Impacts of CO on abortion provision

The exercise of CO can exacerbate the lack of access to abortion care by further reducing the pool of providers. Even pro-choice doctors may decline to or be unable to provide abortion care for a variety of other reasons besides CO, most of which are unique to abortion because of its politicized nature.

The stigma and misconceptions around abortion turn CO into an attractive solution for individual healthcare providers (ironically reinforcing those negative attitudes and beliefs). Allowing CO also encourages opportunistic refusals— doctors who are ambivalent about abortion may begin to adopt CO when given that option, making it very difficult to stop its growth (Millward, 2010). The refusal to perform or assist with abortion is often not even related to personal beliefs. Most pro-choice doctors who should or could perform abortions (obstetricians/gynaecologists and general practitioners) never do them, frequently because they fear that their reputation or livelihood will suffer because of social stigma. In North America, the atmosphere of fear and intimidation created by anti-choice extremists has worsened the provider shortage. The well-publicized violence against providers gives doctors ample reason to back away from performing abortions, irrespective of their personal beliefs.

Doctors who invoke CO to not perform abortions can benefit professionally by spending more of their time delivering more ‘‘reputable’’ or higher status treatments compared to their abortion-providing colleagues. As a result, they can escape stigma and boost their careers, reputations, and salaries.

Doctors who nevertheless want to provide abortion care may be prevented from doing so by their healthcare institution or employer for a variety of reasons, or by a lack of support from their collegial and social networks (Joffe, 2009). Physicians cite obstacles such as an anti-choice climate in their workplace, and widespread ‘‘no-abortion policies’’ that exist in many hospitals and private practices (Coletti, 2011), which may threaten health care providers with instant dismissal if they provide any banned treatment. Further, many doctors are simply unable to find work or training opportunities in an environment where abortion is legally restricted and stigmatized.

Lack of training and expertise is a common reason for not doing abortions, even though early abortion is a simple procedure and doctors routinely treat miscarriage using the same techniques as for surgical abortion. In general though,specific medical school training in common abortion techniques such as vacuum aspiration is often inadequate or non-existent, even in many western countries (Koyama and Williams, 2005).

When access to abortion care is reduced, restricted, and stigmatized in so many ways, allowing any degree of CO adds further to the already serious abrogation of patients’ rights and medical ethics.

Source: Fiala C, Arthur JH. ‘‘Dishonourable disobedience’’ — Why refusal to treat in reproductive healthcare is not conscientious objection. Woman – Psychosom Gynaecol Obstet (2014),