For Italian Catholics, a different debate over ‘choice’

By Michael Wilner

A pharmacy across the street from Vatican City in Rome, Italy. | Photo by Michael Wilner.

ROME  — It may be the last empire in the world on which the sun never sets: the Catholic Church, a kingdom full of believers and skeptics alike, with its one billion followers strewn across the globe. With such reach and untold wealth, it might seem ill-advised to question its influence. But walk across the street from its seat of power, where the spiritual bloodline of St. Peter lives and prays, and you will find a direct challenge to that influence at the most unusual of places: a local pharmacy.

This particular farmacia, a stone’s throw from the Vatican, meets Italian standards of Western medicine. Walk through its glass sliding doors to find four women working behind the counter, routinely opening drawers full of drugs for a constant line of customers. Condoms and birth control pills sit available in these cabinets, which line an entire wall in the back. And when all their doors are closed, the wall unifies into an expansive, clinically sketched and deeply ironic black-on-white depiction of St. Peter’s Basilica.

“If a woman has a prescription, we are required to fill it by law,” Alessandro Leone, the head doctor at the pharmacy on Via di Porta Cavalleggeri in Rome, says of birth control pills. “The Vatican has their opinion, but it’s their opinion. We have ours.”

The Vatican’s Pontifical Academy for Life has made that opinion loud and clear for decades: birth control, abortion and every form of contraception in between are “fruits of the same tree.” These practices undermine the sanctity of human life, it says, outlined succinctly in Pope Paul VI’s encyclical called Humanae Vitae released in 1968.

But casting this policy as winning politics in Western countries has proven an uphill battle — until very recently, when the Church subtly recast its message.

In the United States earlier this year, President Barack Obama’s health care law challenged Catholic-affiliated institutions that receive government funding to provide birth control. And in Italy, older such laws over pharmacies and hospitals, in arm’s reach of the Vatican, constrict doctrine with similar force.

With unique precision, and in a notable shift, the Catholic Church made a remarkable decision in its face-off with the Obama Administration: not to defend its stance on controlled reproduction based on its merits, but rather to cite “religious freedom” as its principal argument.

“As Catholics, we are obliged to defend the right to religious liberty for ourselves and for others,” reads a statement from the United States Conference of Catholic Bishops, titled Our First, Most Cherished Liberty, published earlier this month. “If religious liberty is eroded here at home, American defense of religious liberty abroad is less credible.”

The Rev. Federico Lombardi, director of the Vatican Press Office, said in an interview here that Pope Benedict XVI has followed the American debate from a distance, and noted that Catholics are not the only people who object to reproductive control. But after abortion passed into law in Italy in 1978 — just five years after a Supreme Court ruling made it legal in the United States — numerous prominent Italian bishops made public statements threatening clinicians who perform the deed with excommunication. They also emphasized a unique provision within the Italian law as an alternative: Article 9, which reserves the right of medical practitioners to refuse involvement in the procedure based on objections of moral conscience.

That same tactic is being used today in the debate over birth control in the U.S., where an ancient Judeo-Christian concept — freedom — has become core to the debate. And in taking a stance rooted in democratic ideals, the Vatican may have finally found a way to sell its policies — at least on the political realm.

Meanwhile, condoms, contraceptive jellies and the morning-after pill sell briskly from the pharmacy across the street.

The Uncomfortable Norm

Abortion has become so commonplace in Italy that women often speak about it openly.

Alessandra* recalled being 23 years old and going to a hospital in Milan for an abortion. It was 1989 and she expected it to be routine, given how common the procedure had become. That year in the Lombardy region of Italy, where Milan is located, one in four pregnancies ended in abortion—just above the national average, according to a Guttmacher Institute study from 1996.

But Alessandra’s doctor, who objected based on moral grounds, turned her away.

“For her it was murder,” she said of her doctor.

So Alessandra went to another facility where the doctors were willing, if not exactly welcoming. These new doctors were unhappy to be a part of what she describes an “unpleasant experience” for all involved. But the event that Alessandra found particularly humiliating came after her initial exams, as she awaited the procedure in the hallway of the clinic. Anxious and alone, with her parents in the dark, she watched as protesters raided the hall waiving plastic fetuses in the air. She remembers a dozen of them shouting murder. Alessandra felt implicated.

