In 2012, a woman in Spain who was seven months pregnant learned that her baby would not survive outside the womb because of a fetal congenital anomaly. Paula (a pseudonym) sought an abortion at a nearby hospital, but the doctor refused for moral reasons, according to Spanish newspaper El País. Ultimately, local health authorities decided that “in order to respect the professionals’ right to objection on moral grounds,” the newspaper reported in 2016, they would refer her to a clinic in Madrid. It was 354 miles away.
By the time Paula arrived, she was bleeding heavily and had to undergo an emergency C-section, which resulted in the removal of her uterus. She nearly died. “The doctors' right to object almost cost me my life,” she told El País in an interview. “It was really traumatic.”
Her horrifying story is just one of the accounts included in a new report from the International Women’s Health Coalition (IWHC), which sheds light on the growing trend of healthcare providers refusing abortion services based on religious or moral objections. The work is the result of a three-day summit held last August in which 45 experts from 22 countries gathered together to discuss the ethical, legal, and real-life consequences of policies that allow providers to refuse abortion services based on their individual beliefs.
Known as a “conscience claim” or “conscientious objection,” the practice “goes against everything medicine stands for,” said Françoise Girard, president of IWHC, in a statement. “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.”
While the laws vary in different countries, at least 70 jurisdictions across the world have provisions in place that allow doctors to opt out of abortion care due to claims that the procedure goes against their personal beliefs, the report states. In some areas, providers are required to inform national health officials that they will exercise conscientious objection to avoid terminating a pregnancy: For example, 70 percent of OB/GYNs in Italy were on record for refusing to perform abortions because of their individual feelings. In Uruguay, the report states, up to 80 percent of gynecologists (depending on the area surveyed) won’t perform abortions.
When providers deny patients important—and legal—access to abortion, the consequences can be dire, including continuing an unintended pregnancy or risking her health or life by resorting to an unsafe procedure. Additionally, the report’s authors write, “[a] provider’s refusal to perform abortion services compounds the effects of the many barriers women face in health care: discrimination, stigma, financial burdens, lack of information, transportation difficulties, and limited autonomy to make decisions about their own bodies.” Meanwhile, they add, doctors who promised “to do no harm” are rarely subjected to any consequences.
Susan Wood is IWHC’s director of program, learning, and evaluation, and author of the report. She tells Broadly they first noticed this issue emerging after Uruguay essentially decriminalized abortion in 2012. Soon after, they found that doctors were refusing to provide care using conscience claims that were allowed by law. And then they began to notice a pattern.
“Where the law changes and abortion becomes legal, or partially decriminalized, there was an increase in providers using conscience claims,” she says. “We know it’s going to be an issue in Ireland [whose citizens recently voted to legalize abortion]. It’s come up in Argentina, where there’s progress being made to decriminalize the law. And we see it in the US with a proposed rule from Department of Health and Human Services that would expand the use of conscience claims.” (The proposed rule was announced shortly after HHS opened a new branch dedicated to investigating claims of health care workers being “coerced” to do duties conflicting with their religious or moral beliefs.)
According to the IWHC report, policies that give providers this kind of right of refusal have been utilized by abortion opponents as “a bargaining chip” in countries where restrictive abortion laws are under review. It becomes another barrier, Wood says, for reproductive rights activists to work to overcome.
Otherwise, she adds, patients who are denied abortion services walk away with a profound, and disheartening, message: “That the provider’s personal beliefs are more important than her health, her needs, or her rights … [and] that’s very delegitimizing. It communicates to her that she’s doing something wrong.”