a woman has a medical complication which may put her life at immediate risk or that places her health in grave jeopardy which may lead to death.

While between 2010 and 2019, an average of 55 Maltese residents per year travelled to the UK for abortion services, this number dropped dramatically to 20 in 2020, just 4 in 2021, and 13 in 2022. The figures for 2023 have yet to be published.

Meanwhile, Spain has steadily increased, rising from 7 in 2019, to 14 in 2022 and 27 in 2023.

The Exporting Abortion investigation found that Spain is one of the European countries that receives the most women seeking abortions. 

An analysis of different European laws and country-specific situations by the investigative team highlights that Spain is likely a popular country of choice due to several factors: it is in the European Union, it is one of the countries with easier access to abortion (upon request till 14 weeks, however relatively easy to access abortion until 22 weeks in some regions) and the procedures are cheaper than in countries like the Netherlands and the UK(which have longer timeframes than Spain for abortions on request).

Additionally, a change in legislation in Spain in 2023 now permits 16- and 17-year-olds to access abortion without parental consent, and Spain and Malta are well-connected by air travel.

5 Women Have Had Abortions in Malta Under New Law

A total of five women have had legal abortions in Malta following Malta’s 2023 legal amendment. A freedom of information request has revealed that four of these abortions took place in 2024 and one in 2023. There have been no procedures so far in 2025.

According to the law, a medical team consisting of two gynaecologists or obstetricians, one of whom would be the professional to carry out the termination, and a third specialist in the field related to the health issue affecting the woman must give the go-ahead prior to the procedure being carried out. 

However, the Health Ministry’s Department for Policy in Health could not provide the number of times when a decision by the doctors’ committee did not result in the termination of a pregnancy, saying that they “have no visibility of additional ‘unsuccessful’ discussions.”

The 2023 legal amendment came about in reaction to the case of US national Andrea Prudente, who was denied an abortion in Malta in June 2022, despite experiencing severe pregnancy complications and the risk of infection after her fetus was deemed non-viable. A non-viable fetus is one that cannot survive outside the womb.

Prudente had to be medically evacuated to Spain to terminate the pregnancy. The case threw Malta’s extremely restrictive abortion laws in the spotlight and sparked international criticism.

The bill slightly shifted criminal law surrounding abortion from a total blanket ban to allowing for the procedure in cases where women’s lives are in imminent danger. 

Activists had argued that the revised bill does not sufficiently safeguard women’s health, as it excludes situations where her health is severely compromised. Malta’s abortion laws remain the most restrictive in the EU, making no exceptions to survivors of rape or incest.

More than 5,000 European women have to travel abroad every year to get an abortion

The international investigation Exporting Abortion quantifies for the first time how, even today, thousands of women across Europe cross the borders of their home countries to access an abortion, due to the obstacles that still exist in many states when it comes to termination of pregnancy – even in cases where abortion in their home countries is legal.

The reasons behind this phenomenon vary. Sometimes women realise they are pregnant after the legal deadline for abortion has passed in their country. In other cases, the fetus presents a malformation that local doctors do not consider serious enough to justify terminating the pregnancy.

Exporting Abortion exposes the journeys European women take to access abortion services in other countries. The highest flow is from Germany to the Netherlands, followed by Portugal to Spain. The third most common route is from France to the Netherlands.

Additionally, it shows how women don’t just travel abroad to access abortions. There’s also a growing trend of women ordering and taking abortion pills on their own in countries where abortion rights are highly restricted. This occurs outside the formal healthcare system, leaving women without medical supervision. This trend is particularly evident in countries like Malta and Poland.

Explore the wider investigation here.

Top graphic credit: NSUE Studio

This investigation was developed with the support of Journalismfund Europe.

Exporting Abortion is a cross-border journalistic investigation coordinated by Público (Spain) in collaboration with European media and journalists from across Europe. 

