Conscientious objection

Human rights standards

UN Treaties

UN Treaties are available in all or some of the official UN languages: Arabic, Chinese, English, French, Russian and Spanish.

Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
Article 1. …‘"discrimination against women" shall mean any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field.’
Article 12.1 ‘States Parties shall take all appropriate measures to elimination discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access t health care services, including those related to family planning.’ including…’appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary., as well as adequate nutrition during pregnancy and lactation.’
Article 16.1: ‘States Parties shall take all appropriate measures to eliminate discrimination against women in all matters relating to marriage and family relations and in particular shall ensure, on a basis of equality of men and women...(e) The same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights;…’
International Covenant on Economic, Social and Cultural Rights Health
Article 12.1:protects the right to physical and mental health: states parties are required to recognize "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health."  Note: This is in line with WHO definition of health.
International Covenant on Civil and Political Rights
Article 6: ‘Every human being has the inherent right to life…’
Article 7:  ‘No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment…’
Article 17: ‘No one shall be subjected to arbitrary or unlawful interference with his privacy…’
Article 18:‘
    1. Everyone shall have the right to freedom of thought, conscience and religion. This right shall include freedom to have or to adopt a religion or belief of his choice, and freedom, either individually or in community with others and in public or private, to manifest his religion or belief in worship, observance, practice and teaching.
    2. No one shall be subject to coercion which would impair his freedom to have or to adopt a religion or belief of his choice.
    3. Freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others…’
Treaty Monitoring Bodies: General Comments/Recommendations
(are available in some or all of the official UN languages:  Arabic, Chinese, English, French, Spanish, Russian)
Human Rights Committee (ICCPR) General Comment 22: Freedom of thought, conscience or religion ( (1993)
Paragraph 8: “Article 18.3 permits restrictions on the freedom to manifest religion or belief only if limitations are prescribed by law and are necessary to protect public safety, order, health or morals, or the fundamental rights and freedoms of others.
Paragraph 10: “If a set of beliefs is treated as official ideology in constitutions, statutes, proclamations of ruling parties, etc., or in actual practice, this shall not result in any impairment of the freedoms under article 18 or any other rights recognized under the Covenant nor in any discrimination against persons who do not accept the official ideology or who oppose it.”
The equality of rights between men and women (2000).
Paragraph 5: “Inequality in the enjoyment of rights by women throughout the world is deeply embedded in tradition, history and culture, including religious attitudes…States parties should ensure that traditional, historical, religious or cultural attitudes are not used to justify violations of women's right to equality before the law and to equal enjoyment of all Covenant rights.
Committee on the Elimination of Discrimination against Women (CEDAW), General Recommendation No. 24: Article 12 (women and health),(20th Sess., 1999) Paragraph 11.
“It is discriminatory for a State party to refuse to legally provide for the performance of certain reproductive health services for women. For instance, if health service providers refuse to perform such services based on conscientious objection, measures should be introduced to ensure that women are referred to alternative health providers.”
Committee on Economic, Social and Cultural Rights General Comment 14: The right to the highest attainable standard of health (Art. 12) (2000)
Paragraph 33. The  obligation to protect the right to health requires States to take measures that prevent third parties from interfering with Article 12 guarantees.
Concluding observations from treaty monitoring bodies to states on the issue have raised concern about the insufficient regulation of the practice of conscientious objection to abortion and resort to clandestine abortions because of this barrier.  They have consistently recommended that states regulate the practice in order not to limit women’s access to reproductive health care, including by implementing a mechanism for timely and systematic referrals and ensuring the practice of conscientious objection is an individual, personal decision, and not the views of an institution as a whole. (See generally Zampas and Andion journal article listed below and Ipas and Center for Reproductive Rights publications on UN TMB standards for details.  See also recent concluding observation from CEDAW to Hungary (2013) condemning institutional objection--the first time a human rights body has addressed the growing practice of institutional objection).

Special Rapporteur Reports/Documents

Anand Grover, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Interim report, A/66/254 (2011).
The UN Special Rapporteur on the Right to the Highest Attainable Standard of Health, issued a groundbreaking report in 2011 on the negative impact the criminalization of abortion has on women’s health and lives and specifically articulated state obligations to remove barriers, including laws and practices on conscientious objection which interfere with individual decision-making on abortion. The report notes that such laws and their use create barriers to access by permitting health care providers and ancillary personnel, such as receptionists and pharmacists, to refuse to provide abortion services, information about procedures, and referrals to alternative facilities and providers. He noted that these and other laws make safe abortions unavailable, especially to poor, displaced and young women and noted that such restrictive regimes serve to reinforce the stigma that abortion is an objectionable practice. He recommended that states, in order to fulfill their obligations under the right to health should “[E]nsure that conscientious objection exemptions are well-defined in scope and well-regulated in use and that referrals and alternative services are available in cases where the objection is raised by a service provider.”
Paul Hunt, Special Rapporteur on the Right to Everyone to the Enjoyment of the Highest Attainable Standard of Health, Written Comments in the Case of RR v. Poland, European Court of Human Rights, 2 November 2007.
Where a state allows healthcare providers to refuse services on the basis of conscientious objection, the state must ensure that the right to conscientious objection does not impinge on a woman’s right.

Regional Human Rights Bodies

European Court of Human Rights
The European Court of Human Rights has only addressed the issue of conscientious objection to abortion services in two recent cases against Poland, where women have complained that access to abortion and prenatal diagnostic services were hindered, in part, due to the unregulated practice of conscientious objection. The Court found a violation of Article 3 ( right to be free from inhuman and degrading treatment) and 8 (right to private life) in both cases for obstructing access to lawful reproductive health care information and services.  The Court noted that it held that the Convention does not protect every act motivated or inspired by religion.  ‘…States are obliged to organise the health services system in such a way as to ensure that an effective exercise of the freedom of conscience of health professionals in the professional context does not prevent patients from obtaining access to services to which they are entitled under the applicable legislation.’ RR v Poland, para 206 (2011); P and S v Poland (2012, para 106).  
It also notes the problems with lack of implementation and respect for the law, which includes elements allowing the right to conscientious objection to be reconciled with the patient’s interests, by making it mandatory for such refusals to be made in writing and included in the patient’s medical record and, above all, by imposing on the doctor an obligation to refer the patient to another physician competent to carry out the same service. However, it has not been shown that these procedural requirements were complied with in the present case or that the applicable laws governing the exercise of medical professions were duly respected. (P and S v Poland, para. 107).

RR v Poland

P and S v Poland

The Inter-American Commission on Human Rights,
Acceso a la información en materia reproductiva desde una perspectiva de derechos humanos = Access to information on reproductive health from a human rights perspective (22 November 2011) This report from the IACHR, addresses the need to regulate conscientious objection in its report on access to information on reproductive health. The IACHR articulates that the States must guarantee that women are not prevented from accessing information and reproductive health services, and that in situations involving conscientious objectors in the health arena, the States should establish referral procedures, as well as appropriate sanctions for failure to comply with their obligation. The report also recommends that states “establish protocols for effective access to information in cases involving conscientious objection.”

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