Italy: Where legal abortion does not necessarily mean accessible abortion

, by Maëva Pusiol

Italy: Where legal abortion does not necessarily mean accessible abortion
Credit: Jami430, Commons Wikimedia.

Last autumn, strikes resulting from the Polish Constitutional Court’s ruling on abortion, leading to a near-total abortion ban, brought the issue back into the European media spotlight. Most EU member states allow abortion when requested. This is in stark contrast to Poland and Malta, where abortion is illegal under almost all circumstances. However, whether or not the procedure is lawful does not necessarily guarantee effective access to abortion for women, and this is particularly true in Italy, the country of conscientious objectors.

The Legge 194 and the legalization of abortion in the peninsula

Abortion in Italy was authorized in 1978 by Legge 194 - Law 194 - confirmed by referendum in 1981. This law legalized the procedure up to the twelfth week of pregnancy at the request of the woman, and beyond this period on the advice of the doctor if the pregnancy constituted a danger to the woman’s life. Initially, only so-called surgical abortion was allowed. It was not until 2009 that additional legislation allowed medical abortions by using two drugs (mifepristone and prostaglandin). Nowadays, surgical abortion remains the main method of abortion in the country, representing around 80% of the cases.

The conscience clause: a loophole in Law 194

The restriction of access to abortion in Italy is the result of Article 9 of the abortion law, which states that healthcare workers are not obliged to take part in interventions for the termination of pregnancy when they raise conscientious objection on religious or personal grounds, with a prior declaration. This conscience clause cannot be invoked if the woman’s life is in danger, although some examples contradict this exception. Article 9, meant to be an exception allowing a handful of doctors and anaesthesiologists not to perform abortions, is the cause of restricted access to abortion in the country.

Some healthcare staff have raised their objections for religious or personal reasons, but others have become overwhelmed over the years because of the excessive workload they have had to take on due to the lack of doctors willing to perform abortions in their region. Silvana Agatone, president of LAIGA, an association of non-objecting doctors, stated that in 2005 the percentage of objecting doctors was 58% and by 2016 it had risen to 71%.

It is estimated that about 70% of doctors in Italy are conscientious objectors, but the figures vary greatly depending on the region. For example, in Lombardy, more than 60% of doctors are conscientious objectors, as in Liguria and Piedmont. In southern Italian regions, the number of conscientious objectors is even higher, with 80% of objectors in Lazio, 86% in Puglia and over 90% in Basilicata and Molise.

This situation has led to limited access to abortion in some regions and almost no access in the southernmost regions of the peninsula. The lack of doctors results in a longer waiting time to obtain an abortion appointment, which can cause women to exceed the legal time limit. Thus, women are often forced to travel to another town, region or even abroad to have an abortion. This difficulty in accessing abortion services also has the effect of forcing women to resort to illegal abortions, which were estimated to be between 10,000 and 13,000 per year by the Italian government in 2019.

The impact of Covid-19 on abortion in Italy

Travel restrictions, fear of contagion, and lack of information on available obstetrical services linked to the propagation of Covid-19 have further exacerbated pre-existing difficulties in accessing abortion in Italy. According to a Human Rights Watch report, the Italian government has failed to meet its responsibility to ensure clear pathways to certain essential medical care (of which abortion is a part), resulting in the suspension of abortions in multiple Italian hospitals. All of this created significant delays, which has prevented some women from accessing legal abortion as they had passed the 12-week limit.

This situation led the Italian government to issue a circular modifying the modalities of access to medical abortion, meaning that the delay in accessing medical abortion has been extended from 7 to 9 weeks of pregnancy. This procedure will be available on an ambulatory basis, whereas until now, three days of hospitalization were recommended.

Although this circular constitutes an improvement in the conditions of access to abortion - at least on paper - it is still too early to judge the effectiveness of this measure. This move has also been strongly criticized in some Italian regions such as Umbria where the region’s president, Donatella Tesei of the far-right Lega Nord, had banned the use of the abortion pill without hospitalization in June.

What does Europe say about abortion?

As for the European Union, it has no legal jurisdiction over abortion, but this has not prevented the European Parliament from expressing its concerns about Poland’s near-total ban on abortion.

In Italy’s case, the Council of Europe has criticized the conditions of abortion in the country. Indeed, the social rights committee of the Council of Europe considered that Italian women wishing to have an abortion still face too many hurdles. The committee also affirmed that if a country allows conscientious clauses, it must ensure that this situation does not prevent access to abortion. Only time will tell if this external pressure will be enough to improve access to abortion in the country, and grant Italian women more autonomy over their bodies.

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