Daniel Pizzolato, Dorothea Chatzikonstantinou, and Alice Cavolo
Access to abortion is guaranteed by law in Italy but in practice such access can be difficult to achieve. In October 2022, legislation was proposed that could undermine current abortion rights by granting full personhood and legal rights to an embryo from the moment of conception.1 Currently in Italy, full personhood and legal rights are acquired at birth, as per the European Convention on Human Rights.2 Although the right-wing government claims the proposed legislation will have no impact on access to abortion, it is difficult to see how it could not. Even if the new proposal does not specifically refer to reproductive rights and/or abortion rights, it will inevitably impact on women’s bodily autonomy, dignity, and right to self-determination and abortion.
Granting legal capacity and rights to embryos would raise complex ethical and legal considerations in the context of abortion and beyond. It would mean that the termination of a pregnancy by abortion could be equated with murder and therefore prohibited as a criminal offence. It also raises questions about embryos used in research or for IVF purposes–questions that have not as yet been addressed in the legislation.
Recognizing rights from conception is not the only method being considered in Italy to make access to abortion more difficult. Another bill if passed would require people seeking an abortion to listen to the fetal heartbeat and view the “unborn child they are carrying” before taking terminating a pregnancy.3 Such requirements clearly attempt to make the person seeking an abortion feel shame and guilt. These two separate proposals are a targeted attack on women’s right to self-determination and reproductive freedom.
The right to safe and legal abortion is a crucial aspect of women’s reproductive rights, promoting women’s autonomy, health, and reproductive freedom.4 Although the Council of Europe established that the right to access safe and legal abortion should be granted without restrictions, abortion access in European countries varies significantly.5 Among the countries in which abortion is legal, Italy has one of the lowest abortion rates (and medical abortion makes up a small percentage of total abortions), possibly due to a decreasing birth rate and practical difficulties accessing medical and pharmaceutical abortion.6
Abortion in Italy is currently hyper-regulated under Law 194/1978.7 Abortion is decriminalized in the first 12 weeks of pregnancy, following which it is only permitted for fetal impairments (up to fetal viability) and to safeguard women’s lives. However, gynaecologists have the right to conscientious objection, so they are not obligated to perform abortions. In Italy as a whole, 63.3% of hospital-based gynaecologists will not undertake abortions, with as many as 80% in some hospitals.8
This leaves so few gynaecologists available to perform abortions that people requiring one face average waits of 14 days and up to 28 days in some regions.9 This delay, combined with a seven-day mandatory waiting period, can result in the pregnant person having crossed the 12-week cut off before being able to access an abortion. Moreover, family doctors and pharmacists are frequently opposed to the use of abortion medicines, further limiting people’s choices and forcing many to undergo surgical abortions that are more invasive and riskier than pharmaceutical alternatives.10
Likely increase in illegal abortion
Granting legal rights from the moment of conception could lead to illegal abortion practices increasing, along with people having to travel to other countries for abortions.11 In addition to increased costs, this poses significant risks to the psychosocial and physical well-being of people requiring an abortion.12 Restricting access to abortion may lead to increases in illegal abortions, more violence in obstetric care in Italy, as well as to abuse, coercion, or lack of respect in obstetric care in a country that already struggles with these issues.13
Maintaining legal access to abortion procedures is crucial to ensure the well-being of women, but also to counteract the already substantive gender inequalities in the workplace and elsewhere.14 A ban on abortion would impact educational and career-related plans, and widen the gender gap on multiple levels (for example, in education, salary, wealth, and domestic roles). This has been demonstrated by several studies as part of the Turnaway Study.15 The refusal of an abortion can also lead to increased levels of anxiety, stress, and lower self-esteem.16 In addition, if abortion is generally stigmatized, any negative psychological effects on a person having one may persist for many years.17 One study found that domestic violence decreased after wanted abortions, but restricting access may cause women to avoid leaving violent partners and lead to increased domestic violence.18
Granting legal rights from the moment of conception is an attack on abortion rights, but also on women’s right to dignity and self-determination. Preserving the full autonomy and unrestricted freedom of choice of pregnant women is essential to ensure their physical and psychosocial well-being. The ability to make decisions about one’s own body, including decisions related to pregnancy and childbirth, is a fundamental aspect of individual freedom and human rights. To promote women’s autonomy, it is crucial that pregnant women have access to comprehensive information, unbiased counselling, and safe medical services, including legal and accessible abortion. Respecting pregnant women’s full autonomy and freedom of choice is therefore a crucial pillar for preserving their dignity, ensuring their well-being, and promoting a just society. Instead of a new legal framework that could further restrict the right to abortion, more must be done to improve current legislation so that women’s right to choose and safe access to abortion is guaranteed for all.
Daniel Pizzolato, PhD, is a post-doctoral researchers affiliated with the European Network of Research Ethics Committees and KU Leuven, Belgium. Email: daniel.pizzolato@kuleuven.be
Dorothea Chatzikonstantinou, LLB, is a student of the advanced Master of Bioethics at KU Leuven, Belgium.
