Professionals’ experience with conscientious objection to abortion in Addis Ababa, Ethiopia: An interview study

Abstract

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.

Providers’ experiences with abortion care: A scoping review

“…While most supported their colleagues’ right to conscientiously object from providing abortion care based on moral or ethical grounds, many felt that unclear “opt-out” procedures mean that staff who did not hold these objections refused to partake [ 37 , 43 , 92 , 106 ]. They noted that high rates of conscientious objection can leave a small staff dealing with all abortion cases on top of their designated duties [ 24 , 29 , 34 , 39 , 43 , 44 , 52 , 63 , 66 , 72 , 78 , 86 , 92 , 103 , 104 , 119 ]. There may also be little appreciation or renumeration for these additional duties [ 34 , 43 , 63 , 92 , 106 ].…”

“…Most providers said that they supported the right to bodily autonomy and self-determination. Many said that these views were informed by experiences which evidenced the need for a safe, legal abortion service, such as providers in Bangladesh, Ethiopia, Nepal, South Africa, Switzerland, and the UK who said that by providing abortion, they are helping to reduce unsafe abortion, maternal mortality, and the occurrence of unwanted or abused children [ 28 , 29 , 31 , 38 , 49 , 89 , 90 , 104 , 118 , 119 ]. Further, providers in the USA said that experiences within the workplace, such as hearing patients’ stories, force providers to constantly refine, reinforce, and potentially reshape their beliefs around abortion to become more supportive [ 47 ].…”

“…Many differentiated between these and so-called “elective” or “voluntary” abortions [ 23 , 47 , 53 , 66 , 71 , 89 , 95 ]. A midwife in Sweden expressed sorrow at the termination of healthy fetuses in contrast to women struggling with fertility issues [ 77 ], providers in Ethiopia found it more difficult to justify their involvement if the motivation for abortion was not “safeguarding the women’s health” [ 28 , 29 , 36 ], and a nurse in the USA said their colleagues are more empathetic “if they feel that the client … had no control over [the decision to end the pregnancy]” [ 72 ]. Abortion for non-lethal fetal abnormalities was also viewed negatively [ 71 , 114 , 115 , 121 ], with midwives and obstetricians in France raising concerns over the place of disability in modern society [ 121 ].…”

Balancing personal beliefs against access to legal abortion: An uneven negotiation

“…Interestingly, workers in private clinics saw abortion services as part of their professional obligations and were critical of CO, especially as it might lead to women seeking unsafe abortions elsewhere, especially in rural areas, where access to health care is limited. In public hospitals, the situation is different, with the article describing the reasons that workers felt justified in objecting to performing abortions despite the law prohibiting CO. 11 Basu describes the situation in India where abortion is legal up to 24 weeks for a wide range of conditions including contraceptive failure in marriage. The concept of reincarnation in the Hindu religion allows for the view that the fetus will be born again in other form, thus avoiding the fevered debates around abortion that occur in predominantly Christian countries.…”

Navigating abortion law dilemmas: experiences and attitudes among Ethiopian health care professionals

“…The second paper examined participants’ views on and experiences with conscientious objection (CO) to abortion [ 12 ]. Despite being forbidden by government regulations, CO was practiced.…”