“The phenomenon of decline continues.” With those words Italy’s Minister of Health Beatrice Lorenzin began her recent presentation before Parliament on the Annual Report for 2014 on abortion in Italy, as mandated by enabling Law 194/78. Ms. Lorenzin was referring to preliminary data for 2014 on the number of abortions in Italy, which have fallen consistently for 10 consecutive years.
Last year abortions in Italy (population 61 million) fell below the 100,000 level for the first time. The preliminary total of 97,535 represented a 5.1 percent decline from the previous year and, if confirmed (there are usually only minor revisions), would be the largest yearly drop of the last decade.
Given that one-third of all abortions are had by foreign women residing in Italy, results are even more impressive when only abortions by Italian women are considered. Compared with the peak year for abortions—they topped at 234,801 in 1982—when all involved Italian women, the decline is more than 71 percent.
The report’s details
The Minister of Health’s Report contains definitive data for 2013, given in considerable detail including some international comparisons, and preliminary estimates for 2014. Legal abortion was introduced in Italy in 1979; the number shot up to 234,801 by 1982, then began an almost uninterrupted decline to 97,535 last year.
More important as a trend indicator is the abortion rate—the number of abortions per 1,000 women in the 15-49 age bracket—which fell from 17.2 abortions per 1,000 women in the peak year of 1982 to 7.6 abortions in 2013 and 7.2 abortions last year, a 5.9 percent drop year-on-year and a 58.5 percent decline from 1982. According to Minister Lorenzin: “The Italian data remain among the lowest compared with other industrial countries.”
The report includes comparative data for 20 countries (calculated by covering women aged 15-44) which show that only Switzerland, Germany, and the Netherlands have lower abortion rates. The highest remains Russia. The United States data for 2011 indicated a rate of 16.9 abortions per 1,000 women.
Another significant indicator is the ratio of abortions per 1,000 live births. Provisional data for 2014 show a ratio of 198.2 abortions per 1,000 live births, a decline of only 2.8 percent given that in 2014 the number of live births fell for the second year in a row, and showed a 47.9 percent decline compared with 1982 (380.2 abortions per 1,000 live births). Final data indicate that in 2013 there were 102,760 abortions compared with 503,792 live births.
Abortion data are broken down in terms of Italian and foreign women. With the influx of millions of migrants into Italy, more and more foreign women have had recourse to abortion although the absolute number has stabilized somewhat in recent years. In 1995, the Ministry of Health began collecting data by nationality. Today foreign women account for 34 percent of all abortions and have three to four times the abortion rate of Italian women. In 2013 that rate was 6.2 abortions per 1,000 women for Italians and 19.0 abortions per 1,000 women for foreigners. The latter pushed up the national average that year to 7.6 abortions per 1,000 women.
Minus foreign women the number of abortions in Italy in 2013 was 68,382, an almost 71 percent decline from the 1982 peak, when all abortions were had by Italians. Of the foreign total of 34,378, half were accounted for by women from Eastern Europe (where abortion has been fairly common since Soviet times), 19 percent by Africans, 16 percent by Asians, and 15 percent by women of other areas. The higher incidence may be attributable to a lack of sexual education, according to the report.
The majority of all abortions, or 44 percent, occurred at eight weeks or less, and 38 percent occurred at nine to 10 weeks. There is a mandatory waiting period between abortion approval and when the procedure actually takes place; approximately 62 percent occurred under 14 days while 4.4 percent took place after waiting 28 days or more.
In 2013, only 3.2 percent of all abortions were had by women under 18 years, indicating a low teenage abortion rate. There were 3,225 abortions on minors, 72 percent of whom had obtained parental consent and 27 percent of whom had judicial approval for the procedure. The highest recourse to abortion by age occurred in the 25-34 age range. These women accounted for almost 42 percent of all abortions.
By marital status, 51 percent of abortions were had by single women, 42 percent by married women, and the remainder by others (separated, divorced, widowed).
Women at both ends of the education spectrum had the fewest abortions: highly educated women and women with very little education. Women with tertiary degrees or higher accounted for only 9.8 percent of all abortions, while those with elementary education or less recorded 5.6 percent of the total. Nearly 44 percent were employed and 24 percent were housewives.
Conscientious objectors abound among medical personnel
Last year’s report once again showed a very high percentage of doctors/gynecologists refusing to perform abortions, although the percentage seems to have plateaued at a high level. In Italy 70 percent of gynecologists refuse to perform abortions, as do 49 percent of anesthesiologists and 47 percent of other medical personnel.
The percentage of conscientious objector doctors is over 80 percent in eight of Italy’s 21 regions and over 90 percent in three regions: Molise in central Italy, Bolzano in the Dolomite Mountain area near the Austrian border, and in Basilicata in the south.
Given that so many doctors refuse to perform abortions, Italy’s left-wing government and the Minister of Health became alarmed that women might be inconvenienced if abortion-performing doctors were not readily available. However, data show that 87 percent of abortions were performed in the woman’s province of residence.
Given the high incidence of conscientious-objector doctors, data in the latest edition of the abortion Annual Report include some hospital details. Of 632 medical facilities having an obstetric/gynecological department, only 379, or 60 percent, are willing to perform abortions.
The report even includes information on deaths of women due to abortion. There were only two in 2014, one drug related and the other surgical. Such data—maternal deaths occurring where abortion is legal—are never given by the United Nations. Moreover, the Italian abortion report even makes estimates for clandestine abortions, which they believe continue to occur not because abortion is not covered by the health system, but perhaps for reasons of privacy or anonymity. Using a mathematical model for estimation, the results came up with a range of 12,000 to 15,000 clandestine abortions—perhaps disproving another United Nations shibboleth that legal abortion is necessary in order to end clandestine procedures.
A perspective on procreation
The Ministry of Health Annual Report is largely limited to data collection and presentation. There are no accompanying surveys to assess the results. It might be easy to think that contraception has led to lower abortion rates. Indeed all methods of contraception are available in Italy. However, there are no current data for contraceptive use. UN data for Italy are only available for 1995-96 in its latest publications. At that time the data indicated a low recourse to “modern methods” compared with “natural methods” of contraception.
Other factors may come into play in the abortion scenario. First, Italy remains much more of a strong traditional family-centered society with higher rates of religious observance, certainly when compared with most other European countries. Secondly, Italians are aware of their low fertility rate, which has been below replacement level for decades as it is in most other developed countries. In Italy the fertility rate of 1.4 is below the European Union average of 1.5. Thirdly, since the global economic crisis of 2008, many young Italian professionals—adults of childbearing age—have migrated to more prosperous countries like Switzerland and Germany in search of work. Finally, the stagnant Italian economy has discouraged immigration. As a result, the prime age population has tended to stagnate.
Italian data also indicate that it is possible for a country to have access to abortion on demand—and then discover that the “demand” may not be so compelling. The Report of the Minister of Health includes this statement: “The prevention of abortion is the primary objective of the public health system.” Given recent data, the Ministry can be said to have achieved rather remarkable results.