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Access to Safe Abortion Increasingly Under Threat in Italy

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Access to Safe Abortion Increasingly Under Threat in Italy Access to safe abortion is increasingly under threat in Italy Access to Safe Abortion Increasingly under Threat in Italy Despite progressive steps being made by the Government, Italian women’s reproductive rights remain at risk. by Sabrina D’Andrea URL insert: Italy-safe-abortion-under-threat summary In August 2020 the Italian Ministry of Health adopted new guidelines intended to facilitate better access to medical abortion. However to this date, their implementation remains inadequate. The political debates surrounding the new abortion guidelines not only testify to tensions in Italian society, they also illustrate the growing difficulties met by Italian women seeking to obtain a safe abortion. Background PALERMO, 18 February 2021. In August 2020, the Italian Ministry of Health adopted new guidelines for medical abortion, allowing the abortion pill RU-486 to be administered up until nine weeks of pregnancy (against seven before) and without the necessity of a three-day hospitalisation. The new guidelines, which updated the modalities of abortion allowed under ​ the Italian Abortion Law nr 194 of 1975, were supposed to send a strong political message against regional politicians seeking to limit access to medical abortion on an outpatient basis, notwithstanding the difficulties of accessing hospitals in times of COVID-19. However, after the adoption of these new guidelines, several local politicians and religious groups expressed their disagreement and their determination not to apply the guidelines. In late January 2021, the Regional Council of Le Marche in Central Italy, governed by right-wing party Fratelli d’Italia, refused to adopt an amendment implementing the new guidelines, holding fervid anti-abortion arguments. The Italian political debate surrounding the abortion guidelines and the resistance on behalf of local politicians to implement the latter testify to the strong divisions in Italian society on the issue of abortion and the serious and continual threat to women’s reproductive rights. It also epitomises the abyss between the rights inscribed in the Italian Abortion Law dating from 1975 and the reality of abortion today in Italy, where an average of 70% of doctors refuse to perform abortion on the basis of “personal conscience”. Local DIVISIONS ABOUT THE provision of safe abortion Both before and after the adoption of the new guidelines by the central Italian Government, the provision of safe abortion has been highly contested in local regions. Earlier the same year, in June 2020, the Governor of Umbria Donatella Tesei (from the right-wing party Lega, guided by Matteo Salvini) adopted a resolution making mandatory a three-day hospitalisation after abortion with the RU-486 pill. The forcing of women to stay in hospital for three days after medical abortion, whilst in other countries such a treatment is administered on a out-patient basis, corresponds to a both a wide-spread practice and mindset in Italy. Despite the act giving rise to local protests it was not withdrawn. The new guidelines adopted in August 2020 by the Italian Ministry of Health were a direct reaction to this regional action: this is a way for the central government to ensure that access to abortion was not unnecessarily limited and to ensure the uniform application of the Italian abortion law. In addition, the expansion of access to medical abortion care has also been crucial in the context of the COVID-19 pandemic. Minimising the necessity for hospital stay sees Italy following suit of many other European Union countries. In the majority of cases, women are forced to stay three days in the hospital after taking the RU-486 abortion pill However, the adoption of the new guidelines was immediately met with fierce reactions on behalf of right-wing parties, accusing the guidelines of “risking women’s life for ideological reasons” and of promoting “DIY abortion”. Likewise, Catholic organisations and newspapers expressed strong hostility against the new guidelines. Immediately, regional councils holding right-wing majorities, such as Piemonte and Umbria, expressed their opposition to implement the latter, advancing anti-feminist rhetoric and arguments of “ethnic substitution”. The situation critically resembled the one of 2018, when polemics had arisen concerning the regional act adopted in Verona giving public funding to Catholic associations whose task is to put psychological pressure on women in order to prevent them from resorting to abortion, when the Lega politician Alberto Zelger had declared publicly that “abortion is not a right, it is an abominable crime”. The challenges of getting a safe abortion in Italy: the limited access to medical abortion and the obstacle of “conscience objection” Concerningly these events are not just anecdotal: on the contrary, they are emblematic of the unnecessary difficulties and stigma suffered by Italian women when seeking a safe abortion. In fact, medical abortion, which can be performed on an outpatient basis, is