“The decision is not an easy one,” she says. Alessandra grew up half-Catholic, and had struggled with her relationship in the Church as an Italian woman. “When you are there for the surgery, you really don’t want to change your mind.”

In a country where nine in ten citizens nominally identify as Catholic, Alessandra is one of many Italian women that have been thrown into a complicated, and often contradictory, national debate. Codified in Italian law since 1981 is the right of its women to receive an abortion within 90 days of conception, without questions and free of charge. Women can buy birth control and fill prescriptions for the morning-after pill at their local pharmacy, and by law, these pharmacies are required to acquiesce.

And many Catholic doctors have chosen to exercise their right to refuse. One of the largest hospitals in southern Italy tacitly compels all of its doctors to sign Article 9 paperwork along with employment documents, and accordingly, every doctor at the facility objects to performing abortions. Casa Sollievo Della Sofferenza, a marble-lined hospital founded on the highest hill in San Giovanni Rotondo by Saint Pio of Pietrelcina himself, considers “the centrality of man and the protection of life, from inception to natural death,” to be its paramount values.

“For private hospitals like ours, the state does not place any binding restrictions,” says Domenico Crupi, the vice president and general director of the hospital. “Public hospitals are obliged to guarantee a public service. But in the end, Italian hospitals have, thank God, a certain autonomy, and that autonomy is respected.”

And yet in the Puglia region of Italy, where Casa Sollievo is located, the abortion rate stood at 21.4 percent as recently as 2008 — the country’s highest, according to reports from Italy’s Institute of National Statistics.

A Declaration of Conscience

While Casa Sollievo has institutionalized the practice, most doctors who sign Article 9 do so after a good deal of soul-searching.

At a small clinic on the outskirts of Rome, Emanuela Santuccia, a gynecologist by training, adjusts the diamond cross on her neckline. She is having trouble pinpointing the moment  that she found her religion. All she knows is that, over a period of time, a force or presence in her life ultimately drove her to make her faith and her life’s work coherent.

“I’m an objector of conscience,” Santuccia declares.

As a doctor at a public hospital, Santuccia was often faced with women who needed her to sign off on their abortions. And in her training, she had to actively participate in the surgical process.

Santuccia felt the process was normal at first, as it was widely accepted. She had grown up in a Catholic family —“not too observant, but with a specific idea of religion,” she says — but she never felt a particular affiliation with the God, or with his Church.

It took several years, which she describes as a personal journey. But Santuccia ultimately made a choice.

“At the emotional level, it is challenging to deal with the problems of women,” she explains. “Sometimes you feel powerless.”

Santuccia signed Article 9 paperwork, giving her coworker double the workload in an attempt to clear her conscience and find a way back into the Church. In doing so, she joined 70 percent of Italian gynecologists who now object, the Italian Ministry of Health reports—a number that has been rising over the past decade.

“There’s a difference between professional ethics and private conscious,” says Frank Chervenak, director of Maternal Fetal Medicine at New York Presbyterian Hospital and an honorary member of the Italian Society of Obstetrics and Gynecology. “A doctor who has a moral objection to abortion shouldn’t be forced to perform it, whether it’s [in] Italy or the United States.”

Chervenak, himself a practicing Catholic, notes perhaps one of the strangest Italian contradictions of all: the current rise in “objectors” coinciding with a decline in the Italian birth rate, to below replacement levels.

“The sad truth is that many in Italy don’t practice all of the tenets of the Catholic Church,” he says.

One possibility is that objectors consider abortion a red line, but perceive other contraceptives, such as condoms and birth control, as acceptable, or even beneficial. Santuccia takes this view, and encourages her patients to protect themselves against unwanted, preventable circumstances they may regret for the rest of their lives.

Given that many Catholic doctors like Santuccia are giving such advice, it is perhaps not surprising that condoms and other contraceptive aids are selling so briskly today – in clear sight of the Vatican itself.

*Name has been changed to protect identity

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