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ITALIAN ELECTIONS

What will a right-wing election victory mean for abortion rights in Italy?

The right-wing parties poised to win Italy’s upcoming general elections have a history of denouncing abortion. Could a new conservative government threaten reproductive rights in Italy?

What will a right-wing election victory mean for abortion rights in Italy?
Anti-abortion activists hold a sign reading "God, fatherland, family, what a wonderful life" at a 2019 march in Verona, which the League-run council has declared a “pro-life city”. Photo by Filippo MONTEFORTE / AFP

When Italians go to the polls on September 25th, a coalition of three right-wing parties – Giorgia Meloni’s Brothers of Italy, Matteo Salvini’s League and Forza Italia, led by former premier Silvio Berlusconi – are widely expected to win the vote and secure the opportunity to form Italy’s next government.

READ ALSO: Your ultimate guide to Italy’s crucial elections on Sunday

With all three parties to the right of centre – by quite some way, in the case of Brothers of Italy and the League – activists are concerned about what Italy’s most socially conservative government in years could mean for women seeking to access abortions, as they have had the legal right to do here for over four decades.

Here’s what Italian law says about abortion, what the right-wing alliance has promised it will – or won’t – change, and what all this could mean for people in need of abortion care in Italy.

What is Italy’s law on abortion now?

Abortion – formally referred to in Italian as interruzione volontaria di gravidanza or IVG, ‘voluntary termination of pregnancy’ – has been legal in Italy since 1978.

Passed after years of protests and several other failed bills, Legge 194 (‘Law 194’) decriminalized the procedure and entitled women to request it for any reasons of physical or mental health within the first 90 days after conception.

Women can continue to seek an abortion after 90 days if a significant foetal abnormality is present, or if continuing the pregnancy would endanger the woman’s life.

READ ALSO: The long road to legal abortion in Italy

The procedure is offered free of charge to those who qualify for public healthcare in Italy.

To access it, women first must consult a doctor and discuss options “to help her to overcome the factors which would lead her to have her pregnancy terminated”.

If the patient continues to affirm her original choice, she will be issued a certificate either stating that the termination is urgent and can be carried out immediately, or, if it is not deemed urgent, that she can seek the procedure after a obligatory seven-day wait.

Campaigners in front of a banner reading ‘Don’t touch law 194’. Photo by FABRIZIO VILLA / AFP

In reality, the wait for an appointment is likely to be far longer. Law 194 also affirms the right of health workers to refuse to carry out abortions on the grounds of “conscientious objection”. 

This has translated into serious gaps in coverage across Italy, with some facilities staffed mostly or even entirely by personnel who decline to deliver abortion services.  

READ ALSO: Why abortions in Italy are still hard to access – despite being legal

In fact, a majority of gynaecologists in Italy – 64.6 percent, according to 2020 figures from the Ministry of Health – are registered objectors, as well as 44.6 percent of anaesthesiologists and 36.2 percent of non-medical staff at health facilities. 

In several parts of the country, including the regions of Sicily, Basilicata, Abruzzo, Molise and the province of Bolzano, the percentage of gynaecologists refusing to perform abortions is over 80 percent.

These doctors are probably out of step with public opinion in Italy. A 1981 referendum gave voters the opportunity to reject the new abortion law; 68 percent of them voted to keep it. 

More recently, an Ipsos poll conducted earlier this year found that 73 percent of people surveyed in Italy said abortion should be legal in all or most cases.

What election promises has Italy’s right-wing alliance made about abortion?

No doubt sensing the lack of appetite for a full-scale repeal of Italy’s abortion law, the right-wing coalition has made clear that that’s not on its agenda. 

Abortion doesn’t get a single mention in the joint platform put forward by the Brothers of Italy, League and Forza Italia. 

Law 194 does appear in the Brothers of Italy programme, which promises “full application” of the legislation, “starting with prevention” of abortion.

To this end, it pledges the allocation of funds to support single and economically disadvantaged women to carry pregnancies to term, a proposal echoed by the League and presented by both parties as part of a broader drive to reverse Italy’s plummeting birth rate.

