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‘Absurd’ rules obstruct abortion access in Italy during COVID-19

Abortion has been legal in Italy for 40 years but guidelines say medical terminations must occur in hospitals – now overwhelmed by the pandemic. Italiano

Francesca Visser
3 April 2020
Sanitation workers outside Monaldi Hospital in Naples, Italy. March 2020.
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Photo: Paolo Manzo/NurPhoto.

As coronavirus infections spread throughout northern Italy, Lisa* got pregnant. In her late 40s, with two children, a precarious job and poor health, she said: “Unfortunately I realised I was pregnant unexpectedly, above all at my age”. 

She decided to have an abortion, which has been legal for most of Lisa’s life. But these services are hard to access even in ‘normal’ times. Many doctors refuse to provide them, and unlike in other European countries, medical abortions in Italy are only available at hospitals, and only up to seven weeks of pregnancy. 

Lisa’s experience in February – described in a detailed letter to LAIGA, an association of Italian gynaecologists that support abortion rights, and shared with openDemocracy – was a sign of what was to come for women nationwide. 

She was in the first few weeks of her pregnancy, which could have been terminated with a couple of pills. But her town, Lodi, was surrounded by areas already quarantined before the national lockdown in March. According to women’s rights activists, its hospital had already taken drastic steps: suspending all medical abortions and transforming previously-scheduled medical terminations into surgeries.

Lisa’s options were thus: continue carrying her unwanted pregnancy – or begin an odyssey to try to find another hospital to access these long-legal services. Choosing the latter, she called other hospitals in her region and was again turned away both by those in areas with higher infection rates, because of the emergency, and those in areas with fewer infections, because she came from a higher-risk zone.  

It took Lisa days to find a ward that would accept her. Since then, women’s rights activists have reported that more hospitals across Italy have also suspended medical abortions. Other hospitals have been transformed into so-called ‘COVID hospitals’, shutting down all other surgeries, including abortion services.

The Italian ultra-conservative group ProVita & Famiglia has now seized the moment with an online petition to block women’s abortion rights nationwide, declaring: “During the pandemic, abortion is not an essential service”. 

“Absurd” rules

Anna Pompili, a gynecologist and co-founder of the AMICA pro-choice group of doctors, told openDemocracy in February that “the current emergency is reducing the possibility of having an abortion especially in the north of the country”.

Since then, gynecologists from other regions have noted similar trends. Speaking to openDemocracy from the Umbria region, Marina Toschi, at another pro-choice organisation called AGITE, said medical abortions have been suspended in numerous places “in order to avoid sending women to hospitals multiple times”.

A key problem, say rights advocates, are Ministry of Health guidelines that require women take medical abortion pills in hospitals. A small minority of hospitals offer these as out-patient services, but women must still attend three in-person visits.

Toschi criticised these rules as “an absurd and made-up protocol” and said the current crisis is amplifying long-standing challenges in accessing medical abortion. 

“We should be trying to avoid all unnecessary surgeries by all means”

In many European countries, medical abortion is available up to nine weeks of pregnancy, in line with WHO guidelines, but in Italy the cut off is seven weeks. 

A 2017 Ministry of Health report said just 18% of terminations in Italy were medical abortions; the rest were surgical procedures. (In comparison, 97% of terminations are medical abortions in Finland, 75% in Switzerland, and 68% in France).

“We should be trying to avoid all unnecessary surgeries by all means,” says Toschi. “We are now silenced by the constant news of new deaths… but all we are asking for is to help empty the operating rooms to make space for the most serious cases”.

“Emergency measures” in response to COVID-19, insisted the Council of Europe’s Commissioner for Human Rights Dunja Mijatović, must not undermine access to “time-sensitive essential reproductive health services such as abortion care”.

“It is absurd”, added Neil Datta at the European Parliamentary Forum on Sexual and Reproductive Rights, “that women in Italy should be denied their right to access a medical abortion for the only reason of sticking to outdated bureaucratic rules.” 

“Other countries”, he added, “don’t require women to go to the hospital and take up precious time from medical staff”. Governments, he said, must ensure access to abortion now “as these women cannot wait for the end of the pandemic.”

The Italian contraception and abortion network RICA sent a letter to the Ministry of Health on Friday, said one of its members Sara Martelli, calling for new “emergency measures” to ensure access to abortion during COVID-19 – including by allowing medical abortion up to nine weeks, reducing hospital visits and granting access to telemedicine.

“These women cannot wait for the end of the pandemic”

In Italy, women’s rights activists involved in the Obiezione Respinta (Objection Rejected) project that monitors abortion services say that they have received reports for weeks of increasingly restricted access to terminations across the country. 

Amidst the pandemic, these activists created a Telegram channel to share information on what services are still available and where. They told openDemocracy the current crisis has made “a situation of emergency… even more evident”.  

Protest for abortion rights, Roma, Italia 2018 | NurPhoto/NurPhoto/PA Images.

Among the women who contacted this group in recent weeks was Maria* in Naples. She told them how, seven weeks pregnant, she struggled to access an abortion and “spent the last day before the total lockdown making calls in vain”.

It took her three weeks to finally find a hospital that would take her. She said she got “lucky”, as this hospital had just started taking appointments by phone. Normally, she’d have to go in person and queue for ‘first come first served’ services. 

“If medical abortion were also available in family counselling centres, it would have lessened the present workload on the hospitals,” says Tiziana Antonucci, vice president of the Italian Association for Demographic Education (AIED) non-profit.

There have been previous campaigns to make medical abortions accessible outside of hospitals, but they have been routinely met with dogged opposition especially from right-wing politicians and anti-abortion activists including the ProVita group.

In France the national college of obstetrics and gynecologists has called for remote consultations and medical abortions at home to be made available during the pandemic. In England, the government recently approved the use of abortion pills at home.  

But in Italy, the national college has so far only issued recommendations on pregnancies, births, and breastfeeding amidst coronavirus. 

“It’s a deafening silence that does us no honour,” said Anna Pompili, the gynecologist and co-founder of the AMICA group of pro-choice doctors. “Human rights cannot be put to the side during times of emergency”.

* Names changed to protect privacy

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