Almost as soon as Law 194 was passed in 1978, the Church and its political proxy then, the Christian Democratic Party, tried to have it repealed. A referendum was held in 1981, but voters rejected the idea — roundly, by a margin of 2 to 1. Having failed to change the law, the Church then set out to exploit its internal contradictions — which it had helped create.

Even as Law 194 guarantees the right to an abortion, it “recognizes the social value of motherhood.” According to Angela Balzano, a researcher in philosophy and bioethics at the University of Bologna, that built-in tension, along with “the loophole provided by the clause on conscientious objection,” was an attempt to mediate between “two irreconcilable positions” in the late 1970s: the abortion-rights agenda of the Radical Party, a leading left-wing party, and the anti-abortion Catholics. She called this “a clear case of judicial antinomy.”

Four decades later, it’s apparent who has benefited from that weakness, and this result is no accident. Pope Francis himself, speaking at a gathering of Italian Catholic physicians in 2014, encouraged doctors to make “brave choices that go against the current,” referring pointedly to conscientious objection and abortion.

Although the Christian Democrats are no longer, Catholicism remains a major political force. The religious movement Comunione e Liberazione (Communion and Liberation), whose stated mission is to promote the “education to the Christian faith” and comes under the pope’s direct authority, has thousands of supporters — some say many thousands — including in hospitals, universities and women’s clinics, and among politicians in center-right parties, like those who opposed Mr. Borraccino’s law in Apulia.

In addition to legalizing abortion, Law 194 called for establishing specialized women’s clinics. But after years of cuts to the state health care system, many clinics today are Catholic, and those refuse to provide even information or basic services to women seeking an abortion. What’s more, they are partly funded with taxpayer money: 0.8 percent of personal taxes are directly allocated to the Church, unless taxpayers specifically ask to opt out. So much for the separation of Church and state.

The law granting women access to abortion has been gutted, Assunta Sarlo, a journalist and activist with the feminist group Usciamo dal Silenzio (Let’s End the Silence), told me, partly “because the religious forces have been able to count on political allies in what remains a strongly Catholic country.” But it’s also, she said, “because the reputation of abortion is such that choosing to be a gynecologist who carries out this type of procedure is akin to career suicide.”

Opinion polls suggest that the vast majority of Italians still support access to abortion. But some three-quarters of the population also call themselves Catholic, and so even for some Italians who support women’s right to terminate a pregnancy, abortion still carries a stigma. And that’s just the kind of tension that the Church has been expert at exploiting — at a great cost to women, as well as the rule of law, in Italy.