REPROHEALTHLAW Updates — Oct 2017

October 31, 2017

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DEVELOPMENTS

[Brazil, religious education] STF Conclui Julgamento Sobre Ensino Religioso nas Escolas Públicas ADI No. 4439, September 27, 2017.    The Brazilian Federal Supreme Court dismissed, by a 6 to 5 majority, a Direct Action of Unconstitutionality in which the Public Prosecutor’s Office questioned the model of religious education in the country’s public school system.  In Portuguese: Initial questionConclusion of Decision
English: Comment on I-CONnect Blog.

[Europe: Italy, conscientious objectors] Confederazione Generale Italiana del Lavoro (CGIL) v. Italy (2016), Complaint No. 91/2013 (European Committee on Social Rights, Strasbourg, France)  Decision in English. 
-which builds upon this 2014 decision:  International Planned Parenthood European Network v. Italy (2014), Complaint No. 87/2012, 10 March 2014 (European Committee on Social Rights, Strasbourg, France) Decision in EnglishBoth decisions summarized by Tania Pagotto.

[Kenya] – Court of Appeal acquitted Jackson Tali, a registered nurse sentenced to death on murder charges re pregnancy complications.   October 19, 2017.   Press release by the Center for Reproductive Rights  Overturns:  Republic v Jackson Namunya Tali [2014] eKLR, High Court Criminal Case No. 75 of 2009 (High Court of Kenya at Nairobi).  Overturned decision.  Overturned decision summarized in Legal Grounds III by Godfrey Kangaude and Annagrace Rwehumbiza.

[Spain, conscientious objectors] Zurich Insurance PLC, Sucursal en España v. Doña Encarnacion y don César y Servicio Galego de Saude, Sentencia 00392/2017, Apelación 43/17 (High Court of Galicia at Coruña, Spain)   Decision in SpanishEnglish summary by lawyer F. F. Guillen.

[West Africa: Nigerian police abuse women] Suit no ECW/CCJ/APP/17/14. October 13, 2017, Community Court of Justice, Economic Community of West African States (ECOWAS) awarded 18 million naira as compensation to an actress Dorothy Chioma Njemanze and two other women for the violation of their human rights to dignity following the physical, sexual and psychological violence inflicted on them by agents of the Nigerian State.  Press release from ECOWAS Court.    Newspaper report.

EDUCATIONAL OPPORTUNITY:
Africa – Doctoral Scholarships:   LL.D/D.Phil in Sexual and Reproductive Rights in Africa:
The Centre for Human Rights, University of Pretoria, calls for applications for full-time doctoral scholarships in the field of sexual and/or reproductive rights and their intersection with culture or criminalisation in the African region.  Apply by 15 Nov 2017 Scholarship details

SCHOLARSHIP:
Abortion Law in Transnational Perspective: Cases and Controversies, ed. Rebecca J. Cook, Joanna N. Erdman and Bernard M. Dickens (University of Pennsylvania Press, 2014), now also in Spanish (see next entry) and in paperback, 20% discount code PH70.  English edition from U Penn PressTable of Contents with chapter summaries. 
Abortion Decisions Online, based on the book’s Table of Cases

El aborto en el derecho transnacional: casos y controversias,  ed. Rebecca J. Cook, Joanna N. Erdman y Bernard M. Dickens (Mexico: FCE/CIDE, 2016)   En espanol, 2016: Fondo de Cultura Económica Libreria CIDE.     Índice con resúmenes de capítulos 1-11
Tabla de Casos/Jurisprudencia sobre aborto en línea con enlaces a muchas de las decisiones judiciales

[abortion] “How Laws Fail the Promise of Medical Abortion: A Global Look,” by Patty Skuster, Georgetown Journal of Gender and the Law  18.379, 2017. Abstract and Article.

