Background: The Ethiopian law on abortion was liberalized in 2005. However, as a strongly religious country, the new law has remained controversial from the outset. Many abortion providers have religious allegiances, which begs the question how to negotiate the conflicting demands of their jobs and their commitment to their patients on the one hand, and their religious convictions and moral values on the other. Method: A qualitative study based on in-depth interviews with 30 healthcare professionals involved in abortion services in either private/non-governmental clinics or in public hospitals in Addis Ababa, Ethiopia. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework. Results: For the participants, religious norms and the view that the early fetus has a moral right to life count against providing abortion; while the interests and needs of the pregnant woman supports providing abortion services. The professionals weighed these value considerations differently and reached different conclusions. One group appears to have experienced genuine conflicts of conscience, while another group attempted to reconcile religious norms and values with their work, especially through framing provision of abortion as helping and preventing harm and suffering. The professionals handle this moral balancing act on their own. In general, participants working in the private sector reported less moral dilemma with abortion than did their colleagues from public hospitals. Conclusions: This study highlights the difficulties in reconciling tensions between religious convictions and moral norms and values, and professional duties. Such insights might inform guidelines and healthcare ethics education.

Conscientious objection (CO) in healthcare refers to a health professional's refusal to provide services due to moral or religious reasons. The classic case of CO in healthcare is CO to abortion; however, CO can become a topic in any situation in which what is expected of the professional is at odds with their moral/religious convictions and the professional goes so far as to refuse to perform or participate. In recent years, the academic debate on the ethicality of CO has become voluminous. Some argue for broad toleration of CO, whilst others argue that it is rarely or never acceptable. Yet many also argue broadly in line with the so-called 'conventional compromise', 1 where CO is judged morally ac-ceptable if it is based on a serious moral objection, yet the professional is willing to inform the patient and refer to a colleague, and any burdens to the patient are deemed acceptably small. The responsibility to refer is also emphasized by the World Health Organization (WHO), which states that 'Conscientious objection, where allowed, should be regulated, and provision of alternate care for the woman ensured'. It is also pointed out by The International Federation of Gynecology and Obstetrics (FIGO) with the statement that 'If a physician is either unable or unwilling to provide a desired medical service for non-medical reasons, he or she should make every effort to achieve appropriate referral'. 2 1 A term coined in Brock, D.W. (2008). Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why? Theoretical Medicine and Bioethics.

Background Ethiopia’s 2005 abortion law improved access to legal abortion. In this study we examine the experiences of abortion providers with the revised abortion law, including how they view and resolve perceived moral challenges. Methods Thirty healthcare professionals involved in abortion provisions in Addis Ababa were interviewed. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework. Results Most participants considered the 2005 abortion law a clear improvement—yet it does not solve all problems and has led to new dilemmas. As a main finding, the law appears to have opened a large space for professionals’ individual interpretation and discretion concerning whether criteria for abortion are met or not. Regarding abortion for fetal abnormalities, participants support the woman’s authority in deciding whether to choose abortion or not, although several saw these decisions as moral dilemmas. All thought that abortion was a justified choice when a diagnosis of fetal abnormality had been made. Conclusion Ethiopian practitioners experience moral dilemmas in connection with abortion. The law places significant authority, burden and responsibility on each practitioner.