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The complicated state of abortion access in Italy

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Abortion has been legal in Italy for more than 40 years. But most doctors refuse to perform them, making it difficult to find a provider. As in America, women in Italy fear this right will go away.

STEVE INSKEEP, HOST:

An expected Supreme Court ruling on Roe v. Wade has many Americans comparing U.S. abortion laws to other countries. Abortion in Italy has been legal for more than 40 years. It was allowed after a hard fight in a heavily Catholic country. Adam Raney reports from Rome that the fight isn't over.

ADAM RANEY, BYLINE: Abortion is available for free in Italy in the first 90 days of pregnancy, with a seven-day waiting period. After the first trimester, abortions are only allowed if there's a risk to the mother's health or if there are fetal anomalies. But while it's legal, actually getting the procedure can be difficult.

GIOVANNA GERARDI: (Through interpreter) Abortion access is always difficult because there are too few doctors who perform them.

RANEY: That's Dr. Giovanna Gerardi. She's one of only two abortion providers in Italy's Molise region. Once her colleague retires later this year, she'll be the only one. That's because Molise in Italy's south has the highest percentage of so-called conscientious objectors, doctors who refuse to provide abortions. The Ministry of Health says fewer than 8% of gynecologists there will perform them.

GERARDI: (Through interpreter) The new generation of doctors, they're all conscientious objectors. Pretty soon, there won't be any doctors who do abortions.

RANEY: Molise is an extreme example. But across Italy, a traditionally Catholic country, more than two-thirds of gynecologists object to performing abortions. And that number is growing, according to the health ministry.

SILVANA AGATONE: (Through interpreter) There is a stigma in Italy for those who perform abortions.

RANEY: That's Silvana Agatone, president and founder of LAIGA, an association for abortion providers. She says many of Italy's most prestigious medical schools and hospitals are run by the Catholic Church.

AGATONE: (Through interpreter) They put their men in OB-GYN departments even in non-religious hospitals. The new generation gets a sense that it is better for their careers to be objectors.

RANEY: But gynecologist Niccolo Giovannini (ph) says career advancement has nothing to do with his decision.

NICCOLO GIOVANNINI: Doing the abortive act, it's like going against my ethics.

RANEY: Giovannini supports a woman's right to choose but can't see himself playing any role in that process.

GIOVANNINI: I don't want to be the destroyer of life. From me, life is sacred.

RANEY: With an overwhelming majority of doctors refusing to perform abortions. Many women spend weeks trying to find appointments. And some have to make long trips to other regions of the country. Tiziana Antonucci (ph) organizes a weekly abortion clinic in a small, central Italian hospital, otherwise staffed mainly by doctors who are conscientious objectors. Antonucci says both abortion providers and patients travel to meet there.

TIZIANA ANTONUCCI: (Through interpreter) We have women who travel from far away who couldn't find a spot in a local hospital. As time goes by, it changes a woman's situation from a medical point of view and, above all, from a psychological standpoint. It is hard on them to make them wait.

CARMEN: (Non-English language spoken).

RANEY: Carmen (ph) travelled two hours to Antonucci's clinic rather than wait weeks for an appointment at her local hospital. Carmen, who asked us not to use her last name, had an abortion earlier this month.

CARMEN: (Through interpreter) It makes you angry. I understand why a lot of women have to carry on with their pregnancies. It's not easy to get out of a situation when you come up against such big obstacles. The challenges are so hard to overcome.

RANEY: But Senator Lucio Malan from the right-wing Brothers of Italy party scoffs at the suggestion that having to travel for an abortion - or an interruption in a pregnancy, as he puts it - is an obstacle.

LUCIO MALAN: If a woman says, I would interrupt my pregnancy, but since I have to travel to Milan, I will not - so that means that she's not very persuaded to interrupt that pregnancy.

RANEY: It's comments like those that make some fearful Malan's party, currently leading in Italian polls, could restrict, if not outright ban, abortion if they gain power next year. Back in Molise, Dr. Gerardi, who at 60 will soon be the lone provider in her region, says even with abortion legal, it's hard enough for doctors like her.

GERARDI: (Through interpreter) We perform a little less than 300 abortions a year. One doctor working very hard, never taking a day off can do it. The problem is if you get sick or need to take a vacation, because you can't expect someone to be imprisoned inside, day after day, doing this job.

RANEY: Since November, Molise's public health agency has been looking to fill two openings for gynecologists willing to perform abortions. So far, Doctor Gerardi says, no one has applied.

For NPR News, I'm Adam Raney in Rome.