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Induced Abortion in Italy: Levels, Trends and Characteristics by Silvana Salvini Bettarini and Silvana Schifini D'andrea

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Induced Abortion in Italy: Levels, Trends and Characteristics by Silvana Salvini Bettarini and Silvana Schifini D'andrea Induced Abortion in Italy: Levels, Trends and Characteristics By Silvana Salvini Bettarini and Silvana Schifini D'Andrea Subsequent to the legalization of abortion in Italy in 1978, abortion rates among Italian women these trends are similar to those of other Western European countries,5 suggesting first rose and then declined steadily, from a peak of 16.9 abortions per 1,000 women of repro- that increase, stabilization and decline typ- ductive age in 1983 to 9.8 per 1,000 in 1993. Abortion rates vary considerably by geographic re- ify the pattern of abortion utilization fol- gion, with rates typically highest in the more secular and modernized regions and lowest in re- lowing legalization. Indeed, when the data on induced abortion in Italy are plotted gions where traditional values predominate. Data from 1981 and 1991 indicate that age-specific graphically, the data subsequent to 1984 abortion rates decreased during the 1980s for all age-groups, with the largest declines occur- approximate a straight line, with regres- ring in regions with the highest levels of abortion. Moreover, a shift in the age distribution of abor- sion coefficients equal to –14.7 per year for tion rates occurred during the 1980s, with women aged 30–34 registering the highest abortion abortion ratios and –0.7 per year for abor- tion rates. rate in 1991, whereas in 1981 the highest level of abortion occurred among those aged 25–29. The abortion rate among adolescent women was low at both times (7.6 per 1,000 in 1981 and Regional Differences 4.6 per 1,000 in 1991). These data are based only on reported legal abortions; the number of Twenty regions comprise the five geo- graphical areas of Italy: four northwest- clandestine abortions remains unknown. (Family Planning Perspectives, 28:267–271 & 277, 1996) ern regions (Piedmont, Val D’Aosta, Lom- bardy and Liguria), four northeastern n Western European countries where public hospitals in Italy. Women were in- (Trentino, Veneto, Friuli-Venezia Giulia abortion is legal, the incidence of in- terviewed by health care providers at the and Emilia-Romagna), four central (Tus- Iduced abortion varies: According to a time they underwent the procedure; these cany, Umbria, Marches and Lazio), six recent evaluation, Sweden has the highest data were then collated and published by southern (Abruzzo, Molise, Campania, abortion rate (20.4 abortions per 1,000 the National Institute of Statistics and the Puglia, Basilicata and Calabria) and two women aged 15–44 in 1991) and the Nether- Ministry of Health.3 island regions (Sicily and Sardinia). lands the lowest rate (5.2 per 1,000 in 1990).1 Although total fertility rates (TFRs) are Nevertheless, there are some common pat- Abortion Incidence fairly consistent across these regions terns.2 For example, in countries such as In 1993, approximately 140,000 induced (ranging from 1.0 lifetime births per Denmark, Finland and Sweden, the ratio of abortions were performed in Italy. In com- woman in Tuscany and Liguria to 1.8 legal abortions to live births increased after parison, the average annual number dur- births per woman in Campania),6 levels legalization and then diminished. In such ing the period 1982–1984 was more than of abortion vary considerably (Table 1). countries as France, the Netherlands and 230,000. Similar patterns can also be seen Compared to the overall 1993 rate of 9.8 England and Wales, on the other hand, in abortion rates (Table 1, page 268). After abortions per 1,000 women aged 15–44, abortion levels have not decreased, but have legalization, abortion rates rose modest- abortion rates are relatively low in the remained relatively stable. ly, increasing from 13.7 abortions per 1,000 northeastern regions such as Trentino and In May 1978, Italian women were grant- women aged 15–44 in 1979 to a peak of Veneto (rates of 6.8 and 5.3 per 1,000, re- ed the right to terminate a pregnancy 16.9 per 1,000 in 1982 and 1983. During the spectively) and the islands of Sicily (7.4 per upon request during the first trimester. period 1982–1984, Italian abortion