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ABSTRACT
This article explores obstetricians-gynaecologists’ experiences and attitudes towards abortion, based on two mixed-methods studies respectively undertaken in Italy in 2011–2012, and in Spain (Cataluña) in 2013–2015. Short questionnaires and in-depth interviews were conducted with 54 obstetricians-gynaecologists at 4 hospitals providing abortion care in Rome and Milan, and with 23 obstetricians-gynaecologists at 2 hospitals and one clinic providing abortion care in Barcelona. A medical/moral classification of abortions, from those considered ‘more acceptable’, both medically and morally – for severe foetal malformations – to the ‘least acceptable’ ones – repeated ‘voluntary abortions’, emerged in the discourse of most obstetricians-gynaecologists working in public hospitals, regardless of their religiosity. I argue that this is the result of the increasing medicalisation of contraception as well as of reproduction, which has reinforced the stigmatisation of ‘voluntary abortion’ (in case of unintended pregnancy) in a context of declining fertility rates. This contributes to explain why obstetricians-gynaecologists working in Catalan hospitals, which provide terminations only for medical reasons, unlike Italian hospitals, do not experience abortion stigma and do not object to abortion care as much as their Italian colleagues do.
Acknowledgements
I would like to thank all research participants.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1 Public hospitals sometimes allow Catholic groups to perform these burials.
2 All translations from Italian and Spanish to English are mine.
3 The limit of viability is defined as the stage of foetal maturity that ensures a reasonable chance of extrauterine survival with bio-medical support. The gestational age and birth weight below which infants are too immature to survive, and thus provision of intensive care is unreasonable, appears to be at <23 weeks and <500 g. (Seri & Evans, Citation2008).
4 The Council of Europe (Citation2014) declared that in Italy women’s right to health is violated because of the high rates of conscientious objection and called on the Italian State to ensure access to abortion care in all its territory. It recently added (Citation2016) that abortion providers are, and should not be, discriminated at their working place for providing abortion care.
5 The Ministry of Health (Italia, Ministero della Salute, Citation2016) has estimated that between 2005 and 2012 approx. 12,000–15,000 abortions were performed illegally. News of illegal abortions performed in exchange for money (abortion is free in Italy) at clinics that are not registered as abortion providers, or via self-administered misoprostol, appear periodically in the Italian press, but there are no studies on this issue.
6 Italian women represent the second largest national group of non-resident women (after Irish women) travelling to England to seek abortion services (UK, Department of Health, Citation2016). In October 2016, I started a research project funded by a ERC (European Research Council) Starting Grant to study the barriers to legal abortion in European countries with relatively liberal abortion laws, like Italy and France, and abortion travelling.
7 Under the 2010 abortion laws in Spain abortion up to term is available where malformations are incurable or incompatible with life.
8 The PP government, however, managed to modify one article of the 2010 law, making parental consent mandatory again for minors aged 16 and 17.
9 Fictitious names are used for hospitals and clinics as well as for participants.
10 I was invited to publicly present the results of my study only at one debate on conscientious objection organised by pro-abortion rights organisations in Italy in 2012. At the public debates I attended to as well as at the hospitals where the study was carried out, I always presented myself as an anthropologist who was doing research on abortion and conscientious objection in health professionals’ perspectives. Most physicians did not ask me what my position on abortion was, with the notable exception of a few abortion providers in Italy, who asked me in the end of the interview if ‘I was an objector or not’. When I was asked about my personal position, I answered that I consider abortion as an interesting and highly controversial subject from a researcher perspective, and, at the same time, as an important issue from a public health and human rights perspective, because in countries where abortion is not legal women die from unsafe abortion.
11 In the UK, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior hospital-based physician or surgeon who has completed all of his or her specialist training and been placed on the specialist register in their chosen speciality. I use this term to refer to all Italian and Spanish/Catalan physicians who have completed their residency in obstetrics-gynaecology and have a permanent position at their hospital/clinic.
12 At HB there were serious conflicts and tensions between the obstetrics-gynecology service, whose chief was an objector, and the day hospital abortion service, whose chief openly supported this study, which explains our difficulties in recruiting physicians, particularly objectors.
13 Data collection at HN started half a year later than at HY, which explains the lower participation rate of physicians. Moreover, HY is a University Hospital more accustomed and open to academic studies.
14 All defined themselves as non-religious.
15 In order to recruit potential objectors, I sent my research protocol to two important Catalan hospitals administered by private, Catholic foundations that do not allow abortion provision, but I never received any reply.
16 In Italy, abortion rates are higher (17.2/1000 in 2014) and repeated abortion is more common among immigrant women than among Italian women. However, these rates have started to decrease over the last few years.
17 Most physicians acknowledged not knowing whether sexual education and contraception were easily available in these women’s countries of origin. In the Soviet bloc abortion and contraception were available and free, with the notable exception of Romania during Ceausescu Dictatorship, when both were illegal (1965–1989). However, hormonal contraception was not widely available. Low dosage pills in particular became widely available only after 1989, but the subsequent privatisation of health services did not improve access to contraception, particularly for low income women.
18 Dr Toni used the Spanish term ‘infantilizado’, but he probably meant ‘personified’.