Italy’s gynaecologists demand government action to protect women’s abortion rights

Italy’s gynaecologists demand government action to protect women’s abortion rights

Italian gynaecologists who support a woman’s right to abortion have warned that the procedure may become all but impossible within the next five to 10 years, as the current generation of pro-choice practitioners heads for retirement and the proportion of objectors rises.

In some regions of Italy the proportion of doctors who refuse to perform terminations in the first 90 days of a pregnancy has reached “shocking levels,” said the campaign group, Laiga (—the Free Association of Italian Gynaecologists for the Application of Law 194.

The group’s president, Silvana Agatone, a gynaecologist at Rome’s Sandro Pertini Hospital, said that the eponymous law, which was introduced in 1978 and guarantees women the right to elective termination, was being routinely flouted across Italy. She presented new research by Laiga, which showed that the proportion of medical objectors in one of the worst affected areas—Lazio, the region around Rome—had now reached 91.3%. “The health ministry says the figure is 81.9%. And that was bad enough. But our research suggests it’s even worse,” she said.

As a result, only 51.9% of public hospitals in Lazio now perform abortions. In neighbouring Campania the figure is just 32.9%, and in the northern province of Bolzano less than a quarter of hospitals offer the service. Agatone said, “Even [at] the hospitals that do officially provide the service, the number of willing staff is so low that the service is completely inadequate.”

Laiga has launched a petition, together with the women’s health group Vita di Donna (Woman’s Life), demanding that the health minister, Beatrice Lorenzin, take action to ensure that law 194 is applied. After earlier complaints by Laiga to the European Court in Strasbourg the Italian government has been penalised for denying women their right to abortion, but to little avail, said Agatone.

Elisabetta Canitano, another Laiga member and the head of Vita di Donna, said that the influence of the Catholic Church was particularly strong in and around Rome because many major hospitals, although funded by the state, were owned and run by the church.

On 17 November the last remaining pro-choice gynaecologist at Rome’s biggest hospital, the Policlinico Umberto I, retired on health grounds, so it has also stopped performing elective abortions. Canitano said she feared that the situation will deteriorate. “When this generation of pro-choice gynaecologists goes, I fear there will be no one to replace them,” she said. “What’s going to happen then?”

Laiga announced that it had assembled a group of around 30 lawyers prepared to offer free legal advice to patients and to pro-choice doctors who felt under siege by the health system. Concetta Grande, another Laiga member and a Rome gynaecologist, said, “We have to do something. These women are being abandoned. They often don’t know what to do or where to go.”

The campaigners said that examples of intimidation or poor practice in the field of reproductive health were numerous. In one incident in Naples in 2008, police burst into an operating theatre to arrest medical staff who were preparing to terminate a pregnancy, although magistrates subsequently ruled that the planned procedure was legitimate. It is believed, said Agatone, that objectors among hospital staff had summoned the police.

BMJ 2014;349:g7505