Italy's abortion taboos challenged by new law in Sicily

By Angelo Amante

CATANIA, Italy (Reuters) -Monia, a Sicilian woman in her early forties, was overjoyed when she discovered in October 2022 she was expecting her first child. Her doctor, however, recommended a genetic test due to her age, and the result was one no parent wants to receive.

The foetus had a genetic syndrome. Monia, who declined to give her surname, asked her gynaecologist what she could do.

"Nothing. You don't want to terminate, do you?" the doctor asked her, she said. 

He was a conscientious objector, Monia said, one of hundreds on the southern Italian island. More than 80% of gynaecologists in Sicily refuse to perform abortions for moral or religious reasons, according to the latest health ministry data, which dates to 2022, even though the procedure has been a legal right for women in Italy since 1978.

To address that situation, in late May Sicily's regional council - run by a centre-right coalition - passed a law in a secret ballot requiring all public hospitals to create dedicated abortion wards and to hire staff willing to provide the service.

Under the national rules, abortion is permitted within the first 90 days of a pregnancy, or later if there are risks to the mother's health or foetal abnormalities. The latter circumstance applied to Monia, who went to the Sant'Antonio Abate hospital in the city of Trapani, in western Sicily, to terminate her pregnancy.

"All the gynaecologists were objectors," she said. "An obstetrician gave me a bed with only a mattress cover and said they would administer a pill every three hours until I went into labour." She was told she would receive no further assistance.

Her story is far from unique in southern Italy, where cultural traditions are more conservative than in the Catholic country's richer north and centre.

At first, Monia's pills were ineffective, but after five days and a change of treatment she finally miscarried, attended to by a doctor and a midwife. 

Hospital staff referred to her as "Article 6," she said, after the provision in the law that allows abortions beyond 90 days. 

In response to a request for comment, the Sant'Antonio Abate hospital said it was sorry for Monia's "difficult experience". However, the hospital said it was unable to verify the facts because both the hospital manager and the head of the gynaecology department at that time had left. 

The hospital said it now has three non-objecting doctors and was able to provide abortion services.

Abortions are only available in around half of Sicily's hospitals, health ministry data shows, a figure much lower than in central and northern Italy, where rates are around 70%.

Like most of his colleagues, Fabio Guardala, a 60-year-old doctor, refuses to perform abortions. He operates at the Cannizzaro hospital in the Sicilian city of Catania, on the east coast of the island.

"A doctor's job is to heal," said Guardala, who is also deputy head of a healthcare unit at his local Catholic church. "Abortion is not treatment but killing. Nobody can force a doctor to kill."

Silvia Vaccari, president of the Italian federation of midwives, FNOPO, said health outcomes can be grim in areas where legal abortions are hard to access.

"The absence of facilities sometimes leads people to turn to non-professionals, putting them at risk of death, or to continue with pregnancies and give birth to babies who are abandoned in places where they may never be found alive," she said.

CATHOLIC INFLUENCE    

Most other European Union countries allow health workers to refuse to perform abortions on ethical grounds, according to a 2022 study published in the Acta Biomedica journal. But the right is generally exercised far less commonly than in southern Italy.   

One exception is deeply Catholic Poland, where abortion is only legal in cases of rape or incest or when a woman's health or life is at risk. The Acta study said many Polish women have been forced to travel abroad to terminate their pregnancies.

Abortion has always been contentious in Italy, a Catholic country that hosts the Vatican. Right-wing Prime Minister Giorgia Meloni passed legislation last year to try to deter women from terminating pregnancies. 

Pro-life groups have been allowed into abortion advice clinics, in a move Meloni's party said was aimed at giving women an opportunity for reflection before making a final decision.

Nationally, the number of abortions dropped to 65,000 in 2022, according to the latest health ministry data, against 110,000 in 2011. More than 60% of gynaecologists are conscientious objectors.

On the island of Sardinia, the region's ruling, left-leaning 5-Star Movement last month presented a law proposal similar to the one adopted in Sicily, suggesting that other southern regions may soon follow its example.

Dario Safina, a centre-left Democratic Party lawmaker in Sicily and the promoter of the new law, said many Sicilian women seeking an abortion feel forced to resort to the private sector.

"Access to abortion is not a problem for those who can afford it, because they can go to a private clinic. But healthcare based on wealth is the end of democracy," he said.

Some doctors argue Sicily's high objection rates are not only due to ethics but also to staff shortages and poor working conditions that make it harder for gynaecologists to provide abortions on top of their regular duties.

Data from the GIMBE Foundation, a health sector think-tank, shows Sicily had nine healthcare workers per 1,000 residents in 2022, compared with a national average of 11.6 and far below the northern and central Emilia Romagna and Tuscany regions with 15.

"Hospitals always try to exploit doctors' work without paying them properly, so sometimes professionals are reluctant to perform abortions," said Salvatore Incandela, head of the Sicilian arm of AOGOI, Italy's gynaecologists' association.

Italian anti-abortion group Pro-Life Together rejects this, saying non-objectors in Sicily were only required to perform 1.5 abortions a week on average in 2022 - still above a national average of 0.9.

LEGAL CHALLENGES?

Six Sicilian hospital managers and health professionals contacted by Reuters said the new legislation could strengthen the service, but it was still important to ensure doctors could opt out as allowed under 1978 national law that sanctioned the right to abortion.

Under the law, health workers are exempted from abortion procedures if they declare an ethical or religious objection, so long as the woman's life is not in immediate danger.

Gaetano Sirna, the director general of Catania's Policlinico-San Marco hospital, one of the city's largest, said even with just six non-objecting gynaecologists out of a total of 39, he could still ensure abortions for those who needed them.

"We have no problems guaranteeing the availability (of doctors) ... gynaecologists are free to declare themselves as objectors; we do not discriminate," he told Reuters.

Abortion is not the only case in which conscientious objection is permitted in Italy. It used to be grounds for avoiding compulsory military service, which was abolished in the early 2000s, and an opt-out for scientists from conducting animal experiments was introduced in the early 1990s. 

Giorgia Landolfo, a pro-abortion activist in Catania, called the new law in Sicily a "landmark," but said she feared it would be hard to enforce.

Some anti-abortion groups say it will be challenged in court on the ground that job postings reserved for non-objectors discriminate against the others.

"Many measures in the past aimed at hiring non-objectors have been challenged and ultimately came to nothing," said Vito Trojano, the head of SIGO, the Italian Obstetrics and Gynaecology Society.

Some Sicilian politicians who strongly oppose the new rules believe the region should instead bolster its healthcare and support facilities for pregnant women, who often feel abandoned and see no alternative to abortion.

"Life is life from the moment of conception," said Margherita La Rocca, a Sicilian lawmaker from the centre-right Forza Italia party. "The foetus cannot just be considered a clump of cells when it's convenient." 

(Reporting by Angelo Amante, editing by Gavin Jones and Daniel Flynn)