Figure has risen from 59% in 2005 and has been accompanied by increase in reported miscarriages

Seven in 10 Italian gynaecologists refuse to carry out abortions on the grounds of conscientious objection, according to official government figures.



The rise – which saw the proportion of those objecting go from 59% in 2005 to 70% in 2013 – has been accompanied by a steady increase in reported miscarriages, trends that some doctors say are linked. They suggest more women are seeking abortions in clinics that are not legally providing them or are inducing abortions themselves.



“Women are getting abortions, but doing it illegally, because we know there are so many who are arriving at our clinic who have a quote-unquote spontaneous abortion [or miscarriage]. They probably took a pill … we understand [these to be an] illegal abortion,” said Silvana Agatone, a gynaecologist in Rome.

Data collected by the Italian Department of Health shows that the proportion of gynaecologists who conscientiously object to the procedure is in excess of 90% in some regions. It is highest in the southern regions of Molise (93.3%) and Basilicata (90.2%), where the proportion of objecting doctors more than doubled in the seven years to 2013.

The issue is worrying a relatively small but vocal group of doctors who are nearing retirement age and say that Italy is facing a crisis of the availability of certain kinds of abortion, with many younger doctors uninterested and even unprepared to take on the task. At the same time, they fear more women are taking matters into their own hands.



On paper, the number of abortions in Italy has declined over the last three decades, from 233,976 in 1983 to 102,760 in 2013. But over the same period of time, the number of miscarriages has increased from 93.2 per 1,000 live births to 138.5.

Disputing a link, the Catholic University of the Sacred Heart’s healthcare observatory, which tracks regional data, said the increase in miscarriages was likely to reflect the fact that women were having children at an older age.



An Ipsos poll carried out earlier this year in Italy, Belgium, Poland, Sweden, Hungary, France, Germany, Britain and Spain found that Italians were more likely than all other countries surveyed, with the exception of Poland, to believe that abortion should never be permitted or should only be allowed when the mother’s life is in danger.

Some 15% of Italians agree with these statements compared to just 1% in Sweden, 3% in France, 5% in the UK and 6% in Germany. Nonetheless, some doctors say conscientious objectors are often motivated by factors other than religion such as professional standing and income.



Doctors interviewed by the Guardian said there was an unease with the abortion procedure and a desire by doctors not to be personally affiliated with the practice.

One doctor who works at a hospital that performs abortions said many fellow doctors who were conscientious objectors believed their patients would not return to them in the long-term – for subsequent pregnancies or other care – if they provided abortions because the doctor would have a negative association for the patient, and that would hurt them financially.



“If you are a person who performs abortions, it is not seen as serious [medicine]. It is still considered a negative act. The people – other doctors – will say, maybe he doesn’t earn enough, he performs abortions,” said another doctor who spoke on the condition of anonymity because she works at a Catholic semi-public hospital that does not carry out abortions.



Abortion was legalised in Italy in 1978, in what is still considered one of the most important advances for women in Italian history. Under Italian law, doctors can perform abortion for up to 90 days, either surgically or a pharmaceutical abortion. But after 90 days, a woman must either be physically or mentally at risk because of the pregnancy or have evidence of a serious foetal pathology.

Some female doctors lament that their younger peers do not share their sense of urgency about abortion rights.



“Before we had the law, many women died. And we had the law after other European countries. But we don’t want to go back. It is not possible to go back,” said Giovanna Scassellati, another doctor in Rome who performs abortions after 90 days of pregnancy.



Sometimes, she says, she receives messages pleading for help from women all over Italy. Her dedication to the women – “I want to be there, I want to help them as much as possible” – has strained the 63-year-old, who said she was probably among the busiest providers of abortions in the country.



“The job is important, it is part of my life, but it is not the only thing I want to do. But why are young women not fighting? Because our generation had to fight a lot to have abortion,” she said. “The problem is that they don’t teach it – this is the big question – they don’t explain to young students how to perform an abortion.”



While another doctor, Agatone, said that early-stage abortions were not necessarily too difficult to procure, abortions done after 90 days can be exceedingly difficult for a woman to obtain because of an acute lack of doctors. Agatone herself is one of just seven who perform the procedure in all of Lazio, the region that includes Rome. She has known doctors who send patients out of the country to get an abortion.



“Usually a woman at that stage has discovered a pathology, and it is terrible because usually the couple wants to have the baby and the diagnosis is done in one of these places that is governed by objectors,” she said.

“The government says there is access to abortion in 60% of all hospitals, but what kind of abortion? The government does not talk about abortions after 90 days,” she said. “I talk about this kind of abortion because we worry very much about it. It will be the first kind that will disappear.”

Meanwhile, in an apparent attempt to crack down on illegal abortions, women in Italy can now face fines of up to €10,000 if they are suspected of procuring an abortion illegally. Previously, such an offence resulted in a symbolic €51 fine.



“It’s a new law and a very big problem. Now if a woman risks being denounced for an illegal abortion, she will stay at home [instead of seeking emergency treatment in hospital], even if she is not well. This is very dangerous,” says Agatone, who founded a website that helps women locate abortion physicians.

A spokesperson for the Italian health ministry told the Guardian that the rising number of objectors was not critical because the number of abortions was decreasing. They stressed that the workload of non-objectors had not been particularly affected by the issue, even in those regions where the rate of conscientious objectors was higher, and that 90.8% of abortions took place in a patient’s region of residence.



Like most aspects of healthcare in Italy, the number of objectors differs from region to region. Aside from Molise and Basilicata, a region that has seen a significant increase in the number of objecting doctors is Abruzzo, where the proportion of objectors rose from 45.5% in 2006, from when regional data is available, to almost 81% in 2013.

Sicily, which recorded the highest proportion of objectors in 2006 at 84.2%, also recorded a high level of objection in 2013 with 87.6% of gynaecologists refusing to carry out abortions.



Conscientious objection is permissible by law in the majority of EU countries although exceptions exist in Bulgaria, the Czech Republic, Finland and Sweden. However there are few statistics, other than Italy’s, available.