Remark

• Health services should be organized in such a way as to ensure the exercise of conscientious objection does not prevent people from accessing available abortion services.
• Where conscientious objection is permitted, international human rights law requires States to take steps to ensure that it does not operate as a barrier to access to abortion care. The mere existence of regulation of conscientious objection is not sufficient. In practice, this means that if States permit conscientious objection, they must regulate it in a way that is effective in ensuring that abortion is available and accessible in practice.
• 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: ☐  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]); ☐  organizing the health system to ensure that sufficient, non-objecting providers are employed and distributed fairly across the country (3); ☐  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).
• Accordingly, States that permit conscientious objection should reform the regulation of conscientious objection to ensure that the human rights of pregnant people are respected, protected and fulfilled, and that abortion is available and accessible.
• 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. In such circumstances, it may be appropriate to consider prohibiting conscientious objection and/or revising national law and policy frameworks that govern health workers’ professional and ethical obligations.

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. For further information and sources, please refer to Box 1.2 and Web annex A: Key international human rights standards on abortion.