Abortion regulation is an issue that continues to make headlines and polarize opinions all over the world. In most European countries, the interruption of a pregnancy is authorized by law and embedded in the national health system. However, in some the law also allows healthcare professionals to abstain from performing an abortion on the grounds of conscientious objection. This means that practitioners can refuse to perform abortions because of ethical or religious reservations.
One of the most alarming examples is Italy, where over 67% of gynaecologists are objectors and 35.1% of healthcare facilities do not provide abortion services. These high percentages cause significant delays and inefficiencies that put the health of many women at risk. Some are forced to travel across regional borders and even abroad to access the treatment they need. In extreme circumstances, they must even resort to unsafe alternatives. The Covid-19 pandemic has further exacerbated this issue demonstrating how the country’s outdated restrictions cause harm instead of protection. Allowing healthcare practitioners to refuse to provide a service that is required by law is harmful to the health of many women and is an unjustifiable abandonment of professional obligations to patients.
An inadequate, contradictory law
Abortion in Italy is regulated by Law 194. In addition to stating the conditions for the voluntary termination of a pregnancy, the Law recognizes the right of healthcare personnel to object to performing abortions. The principle behind this is that the rule of law must allow doctors to maintain their oath to protect life by abstaining from practices that go against their religious or ethical beliefs.
According to the same law, however, all hospital bodies must be able to offer abortion services. In facilities where 100% of the personnel are objectors, this is theoretically, but not practically possible. Furthermore, in some regions, such as Sicily (83% objectors) and Molise (96.4% objectors), where only a few non-objecting gynaecologists are available, facilities struggle to organize their shifts. This has a significant impact on the timeliness and efficiency of abortion services. How are hospitals and regional authorities supposed to guarantee safe access to abortion with so many objectors? By attempting to equally guarantee the rights of both patients and practitioners, the law is clearly inadequate in safeguarding the well-being of the patients themselves.
What is behind conscientious objection?
In some cases, conscientious objection is motivated by religious convictions, but with practising Catholics in steady decline, the high number of objectors requires another explanation. Studies show that objection is actually more of a career choice. Some doctors become objectors to avoid discrimination by the director of their medical division. Others do so because non-objectors are perceived as being professionally disadvantaged. Due to the high number of objectors, practitioners who are available to carry out these procedures often find themselves relegated to solely performing abortions. As a consequence, many young gynaecologists, fearful of being professionally disadvantaged, become objectors.
Another reason is economic. Abortion in Italy is one of the few practices that cannot be performed outside of hospitals at the expense of patients. Many practitioners, therefore, become objectors because the practice of pregnancy termination is not considered financially rewarding. Objection is therefore not so much dictated by ethical motivations, but rather by other, more pragmatic interests. It proves that there is hardly anything conscientious about the choice to object anymore. The law cannot continue to protect a choice that is no longer justified by ethical reservations and continues to deprive women of a fundamental right.
One of the main reasons why this problem persists is that access to abortion services varies significantly at the regional level, with high percentages of objectors in southern Italy and lower ones in the North. Because of this, the State can continue to argue that access to abortion is always guaranteed by law without ever taking a stand on what should be done when there are not enough practitioners available. Furthermore, in Italy, only gynaecologists and obstetricians can perform abortions and not general practitioners like in other countries.
Supporters of conscientious objection would argue that healthcare practitioners have the right to refuse to treat a patient even if it compromises a patient’s right to be treated. This argument however is particularly questionable in a public health system such as Italy’s that has the duty and responsibility to guarantee all necessary treatments to its citizens. In 2016, the Council of Europe even reprimanded Italy for the difficulties in applying the law and again in 2019 acknowledged that there are still considerable disparities when it comes to accessing termination of pregnancy services at the local level. This should be more than enough evidence that something needs to change.
How do we move forward?
The issue of conscientious objection in Italy needs to be more clearly regulated. The current law overseeing abortion is inadequate in safeguarding the wellbeing of women, and objectors are abandoning their professional obligations for unjustifiable reasons. Changing Law 194 is a rather idealistic objective but there are some practical solutions that would improve access to safe and timely abortion services.
First, general practitioners could be involved in abortion procedures, as in other countries. This would automatically lead more people to be available and willing to perform abortions. Conscientious objection could also be discouraged by offering benefits to non-objectors such as better salaries or more holidays. Lastly, all health facilities should ensure they have at least 50% non-objector staff so that a more equal ratio can be achieved. These steps would concretely address the current constraints and ensure that women have unrestricted, safe access to the care they are entitled to by law.