1. Traditionally, conscientious objection has been used ‘in the context of refusal to perform military service.’ In other words, when individuals refuse to do military service due to their personal conviction that it is morally wrong.
Conscientious objection derives from the right to freedom of thought, conscience and religion, which is enshrined in many human rights agreements such as the Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights. However, the right to conscientious objection to military service has not been defined as a right in itself in any UN document.
2. The right to conscientious objection in the context of abortion is the idea that a healthcare worker has the right to refuse to administer abortion because it is contrary to their personal convictions or moral beliefs.
However, conscientious objection in terms of healthcare provision is different from conscientious objection to military service, due to the fact that a healthcare professional’s refusal to provide certain health services has consequences for more people than just themselves. In other words, their decision affects the health and /or lives of the women and girls to whom they refuse.*
3. Refusal to administer abortion on the grounds of conscientious objection can put women’s health and lives at risk in many ways.
Conscientious objectors may delay women’s access to abortion services to the point that, they will have already reached the legal gestational limit by the time they find a medical professional who is willing to perform the procedure. In other words, they would, at that point, be ineligible for legal abortion. This may force them to seek unsafe abortion, which can endanger their health and lives. In fact, according to a study by UN DESA, rates of unsafe abortion are estimated to be over four times higher in countries with more restrictive abortion legislation than in countries with less restrictive legislation.
4. Let’s talk about stigma:
Conscientious objection leads to the stigmatization of women in need of abortion, and this stigma prevents women and girls from accessing the abortion services that they need. Widespread stigmatization of abortion may also lead to prejudices against doctors who do provide abortion, potentially creating a vicious circle of stigma between healthcare provider and patients.
5. Referral: In countries where abortion is legal, conscientious objectors are generally obliged to refer the patient to another healthcare professional who will carry out the termination.
In other words, ‘States are obliged to organize their health systems in a way that reconciles the freedom of conscience of health professionals with patients’ rights to lawful services.’ (European Court of Human Rights).
Furthermore, the WHO states that the woman should be referred to a health care professional in the same or a nearby health care facility and, if referral is not possible, the conscientious objector must carry out the abortion if it is needed to save the woman’s life or prevent serious consequences to her health.
In practice however, referral often doesn’t happen and if it does, there may be a long delay before the patient is referred to a willing and qualified healthcare professional, delays that lead to the consequences outlined above.
6. Despite the fact that conscientious objection should be based on personal conviction, it is sometimes applied as a blanket policy across entire institutions.
This means that entire hospitals and healthcare facilities fail to provide abortions, and so, women’s access to abortion becomes a ‘game of chance,’ entirely dependent on where she lives or her wealth.
7. Blanket anti-abortion policies may also lead some medical professionals to become conscientious objectors, even if they are not morally opposed to abortion.
Pro-choice doctors may experience discrimination in terms of their career opportunities, and so, they may decide to become conscientious objectors in order to find a job at an anti-choice healthcare facility.
8. Realities on the Ground: In Poland, the Federation for Women and Family Planning have been recording up to three cases of conscientious objection in the context of abortion, every day. (2016)
The organisation has also recorded of incidences where doctors refuse to provide abortion in their jobs at public hospitals, but provide them in their private clinics, at a high price. This situation is hugely worsened by the fact that, as of the Constitutional Tribunal’s judgement (October 2016), Polish medical professionals who object to abortion are no longer obliged to refer women to another professional who will be willing to perform the procedure.
Advocacy Entry Points
Once armed with the facts and arguments against conscientious objection, we can start thinking about how we can advocate for its prevention. Here are a few key concepts and entry points that might prove useful:
The Right to Health is enshrined in many human rights agreements, such as The Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights.
The right to health is defined in the constitution of the World Health Organization as:
“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
Use of conscientious objection and failure of referral in the context of abortion therefore jeopardizes women’s right to health.
Furthermore, The Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women (CEDAW) have both clearly indicated that women’s right to health includes their sexual and reproductive health. This means that states have obligations to respect, protect and fulfill rights related to women’s sexual and reproductive health.
If your country has ratified or acceded to the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), it is legally bound to put the Convention’s provisions into practice, and to submit national reports on its progress in doing so. The CEDAW Treaty Body Review monitors implementation of CEDAW in UN Member States and provides opportunity for input from NGOs on states’ implementation.
Do some research on your country’s most recent CEDAW Treaty Body Review and see how you might engage with this review process to raise the issues of conscientious objection and women’s right to health in the future.
The UN Universal Periodic Review (UPR) takes a look at the human rights situation in UN Member States and provides recommendations on how each state should improve its human rights record. Stakeholders, or NGOs, from the State under Review (SuR) can submit reports to be considered under the UPR, and this provides advocates with the opportunity to raise certain human rights concerns to be considered at UN level.
The Sustainable Development Goals (Goal 3 – Health and Wellbeing and Goal 5 – Gender Equality) are important entry-points for advocacy on sexual and reproductive rights (SRHR). Do some research on your country’s national policies and accountability mechanisms to see what steps are being taken to achieve the goals of the Agenda 2030.
For national level advocacy – a good tip is to do some research on upcoming government consultations with civil society that might be related to the issue you’re advocating for (say, health or women’s rights if you are advocating for abortion rights). You should also see if there are any National Strategies on your advocacy issue and if there are, you can try to email or arrange to meet your local politician in order to keep them accountable to this strategy. Meeting or contacting politicians from your country can be an important step in national advocacy, however, it is not always possible for citizens in some countries in the EECA Region.