As of January 2022, the Italian region of Molise employs only one doctor who does not identify as a “conscientious objector.” In this context, the term refers to someone who refuses to perform abortions on the grounds of moral, personal or religious beliefs, and simply put, this means that women in Molise are currently being forced to travel to other parts of the country in order to seek something that Italian law enshrines as their right: a safe and legal abortion.
For years, Dr. Michele Mariano was one of two practitioners in the region who regularly performed pregnancy terminations at Campobasso’s Cardarelli, the only hospital that would offer this as a service in a 4000 km radius. At 69 years old, he postponed his retirement twice, hoping in the meantime to find a replacement -but no one wanted the job. He was forced to retire in December 2021, leaving the doctor he’d worked side by side with, Giovanna Gerardi, alone.
Fifteen Italian hospitals currently count at least one category between gynecologists, anesthesiologists, and nurse personnel, entirely made up of conscientious objectors. In up to another 20 Italian hospitals, the rate is still as high as 80%. These figures are spread out among regions all throughout the peninsula (Abruzzo, Veneto, Umbria, Basilicata, Campania, Lombardia, Puglia, Piemonte, Marche, Toscana, Sicilia), but Molise, in Central Italy, is unquestionably the one with the highest percentage. The rate of conscious objectors in Molise is currently estimated at 92,3% among gynecologists, 75% among anesthesiologists, and 90,9% among non-medical personnel.
A first question could be, why should anesthesiologists be allowed to object to abortion?
The main one, however, is how this all came to be the norm: ever since an Italian 1978 law decriminalized and regulated abortion, following heated debate and finally, a referendum, the country’s immensely powerful Catholic base has been fighting back. Italy largely protects healthcare professionals who wish to invoke their right to consciously object to providing care, or treatment, should this irreconcilably conflict with their personal beliefs. This also applies to pharmacists, who are allowed to refuse selling contraceptives such as condoms and forms of hormonal birth control, and even, more broadly, in non-medical contexts such as experimentation on animals.
But while the text of the law allows for the possibility of objection, thus safeguarding the individual’s right to autodetermination, it also explicitly states that this should remain the legal right of the individual, not that of any one facility. Hospitals and other medical facilities are “in any case, obliged to guarantee” abortion as an available service, which is not the case in the fifteen hospitals previously mentioned and the whole of Molise.
In the eventuality that a woman’s life should be in danger, the law adds, the right to object is immediately void if such an intervention could be considered lifesaving. So for example, if a woman turns up to the ER with heavy hemorrhaging due to an unsuccessful clandestine abortion, no doctor can invoke his right to object, as the law requires them to conclude carrying out the operation to save the woman’s life.
But that is not (thankfully) the part most people object to: as Italy is a highly religious country, the phenomenon mostly relates to the presence of the Church on its territory. “As long as the Vatican calls the shots,” Dr. Mariano says, “Italy will deal with this problem.”
In 2018, the latest year where data from the Health Ministry is available, the number of IVGs in Italy was 76.328. In Molise they amounted to 338, the lowest figure in the country, and on this point, the official Ministry’s report itself notes that the declining number is mostly due to women who have found themselves forced to travel outside of the region in order to seek an abortion.
This is, besides, a disservice to non-objecting doctors, for the more objectors there are in a single hospital, the more procedures non-objectors will find themselves performing in order to compensate. Official data estimates the national average of performed abortions at 1,2 per week, but in some hospitals the number soars to 8, 9, or even 14 per week. In Molise’s case, where Dr. Mariano found himself the only non-objector in the region, this dynamic helps explain why, when the region arranged a public contest for his post, not a single entry was registered. There will now be a second opportunity, so we can only hope that increased scrutiny on this case by Italian media and public alike will result in a more favorable outcome.
For the women of Molise, but also for Italy’s reputation as a modern country: in the 21st century, with separation of Church and State long codified into law, doctors with a conscience can’t retire for fear of losing it.
Only last year, Texas passed the strictest anti-abortion law in the United States, the so-called heartbeat act. The war on women goes even further in Poland, where abortions are now only allowed in extreme and extremely restricted cases. Forcing women to travel outside of their region or state in order to exercise bodily autonomy is a dangerous trend, and while Italian law is nowhere as limiting as that of Poland or Texas, that is effectively what is happening in Molise, just the same. Will other regions follow its lead, or protect their citizen’s rights? What direction will Italy choose? We now look to the second contest for Dr. Mariano’s post, set to happen this year, for answers.