Italy’s fertility rate has declined since 2008, when the country’s economic crisis hit. Nowadays, Italy has one of the lowest fertility rates in Europe. In 2020, the average fertility rate was 1.24 children per woman. Furthermore, Italy is, along with Spain, one of the European Union countries with the highest maternal age. In 2020, the average maternal age at the first birth was 31.4 years. However, high rates of unemployment and the impact of the economic crisis in the country seem to have affected its fertility trends, leading women to put off pregnancy and decreasing fertility rates.
Medically Assisted Procreation (MAP) treatments in Italy are regulated by Law 40/2004. According to this law, MAP techniques can only be used by adult couples of different sexes, married or cohabiting, with a diagnosis of sterility or infertility documented by a medical act. Moreover, ART techniques are not accessible to single women and men or homosexual couples. Therefore, Italian legislation on ART techniques has been described as one of the most restrictive, discriminatory and conservative among European countries.
The ART techniques allowed in Italy are intrauterine insemination (IUI), in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), egg and sperm donation, freezing of oocytes, frozen embryo transfer and testicular sperm extraction. Preimplantation Genetic Screening is permitted only for serious illnesses as long as they are certified by a specialist. On the other hand, embryo donation, embryo adoption and surrogacy are not allowed. Egg and sperm donation is entirely anonymous in Italy, meaning recipients and donor-conceived children are not allowed to know the donor’s identity. The maximum number of children conceived from the same donor is 10. The full legal age for the female partner to access ART treatments is 50 years.
In 2005, the National Health Institute (Istituto Superiore di Sanità – ISS) established the National Register on Assisted Reproductive Technology (ART) procedures. All the Italian ART centres must send their data to the Register, which provides complete annual reports on all the ART treatments performed in the country. In Italy, the number of ART clinics is not limited by legislation. According to the Italian registry, there are 330 fertility centres which provide ART treatments in the country, 97 of them public and 233 private. In 2018, 58,407 treatment cycles were initiated, and 12,646 children were born due to these techniques.
The publicly funded ART treatments are three cycles of IUIs plus three cycles of IVF/ICSI. The maximum female age to access public services is 46 years old. It is possible to claim tax deductions. Medication costs might be covered or partially depending on the regional health authority. Reportedly, public centres have a waiting list of 12-24 months approximately.
15 young people from Italy were interviewed. When conducting the interviews, one of the interviewees reveals she has a daughter who lives with her, and the other indicates that she cannot have children, which are exclusion criteria for the study. Therefore, the data from this interview was removed from the sample, and the sociodemographic characteristics of the 13 interviewees analysed are described in table 3. The average age was 24 years old (standard deviation=7.23).
The table below shows the sociodemographic characteristics of the sample in Italy
Participants (n=13)
| Age in years | n° | % |
|---|---|---|
| 18 – 22 | 6 | 46 |
| 23 – 26 | 3 | 23 |
| 27 – 30 | 4 | 31 |
| Gender | n° | % |
|---|---|---|
| Male | 6 | 46 |
| Female | 4 | 31 |
| Transgender male to female | 2 | 15 |
| Transgender female to male | 1 | 8 |
| Other | 0 | 0 |
| Sexual Orientation | n° | % |
|---|---|---|
| Heterosexual | 6 | 46 |
| Homosexual | 4 | 31 |
| Bisexual | 0 | 0 |
| Other | 3 | 23 |
| Occupation | n° | % |
|---|---|---|
| Student | 5 | 38 |
| Student and worker | 2 | 15 |
| Self-employed | 1 | 8 |
| Employed for wages | 4 | 31 |
| Homemaker | 0 | 0 |
| Unemployed | 1 | 8 |
| Unable to work | 0 | 0 |
| Highest educational level achieved | n° | % |
|---|---|---|
| No schooling completed | 0 | 0 |
| School | 2 | 15 |
| High school | 8 | 62 |
| Bachelor degree | 3 | 23 |
| Doctorate degree | 0 | 0 |
| Residence | n° | % |
|---|---|---|
| Urban area | 10 | 77 |
| Semi-urban area | 3 | 23 |
| Rural area | 0 | 0 |
| Relationship | n° | % |
|---|---|---|
| Yes | 10 | 77 |
| No | 3 | 23 |
| Marital status | n° | % |
|---|---|---|
| Single | 10 | 77 |
| Married or domestic partnership | 3 | 23 |
| Widow | 0 | 0 |
| Divorced | 0 | 0 |
| Separated | 0 | 0 |
| Religious beliefs | n° | % |
|---|---|---|
| Christian | 6 | 46 |
| Muslim | 0 | 0 |
| Jewish | 0 | 0 |
| Orthodox | 0 | 0 |
| Other | 1 | 8 |
| None | 6 | 46 |
The recruitment was organised by a contracted company based in Italy. This company contacted the young people in its panel with a selection of the relevant age group by email and then contacted respondents by phone for specific questions.
Interviews were carried out in June 2021. The interviewees were from the region of Lombardia, most of them from Milan, where the company is based. All the interviews were conducted in Italian and took place online via Zoom because of the COVID-19 pandemic. Therefore, no issues related to internet connections or respondents were reported, and participants were willing to cooperate and speak openly.
REFERENCES
- The World Bank. Fertility rate, total (births per woman) – European Union | Data [Internet]. [cited 2021 Jul 15]. Available from: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?contextual=min&locations=EU&most_recent_value_desc=false
- Istituto Nazionale di Statistica. Natalità i fecondità della popolazione residente – Anno 2020 [Internet]. 2021 [cited 2022 Jan 4]. Available from: https://www.istat.it/it/files//2021/12/REPORT-NATALITA-2020.pdf
- Eurostat. Women are having their first child at an older age – Products Eurostat News [Internet]. 2020 [cited 2021 Jul 15]. Available from: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20200515-2
- Cazzola A, Pasquini L, Angeli A. The relationship between unemployment and fertility in Italy: A time-series analysis. Demogr Res [Internet]. 2016 Jan 8 [cited 2022 Jan 10];34(1):1–38. Available from: https://www.demographic-research.org/volumes/vol34/1/default.htm
- Hanafin P. Rights, bioconstitutionalism and the politics of reproductive citizenship in Italy. https://doi.org/101080/136210252013851144 [Internet]. 2013 [cited 2022 Jan 10];17(8):942–55. Available from: https://www.tandfonline.com/doi/abs/10.1080/13621025.2013.851144
- Istituto Superiore di Sanità. Registro Nazionale Procreazione Medicalmente Assistita – Centri in Italia [Internet]. [cited 2022 Jan 10]. Available from: https://w3.iss.it/site/RegistroPMA/PUB/Centri/CentriPma.aspx
- Registro Nazionale de Procreazione Medicalmente Assitita. Monitoring the activity and outcomes of Italian Assisted Reproductive Technology Centers 2018. 2018.