A pharmacy across the street from Vatican City in Rome, Italy. | Photo by Michael Wilner.

ROME  — It may be the last empire in the world on which the sun never sets: the Catholic Church, a kingdom full of believers and skeptics alike, with its one billion followers strewn across the globe. With such reach and untold wealth, it might seem ill-advised to question its influence. But walk across the street from its seat of power, where the spiritual bloodline of St. Peter lives and prays, and you will find a direct challenge to that influence at the most unusual of places: a local pharmacy.

This particular farmacia, a stone’s throw from the Vatican, meets Italian standards of Western medicine. Walk through its glass sliding doors to find four women working behind the counter, routinely opening drawers full of drugs for a constant line of customers. Condoms and birth control pills sit available in these cabinets, which line an entire wall in the back. And when all their doors are closed, the wall unifies into an expansive, clinically sketched and deeply ironic black-on-white depiction of St. Peter’s Basilica.

“If a woman has a prescription, we are required to fill it by law,” Alessandro Leone, the head doctor at the pharmacy on Via di Porta Cavalleggeri in Rome, says of birth control pills. “The Vatican has their opinion, but it’s their opinion. We have ours.”

The Vatican’s Pontifical Academy for Life has made that opinion loud and clear for decades: birth control, abortion and every form of contraception in between are “fruits of the same tree.” These practices undermine the sanctity of human life, it says, outlined succinctly in Pope Paul VI’s encyclical called Humanae Vitae released in 1968.

But casting this policy as winning politics in Western countries has proven an uphill battle — until very recently, when the Church subtly recast its message.

In the United States earlier this year, President Barack Obama’s health care law challenged Catholic-affiliated institutions that receive government funding to provide birth control. And in Italy, older such laws over pharmacies and hospitals, in arm’s reach of the Vatican, constrict doctrine with similar force.

With unique precision, and in a notable shift, the Catholic Church made a remarkable decision in its face-off with the Obama Administration: not to defend its stance on controlled reproduction based on its merits, but rather to cite “religious freedom” as its principal argument.

“As Catholics, we are obliged to defend the right to religious liberty for ourselves and for others,” reads a statement from the United States Conference of Catholic Bishops, titled Our First, Most Cherished Liberty, published earlier this month. “If religious liberty is eroded here at home, American defense of religious liberty abroad is less credible.”

The Rev. Federico Lombardi, director of the Vatican Press Office, said in an interview here that Pope Benedict XVI has followed the American debate from a distance, and noted that Catholics are not the only people who object to reproductive control. But after abortion passed into law in Italy in 1978 — just five years after a Supreme Court ruling made it legal in the United States — numerous prominent Italian bishops made public statements threatening clinicians who perform the deed with excommunication. They also emphasized a unique provision within the Italian law as an alternative: Article 9, which reserves the right of medical practitioners to refuse involvement in the procedure based on objections of moral conscience.

That same tactic is being used today in the debate over birth control in the U.S., where an ancient Judeo-Christian concept — freedom — has become core to the debate. And in taking a stance rooted in democratic ideals, the Vatican may have finally found a way to sell its policies — at least on the political realm.

Meanwhile, condoms, contraceptive jellies and the morning-after pill sell briskly from the pharmacy across the street.

The Uncomfortable Norm

Abortion has become so commonplace in Italy that women often speak about it openly.

Alessandra* recalled being 23 years old and going to a hospital in Milan for an abortion. It was 1989 and she expected it to be routine, given how common the procedure had become. That year in the Lombardy region of Italy, where Milan is located, one in four pregnancies ended in abortion—just above the national average, according to a Guttmacher Institute study from 1996.

But Alessandra’s doctor, who objected based on moral grounds, turned her away.

“For her it was murder,” she said of her doctor.

So Alessandra went to another facility where the doctors were willing, if not exactly welcoming. These new doctors were unhappy to be a part of what she describes an “unpleasant experience” for all involved. But the event that Alessandra found particularly humiliating came after her initial exams, as she awaited the procedure in the hallway of the clinic. Anxious and alone, with her parents in the dark, she watched as protesters raided the hall waiving plastic fetuses in the air. She remembers a dozen of them shouting murder. Alessandra felt implicated.

“The decision is not an easy one,” she says. Alessandra grew up half-Catholic, and had struggled with her relationship in the Church as an Italian woman. “When you are there for the surgery, you really don’t want to change your mind.”

In a country where nine in ten citizens nominally identify as Catholic, Alessandra is one of many Italian women that have been thrown into a complicated, and often contradictory, national debate. Codified in Italian law since 1981 is the right of its women to receive an abortion within 90 days of conception, without questions and free of charge. Women can buy birth control and fill prescriptions for the morning-after pill at their local pharmacy, and by law, these pharmacies are required to acquiesce.

