At 8am on a Friday morning in winter, the road to the San Pio hospital in Benevento, a small city in southern Italy, is covered by mist. The hospital’s corridors are quiet, except on the second floor, where abortion-related visits are scheduled to start.

More than 40 years after abortions were legalised in Italy, they remain hard for women to access – especially in the south, where most doctors refuse to perform them. In 2017, the entire Benevento province was briefly left with no abortion provider after the only non-refuser at the San Pio hospital retired.

Today, abortion services are available only two days a week. On each of those days, every week, another obstacle awaits women: local activists connected to an international network of so-called ‘crisis pregnancy centres’, which seek to reach women considering abortions and stop them from making that choice.

In the obstetrics ward, one of the activists pointed to a picture of a foetus on their leaflet and asked: “Are you here for this?” “Mom,” the leaflet read, “there is always a solution to your problems, but there is no remedy for abortion.” Inside were graphic images and frightening claims that having an abortion carries many serious risks.

I went to this hospital as part of an undercover investigation, posing as a poor young woman with an unwanted pregnancy, looking for information about abortion. But the information I received inside the ward included incorrect claims that I could face “post-abortion syndrome” and a 50% increased risk of breast cancer.

Both of these claims have been widely discredited by medical experts, who say there is simply no such link between abortion and mental illness or cancer risks. But this is not a story about local-level misinformation. The Italian volunteers I met in Benevento are part of a national federation that has powerful American partners.

The Italian federation is called Movimento per la Vita (‘Movement for Life’). Since 2013, it has had a partnership with the US Christian Right group Heartbeat International, which is a pioneer of ‘crisis pregnancy centres’ and is among several US anti-abortion groups that have been emboldened by Trump’s White House.

Heartbeat also opposes modern contraception, and has been a partner of the ultra-conservative World Congress of Families network. The WCF held its 2019 global gathering in Verona, where Matteo Salvini – then Italy’s deputy prime minister and leader of the far-Right Lega party – gave a keynote speech.

Last month, openDemocracy revealed numerous examples of incorrect and misleading information being provided by other centres in Heartbeat’s network around the world. In South Africa, another reporter also found one of these centres operating out of a hospital, pushing women to eschew abortions at any cost.

Elsewhere in Italy, I found posters in hospitals advertising these centres’ activities without disclosing their anti-abortion agenda. Instead, they say: “Are you concerned about a difficult or undesired pregnancy? […] Call us.” At another hospital, north-west of Milan, more volunteers warned me again about cancer risks.

Lawmakers across Europe have already called for action in response to openDemocracy’s global investigation. “Every politician,” said Neil Datta, secretary of the European Parliamentary Forum on Sexual and Reproductive Rights, should be concerned about “disinformation, emotional manipulation and outright deceit”.

In Italy, Michele Usuelli, a doctor and Lombardy regional councillor, pledged to look into these centres’ activities immediately and ask hospital directors how they ensure that women receive accurate information inside their facilities.

Giuditta Pini, a member of the Italian Chamber of Deputies, said she will also discuss these findings with other lawmakers in Rome. She said that they reflect “an organised system on the international level with the explicit goal of weakening women’s rights, their health and their personal freedom”.

When I showed the leaflet I received in Benevento to Silvana Agatone, president of the LAIGA association of doctors that support access to safe abortion, she called it “deceptive” and a “manipulation of information with no serious scientific basis”.

Silvio Viale, a gynaecologist at the Sant’Anna hospital in Turin and a well-known member of the Radical Party, similarly denounced this information as “a hoax”.

Feminist activists from the Non Una Di Meno (‘Not One Woman Less’) movement in Milan condemned these centres’ for “blaming and humiliating women who have abortions” – and called for “more checks in the gynaecology ward, so that women do not suffer abuse from people who feel they have the right to judge them”.

“This is an abuse of power and an abuse of trust,” added Irene Donadio, head of partnerships and strategy at the International Planned Parenthood Federation in Europe, demanding “immediate action from the government”.

Outnumbering abortion providers

There are thousands of anti-abortion ‘crisis pregnancy centres’ in the US, where they outnumber the hospitals, clinics and physicians’ offices that provide abortions. Now, openDemocracy can reveal a similar trend in Italy.

According to 2017 data from the Ministry of Health, there are only 381 public or private health facilities that provide abortions nationwide. Meanwhile, there are more than 400 anti-abortion centres in Movimento per la Vita’s network.

Heartbeat says on its website that all of these Italian anti-abortion centres are also its “affiliates”. The US group has additionally given Movimento per la Vita at least $80,000 in grants, according to its financial filings, whch say this money is supposed to train and support their “common affiliates”.

Today, Heartbeat describes itself as a “non-profit federation” of diverse affiliates that must follow “basic principles”, and commit, for example, to accuracy in their information and advertising, but are otherwise autonomous.

