Report Highlights:


A Worrisome Trend:

  • According to the World Health Organization, more than 70 jurisdictions worldwide allow for denial of health care based on personal belief.
  • 45 of 50 US states have laws allowing health providers to deny abortion care based on provider’s belief.

Dangerous & Unethical:

  • Experts from 22 countries agree that denial of health care services based on personal belief is a violation of human rights.
  • A person’s need for evidence-based, medically sound, legal health care services should take precedence over a provider’s religious or personal beliefs.
  • Policies allowing health providers to deny care based on belief put patients at risk of discrimination, physical & emotional harm, and financial stress.

Policy Recommendations from IWHC:

  • Policymakers should support women’s access to health care and reject policies that allow providers to deny care to people in need.
  • Policymakers should never allow institutions to refuse care based on religious belief.
  • Advocates should reclaim “conscience” for those who follow theirs to affirm the right to health.


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This report pairs with IWHC’s Policy Recommendations to Prevent Denial of Abortion Care.



The global women’s movement has fought for many years to affirm safe and legal abortion as a fundamental right, and the global trend has been the liberalization of abortion laws. Progress is not linear, however, and persistent barriers prevent these laws and policies from increasing women’s access to services. One such obstacle is the growing use of conscience claims to justify refusal of abortion care.

Often called “conscientious objection,” a concept historically associated with the right to refuse to take part in the military or in warfare on religious or moral grounds, the term has recently been co-opted by anti-choice movements. Indeed, accommodations for health care providers to refuse to provide care are often deliberately inserted into policies with the aim of negating the hard-fought right to abortion care.

Existing evidence reveals a worrisome and growing global trend of health care providers who are refusing to deliver abortion and other sexual and reproductive health care. This phenomenon violates the ethical principle of “do no harm,” and has grave consequences for women, especially those who are already more vulnerable and marginalized.


A woman denied an abortion might have no choice but to continue an unintended pregnancy. She may resort to a clandestine, unsafe abortion, with severe consequences for her health or risk of death. She might be forced to seek out another provider, which can be costly in time and expense. All of these scenarios can lead to health problems, mental anguish, and economic hardship.

International human rights standards to date do not require states to guarantee a right to “conscientious objection” for health care providers. On the contrary, human rights treaty monitoring bodies have called for limitations on the exercise of conscience claims when states do allow them, in order to ensure that providers do not hinder access to services and thus infringe on the rights of patients. They call out states’ insufficient regulation of the use of “conscientious objection,” and direct states to take steps to guarantee patient access to services.

Noting the increase in the use of conscience claims by health care providers to deny abortion to those who seek them, with dire consequences for women, the International Women’s Health Coalition (IWHC) and Mujer y Salud en Uruguay (MYSU) co-organized the Convening on Conscientious Objection: Strategies to Counter the Effects, in August 2017. The convening brought together 45 participants from 22 countries, including activists and advocates, health and legal professionals, researchers, academics, and policy-makers. Over three days, participants discussed the consequences of the refusal of care by health care providers claiming a moral or religious objection, possible legal and policy responses to arrest this trend, and the need to reframe the way so-called “conscientious objection” is understood in the context of healthcare.

Participants at the IWHC- and MYSU-led convening agreed that, while health care professionals are entitled to their religious beliefs, they must not prioritize these beliefs over their duty to provide services.

Patients’ health and rights should never be subordinate to providers’ individual concerns. Health care providers who put their personal beliefs over their professional obligations toward their patients threaten the health care profession’s integrity and its objectives. Nothing would stop such individuals from joining the health care profession, but they ought to specialize in fields in which their abilities to provide comprehensive services is not undermined by their personal beliefs.