[abortion] “The Politics of Global Abortion Rights,”  by Joanna N. Erdman,  Brown Journal of World Affairs 22.2 (2016): 39-57.   Article online

[abortion, Central and Eastern Europe]  “Mandatory Waiting Periods and Biased Abortion Counseling in Central and Eastern Europe,” by Leah Hoctor and Adriana Lamačková, International Journal of Gynecology and Obstetrics, 139 (Nov. 2017): 253–258.    PDF at Wiley Online Library.    Submitted text online at SSRN.

“Abortion Travel and the Limits of Choice,” by Lisa Kelly, 12 FIU L. Rev. 27 (2016).
Article online.

[Africa] “Conscientious Objection to Abortion and Accommodating Women’s Reproductive Health Rights: Reflections on a Decision of the Constitutional Court of Colombia from an African Regional Human Rights Perspective,” by Charles G. Ngwena, Journal of African Law, 58 (2014): 183-209  Article now online.

[Africa]  Legal Grounds III, Reproductive and Sexual Rights in Sub-Saharan African Courts (2017)   Entire book, 228-pages, online here.
Print copies available for courses, conferences or organizations.

Legal Grounds III Online now includes searchable links to entire book, individual case summaries and decisions, plus more recent cases.

[Zika, Brasil and Human Rights Obligations]: now in Spanish, Portuguese and English:
—“Infección por el virus de Zika en Brasil y obligaciones relacionadas con los derechos humanos,” por Debora Diniz, Sinara Gumieri, Beatriz Galli Bevilacqua, Rebecca J. Cook, y Bernard M. Dickens, Boletin FLASOG 5.2( June 2017): 6-12.
En espanol Boletin FLASOG, pp 6-12
Em português do Brasil, forthcoming in Revista Uni Brasilia Direito.
—“Zika Infection in Brazil and Human Rights Obligations,” by Debora Diniz, Sinara Gumieri, Beatriz Galli Bevilacqua, Rebecca J. Cook and Bernard M. Dickens, International Journal of Gynecology and Obstetrics 136.1 (Jan. 2017) 105-110.
PDF online.   Submitted text in English at SSRN.

NEWS

International news and resources for advocacy:  International Campaign for Women’s Right to Safe Abortion.

US-focused news, resources, and legal developments are available on Repro Rights Prof Blog.  View or subscribe.

JOBS
Links to employers in the field of Reproductive and Sexual Health Law are online here

______________
Compiled by the Coordinator of the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.


Conscientious Objection: African reflections on Colombian abortion decision T-388/09, by Charles G. Ngwena

October 31, 2017

Congratulations to Charles Ngwena of the Centre for Human Rights, Faculty of Law, University of Pretoria, South Africa, whose 2014 article in the Journal of African Law is now available online.

Charles G. Ngwena. “Conscientious Objection to Abortion and Accommodating

Women’s Reproductive Health Rights: Reflections on a Decision of the Constitutional Court of Colombia from an African Regional Human Rights Perspective. Journal of African Law, 58 (2014): 183-209  Article now online.

Abstract and Overview:  If applied in isolation from the fundamental rights of women seeking abortion services, the right to conscientious objection can render any given rights to abortion illusory, including the rights to health, life, equality and dignity that are attendant to abortion. A transformative understanding of human rights requires that the right to conscientious objection to abortion be construed in a manner that is subject to the correlative duties which are imposed on the conscientious objector, as well as the state, in order to accommodate women’s reproductive health rights. In recent years, the Colombian Constitutional Court has been giving a judicial lead on the development of a right to conscientious objection that accommodates women’s fundamental rights. This article reflects on one of the court’s decisions and draws lessons for the African region.

After reviewing the history and status of abortion restriction in Africa, and comparing approaches to conscience clauses in South Africa, Zambia and Zimbabwe, Dr. Ngwena carefully reviews the Colombian decision in Case T-388/09 which, he concludes, “is ultimately about recognizing an overlapping consensus of the imperative of mutual co-existence in a liberal and heterogeneous society. . . .   [At the] interface between the right to conscientious objection and the right to abortion, African domestic courts and institutions can do well to look, among other juridical resources, to the Colombian decision for the development of constitutional and human rights standards that are aimed at accommodating the fundamental rights of conscientious objectors with the equally fundamental rights of women seeking abortion.  African regional treaty bodies have the same need.   . . . [In] African states, judicial interpretation has a crucial role to play in the authoritative interpretation and application of human rights protections under the African Charter system.