Movimento per la Vita similarly describes itself as a federation of autonomous centres that are run by local volunteers, for which it provides “services and […] continuing education, to ensure competence, sensitivity, diligence.”

However, the Italian group told openDemocracy that its centres are not “affiliated to Heartbeat”, although they share a vision for society “in which abortion is unthinkable” and a “collaboration agreement” that supports volunteer training.

According to openDemocracy’s research, these centres, often advertised as Centri di Aiuto alla Vita (‘Centres for Life Support’), are located in 104 of Italy’s 109 provinces. Overall, most are in the north. In the most extreme case, in the region of Trentino Alto Adige, they outnumber facilities that provide abortions by three to one.

The hundreds of these centres in Movimento per la Vita’s network include dozens that appear to be based inside women’s shelters and family planning clinics, as well as at least 30 that are either based or have activities at public hospitals.

In Benevento, the San Pio hospital is the only one in the province that provides abortion services. Valentina Leone, 33, a local women’s rights activist, said the local Movimento per la Vita centre has been active inside its wards for decades.

It has also had support from the local church, she said. At the hospital, she pointed to a cabin where a parking attendant now sits: “That used to be their main office.”

In 2018, Leone and other activists from Non Una di Meno Benevento demanded to see proof that a valid agreement existed between the centre and the hospital. It transpired that a one-year deal had been signed in 2015, and had long expired. The centre moved its office outside the hospital, but its volunteer work continued inside.

In town, where the centre's office is now in another public building, its other activities have included distributing flyers against surrogacy, euthanasia and homosexuality. It has also parked vans displaying similar posters in front of public schools.

In total, I visited six Italian anti-abortion centres in Movimento per la Vita’s network, in five provinces across the regions of Campania, Lombardy and Piedmont – and found false, misleading or manipulative information at four of them.

At the opposite end of the country from Benevento, I phoned the local centre that is active in the Vigevano hospital, north-west of Milan, and spoke to its director. He warned me of the health risks of abortion in vague and general terms, discouraged me from seeking other information online, and told me to go to the hospital.

I did as he suggested, and found this centre’s volunteers waiting for me in the obstetrics ward where they have a room specifically dedicated to their counselling sessions. Over the next hour and a half, they pushed me to change my mind – using graphic language, guilt and overinflated claims about the health risks of abortion.

Most of these claims were conveyed in the form of stories of women who, they said, had suffered serious psychological, fertility and relationship issues after abortions.

At one point, one of the women also referred vaguely to “some research” supposedly linking abortion to breast cancer risks. But then she added another story: “I know of a woman who had leukaemia, and then she got pregnant and she was healed by it.”

Meanwhile, at the Mangiagalli hospital in Milan, I saw how another centre appears to take a different approach. Its volunteers offered me financial and other support if I continued my pregnancy. But they also reassured me that abortion is a safe procedure, described different methods clearly, and wished me luck with my choice.

Across the country, Movimento per la Vita has an initiative called the Gemma Project, which provides clothes, food and other items as well as cash payments and help for poor pregnant women and mothers to access public services.

Michele Usuelli, the Lombardy regional councillor, said this support for women with financial difficulties is good, “but it is unacceptable if they violently use unscientific information to provoke a sense of guilt in women.”

The Ministry of Health did not respond to openDemocracy’s questions and requests for comment. Both the hospital and the centre in Benevento declined to comment.

In Vigevano, we received no response from the centre, while the hospital sent a one-sentence response, saying that it "scrupulously” follows Italy’s 1978 abortion law, “guaranteeing the possibility of free choice for assisted women".

In a four-page response, Movimento per la Vita said its activities are not “against women’s rights, health and freedom”. It said it is “welcomed and [has] offered totally free help” to more than 750,000 women over 40 years, and that "no one has ever come back to complain.”

It denied that its volunteers intercept, blame or humiliate women at hospitals but rather offer “loving support”. It added: “The presence of MPV volunteers in hospitals is the result of public administrative agreements, according to law.”

Heartbeat said in a statement: “We stand firmly by our Commitment of Care” – which outlines standards for affiliates including to provide “accurate information”.

“Public mischaracterisations of Heartbeat-affiliated pregnancy help centres have consistently not withstood scrutiny when brought into a court of law,” it added, and “a recent survey of pregnancy help center clients revealed a 99% satisfaction score.”

Meanwhile, at the University of Verona, Massimo Prearo, a political studies researcher, said “it is clear that in recent years there has been a significant increase” in ultra-conservative campaigns in Italy including those “with murky methods".

“By infiltrating medical facilities,” he warned, these anti-abortion centres “aim to dismantle rights and achievements gained from years of struggle.” He criticised these movements’ goal as nothing less than “a new society founded on an outdated law of God and religious principles disguised in pseudo-scientific theories."