The journalists who have participated in this investigation are, in alphabetical order: Joana Ascensão (Portugal – Expresso), Kristina Bohmer (Slovakia), Magdalena Chrzczonowicz (Poland – OKO.press), Mayya Chernobylskaya (Germany), Nacho Calle (Spain – Público), Maria Delaney (Ireland – The Journal Investigates), Joanna Demarco (Malta), Armelle Desmaison (France), Emilia G. Morales (Spain – Público), Bru Noya (Andorra), Apolena Rychlíková (Czech Republic), Órla Ryan (Ireland – The Journal Investigates), Sergio Sangiao (Spain – Público), Margot Smolenaars (Netherlands – Follow The Money).

• Abortion Pill Shipments Double in Four Years
• Four Police Reports, Two Arraignments Linked to Abortion Pills Since 2018
• Traveling for Abortion Up to 25 Times More Expensive Than Pills

“I remember sitting on the edge of the bathtub, Googling ‘abortion in Malta,’ then panicking, thinking they were going to trace my search back to my IP address… Imma paranojja ridikula. Well, it’s not ridiculous because it’s not unrealistic…”

*Stephanie was 25 and had just begun a new scholastic year working as a secondary school teacher when she unexpectedly became pregnant, despite using contraception.

Her abortion was one of over 2,000 cases in Malta in the past five years for which women have used pills shipped from international organisations that provide them, according to data kept by the two main abortion pill suppliers and shared with Amphora Media through local NGO Doctors for Choice. The data was shared as part of the European cross-border investigation Exporting Abortion, coordinated by Público (Spain). 

The numbers signal that Malta’s near-total abortion ban has not stopped women from seeking abortions. Rather, access to abortion pills is increasingly leading to more self-managed terminations.

Yet, the framework of illegality and stigma fosters a climate of fear, risk, and isolation as these procedures continue to take place outside the healthcare system.

In an interview with Amphora Media, held in a private location, Stephanie described the experience of having an abortion within this climate as triggering “all the worst emotions” — fear, anger, shame and mistrust; including towards her siblings, her gynae and even her GP.

“You feel angry at the state, frustrated, you are nauseous and worried about the actual abortion and worried about being caught. So there are a lot of layers to the upset, because it is distressing… And that is what made the whole thing difficult. Not the procedure,” Stephanie said.

Dr Natalie Psaila Stabile, a specialist in family medicine and co-founder of Doctors for Choice Malta, speaks to women daily who want to have, or have had, abortions, through the NGO’s Abortion Doula Support Service that she helps run. The service offers women free, confidential abortion information and support.

Without hearing the interviewee’s story, she echoed Stephanie’s fears as ones expressed by the women she talks to. 

“People get very concerned about the pills being stuck at customs or being found out… Some fear being reported by family members, partners, or even their ex-partners. Some are in abusive relationships where their partner wants them to keep the pregnancy, and they don’t — as this ties them down even more”.

The safety of pills purchased online, potential complications, and how to recognise excessive bleeding or failed procedures are other concerns the women who speak to Dr Psaila Stabile raise.

Psaila Stabile’s mother, Professor Isabel Stabile, a gynaecologist and the co-founder of Doctors for Choice Malta, told Amphora Media that from a medical point of view, the pills are safe, save for a “rare” occurrence of very heavy bleeding, which would require hospital care.

The latter is the scenario which women taking the pills fear – having to need to go to hospital and risk the chance of being found out.

Four Police Reports Linked to Abortion Pills Since 2018 – Two Arraigned

While the fear of being reported to the police is a main concern for women using abortion pills, since 2018, only four reports have been filed with the police in relation to the pills –two in 2023 and two in 2024.

Through a freedom of information request, Amphora Media found that two reports led to arraignments in court, one did not lead to any charges, and one is currently being investigated.

Additionally, a recent report by  Voice For Choice revealed that between a longer timeframe – 2012 and November 2024 – three of seven reports on abortions that were sent to the police, were made by healthcare professionals, while the remaining four reports were filed by partners, former partners or family members.

Under Maltese law, it is legal to purchase the pills, possess them, and even consume them. It is only illegal to consume them while pregnant.

Malta has the strictest abortion laws in the EU – allowing a legal abortion only in cases where  a woman has a medical complication which may put her life at immediate risk, or that places her health in grave jeopardy which may lead to death.

Under the Criminal Code, a woman who causes her own miscarriage or consents to an abortion can face 18 months to three years in prison. No one has been imprisoned for having an abortion in the last 25 years.

