Impacts of CO on women’s healthcare

Because reproductive healthcare is largely delivered to women, CO in this field has implications for women’s humanrights and constitutes discrimination. Women are often expected to fulfil a motherhood role, so they frequently face ignorance, disapproval, or even hostility when requesting abortion. In these circumstances, the exercise of CO becomes a paternalistic initiative to compel women to give birth.

Refusals to provide emergency contraception also force women to risk unwanted pregnancy, while referrals to other pharmacies can cause delays that reduce the effectiveness of the medication. Prescriptions for birth control or emergency contraception have been refused by anti-choice pharmacists in the U.S. (Planned Parenthood (Affiliates of New Jersey), 2005) and occasionally in other countries such as the U.K. (Brooke, 2010) and New Zealand (Sparrow, 2012). At least six U.S. states explicitly allow pharmacists to refuse to dispense contraception (Guttmacher Institute, 2013a). As with abortion, refusals to dispense contraception are not a mere inconvenience to women, but cause genuine harm to their reproductive autonomy, their sense of security, and their moral identity as people who deserve to be treated respectfully when requesting sexual and reproductive healthservices (McLeod, 2010). Public confrontations with objecting pharmacists compromise patient confidentiality and can shame or humiliate women.

The presumption that only a small minority of healthcare professionals will exercise CO and that others will be available to perform the medical service places limited CO on a foundation of shifting sand, further revealing its contradictory and dangerous nature. Indeed, CO can become quite widespread, leaving women without access to services across entire regions. In Italy, 69% of all gynaecologist srefuse to perform abortions, with the figure rising to over 80% in some regions (Italy Ministry of Health, 2007—2008).
In Austria, abortion providers must travel from Vienna to Salzburg once a week to do abortions at one public hospital, because gynaecologists in the region invoked CO after intense pressure from the Catholic Church and anti-choice groups. Abortion is unavailable elsewhere in Salzburg or the surrounding county (Fiala, 2013).

The example of South Africa is an important lesson in the anti-democratic nature of CO and the negative impact it can have on women. Abortion was illegal during Apartheid, and one of the first actions of the newly elected democratic government was to legalize abortion to improve women’s health (in 1996). But religious groups mounted campaigns against abortion that significantly reduced the number of willing providers. As a result, most of the healthcare professionals who should be responsible for performing abortions refuse to participate. Because of the latitude given to CO in South Africa, almost a third of South African women believe abortion is still banned, illegal abortions appear to be more common than legal ones (van Bogaert, 2002), and women who show up at public hospitals with complications are often mistreated and shamed (SANGONeT, 2012).

In countries with a minority of anti-choice doctors, women may suffer worse hardship than a short delay and a minor inconvenience, even if the doctor makes a referral. Women may be burdened with additional costs, such as for travel or daycare, and may need to take more time off work — if they can find and get to another doctor or clinic. Delayed access to abortion can also result in significant morbidity. Waiting extra weeks or even months for the procedure increases the medical risk of abortion and may require a more complicated method (for example, D&C instead of vacuum aspiration) (Cheng, 2008). Further, the delay may lead to debilitating symptoms such as severe nausea and psychological distress from a developing pregnancy they want to terminate. They may also need to hide the pregnancy from employers, friends, and family members.

Low-income and rural women are hurt the most by the exercise of CO, because such women may not have there sources to seek services elsewhere. It also disproportionately affects women from ethnic minorities, and women who experience intimate partner violence or sexual violation, who are twice as likely to need abortion services than women who don’t experience such violence (World Health Organization, 2013).

Finally, allowing CO for abortion ignores the realities of poor abortion access and the negative impact of allowing CO in that environment. Abortion is probably the most heavily restricted medical procedure in the world, despite it being one of the most common — and one that only women need, often desperately.  In such a context, governments and health systems have an even greater obligation to ensure that abortion care is fully available and accessible. Instead,abortion is frequently singled out as the main or only target for CO in many countries, reducing access even further.

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