A narrative literature review of the impact of conscientious objection by health professionals on women’s access to abortion worldwide 2013–2021

ABSTRACT

Conscientious objection to provide abortion has been enshrined in laws and policies globally. Insufficient attention has been paid to the direct and indirect ways in which conscientious objection compromises women’s access to a lawful abortion. Using a systematic search strategy, this narrative literature review synthesises the literature exploring conscientious objection’s impact on women’s access to abortion in a range of countries. This narrative literature review builds on an extensive literature review published by Chavkin et al. (2013. Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses. International Journal of Gynecology & Obstetrics, 123, S41–S56. https://doi.org/10.1016/S0020-7292(13)60002-8). Searches were undertaken on the Medline (Ovid), Global Health, CINAHL, Scopus and Science Direct databases. Thirty six papers were included for thematic analysis. Conscientious objection to abortion was found to impact women’s access to abortion at three main levels: the practitioner level, the healthcare system level and the sociocultural environment level. Conscientious objection was found to impact access directly through attempts by health professionals to restrict access, and indirectly by exacerbating pre-existing barriers to access. Further research is required to better quantify the extent to which this impacts women and whether interventions are effective in reducing the barriers that conscientious objection creates and exacerbates.

KEYWORDS:

• Conscientious objection
• abortion
• narrative literature review
• access
• health professionals

Acknowledgements

The authors would like to thank the anonymous reviewers for their thoughtful and constructive comments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The authors have relied on background sections of the relevant included articles to provide this insight. It may be the case that the law and/or policy has subsequently changed. Additionally, referral requirements may not exist in emergency circumstances. With respect to Argentina, the article by Ramón Michel et al. (2020) does not explictly refer to the referral requirement in their paper, but does reference Argentinian abortion guidelines from 2019 (Guía nacional para la atención integral de personas con derecho a la interrupción legal del embarazo) that include a referral requirment.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.