The global women’s movement has fought for many years to affirm safe and legal abortion as a fundamental right. These efforts have paid off, with countries around the world liberalizing their laws over recent decades. But progress is not linear, and persistent barriers still prevent these laws and policies from becoming a reality. One such blockade is the growing trend of the use of “conscientious objection,” a concept typically associated with the right of refusal to take part in the military, or in warfare, on religious or moral grounds. It has recently been co-opted by anti-choice movements; reproductive rights advocates have noted an increase in the use of conscientious objection by health providers to deny abortions to those who need or want them. This has dire consequences on women’s health and lives.
Last month, nearly 50 champions of women’s health and rights gathered in Montevideo, Uruguay, for the first global convening to explore the rising trend of conscientious objection to abortion. Activists, legal experts, health care providers, academics, and policymakers from 20 countries met to develop strategies to safeguard abortion access in the face of the mounting use of conscientious objection to abortion by health care providers. The three-day meeting, co-hosted by Mujer y Salud en Uruguay (MYSU) and the International Women’s Health Coalition (IWHC), resulted in recommendations that advocates can use to tackle this growing phenomenon. In a forthcoming IWHC and MYSU report, we will capture practical strategies discussed at the convening.
Research shows that conscientious objection to abortion is a global phenomenon: currently, seventy countries allow conscientious objection in health care, according to the newly launched Global Abortion Policies Database. In Italy, for example, abortion has been legal since 1978, yet it is nearly inaccessible for most women; approximately 70 percent of Italian gynecologists (the number is higher in some regions) have registered as conscientious objectors who refuse to provide abortion services. Similarly, Uruguay passed a landmark law that expanded the right to abortion in 2012. But the law allows for conscientious objection, and in some areas of the country, up to 80 percent of providers object to providing abortion services.
Conscientious objection in the context of health care has been used by providers to exempt themselves from delivering services by invoking their rights to freedom of thought, conscience, and religion. This results in the denial of patients’ right to health care. While international human rights standards uphold an individual’s right to conscience, no international bodies recognize the right to conscientious objection in the health care context. Throughout the meeting, we heard the consistent refrain—including from many in medical and research fields—that health professionals had a moral and ethical duty to put the lives and health of their patients first.
“There should be no place for health workers to refuse abortion,” a South African doctor said. But he further explained the complexities of the issue and the complicated medical environment he has seen firsthand: even when health providers do not object to providing abortion, they might not have the necessary skills or support from management to offer it. And, they may face stigma if they do provide the service. In some cases, health providers use conscientious objection as an excuse to exempt themselves from providing a service that they don’t know how to deliver or that they find stigmatizing.
Convening participants developed practical strategies that would address these challenges and mitigate the harms of conscientious objection. These include advocating for health professionals to receive pre-service training, continuing education, and ongoing professional and psychosocial support and networking.
Everyone unwaveringly agreed that efforts to tackle conscientious objection to abortion must be based on the experiences of women and girls who are disproportionately affected, as well as those courageous providers who ensure that women and girls can access the services they need and are entitled to. One of the most compelling messages we heard throughout the meeting was the need to reclaim “conscience” from the religious anti-choice movement. An attention to conscience as a decision-making tool for practitioners can also mean placing emphasis on providing abortion services as a professional obligation, and as a way to uphold women’s rights.
With attacks on reproductive rights increasing, we must become better equipped to not only understand and anticipate the evolving strategies of those opposed to abortion, but also to expose and counter the effects of their attacks.
“We must call in our colleagues,” said another doctor from South Africa. “And we must call out administrators, policies, and structures that don’t prioritize the right to abortion.”