Remarks:

• In spite of the human rights obligation to ensure conscientious objection does not hinder access to quality abortion care, and previous WHO recommendations aimed at ensuring conscientious objection does not undermine or hinder access to abortion care, conscientious objection continues to operate as a barrier to access to quality abortion care. It is critical that States ensure compliance with regulations and design/ organize health systems to ensure access to and continuity of quality abortion care. If it proves impossible to regulate conscientious objection in a way that respects, protects and fulfils abortion seekers’ rights, conscientious objection in abortion provision may become indefensible.
• The evidence reviewed considered the impact of conscientious objection on access to and availability of abortion care and not the effectiveness of regulating conscientious objection in terms of improvements in those outcomes. However, international human rights law provides some guidance as to how States can ensure that human rights of abortion seekers are respected, protected and fulfilled. These include: ☐  organizing the health system to ensure that sufficient, non-objecting providers are employed and distributed fairly across the country (3); ☐  putting in place clear and enforceable regulation of conscientious objection (147 [paras 30, 31], 148 [para. 41(f)], 149 [para. 37(b)]); ☐  ensuring adequate enforcement of the regulation of conscientious objection, including identifying, addressing and sanctioning non-compliance (147 [paras 30, 31], 148 [para. 41(f)], 149 [para. 37(b)]); ☐  outlining clearly who may object to what components of care (150 [paras 30-31], 148 [para. 41(f)], 3 [para. 43]); ☐  prohibiting institutional claims of conscience (147, 150 [para. 33(c)], 148 [para. 41(f)]); ☐  requiring objectors to provide prompt referral to accessible, non-objecting providers (3 [para. 43], 37 [para. 65(m)], 39 [para. 11], 150 [para. 33(c)], 146 [para. 28]); ☐  requiring conscientious objection to be exercised in a respectful and non-punitive manner; and ☐  prohibiting conscientious objection in urgent or emergency situations (3, para. 43).

KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO CONSCIENTIOUS OBJECTION

• Availability, accessibility, acceptability and quality must be central to the regulation of sexual and reproductive health (SRH) services.
• States that allow conscientious objection must organize their health system and abortion provision in a way that ensures that conscientious objection does not hinder access to or result in the refusal of legally available abortion care.
• States that allow conscientious objection should regulate the exercise of conscientious objection in a way that reflects best international clinical practice, protects abortion seekers, and ensures that provider refusal does not undermine or hinder access to quality abortion.
• Everyone has the right to accurate information on SRH.
• Everyone has a right to privacy and confidentiality in SRH services.
• Everyone has a right to non-discrimination and equality in accessing SRH services.