Abortion in Italy: Law 194, Access, and Recent Changes

Abortion in Italy is legal and provided free of charge through the national health service within the first 90 days of pregnancy, on broadly defined health, economic, family, or social grounds. After 90 days, it is permitted only when the pregnancy seriously endangers the woman’s life or when fetal abnormalities create a serious risk to her physical or mental health. The framework has been set by Law 194 since 1978, and while the rules are permissive on paper, a mandatory seven-day waiting period and high rates of conscientious objection among gynecologists shape what access actually looks like on the ground.¹

When Abortion Is Allowed

The 90-day window is the key threshold. It runs from the first day of the last menstrual period, and Italian providers generally interpret it as 12 weeks and 6 days. Within that window, a woman can request an abortion based on concerns about her physical or mental health, her economic situation, her social circumstances, or her family conditions. The criteria are intentionally broad; in practice, a woman who states that continuing the pregnancy would harm her wellbeing qualifies. The likelihood that the child would be born with abnormalities also counts as a valid reason during this period.²

After 90 days, the rules tighten sharply. An abortion is permitted only when the pregnancy or childbirth poses a serious threat to the woman’s life, or when diagnosed fetal abnormalities create a serious risk to her physical or mental health. Both conditions must be verified by medical specialists and documented before the procedure can proceed. The law sets no explicit upper gestational limit for these therapeutic abortions, but the focus on the woman’s health means late procedures are rare and closely scrutinized.¹

How the Process Works

The process begins with a consultation, not at a hospital, but at a public family counseling center (consultorio familiare) or with any doctor. The doctor or counselor’s role is to assess the woman’s situation and inform her of the social services and support available to her. The law requires that this conversation happen with full respect for the woman’s dignity and confidentiality. The father of the conceived child may be included only if the woman consents.¹

At the end of the consultation, the doctor issues a signed certificate (certificato di IVG) confirming the pregnancy and the woman’s request. Any doctor can issue it; a gynecologist is not required.³

Once the certificate is issued, a mandatory seven-day reflection period begins. No medical intervention can take place until those seven days have passed. The one exception is urgency: if a doctor determines that delay would endanger the woman’s health, they can issue a certificate of urgency that bypasses the waiting period. Outside of a genuine medical emergency, the seven days are not negotiable.⁴

After the wait, the woman contacts a public hospital or authorized facility to schedule the procedure.

Rules for Minors

Law 194 sets 18 as the age at which a woman can request an abortion on her own. A minor needs consent from a parent or legal guardian. If consent is refused, or if there are reasons to exclude the parent from the process, the minor can petition a guardianship judge (giudice tutelare), who must rule within five days.⁵ The judicial route exists so that a parental refusal doesn’t trap a minor, though it adds time to an already time-sensitive process.

Cost and Identification

Abortion is free when performed at a public facility within the national health system or at a private facility contracted and authorized by regional health authorities. This covers both the consultation and the procedure itself.²

Italian residents need a valid ID (the electronic Carta d’Identità works) and their health insurance card (Tessera Sanitaria), which links them to the national health service and covers the cost of care.⁶

Foreign nationals without legal residency are not shut out. They can obtain an STP code (Straniero Temporaneamente Presente) from local health authorities, which grants access to essential medical services on the same terms as Italian citizens, including the same co-payment rules.⁷ Immigration status does not decide whether someone can access the procedure.

Medical and Surgical Methods

Two methods are available. The pharmacological method uses mifepristone (RU-486) followed by misoprostol about 48 hours later. It is available through the first nine weeks of pregnancy.⁴ In August 2020, the Ministry of Health updated its guidelines to allow medical abortion in hospital day units, properly equipped public outpatient facilities, and family counseling centers. Before that change, three days of hospitalization were required, which made the pill option more burdensome than the surgical one for many patients.⁸

Surgical abortion is used for pregnancies beyond nine weeks or when the pharmacological method is not medically suitable. Surgical procedures are performed under anesthesia in public hospital surgical units. Which method is used depends on gestational age, the woman’s health, and what the specific facility offers.

Conscientious Objection and Regional Access

This is where the law and the reality diverge most. Article 9 of Law 194 lets any healthcare worker declare conscientious objection and refuse to take part in abortion procedures.¹ Nationally, roughly 70 percent of gynecologists are registered objectors, a figure that has held steady for decades.⁹

That national average hides sharp regional differences. In southern Italy, objection rates average around 75 percent, and certain regions exceed 90 percent. Central and northern regions hover closer to 56 percent, still more than half of all gynecologists. Where non-objecting doctors carry heavier caseloads, fewer abortions are completed within 14 days, and more are pushed past 21 days.⁹

In practice this often means calling multiple hospitals to find one with non-objecting staff and an available slot, and sometimes traveling to another city or region. Combined with the mandatory seven-day wait and scheduling delays, women in high-objection areas can find themselves pressed against the 90-day cutoff.

Recent Political Changes

Law 194 itself has not been amended in substance. The 90-day limit, the consultation requirement, the reflection period, and the objection provision are all as they were in 1978. In 2024, however, Italy’s Senate passed an amendment allowing regional authorities to grant organizations “with a qualified experience supporting motherhood” access to women considering abortions at public counseling centers. Prime Minister Giorgia Meloni’s government framed the measure as fulfilling Law 194’s original mandate to help women explore alternatives. Critics said it introduced pro-life advocacy into a clinical setting where women are already legally required to attend a consultation.

What tends to shift from one administration to the next is the environment around the rules: how family counseling centers are funded, who is allowed inside them, and whether regions take steps to secure enough non-objecting providers. For anyone seeking an abortion in Italy, both the letter of Law 194 and the local conditions at specific hospitals matter.

1
Gazzetta Ufficiale della Repubblica Italiana. Law No. 194 of 22 May 1978
2
Istituto Superiore di Sanità. Abortion in Italy
3
Laiga 194. Voluntary Early Abortion in Italy
4
Istituto Superiore di Sanità. Voluntary Termination of Pregnancy in Italy
5
European Union Agency for Fundamental Rights. Accessing Abortion Services
6
Agenzia delle Entrate. The Italian Health Insurance Card
7
I.C.A.R.E. Toscana. Health Care for Foreigners Not in Compliance With the Rules on Entry and Residence
8
Istituto Superiore di Sanità. Voluntary Termination of Pregnancy in Italy in 2020
9
National Center for Biotechnology Information. The Impact of Conscientious Objection on Voluntary Abortion in Italy