UN Advises Against Institutional Conscientious Objection to Abortion

2 February 2025

Dana Repka

The United Nations Human Rights Council’s Working Group on Discrimination against Women and Girls has released a guiding document on key considerations for conscientious objection to abortion, explicitly recommending that States prohibit institutions from objecting. This move followed numerous reports indicating that institutions are increasingly using conscientious objection as a rationale for refusing to provide abortion care. In their analysis, the Working Group underscored that “any laws authorizing institutional conscientious objection are incompatible with a human rights-based approach to conscientious objection” and clarified that “when States permit conscientious objection, they must ensure that… conscientious objection is a personal, not an institutional, practice.”

Although only a handful of countries formally recognize institutional conscientious objection (ICO), health institutions in many parts of the world—sometimes even where it is legally prohibited—have attempted to invoke conscientious objection as grounds to deny abortion services. From Europe to Latin America, activists, human rights bodies, and the courts have documented the serious repercussions for patients seeking legal abortion care when entire hospitals or clinics refuse to provide services.

Drawing on scholarly literature and relevant case law, there are at least six compelling reasons why health institutions should not be granted the right to invoke conscientious objection to abortion. These arguments encompass ethical considerations, human rights principles, and democratic values.

1. Institutions lack a conscience. The right to invoke conscientious objection presupposes the existence of a conscience, which is inherently personal and rooted in an individual’s moral convictions, beliefs, and ethical reasoning. In contrast, institutions are corporate entities that do not possess personal moral frameworks. Consequently, it is inappropriate to view institutions as moral agents capable of having a conscience. Granting institutions the right to conscientious objection, therefore, undermines the core idea that conscience is an intrinsically individual attribute.

2. ICO undermines access to health services. When health institutions declare themselves “conscientious objectors,” accessibility to abortion services is reduced, and in rural or remote areas, this can effectively result in a complete denial of care. In this sense, as noted by the Constitutional Court of Ecuador, ICO creates insurmountable barriers for those who cannot travel to larger urban centers, disproportionately affecting migrant women, girls, and adolescents living in remote or underserved regions.

3. ICO restricts women’s freedom of conscience. By allowing institutions to object on behalf of an entire facility, the moral agency of women and girls is denied. As the Constitutional Court of Colombia has observed, these patients are denied the freedom to act according to their conscience when seeking legal reproductive care. This leads to a one-sided prioritization of institutional claims over the autonomy of pregnant individuals—who themselves are rights holders of freedom of conscience.

4. ICO violates health care personnel rights. Not only does ICO impede the rights of women and girls, but it also constrains the freedom of conscience of health care professionals within the institution. Providers who feel ethically and professionally compelled to offer abortion services may be forced to align with the institution’s objection, even if it contradicts their own moral convictions and their legal and professional obligations. This can result in discriminatory treatment, as noted by the European Committee of Social Rights.

5. The nature of conscientious objection is tied to performing a procedure. Conscientious objection applies to a specific act that contravenes an individual’s deeply held beliefs—such as performing an abortion. Institutions, however, do not physically carry out abortions, health professionals do. Therefore, extending objection rights to institutions unjustly broadens the scope of who (or what) can object, and shifts focus away from the individuals directly involved in providing care.

6. Institutions have already assumed obligations by offering health services. By accepting licenses, funding, or accreditation to deliver health services, institutions effectively acknowledge their responsibility to uphold the legally required standard of care. Under the doctrine of estoppel by one’s own acts, an institution that willingly becomes part of the health care system cannot retrospectively claim a right to deny legally permitted services.

As a result, the vast majority of countries in the world permit only individual conscientious objection rather than institutional. In a study covering 180 countries, 176 allowed conscientious objection on an individual basis, while only Chile, France, the United States, and Uruguay permitted ICO.

As the Working Group on Discrimination against Women and Girls at the Human Rights Council emphasizes, abolishing ICO is a crucial step toward adopting a human rights-based approach that respects freedom of conscience for all individuals—both those who object and those who do not. It not only safeguards patients’ health, autonomy, and well-being but also preserves the integrity of healthcare systems and protects individual providers committed to delivering reproductive services.

For these reasons, the guiding document from the Human Rights Council is a milestone worthy of celebration.

Acknowledgments

The author extends her gratitude to Professor Rebecca Cook for her insightful feedback and thoughtful review of this work and to Professor Agustina Ramón Michel for her leadership in the research on conscientious objection that forms the foundation of this blog.

Dana Repka is an LLM Candidate and Fellow at the International Reproductive and Sexual Health Law Program at the University of Toronto, Canada.