Abortion Is Legal in Italy, But It's Almost Impossible to Get One
Valentina Magnanti miscarried alone in a hospital bathroom after the doctor on shift refused to help her. While abortion remains technically legal in Italy, 70 percent of Italian gynecologists refuse to offer the procedure—with terrifying results for...
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The unbearable pain began at four in an early morning during October 2010. Valentina Magnanti, 24, was in her hospital bed. The oxytocin injected into her body hours earlier to prompt the expulsion of her fetus was causing excruciating contractions.
Fabrizio, her husband was sleeping, perched on a chair at her bedside. Clutching his arm, she woke him up. "Help me," she could just about say.
Valentina had entered the Sandro Pertini hospital in Rome the same morning, 17 weeks into her pregnancy. Three days earlier, she had discovered that the fetus in her womb was malformed and had no chance of survival. The couple decided to have an abortion.
After contacting one of the only seven gynecologists practicing abortions in Lazio—the region whose capital is Rome—she finally began the 12-hour-long procedure. The gynecologist who began the abortion finished her shift later that afternoon. Another doctor took over for the night.
That night, Magnanti had to crawl to the bathroom of her room and miscarried alone. No medical staff came. The doctor on shift—a conscientious objector—had decided not to assist her.
Although one of the most extreme, Magnanti's story is a reality shared by many of those who decide not to carry on with their pregnancies. Though the practice has been legal since 1978, Italy is no country for women seeking abortions.
La 194—colloquially named after the official law 194/1978—still echoes in the street chants of the feminist struggle that brought Italian women out of the patriarchal 50s. "L'utero e' mio e me lo gestisco io!": It's my uterus, I manage it.
But despite the huge step that allowed women to access abortions in safe medical circumstances, the 194 law created a dangerous legal loophole. By law, Italian women can undergo a termination 12 weeks from the date of conception. But doctors can also decline to perform abortions for personal or religious reasons, declaring themselves conscientious objectors.
"When I told my [first] doctor I wanted to have an abortion, he refused despite the obvious medical reason," Magnanti says, recalling the days leading up to her traumatic stay in hospital. "He referred me to a colleague who was willing to help me."
In a country where the practice is still a cultural and religious taboo, the amount of doctors who refuse to help with abortions is increasing.
Declaring your status as a conscientious objecter only involves submitting a formal request to the health authority. Today, 70 percent of Italian gynecologists are conscientious objectors. The rate rises to up to 84 percent of doctors in more conservative Southern regions, which includes cities like Naples and Bari.
That leaves a tiny group of abortion providers to deal with a huge demand for terminations and a lot of women uncertain about their future.
"The rising numbers of objectors is probably the most dangerous trend," says Silvana Agatone, one of the seven gynecologists operating in Lazio, a region of five million people. She is the founder and president of LAIGA, the Italian association of non-conscious objectors. She founded the organization in 2008 after police raided an operating room in Naples to stop an abortion that the officers mistakenly believed to be illegal.
Agatone says that only those who are on the frontline understand the gravity of the situation. "In Rome, you can see droves of women queueing up, in front of hospitals at four or five in the morning to make sure they can grab the day's limited slots," she told Broadly. "That's how bad the situation is."
But according to the Italian government, the emergency does not exist. A report issued by the Italian Ministry of Health last autumn states that abortions have plummeted over the last few decades. In 2014, the number was 97,535, compared to 234,801 in 1982.
More worrying trends emerge when you look closer at the data. The number of miscarriages is increasing. Between 1983 and 2013, it rose from 93.2 per 1,000 live births to 138.5. Some doctors believe the increase is linked to the number of women seeking underground treatment or inducing abortions themselves. The government estimates that an estimated 12,000 and 15,000 illegal abortions are performed every year; independent sources put that number at closer to 50,000.
"Abortions have gone down because of a better understanding of contraception. Monitoring the amount of abortions per year doesn't give an accurate picture," says Agatone. "That's just counting those who manage to get an abortion, without paying attention to those who could not get an abortion and had to choose other paths."
It has a lot to do with a culture of shame. You sin; you have to be punished. You fuck; you have to be punished.
According to some, the lack of options risks to push women to take matters in their own hands.
"Provoking a miscarriage is relatively easy," says Matteo Nafi, a Milan-based anesthetist who works with abortion providers. "It's common to see cases of induced miscarriages. You can abuse an elevated amount of alcohol or drugs in a short amount of time to disrupt the blood flow to the fetus and cause a miscarriage."