rates 1,000) and Sardinia (6.5 per 1,000). In the The law stipulates that induced abortion stabilized, and this period was followed northwest, rates are similar to the nation- be confined to women whose physical and by a steady decline: By 1986, the rate had al rate (e.g., 9.8 per 1,000 in Liguria) or psychological health may be at risk. Al- dropped to 14.0 abortions per 1,000 moderately higher. Levels of abortion are though a proposal to repeal the law was women, and by 1990 it had reached 11.1 quite disparate across the central and considered in a 1981 national referendum, per 1,000; by 1993, the abortion rate had de- southern regions: Basilicata registers 6.0 it was rejected by nearly 80% of voters. creased to 9.8 per 1,000. abortions per 1,000 women of childbear- Abortion remains controversial in Italy, Abortion ratios (the number of abortions ing age, while neighboring Puglia has a however, and was criticized in a recent per 1,000 live births) displayed a similar rate of 16.8 per 1,000, the highest in the Papal Encyclical (“Evangelium Vitae”) on pattern subsequent to the 1979 law. The country. Similarly, centrally located ethical issues. abortion ratio, at 280 per 1,000 in 1979, rose Marches has a rate of 8.2 per 1,000, com- In this article, we present information steadily through 1984 when it reached pared to a rate of 14.0 per 1,000 in neigh- on the incidence of abortion in Italy since about 390 per 1,000 (Table 2, page 269). boring Umbria. its legalization. These data were collect- Since that time, the ratio has decreased Since the legalization of abortion in 1979, ed from women obtaining abortions in all continually, reaching a low of 261 per 1,000 declines in abortion rates have been great- in 1992. While abortion ratios in Italy are est in the north, where family planning and Silvana Salvini Bettarini is professor of demographic notably higher than those of many other reproductive health services are more ex- analysis and Silvana Schifini D'Andrea is professor of so- 7 cial statistics in the Department of Statistics, University Western European countries because of tensive and well-established. The abortion of Florence, Italy. Italy’s comparatively low fertility rates,4 rate in Liguria, for example, dropped by Volume 28, Number 6, November/December 1996 267 Induced Abortion in Italy Table 1. Abortion rates per 1,000 women aged 15–49, by region, Italy, 1979–1993 Region 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 Italy 13.7 16.0 16.3 16.9 16.9 16.3 14.8 14.0 13.0 12.0 11.4 11.1 10.6 10.2 9.8 Northwest Piedmont 18.6 20.8 20.5 20.1 19.9 19.5 17.4 16.1 14.9 14.1 13.0 12.4 12.6 11.8 11.5 Val D’Aosta 16.6 18.7 19.7 19.7 19.2 19.4 17.6 18.8 15.2 13.1 14.3 12.0 11.5 12.8 11.7 Lombardy 14.1 15.9 16.5 16.8 16.4 15.9 14.4 13.5 11.9 11.6 11.2 10.9 10.4 9.7 8.9 Liguria 20.1 19.5 19.3 19.8 19.1 18.6 16.4 15.6 14.6 13.8 12.5 12.2 11.9 11.4 9.8 Northeast Trentino 8.0 9.6 9.1 9.5 9.6 9.7 9.3 8.7 8.3 7.7 7.4 7.0 7.3 6.8 6.8 Veneto 10.3 11.1 10.3 10.0 9.5 9.1 8.0 7.7 6.9 6.4 6.0 5.7 5.6 5.5 5.3 Friuli V.G. 14.0 18.3 17.8 18.0 18.2 17.5 14.9 14.5 12.8 12.2 11.7 11.3 10.6 9.6 9.1 Emilia-Romagna 22.5 26.2 26.6 24.8 23.9 22.3 19.5 18.3 16.7 15.5 14.5 14.3 13.8 12.8 12.8 Central Tuscany 17.8 20.9 20.3 21.1 20.7 19.5 17.2 15.6 16.2 12.1 13.1 13.3 12.5 12.0 12.2 Umbria 18.0 21.4 20.4 21.6 21.0 21.7 20.4 19.0 15.6 15.9 15.1 14.1 14.6 15.1 14.0 Marches 13.0 15.3 16.2 15.0 15.6 15.5 13.8 12.8 10.9 9.7 9.2 8.6 8.3 8.2 8.2 Lazio 14.9 16.6 19.1 20.3 20.2 19.7 17.7 16.3 15.4 14.0 13.3 12.8 12.1 11.8 11.2 South Abruzzo 15.4 15.1 16.1 16.7 16.0 16.5 15.4 14.9 13.9 12.6 12.1 11.9 10.6 9.5 9.7 Molise 7.8 11.1 13.4 15.3 16.3 15.4 14.8 13.7 15.6 15.3 14.8 15.2 15.5 15.4 15.6 Campania 7.8 9.0 9.4 11.4 11.7 11.3 10.0 10.4 11.4 10.8 9.8 9.1 8.6 9.0 8.5 Puglia 16.5 23.7 25.1 25.7 28.0 27.8 25.7 24.9 21.1 18.6 19.7 19.2 18.1 17.8 16.8 Basilicata 8.5 7.6 8.4 9.7 13.7 12.0 10.7 10.0 9.4 7.4 6.9 6.5 6.4 6.1 6.0 Calabria 5.8 8.9 6.9 9.8 15.0 9.9 7.3 8.6 9.2 7.0 6.6 7.8 7.5 8.1 7.6 Islands Sicily 8.5 10.1 9.7 11.8 11.9 10.7 11.7 10.8 10.4 9.8 8.7 8.6 7.8 7.2 7.4 Sardinia 9.0 12.8 12.0 11.8 11.2 10.8 11.5 9.9 8.9 9.1 7.1 6.4 6.8 6.3 6.5 more than 50%, from 20.1 abortions per dard deviation divided by the mean, mul- specific regional information about the age 1,000 in 1979 to 9.8 per 1,000 in 1993, while tiplied by 100).
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