Institutional objection to abortion: A mixed-methods narrative review

Area of Science:

• Medical Ethics
• Healthcare Policy
• Reproductive Health Services

Background:

• Institutional objection (IO) is the refusal of healthcare institutions to provide legal health services, such as abortion.
• Regulation of IO involves laws, ethical codes, and institutional policies.
• Understanding the global landscape of IO is crucial for reproductive health access.

Purpose of the Study:

• To conduct a mixed-methods narrative review of empirical evidence on institutional objection to abortion provision globally.
• To identify research gaps and inform future studies on IO.
• To explore the impact of IO on abortion access and provider training.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (MEDLINE, Embase, CINAHL, Global Health, ScienceDirect, Scopus) in August 2021.
• Keywords included 'conscientious objection,' 'faith-based organizations,' 'religious hospitals,' and 'abortion.'
• Included studies focused on clinicians' attitudes and experiences with IO to abortion, with 28 studies from nine countries analyzed.

Main Results:

• Institutional objection to abortion is prevalent across various countries with differing legal and policy frameworks.
• In the United States, clinicians in religious institutions were less likely to provide abortions or referrals, negatively impacting provider training.
• Qualitative data indicated that both secular and religious institutions claim IO, and individual objections can enforce institutional policies.

Conclusions:

• Further research is necessary to determine the moral justification and decision-making processes behind IO claims.
• Developing appropriate regulatory models for IO is essential to safeguard women's access to abortion services.
• Models for regulating IO could draw from existing frameworks, such as those for voluntary assisted dying.