Ipas > The "new" conscientious objection

The "new" conscientious objection

April 3, 2006

A doctor's denial of abortion services or a pharmacist's refusal to prescribe emergency contraception (above) can have dire health consequences for women.

Illustration by Maalin.

"Mavis Molepo" went to a public-health facility to request an abortion or, as it’s called in South Africa, a termination of pregnancy (TOP). She informed the doctor on duty, "Dr. Nadoo," that she had been raped but did not report the matter to the police. But he refused to perform the abortion and wouldn’t even tell her where else to go for the procedure.

Can "Nadoo" refuse to serve "Molepo"? That’s the type of question that health-care workers and management worldwide are facing more and more. Conscientious objection, once widely understood as refusal to serve in the military due to religious or pacifist beliefs, has taken on new meaning.

In South Africa and other countries, opposition to abortion has sometimes reared its head in the form of health-care professionals refusing to perform abortions and other staff refusing to make beds or provide nonmedical help to patients.

That’s why Ipas South Africa and the Women’s Legal Centre of Cape Town recently re-released their manual about conscientious objection. With explanations of their country’s 1996 Choice on Termination of Pregnancy (CTOP) Act and practical examples, Conscientious objection and the implementation of the choice on termination of pregnancy act 92 of 1996 in South Africa helps health-care workers who might have questions about the line between professional duty and personal belief.

Mosotho Gabriel, Director of Ipas South Africa, said: “Increasingly, health-care professionals and management teams are using conscientious objection as the reason for not implementing abortion services in facilities designated by the state to provide abortion care services, particularly second-trimester abortions,” which are allowed up to 20 weeks in certain circumstances.

“Now, legal practitioners and health-care providers must consider how to deal with conscientious objection in this context. A great deal of uncertainty and misinformation surrounds the right to conscientiously object to providing abortion services, and it is often believed that a person’s right to object supersedes a woman’s right to access a safe and legal abortion.”

Gabriel said that a woman’s right to reproductive autonomy, privacy and information must be weighed against the service provider’s right to their personal beliefs.

The Ipas South Africa and Women’s Legal Centre manual summarizes the CTOP Act, using a set of questions and hypothetical scenarios. Health-care providers have the right to refuse to perform terminations of pregnancy, but they do not have the right to hinder access to services. They cannot refuse to direct a woman to a facility or person who will perform the termination. Neither do they have the right to refuse to give information regarding the access to safe legal abortion services.

Under South African law, the right to refuse to provide abortion services applies only to the actual performance of the abortion. Health-care providers who are not directly involved with the procedure cannot use their beliefs as a reason for not assisting a woman in her care. They also cannot deny routine nursing care, the provision of clean linen, food or general assistance not related to the procedure.

Gabriel noted that just as South Africa limits abortions to pregnancies at or under 20 weeks, the right to object is also limited. In an emergency situation where the abortion is necessary to save the woman’s life, the health-care provider is expected to assist regardless of personal beliefs. Failure to do so could lead to charges of negligence against the provider — and serious health consequences for women.

When a health-care provider delays referral, withholds information or refuses to dispense medication, he or she does not merely block a woman’s right to access legal services. The denial itself is a threat to a woman’s life or health: Once denied, many women will consider risky procedures by unqualified providers outside the formal health sector.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258