Why doctors in Italy refuse to give abortions

Abortion may be legal in Catholic Italy but more and more doctors are refusing to terminate pregnancies, with many women now having to resort to procedures carried out in secret, The Local's Angela Giuffrida discovers.

Why doctors in Italy refuse to give abortions
Protesters during a demonstration in Italy in 2008 to protect the country's abortion law. Photo: Andreas Solaro/AFP

Ever since a Benito Mussolini-era ban on abortions as a “crime against the purity of the Italian race” was wiped out in 1978, thanks to a group of determined women, including the former foreign minister Emma Bonino, women in Italy are, by law, entitled to terminate a pregnancy within the first three months.

After 90 days, abortions are only allowed if the foetus is badly harmed or the mother’s life is at risk.

The so-called Law 194 was a giant leap for a country that is predominantly Catholic: before it was enacted, illegal abortions were the third-biggest cause of death for women, and several battles have since been won against those trying to revoke it.

But that doesn’t mean to say that women – many of whom would have endured a painful decision-making process – can easily access abortion services in Italy.

“The situation has got worse in recent years…There is a big problem with stigma in Italy,” Elisabetta Canitano, a gynaecologist and president of Vita di Donna, an organization that provides support to women over health issues, tells The Local.

In fact, several cases over the past year prove that, in reality, little has changed.

In March, 28-year-old Valentina Magnanti told a court in Rome that she went through 15 hours of excruciating pain before being forced to give birth in a hospital toilet after doctors allegedly abandoned her part of the way through a procedure to abort a foetus which, at five months, was severely deformed.

Meanwhile, a woman from Genoa had to call police to a hospital in the city over the Easter weekend after doctors there refused to assist her through the second stage of a medical abortion.

In other cases, women have been risking their lives by undergoing illegal abortions.

The problem with part of Law 194 is that doctors are also within their rights to refuse to perform an abortion on moral grounds, and over the past ten years the number of those choosing to do so has increased dramatically.

Massimo Gandolfini, a spokesman for the anti-abortion group Associazione Scienza e Vita, puts this down to doctors feeling “that abortion is fundamentally unfair and unjust”.

“The murder of a small human being is not part of a doctor’s cultural heritage,” he tells The Local. The group believes "there is no reason at all to justify the killing of a child" and is calling on women considering a termination to be "healed and assisted". 

Silvana Agatone, a doctor at a hospital in Rome and president of the Free Italian Association of Gynaecologists for the Application of Law 194 (LAIGA), takes the opposite stance, arguing that performing terminations is part of a gynaecologist’s job and that, by law, hospitals must provide safe abortion services.

“The law gives women the choice to have an abortion in a safe and secure way, not in a secret, dangerous way, which is what many end up doing,” she tells The Local.

In the Lazio region alone, 80 percent of gynaecologists are “moral objectors”, with the figure standing at 70 percent across Italy, Agatone continues.

The situation is even more chronic in the south, with 90 percent of doctors invoking the conscience clause.

The biggest dilemma is finding doctors willing to perform abortions after 90 days, the period when the procedure requires more care and, especially if delayed, puts the mother’s life at greater risk.

Hospitals often rely on the help of outside medics if nobody within their institution will carry out the termination.

“In five provinces across Lazio, only two doctors give abortions after 90 days,” Agatone says.

“For an abortion at this stage, women have to go to the hospital and be monitored, to spend a few days there and to take tablets to ensure that it works properly.

“We need doctors providing this type of abortion to be within the hospital, not from the outside," she said, adding that "many women are forced to find a hospital in another city or travel abroad."

As the few non-objectors head towards retirement, another major concern is the scarcity of doctors trained to perform an abortion, Agatone adds.

“In university hospitals where no gynaecologist will give an abortion, the young doctors are not being trained.”

Agatone doesn’t lay the blame entirely on morality or religion either, “as many doctors who are against abortion still perform it.”

But needless to say, the Catholic Church plays a major role in influencing opinion, with the much-respected Pope Francis coming out in support of objectors earlier this year.

