Conscientious objection as structural violence in the voluntary termination of pregnancy in Chile

Abstract

IntroductionAfter three decades of the absolute prohibition of abortion, Chile enacted Law 21,030, which decriminalizes voluntary pregnancy termination when the person is at vital risk, when the embryo or fetus suffers from a congenital or genetic lethal pathology, and in pregnancy due to rape. The law incorporates conscientious objection as a broad right at the individual and institutional levels.ObjectivesThe aim of the study was to explore the exercise of conscientious objection in public health institutions, describing and analyzing its consequences and proposals to prevent it from operating as structural violence.Materials and methodsThis study uses a qualitative, post-positivist design. At the national level, according to the chain technique, people who were identified as key actors due to their direct participation in implementing the law were included. Grounded theory was used to analyze the information obtained through a semi-structured interview. The methodological rigor criteria of transferability or applicability, dependability, credibility, auditability, and theoretical-methodological adequacy were met.ResultsData from 17 physicians, 5 midwives, 6 psychologists, 8 social workers, 2 nursing technicians, and 1 lawyer are included. From an inductive process through open coding, conscientious objection as structural violence and strategies to minimize the impact of objection emerge as meta-categories. The first meta-category emerges from the barriers linked to the implementation of the law, the infringement of the rights of the pregnant person, and pseudo conscientious objection, affecting timely and effective access to pregnancy termination. The second meta-category emerges as a response from the participants, proposing strategies to prevent conscientious objection from operating as structural violence.ConclusionConscientious objection acts as structural violence by infringing the exercise of sexual and reproductive rights. The State must fulfill its role as guarantor in implementing public policies, preventing conscientious objection from becoming hegemonic and institutionalized violence.

Main barriers to services linked to voluntary pregnancy termination on three grounds in Chile

“…The conscientious objection by those who are part of healthcare teams, in practical terms, operates as structural violence as a result of its invocation for any action that directly or indirectly contributes to a VTP, the lack of argumentation by those who object, the unawareness of the identity of the objectors by the rest of the team, the relaying of dissuasive and erroneous information, for questioning accounts in the case of rape, for pressuring a woman to retract their decision to terminate, for the obfuscation or delay to constitute a ground and due to false conscientious objection that is presented arbitrarily, without moral support, not to fulfill professional responsibility ( 28 ).…”