ROME – Italy has enjoyed almost forty years of uneasy political peace on the abortion issue, ever since the procedure was legalized in 1978 during the first 90 days of pregnancy. Two hugely controversial ballot propositions were put up for a vote in 1981, the first seeking to re-criminalize abortion and the other to legalize it with no restrictions at all.

Both measures went down in flames, the first by almost 70 percent and the second by nearly 90 percent.

Ever since, there’s been a basic social compact: Women and doctors aren’t going to jail over abortion, but it’s not going to be “anything goes” either, and medical personnel who don’t want to be part of an abortion won’t be coerced.

The law on abortion adopted in 1978 was numbered 194, and for decades the watchword of Italian politics has been legge 194 non si tocca – “hands off law 194.”

All that helps explain why a regulatory move this week by Italy’s Ministry for Health, announced only by way of a tweet, has created such a frisson, because to some it suggests that social compact may be dissolving.

Health Minister Roberto Speranza used Twitter to announce Saturday that RU486, commonly known as the “abortion pill,” has been approved for outpatient use. His decision followed a recommendation in April by the Italian Agency for Pharmacies, a government regulatory body, to issue such approval, as has already occurred in most other EU states.

RU486 was first approved for use in Italy in 2010 as an alternative to the traditional surgical abortion.

Since that time, women wishing to use the drug were required to be hospitalized, on the grounds that they should be under the care of a doctor who can ascertain the patient’s genuine desire to end her pregnancy and then monitor the use of the drug in case of adverse reactions.

The requirement, however, led to complaints about delays given the high number of physicians in the country who are conscientious objectors and refuse to prescribe or administer the drug.

Supporters of outpatient treatment argue that it better protects women’s privacy and also their ability to control the nature, and level, of their treatment.

Critics, such as Avvenire, the official newspaper of the Italian bishops’ conference, contend instead that it actually deprives women of needed care, especially in terms of monitoring the effects of the drug, and that Speranza’s ruling may well have been driven more by the lower cost of outpatient care rather than a genuine concern for the wellbeing of the patient.

“Not to calculate the potential risk that this decision carries is irresponsible,” said Giorgia Melloni, leader of the right-wing opposition party Fratelli d’Italia. “It’s creating an ideological furor on women’s bodies, trampling the principle of protecting someone’s health.”

Notably, the decision also was made over Vatican objections.

When speculation about outpatient use of RU486 began to circulate earlier in the summer, Archbishop Rino Fisichella, President of the Pontifical Council for New Evangelization and a former chaplain to the Italian parliament, took to the pages of L’Oservatore Romano, the official Vatican newspaper, to sound an alarm.

Fisichella referred to the abortion pill as “lethal poison,” the use of which is a “crime” that also means an automatic excommunication from the Church, as well as for those who prescribe it or participate in its administration.

“The Church can never be passive about what’s happening in society,” Fisichella wrote.

Use of the drug, he said, is using “an abortive technique” that means ending a “full and true human life,” which is “a responsibility that no one can permit themselves to assume without  knowing the consequences fully.”

Under ordinary circumstances, it might be legitimate to wonder whether Fisichella was speaking for the pope. Arguably at no point in modern history has there been as much space between the terms “Vatican” and “papacy” as under Francis.

In this case, however, that space seems fairly thin.

While Pope Francis has not directly weighed in on the debate over outpatient use of RU486, he certainly has condemned abortion, in vigorous terms, on multiple occasions. In April, for instance, during a reflection on the coronavirus pandemic, Francis urged Christians to carry the “song of life” into their own spheres of life.

“Let’s silence the cries of death,” he said, adding: “Let abortions end, which kill innocent lives.”

Ultimately, the concern among Italy’s pro-life movements and politicians is that the RU 486 decision could signal an unraveling of the social compact on abortion that’s held more or less since 1981, leading to pressure from the country’s left-leaning forces for expansion of abortion rights on other fronts.

Politically speaking, what’s interesting about all this is that Pope Francis and the Vatican generally are seen as on good terms with the government of Italian Prime Minister Giuseppe Conte, whose ruling coalition is composed of the center-left Democratic Party and the populist leftist Five Star movement.

Francis gave Conte badly needed support at critical moments of the coronavirus crisis, at one stage forcing the Italian bishops to back down when they appeared poised to defy government restrictions on public celebration of the Mass.

Going forward, it will be interesting to see whether Francis opts to cash in some of that political capital by sending signals that he’s prepared to push back if similar efforts crop up. This is a government that might not be especially concerned about “the Vatican,” but they certainly pay attention to the pope.

Follow John Allen on Twitter at @JohnLAllenJr.