This has given fresh impetus to anti-abortion groups, which have organized several protests in recent months.

“The church meddles, it is a power battle,” Canitano of Vita di Donna adds.

Reputation also weighs heavily on the minds of doctors who are willing to perform abortions, she says, with medics who do so often being “pushed out of the system” or carrying out secret abortions.

“Genoa is a very Catholic city…if you do abortions you are out of the system,” she says.

“Doctors living in small towns especially, where everyone knows everyone and where they see the local mayor at church every Sunday, find it very shameful.”

In the late 1990s, that shame had a devastating consequence when a doctor killed himself after being exposed for carrying out abortions in secret.

“He felt ashamed,” Canitano says.

“He was married and with a child…secret abortions are terrible for women and for the doctors who perform them.”

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What you need to know about Spain’s plan to change its abortion laws

In Spain women can get an abortion for free in all public hospitals up until 14 weeks, no questions asked. But the reality is that many doctors refuse to perform them. The Spanish government is revising its laws to make sure it is enforced across the country.

What you need to know about Spain’s plan to change its abortion laws
Anti-abortion supporters take part in a march in Madrid in 2014. In Spain women have the right to abortions up to the 14th week of their pregnancy, but many doctors across the country refuse to perform the procedure. Photo by DANI POZO / AFP

Under the current legislation introduced by the previous Socialist government in 2010, women in Spain have the right to abortions up to the 14th week of their pregnancy, which is standard in much of Europe.

They also have the legal right to abort up to the 22nd week of pregnancy in cases where the mother’s health is at risk or the foetus has serious deformities.

‘Conscientious objectors’

However, in practice this law translates into a very different reality.  

Many doctors across Spain refuse to practice abortions, calling themselves “conscientious objectors”.

So many doctors deny the procedure across the country, that in five out of the 17 autonomous regions in Spain, no public hospitals offer abortions, according to data from the Health Ministry

This causes stark regional inequalities, forcing thousands of women to either travel to another part of the country, or pay for one in a private clinic, despite the 2010 law stating that “all women should benefit from equal access to abortion regardless of where they reside”.

According to the data, the provinces of Teruel, Ávila, Palencia, Segovia, Zamora, Cuenca, Toledo and Cáceres have not performed a single abortion in the past 30 years.

And, another even more revealing statistic: in 2019, 85 per cent of abortions took place in private clinics.

The map below shows the provinces that never perform abortions in red, the ones where it has varied over the years in orange, and the ones where they have always been available in green.

READ ALSO: Why does Spain top Europe’s Covid vaccination league table?

Law reform

The minister of equality, Irene Montero, has proposed a reform of the current law that would limit doctors being able to refuse the procedure.

“Conscientious objection cannot be an obstacle for women to exercise their right to terminate a pregnancy,” Montero said in a tweet. “We must reform the law to regulate it and make sure abortion is guaranteed in the public health system.”

Montero said the draft law would be ready in December after a consultation process.

However, others have said doctors should not be forced to perform abortions.

The president of Madrid’s regional government, Isabel Díaz Ayuso, said she would not force “any doctor in Madrid’s public health system to practice an abortion against their will” because doctors study medicine “to save lives and not to do the opposite”.


The situation shows abortion remains a dividing issue in Spain, where a large part of the conservative population is still opposed to a law that was introduced over a decade ago.

The former conservative Prime Minister Mariano Rajoy had promised to tighten Spain’s abortion law before he came into power in 2011.

However he was forced to drop the plans in 2014 due to disagreement within his Popular Party (PP). This angered many Catholic and other pro-life groups.

The reform would have ended women’s rights to freely terminate their pregnancies up until the 14th weeks. 

In 2015 Rajoy’s government passed another reform requiring girls aged 16 and 17 to get their parents’ consent if they wished to terminate a pregnancy. But the measure failed to pacify pro-life campaigners.

Montero also announced plans to repeal the 2015 reform as part of the draft law.