By Tony Connelly, Europe Editor, Brussels

It may come as a surprise, but a relatively liberal abortion regime has existed in Italy since 1978.

Law 194 was introduced following a determined campaign by women’s groups, but also due to the rise in illegal abortions.

In 1981 there was a move by Catholic groups, supported by the church, to overturn the law, but it was defeated by nearly 68% in a referendum.

A second referendum saw support for legal abortion rise to 88.4%.

More Italian doctors refusing to carry out abortions

The law provides for abortion up to 12 weeks into the pregnancy, and up to 23 weeks if there are foetal abnormalities.

Terminations can only be carried out in public hospitals once the woman has been given a certificate at a state-mandated family planning consultancy.

But Law 194 is back in the news in Italy, and the reason may resonate with the debate in Ireland.

The law permits medical personnel to refuse to carry out abortions on conscientious grounds.

The numbers who are now doing so have risen so dramatically that groups in favour of the availability of abortion say the phenomenon is forcing Italian women to seek terminations abroad, or even to submit to illegal abortions in Italy.

“The number of doctors and gynaecologists objecting has reached nearly 80% across the country,” says Donata Lenzi MP, a member of the governing Partito Democratico (PD) and head of the parliament’s social affairs committee.

“This means that voluntary terminations become very difficult. There are even areas in Italy where having an abortion is not possible.”

Last October figures presented to parliament by the health minister showed that the number of conscientious objectors among gynaecologists rose from 58.7% in 2005 to 70.7% in 2009.

Among anaesthesiologists the figure rose from 45.7% in 2005 to 50.8% in 2010.

Non-medical personnel refusing to facilitate abortions had also from 38.6% to 44.7%.

The trend depends very much on the region. In more conservative southern Italy the figure is higher (91% in Lazio, according to one estimate), with large numbers of gynaecologists declining to perform abortions in Sicily and Calabria.

The greater Naples area, with a population of nearly four million, was left for a year without any abortion services since the sole remaining doctor willing to perform terminations in a public hospital had died and had not been replaced.

However, in northern Italy, and in more traditionally left-wing regions like Tuscany and Emilia-Romagna, the numbers of objectors is much lower (27% in Tuscany).

More women travelling for terminations

The result, according to organisations who believe abortion should be widely available, is that women will either have to wait for four to five weeks in their own area for the termination to go ahead, or will travel to another region.

A growing number of women are travelling to Switzerland, Spain, France, the UK and the Netherlands for terminations, even though abortions are theoretically legal at home.

Not surprisingly, Catholic organisations are encouraged by the figures.

One such is Scienza e Vita (Science and Life). It is supported by the Vatican and has been increasing its profile across Italy, with 106 centres providing legal advice on a range of issues.

The organisation says it is not looking for the repeal of Law 194, but for other clauses in the law to be applied more rigorously.

These include more financial support to encourage women to go through with their pregnancies rather than to seek terminations.

But Scienze e Vita is becoming increasingly active in universities and medical faculties, providing support and legal advice to those studying to become gynaecologists.

“The number of conscientious objectors is increasing,” says spokesman Massimo Gandolfini. “It’s mainly thanks to organisations like ours and others. This is important because it’s a victory for democracy.

“The church certainly has an influence, but it has always had an influence on the development of culture and tradition in Italy.”

One of the foremost objectors is Dr Romano Forleo, the country’s most eminent gynaecologist. A former senator, who has been practising obstetrics since the early 1960s, he has never performed an abortion.

“Some people think that the embryo, especially at the beginning, is not a person,” he says. “But I believe that it is a person.”

Dr Forleo believes that the right of conscientious objection is fundamental. But he feels that the right, enshrined in Law 194, doesn’t go far enough since those gynaecologists who choose to object have to immediately withdraw from the situation altogether.

“Right now you can’t get involved in the case, and this is a mistake because in this moment the pregnant woman wants to have an abortion,” he says.

“If you’re an objector you can’t even persuade her not to go ahead with this act.”

Groups who support the law, however, say they are increasingly concerned about the rise in conscientious objection and argue that it is degrading what they say should be a free and legal service.

Some argue that not all doctors are refusing for moral reasons only. The more doctors who object, they say, the more remaining gynaecologists become isolated, stigmatised, or end up simply having too big a workload.

One group, Vita di Donna, claims that because of numerous Catholic-influenced medical associations, doctors are often discouraged from performing abortions in case it inhibits career mobility.

“We think that there is too much interference in public hospitals from the Vatican,” says spokeswoman Gabriella Pacini.

Rise in underground abortions

In May, La Repubblica reported that the scale of conscientious objection was driving more and more women into a shadowy world of illegal abortions, claiming that the true figure of clandestine terminations was up to 50,000 annually, far above the official figure of 15,000.

It reported that criminal gangs were smuggling Misoprostol from Latin America to Italy through the port of Genoa.

It’s a drug used treat ulcers but which taken in sufficient quantities can induce a miscarriage. The paper reported that gangs were then selling the drug at half the price it costs on the internet.

Mirella Parachini, a practising gynaecologist and former president of FIAPAC, the International Federation of Professional Abortion and Contraception Associates, says that women suffering from the after effects of illegal abortions – through Misoprostol use – are regularly presenting themselves for help at her hospital.

Many of these women are seeking illegal abortions through underground networks often run by immigrant women, she says.

“Chinese women, we don’t see them in the hospital. And we know there is a large community of Chinese immigrants in Italy, so, where do they go?”

For the moment, abortion does not look like it will reawaken as a major divisive issue in what is still a predominantly Catholic country.

The social affairs committee in the Italian parliament is looking at how Law 194 is applied, and what to do about the large numbers of conscientious objectors.

Groups who favour the availability of abortion fear that conscientious objection is simply becoming a cover for doctors who don’t want the extra workload, or who fear that their careers will be blocked if they perform abortions.

Some campaigners say that so-called conscientious objectors actually perform illegal abortions on the side for payment, but this has so far been impossible to prove.

Debate set to intensify

Anti-abortion campaigners, however, are taking comfort from the growing numbers of objectors.

While it may not yet be a hot political topic – a repeal of the law looks unlikely – the debate is likely to intensify.

The Vatican may be a separate state, but the Italian Bishops Conference (CEI) still wields considerable influence over both voters and parties, managing in 2005 to convince many Italians not to support stem cell research in a referendum.

Even left-wing parties have leaders who describe themselves as Catholic while both former prime minister Mario Monti and the current leader Enrico Letta are seen as coming from the “Catholic wing” of their respective parties.

“Today there are elements of the church in almost all parties,” says Professor James Walston of the American University in Rome.

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