Abortion law in Italy
In 2017, India’s High Court denied the permission of abortion to a ten-year-old girl who was more than 20 weeks pregnant at the time. Under the Medical Termination of Pregnancy (MTP) Act, 1971, abortion in India is allowed only under specific circumstances and up to the 20th week of pregnancy, after which time it is up to the Supreme Court to decide for an exception if the mother's life is in danger. The girl, allegedly raped by her uncle, was not aware that she was giving birth, reported The New York Times. The news captured the media attention, stimulating the debate on whether this 41-year-old norm should be amended since scientific development has provided the conditions for safer procedures.
As this news has highlighted the need to rethink some old norms, the same cannot be said for many other countries that have not benefited from international exposure. In Italy, the legislation regarding reproductive rights, for example, is hindering the right to abortion for many Italian women due to the practice of the so called conscientious objectors – doctors that refuse to carry out abortion for moral or religious reasons.
Law No. 194, which liberalised abortion, was approved in 1978. The Law states that abortion is legal during the first three months if the continuation of pregnancy, childbirth, or motherhood would seriously endanger the physical or mental health of the woman. Her state of health, her economic, social or family situation should be taken into account, as well as the circumstances under which conception occurred or the likelihood that the child would be born with abnormalities or malformations. A woman who wants to interrupt her pregnancy for any of the aforementioned reasons must apply to either a public counselling centre, a fully authorised medico-social agency in the region or to a physician of her choice.
After the first 90 days of pregnancy, abortion is allowed only to save the woman's life or when the mother's physical or mental health is endangered. The person performing the abortion and the woman who asks for it are subject to penalties when the termination of pregnancy occurs outside the legal provisions. When this Law was first issued, it was considered one of the most liberal abortion laws in Western Europe. It encompasses a wide spectrum of factors under which abortion is permitted. This empowered women to decide if they wanted to terminate a pregnancy, while the main role of the physician was to certify the existence of a pregnancy.
However, the legislator included one provision that has hindered the possibilities to get an abortion for many women: medical and paramedical personnel that are opposed to abortion on moral or religious grounds can declare in advance their conscientious objection and refuse to perform or assist in the performance of an abortion. This has made the practice very different from the legislation, and therefore it varies from region to region.
Many factors have contributed to the high number of conscientious objectors in Italy, where seven out of 10 doctors refuse to carry out abortions. Historically, the Holy See has had a major influence on every aspect of culture in Italy. After the approval of Law 194, the Church warned that any person performing an abortion and any woman obtaining an abortion would be excommunicated. The fact that many Italian gynaecologists were formed in Catholic Medical schools, and that non-objecting doctors constantly face discrimination at work and have to work in fear that their career could be threatened by such decision, adds to the reasons why objection of conscience is so widespread in Italy.
The Catholic Church has kept its influence and impact on women’s decisions and access to abortion. One of the latest examples of how religion affects society’s perceptions of abortion in Italy can be seen in last year’s apostolic letter, in which Pope Francis gave all priests the power to forgive women who have chosen to have an abortion. He reiterated that ‘abortion is a grave sin,’ but ‘there is no sin that God’s mercy cannot reach and wipe away,’ as reported in the Guardian.
From 2010 to 2013, the number of conscientious objectors has increased from 69.3% to 70%. In a recent report, Italian Health Minister Beatrice Lorenzin stated that the voluntary interruption of pregnancy had decreased and, therefore, the number of abortions carried on by each non-objector doctor can guarantee the effectiveness of the Law. If this is true for some of the regions in Italy, the situation is far from being in accordance with the Law in many other parts of the country. The situation is more dramatic in the South, where in some regions the proportion of doctors refusing to interrupt pregnancies can reach 94%, as in Molise, where there is only one non-objecting doctor.
In an interview for La Repubblica, a daily general-interest newspaper, Dr Michele Mariano, gynaecologist at the hospital Caldarelli, explains what it is like to be the only doctor practising abortions in Molise. He carries out 400 abortions per year and he receives women from nearby regions, too. When asked why doctors decide not to practise interruption of pregnancies, he replies that non-ojectors face many risks in they career. He admits that he was due to become head physician of the Gynaecology’s department, but when the Caldarelli stipulated an agreement with La Cattolica, a Catholic hospital, he became troublesome and was not hired for the job. He explained what it means to be the only doctor practising abortion, from being discriminated at work to finding holy cards or insulting Post-it notes left on his car.
To the question about why he is continuing to practise abortion, he replies, ‘Because I am part of that generation that fought for the Law No. 194. Because I don’t want women to go back to clandestine abortions or die in the hands of some butchers. This doesn’t mean that when I practise abortions I am happy.’ He said that the greatest joy of his work is when a mother decides to keep her child, but he always works hard to ensure that every one of his patients is taken in the best care possible.
Abortion is a sensitive topic, it has consequences and can cause difficulties of some kind for every woman and everyone who is involved with this practice. The Council of Europe states that parties should take the necessary steps to ensure women full and equal access to sexual and reproductive health and rights. In a decision for the case ‘Confederazione Generale Italiana del Lavoro (CGIL) v Italy’, 2016, the European Committee for Social Rights stated that Italy was violating women’s right to health for the non-accessibility to a service. The Committee decided also that non-objecting doctors faced moral harassment, and that could constitute a violation due to the failure of the Government to take any preventative action, training or raising awareness to ensure their protection.
In 2017, Hospital San Camillo, one of the main hospitals in Rome, held a competition to hire two non-objecting doctors. This has been strongly contested not only by Minister Lorenzin, who said that the decision did not comply with the norm, but by Don Carmine Arice, member of the Italian Episcopal Conference, as well as other politicians, especially those belonging to the right-wing populist party Lega Nord. Fabrizio D’Alba, director of the hospital San Camillo, replied with a powerful statement saying that the decision was not ‘a discrimination but protection of a right’.
As the political class is unwilling to take steps in the direction of an effectiveness of the right of abortion, women in Italy will continue to face difficulties and discrimination. This choice must be respected and women must receive the proper safeguards they are entitled to have. Standpoints and actions such as the ones by Dr Mariano and Fabrizio D’Alba are courageous and should be valued, but a wider change needs to take place in the Italian legislation about abortion and the right for women to have a choice.
Italian pro-choice organisations: