Italy approving outpatient use for the abortion pill is finally a step in the right direction for women's rights

Women will now be able to take the abortion pill in day hospital, Italy’s health minister says. At last, some good news for women’s rights

Roberto Speranza announced an update of the regulation of medical abortion last weekend. “The new guidelines, based on scientific evidence, provide for the medical voluntary termination of pregnancy in day hospital and up to the ninth week. It is an important step forward in full compliance with Law 194 [Italy’s abortion law] which is and remains a law of civility”, he tweeted.

The change in guidelines is the first in 10 years and will allow women to use the abortion pill on an outpatient basis. In a country where seven out of 10 gynaecologists are conscientious objectors and ultra-Catholic groups are particularly strong, the regulation shows an advancement of women’s rights.

Before this review, in fact, women needing the abortion drug mifepristone (also known as RU486) had to be admitted to hospital for three days and were able to take the medication only within seven weeks of amenorrhea - one or more missed menstrual periods. Both these recommendations go against World Health Organisation’s guidelines on medical abortion and differ from the practice of most European countries.

Now, women in Italy will be able to take the mifepristone in day hospital, where they’ll be monitored for half an hour. Once assured that the patient is physically and emotionally well, they’ll be sent home to take a misoprostol pill 48 hours later.

Heartily welcomed by women’s rights and pro-choice organisations, the new change in guidelines is a success for both women and the public health system.

Medical abortion was first introduced in Italy in 2009, almost 20 years after the UK. It involves a simple medication, which causes the cervix to soften and the uterus to contract. The pregnancy is subsequently expelled from the uterus.

Opposed by the church and, now, far-right and ultra-Catholic groups, its use has been hampered over the years. With authorities imposing time restrictions and strongly advising a three-day stay in hospital, fewer and fewer women opted for non-surgical abortions. According to Italy’s health ministry, only 18 per cent of abortions in 2017 were done using the mifepristone pill.

On the one hand, the prospect of staying in hospital might scare women who are likely to prefer being surrounded by the support of their families and friends. On the other, Italy’s gender inequalities are particularly pronounced in the domain of work; therefore, women might feel intimidated by the idea of taking days off.

Medical abortion is not only a safe procedure which is less invasive than its surgical counterpart, but can also be easily accessible. This is crucial, especially during a pandemic which saw Italy adopt a strict lockdown. Opting for medical abortions means reducing contact and avoiding women taking up hospital beds unnecessarily.

During the Covid-19 emergency, in fact, abortion rights have been trampled upon. Multiple hospitals across Italy suspended medical abortions, while others had been transformed into so-called “Covid hospitals”, shutting down all other surgeries, including abortion services.

At the same time, Italian ultra-conservative group ProVita e Famiglia tried to seize the moment with an online petition to block women’s abortion rights nationwide, claiming that abortion was not an essential service during a pandemic.

Ultra-conservatives have felt threatened the most by the new regulation, especially after spending years trying to tamper with women’s reproductive rights. In 2018, in fact, pro-life activists promoted several municipal anti-abortion motions across the country, one of which of was passed in Verona. It’s in that northern Italian city that ultra-conservative groups chose to host the World Congress of Families, which was described by the Southern Poverty Law Center as a coalition of far-right, anti-gay, Christian groups.

They were among the supporters of Donatella Tesei, president of the Umbria region. Two months ago, she announced that women in Umbria would no longer be able to access pharmacological abortions in day hospitals or at home. Her decision was met with stark criticism from gynaechologysts, women, and feminist groups.

The new legislation was introduced specifically in response to the controversy surrounding Tesei’s resolution, which as a consequence has been overturned. However, in a country where most doctors who can carry out abortions are conscientious objectors, often refusing to carry out the procedure, the new guidelines need to be just the first step. Italy needs to do more to protect women’s rights.