And many Catholic doctors have chosen to exercise their right to refuse. One of the largest hospitals in southern Italy tacitly compels all of its doctors to sign Article 9 paperwork along with employment documents, and accordingly, every doctor at the facility objects to performing abortions. Casa Sollievo Della Sofferenza, a marble-lined hospital founded on the highest hill in San Giovanni Rotondo by Saint Pio of Pietrelcina himself, considers “the centrality of man and the protection of life, from inception to natural death,” to be its paramount values.

“For private hospitals like ours, the state does not place any binding restrictions,” says Domenico Crupi, the vice president and general director of the hospital. “Public hospitals are obliged to guarantee a public service. But in the end, Italian hospitals have, thank God, a certain autonomy, and that autonomy is respected.”

And yet in the Puglia region of Italy, where Casa Sollievo is located, the abortion rate stood at 21.4 percent as recently as 2008 — the country’s highest, according to reports from Italy’s Institute of National Statistics.

A Declaration of Conscience

While Casa Sollievo has institutionalized the practice, most doctors who sign Article 9 do so after a good deal of soul-searching.

At a small clinic on the outskirts of Rome, Emanuela Santuccia, a gynecologist by training, adjusts the diamond cross on her neckline. She is having trouble pinpointing the moment  that she found her religion. All she knows is that, over a period of time, a force or presence in her life ultimately drove her to make her faith and her life’s work coherent.

“I’m an objector of conscience,” Santuccia declares.

As a doctor at a public hospital, Santuccia was often faced with women who needed her to sign off on their abortions. And in her training, she had to actively participate in the surgical process.

Santuccia felt the process was normal at first, as it was widely accepted. She had grown up in a Catholic family —“not too observant, but with a specific idea of religion,” she says — but she never felt a particular affiliation with the God, or with his Church.

It took several years, which she describes as a personal journey. But Santuccia ultimately made a choice.

“At the emotional level, it is challenging to deal with the problems of women,” she explains. “Sometimes you feel powerless.”

Santuccia signed Article 9 paperwork, giving her coworker double the workload in an attempt to clear her conscience and find a way back into the Church. In doing so, she joined 70 percent of Italian gynecologists who now object, the Italian Ministry of Health reports—a number that has been rising over the past decade.

“There’s a difference between professional ethics and private conscious,” says Frank Chervenak, director of Maternal Fetal Medicine at New York Presbyterian Hospital and an honorary member of the Italian Society of Obstetrics and Gynecology. “A doctor who has a moral objection to abortion shouldn’t be forced to perform it, whether it’s [in] Italy or the United States.”

Chervenak, himself a practicing Catholic, notes perhaps one of the strangest Italian contradictions of all: the current rise in “objectors” coinciding with a decline in the Italian birth rate, to below replacement levels.

“The sad truth is that many in Italy don’t practice all of the tenets of the Catholic Church,” he says.

One possibility is that objectors consider abortion a red line, but perceive other contraceptives, such as condoms and birth control, as acceptable, or even beneficial. Santuccia takes this view, and encourages her patients to protect themselves against unwanted, preventable circumstances they may regret for the rest of their lives.

Given that many Catholic doctors like Santuccia are giving such advice, it is perhaps not surprising that condoms and other contraceptive aids are selling so briskly today – in clear sight of the Vatican itself.

*Name has been changed to protect identity

San Rafaelle Articoli Religiosi souvenir shop was one of the first to open 45 years ago in front of the old church in San Gioavanni Rotondo. It moved down to its current storefront down the street and competes with nearly two dozen other vendors. | Photo by Teresa Mahoney.

The legacy of a saint has inspired the founding of a hospital with over a thousand beds, the construction of a mega church with over 6,500 seats and a flurry of new residential developments that have together expanded San Giovanni Rotondo. But Padre Pio of Pietrelcina also created a new faith-fueled economy in this small town in southern Italy, which though home to only 26,000 inhabitants, has become the pilgrimage site for over four million believers each year.

Rodolfo San Raffaele has seen this evolution since his family opened a small souvenir shop in 1967. Originally from Africa, his father moved to Rome after the Second World War, where he crossed paths with the budding saint. His father was originally skeptical of Pio as he was unfamiliar with Catholic customs. But on a business trip to San Giovanni Rotondo several years later, Pio greeted him with a kiss on the hand. Somehow, Pio remembered who he was from their original encounter.

They remained friends until the day Rodolfo’s father died.

