The Women Fighting For Legal Abortions in One of Europe's Tiniest Countries

Silvia was 39 when she found out she was expecting her third child. She went to a private gynaecologist where she lives in San Marino, the tiny Catholic traditionalist state surrounded by Italy, but the doctor told her that it was impossible to detect the foetal heartbeat.

“I went to the hospital where another physician confirmed the absence of the pulse and booked me for a curettage procedure,” a procedure that removes tissue from the uterus that is sometimes performed following an abortion. “Then, during another check-up, the heartbeat was present,” she said in testimony to women’s organisation Unione Donne Sammarinesi (UDS – Union of Sammarinese Women) and provided to VICE World News on condition of anonymity to protect her privacy due to the stigma around abortion in San Marino. A third pregnancy would have been difficult for her and her family and the uncertainty around the health of her foetus made her nervous. Silvia decided to have an abortion.

If she had lived just 10 kilometres away in Italy, this would have been simple enough – at least in legal terms. But along with many of other women, she could not do it legally in her country, one of the smallest in Europe, with a population of just over 30,000.

The Republic of San Marino is one of the few territories in Europe – together with Malta, Andorra, the Vatican City State and Poland, which approved a ban in 2020 – where having an abortion is still a crime.

Women seeking an abortion or those who help them are punished with three to six years in prison, regardless the reasons behind the choice. In San Marino, abortion is forbidden even in cases of rape, incest or severe foetal anomaly.

Like other women from San Marino, Silvia had to cross the border and go to a hospital in Italy and pay more than 1,000 euros (£850) to access the procedure. Abortion has been legal in Italy since 1978, although 71 precent of gynaecologists declare themselves conscientious objectors.

A few years ago, when she was 31, Paola did the same. She found out that the foetus she was carrying was diagnosed with Down’s syndrome and other complications and decided to have an abortion. This meant she had to travel to Italy. “It was emotionally hard. The doctor helped me, she explained to me that abortion was illegal in San Marino and suggested where I should go. I had to pay for everything, even to see a psychologist as prescribed”, she said in testimony to UDS and provided to VICE World News on condition of anonymity to protect her privacy and because of the stigma around having an abortion in San Marino.

“I knew that in my county my choice was a crime, so I did not tell anyone. Now, after a few years, at least I can talk about it. But I find it very serious that today there are still no options for the people in the same condition I was in at the time.”

According to doctor Francesca Nicolini, who runs one of San Marino’s medical facilities, the majority of women seeking abortions go to hospitals in the nearby Italian region of Emilia Romagna. They keep their decision a secret and pay for the procedure because they have no access to the Italian National Health Services. “Luckily Italy is close. Women count on the privacy that the Italian system gives them,” she says.

The fees are around 1,500 to 2,000 euros (£1,300 to £1,700), and people have to pay for travel and accommodation. San Marino is has historically been economically well off, so for years the cost of travelling for an abortion wasn’t a huge issue, but that’s no longer the case. “Now the problem can get serious because it is not true that anyone can afford such amounts of money. This encourages clandestine abortions outside hospitals – always crossing the border – in structures where they may make you pay 150 euros or less,” says Nicolini.

During the past few months a group of women behind the UDS has worked to change things. Taking inspiration from Ireland, which voted to legalise abortion at a referendum in 2018, they collected the signatures required by law to demand a referendum to decriminalise abortion in San Marino.

San Marino’s referendum will be held on the 26th of September and will ask citizens if they want to make abortion legal up to 12 weeks (in the UK it is legal up to 24 weeks) – and beyond this term in case of risks for the life of the woman or if there are serious malformations of the foetus. Campaigning will start 15 days before the date of the referendum.

“We feel this is the time for San Marino, we feel the majority of the citizens are with us. We saw people from all ages coming to sign for the referendum,” says Elena D’Amelio Mueller from UDS. She was among the group of women that delivered the signatures to the government on the 31st of May. “We needed at least 3 percent of the population to sign our request. We got more signatures than required, and more than we expected”.

In the same day that the UDS completed the collection of the signatures, a group close to the Democrazia Cristiana party – a Catholic political party which has governed the country for almost all of the last 20 years and is opposed to abortion – founded a committee to oppose the referendum, called Uno di Noi (One Of Us).

However, according to UDS activists, new generations are embracing a less traditionalist worldview. “The youngest people who came to our initiatives could hardly believe that abortion is illegal here. They found it normal for a woman to self-determine. This makes us quite optimistic,” D’Amelio Mueller says.

In San Marino, abortion is criminalised under a law that hasn’t changed since 1865. The country’s proximity to Italy has enabled the ban has persisted over the years, as most women who need to get an abortion are able to travel, while politicians look the other way. This is sustained by a glaring hypocrisy: No Sammarinese woman has been convicted in recent history, but instead many have been forced to travel to Italian hospitals.

No data is collected about these journeys, though. “It is like the problem doesn’t exist. Since no one talks about it, and no one has an abortion in San Marino. But banning abortion has never prevented women from having abortions. It hasn’t done so in the past centuries, it won’t do it now,” doctor Nicolini says. “We don’t know how many women interrupt their pregnancy, and most of all we don’t know why they do it. Do we have a problem with contraception? Do we have a high percentage of foetal deformity? We don’t know, so we can’t even think of targeted health policies.”

Former politician Maria Lea Pedini – who was the first woman to be nominated as “Capitano Reggente”, the head of the government, back in 1981 – looks to San Marino’s history to understand its long struggle for abortion rights.

“Despite the proximity with Italy and many common battles on rights, San Marino is far behind on many fronts,” Pedini says. Women gained the right to vote In the little republic in 1964, and the right to run for the elections in 1974. In the 70s, when there were feminist marches for the right to abortion in Rome, women in San Marino were fighting for the right to pass their citizenship to their children when they married a foreigner. Divorce was legalised in 1986, while homosexuality was a crime until 2004 (in 2018 the country approved civil unions law for same-sex couples). 

“Civil and women’s rights are always considered as secondary, expendable to political considerations,” says Vanessa Muratori, a UDS activist and former left-wing politician. “Therefore Sammarinese women have organised themselves, because it is basically legal to have abortion beyond the border. It is an uncomfortable situation but the solution is close to home. So nobody has to take care of this problem. This is a big hypocrisy”.