Abortion is a right in Italy. For many women, getting one is nearly impossible
Rome (CNN) – In a sparsely decorated hospital room in central Rome, 29-year-old Emma waits quietly on her bed for the day to pass – her deep brown eyes staring into the middle distance, illuminated by the marigold hues of the early spring sun.
Floors above, women are laboring and welcoming their newborns into the world.
Emma had dreamed of experiencing those moments for herself since December, when she and her husband, who are from Agropoli in Italy’s southern Campania region, first found out she was expecting.
During her first three doctor’s visits at seven, 12 and 15 weeks, Emma – whose name has been changed to protect her identity due to societal stigma around abortion – says she was told everything was going well.
But at 23 weeks, she was plunged into a nightmare when she discovered that an ultrasound scan carried out by her gynecologist a week earlier showed the fetus she was carrying had a severe abnormality with a possible fatal diagnosis. The brain of the fetus had only partially formed, and if it survived birth, it would suffer.
“I felt like a truck had run me over,” Emma said of the diagnosis, and the circumstances that surrounded it, talking to CNN as she prepared for a very different end to her pregnancy than the one she first imagined.
“If this baby could live … even if he would have had a day of hope, a year of hope, he would have been practically nonexistent,” Emma said, explaining her decision to seek a termination. “It wouldn’t have been right for him, or for me,” she said.
Abortion has been legal here since 1978; women seeking terminations in the first 90 days of pregnancy are protected under Italy’s Law 194. The law also allows for “therapeutic” abortions – beyond the 90-day mark – but only if there are serious fetal abnormalities or if the mother’s life or health is at risk.
Law 194 stipulates that all hospitals should provide abortions at their facilities, but it also gives doctors – as well as nurses, anesthesiologists and other medical support staff – the option to “conscientiously object” to performing them, for example, if doing so would go against their religious or personal beliefs.
In the European Union, 22 out of 28 member states, including Italy, currently provide the right to conscientious objection over abortion, according to the WHO’s 2018 Global Abortion Policies Database.
Across Italy, 68.4% of gynecologists identify as “conscientious objectors,” according to 2017 Italian Ministry of Health data.
In some parts of the country, accessing an abortion can be nearly impossible, with gynecologists in the southern regions of Molise and Basilicata objecting at rates of 96.4% and 88.1% respectively.
In Emma’s own region, Campania, 77.3% of gynecologists do not practice terminations, far above the national average.
Almost 7/10 Italian doctors
refuse to carry out abortions
Proportion of gynecologists that are
"conscientious objectors"
20
60
80
100
0%
40
Lombardy
70.5%
Trento
56.7%
Bolzano
85.2%
Aosta Valley
17.6%
Friuli-Venezia Giulia
51.7%
Veneto
73.7%
Emilia-Romagna
49.8%
Marche
66.9%
Tuscany
59.4%
Piedmont
64.5%
Abruzzo
80.4%
Liguria
60.0%
Umbria
60.7%
Molise
96.4%
Lazio
74.1%
Campania
77.3%
Sardinia
53.6%
Basilicata
88.1%
Puglia
79.4%
Sicily
83.2%
Calabria
76.0%
National average
68.4%
22 of the 28 EU member states allow
for conscientious objection
Germany
Greece
Hungary
Ireland
Latvia
Luxembourg
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
United Kingdom
Austria
Belgium
Croatia
Czech Republic
Denmark
Estonia
France
Source: Italy's Ministry of Health 2017,
WHO Global Abortion Policies Database, 2018
Graphic: Henrik Pettersson, CNN, CNN. Map: Maps4news
Almost 7/10 Italian doctors
refuse to carry out abortions
Proportion of gynecologists that are
"conscientious objectors"
20
60
80
100
0%
40
Lombardy
70.5%
Trento
56.7%
Bolzano
85.2%
Aosta Valley
17.6%
Friuli-Venezia Giulia
51.7%
Veneto
73.7%
Emilia-Romagna
49.8%
Marche
66.9%
Tuscany
59.4%
Piedmont
64.5%
Abruzzo
80.4%
Liguria
60.0%
Umbria
60.7%
Molise
96.4%
Lazio
74.1%
Campania
77.3%
Sardinia
53.6%
Basilicata
88.1%
Puglia
79.4%
Sicily
83.2%
Calabria
76.0%
National average
68.4%
22 of the 28 EU member states allow
for conscientious objection
Germany
Greece
Hungary
Ireland
Latvia
Luxembourg
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
United Kingdom
Austria
Belgium
Croatia
Czech Republic
Denmark
Estonia
France
Source: Italy's Ministry of Health 2017,
WHO Global Abortion Policies Database, 2018
Graphic: Henrik Pettersson, CNN, CNN. Map: Maps4news
Almost 7/10 Italian doctors refuse to carry out abortions
22 of the 28
EU member states allow for conscientious objection
Bolzano
85.2%
Trento
56.7%
Lombardy
70.5%
Proportion of gynecologists that are "conscientious objectors"
