Abortion in Italy became legal in May 1978, when Italian women were allowed to terminate a pregnancy on request during the first 90 days. A proposal to repeal the law was considered in a 1981 national referendum, but was rejected by nearly 68% of voters; another referendum aimed at eliminating the restrictions was rejected by 88.4%.
Italian women are eligible to request an abortion for health, economic or social reasons, including the circumstances under which conception occurred. Abortions are performed free-of-charge in public hospitals or in private structures authorized by the regional health authorities. The law also allows termination in the second trimester of the pregnancy only when the life of the woman would be at risk if the pregnancy is carried to term or the fetus carries genetic or other serious malformations which would put the mother at risk of serious psychological or physical consequences.
The law states that, unless a state of emergency requires immediate intervention, a period of seven days has to occur between the medical authorization and the effective date of the termination. Although the law only permits pregnancy termination to women at least eighteen years old, it also includes provisions for women younger than eighteen, who can request the intervention of a judge when the legal tutor refuses the intervention, or there are reasons to exclude the legal tutor from the process. The judge has to make a decision within five days of the request.
Since 1980, the Laboratory of Epidemiology and Biostatistics at the Istituto Superiore di Sanità (ISS) in Rome has maintained a surveillance system for legal induced abortions. This system is based on quarterly reporting by the regional health authorities. A standardized form is compiled that contains aggregate data on major social-demographic characteristics of the woman (age, residency status, marital status, reproductive history) as well as details about the procedure (weeks of gestation, whether the procedure is elective or performed on an emergency basis, where certification was issued, type of procedure and location where it was performed, duration of stay, and immediate complications. This information is then sent to the ISS, which examines data quality and performs data analysis of trends, geographic distribution, and characteristics of women undergoing abortion. These analyses are performed annually by the ISS and the Ministry of Health (MH) and presented by the Minister of Health to the Parliament; results are also published in ISTISAN reports, an official publication of the ISS. Italy is considered to have one of the most accurate and timely abortion surveillance systems in the world.
In 1993, the abortion ratio in Italy was 9.8 per 1,000 live births (Table 2). However, this measure also varies regionally. The central and northern regions (in particular Emilia-Romagna, Liguria and Tuscany) are characterized by relatively low TFRs (one lifetime birth per woman), high abortion rates and elevated abortion ratios. While low levels of fertility can also be found in some of the northwestern regions, abortion rates are moderate in these regions (9-12 abortions per 1,000); therefore, abortion ratios in a few of these areas are closer to the national level.
Subsequent to the legalization of abortion in Italy in 1978, abortion rates among Italian women first rose and then declined steadily, from a peak of 16.9 abortions per 1,000 women of reproductive age in 1983 to 9.8 per 1,000 in 1993. Abortion rates vary considerably by geographic region, with rates typically highest in the more secular regions and lowest in regions where traditional values predominate. Data from 1981 and 1991 indicate that age-specific abortion rates decreased during the 1980s for all age-groups, with the largest declines occurring in regions with the highest levels of abortion. Moreover, a shift in the age distribution of abortion rates occurred during the 1980s, with women aged 30–34 registering the highest abortion rate in 1991, whereas in 1981 the highest level of abortion occurred among those aged 25–29. The abortion rate among adolescent women was low at both times (7.6 per 1,000 in 1981 and 4.6 per 1,000 in 1991). These data are based only on reported legal abortions; the number of clandestine abortions remains unknown.
A phenomenon to emerge in recent years has been an increase in the number of abortions requested by immigrant women. Among the 138,357 abortions performed in 1993, 13,826 (10%) involved foreign residents, an increase from 9,850 in 1996. This increase is most likely due to the rising number of immigrant women in Italy; the resident permits, for example, according to the data of the National Statitstics Institute (ISTAT), have increased from 678,000 in 1995 to 1,100,000 in1999. Based on estimates of the population of immigrant women 18–49 years of age, Istat has calculated that the AR for immigrant women was 28.7/1000 in 1998, approximately three times higher than that observed in Italian citizens. Indeed the increase in the numbers of immigrant women may be the main cause of the leveling-off of the abortion rate in Italy. If the analysis of trends is limited to 1996-1998, years for which information is most complete on residency status, the number of abortions in Italian women declined from 127,700 in 1996 to 123,728 in 1998
In 1993, approximately 140,000 induced abortions were performed in Italy. In comparison, the average annual number during the period 1982-1984 was more than 230,000. Similar patterns can also be seen in abortion rates. After legalization, abortion rates rose modestly, increasing from 13.7 abortions per 1,000 women aged 15–44 in 1979 to a peak of 16.9 per 1,000 in 1982 and 1983. During the period 1982-1984, Italian abortion rates stabilized, and this period was followed by a steady decline: By 1986, the rate had dropped to 14.0 abortions per 1,000 women, and by 1990 it had reached 11.1 per 1,000; by 1993, the abortion rate had decreased to 9.8 per 1,000.