Spinelli e Michele Grandolfo
1978, a law was passed in Italy which set forth the regulations
governing the procedures for obtaining an induced abortion.
According to this law, all women are eligible to request
an abortion during the first 90 days of gestation for health,
economic, social, or familial reasons. To obtain an abortion, the woman must have a certificate
attesting to the state of the pregnancy from her general
practitioner, or a private physician or a public maternal-child
health clinic. The abortion is performed free-of-charge at
either at a health care structure in the National Health Care
System or in a private structure contracted and authorized by
regional health authorities.
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 socio-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.
legalization of abortion in 1978, there was an initial increase
in incidence, with a peak of 234,000 abortions performed in 1982
(abortion rate = 17.2 per 1000 women ages 15-49 years, abortion
ratio = 380.2 per 1000 live births).
Subsequently, there has been a steady decline, with
139,000 abortions performed in 1999 (abortion rate = 9.9/1000,
abortion ratio = 266.9/1000).
This reduction represents a decline of 42% for the
abortion rate and 30% for the abortion ratio over the past 15
years, with an estimated 100,000 fewer abortions in 1999
compared with 1982.
incidence of abortion in Italy is similar to that of other
countries in northwestern Europe (where rates range from
6.5/1000 in the Netherlands to 18.7/1000
in Sweden), but it is much lower than in Eastern Europe
(where rates are in the 50/1000 range) and in the United States (22.9/1000).
As with many other health conditions, there are
major differences within Italy between regions and geographic
areas: in 1999, the
rate was 9.6/1000 in the North, 11.0/1000 in the Center, 10.5 in the South,
and 7.8% in the Islands (Sardinia and Sicily).
The declining rates over time were present in all areas
of the country, with a trend toward convergence of the rates
over time (Table) The
greatest decreases have occurred in those regions where women
obtain the required certification through maternal-child health
clinics rather than from their general practitioner or private
addition to the legal abortions described above, the ISS has
estimated, using mathematical models, that illegal abortion
persists, with an estimated 27,000 performed in 1998.
These illegal abortions are not equally distributed
throughout the country and are more common in the South.
As is the case with legal abortions, illegal procedures
have also decreased dramatically over time.
Applying the same mathematical models, it has been
estimated in 1983 that there were approximately 100,000 illegal
estimated number of illegal abortions has thus decreased by 73%
since the early 1980s (1, 2).
From other studies performed in the past (3), it has been observed that
in most cases, abortion is not considered to be the
contraceptive method of choice but instead results from the
failure to control fertility using other methods.
More than 70% of women undergoing abortion were using a
contraceptive method at the time of conception (primarily coitus
interruptus). The finding that the
number of repeat abortions is lower than that estimated by
mathematical models that assume no changes in contraceptive
behavior supports the hypothesis that the reduction in induced
abortion is the consequence of a greater diffusion and more
effective use of birth control methods (4).
There do appear to be some subpopulations in which abortion rates are
higher: women with
children, those with lower levels of education, and housewives.
The most consistent declines in abortion rates are seen
among married women, among those between 25 and 34 years of age
(Figure), and in those
with children (5).
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 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 (6).
conclusion, the reduction of induced abortion appears related to
improved use of fertility control methods and to the important
role of maternal-child health clinics.
Taking into account the social-demographic
characteristics of women who are currently undergoing abortion,
further reductions are undoubtedly possible, especially if
maternal-child health services can be further strengthened.
del Ministro della Sanità sulla attuazione della legge
contenente norme per la tutela della maternità e per
l’interruzione volontaria di gravidanza (legge 194/78): Dati
preliminari 1999, dati definitivi 1998. Luglio 2000
Talamanca I., Spinelli A. L’aborto illegale in Italia: è
ancora un problema reale? Contraccezione
Fertilità Sessualità 1986; 13: 263-269.
M.E., Spinelli A., Donati S., Pediconi M., Timperi F., Stazi
M.A., Andreozzi S., Greco V., Medda E., Lauria L. Epidemiologia
dell’interruzione volontaria di gravidanza in Italia e
possibilità di prevenzione. Roma: Istituto Superiore di
Sanità; 1991. Rapporto ISTISAN 91/25.
Blasio R., Spinelli A., Grandolfo M.E. Applicazione di un
modello matematico alla stima degli aborti ripetuti in Italia. Annali
dell’Istituto Superiore di Sanità 1988; 24: 331-338.
A., Boccuzzo G., Grandolfo M.E., Buratta V., Pediconi M., Donati
S., Frova L., Timperi F. L’evoluzione dell’interruzione
volontaria di gravidanza in Italia dalla legalizzazione ad oggi.
Annali dell’Istituto Superiore di Sanità 1999; 35:
G. editor. L'abortività volontaria in Italia. Tendenze e comportamente degli anni
’90. Informazioni n. 3. Roma: ISTAT; 2000.