Friuli-Venezia Giulia
51.7%
Austria
Belgium
Croatia
Czech Republic
Denmark
Estonia
France
Germany
Greece
Hungary
Ireland
Latvia
Luxembourg
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
United Kingdom
Aosta Valley
17.6%
Veneto
73.7%
Piedmont
64.5%
100%
Emilia-Romagna
49.8%
Liguria
60.0%
80
Marche
66.9%
60
Tuscany
59.4%
Abruzzo
80.4%
40
Umbria
60.7%
Molise
96.4%
20
Lazio
74.1%
Puglia
79.4%
0
Sardinia
53.6%
Campania
77.3%
National average
Basilicata
88.1%
68.4%
Calabria
76.0%
Sicily
83.2%
Source: Italy's Ministry of Health 2017, WHO Global Abortion Policies Database, 2018
Graphic: Henrik Pettersson, CNN. Map source: Maps4news
Almost 7/10 Italian doctors refuse to carry out abortions
22 of the 28
EU member states allow for conscientious objection
Bolzano
85.2%
Trento
56.7%
Lombardy
70.5%
Proportion of gynecologists that are "conscientious objectors"
Friuli-Venezia Giulia
51.7%
Austria
Belgium
Croatia
Czech Republic
Denmark
Estonia
France
Germany
Greece
Hungary
Ireland
Latvia
Luxembourg
Netherlands
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
United Kingdom
Aosta Valley
17.6%
Veneto
73.7%
Piedmont
64.5%
100%
Emilia-Romagna
49.8%
Liguria
60.0%
80
Marche
66.9%
60
Tuscany
59.4%
Abruzzo
80.4%
40
Umbria
60.7%
Molise
96.4%
20
Lazio
74.1%
Puglia
79.4%
0
Sardinia
53.6%
Campania
77.3%
National average
Basilicata
88.1%
68.4%
Sicily
83.2%
Calabria
76.0%
Source: Italy's Ministry of Health 2017, WHO Global Abortion Policies Database, 2018
Graphic: Henrik Pettersson, CNN. Map source: Maps4news
Italy’s Health Ministry says that even in places where conscientious objection rates are higher than the national average, there are “no particular critical points” in first trimester abortion services.
But the experiences of many women, like Emma, tell a different story.
Emma believes her doctor, who is an “objector,” might have willfully neglected to tell her about her fetus’ malformation until after the 90-day window had closed, making it more difficult for her to get an abortion.
Following her diagnosis, Emma’s doctor made it clear that she would not be able to help her access a termination, instead recommending that she consider traveling to London for the procedure.
Emma searched for a doctor in Italy who could handle her case, ultimately finding the closest one who would treat her at the San Camillo-Forlanini Hospital in Rome, more than 300 kilometers (186 miles) away.
The hospital made headlines in 2017 when it publicly advertised for two new doctors, specifying that they would have to provide abortions as part of their work. The hospital says it has become known as a facility open to women seeking abortions, though only six of its 25 gynecologists carry out the procedure.
Dr. Giovanna Scassellati is one of them. She’s worked at San Camillo for more than 22 years, and treats women who live in the capital, as well as those who have travelled for a termination, after being denied one in their home regions.
In her tenure, Scassellati has seen the number of gynecologists who “object” rise significantly. Ministry of Health data shows that in 2005, the number of doctors objecting to abortion was 59%; now it’s almost 70%.
Scassellati attributes that change to several factors, including a “radical” shift in the way doctors are educated.
“Gynecologists never enter a ward where abortions are done during their training – it’s not like this in other European countries,” she said, adding that general practitioners are also not educated on preventative care, such as contraception.
Dr. Silvana Agatone, president of the Free Italian Association of Gynecologists (LAIGA), agrees, explaining that Italian healthcare is heavily influenced by both politics and the Catholic Church and this, in turn, impacts the attitudes of doctors and other healthcare workers.
If a hospital’s head of staff is known to object to abortion, Agatone says, other doctors working there may fear that going against the grain – by being open to carrying out terminations – could hinder their career prospects.
Dr. Francesco Cucinelli, one of the 19 objecting gynecologists at San Camillo told CNN that in his work environment, he doesn’t see any pressure on doctors to object, saying that his decision is purely personal.
Dr. Maria Giovanna Salerno, the head of San Camillo’s gynecology department, insisted that “a public hospital must respect the Italian law,” by offering abortions.
Salerno refused to say whether she personally objected to carrying out terminations.
“I believe that all doctors must work with their conscience. Every doctor must work under science and conscience – and every director must guarantee that in their operating unit the law is respected,” she said, adding she doesn’t believe the “presence of objecting doctors could in some way influence the care of women.”