“Padre Pio put his hand on my head and said to me, ‘Worry not for your father, because your father is in heaven with God,’” San Raffaele said of his most powerful moment with the venerable priest. After his father’s death, he looked to Pio for guidance. “This makes me grande happy. Grande happy.”

Rodolfo San Rafaelle (right) and his wife (left) at their small souvenir shop in San Giovanni Rotondo. | Photo by Teresa Mahoney.

In the 45 years since, Rodolfo has continued to run the Chiosco San Raffaele Articoli Religiosi shop alongside his wife, selling Italian-crafted rosaries, Padre Pio sculptures, photo frames, pendants, necklaces, bracelets, talismans, icons and other trinkets. The store used to be right across the town’s main square from its original church, but in 1968, the year San Raffaele’s mother and Padre Pio died, the store relocated down the street, where it has since been in competition with an increasing number of vendors.

“There were only three or four shops back then,” he says. “Now it is difficult.”

Over two-dozen shops within a one-block radius alone have capitalized on Pio’s stature since his death and canonization in 2004, selling many similar souvenirs that have challenged San Raffaele to stay competitive.

San Raffaele, brushing back his silvered hair, says, “I’m not young anymore,” explaining the physical exhaustion of running the shop. “Maybe next year we’ll close.”

Check out this video of Rodolfo San Raffaele, speaking about his first-hand encounters with Saint Pio of Pietrelcina, after his parents died. (Produced by Teresa Mahoney.)

Naples by day. | Photo by Aby Sam Thomas.

“Broken windows theory” is an American notion that a neighborhood with urban blight is only going to get more blighted unless someone fixes a window. It seems that this theory has not yet made its way to Napoli, where the cycle of dirt and crime continues without much apparent effort to stop it. Residents end their days here not cleaning up the garbage but adding more to the piles. And nights in Naples are particularly unsettling.

During the day one sees rows of stunning medieval churches, but when the sun sets and the dim street lights come on, garbage and graffiti seem to be the city’s main characteristics.  The fear of God is replaced by the fear of trash. As we walk the streets, one classmate jokes about becoming a filmmaker; “a black plague movie would be perfect here,” she points out.

And yet, the residents of Naples seem to embrace what is. A bar across the city’s central stone-paved street welcomes drinkers in to “Stay Insane,” a song by the aptly named Black Devil Disco Club. By twilight, all vendors have closed their shops, locking their phallic and deeply religious souvenirs away behind lewdly painted grates to a deserted street, watched over only by saints carved in robes of worn stone.

Through the garbage, the cast bronze skulls and the active breeze from the vents of crypts is the life of the modern Neapolitan: stylish at the bar and content with pizza that is deservedly famed. Walking these streets, one finds a tender balance between faith and refuse.

The Torah. | Photo courtesy of The AP.

On a rainy Friday night, two young men in their mid-twenties arrive early for prayer at Congregation Ramath Orah on 110th Street off Broadway in Manhattan. The synagogue’s main sanctuary, lit by four brass, twelve-pronged chandeliers, is painted a warm eggshell, divided along the middle by a thin white fabric, translucent enough to see the shadows of the other through the gender divide. There are 21 rows on each side, and the men fill them comfortably as the service gets into full swing; 35 men attended at its peak, with only six women showing up to pray on the other side.

As it was the beginning of Shabbat, the Torah remained dressed in its ark at the front of the room, protected by a grand red-velvet curtain with gold trimmings. Two gargantuan medieval chairs stand on the left of the holy vessel. The scroll will emerge the next morning; but in preparation, between Kaballat Shabbat and Ma’ariv, Rabbi Moshe Grussgott would give remarks to the congregation on the parsha of the week.

In opening his speech, Grussgott quotes a favorite film of his: Phil Alden Robinson’s 1989 “Field of Dreams.”

“I usually start off with an anecdote or a story to hook people and get their attention,” Grussgott says after Shabbat.

For this particular parsha, on Terumah, Exodus 25-27, evoking the image of Kevin Costner walking through a cornfield has surprising resonance. “If you build it, he will come,” Grussgott reminds the congregation. This is a key message in the movie, but more importantly, the message of the week. “Meet God halfway,” Grussgott repeats, “and He will come.”

This week’s Torah portion was on the building of the mishkan, or Tabernacle, in the desert after the exodus from Egypt. “Jews were struggling about the elaborate plans of building this temple,” Grussgott explains. “Rabbis usually find allegorical meaning in these parshas.”

In his speech, Grussgott describes two different interpretations of the parsha: one that is figurative and one that is quite literal. Figuratively, Rashi, a medieval French rabbi who wrote extensively on Talmud interpretation, said Jews have a duty to make the home a hospitable place for God to reside, and that the mishkan represents that. But literally, Grussgott explains, Jews have historically built separate rooms for God, fully equipped with a desk, a chair, and a menorah for light.