Alice Cavolo, PhD, is a postdoctoral researcher affiliated with the University of Zurich and KU Leuven, Belgium.
References
[1] Senato della Repubblica Italiana, Disegno di Legge d’iniziativa del senatore Gasparri, (October 13, 2022). Available at: https://www.senato.it/service/PDF/PDFServer/DF/420885.pdf
[2] The European Convention on Human Rights, “Guide on Article 2 of the European Convention on Human Rights”, Available at: https://www.echr.coe.int/documents/d/echr/Guide_Art_2_ENG; Paton v United Kingdom 8416/78 (1981) 3 EHRR 408 European Commission of Human Rights, Available at : https://e-lawresources.co.uk/cases/Paton-v-United-Kingdom-8416-78.php#:~:text=Paton%20v%20United%20Kingdom%208416%2F78%20(1981)%203%20EHRR,separate%20existence%20to%20it’s%20mother
[3] M. Naguib, “La Nuova proposta di Legge contro l’aborto costringe Le donne ad ascoltare il Battito del Feto,” Agenda17 (June 2, 2023). Available at: https://www.agenda17.it/2023/06/02/la-nuova-proposta-di-legge-contro-laborto-costringe-le-donne-ad-ascoltare-il-battito-del-feto/.
[4] C. Horn, “Abortion Rights after Artificial Wombs: Why Decriminalisation is Needed Ahead of Ectogenesis,” Medical Law Review 29/1 p.80–105 (2021).
[5] Council of Europe, Parliamentary Assembly, PACE website, Resolution 1607/2008. Available at: http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=17638. (Accessed: 13 December 2023); C. Fiala, A. Agostini, T. Bombas, et al., “Abortion: legislation and statistics in Europe,” European Journal of Contraception and Reproductive Health Care 27 (2022).
[6] F. Doran and S. Nancarrow, “Barriers and facilitators of access to first-trimester abortion services for women in the developed world: A systematic review,” Journal of Family Planning and Reproductive Health Care 41 (2015); M. Reichlin and A. Lavazza, “A Balance of Rights: The Italian Way to the Abortion Controversy,” Cambridge Quarterly Healthcare Ethics 32 (2023).
[7] E. Caruso, “The hyper-regulation of abortion care in Italy,” International Journal of Gynecology and Obstetrics (2023); doi: 10.1002/ijgo.15150.
[8] M. Bo, C. M.Zotti, and L. Charrier, “Conscientious objection and waiting time for voluntary abortion in Italy,” European Journal of Contraception and Reproductive Health Care 20 (2015); R. Saporiti, “In Italia ci sono oltre 70 Ospedali dove gli obiettori all’aborto sono più dell’80%”, Wired Italia (June 05, 2022) Available at: https://www.wired.it/article/aborto-italia-obiettori-ospedali-mai-dati-inchiesta/.
[9] Ibid.
10 E. Ceva and S. Moratti, “Whose self-determination? Barriers to access to emergency hormonal contraception in Italy,” Kennedy Institute of Ethics Journal 23 (2013); “Abortion in Italy is legal, but finding one is hard,” France 24 (June 14, 2022). Available at: https://www.france24.com/en/live-news/20220614-abortion-in-italy-is-legal-but-finding-one-is-hard.
[11] “Abortion in Italy is legal, but finding one is hard”, France 24 (June 14, 2022). Available at: https://www.france24.com/en/live-news/20220614-abortion-in-italy-is-legal-but-finding-one-is-hard (Accessed: 13 December 2023); E. Caruso, “The hyper-regulation of abortion care in Italy,” International Journal of Gynecology and Obstetrics (2023); doi: 10.1002/ijgo.15150.
[12] ANSIRH, The Turnaway Study (2022). Available at: https://www.ansirh.org/research/ongoing/turnaway-study (Accessed: 13 December 2023); PLoS Medice Editors, “Why restricting access to abortion damages women’s health,” PLoS Medicine (July 26, 2022).
[13] C. Scandurra, R. Zapparella, M. Policastro, et al, “Obstetric violence in a group of Italian women: socio-demographic predictors and effects on mental health,” Culture, Health and Sexuality 24 (2022); H. Minkoff, R. U. Vullikanti, M. F. Marshall, “The two front war on reproductive rights—when the right to abortion is banned, can the right to refuse obstetrical interventions be far behind?” American Journal of Bioethics (2023).
[14] D. G. Foster, M. A. Biggs, L. Ralph, et al., “Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States,” American Journal of Public Health 108 (2018); G. Deiana, M. Dettori, N. Muresu, et al., “Gender equality in the Italian academic context,” Results from the IGEA project, Frontiers Public Health 11 (2023).
[15] ANSIRH, The Turnaway Study (2022). Available at: https://www.ansirh.org/research/ongoing/turnaway-study (Accessed: 13 December 2023).
[16] Ibid.
[17] Ibid.
[18] S. C. M. Roberts, M. A. Biggs, K. S. Chibber, et al., “Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion,” BMC Medicine 12 (2014).