The lack of gynecologists willing to terminate a pregnancy is also the reason some women seek the procedure abroad. While there is no data on the number of people who travel to neighboring European countries for abortions, Agatone comments: "In France, they stopped keeping track of the Italian women who seek assistance there. There are so many of them."
Marine Valentino was one woman who sought an abortion out of the country. When she was 21, she found out she was three and a half months pregnant. She visited several hospitals trying to get help, and says she witnessed the deep problems within the system then—including an exhausted 70-year-old retired gynecologist who had been called back into service to cope with the demand for abortions.
Valentino fell outside the twelve-week limit to get an abortion. There was no way of terminating her pregnancy in Milan, where she just started studying psychology at university.
"My gynecologist begged me not to tell anyone what he was about to do," she says. The doctor gave Valentino the contact of a private clinic in Barcelona, Spain, where the abortion limit is laxer. Her parents came with her to support her through the operation.
"What struck me," Valentino remembers, "was that the staff spoke Italian, French, and English. They were used to having people from all over Europe." The procedure lasted one hour and she was discharged the very same day; a stark difference compared to Italy.
The high number of conscientious objectors is commonly associated with Italy's cultural stance on abortion. AnIPSOS poll carried out earlier this year showed that 15 percent of Italians believe that abortions should never be permitted or should be allowed to be carried out only if the mother's life is at risk.
Religion plays an important role. According to Doxa, an independent opinion research company, almost three-quarters of Italians are Catholic Christian, with 59 percent of them convinced that religious dogmas and precepts have an influence on everyday life. The abortion providers who spoke to Broadly believe there may be a more prosaic reason behind the rise of conscious objectors.
"Catholic elites are very well represented at the high levels of the national healthcare system," explains Nafi. He argues that carrying out abortions can have a negative impact on one's career because of the stigma that is associated with the practice. "It doesn't really have to do with individual moral convictions—not always, at least—but with career advancement."
"The life of a non-objector is not easy," adds Agatone. "As abortionists are already facing a huge workload, they are left out of other types of operations that could help them progress professionally."
This month, the Council of Europe ruled against Italy for the second time in two years, slamming its abortion system as in breach of women's rights to protection of health and the doctor's right to dignity at work.
Marilisa D'Amico and Benedetta Liberali are two lawyers who helped prepare the case against the Italian government, bringing witnesses together to form a class action suit. They believe that the two consecutive rulings represent a chance to reform Italy's current system. "This ruling should be a wake-up call to fix all the problems that are being reported. It is a victory for each and every one of us, women and doctors alike," the pair told Broadly.
A universal desire of the pro-choice movement is to see a change in Italian culture, with more respect for a woman's decision to have an abortion. When Magnanti was in the early stages of her abortion, a small group of people entered her hospital room holding copies of the Bible. They accused her of being a sinner and a murderer.
Magnanti now wants to lift the veil on the taboos and cultural denial around abortion. When talking about the psychological toll of being left alone during her abortion, she sighs: "When it's all over, you don't feel a thing. You don't feel a woman anymore, you don't feel a person anymore. It impacts every aspect of your life. Rather, the thing you feel is anger... Anger towards those who left me in that bathroom."
With the support of a Rome-based pro-choice association, she shared her story at a news conference.
"Somebody who attended the conference took the video and edited it, accusing me of being a murderer," she says. Death threats and insults flooded her Facebook inbox. Some messages told her she had effectively performed eugenics: "They were accusing me of being a Nazi."
But speaking out prompted many more women to come out and tell their dramatic stories of abortion and abandonment by the medical establishment.
"It's not just the difficulty you have to physically abort. It's also the pressure society puts on you. It has a lot to do with a culture of shame," Valentino says. "You sin; you have to be punished. You fuck; you have to be punished. It's a notion embedded in Christianity. I wonder who is the deranged mind who came up with the idea of the 'immaculate conception,' procreating without the sin of a sexual act."
For Valentino, the priority is to remove the stigma that surrounds the decision of having an abortion: "The way you are being treated, marginalized and forced to feel guilty... I don't think that giving a birth is the ultimate accomplishment for a woman. A woman is a woman, even without being a mother or a wife.
"Giving birth doesn't define you as a woman, as much as aborting [a fetus] doesn't qualify you as a murderer."