On the Revolutionary Road to Reproductive Justice

Dr. Willie Parker is an abortion provider because of, not despite, his Christian faith. At a moment when refusal of care due to conscience claims obstructs reproductive justice, emphasizing the role conscience plays in compassionate and ethical medical care, as Dr. Parker does, means a revolutionary shift in thinking about power—prioritizing the needs of the woman seeking care.

The use of conscience claims to deny health care services is a focal point in current debates on abortion access and was a central issue at the recent Abortion and Reproductive Justice Conference (ARJC) in South Africa. In an auspicious start to the ARJC, the host-city, formerly known as Grahamstown, had recently voted to discard the name of Graham, a brutal colonizer, to rename in honor of Makhanda, a Xhosa freedom fighter and philosopher.

Revolution and reproductive justice share an intertwined history in South Africa. The Choice on Termination of Pregnancy (CTOP) Act is heralded as one of the most liberal abortion laws in the world. Thanks to the sustained advocacy of women’s groups, it was passed in 1996 by the first post-apartheid parliament. While the CTOP Act is revolutionary on paper, more than two decades later, the promise of reproductive justice remains unrealized for South Africans.

In South Africa, fewer than half of licensed facilities provide abortion services. The country is hardly alone in this struggle; advocates for women’s rights have noted the global pattern of conservative backlash to hard-won sexual and reproductive health rights, particularly the liberalization of abortion laws. In a coordinated campaign, anti-choice forces deliberately create barriers that make it harder, if not impossible, for women to get the care they want and need. A key tactic is the use of conscience claims to deny the provision of abortion and other reproductive health services. This makes it even harder for women to access these services in a country that suffers from extraordinarily high rates of sexual violence.

It was in this context that delegates from around the world convened to explore strategies to advance the unfinished revolution of abortion and reproductive justice. To this end, the International Women’s Health Coalition (IWHC) organized a roundtable discussion on refusals to care featuring Dr. Willie Parker, an abortion provider and author from the United States, Judiac Ranape, a comprehensive nurse trainer for the Department of Health in Cape Town, South Africa, and Mandy Mudarikwa, an attorney with the South African Legal Resources Centre. Their discussion shed light on the individual and systemic costs of refusal of care due to conscience claims both in South Africa and globally, focusing on strategies to combat this dangerous and unethical practice.

Refusal to provide services based on personal beliefs is a significant barrier to accessing abortion, exacerbating existing inequalities, and reinforcing the power dynamics that prioritize providers over patients. Seventy national and sub-national jurisdictions allow the use of conscience claims to deny abortion care; it is prevalent in South Africa and other countries where abortion laws have been liberalized, such as Chile, Italy, and Uruguay. These countries have witnessed how refusal of care erodes access to legal abortion and has negative impacts on women’s health. The consequences for both women and health systems serve as a warning for countries such as Ireland and Argentina, where legal reforms expanding abortion rights are underway.

The panelists’ powerful testimonies made the case that providing abortion care is actually an act of conscience. They illustrated how and why the mounting practice of refusal of services based on personal beliefs is unconscionable.

When providers deny care, they undermine women’s rights. Mudarikwa, a lawyer, stated that human rights are for everyone, but are not absolute: health care providers’ right to freedom of religion does not negate women’s right to access health care with equality and dignity. Yet this is what is happens when providers claim “conscientious objection” to deny care.

Dr. Parker emphasized the need to provide a counter-narrative about the intersection of religion and reproductive justice that does not diminish women’s choices: “While some people say it is mutually exclusive to be a Christian and an abortion provider, I say no. I say that it is immoral for me not to help women when I know what they face.” Though Dr. Parker’s evolution as an abortion advocate took place in the United States, his story reverberates around the world, as faith-based anti-choice movements export their ideology and strategies to countries in Latin America, Africa, and Europe. By speaking out, Dr. Parker aims to reframe the relationship between religion and reproductive rights and neutralize the harmful effects of stigma for those who seek and provide abortion.

Refusals of care also burden willing providers and public health systems. Nurse Ranape described the South African context and recounted how the Department of Health in South Africa has failed her and the women she serves. The impunity around her colleagues’ refusal to provide services or even help her means she often works alone—from prepping the patient, to performing the procedure, to mopping the floors. Like Dr. Parker, she is also a provider of faith, a conscientious provider; her initial discomfort with abortion has been overcome by witnessing the harms her patients face due to refusals of care by other providers.

Refusal of care is becoming a central battleground for abortion access. A shift is needed in how we discuss the issue and its impacts. Crucially, “conscientious objection” is a misnomer. To be accurate, this practice must be termed refusal of care. Reclaiming the concept of conscience in reproductive health, the panelists emphasized, requires advocacy, policy debates, strategic litigation, medical training, and public discourse that focus on the patient. When the needs of women are at the center, it becomes clear that refusal of care based on conscience claims has no place in health care as it denies reproductive justice by preventing women from making fundamental choices about their health, families, and lives.

Photo: Lorie Shaull

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