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

Italy marks 40 years of legalized abortion this month, but many women are still unable to access the procedure due to a rising rate of conscientious objection among doctors.

The anniversary of Italy’s abortion law, first passed in May 1978, is a chance to reflect on the long road to legal abortion in Italy, and on the many obstacles, women continue to face.

Before the 1978 referendum, causing the abortion of a consenting woman could result in a prison sentence of between one and five years for both the woman and the person who carried out the procedure.

But in the 1970s, as in other European countries, Italy saw a wave of feminist activism. Their achievements included changes to family law that made men and women equal partners in a marriage, legalization of divorce, and the law allowing abortion.

In 1973, the Centre for Information on Sterilization and Abortion (CISA) was founded in Milan by political activists including Emma Bonino, who has since gone on to hold prominent roles including that of Foreign Minister, and Adele Faccio. The organization gave advice on contraception, sterilization, and abortion to Italian women, including helping women experiencing crisis pregnancies travel to countries including England and the Netherlands to undergo an abortion.

Two years later, Bonino, Faccio, and Radical Party secretary Gianfranco Spadaccia reported themselves to police and were arrested for carrying out abortions.

This marked the start of a huge campaign for a new abortion law. This law, known as Legge 194, was passed by a narrow margin in both of Italy’s houses of parliament and is still in place today. A 1981 referendum of repealing the law was rejected by two-thirds of voters.

Under Legge 194, women have the right to an abortion in the first 90 days of pregnancy. The procedure is free for women who have the Italian health insurance card (tessera sanitaria) under the state healthcare system, but women without the card need to pay. Under-18’s require permission from parents or guardians, or a judge might make the decision.

Within these first 12 weeks, the cause for abortion may be due to health, economic, social or family reasons, while between the 12th and 20th week, either a significant fetal abnormality must be present, posing a serious risk to the woman’s mental or physical health, or there must be a danger to the woman’s life if she continues with the pregnancy.

But in practice, these are rights that not all women are able to benefit from.

The legislation also includes a recognition of the “social value of motherhood”, and allows medical professionals to refuse to carry out abortions on the grounds of conscientious objection, often linked to their personal religious beliefs. Doctors applying for jobs at Vatican-run hospitals must object to the procedure, while by contrast, when a Rome hospital advertised for two specifically non-objecting doctors last year, there was a huge backlash.

And the number of objecting doctors is growing.

According to health ministry figures, just over 70 percent of gynecologists in Italy refuse to carry out the procedure, and the proportion is far from even across the country, soaring as high as 90 percent in some areas. These figures from 2016 were up from 58.7 percent in 2005.

All medics involved in the procedure, including anesthetists and nurses, have the right to object, with the result that only around 60 percent of all hospitals and clinics can actually offer abortions, and women often have to travel far from home and wait days or weeks in order to access the service. One woman in Padua was turned away from 23 hospitals and only able to undergo the procedure when a trade union, CGIL, intervened on her behalf.

At the time, CGIL described the waiting lists for abortions in Italy as “dangerously long, forcing women to turn to private structures or, worse, to resort to clandestine abortions, a social shame which Law 194 was created to prevent.”

“It is inconceivable to force women to undertake actual odysseys in order to see the state law respected,” the union said.

Another factor making safe, legal abortions hard to access in Italy is the resistance to medical abortion or abortion pills.

The Ru486 (mifepristone) pill was only approved in Italy in 2009, following strong opposition from the Vatican and conservative politicians. By contrast, it was approved in France over 20 years earlier, and in the UK and Sweden in 1991 and 1992 respectively; in each of these countries, the majority of abortions are now medical rather than surgical.

Despite being legal, regional governments are allowed to issue their own protocol for use of the drug.

Medical abortion is only considered an outpatient procedure in five of Italy’s 20 regions. In others, patients are hospitalized for three days while they take the pills, though surgical abortion is usually a one-day procedure, meaning Ru486 is rarely used. The problem is exacerbated by long waiting lists at hospitals and the fact the pill is only effective if taken in the first 50 days of pregnancy.

Things are changing on that front, albeit slowly. In 2017, Lazio became the first region to offer the abortion pill at family-planning clinics — removing the need for a hospital stay — as part of a trial period that’s still underway.

The latest data from statistics agency Istat shows a steady decline in the number of legal abortions in Italy since 1982, and in the EU Italy has one of the lowest rates of abortion. In 2016, Health Ministry data shows there were around 82,000 abortions, compared to around 235,000 in 1982, when the number reached its peak.

While the Health Ministry has argued that the decline in abortions means the rise in conscientious objectors isn’t affecting women in crisis pregnancies, many campaigners say it’s the opposite, and that the increased difficulty in accessing abortion is pushing more women to illegal, unsafe abortions or to travel abroad for the procedure. The number of miscarriages has risen over the past 20 years, and CGIL estimates the number of illegal abortions at 50,000 each year — far higher than the government estimate of 15,000.

Women found to have had illegal abortions face hefty fines. These penalties, which range between €5,000 and €10,000, were introduced in 2016 to replace a ‘symbolic’ fine of €51. The former fine was aimed at encouraging them to denounce doctors who performed it as well as encourage them to use the state healthcare system in case any complications arose.

The anti-abortion movement is significantly stronger in Italy than in much of northern Europe, due in part to the strong influence of the Catholic Church.

Pope Francis, who was hailed as a reformer when he first took on the role, has repeatedly spoken out against abortion, despite having made the small progressive step to authorize priests to absolve women who have had terminations. The pontiff last year called on Catholics to “promote a culture of life as a response to the logic of throwing away”. Just a month earlier, he claimed to have met a woman in Buenos Aires who said she had chosen abortion to “save her looks”, in a speech in which he called physical beauty and even health “false idols” which “drive us towards death”.

Last winter, a priest in the university city of Bologna compared politician and longtime campaigner for women’s rights Emma Bonino to one of Italy’s most notorious mafia killers, saying there was “morally” no difference between brutal mafia murder and abortion.

According to a 2015 Ipsos survey, 17 percent of Italians surveyed said abortion should either never be permitted, or only in cases where the mother’s life was in danger. That was higher than the figure of 15 percent in Ireland, though there was slightly stronger support for abortion to be permitted in any circumstances (47 percent in Italy compared to 37 percent in Ireland).

As the 40-year anniversary of the abortion law drew near, anti-abortion groups stuck up campaign posters around Rome, describing abortion as femicide — a term for gender-based murder of a woman. Monica Cirinnà, the Democratic Party senator who drafted Italy’s civil union’s bill called on Roman mayor Virginia Raggi to remove the “shameful” posters.

Of course, there is campaigning on the other side too. Trade union CGIL and LAIGA (an organization for gynecologists who support the right to abortion) are two of the groups speaking out for women’s right to bodily autonomy to be safeguarded in Italy.

There has also been international intervention: Italy has been criticized by both the Council of Europe and the UN for the serious obstacles to accessing safe abortion.

Emma Bonino called on Italian women not to “take their rights for granted”, speaking on the 40th anniversary of the law she helped introduce.

“40 years on from the passing of Legge 194, there is still a long road ahead of us,” she said.