Tuesday, November 21, 2017

Abortion, Birth Rates, The New York Times

As the Italians say, it’s been raining on wet ground. Following my recent blog entry on contraception in Italy I received several emails from readers asking whether the rock-bottom Italian birth rate might be the result of a sky-high abortion rate. By amazing coincidence, two days later the New York Times published an article about abortions in Italy and how hard it can be to get one. So the subject matter of this post is overdetermined – I get to write a wonky post about abortions in Italy at the same time as firing off a Letter to the Editor.

Amazingly, the Italian Parliament legalized first-trimester abortion in public hospitals back in 1978, making it available on demand and free of charge on the National Health Service. Three years later a nominally Catholic electorate roundly scotched a Church-promoted national referendum that tried to re-criminalize it. The Church retreated licking its wounds but eventually hit on an excellent means of sabotage: conscientious objection. The law’s option for gynecologists to refuse to participate was originally intended to remain buried in the fine print but by now 70% of all Italian gynecologists are registered as conscientious objectors. So waiting lists, despite shrinking due to the increasing use of pills rather than surgery, are still scandalously long. One out of three women seeking a legal abortion is given an appointment more than two weeks away, which drives many (20%, it’s estimated) to get one illegally instead.

As the Times article points out, it’s obvious that conscientious objection and Catholicism are related. But the Church uses stronger weapons than mere moral persuasion in its promotion. I explain in the letter I submitted (in vain) to The Times:

To The Editor,

In her otherwise excellent article, “Abortion in Italy, a Right Wronged,” Ilaria Maria Sala omits one crucial element in why so many Italian gynecologists register as conscientious objectors. In addition to the genuine religious convictions of some, and the fear of others that performing abortions would tarnish their reputation, there are more practical threats to their livelihoods. Abortions are performed only in public hospitals, by gynecologists employed by the National Health Service. Many public system gynecologists, however, want also to be able to treat their own patients, after hours, within a large network of private hospitals which in Italy are mostly owned and/or run by the Catholic Church. Any physician who performs abortions – supposedly, any physician who even just counsels patients about them – is barred from operating, delivering babies, or hospitalizing patients in any Church-run institution. Thus a gynecologist who wants to be able to work privately in Italy is virtually obliged to declare him- or herself a conscientious objector to abortion.

So to get back to our original question, do abortions have a big influence on Italian birth rates? Nope. Italy has one of the lowest abortion rates in western Europe. In proportion to the number of babies born alive Swedish women have 40% more abortions than Italians, French women 35%, English and Spanish about 18%. And only one in five abortions performed on Italian women is a repeat procedure.

Since legalization there have been fewer and fewer abortions in Italy, especially among citizens – non-Italians, many of them immigrants from developing countries, now account for one in three.

The bottom line is that the Church has indeed succeeded in mounting barriers to abortion, especially in southern Italy, but those barriers can be overcome. And women here don’t have to run the gauntlet of demonstrators you find screaming abuse outside the entrances to abortion clinics in the USA. And no one has ever shot an Italian abortionist.


  1. How lucky those countries where church and state have been effectively separated.

  2. One would think that it would not happen in the US— but I’m a gynecologist in a major town in Northern California with a population of over 70,000. The only hospital in town is a Catholic Hospital and anyone working for that Hospital not only cannot do abortions, but also cannot prescribe birth control or do sterilization procedures! How antiquated and anti-women! Luckily I am not employed by that hospital and they don’t bar doctors who DO perform those procedures from delivering babies in that hospital.

    1. How astonishing! I had vaguely read that the Church was aggressively expanding its reach into control of health care and therefore reproductive rights in the US, but you've really brought it home for me. Keep up the good work. (Please pardon the late posting and reply - I've been on vacation truly without internet access.)