Why abortions in Italy are still hard to access – despite being legal

Women in Italy say they continue to face ‘absurd’ difficulties in accessing abortion and even the morning-after pill, but many are reluctant to question existing laws.

Why abortions in Italy are still hard to access - despite being legal
A protestor holds a sign reading “My body, I decide” at a demonstration in central Rome in support of abortion rights. Photo by TIZIANA FABI / AFP

For 40 years, gynaecologist Michele Mariano has been the only person performing abortions in Italy’s rural southern Molise region.

He has delayed retiring twice because no one will replace him, many refusing to terminate pregnancies as conscientious objectors.

READ ALSO: Why an Italian woman was forced to go to 23 hospitals to have an abortion

It’s an extreme example that’s emblematic of a wider issue in Italy, where abortion up to 90 days after conception has been legal since 1978 – but is still almost impossible to access in some parts of the country.

A majority of gynaecologists refuse on conscientious objection grounds, driven either by religion or societal pressure, while recent moves by right-wing politicians with links to the Church have only increased obstacles for women.

As a result, dozens of hospitals and clinics across the country provide no abortion services at all.

Finding doctors to perform them can be a minefield, since there are no official lists disclosing those who do, while services vary wildly across the country.

“Someone goes to the hospital not knowing whether the doctor in front of them will do it,” said Eleonora Mizzoni, 32, an abortion activist in Pisa.

‘Absurd situation’

Some 67 percent of gynaecologists across Italy – in cities and rural areas alike – are conscientious objectors, according to the latest health ministry figures from 2019.

That figure exceeds 80 percent in five of Italy’s 20 regions.

The only resources available to signpost women towards the services they need come in the form of unofficial websites, such as the map compiled by Laiga, an association of Italian gynaecologists.

Martina Patone, 35, described how she called about 10 hospitals in Rome and other cities to get an abortion eight years ago before a charity helped her out.

She had sought a medical abortion, which involves taking pills, but in the end had to undergo surgery.

Patone recalled having to explain to a nurse how the abortion pills worked, and before getting help from the charity having to lining up at 6am on a “rusty staircase” in a Rome hospital basement to be put on a long waiting list.

“I really thought that going to the hospital would be easy. Not at all,” she told AFP.

Besides the red tape, the process makes women feel as if “you did something wrong, you shouldn’t say anything”, she said.

She called it “absurd” that women continue to have the same problems exercising their right to abortion.

‘See you later’

Data published in May by the Luca Coscioni Association, which advocates for abortion rights, found that in at least 31 hospitals, all doctors or health workers who would assist in an abortion were objectors.

To help avoid such roadblocks, Mizzoni’s group “Obiezione Respinta” (Objection Overruled) created an interactive online map where women can warn others where they will be turned away.

One woman on the site described waiting hours outside an operating room in Caserta, north of Naples, only for the hospital’s gynaecologist to dismiss her saying, “I’m an objector, see you later”.

READ ALSO: The long road to legal abortion in Italy – and why many women are still denied it

Another in the Tuscan city of Pistoia recalled how the gynaecologist wrote her a prescription for a fertility drug, instead of the requested morning-after pill.

A woman in the Umbrian town of Foligno said she was refused follow-up care after an abortion – administered by the hospital’s sole non-objector – despite suffering from pain and fever.

The law stipulates that objectors cannot refuse medical care before and after abortion, but that is not always respected.

A 32-year-old Sicilian, Valentina Milluzzo, died of sepsis in 2016 in the fifth month of pregnancy when doctors refused to intervene when one twin died inside her womb but another was still alive.

Priests join an anti-abortion demonstration on May 21st 2022 in central Rome. The placard reads “Human Rights are born in the womb”. Photo by Alberto PIZZOLI / AFP

‘Outlier in Europe’

Italy is an outlier in western Europe, where the trend in recent decades has been to remove barriers to abortion, said Leah Hoctor, the Center for Reproductive Health’s European director.

“Patients are going through a quagmire, an obstacle course, barrier after barrier because of these widespread refusals of care and the complete abdication of the state… this is unacceptable,” she told AFP.

