Access to abortion care in parts of Italy has always been difficult, but with the coronavirus outbreak, the situation has become even more dire and urgent.
Abortion in Italy was legalized in 1974. It was the result of a power struggle for safe abortion between the women’s movement, conservative forces and the Vatican. The text of the Law (N 194) seems liberal and quite progressive but in reality, the feminist victory was not enough to ensure women’s access to the service.
‘Conscientious objection’ of healthcare providers has emerged as a serious obstacle to the effective exercise of the right to abortion care over the past forty years. Doctors refusing care account for approximately 70% of all gynaecologists in Italy — leaving a small number of providers in public hospitals willing to provide the service.
Some women’s rights activists fear that coronavirus is being used in religious and anti-choice rhetoric as another tool to dismantle women’s access to safe and legal abortion in the country. With curfews, lockdowns, and restriction on movement, many public hospitals that provided abortion care did not keep abortion care under the essential services to be provided by obstetric departments.
For example, in Lombardy, a traditional anti-choice bastion and the region worst hit by the virus, women seeking an abortion in nearby towns are being turned under the guise of coronavirus fears, while in the south of Italy — where the up to 90% of doctors and hospitals refuse abortion care — women now face even greater challenges.
IPPF spoke to two gynaecologist and women’s rights activists — Silvana Agatone and Lisa Canitano — about the impact of coronavirus on abortion care access in Italy.
What impact has coronavirus had on sexual and reproductive healthcare in Italy specifically around abortion care access?
During the initial chaos of coronavirus, abortion care services were stopped and remain almost unavailable, even though abortion is considered as an ‘urgent intervention’ under Italian law (Law 194/78). In addition to this, women trying to obtain a certificate to access abortion care has got much more difficult.
The current law in Italy requires that a woman seeking an abortion must obtain a certificate from a doctor first, confirming her decision to end the pregnancy. The doctor, who completes this certificate, can decide whether the woman urgently needs an abortion and therefore certifies the urgency, or can ask her to think about it for seven days. After these seven days, the certificate enables the woman, in theory, to get an abortion as an urgent procedure. Many doctors are unwilling to make the effort to certify the urgency.
There were two problems straight away when coronavirus hit.
The first problem concerned the certificate: family doctors were less willing to provide a certificate and many public family counselling facilities, where women could also obtain a certificate, were closed. The second problem was that some women seeking abortion care found abortion services closed in their own city. When they sought care from hospitals in neighbouring cities, particularly in Lombardy, they were not allowed in many cases because the women came from areas which had the coronavirus.
Another issue is the impact on migrant women, especially in Lombardy, where there is a large community of migrants. These women, who often had expired documents, were not allowed to receive any type of service from healthcare providers.
Given that across the country 68.4% of gynaecologists identify as ‘conscientious objectors’, would you say conscientious objection is one of the biggest barriers facing women seeking abortion care in Italy?
In recent years, it has been possible to conduct a small-scale study on abortion in Italy. The health minister presents a report on this topic every year, which confirms the situation in Italy is worsening.
At the national level, with regards to conscientious objection among gynaecologists, the number has risen from 58.7% in 2005 to 68.4% in 2017, as an average but you have to keep in mind that in some areas that figure reaches 96.4%. According to the most recent statistics from 2017, only 64.5% of hospitals offer IVG (abortion care services) for the first 90 days. It is also very difficult to find hospitals where you can have an abortion after 90 days even when there are foetal malformations or threat of serious injury to the woman.
In medical schools, where young gynaecologists train, there is a high number of conscientious objectors, and in some schools, there is not even abortion care training.
We’ve seen a small number of European governments adapt service provision around abortion care and telemedicine. Do you think these services will remain after the pandemic is over, and what does this tell us about the future of healthcare provision and telemedicine?
We are learning that an acquired right under such circumstances is not permanent therefore it must be protected. I believe that laws regarding abortion and telemedicine depend on how much we can pressure our governments into creating and adopting them. Let us hope that women will have greater freedom through these innovations.
What is the future for abortion care in Italy and how do you think it will be achieved?
The future of abortion in Italy?
We know that there are strong global anti-abortion forces that use an ideology that is aggressive in its attempts to block women’s rights. It will only be possible to stop them by creating a bigger global network dedicated to defending human rights.
A better future for women and girls — when it comes to abortion care — can only be achieved by leveraging the law, which is bound by the constitution.
Finally, do you have any words of hope for anyone reading this during these testing times?
I hope that this tragedy will enable us to make people understand that healthcare must be in the interests of the citizens. It is about care, prevention, and freedom of choice.
IPPF Global would like to thank IPPF European Network for arranging the interview, and Silvana Agatone and Lisa Canitano for their time and insight.