The League’s platform also calls for implementation of Law 194’s provisions on the “effective promotion of life”, including by involving non-profit groups – presumably Catholic and other pro-life ones – in pre-abortion counselling.

Forza Italia, historically the most centrist of the three, hasn’t broached the subject at all. 

READ ALSO: Salvini vs Meloni: Can Italy’s far-right rivals put differences aside?

Both Meloni and Salvini have faced questions on the campaign trail about their position on abortion, given previous comments calling abortion “a defeat for society” (Meloni), loudly professed Catholicism (Salvini) and support for European allies who have restricted access to abortion, such as Hungarian Prime Minister Viktor Orban (both). 

“Law 194 isn’t to be touched,” Salvini told reporters this week. “The last thing Italy needs is a country divided and arguing over the laws in place – which can be improved and updated, but certainly not scrapped.”

Meloni, meanwhile, told a recent interviewer that “I never said I want to modify Law 194, but that I want to apply it”. That includes supporting women who feel obliged to abort for economic or practical reasons, she said – as well as supporting health workers who refuse to provide the procedure. 

Why are activists worried a new right-wing government could threaten abortion rights in Italy?

The problem is that Law 194 perhaps does need an overhaul if it is to guarantee access to safe, legal abortions across Italy. 

Those who support women’s right to choose have long complained that the 44-year-old law – whose primary objective, the Italian Health Ministry’s website states, “is the social protection of motherhood and the prevention of abortion” – is not fit for purpose.

A demonstrator holds a sign reading ‘free to choose’ at a rally in defence of Italy’s abortion law. Photo by FABRIZIO VILLA / AFP

Law 194 “does not establish in a strong sense women’s right to choice and self-determination: it establishes when access to it is permitted and granted,” Chiara Lalli, a writer and academic with a focus on abortion, told Il Post

The multiple doctor visits, mandatory counselling session and seven-day “reflection” period are attempts to interfere with women’s decisions, activists say. 

READ ALSO: ‘Ugly act’: Outrage in Italy over discovery of foetus graves marked with women’s names

Separately, watchdogs including the United Nations Human Rights Committee, Human Rights Watch and the Council of Europe’s committee of social rights have flagged the high rates of conscientious objectors as a persistent barrier to abortion access in Italy.

While authorities are supposed to ensure that women can access terminations and that objecting doctors can’t refuse care beyond the procedure itself, with no mechanisms to enforce these requirements specified in the existing law, in practice women report facing long delays or being denied assistance altogether. 

In the past, both Brothers and Italy and the League have resisted attempts to help the problem, such as by recruiting specifically non-objecting doctors.

While these problems are longstanding, there have been attempts in recent years to put more obstacles between women and abortions – mainly from regional or municipal politicians, who tend to be more explicit in their opposition than those on the national stage.

Many of these have come from members of the three main right-wing parties, which together have governed 14 of Italy’s 20 regions for the past two years.

And with each region largely in charge of managing its own public health service, regional governments have the power to make decisions that significantly affect how and where women can access abortions.

In Le Marche, headed by the Brothers of Italy, the regional government refused to implement 2020 national guidelines from the Ministry of Health that would have extended the window for medical abortions from seven to nine weeks and made it possible for women to obtain abortion pills in outpatient clinics and family planning centres instead of going into hospital. 

Abruzzo, whose council is also led by Brothers of Italy, as well as Piedmont and Umbria, two regions governed by the League, resisted the change too.

Priests join an anti-abortion demonstration on May 21st 2022 in central Rome. The placard reads “Human Rights are born in the womb”. Photo by Alberto PIZZOLI / AFP

Piedmont has further allowed anti-abortion groups to set up stands in public hospitals, and councillors have proposed funnelling public funds to groups that would pay women not to abort

The League-run council in Verona declared it a “pro-life city” and called for funding for anti-abortion projects to be written into the town budget, as well as authorizing anti-abortion groups to display promotional material in council buildings. 

