In 2020, medical abortion accounted for only 31.9% of voluntary termination of pregnancy (VTP) procedures in Italy. This finding comes from the most recent Ministry of Health report on the implementation of Law 194 of 1978. Data show that Italy’s percentage of medical abortion is significantly lower in comparison with other countries in Europe. For example, in France and England, medical abortion is used in more than 70% of VTPs, and in Nordic countries, it is used in more than 90%.
Why are women in Italy more likely to rule out use of medical agents to end a pregnancy? One reason is the widespread and unfounded misconceptions about efficacy and safety, misconceptions that become stronger whenever there is a political debate on the subject. “It’s important that we use scientific evidence to clarify the issue,” said Valeria Dubini, MD, president of the Association of Italian Gynecologists. She was one of the participants at the National Congress of the Italian Independent Association of Gynecologists in Support of the Implementation of Law 194, which was held in Rome in October. “A few months ago, the World Health Organization issued its Abortion Care Guideline. This document confirms what the medical literature has long held to be true: a medical abortion that uses a combination of mifepristone and misoprostol is highly effective and safe.”
A review published in 2020 in the Journal of Obstetrics and Gynaecology Canada reported that, when performed within the first 9 weeks of pregnancy, the procedure had a success rate of more than 95%. If the procedure fails — in other words, if the pregnancy continues or if the pregnancy is terminated but some tissue remains in the uterus — the medicines can be given again, or a surgical abortion can be performed. For 0.8% of medical abortions, it was necessary that the woman be admitted to the hospital because of complications. Of those who underwent the procedure, 94% would choose the method again, and the same percentage would recommend it to a friend.
The Italian Ministry of Health’s Circular of August 4, 2020, made it possible for a woman to medically terminate her pregnancy within 63 days of gestation at hospital day units, family planning clinics, or at properly equipped public outpatient facilities functionally linked to a hospital and authorized by the Regions.
Only a few regions have taken the necessary steps to adopt such guidelines and currently offer the procedure on an outpatient basis. Where women have access to medical abortions, the woman takes mifepristone in a clinical setting; she can receive misoprostol there as well, or she can choose to give it to herself at home and wait for the products of conception to be expelled.
“Even in these circumstances, medical abortion is a safe procedure,” explained Dubini. “Obviously, the woman is informed about what to expect. The clinic will provide her with painkillers. She will also be given a phone number that she can call at any time if she has questions or concerns, or if she needs instructions or directions.”
General practitioners play an essential role. “They can help combat those unfounded misconceptions by giving their patients correct and accurate information about this procedure, the same as they do when it comes to other areas of healthcare,” added gynecologist Marina Toschi, MD, the moderator at the National Congress.
This article was translated from Univadis Italy.
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