ROME — Abortion advocates in San Marino expressed satisfaction Thursday that lawmakers voted to legalize abortion in the tiny republic, one of the last European states to have had the procedure outlawed under all circumstances.

Wednesday’s parliamentary vote was the culmination of a referendum last year in which citizens overwhelmingly voted to overturn a 150-year-old law that criminalized the procedure.

The legislature of the predominantly Catholic nation voted 32 in favor, seven against and 10 abstaining to make abortion legal in the first 12 weeks of pregnancy.

The September 2021 referendum found that 77 percent of voters wanted the new law, which would also allow abortion beyond the first trimester of pregnancy if the grave fetal anomalies put a woman’s life or health – both physically or psychologically – at risk.

“We are satisfied,” said Elena D’Amelio, one of the advocates who had collected signatures as part of a petition drive to hold the referendum.

The cost of the procedure will be covered by San Marino’s public health system.

San Marino is surrounded by central Italy, and many women traveled to have an abortion an a hospital in Italy, where the procedure was made legal — over fierce objections from the Vatican — in 1978. Under the old law, women risked criminal prosecution if their abortion abroad became known, although D’Amelio said, no one was actually prosecuted.

“Before the new law legalizing it, women not only had to pay for it, you had to do it in secret,” D’Amelio said.

Passage of the new law gave women “the right that was asked for resoundingly through the referendum,” lawmaker Giacomo Simoncini told San Marino RTV.

Turnout in the referendum was 41 percent in the republic of 33,300 inhabitants.

In 2018, voters in Ireland overwhelmingly called for abortion’s legalization. Abortion is still illegal in Malta and Andorra. Poland introduced a near-total ban on abortion in 2021.

One of the provisions of San Marino’s law provides for sex education in the republic’s schools, a measure aimed at preventing unwanted pregnancies, D’Amelio said.

It is too soon to know what percentage of health care workers in San Marino’s only public hospital might declare themselves conscientious objectors, meaning they could opt out of providing an abortion. But the law calls for San Marino’s citizens to be reimbursed by the government for any abortion they might have in Italy as a result of a lack of health care workers refusing to perform one in their own country.

Women in San Marino must have a consultation with medical personnel before having an abortion, but that can be done online. No one can be denied the procedure in the first 12 weeks of pregnancy.