Da Trieste in Giù: Italy's Postcode Lottery of Reproductive Rights

Since 1978, Italy's Law 194 has guaranteed abortion right, yet conscientious objection among medical staff severely undermines access. On average, 65% of Italian gynaecologists refuse to perform abortions, with rates exceeding 75% in southern regions (peaking at 85% in Sicily and 84% in Abruzzo). Northern regions report lower rates (around 55%), with notable exceptions like Aosta Valley (17.1%) and Emilia-Romagna (45%). While the north-south divide and regional religiosity partially explain these disparities, anomalies persist. For example, Lazio, despite low religiosity, has above-average objection rates; Emilia-Romagna and Abruzzo, with similar religiosity levels, exhibit different objection rates (45% and 84%, respectively). This raises the following question: what factors explain the variation in conscientious objection to abortion across different Italian regions? Most scholarship on abortion policy focuses on formal, cross-national adoption, neglecting subnational implementation gaps. This paper addresses this gap by analysing conscientious objection as an informal barrier to abortion access in Italy, contributing to debates on informal institutional barriers, subnational policy implementation, and abortion rights in Italy. It investigates subnational variation in objection rates, testing eight potential explanations: 1) hospitals’ decisions to hire objectors, 2) gynaecologists’ career concerns related to performing abortions, 3) religiosity and public support for abortion access, 4) civic (dis)engagement and political participation, 5) anti-abortion and pro-choice social movement mobilisation capacity, 6) political party mobilisation and level of support for different political parties, 7) media coverage of objection and misinformation about abortion access, 8) historical church-state relationships. Related to this first puzzle, the paper also explores why there isn’t greater social movement mobilisation in the regions with high levels of objection. Methodologically, we adopt a mixed-methods approach combining large-n quantitative time series analysis across the regions with case studies to test causal mechanisms.