But the Council of Europe, the body that upholds the European Convention on Human Rights, found in 2016 that “women seeking access to abortion services continue to face substantial difficulties in obtaining access to such services” in Italy, and that non-objecting medical practitioners “face several types of cumulative disadvantages at work both direct and indirect, in terms of workload, distribution of tasks, career development opportunities.”
Even more worrying to activist doctors like Scassellati and Agatone is a political shift that could eventually threaten the existence of Law 194.
That shift is on full display in Verona, a city some 500 kilometers (310 miles) north of the capital that has become a laboratory for the anti-abortion movement.
Last October, 40 years since the creation of Italy’s abortion law, Verona’s mayor declared the city “pro-life” after the local council passed a motion allowing the use of public funds to finance anti-abortion programs that encourage women to carry their pregnancies to term and give their babies up for adoption.
The motion, brought by local councilor Alberto Zelger, a member of the deputy Prime Minister Matteo Salvini’s anti-immigrant League party, has since inspired politicians in some other cities, including Milan, Rome, Ferrara, Trieste and Sestri Levante to propose similar action, though each failed to pass.
Speaking to CNN from the World Congress of Families (WCF) event – a forum for an international alliance of far-right politicians, conservative activists and religious leaders – in Verona in March, Zelger said Italy’s abortion law needed to be re-examined.
“Just as it’s done with cars, revisions are made every couple of years, verifying if the car works or if it has a defect,” he said, adding that Law 194 is “incredibly unjust because it claims the self determination of the woman but in reality, it doesn’t protect the right to life of the baby.”
Pointing to a small gold pin in the shape of a baby’s foot on his lapel, Zelger said Italy has “forgotten” that “children are the most precious gift of the nation.”
His motion, he insists, is “not against anyone,” adding that abortion rights activists “have demonized us in every way, saying we shouldn’t speak; it’s not clear why, honestly.”
Women’s rights activists disagree, saying not only does Zelger have a clear platform on which to speak, but it’s one actively supported by Salvini and his party.
'The Europe that we like'
After Verona branded itself as a “pro-life” city and announced it would host the controversial WCF forum, Salvini declared, “this is the Europe that we like.”
Salvini recently said he does not plan to change the country’s abortion laws, but activists say his decision to appoint Lorenzo Fontana as Minister for Health and Disability has created a hostile atmosphere for women seeking terminations.
Verona native Fontana, who has said same sex parents “don’t exist,” has pledged to reduce the number of abortions in Italy by urging doctors to encourage women to consider adoption instead.
Salvini’s “pro-family” stance has helped to bring in electoral support from Italians who previously might have not voted so far to the right. In 2018, Salvini said Italy’s birth rate – the lowest in Europe – was being used as an excuse to “import immigrants.”
And he’s touched a nerve with an economically-frustrated population. In the November draft budget, Salvini supported a League initiative to give families who have a third child between 2019 and 2021 state-held land for 20 years.
Dr. Elisabetta Canitano, a gynecologist and president of the feminist group Vita di Donna, says migrant and trafficked women are disproportionately affected by this rhetoric.
She cited a recent case where a Romanian woman living in the northern Lombardy region was charged a 1,000 euro fee ($1,130) for seeking an abortion – which would normally be free – without a medical card.
Canitano says Lombardy does not allow foreigners to obtain such cards easily, but a representative for the region told CNN foreigners are entitled to medical cards and added that “compliance with Law 194 is guaranteed to everyone with the support of the network of counseling offices.”
In another case, Canitano says a Somali woman fell ill after taking what she thought was an abortion pill. When she eventually ended up at hospital, Canitano says the woman was charged with carrying out an illegal abortion and fined 3,000 euros ($3,371) – the charge is punishable by fines of up to 10,000 euro ($11,237).
Wide-ranging changes to abortion rights and Law 194 are unlikely, for the moment at least, since the League governs as part of a power-sharing deal with the Five Star Movement, whose members do not support an anti-abortion agenda.
In the city of Verona, where the anti-abortion movement is strong, local gynecologist Dr. Maria Geneth says women are still able to access the treatments they need – for now. But she worries about the future.
In the wider Veneto region around Verona, however, women seeking access to abortions already appear to be facing more difficulty finding out where and how to access a safe, legal termination.
The Veneto is a League party stronghold where 73.7% of health care providers “object” to abortion. Its regional government is currently suing one of Italy’s largest trade unions for telling Italian media that two women had been denied access to abortion in 23 facilities across the region.
Dr. Scassellati in Rome says it is not unusual to receive women from Veneto who, like Emma, had to travel hours away from their homes to find doctors willing to provide a service that is a legally protected right.
Emma, who has since recovered from her abortion, says she was a victim of a “bad healthcare” system that is tipped against women’s choice; its political policies are tone deaf to their personal pain.
“The reality is, what would I have given up for adoption with the diagnosis that was given? There was no hope – I couldn’t have given a life like that up for adoption because it didn’t exist.”
