Between Stigma and Objection: Italy’s Troubled Relationship with Abortion
CW: Graphic depiction of medical mistreatment
“For most, it’s just a matter of saving themselves some trouble. Of course, some really have religious reasons. And then there are the ones who practice abortions in private clinics while refusing to do so in public hospitals.” With 68 years on her shoulders, 25 of which she spent in a public hospital in Northern Italy, retired OB-GYN Annamaria Tormene tells a story that women in this Southern European country have heard a thousand times — that of physicians’ conscientious objection to abortion. Conscientious objection remains one of the main obstacles keeping Italian women from accessing their legal right to terminate their pregnancies, often forcing them to seek treatment abroad.
In Italy, abortion was legalized in May 1978, when the so-called “Legge 194” finally passed after a tedious decades-long legislative battle. Legge 194 grants women the freedom to terminate their pregnancy within the first 90 days of pregnancy, or within the first 22 to 24 weeks if the pregnancy constitutes a serious threat to the woman’s life or to her physical and mental health. The Legge 194, however, contains a legal clause that grants health professionals the right to refuse to practice abortions as conscientious objectors.
Borrowing their name from those who historically claimed the right to refuse to perform military service on the grounds of their freedom of thought, conscience, or religion, conscientious objectors refuse to provide certain medical services for reasons related to their personal religious beliefs. The conscience clause reads: “The healthcare and auxiliary professionals are not obliged to participate in the procedures to interrupt pregnancies whenever they preemptively raise their conscientious objection.”
The number of objectors has grown in the 30 years following Legge 194. While the clause initially served to protect the rights of pro-life OB-GYNs who were already in the field when abortions were legalized, the number did not decrease as older healthcare providers retired. Five years after the law was introduced the number of objector doctors was 59 percent, but in 2016, over 70 percent of Italian gynecologists were conscientious objectors, with peaks of 90 percent in certain regions. Historically, conscientious objection from military service was met with harsh fines, imprisonment, or even death sentences, but medical practitioners who decide to abstain from this responsibility face no consequences for their choice. This, coupled with the fact that gynecology departments are often in the hands of objectors, has contributed to rising numbers of doctors claiming their right to objection.
Although several Italian courts have ruled that conscientious objection is illegitimate in treatment that occurs before and after the abortion takes place, this doesn’t stop anyone, from pharmacists to nurses, from hiding behind the conscience clause. A 2013 report denouncing this misconduct, published by Italian associations Laiga, Vita di Donna and the trade union Confederazione Generale Italiana del Lavoro, found that, “[a]nesthetists don’t deliver anesthesia; assistants don’t set up the tool for abortion surgeries; nurses don’t push the stretchers of women who are interrupting their pregnancy. This means that the few non-objector doctors have to carry out these little tasks on their own too, wasting time they could use to do their actual job.”
To doctors like Tormene, who often end up being the only non-objector healthcare providers in their department, this has become an obstacle to their career advancement. “You get calls during your free time asking you back at the hospital to interrupt a pregnancy,” Tormene says. “You get excluded, kept at the margins because you’re the weird one.” She doesn’t remember exactly how many women she has treated — around four each week, every working week, for 25 years.
“I always got assigned the worst operations, like that time I had to do a C-section on a woman with a dead baby in her uterus. ‘You don’t even care, you won’t have any problem doing that’, they told me,” Tormene recalls. She was singled out to perform these procedures, and she has watched as colleagues who had been non-objectors alongside her at the beginning gradually broke underneath the social pressure, which stems largely from historically-held religious beliefs.
Controlled by the Vatican for centuries, Italy is still heavily influenced by Catholic stances on issues surrounding sexual and reproductive rights. Sexual education in schools is often insufficient and sometimes non-existent, and it’s not uncommon to hear about pharmacists refusing to sell the morning after pill or contraceptive pills. Pro-life groups have a strong sway over public opinion, even funding billboards that read, “abortion is the first cause of femicide in Italy.” The rhetoric of abortion as murder has found fertile ground in Italy, especially since the Church firmly adopts the belief that abortion at any stage is equivalent to murder. Religious stances on abortion, combined with cultural beliefs that dictate women to be mothers — as illustrated by the current Minister for Family and Disabilities, Lorenzo Fontana, a fervid pro-lifer who has made it a crusade of his to reduce the number of abortions in Italy — leave few reasons for doctors to provide abortions.
