19 January 2012

The Catholic Church and reproductive freedom in Italy, part 1 of 2: Emergency contraception

So here have you my first “real” blog entry. I'm basing the information on a number of Italian articles on the subject (linked throughout). Consider this an attempt to spread the news outside Italy.

A remark I often hear when talking to Italians is that, ”Il problema dell'Italia è che abbiamo la chiesa a casa”; ”Italy's problem is that we have the church within our home.” With this they refer to the profound influence of the Catholic Church and the Vatican on a number of issues in Italian society, which are elsewhere in the world solved without glancing towards Papa Ratzinger's opinion on the matter.
An example: emergency contraception, also known as morning-after pills. In other European countries you can buy this without a prescription, in some you do need to shortly speak to a doctor first, before getting a prescription and perhaps some admonishing words along the way. Where in Denmark these pills have been sold freely the last ten years or so, in Italy you need a prescription, and the doctor can refuse to prescribe it if he or she is a Catholic.

How so? Read more after the jump.

In the Italian legislation on abortion there is an option for doctors to be conscientious objectors (obiettori di coscienza, a term normally used in relation to the military and conscription), on grounds of religious beliefs. This has been interpreted in such a way that they on the same grounds can deny prescribing emergency contraception. This, because there is some doubts as to whether the pill technically might prevent a fertilised ovum from sticking to the uterine lining; even though there is general agreement to the pills functioning contraceptively by preventing the ovum from 1. leaving the ovary and 2. being fertilised; and that even if the pills actually do work by preventing the sticking to the uterine lining part, there are varying interpretations of whether this can even be considered an abortion. So, because the pill might possibly have a certain effect, by Catholic organisations it becomes conflated with abortion as such, and this lets doctors refuse to do their job, on religious grounds.

A variety of the pill, EllaOne, which works for up to 120 hours (5 days) after the ”inopportune moment” (ahem), was approved in the rest of Europe and put into trade in 2009, while it in Italy will only be available sometime in spring 2012, because of the lobbying from various Catholic organisations referred to above, which argued against it and called it abortive, and therefore wanted it to remain unapproved. Never mind that abortion is legal in Italy!

In connection with the release of the pill into trade, a number of conditions were put on its distribution to individuals with the need and wish for it: it is available only on prescription, and should one manage to find a doctor who does not refuse to prescribe it due to religion, the pharmacist might refuse to sell it for that reason. (See this video (in Italian) for an example of a woman going in vain to several different hospitals in Rome trying to get a prescription.)

Before the doctor is allowed to make the prescription, he or she is obliged to prescribe a blood test which is to be examined in a laboratory in order to be sure that the woman isn't pregnant (and the pill might work abortively). So basically: you are only given access to emergency contraception when it has been ascertained that you do no longer have any need for it (because fertilisation did not in fact occur).

Here it is part of the story that in Italy a general practitioner cannot take a blood sample. The doctor makes out a prescription, sends you to another office where you book an appointment for a third place where they take the actual sample and ask you to return after a certain period for the results, which you will then take back to your doctor. It moves this smoothly, if you're lucky, naturally. I also assume that in these cases they can actually manage to do all the testing in less than a week, though I never experienced that personally.*)

The point of a morning-after pill is, of course, that it should be taken as soon as possible after the situation creating the need, so the more time that passes with blood tests and prescriptions, the less likeliness of it having any effect. I think the time issue is behind the whole bureaucratic exercise of blood tests and paperwork. A urine test would be just as effective in determining pregnancy, and could be done on the spot, no need for laboratory tests and whatnot, but is not allowed.+)

So, should it turn out that you are in fact pregnant, you will of course not get the prescription (but since it would no longer have any effect, that suddenly seems somehow unimportant), whilst if you did not become pregnant you can get it, though it no longer serves it purpose, or is highly unlikely to anyway.

If you do not let people have the morning-after pill while it might work, and then put up all sorts of conditions for it, you are in reality determining women's rights to decide their own pregnancies (and when or not to have them). So what the influence of the Catholic Church does, through an incredibly immense respect for the moral scruples of each doctor, is to control the reproductive rights of Italian women. Even though the possibilities for auto-control exist, and are fully legal, through a series of bureaucratic exercises the access to them is made so complicated that in some cases it is impossible in practice.
This might seem relatively harmless (not that I personally think it is, mind you) – I already mentioned that abortion is legal, so should things go wrong, and a women get into an unwanted pregnancy, something can still be done! Right?

Not as simple as you might think, and in the second instalment of the post I will go into some of the difficulties surrounding access to abortion in Italy and the influence the Catholic Church is exercising hereupon. Stay tuned!

*) This is the procedure for blood tests and other healthcare services in Bologna anyway (from personal experience), and conversations with others indicate that it generally works likewise in other areas of Italy as well.

+) I cannot currently find the article where I read this information. Link will be up as soon as possible.

Also published (in a slightly different version in Danish) at: http://okumeni.eftertanke.dk/2012/01/19/n%C3%B8dpraevention-i-italien-vatikanet-og-italien-12/


  1. Wow! I did find your post great!

    I didn't know anything on how this issue is being carried out in other countries of our (beloved) Europe. Here in Spain we're dealing with a similar problem. Surely you've already heard of it.

    The reasons given in Spain against the pill (or at least the ones I've heard) are more of another kind: they deal with the health troubles that it may cause: undesired menstruations, a real alteration of the menstrual period, sickness after the consumption, etc...

    So, is it good to make the access to this pill easy, or should we put some "troubles" when looking for it?

    If the risks for the health of a woman are that true, I think we should make efforts to educate society on the risks of the pill, and this could be done on the same "quest" for the pill. Doctors also shouldn't have the possibility of refusing the prescriptions because of being conscientious objectors.

    I'm only sure that the second step (the one that prevents doctors from being conscientious objectors) is working fine. However, I don't know which campaign has been prepared to make people aware of the risks, and this upsets me a bit. We are dealing with health! There are A LOT of campaigns to prevent young people from smoking, or to prevent drivers from drinking. There are even TV channels that are proud to show how much they care about obesity (i.e. Antena 3). There are TV spots to make people conscious about the risks of self-medicating when, for example, you have to take antibiotics, but nothing public has been said about the risks of the pill.

    The way you're explaining makes me think that Italy’s methods are nonsensical. For sure I don't want this to happen here!

    But what you say is true. Science evolves, and makes steps towards helping people with issues like this one. Religion should never be a barrier when taking decisions like this one. Or at least, others beliefs should not be a barrier for your wills.

    I'll stay tuned for more!

  2. Thanks for your comment Gonzalo :) And sorry for the late reply..

    Basically, regarding health risks of the pill, there are a few points to make (not necessarily directed at you in particular)
    - Consider the health risks of pregnancy. Thousands of women (or more) die due to pregnancy related issues worldwide. Arguing that the pill MAY be dangerous, but not taking account of the risks of pregnancy in making the weighing is incosiderate.
    - Regarding education - of course. The consequences you mention are real, and important, but many things are dangerous and not forbidden, I fail to see why this is any different. Are women somehow considered incompetent for making this kind of decision about their own bodies? Most people (well, women) I know would not take this sort of medication without looking into the possible health related consequences.
    At least in Denmark contraception is no secret, and when problems appear that people should know about, they are made public.

    Generally I have an impression of Spain somehow infantilising its citizens on certain areas, if it's more convenient for them not to be aware.. contraception seems to be one of them.