People in San Marino overwhelmingly voted to end a blanket ban on abortion in a September 2021 referendum. The result, belying the country’s socially conservative image, reflected years of advocacy by women’s rights groups, and a positive, broad-based campaign for change in contrast to the negative campaigning of church groups opposed to reform. The decision must now be reflected in the passing of a progressive law that expands rights. Outside San Marino, the result should give heart to campaigners in other highly Catholic countries – including Poland, where rights have shockingly been reversed, and Malta, where abortion remains illegal – showing that powerful conservative forces can be overcome.

It’s rare for San Marino to make the headlines. This tiny mountain enclave, surrounded by Italy, promises a quiet life for its 33,600 people. But even the world’s smallest countries are home to people who demand rights and can come together to bring about positive change.

An overwhelming yes

In a referendum held on 26 September, people in San Marino overwhelmingly chose to legalise abortion, with a 77.3 per cent vote in favour. They said yes to a proposal that allows abortion on demand up to 12 weeks into pregnancy, and on medical grounds after that.

Previously abortion was entirely illegal; a de facto exception applied to medically necessary abortions, but this was not recognised by law. Pregnant women who broke the law could be jailed for up to three years, while doctors could be jailed for six.

While in practice no one was prosecuted, the law forced women who needed abortions to go to Italy, where abortion has been legal since 1978. An estimated 20 women a year did just that. But Italian doctors are allowed to refuse to carry out an abortion, and the cost of the procedure, at around €2,000 (approx. US$2,260), penalised poorer women, since it was not covered by San Marino’s health insurance.

The referendum came after a campaign organised by the Union of San Marino Women (UDS), working in partnership with a political party, the RETE movement, which since 2019 has been part of the four-party coalition government. They collected over 3,000 signatures, far beyond the number required to trigger a referendum. As part of the campaign to collect signatures, public conversations about abortion took place, helping challenge disinformation and taboos.


Sara Casadei is vice-president of Noi Ci Siamo San Marino (‘We are here San Marino’), a volunteer initiative aimed at informing, supporting and empowering young people through recreational and socio-cultural activities.


Before the referendum, abortion was a criminal offence punished with between three to six years in prison, regardless of the reasons leading to the abortion. Punishment applied to all people involved: the woman seeking an abortion and all those contributing, including doctors. That is why women would typically travel to Italy to have abortions.

The process started by the initiative of the UDS. The organisation had spent almost two decades advocating for the legalisation of abortion, but its proposals had been systematically vetoed by conservative governments, so they felt they had no other choice but to resort to this direct democracy mechanism and ask citizens directly whether they agreed with legalising abortion.

To trigger this mechanism, there was the need to gather the signatures of three per cent of registered voters. The UDS led the collection of signatures along with the RETE movement. The signature collection campaign was conducted in March 2021 and gathered a lot more support than required. Advancing this right was the people’s will, rather than just the UDS’s. It was an overwhelming demand for women to gain the right to choose.

Noi Ci Siamo San Marino supported the whole process, from the signature collection to the referendum campaign, in which we made several calls for our target audience – San Marino youth – to vote ‘yes’ for their own sake and that of future generations. We were up against the opposition of the Catholic Church and the ruling party, the Christian Democrats. The fact that 77 per cent of citizens, many of whom are Catholics and support the ruling party, voted ‘yes’, shows that people’s views have evolved faster than those of their political and religious representatives.


This is an edited extract of our interview with Sara Casadei. Read the full interview here.

A close result had been expected, so the landslide win was a welcome surprise. It reflected the power of the pro-choice campaign, which was overwhelmingly powered by young women. The UDS mobilised a positive, broad-based campaign, bringing together women across the political spectrum and reaching out to women of faith, a crucial action in a country where nine out of 10 people identify as Catholic and the church remains a powerful influence.

The campaign collected and shared the testimonies of Sammarinese women, knowing that the best way to build campaign momentum was to break the silence. It framed the reform as partly a question of showing that San Marino is a modern, responsible state that looks after its people and respects their private choices. They made the point that abortions are a reality and there is a need to give people the ability to make responsible and safe choices.

Campaigners also called for a law that enables easier access to contraception and sex education, with the aim of making abortion one of a range of options, and a law that protects women who go ahead with pregnancies, including by preventing discrimination against mothers in the workplace.

The church, as might be expected, campaigned against, along with the largest partner in the governing coalition, the church-aligned Sammarinese Christian Democratic Party. Abortion opponents held prayer vigils against the proposal, and they fought aggressively too, plastering walls with images of foetuses and children with Down’s syndrome. In common with anti-choice campaigners in other countries, they sought to present themselves not as opposing the rights of women but rather as defending the rights of the unborn.

What next and where next?

For the Sammarinese women’s movement, the referendum marked the culmination of decades of struggle: attempts to change the law first mobilised in the 1970s and were repeatedly rebuffed by socially conservative governments. They have finally overcome entrenched conservative forces in the heart of the establishment.

Parliament is now required to pass a law honouring the results of referendum. Women’s rights campaigners will press it to do so as quickly as possible and pass a law that respects both the letter and spirit of the referendum, advancing the rights of all women – those who need abortions, those who want access to effective contraception and those who want to carry a pregnancy to term.

Beyond the microstate, the result has wider resonance. It proves once more there is nothing inevitable about abortion restrictions in Catholic countries, and makes clear that the recent move by the Polish government to pander to ultra-conservative groups by almost entirely removing abortion rights was nothing other than an ideological choice. It is now Poland, rather than San Marino, that has become an outlier.

The result has wider resonance. It proves once more there is nothing inevitable about abortion restrictions in Catholic countries.

San Marino’s reform will leave only a few states across Europe with outright abortion bans: Andorra, Malta and the Vatican. The Vatican will always be a holdout, but what’s stopping the other two? If San Marino can do it, so can they.

Andorra has seen protests for abortion rights in recent years. Malta, as a European Union member, should now face increased pressure to get in line with the rest of Europe. San Marino has shown, as has been seen time after time around the world, how years of dogged campaigning can suddenly pay off as change reaches a tipping point. Campaigners in Malta and elsewhere should take heart, and keep pushing on.


  • The parliament of San Marino should pass a law fully respecting the results of the referendum and expanding women’s rights as soon as possible.
  • The government of San Marino should commit to ongoing dialogue with women’s rights groups to help overcome other barriers to equality.
  • The government of Malta should cease its ban on abortions and work with civil society groups to liberalise its laws.