In a study on conscientious objection, anthropologist Silvia de Zordo interviewed 120 healthcare providers in four Italian hospitals and found that a great majority of those claiming the conscience clause actually support the existence of a law granting women the right to abortion. But, at the same time, “they didn’t feel like providing it themselves,” de Zordo writes. “They felt, and they basically are, authorized to subtract themselves from this practice.”
“The fear of being stigmatized or discriminated against in their workplace by colleagues or superiors who object, and a lack of quality training on abortion as well as in the updating of abortion techniques make the choice of applying Legge 194 hard and unattractive,” de Zordo continues. Although abortion is the second most common OB-GYN procedure in Italy after giving birth, de Zordo finds that for some, “[d]eclaring conscientious objections means, to some, avoiding an uninteresting task, a facultative job.”
A recurring theme in many of de Zordo’s interviews is the perception of abortions as an ungratifying, “dirty” practice that is the result of a woman’s failure; women alone are held responsible for contraception and avoiding unwanted pregnancies. Mirella Parachini, an Italian OB-GYN who was a member of the Radical party to pass the law in the ‘70s and has been practicing gynecology ever since, attests to this perception saying, “There’s a sort of generalized moral laissez-faire that means that OB-GYNs don’t see abortions as a true part of their job. They feel like the issue doesn’t concern them. There’s the feeling that abortions aren’t a real medical practice.”
The abuse, though, goes much further than individual doctors. Although Legge 194 clearly states that abortions have to be granted in every healthcare structure with an OB-GYN department – even by calling in outside non-objectors, if necessary – entire clinics exercise a so-called “structure objection.” Some Catholic clinics even ask their staff to sign documents confirming that they abide by the Church’s stances on issues such as abortion when they’re hired. Out of 654 structures hosting an OB-GYN department in Italy, only 390 provide abortions.
This lack of access to proper health care leaves thousands of women alone, facing hostile doctors and societal pressure in a country that still holds tight to its traditionalist beliefs. In 2016, a survey calculated that 10 to 13 thousand women resorted to dangerous back-alley abortions, and stories of women having to travel to other regions to terminate their pregnancy multiply.
Either to escape the shame that comes with being treated in departments crawling with objectors, or because the diagnoses of malformations or other health hazards came too late to resort to therapeutic abortion in Italy, many women resort to seeking abortions abroad.
Claudia Carfagna had to travel to Nice, in France for a therapeutic abortion after her fetus was diagnosed with hydrocephalus, a condition in which the cerebrospinal fluid occurs within the brain, dramatically limiting the space for the brain to develop. During her treatment in France, Carfagna describes a situation that she believes she could never have found in Italy. “They came to check whether I needed anything every hour,” she said. “They asked whether I was suffering and needed an epidural or anything else.”
The financial cost was higher than if she had stayed at her local hospital. “[W]hen I speak to women who had to go through the same in Italy, I would pay that price another thousand times. I read of horrific treatments – of living fetuses left hanging from the mother, or mothers left alone for three days because the on-call doctors refused them help… It’s just cruelty. Plain and simple.”
Despite all the obstacles, Italian women aren’t left completely on their own. Associations like Laiga or Vita di Donna strongly advocate for an actual implementation of the law, while also providing women with useful information on what hospitals they can rely on. Non Una Di Meno, the largest transregional feminist network, even set up an interactive map of Italy – Obiezione Respinta – on which women can flag pharmacies, clinics, and hospitals where they met objectors. Advocates continue to have their work cut out for them, as several members of the ruling party push for more restrictions on reproductive rights, making the already uphill struggle for reliable access to safe abortions steeper still.