When Francesca Tolino, 37, found out that her second baby would have been born with a serious heart malfunction and a life expectancy of three years, she decided to get an abortion twenty weeks into her pregnancy.

In September 2019, after having the diagnosis confirmed by two different doctors, the second of whom tried to talk her out of her decision, playing down the condition of the fetus, she started looking for a facility that could take charge of her case. But in Rome, a city of three million people, only five doctors are willing to perform therapeutic abortions.

Since 1978, thanks to Law no. 194, it has been possible to terminate an unwanted pregnancy in Italy, but this procedure is still difficult to access due to the high number of conscientious objectors among medical staff. With the inability of the system to meet demand, which was exacerbated during the pandemic, pro-choice associations like Laiga194, are concerned about the number of illegal abortions, which is estimated to be around 15,000 cases yearly (though this figure could be as high as 50,000 according to some sources).

 ‘We don’t do those things here’

Since a therapeutic abortion can only be carried out in cases where there is a danger to the pregnant person’s psychological and physical health — which may be influenced by the health condition of the fetus — the first thing Tolino had to do was undergo a psychiatric examination. The man who spoke with her was also a conscientious objector and tried again to make her change her mind before issuing the certificate. After the visit, she remained in the hospital for four days: ‘I remember that I was surrounded by people giving birth, balloons, bows, and shrieks’, she says; They made me stay in that hospital by force, for four long days, in silence’.

Finally, someone gave her some coloured pills without telling her what they contained and as soon as she took them, she began to feel indescribable pain. She was, in fact, giving birth and nobody had prepared her for this. The only non-objecting gynaecologist in the hospital had other deliveries to attend to and never entered her room. Since the whole staff team consisted of conscientious objectors, no one gave her an anaesthetic.

When she managed to retrieve her medical records, months after the operation, they said that the abortion was performed because she was a woman on psychotropic drugs not fit to be a mother’.

According to the latest official government report, in 2019, 67 per cent of gynaecologists and 43.5 per cent of anaesthetists in Italy did not want to perform abortions. Dr Silvana Agatone, a pro-choice gynaecologist and the president of Laiga194, says she is very concerned about the rising number of objecting medical staff. Having one non-objecting doctor in a hospital is of no use when the whole system works against you. Being a non-objector means dealing with nurses who refuse to move the bed where the patient lies from one room to another, or place abortion pills on the bedside table’, she explains. ‘It also means working with anesthesiologists who refuse to provide anaesthesia to the patient’, as happened in Tolino’s case.

The numbers vary greatly across Italy, but that of objecting gynaecologists exceeds 70 per cent in ten out of twenty regions, peaking at 92.3 per cent in Molise. In Campania, only 26.4 per cent of hospitals perform abortions and in Lazio, Tolinos region, there are less than two hospitals available for every 100,000 people of childbearing age. Non-conscientious objectors, therefore, bear a heavy burden. In 2019, in Molise, the only non-objecting gynaecologist terminated an average of 6.6 pregnancies per week over 44 working weeks (in 2016, it was 9 per week). 

Indeed, Dr Agatone points out that this is a growing trend, emphasizing that the overall number of hospitals that do not carry out this procedure (64.9 per cent) is also on the rise. ‘We are still evaluating the damage of the pandemic’, she adds, but we are realizing by calling many hospitals that several departments were closed in 2020 and have yet to reopen — if they [even] will’.

Even fewer facilities perform medical abortions, despite this being the most common type of abortion in Europe. This is because, until the start of 2021, the procedure could only be carried out up to the seventh week and required a three-day hospitalization period in many regions.

People are not informed about their rights’, explains Dr Agatone. Recently, a woman with only fifteen days ahead of her to terminate the pregnancy called us from Naples’, she recalls. ‘The people in the first hospital she went to told her, “We don’t do those things here”, while those in the second hospital sent her back home because the doctor “had no time for her” and invited her to come back in a couple of weeks’. People are unaware that they can threaten to sue the hospital. Many leave feeling rejected and ashamed.

The Garden of Angels

Tolinos experience led her to become an abortion rights activist. She revealed her case in a famous article for LEspresso, a publication where women can anonymously submit their stories. She also created Libera di Abortire, an awareness-raising campaign that frames conscientious objection not as an individual choice, but as a structural problem within the Italian medical field. However, Tolino’s traumatic chapter was not yet over. In September 2020, a year after her abortion, she read a viral Facebook post written by a woman, Marta Loi, who had found a grave in Romes Flaminio Cemetery bearing her name. It was the grave of her aborted fetus. Tolino went to the cemetery to see for herself. ‘I went to an office of the cemetery and asked if there was a tomb in my name’, she recalls. ‘They said that there was one and gave me a map to find it. My legs were shaking, I felt terrible, so I asked a guy who worked there to take me to the grave in his car. The cross was new and made of iron, and my name had been written on it with a white marker’.

According to a 1990 presidential decree, if a person has a miscarriage or a therapeutic abortion between the twentieth and twenty-eighth week, the fetus must be buried by them or by the hospital that assisted them. If the parent decides not to do this, the fetus is buried showing the number on the medical record. In Rome, however, the AMA, the company that deals with the citys disposal of waste, and the ASL Roma 1, which runs the citys public healthcare system, buried fetuses with a Catholic ceremony and wrote the name of the person who was pregnant with them on the graves without their consent.

This discovery led Tolino and Italian Radicals, a political movement whose members have always been active in the fight for civil and political rights, to start an actio popularis against AMA, ASL Roma 1, and San Giovanni Addolorata Hospital. This type of lawsuit allows a member of a community to take legal action when a breach of public interest occurs. Tolino chose not to make hers an individual case.

When asked about the future of Law no. 194, Tolino believes it is unlikely that it will ever be overturned. However, she is ardently committed to ensuring that what happened to her never happens to anyone else again.

Dr Agatone is less hopeful about the future. There is a high likelihood that the next Italian government will be formed by a coalition of the two far-right parties whose members call themselves anti-abortionists and defenders of ‘traditional family’. ‘We should not think that this law will be safe as long as we are part of the European Union’, she says. ‘Poland is also in the Union but that did not stop its government from completely banning abortions, exactly one year ago’.

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