ROME — If a woman wants to end her pregnancy in Italy, she has the legal right to do so under the public health system within the first 90 days, or first trimester, of the gestation. The law, known in Italy as Law 194, has been on the books for nearly 40 years, but it has one major flaw, say pro-choice advocates: It allows for doctors, nurses, anesthetists, and other assistants to an abortion procedure to be conscientious objectors. Boiled down, that means that many administrators of hospitals and clinics who do not support the pro-choice law simply hire abortion doctors who object to performing abortions.

The practice of hiring conscientious objectors is all-too-common across Italy. The national estimate of conscientious objectors hired as public health gynecologists mandated to perform abortions is around 70 percent, meaning seven out of 10 doctors can, but won’t, do the procedure.

That average is slightly higher in Rome, at 78 percent, likely because of the proximity to the Vatican, easily the world’s greatest objector to the practice. Late month, Nicola Zingaretti, the governor of Lazio (the region where Rome is), put out a call for two non-objecting abortion doctors to join the staff at the city’s massive San Camillo Hospital. Writing on his blog, he lamented the obstacle the dearth of abortion doctors poses on women. “The real risk is that the right to abortion is denied to women on a daily basis,” he said, explaining why gynecologists interviewed for the post were being asked specifically if they would actually perform the procedure. 

The Italian Bishops Conference swiftly responded, condemning what it called a stifling of a doctor’s ability to object. Citing a long-held theory that Italy included the conscientious-objector clause in the 40-year-old law as a way to enact the law without actually having to implement it, Father Carmine Arice charged that Zingaretti was the one who was bending the rules. “It fundamentally changes the nature of Law 194—that did not have the goal of inducing abortions but to prevent them,” Arice told ANSA after Zingaretti’s blog post. “It does not respect the constitutional right of being a conscientious objector.”

Italian Health Minister Beatrice Lorenzin said public hospitals can, indeed, hire doctors to perform specific duties, but they couldn’t be held to those duties if they change their mind and decide they can no longer perform abortions, even if they said they would when they were hired. “The right to conscious objection must be maintained,” she said in a statement.

Emma Bonino, a lawmaker with the Radical party and one of Italy’s most ardent fighters for equal rights, said institutions “have long abused the conscientious-objector law to placate the Catholic Church.” She says that San Camillo and other facilities like it, whose abortion doctors won’t perform abortions, are the ones “breaking the law by not guaranteeing the right to a safe procedure.”

Over the weekend, a 41-year-old woman from Padua in northern Italy, speaking through a spokesperson with the trade union CGIL, revealed that she had to try 23 different hospitals before she finally found one to terminate her high-risk pregnancy. The married woman and mother of two got pregnant while using an inter-uterine device, a situation that can cause complications to both mother and child. Even with her special circumstances, and just a few weeks into her pregnancy, she couldn’t find anyone to help her until CGIL got involved. They were able to intervene and find a doctor within a week.

The alternative for many women is to go to an illegal abortion doctor, a practice that was made a crime last February and comes with fines of as much as €10,000 if women are caught.

Silvanna Agatone, president of the Free Italian Association of Gynecologists, said women who undergo illegal procedures often refuse to seek medical care from public hospitals if they have complications from the rogue abortions out of fear they will be reported and fined.

“Now if women have complications it is unlikely that they will go to a public hospital for treatment, because if the doctor who treats them reports their illegal abortion they will be heavily sanctioned,” Agatone ++said last year++[[ http://www.thelocal.it/20160224/anger-as-italian-women-to-be-fined-up-to-10k-for-secret-abortions ]] in opposition to the hefty fines. “It is not uncommon for women to experience life-threatening septicemia after an abortion. They should be made to feel comfortable about getting treatment, without fear of reprisal.”

As of this week, San Camillo Hospital in Rome still hadn’t filled its positions for two doctors willing to perform abortions. It’s impossible to calculate what that continued lack of legal health care means for women at risk or to determine just how many women are being forced to carry unwanted or unsafe pregnancies. Or, how many women feel forced to go to an illegal abortion provider to get what should be provided legally.