By Danielle Pullan and Payton Gannon
Delayed data on abortion care in Italy impacts citizens’ ability to effectively advocate and hold their government accountable for the management of public healthcare. The Italian Ministry of Health is required to report data on abortion yearly, but this year’s report was significantly delayed. Scholars, advocates, and doctors themselves have raised concerns about transparency and data quality, and how delays affect trust in democratic institutions.
Abortion in Italy is governed by Law 194 of 1978. Alongside defining the circumstances under which abortion is permitted, this law requires the Ministry of Health to produce an annual report about the implementation of the law. In many ways, this law was ahead of its time in mandating the publication of data on public institutions. Nearly identical reports have been produced each year since its passage, and the law itself has not been amended. The report includes a significant amount of data about the personal characteristics of people who have abortions, how far along their pregnancies are at the time of abortion, differences in abortion trends across regions, and regional data about the availability of abortion services. Most of this data, particularly that focused on patients, is of high quality and provides interesting insights into the demographic trends in Italy.
The report also includes data on conscientious objection rates, or the proportion of healthcare providers refusing to participate in abortion care due to ethical or moral beliefs.
Conscientious objection to abortion is a significant component of the abortion debate, impacting patients’ ability to access abortion in Italy, and it is the most controversial aspect of what could otherwise be a rather technical report that primarily interests scholars.
Medical personnel opposed to abortion use conscientious objection to opt out of the abortion provision, though the law does not explicitly define the term.
Conscientious objection is not unique to Italy: 87 countries allow conscientious objection in some form. Scholars, journalists, activists, and doctors in Italy and elsewhere report that conscientious objection causes problems accessing abortion care. Due to the required annual report on Law 194, Italy has robust data about conscientious objection that is simply not collected or not available in many countries, and because of this, we can see that Italy has quite a high rate of objection.
The data released on conscientious objection is incorrect
While the demographic and medical data is robust, the Ministry also releases the percentage and number of gynecologists, anesthesiologists, and other medical personnel who identify as objectors. The Ministry uses these numbers to calculate the number of abortions per non-objector per week in each region.
The Ministry incorrectly conflates the number of non-objectors with the number of abortion providers. Many doctors who identify as non-objectors do not actually work to provide abortion services because of bureaucratic choices by the hospitals and regional health authorities.
In addition to issues with data accuracy, the Ministry’s reports are plagued by recurring delays in publication. According to the letter of Law 194, the data on abortion services from the prior year should be published in February of the next year, i.e., the 2023 data should have been published in February 2024. In practice, this has not been the case in the last 20 years, and there seems to be confusion in the media about when exactly the report is due. The data for 2022 was just published at the beginning of December 2024, and the 2023 data is not expected any time soon. The Ministry of Health says there were problems collecting the data, with some regions not reporting their 2022 data until December 2023 (p.18). While regional delays are obviously beyond the Ministry’s control, the second year of delay in the publication timeline is not explained.
Source: Authors’ representation of the annual reports from the Ministry of Health on Law 194 of 1978 published from 2005-2024 onward. http://www.salute.gov.it
Some suggest that this delay in releasing the data is part of Prime Minister Giorgia Meloni’s government’s general hostility to abortion and nontraditional families in general. Her party, Fratelli d’Italia, passed a law this year that allows pro-life groups to enter family planning clinics, where patients seeking abortions need to go to have their pregnancy certified. In October 2024, Fratelli d’Italia spearheaded another law that prohibits Italians from registering children born in surrogacy arrangements abroad, with surrogacy already having been domestically banned since 2004. The Ministry is currently led by Orazio Schillaci, a member of Fratelli d’Italia and professor of nuclear medicine, who has previously been criticized for his team’s management of data in scientific publications. Given the Ministry’s history of delayed publication, we doubt that the government’s anti-abortion stance fully explains this – there are clearly documented delays in the publication of this report going back at least 20 years, and civil society groups have criticized the quality of the data well before the Meloni government took power.
Why does it matter that the abortion data is delayed?
Italy has a nationalized healthcare system. Law 194 requires that abortions be available in public hospitals. The only way citizens can ensure the government is living up to its legal obligations is to assess this data each year.
When the data is severely delayed, activists, civil society, patients, and the public are not able to properly advocate to fix any problems that have arisen.
These delays undermine democratic accountability, erode public trust in institutions, and weaken civil society’s capacity to advocate for change.
The repeated failure to properly manage conscientious objection as required by Law 194 has been recognized by international courts. In 2015, the European Committee on Social Rights found that Italy was violating the European Social Charter. In their decision, they reference LAIGA’s (Free Association of Italian Gynecologists for the implementation of Law 194, Libera Associazione Italiana Ginecologi per Applicazione Legge 194) finding that there were 391 gynecologists working at hospitals in Lazio, of whom only 33 actually performed abortions, or a 91.3% rate of objection. The Ministry, contrastingly, reported Lazio had an objection rate of 80.7% that year.
The intentions behind gathering and reporting such robust data on abortion services are admirable, but they are not effectively implemented.
Activists, advocates, journalists, and researchers have been sounding the alarm that the conscientious objection data is incorrect and paints a rosier picture of access than exists on the ground for years.
In lieu of more current or detailed data from the Ministry, several civil society groups have created maps showing which hospitals actually provide abortion services. Reporters undertook an extensive project to attempt to calculate the percentage of gynecologists actually providing abortions in Italy. Academics have also critiqued the claim that the levels of objection do not affect the waiting period to receive an abortion and that the number of abortion providers is substantially lower than the number of objectors suggests. The Ministry has never officially opined on these organized efforts, though they pledged in 2022 to address the quality of data published in the annual report on Law 194. This program has minimal public documentation of its work but is certainly a first step towards producing more useful, timely data.
Good public administration requires good data
Ultimately, the delay in the data can cause issues for both patients and abortion providers.
It is already difficult to figure out which hospitals in Italy actually run abortion services, and this is an effort primarily shouldered by activist groups.
However, the number of abortions, doctors, or the most common method of abortion is also useful information for patients seeking care. For example, over the past five years, because of regulatory changes, the number of medication abortions (or “pharmacological abortions” in Italian) has almost doubled.
High-quality abortion data is helpful for doctors and regions when organizing their abortion services and evaluating the most effective way to train and utilize doctors.
Fundamentally, Law 194 requires that Italy collect and report each year on the state of abortion; failing to live up to this legal requirement erodes the public trust and undermines Law 194 and democratic principles. This data must be both timely and accurate, and currently, there are serious doubts on both of these fronts. Feminists and bioethicists have long critiqued the concept of conscientious objection altogether, and abolishing Article 9 of Law 194 would solve the problem of inaccurate data by making it obsolete. Citizens struggle to trust Ministry data when it is heavily criticized by reputable advocates, and Ministry efforts to improve the data quality and increase transparency move very slowly. Without trust in this data, citizens lack the capacity to hold their government accountable for adequate management of the public health service and, ultimately, for the guarantee of abortion rights promised by Law 194.
Danielle Pullan is a postdoctoral researcher and instructor at the Cologne Center for Comparative Politics at the University of Cologne. She researches abortion policy and abortion access as well as gender in parliaments.
Payton Gannon is a JD candidate at Georgetown University Law Center and Editor-in-Chief of the Annual Review of Gender and the Law. She was a Fulbright Scholar in 2021-22, during which time she was based at Bocconi University and conducted research on abortion in Italy.