In the wider region of Veneto, such groups are allowed to offer family counselling services alongside those providing neutral information – a move the League’s manifesto suggests extending when it talks about involving non-profits in “the promotion of life”. 

To those who support abortion, it all starts to look like a pattern. “As soon as a right-wing council takes charge, it seems like these issues are at the top of the agenda,” Beatrice Brignone, head of the small left-wing party Possibile, told L’Espresso back in 2020.

READ ALSO: Why an Italian woman was forced to go to 23 hospitals to have an abortion

With threats to abortion access in Italy emerging locally and unchecked at national level, some activists say they would in fact welcome putting Law 194 up for debate under the next government.

“As much to better implement it as to make the necessary modifications … it is time to begin an informed discussion on abortion and free ourselves from the prejudice that the law is untouchable,” comments the Luca Coscioni Association, which advocates for freedom of scientific research and backs abortion rights.

Meloni and her allies have already made clear that such a discussion will not be among their priorities if they win this weekend. 

What do other parties say about abortion?

Abortion isn’t an issue for either the centrists Italia Viva or Azione, nor for the populist Five Star Movement.

The centre-left Democratic Party promises the full application of Law 194 throughout the country, without going into further details.

The only concrete proposals come from much smaller parties on the left: Possibile proposes establishing a quota of at least 60 percent of non-objecting staff in each health facility, as well as tracking the service provided by each region and punishing those who fail to meet minimum standards. 

The Greens and Left Alliance wants to change recruitment rules to hire more non-objecting medical staff, while +Europa suggests partnering with private clinics to expand access and making medical abortion more widely available as an outpatient procedure.

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HEALTH

‘Behind the times’: Why women in Italy struggle to get menopause treatment

For many women living in Italy, accessing HRT means paying for private treatment and, in some cases, travelling abroad in order to find a doctor willing to prescribe the medication they need.

'Behind the times': Why women in Italy struggle to get menopause treatment

Sitting in her garden in rural Tuscany, Tara Gould, a 55-year-old British national, reminisces about her old job back in the United Kingdom. 

“It was such a support group for people like me, so to be able to work for it and help other women was such a bonus,” Tara says.

The support group Tara worked for was the Latte Lounge, an online community for UK women over the age of 40 going through menopause. The site had resources such as articles, help finding a nearby specialist and in-person events. Tara managed the emails sent in by women who were either asking questions or struggling.

READ ALSO: Public vs private: What are your healthcare options in Italy?

“I had a few women reach out to me who were feeling suicidal and had nowhere to go or no one to ask about what they were going through. Talking to them about their options and helping them out, helped me out too.

But in Italy, she says, “I cannot find any support network like that here.”

In the two years she’s been living here full-time, Tara has had to go back to the UK for her hormone replacement therapy (HRT) which is crucial in managing symptoms such as hot flashes, sleep problems, and low moods. 

“In Italy, it is like what it was like in the UK 30 years ago, and coming from there two years ago was a massive shock to the system,” she adds.

“Women just have to grin and bear it.”

She believes the situation in Italy boils down to a lack of knowledge and possible embarrassment about discussing menopause. While the UK is far from perfect on the issue, she says, there is help available for women needing it, while Italy is “behind the times”.

READ ALSO: Why are medicines so expensive in Italy?

Tara is not alone in feeling this way. A post on the topic in one expat Facebook group this month sparked a lively discussion, attracting hundreds of comments from women in Italy sharing their personal stories, advice, and observations on the differences in menopause treatment between Italy and other countries.

But, she says, continuing to travel back to the UK for this routine treatment is “becoming too expensive for me especially as I’m paying into the SSN here too.

“I shouldn’t have to go back to the UK for this.”

Tara returns to the UK once her medication finishes and forks out around €600 each time she goes: €100 for flights and €500 for the HRT medication via private healthcare. 

“It should be a standard medical procedure, but it isn’t here. I can’t keep on going back to the UK and paying out every time I need something, because it is a need not a want.”

