Abortion: what happened in Italy during the lockdown and why it matters
By: Valentina Petrucci
Tags: Lockdown, Abortion Rights, Italy, Abortion

February 11, 2020. In China, the quarantine has been going on for three weeks. The WHO announces the name of the new infectious disease: COVID-19.

February 20, 2020. A 30-year-old positive for SARS-COV-2 is hospitalized in Codogno’s hospital (near Milan).

March 8, 2020. Everything quickly degenerates. The Italian government establishes the first European lockdown; two days after, the quarantine will be extended to the whole country. Schools are closed, commercial activities are suspended; no one can leave their home except for proven work needs, urgent health care or situations of absolute necessity.

What happened to the health system during the lockdown?

In full crisis, the public health system, especially in some regions, collapsed: therefore, to control the propagation of the virus and to make up for the lack of space and staff -given the rapid growth of infected patients-, all health care services were reorganized. In particular, the hospitals adopted an extreme measure: the suspension of all non-urgent outpatient care and surgical operations that were not strictly necessary. This measure was first adopted in the the most affected areas, then extended to other regions. All planned surgical activities for which postoperative care in the intensive care unit is mandatory was suspended, with the exception of the most urgent surgeries — concerning life-threatening conditions-. Some fundamental services were guaranteed, for example dialysis, chemotherapy and radiotherapy. These services included activities of the obstetrics and gynaecology units, for example the voluntary termination of pregnancy — obviously not deferrable, therefore considered urgent.

How does abortion work in Italy?

Every woman in Italy can request voluntary termination of pregnancy within the first 90 days of gestation, for “health, economic, social or family” reasons. The days of gestation are calculated based on the date of the last menstruation; in addition, a blood test — Beta-HCG test — is required and, in case of surgical interruption, a recent ultrasound. Law 194, dating back to 1978, provides regulations for the voluntary termination of pregnancy. The procedure has not changed a bit: first, examination of the causes of the problem and possible solutions is conducted in specialized centers, then a certification of voluntary interruption is released, only valid after seven days — in fact, it includes an invitation to postpone the decision for seven days, in the absence of urgency, to ponder it; Law 194 is in fact based on the assumption that maternity should be protected and abortion should be prevented. Only then can you go on with the actual abortion procedure, which consists of two methods: pharmacological and surgical methods. The surgical method consists of a hysterosuction — aspiration of the embryonic material — sometimes followed by curettage— removal of the material. The pharmacological method is based on the two-phase intake of mifepristone (known as the RU486 pill) and a prostaglandin, within 48 hours from each other.

This drug, marketed in Italy only in 2009, allows the termination of pregnancy within the first seven weeks and, unlike traditional abortion methods, has enormous benefits: it makes hospitalization unnecessary, and above all it allows you to avoid surgery and all that it entails — risks due to anesthesia, complications such as uterine perforation and hemorrhages. Although the drug is widespread all over the world — precisely because of its simpleness -, its use is thwarted in Italy: in fact, unlike other countries, Italy requires a hospitalization period after the pill intake, i.e. a hospitalization of three days, often bypassed by the trick of discharge “against medical advice”. Not to mention that, on paper, abortion is guaranteed, but in practice one has to deal with the very high number of objecting doctors: this, for some women, means traveling hundreds of miles to reach a doctor or a facility that practice termination of pregnancy, by either method.

On August 14, 2020, the guidelines regarding the pharmacological method were finally changed: from now on it will be possible to take the pill up to 9 weeks of pregnancy, and there will no longer be a hospitalization constraint.

Unfortunately, the previous directives still applied during the lockdown. This is what happened as a result.

Getting an abortion in the middle of the lockdown

Leaving the house is dangerous, let alone get to a clinic or a hospital. With the risk of being fined on the way because you cannot be sure yours will be considered a medical situation of absolute urgency. Traveling far and wide to find hospitals that practice termination of pregnancy in times of crisis, and non-objecting doctors willing to perform the surgery. Most importantly, not knowing whether you will actually manage to get an abortion before 9 weeks of pregnancy. This is what thousands of women experienced during the lockdown period. But that is not all.

The Luca Coscioni Association, which fights for abortion rights, pointed out in times of Covid-19:

“… some hospitals are reducing, others suspending, access to abortion practices, without providing clear information, with huge differences from region to region”

Voluntary termination of pregnancy in Italy has always been an obstacle course, but it became a tragedy during the lockdown. During the pandemic, almost all facilities suspended the abortion services, and the few places which still guaranteed these services denied the access to medical abortion. The law is clear; the sugical abortion can be performed in day surgery, while the medical abortion requires a three-days hospitalization. Paradoxically, the surgical method became the safest solution, therefore the only one allowed — despite the opportunity of voluntary discharge; despite how embarassingly simple taking the abortion pill is, the intake of which can easily be self-managed, perhaps with the support of a doctor, even by phone, just as it happened in France, Ireland and the United Kingdom.

Italian women in desperate need of an abortion were denied the right to choose. Abortion brings with it, for many women, an enormous burden of suffering; it’s hard enough to make such an important decision, one that will stay with you for a lifetime, let alone not being able to decide how to do it. Subjected to surgery, many women contended with hospitalization and what it entails. In addition to the already mentioned risks from the surgery, the psychological implications should not be underestimated. A surgical termination of pregnancy means laying still on a hospital bed for a whole day; being tossed from room to room, from doctor to doctor, without any family support, sometimes not even receiving acts of kindness from nurses or doctors; enduring needles, blood tests, pain; being anesthetized or sedated, just to wake up, minutes or hours later, with the awareness that your child is no longer there, and you were not present to witness its departure — and this feeling, of not being in control, of not being there, can become a torment.

Surgical abortion is an invasive, traumatic and dangerous practice compared to the pharmacological procedure, yet it continues to be privileged in Italy, while all the other European countries foster the use of the pill. Yes, because the law 194 “safeguards maternity”; even at the cost of making the abortion experience as traumatic as possible. It seems that a negative judgment keeps weighing on those who decide to resort to abortion; it seems that the nation’s finger keeps being pointed at these people. It seems feelings of reproach are there, and contempt; if you really want to get an abortion, it is only right that you suffer. What happened during the epidemic made it even more clear. It was just one of many inefficiencies, one of many injustices perpetrated by a system which should take care of people but does not really, at least not fully. I’m writing with the hope that the new guidelines will make abortion easier for women in Italy, avoiding so much unnecessary suffering; hoping we’re not going through a new lockdown.