She said the failure of the state to manage its objectors efficiently amounts to “abdication of its responsibility under international human rights law”.

The Council of Europe has twice censured Italy over inadequate access to abortion, with little consequence.

Conscientious objectors say faith drives their refusal to perform abortions. The Catholic Church is uncompromising on the issue, with Pope Francis calling it “murder”.

The Italian Association of Catholic Obstetricians and Gynaecologists says its mission is “to counter the culture of death” and promote respect for life following “Christian principles”.

READ ALSO: Pope calls couples who choose pets over having children ‘selfish’

But abortion activists say objection has ballooned beyond a moral issue and is now often based on expediency. In short, it’s more professionally beneficial to be an objector than not in Italy.

Mariano, Molise’s sole abortion doctor, told La Repubblica daily last year “those who perform abortions don’t have a career”.

The public pressure arises in a society increasingly concerned with its declining birth rate.

Abortion is not part of normal medical training, sex education in schools is not compulsory, and some pharmacists illegally refuse to dispense morning-after pills.

‘Wind from the USA’

Politics also play a role, with piecemeal attempts to limit abortion access in certain regions controlled by right-wing parties with strong Church ties.

Piedmont, governed by a far-right coalition, announced in April it would offer 4,000 euros ($4,300) each to 100 pregnant women considering abortion for financial reasons, to convince them to reconsider.

Meanwhile, authorities in left-leaning Tuscany named an objector gynecologist last month to head a family planning centre in Pontedera by the Arno river, which had been the first to introduce the abortion pill in 2005.

READ ALSO: Verona defies Italy’s abortion law and declares itself a ‘pro-life city’

“Obviously times change and the anti-abortionist wind arriving from the USA is also sweeping over the Arno,” consumer rights association ADUC noted.

However, unlike in the United States, abortion is not at the top of the political agenda in Italy and even for right-leaning parties there is no real push to overturn the law.

Meanwhile, advocates of abortion rights worry that calling for improvements to the law – by making doctors easier to find or even limiting conscientious objections – might backfire, gynaecologist Mirella Parachini told AFP.

“No one feels like questioning the abortion law for fear that reopening it would only lead to its deterioration.”

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Fuel tax cut and help with energy bills: Italy approves inflation aid package

Italy on Thursday night approved new measures worth around 17 billion euros ($17.4 billion) to help families and businesses manage the surging cost of fuel and essentials.

Fuel tax cut and help with energy bills: Italy approves inflation aid package

As expected, the final version of the ‘aiuti-bis‘ decree provides another extension to the existing 30-cents-per-litre cut to fuel duty, more help with energy bills, and a tax cut for workers earning under 35,000 euros a year.

The package also includes further funding for mental health treatment: there’s another 15 million euros for the recently-introduced ‘psychologist bonus’ on top of the 10 million previously allocated.

READ ALSO: What is Italy doing to cut the rising cost of living?

There are also measures to help agricultural firms deal with this year’s severe drought.

Italian Prime Minister Mario Draghi described the new package as an intervention “of incredible proportions”, which corresponds to “a little over 2 points of national GDP”.

However, he said, no changes were made to the national budget to pave the way for the new measures.

The measures will be funded with 14.3 billion euros in higher-than-expected tax revenues this year, and the deployment of funds that have not yet been spent, Economy and Finance Minister Daniele Franco said.

Italy has already budgeted some 35 billion euros since January to soften the impact of rising fuel costs.

The decree is one of the last major acts by outgoing Prime Minister Mario Draghi before an early general election next month.

Elections are set for September 25th but the former European Central Bank chief is staying on in a caretaker role until a new government is formed.

Draghi said the Italian economy was performing better than expected, citing the International Monetary Fund’s estimate of three percent for 2022.

“They say that in 2022, we will grow more than Germany, than France, than the average of the eurozone, more than the United States,” he told a press conference.

But he noted the many problems facing Italy, “from the high cost of living, to inflation, the rise in energy prices and other materials, to supply difficulties, widespread insecurity and, of course political insecurity”.

Inflation hit 8 percent in Italy in June – the most severe spike the country has experienced since 1976.