On June 19, 2018, IWHC hosted a press conference for the launch of the report with four international experts. Listen to the full press conference here.
The rise of policies that allow health professionals to invoke personal beliefs to deny patients abortion and other reproductive health services is threatening access to health care for women worldwide, a new report has found. The resulting practices violate principles of medical ethics and have devastating consequences for women and girls who are denied abortions, contraception, and other services. Some health professionals are also using these claims to deny services to LGBTQ individuals and their families.
In the report, Unconscionable: When Providers Deny Abortion Care, the International Women’s Health Coalition (IWHC) captures the conclusions of 45 experts from 22 countries on the ethical, legal and human consequences of policies that allow providers to deny essential and legal health care based on their individual beliefs. A companion policy brief exhorts governments, international agencies and advocates to refrain from adopting policies that allow health professionals to deny care and to seek to limit the impact of any existing polices on patients through strict regulation.
“Refusing to provide healthcare based on one’s personal beliefs goes against everything medicine stands for,” said Françoise Girard, president of IWHC. “Policies that allow health care providers to invoke their personal views to deny medically sound, evidence-based, needed and wanted health care, are unethical, discriminatory, inhumane and a violation of patients’ human rights.”
More than 70 jurisdictions worldwide currently allow for denial of care based on these “conscience claims,” according to the World Health Organization (WHO). The growing phenomenon of medical professionals placing their personal beliefs before their professional duties is a major barrier for women to access health care. Some examples highlighted in the report include:
- In Ghana, nearly 38 percent of providers refuse care on conscience grounds;
- In Italy, recent research shows that, seven out of 10 Italian gynecologists refuse to carry out abortions on these grounds;
- The new law decriminalizing abortion in some cases in Chile, allows entire hospitals to refuse care;
- In Uruguay, up to 80 percent of professionals working in gynecology refuse to prescribe abortion pills;
- In the United States, one in six hospital beds is in a Catholic hospital, either owned by or affiliated with, a Catholic health system. Those hospitals are governed by directives that contradict medical evidence and prohibit a range of reproductive health services, including abortion, even when the life of the woman is in jeopardy. A recently proposed government rule in the US, would support health care professionals and institutions to go further and deny any health service to any individual on grounds of conscience.
The report’s authors note that international human rights bodies have not recognized a right to deny care on the grounds of conscience. However, only Sweden, Iceland and Finland explicitly prohibit health professionals from doing so.
According to the report, refusals grounded in conscience have potentially dire consequences for women. When providers deny women access to abortion, they create a range of hindrances—delays, travel requirements, increased financial costs—that steer women towards clandestine, unsafe abortions, often at the risk of their lives. If she cannot surmount these obstacles, a woman may be forced to carry a risky or unwanted pregnancy to term. These events can be traumatic for the woman, causing economic hardship and increased feelings of stigmatization and mental anguish, the report indicates.
“Many doctors and health workers are crucial allies to women in this struggle. They support the rights of women, and play a significant role in ensuring that ethical medical practices are upheld,” said Girard. “But women also need the right policies from governments, hospitals, professional associations and global health agencies, to ensure that providers who refuse to provide health care on personal or religious grounds understand this is not acceptable. We must stop burdening and penalizing women in need of vital health services.”
To enable full access to legal reproductive health services, IWHC makes the following key recommendations:
- Policymakers should not include provisions in health care policies that allow providers to refuse services based on conscience claims.
- Where laws permitting refusals are in place, governments should strictly limit and regulate the use of conscience claims and enforce those regulations. Policymakers should never allow institutions to refuse care. Policymakers should also establish and enforce strict regulations that ensure women can get the care they need and are legally entitled to. In the case of medical emergency or if another provider is not accessible, the provider must deliver needed care.
- International agencies and professional organizations working in health should take a clear position that refusal of care based on personal beliefs is unacceptable. This includes the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Nurse Midwives.
- Where the law is changing, health professionals need training and support to prepare to fulfill their professional duties. Health professionals should also receive on-going education in bioethics and human rights, including values clarification on abortion.
- Human rights bodies should further elaborate on how refusals to provide care specifically violate human rights.
Note to Editors:
IWHC experts are available for interviews in English, French and Spanish. A broad range of legal, ethical, medical experts and activists from around the world can be available for interviews, upon request.
Click to listen to the press conference, featuring Françoise Girard, president of IWHC; Dr. Tlaleng Mofokeng, vice chairperson of the Sexual Health and Reproductive Justice Coalition (SRJC); Udo Schüklenk, Ontario Research Chair in bioethics and public policy at Queens University; and Susan Wood, IWHC director of program learning and evaluation.
Contact: Liza Kane-Hartnett