And yet no bed is ever included in these rooms, he emphasizes.

“Do you know why?” he asks the crowd with a chuckle. “This is how rabbis make you feel guilty! They say, ‘you just read it! You don’t realize!’”

Grussgott finally gets a raised hand from the pews, and the participating gentleman answers correctly: it would be an insult to imply that God requires rest.

“When you have a beautiful Friday night meal, and the kids don’t have their smart phones with them and everyone is dressed beautifully, you create a structure that invites religious peace,” Grussgott explains. This is how Jews today can build mishkan in their own lives.

Grussgott’s lesson is short, and he speaks quickly. But in teaching his congregation through a miniature lecture, the weekly prayer is elevated to a practical education in how to live a more religious and spiritual Jewish life. It’s an opportunity for rabbis to connect the Book, usually separated from its people by ark doors and velvet curtains, with every day living.

“Not everyone there is going to be on that level,” Grussgott says. “I know that I have to be conscious to translate every Hebrew word. But I also want it to be challenging to those who are fluent, and active.”

The Park Avenue Synagogue. | Photo courtesy of The AP.

On the Upper East Side of Manhattan, nine men stand around anxiously at 7:30 a.m. on a Saturday morning, prayer shawls yet to be adorned, hoping a tenth will arrive. The tenth man does not have to be a Kohane or a Levi—a member of a priestly tribe—though it would be preferred. He just needs to be a he, and he needs to be over 13. Once a tenth arrives, the Jews of this small Orthodox service at Park Avenue Synagogue will have the quorum, or minyan, required for the week’s Shabbat service. Without him, the Torah cannot be read aloud.

I arrive much to their appreciation, and the service begins in a room offset from the main prayer hall where a Bar Mitzvah will soon be under way. The two rooms look nothing alike, and according to the Torah, that is just fine; despite often being described as a religion of laws, the only temple in Judaism with specific architectural requirements is the Holy Temple of Jerusalem, which awaits its next resurrection. The unique result for these congregants is a prayer room with the layout of a miniature legislature hall, like a shrunken U.S. House of Representatives, with semicircular isles ringing around a central amud, or lectern, where the laws are read and the stories are told.

Park Avenue Synagogue, on 87^th Street between Park and Madison Avenues in New York City, is part of the Conservative movement of Judaism, a movement that believes in gender equality. However, one member, Bernard Goldberg, a prominent donor to the synagogue, set up an Orthodox-style auxiliary minyan to the main service, where only men are counted in the quorum. Goldberg leads the opening portion of the service on this morning, known as the shacharit. The service moves quickly to the second portion, in which Torah is read out loud in Hebrew.  Seven members of the minyan are given an honor at the Torah known as an aliyah: special blessings that are before and after the readings.

While much of the service happily adopts the sentiments that come with requirement and habit, with the reading of prayers as law and laws as prayer, aliyahs are somehow preserved as personal moments to those granted the honor, bringing them out of their intimate space and up to the amud, where they will hold a silver yad and point to where the year has taken Torah reading so far, and will give the great Book a kiss through the proxy of their tallit, or prayer shawl, now adorned and in full employment.

If a Kohane, a member of the priestly family, had been present this morning, he would have had the first honor. But only a Levi is present, so instead he is the first to aliyah—or ascend, when translated directly to English. Like many words in Hebrew, aliyah has a double meaning: it also refers to the immigration or “ascent” of Jews from around the world to the Holy Land of Israel.

But how are these coveted prayers selectively granted? When questioned, Frank Pollack, a New York jeweler active in the shul, rolled his eyes.

“Well,” Pollack sighs, “on a day like today, everyone plays a role,” referring to the scrape-small size of the minyan. “When there’s a groom to be married, we give him uff ruff. And then to those in mourning, as well, we’ll give to them.”

But Pollack rolled his eyes not at the size of the minyan; he knows that, in New York City, there exists no shortage of locations for Jewish men who straddle the “Conservadox” line, between orthodox prayer and conservative practice, to observe Shabbat. The options are as varied as a Kiddush platter. Rather, Pollack was reacting to the politics of the prayer in some synagogues: the bias toward newcomers over the loyal, toward donors over those perhaps with smaller pockets.

At least this morning, at this shul, politics were distant. After each aliyah, the chosen tribesman remains in the front of the room to oversee the next man’s performance on the amud before finally stepping down. He is greeted by his peers in the pews with the well-wishing prayer of yasher koach, a blessing of strength. And after all seven ascents are complete, the Torah is wrapped back in the comfort of its bejeweled, red velvet dress, shielded, and crowned.