deemed by the WHO to be safer and less invasive than surgical abortion. However, this type of abortion is only practiced in 20% of cases: the vast majority of abortion performed in Italy are done by surgical means, which involves aspiration and can in rare cases cause scarring of the uterine wall. The difference is striking when comparing abortion practices in Italy with those of other European countries: in the North of Europe, about 100% of abortion are performed through medical means, while in France, Portugal, Switzerland and the UK, they constitute around 75% of abortion. Italy also imposes a “reflection” period of seven days, the longest in the EU. This causes significant delay in the procedure and undermines women’s reproductive choices. However, the most severe problem regarding abortion in Italy remains the high number of medical practitioners who refuse to perform abortion on the basis of “conscience objection”. In 2020, an average of seven out of ten doctors in Italy refused to practice abortion, a percentage that rises dangerously in certain regions of the South. This impedes women to decide over their own body and put their physical and mental health at risk, as it consequently delays the possibility of getting a safe abortion, forcing Italian women to travel hundreds of kilometers far from their home or to bypass the authorities in order to obtain an abortion (clandestine abortion is estimated at around 10,000 per year in Italy). Looking Forward The difficulties for women to obtain a safe abortion in Italy has not gone unrecognised. In 2016, Italy was condemned by the Council of Europe for violating women’s rights. Shockingly, little has been done in order to remedy this situation which has only been exacerbated since the beginning of the COVID-19 pandemic. The major problem in Italy remains the stigma associated with abortion due to the strong presence of the Catholic church in the political debate, as well as the promotion mechanisms inside public hospitals making it difficult to eradicate systematic discrimination against non-objector doctors. Within this context, Italian women’s reproductive choices are put at serious risk. The August 2020 guidelines constitute a step in the right direction, however, if Italy wants to ensure the right to a safe abortion a number of key actions that must follow: first of all, the Italian Government needs to guarantee a close follow-up in order to ensure the effective implementation of the guidelines. The best way to overcome regional resistance would be to adopt a national law which imposes, wherever possible and chosen by the women, medical abortion on an outpatient basis. Another crucial step would be to start monitoring again the phenomenon of conscience objection in the Italian healthcare system: in 2017, such a reporting was abandoned in the official data on the basis that “no criticality was found”. Such a statement is utterly critical as it denies the problem of conscience objection in Italy and the major obstacle that it constitutes to women’s right reproductive rights. It is time for the Italian Government to seriously and openly tackle the issue of safe abortion. This cannot be done without lifting the taboo surrounding abortion in Italian society and challenging the stigma faced by women seeking for a safe abortion. The Government should dare to question the legitimacy of the Catholic church on such important societal issues and to contribute to the secularization of the political debate surrounding women’s rights. Only then can Italy guarantee women’s reproductive rights as well as their physical and mental health. NOTES: [1] Fiala C. and Arthur J. H. (2014) ’“Dishonourable disobedience” – Why refusal to treat in reproductive healthcare is not conscientious objection’, Woman – Psychosomatic Gynaecology and Obstetrics, Vol.1, DOI: https://doi.org/10.1016/j.woman.2014.03.001 [accessed 18 Feb. 2021]. [2] Pioggia, A. (2015) ’L’obiezione di coscienza nei consultori pubblici’, Le istituzioni del federalismo, Vol. 36, available at https://www.regione.emilia-romagna.it/affari_ist/Rivista_1_2015/Pioggia.pdf [accessed 18 February 2021]. [3] Abort-report.eu (2020) European data, available at https://abort-report.eu/europe/ [accessed 18 Feb. 2021]. [4] World Health Organization (2018) Medical management of abortion, available at https://www.who.int/reproductivehealth/publications/medical-management-abortion/en/ [accessed 18 Feb. 2021]. [5] Human Rights Watch (2020) Italia: Covid-19 aggrava gli ostacoli all'aborto legale, available at https://www.hrw.org/it/news/2020/07/30/375941 [accessed 18 Feb. 2021]. [6] La Repubblica (2020) Pillola abortiva, il Pd torna all'attacco della presidente dell'Umbria. Family day: "Promosso l'aborto fai da te", available at https://www.repubblica.it/politica/2020/08/08/news/aborto_pillola_reazioni-264094945/?fbclid =IwAR0FT2KIUDrCf6SMLIgqz35dggmWFprIa1ZS9J-d53ZxgPidCF0FsSVShTA [accessed 18 Feb. 2021]. [7] Moreau C, Shankar M, Glasier A, et al (2020) ‘Abortion regulation in Europe in the era of COVID-19: a spectrum of policy responses’, BMJ Sexual & Reproductive Health, DOI: 10.1136/bmjsrh-2020-200724 [accessed 18 Feb.
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