Flipping the Script on Conscientious Objection

As laws on abortion have liberalized around the world, many women have benefited and enjoy more reproductive rights than ever before. But, this is definitely not the case for all women and girls. Even in more progressive environments, women still face barriers to getting an abortion because many health providers claim conscientious objection and refuse to provide it. Today, as we mark International Safe Abortion Day, we should look at how the growing trend of conscientious objection denies women their rights. Moreover, can women’s advocates actually use conscientious provision as a tool of resistance? There is a strong argument to be made that we can.

In the context of health care, conscientious objection is defined as the refusal to provide a service that violates one’s ethical or moral principles. Health care providers use it to exempt themselves from providing services they disapprove of by invoking their right to freedom of thought, conscience, and religion. But these rights can come into conflict with the fulfillment and protection of women’s health and rights. The United Nations’ Universal Declaration of Human Rights protects both the right to conscience and the right to health.

The International Federation of Gynecology and Obstetrics and the World Health Organization have established ethical guidelines that require providers to prioritize patient care over objections based on conscience. However, in practice, regulations are patchy at best and nonexistent or abused at worst. This has grave implications for women seeking abortion services, especially those who already lack information and access to services and who face discrimination, stigma, or financial burden.

A global snapshot shows that conscientious objection is not specific to any one region or country but is a phenomenon that plays out differently across the world, in a variety of political and cultural settings. In Sweden, Iceland, and Finland, for example, conscientious objection to providing abortion is not allowed as it is viewed as a professional obligation. Reproductive health care providers receive mandatory abortion training as part of their medical education. Anti-choice students are dissuaded from joining the field, and anti-choice providers are not likely to get hired.

In countries such as Colombia and South Africa, conscientious objection is written into abortion policy in an effort to regulate its use and to balance the rights of providers and women.

Because of the complicated motivations behind conscientious objection, it is difficult to document how exactly it is used or misused and how it affects women. Preliminary research shows that it causes significant barriers because providers are either unaware of the laws and guidelines or simply don’t uphold their responsibility to refer their patients to other professionals. Some are misusing conscientious objection with impunity.

A well publicized case in Colombia in 2008 brought the issue to the fore. After a health care facility refused to provide abortion services to a 13-year-old who was raped, acquired an STD, and became pregnant, the Colombian Constitutional Court ruled that the girl’s fundamental rights were violated. In response, the Court mandated a fine and monetary compensation and clarified that conscientious objection can only be exercised by the individual medical person directly involved in the procedure.

We are also seeing examples of conscientious objection in the United States, where approximately 1 in 6 of the nation’s hospital beds is in a facility governed by the Catholic Church. According to the guidelines set by the U.S. Conference of Catholic Bishops, Catholic health care facilities are bound by standards that prohibit a range of reproductive health services, including contraception, infertility treatments, and abortion—even when a woman’s life or health is jeopardized. These guidelines have resulted in women being refused care when they are miscarrying, have dislodged IUDs, or require hysterectomies.

This is an alarming trend because wider application of conscientious objection can exacerbate existing disparities in places like Texas. Even if a woman is able to jump through all the hoops to access an abortion in Texas, there is a chance she may face a provider who objects and refuses to provide it.

There are many ways to regulate conscientious objection and more research is needed to better understand them. But we can also shine a light on the role that conscience plays in the provision of abortion; it doesn’t have to be a barrier and can promote health and rights. Highlighting conscientious provision places emphasis on providing abortion services as a professional obligation and as a way to uphold women’s rights. We shouldn’t cede the concept of conscience to the anti-choice movement.

As Dr. Willie Parker, who provides abortion care in southern states, has written: “The clarity I have about loving my neighbor as myself has been simply to want for women what I want for myself. I want a life of dignity, self-determination, well-being and the ability to participate in the common good….Providing abortion care when women request it is a primary way that I can preserve these possibilities…My conscience demands it.”

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