Abortion Pill Shipments Double in Four Years

The data provided to Amphora Media by Doctors for Choice lists shipments from the two main organisations that provide abortion pills: Women on Web and Women Help Women. The figures specifically account for pills ordered for immediate use, excluding precautionary or “advanced provision” orders.

Professor Stabile stated that the pills shipped “are taken”, thus making them a reliable indicator of how many abortions are occurring in Malta each year.

The numbers have surged, more than doubling since 2020. In 2024 alone, 590 shipments were made, almost double the 289 in 2020. Analysis shows that from 2020 to the end of 2024, there were over 2,000 instances women in Malta taking abortion pills. 

However, due to the legal risks, these abortions happened without medical supervision and often without the support of a loved one.

“They are literally on their own, alone in the bathroom, bleeding with no one around them. That’s not the way to do it,” Stabile said.

The increase in the use of abortion pills has also been noticed through first-hand experience by Dr Psaila Stabile through the Doula Support Service.

A sample of logbook entries from 2024 shared with Amphora Media shows that a majority of calls are made during early pregnancy and are mostly inquiries about the abortion pill.

Stabile also highlighted specific cases she is aware of in which travel was not possible and access to pills has been crucial. In one instance, a migrant woman living in Malta’s detention centres ordered abortion pills after allegedly being raped at a detention centre in Libya. In Malta, abortion remains illegal in cases of rape and incest.

It is important to note that these 2000+ cases also do not include the number of pills that could have been purchased on the black market or from other providers. They also don’t include other potential instances of self-managed abortions.

Traveling for Abortion Up to 25 Times More Expensive Than Pills

Despite users knowing that it is illegal, women are still choosing to have abortion pills in Malta for practical and financial reasons, Professor Stabile explained.

“Women in Malta are generally not travelling in early pregnancy. They’re not. They don’t because it’s just so much easier to get the pills here,” she said.

Traditionally, Maltese women seeking abortions during early pregnancy would travel to countries such as the UK. However, the growing awareness of overseas medical abortion providers has offered a cheaper and more accessible alternative.

While the numbers for travelling in early pregnancy have dwindled and changed, women still travel for procedures following the 12-week time limit catered for by the pills.

The abortion pills – mifepristone and misoprostol – which are considered as safe options by the World Health Organisation cost 25 times less than traveling abroad for a procedure. While a medical abortion costs between €80 and €120, traveling for an abortion can cost between €2,000 and €3,000 (not including time taken off work, childcare costs, etc.)

Echoing Professor Stabile, Stephanie told Amphora Media that she decided to choose the pills over travelling, despite the illegality, for practical and financial reasons. “It’s less hassle, as you don’t have to look into flights and accommodation and coordinate your schedule with someone else to join you for support,” she said.

“It’s cheaper, because you don’t need flights and accommodation, and it’s less disruptive on life and responsibilities, at that time I also couldn’t afford to take a week off.”

“It’s a struggle not being able to trust anyone when you need help… (and) although that is what you decide — no one wants to go through having an abortion.. and it was made more difficult than it had to be simply because of the laws that affect it. It didn’t have to be like that,” she said.

Amphora Media reached out to Health Minister Jo-Etienne Abela for comment, however received no reply.

*the interviewee’s name was changed to protect her identity.

This investigation was developed with the support of Journalismfund Europe.

Exporting Abortion is a cross-border journalistic investigation coordinated by Público (Spain) in collaboration with European media and journalists from across Europe. 

The journalists who have participated in this investigation are, in alphabetical order: Joana Ascensão (Portugal – Expresso), Kristina Bohmer (Slovakia), Magdalena Chrzczonowicz (Poland – OKO.press), Mayya Chernobylskaya (Germany), Nacho Calle (Spain – Público), Maria Delaney (Ireland – The Journal Investigates), Joanna Demarco (Malta), Armelle Desmaison (France), Emilia G. Morales (Spain – Público), Bru Noya (Andorra), Apolena Rychlíková (Czech Republic), Órla Ryan (Ireland – The Journal Investigates), Sergio Sangiao (Spain – Público), Margot Smolenaars (Netherlands – Follow The Money).