Doctors’ rights vs. patients’ rights: analysing the implementation of Italian abortion policy in Puglia

Even decades after most European countries legalized abortion to some degree, the issue remains contentious and often positions feminist and human rights claims against the protected status of religion and an individual’s freedom of conscience. There has been considerable scholarship on abortion as the quintessential morality policy and on the role that religious institutions, particularly the Catholic Church, play in shaping abortion policy around the world. Many scholars have also analyzed the socioeconomic impacts of policies that limit access to abortion: in short, people with wealth and privilege have a much easier time getting an abortion than their peers with less money and limited ability to travel. Italy’s abortion law appears to address this issue by guaranteeing abortion services at public hospitals for no cost to the patient. In reality, however, Italian abortion seekers report difficulty procuring an abortion. This is often attributed Italy’s provision for doctors to register as conscientious objectors and thereby opt out of abortion care. Many countries allow conscientious objection to abortion, but Italy has higher rates of objection than other countries as well as high quality data on the rates of objection. There has been a great deal of theory written about the ethics of conscientious objection, as well as analyses of its impact on abortion access, particularly in the Italian case. By considering the doctor’s desire to object and the patient’s desire to choose abortion both to be legally protected rights, Italian Law 194/78 promises a contradiction. Past scholars have explored the experiences of abortion seekers in Italy and elsewhere, so in my analysis I focus on healthcare personnel. By speaking with doctors on both sides of this issue as well as healthcare administrators on various levels, I seek to better understand why Italy struggles to guarantee abortion access through policy measures, with an eye towards what changes might improve the administration of this law. I focused my interviews in the region of Puglia, where there is an above average level of objection among gynecologists, an above average abortion rate, net inflows of abortion seekers from outside the region, and a historical court decision that makes it difficult for hospitals to hire abortion providers. At first glance, it is not surprising that Italy has high rates of objectors, given its strong Catholic heritage and close relations with the Vatican. In this paper, I investigate the nature of conscientious objection claims in Italy today. Based on the literature, I expect to find that there may be abuse of claiming conscientious objection, where some people do not truly have a religious or moral objection to abortion. Instead of moral values, I expect to find that economic, labor, and social concerns motivate these doctors to object. I also anticipate that various authorities will attribute responsibility for guaranteeing the provision of abortion services to other levels of authority, resulting in a situation where no actor feels empowered to enforce this policy.