Termination of pregnancy can be done within the first 90 actual days of pregnancy for reasons related to the pregnant person’s choice or health, and after 90 days, as the law states, “only if the pregnancy/delivery endangers the woman’s life or for significant fetal abnormalities/malformations”. Pregnancy dating is done from the date of the last menstruation.

In Italy, before the 90th day, the abortion is called voluntary interruption of pregnancy (or IVG) and it can be carried out in two modalities: pharmacological or surgical. After the 90th day, it is called a therapeutic abortion and is performed by surgical modality or by inducing delivery (see “abortion after 90 days”).

WHAT IS NEEDED TO ACCESS THE SERVICE

Once pregnancy has been established, the pregnant person may go to a family counselling centre (consultorio), to the voluntary interruption of pregnancy (IVG) department of a hospital, or to her own physician to express the will to terminate the pregnancy.

The IVG certificate

This will be documented through a certificate. After 7 days from the date of the certificate, the pregnant person can access the voluntary interruption of pregnancy (IVG) service. There is also the possibility–for health or other reasons–that the doctor completing the certificate will attest the urgent nature of the procedure, and that the person will not be forced to “supersede for at least seven days,” as Law 194/78 (regulating abortion in Italy) says.

Where to go?

According to Law 194, all authorised hospitals and clinics must perform such procedures. In fact, Article 9 of Law 194 states, “Authorised hospital institutions and clinics are required in all cases to ensure the completion of the procedures provided for in Article 7 and the performance of the required pregnancy termination interventions in the manner provided for in Articles 5, 7 and 8. The Region shall monitor and ensure its implementation, including through staff mobility.”

However, in reality, this isn’t the case, and the service varies greatly from city to city. We recommend consulting our map or contacting us.

HOW DOES MEDICAL ABORTION WORK?

In Italy, you can access this type of termination if you are in the first 63 days of pregnancy, i.e., by the ninth week. However, from the medical point of view, medical abortion is a viable and less invasive alternative to surgical abortion for procedures within twelve weeks of pregnancy. Some Italian regions (or hospitals), like the Marche, have a seven-week limit; it’s advisable to check before you start.

Nella struttura a cui ci si rivolge viene:

• valutata l’esatta epoca gestazionale, solitamente tramite ecografia svolta in loco. Per questo motivo eseguire a priori ecografie altrove potrebbe essere uno spreco di risorse;
• fatto un colloquio per capire lo stato di salute psico-fisica della persona coinvolta;
• eseguito il prelievo del sangue per delle analisi;
• se la persona non lo ha con sé, compilato il certificato di IVG.

The facility you choose will:

• assess the exact gestational age, usually via an on-site ultrasound. Therefore, performing ultrasounds elsewhere in advance could be a waste of resources;
• conduct an interview to assess the person’s physical and mental health;
• take a blood sample for analysis;
• if the person doesn’t have it with them, complete the IVG certificate.

The administration of abortifacient drugs occurs in two stages:

1. Mifepristone

The first administration is that of the drug mifepristone (known as RU486), which is swallowed. This part can’t happen at the patient’s home.

2. Misoprostolo

Today, the second dose can be administered at home (if the person prefers and if the Region has complied), following the instructions of medical staff.

After 48 hours, a second drug is administered, the misoprostol (Cytotec), which usually consists of two tablets to be dissolved under the tongue. The end of the abortion usually occurs after about 3 hours from the administration of the second drug, through menstruation-like discharge; the proper completion of the termination of pregnancy is checked by ultrasound. In rare cases of abortifacient failure, the patient continues hospitalisation, an ultrasound is performed again, and the possibility of further administration of the second drug, or the performance of the procedure by surgical technique, is considered.

All of this is possible on an outpatient basis, accessing the hospital facility only for administration, as in Italy, the requirement for hospitalisation has been removed. However, some facilities might still require hospitalisation; if you encounter such a case, we encourage you to notify us, so that we can work for an appropriate adjustment.

Depending on how the procedure for abortion is established and managed by a facility’s voluntary interruption of pregnancy (IVG) service, it is possible that the timing and modalities might differ from the above explanation; this is because even though the guidelines change, each facility takes the time to figure out how to offer the medical abortion service to the best of its ability, in order to safeguard the person’s health and the structure’s professionalism.

HOW DOES SURGICAL ABORTION WORK?

The procedure is called hysterosuction, and in Italy it is usually performed under local or general anaesthesia. After checking the necessary documentation (voluntary interruption of pregnancy/IVG certificate, ultrasound, other documents), admission and blood tests are done (unless they were done privately or previously).

An interview is done with the health care personnel who will perform the procedure and, in case of general anaesthesia, with the anesthesiologist. Sometimes the procedure is preceded by the administration of drugs that facilitate dilation of the cervix (vaginally or sublingually). During the procedure, the cervix is dilated so that a cannula can enter (Karman method), and suction of the contents is performed. Rarely, the surgery may be performed with a steel curette, as in the classic ‘uterine curettage’ (RCU, revision of the uterine cavity). After the surgery, within a period of time that varies depending on the patient’s status (vital parameters, emotional state), she is discharged from the hospital. Bleeding may follow for about 15 to 20 days, after which a urine pregnancy test should be repeated to be sure that pregnancy-related hormones have disappeared from the blood. Menstruation will return 30 to 40 days after surgery, but it is important to start using your chosen method of contraception immediately after surgery. Before the performance of the surgery, it is possible to ask for the insertion of an intra-uterine device (IUD) during the procedure.

CHE SUCCEDE DOPO L’ABORTO

Potranno seguire perdite di sangue per circa 15/20 giorni, per alcune persone fino a 40, dopodiché è opportuno ripetere un test di gravidanza in laboratorio (beta HCG) per avere la certezza che si siano ridotti nel sangue gli ormoni relativi alla gravidanza. Non effettuate i test casalinghi, perché gli ormoni restano attivi per diverse settimane e quindi saranno senza dubbio positivi. Le mestruazioni torneranno dopo 30 o 40 giorni dall’intervento, ma è importante iniziare subito dopo l’intervento a utilizzare il metodo contraccettivo prescelto. Ad esempio, si può chiedere prima dell’intervento se durante lo stesso è possibile inserire a titolo gratuito una spirale intra-uterina.