Italy’s pro-choice gynecologists reel from post-Roe shockwaves
Every day, in a secret online group chat, several dozen doctors in Italy discuss the constant pressures they’re facing. Some can’t get the drugs they need for their patients. Others are demoralized by their bosses or thwarted by their colleagues. They’re experiencing these issues for one reason: They provide abortion care.
They are in a shrinking minority. In Italy today, 3 in 10 gynecologists provide abortion care. The rest refuse on the grounds of “conscientious objection.” And in numerous hospital systems around Italy, it’s impossible to find a single gynecologist willing to provide an abortion.
“If your boss is an objector, your working life will be difficult. He might not lay it out in black and white, but he’ll let you know he won’t make it any easier if you continue giving abortions,” said Silvana Agatone, a gynecologist in Rome who leads the Free Italian Gynecologists’ Association, a group dedicated to protecting abortion rights in Italy. “It’s psychologically taxing.”
The group chat has become a refuge where doctors can exchange advice about how to keep doing their work and find some support too. This is critical for doctors like Agatone, who are facing a new wave of anti-abortion sentiment brought on by Italy’s ruling government and by forces across the Atlantic.
“You’re given the hardest shifts, you’re sent continuous letters being reprimanded for this, that or the other. You’re ground down in an environment where you’re persecuted every day,” Agatone told me.
It wasn’t always like this. In 1978, joining a global wave of reforms that followed the legalization of abortion in the U.S., Italy passed a law protecting a woman’s right to an abortion — and doctors’ rights to provide abortion care — in the first 90 days of pregnancy. While the law stipulates that doctors can refuse to provide an abortion on the grounds of conscientious objection, it also says that this should not limit women’s access to abortion care.
But today, abortion access is harder and harder to come by. Catholic universities run many of Italy’s top hospitals — so the heads of gynecology units tend to oppose abortion, Agatone told me. In many cases, entire facilities don’t offer abortion care, due in part to their religious affiliation. Patients regularly come up against doctors who try to coerce them out of the decision or deny them access to abortion pills.
As the U.S. Supreme Court’s overturning of Roe v. Wade has galvanized far-right, anti-abortion campaigns around the world, the mood among Italian gynecologists who carry out abortions has reached a new low.
“It worries me. It worries me a lot. This movement has touched everyone in different countries. It’s as if we’re having to start all over again to get our rights back,” said Agatone. “It feels like we’re on a roller coaster — we got our rights, now they’re being taken away, and now we have to fight to get them back.”
More and more of Italy’s doctors have declared themselves anti-abortion in recent years, as they’ve faced ever-increasing challenges to their work and their well-being. In the 1970s, 59% of doctors opted out of providing abortion care. But for the last decade, the number has hovered around 65%, with some regions seeing objector rates as high as 80%.
In September 2022, Italians voted in a new prime minister, Giorgia Meloni, who campaigned for years on a platform claiming to champion “family values.” She has made consistent pledges to raise Italy’s birth rate, warning voters that without intervention, the nation is “destined to disappear.”
When she first took office, Meloni softened her stance, saying she had no intention of going after abortion rights. In an interview in March 2023, she pledged that the state would financially support women who might otherwise seek abortions so that they don’t “miss out on the joy of having a child.” But under Meloni, the joy she spoke of is not intended for everyone. The same month, the Italian government stopped the city of Milan from officially recognizing LGBTQ parents on birth registers, leaving these families in legal limbo. Milan was previously the only city in the country where LGBTQ families had full legal recognition. In other regions that had been moving toward a similar equal rights regime, Meloni’s government threatened legal action on the matter shortly after she came to power.
“Everything is linked to this movement that doesn’t want contraception, divorce or homosexuality,” said Agatone, who believes that the money and influence of these groups continue to be a top concern in Italy.
In some parts of Italy, abortion access is hanging on by a thread, with just one pro-choice gynecologist serving entire regions. Patients needing an abortion have to navigate a number of bureaucratic and practical obstacles before the 90-day deadline. They must observe a mandatory “cooling-off period” of seven days before undergoing the procedure. And some now have to make journeys of hundreds of miles before they can find a doctor willing to provide the care they need. For a person facing serious health repercussions from an unviable pregnancy, these obstacles are dangerous. It’s a system that Human Rights Watch described in 2020 as “labyrinthine” and “burdensome,” demonstrating “how the country’s outdated restrictions cause harm instead of providing protection.”
Agatone described how her colleagues would thwart her when she was trying to take care of her patients by refusing to give them the medication they needed or by putting women having abortions into labor and delivery units, where other women were giving birth. “I would try in every way to have them put in a different ward, and I’d have to fight with the staff,” she said.
Obstetricians and gynecologists in Europe only have to look at the United States to see what might come next. This January, anti-abortion activists firebombed a Planned Parenthood clinic in Illinois. And the U.S. is facing an acute shortage of OBGYN specialists, particularly in anti-abortion states, where the number of medical students pursuing gynecology residencies has plummeted since the reversal.
“The fact that abortion has been overturned in America has made people think that they can’t be complacent about the right,” said Mara Clarke, the co-founder of Supporting Abortions for Everyone (SAFE), a European abortion charity she started in February 2023 to combat the attack on abortion rights in Europe. “When the right rises,” she said, referring to the political right, “women, children and LGTBQ people are the first targets.”
Italy — alongside other European states like Poland and Hungary — has long been a target for pan-Christian conservative movements that promote anti-abortion and anti-LGBTQ rhetoric and lobby for a rollback of those rights in Europe. Often, the first step in their strategy is to limit access to abortion care with tactics like imposing waiting periods and restrictions on abortion medications. But the ultimate goal is to introduce a blanket ban, according to research by the European Parliamentary Forum for Sexual and Reproductive Rights.
Rather than banning abortion completely, the current strategy is “more a chipping away of rights,” said Irene Donadio of the International Planned Parenthood Federation, who spoke to me in a personal capacity.
For years, these networks and their myriad backers — including Russian oligarchs, Italian politicians, European aristocrats and American Christian conservatives — have made significant inroads. One network, Agenda Europe, is thought to have played a key role in influencing Poland’s abortion ban, while successfully lobbying against same-sex marriage during referendums in Croatia, Slovenia and Romania.
The “family values” movement reached a fever-pitch in Italy in 2019, when Verona played host to the World Congress of Families, the flagship event of the U.S.-based International Organization of the Family — a coalition of groups that promote anti-abortion and anti-LGTBQ agendas in the name of “affirming, celebrating and defending the natural family.” Among the speakers was Matteo Salvini, the leader of Italy’s far-right League party, and Giorgia Meloni herself. In a speech at the event, Meloni warned of a world in which a woman is “forced to have an abortion because she sees no viable alternative” and added: “Is it right for a society to spend a lot more energy and resources on finding immediate, easy, quick ways to get rid of human life rather than on fostering it? Is that normal? Can you call that ‘civilization?’” She also spoke of her opposition to the use of surrogates by gay families, likening it to “snatching a puppy dog away from its mother.”
“In this cultural climate, which is becoming heavier and heavier, it’s becoming harder every day for young gynecologists to declare themselves non-objectors,” said Agatone, referring to the high number of OBGYN practitioners who opt out of providing abortion care. At 69, she sees pro-choice doctors like herself, who trained in the 1970s and 1980s, during an impassioned era of pro-choice activism, aging out of the system.
“I believe abortion access in this country could lapse,” said Agatone. “Because even if there’s a law protecting people’s rights to abortion, if no one’s there to do them, then that’s that.”
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