Although abortion has been legal since 1978 in Italy, women frequently encounter conscientious objection from practitioners. The latter are a majority to refuse to carry out the procedure.
“The Italian law on the right to abortion is rather well designed. The problem is that it is not applied.” In two sentences, Irene Donadio, Advocacy Manager at the European branch of the International Planned Parenthood Federation (IPPF-EN), summarizes the difficulties encountered by Italian women in accessing voluntary termination of pregnancy (IVG). A process that is more a matter of “way of the cross”as illustrated by the report of “Special Envoy” broadcast on France 2 Thursday, March 9, the day after International Women’s Rights Day.
In Italy, the right to abortion is protected by law 194, adopted in 1978. This text authorizes abortion up to 90 days of amenorrhea, that is to say a little more than twelve weeks after the last period. A period similar to that in force in the majority of other European countries. But “this law is not perfect”, tempers Irene Donadio. Women are indeed obliged to obtain a medical certificate, then to wait seven days of reflection, before being able to carry out the procedure. These constraints are however deemed unnecessary by the World Health Organization.
Two out of three gynecologists refuse the procedure
The main obstacle to abortion is the Italian doctors themselves. A majority refuses to perform abortions, on the grounds of conscientious objection. Also guaranteed by law 194, this measure allows caregivers not to participate in the procedure because of their personal or religious beliefs. In 2020, 64.6% of gynecologists made this choice, according to the most recent data from the Italian Ministry of Health*.
This percentage is down slightly, after having hovered around 70% for about ten years. Among anesthesiologists and non-medical staff, present during surgical interventions, the rate of objectors, on the other hand, fell below 50%.
“Italian women think they have the right to have an abortion, but when they need it, they discover that it is incredibly difficult”, comments Irene Donadio, from IPPF-EN. These obstacles have already earned the Italian State two condemnations by the Council of Europe, reveals the specialized media Euractiv. In 2016, the body again reminded Rome of its obligation to enforce the law.
Seven years later, “depending on the city where you live” in Italy it is always “the lottery”, notes Irene Donadio. Because the rate of conscientious objector gynecologists varies greatly from one region to another. In 2020, it exceeded 80% in Abruzzo or Sicily. But in the Aosta Valley, in the very north of the country, it was 25%. “Health is a regional competence, and access to abortion therefore depends on political factors”, decrypts Marina Toschi, gynecologist and pro-abortion activist.
In theory, the law requires all hospitals to have a department offering this care. Some, however, have a rate of 100% of objecting physicians. The Obiezione Respinta* association (“Objection overruled”) and the Mai Dati* project (“Never any data”) have undertaken to identify these establishments, to avoid patients wasting time contacting services that do not offer the procedure. “There is no public, accurate, up-to-date and easily accessible data on this practice”, underlines the journalist Sonia Montegiove, co-author of Mai Dati. However, having this information is “an essential condition for improving access to abortion”she insists.
Conscientious and convenience objection
To make up for the shortcomings, Marina Toschi continues, at 68, to perform abortions in regions where abortion is the least accessible. “Resistance operates at all levels: hospital directors do not organize their services in such a way as to be able to offer this procedure; gynecologists refuse to do it; others do not want to sign the initial certificate, whereas it is only a question of noting the patient’s desire to terminate her pregnancy…”, list this nurse. “In Italy, abortion is done at the whim of doctors.
>> VIDEO. In Italy, many doctors refuse to perform abortions citing their conscience clause
The Italian Association of Gynecologists and Obstetricians, quoted by TV5 Monde, states “to promote respect for human life in its entirety, from conception to natural death”. But according to feminist collectives, this situation is not the result of ethical questioning alone. “Some conscientious objectors worry about the consequences on their career. They fear being stigmatized by their colleagues and deprived of certain professional opportunities if they perform abortions, says Irene Donadio, from IPPF-EN. At the same time, they would have a tenfold workload, as the number of doctors who agree to do so is low.
“The influence on society of religion, and in particular of the Catholic Church, also contributes to this situation.”
Irene Donadio, Advocacy Officer at IPPF-ENat franceinfo
In 2018, during a speech delivered at the Vatican, Pope Francis compared abortion to “use of a contract killer”. This weight of religion has consequences for the training of doctors in reproductive health, argues Marina Toschi. “You can do five years of specialized studies in gynecology and not be able to insert an IUD, carry out an abortion or know how the abortion pill works.alarms the specialist. It’s even worse in Catholic universities, which are often considered the best.”
“Unnecessary and unfair stress”
For Marina Toschi, this lack of skills partly explains the low use of the abortion pill. In 2020, 31.9% of abortions in Italy were performed by medication, reports the Italian National Institute of Health*. By way of comparison, in France, this rate was 72% the same year, according to the Ministry of Health. “There have been misinformation campaigns claiming that the abortion pill is ‘poison’“while this method is known to be safe and effective, points out the gynecologist.
Another hurdle: “the procedure is very cumbersome in Italy, whereas it could be carried out at home in most cases”. In France, it is thus possible to obtain the pills directly from the pharmacy, on prescription from a doctor or a midwife, recalls the National Medicines Safety Agency.
“It takes four appointments for a medical abortion in Italy: one for the certificate, two for the treatment and one for the check-up. When you have to drive several hours to find a hospital that agrees to take care of you , it is often simpler to undergo a single surgery.”
Marina Toschi, Italian gynecologistat franceinfo
All these barriers add “unnecessary and unfair stress for women wishing to terminate a pregnancy”argues Irene Donadio. “It can have consequences on their mental and physical health”continues the activist, who notes that “foreign nationals, less educated people, in precarious or marginalized situations are even more affected”.
Conscientious objection can have even more serious repercussions. Irene Donadio thus recalls the case of Valentina Milluzzo, who died of sepsis in 2016, in a hospital in Sicily. According to the family of this 30-year-old, quoted by La Republica*, the doctor refused to perform a therapeutic abortion after the death in utero of one of his twins.
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“Of course, the situation is even worse in countries where the right to abortion is illegal.admits Irene Donadio. But the fact remains that Italian women who want to end their pregnancy are often left to their own devices.” However, there is a solution to guarantee access to abortion, says IPPF-EN’s advocacy officer. “He The state has to enforce the law.”
The report “Italy: Abortion, the Stations of the Cross”, directed by Anaïs Bard, Giona Messina and Gaëlle Pidoux, will be broadcast on Thursday March 9 in “Special Envoy”, on France 2.
* Links marked with asterisks refer to content in Italian.