Tara started going back to the UK after her family doctor in Italy told her they didn’t prescribe HRT and advised her to buy it online, go abroad or go to a gynaecologist. 

“I thought it was outrageous that a female doctor was telling me these things, especially someone trained in the medical field advising a patient to buy medication online.

“I don’t feel hopeful,” Tara says.

Without her oestrogen, Tara says her anxiety goes through the roof making everyday life a struggle. She’s too worried she’d be dismissed in the same way her doctor dismissed her if she went to a private gynaecologist here. 

“It’s worrying. I don’t know what I’ll do. There must be someone here, but I don’t know how I feel. They tend to be more city-focused, and if I’m going to Rome I might as well go to the UK,” she adds.

In a recent study named Menopause: Knowledge, attitude and practice among Italian women co-written by Italian biologist Paola Mosconi along with six other researchers, more than half of their study sample (women with menopause) had not received any information about the condition and possible therapies.

Another survey conducted in 2021 found only 7.6 percent of the 1028 Italian women surveyed were on HRT. The majority of them were on herbal remedies.

Whilst a global shortage of HRT was widely reported last year, both the studies found medical expertise in the field of menopause to be only “satisfactory”.

READ ALSO: OPINION: Why Italy’s private healthcare isn’t always worth the cost

This is in spite of the Italian health ministry’s webpage outlining the numerous benefits of hormone therapy for menopausal women, such as improved heart health and a reduced risk of strokes.

Tara says she feels as though the lack of information on this topic trickles down into society, as she has tried talking to her Italian friends about it with little success.

For Liguria-based Noah, from the United States, the experience of obtaining HRT from her doctor was not an easy task.

Like Tara, she finds there is a huge lack of education for practitioners and the general public not just on HRT but around menopause in general, which differs from her experience back home. She also thinks views on it are outdated.

She moved over to Italy four years ago whilst she was going through the change. 

“Our family doctor would not prescribe it and lacked any knowledge around it so she sent us to private clinics instead,” Noah says. “I can laugh about it now, because I finally have it, but it was very frustrating in the beginning.”

Noah and her husband, who is Italian, found out about a doctor in another region who specialised in menopause and whose work on the condition was published in medical journals. She got her HRT from him. Whilst Noah felt very comfortable in his care, she had to stop visiting him because of the distance.

“We went back to our family doctor with literature on the use of HRT and the effects of stopping it abruptly. She then did her own research and now has started prescribing it to me,” Noah says.

Noah largely considers herself lucky. Nevertheless, she has to drive 45 minutes to another town in the region to pick up her prescription.

READ ALSO: ‘Very professional but underequipped’: What readers think of Italy’s hospitals

Tuscany resident Kelly Hodgson, like Noah, has also had to do extensive research into the benefits of HRT before she was prescribed it. She found the process of obtaining her medication extremely time-consuming and disheartening. 

“I had to do all the research myself until finally I found a gynaecologist who is open to HRT,” Kelly explains.

Kelly feels like she should have been able to get HRT from her doctor rather than pay privately. She argues that Italy is advanced in most areas of medical care – but not for menopause.

She thinks a huge reason why doctors are hesitant about giving it out is because they associate it with a high cancer risk.

“There is so much scaremongering,” she continues. “My doctor is female and she point blank said to me no, because I could get cancer, even though I’ve been on the contraceptive pill for years which comes with its own cancer risks.

“I come from a family with osteoporosis so HRT is beneficial to me. If I were in the United Kingdom now, I’d have access to it without having a full gynaecological visit before it’s prescribed.”

Kelly says friends from Turin who are also going through the menopause have had to go privately too, rather than get treatment from their doctor. 

“There has to be more education on menopause here,” Kelly concludes.

For Noah and Kelly at least, their journey to get their medication is within the country. For Tara, unless things change culturally and medically, going abroad is the only option she feels comfortable with.

“The way Italians think about menopause is the old-fashioned way everyone used to think. They view us as grumpy old women rather than looking at the reasons,” Tara says.

“It’s just something you have to deal with. It’s frustrating to say the least.”

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