The Colombian decision is an important juridical resource and advocacy tool for human rights practitioners, civil society and non-governmental organisations that seek to promote women’s sexual and reproductive health,including access to abortion as a human right. In Case T-388/09, the Colombian Constitutional Court adopted a judicial approach that is gender sensitive and transcended a classical liberal interpretation of rights by avoiding the trap of enunciating abortion rights in a manner which reduces them to a mere rhetorical flourish.  Application of abortion rights requires judicial awareness that rights holders will often be unable to realize the rights in the same way for the reason that they have different capabilities and are differently situated, particularly in an environment in which gender inequalities are embedded.  Thus, imposition of state duties to provide adequate information and material resources to facilitate equitable access to healthcare services becomes a more meaningful way of vindicating abortion rights as not just tangible human rights but also human capabilities.

Abortion has a long history of being at the receiving end of moral censure by patriarchal political and religious authorities. Women remain a political minority. Unless closely interrogated, the right to conscientious objection to abortion can easily come to deny the very heterogeneity it seeks to acknowledge. Instead, it can become a Trojan horse for popular patriarchal and religious prejudices that deny women’s reproductive agency and accentuate the historical marginalization and stigmatization of reproductive healthcare services which only women need. How health care professionals understand and exercise the right to conscientious objection has implications for the realization of the reproductive rights of women seeking abortion services.
Charles G. Ngwena. “Conscientious Objection to Abortion and Accommodating
Women’s Reproductive Health Rights: Reflections on a Decision of the Constitutional Court of Colombia from an African Regional Human Rights Perspective. Journal of African Law, 58 (2014): 183-209  Article now online.
Related resources:
Colombian decision T-388/09  Corte Constitucional [Constitutional Court] 2009,  Decision in Spanish

T-388/09:  Conscientious Objection and Abortion: A Global Perspective on the Colombian Experience. (Georgetown, USA, O’Neill Institute for National and Global Health Law / Women’s Link Worldwide, 2014)    English | Español

 “Healthcare responsibilities and Conscientious Objection” by R. J. Cook, M. Arango Olaya and B.M. Dickens,  International Journal of Gynecology and Obstetrics 104 (2009): 249-252. Spanish translation.
The Scope and Limits of Conscientious Objection,” by B.M. Dickens and R. J. Cook (2000) 71 International Journal of Gynecology and Obstetrics 71-77.

Conscientious Objection-
Articles and other resources from the International Reproductive and Sexual Health Law Program at University of Toronto, online here.
Ethical and Legal Issues in Reproductive Health80 concise articles.
_____________
The REPROHEALTHLAW BLOG is managed by the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.  For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.

“El derecho a la conciencia” por Bernard M. Dickens

October 31, 2017
[The Right to Conscience -by Bernard Dickens]

El aborto en el derecho transnacional: Casos y controversias fue publicado en agosto de 2016 por el Fondo de Cultura Económica y el Centro de Investigación y Docencia Económicas.

Bernard M. Dickens, “El derecho a la conciencia,” El aborto en el derecho transnacional: Casos y controversias, editoras/es  Rebecca J. Cook, Joanna N. Erdman, y Bernard M. Dickens (FCE/CIDE, 2016) págs. 270-305.
en españolen inglés.

En el decimo capítulo de El aborto en el derecho transnacional: Casos y controversias, Bernard M. Dickens explora las variantes del derecho humano a la libertad de conciencia en los debates sobre el aborto; enfocándose en la noción de que el derecho de actuar legítimamente de acuerdo con la conciencia del individuo no es monopolio de los opositores al aborto. El autor además afirma que el compromiso de los proveedores de abortos también esta protegido por el derecho a la conciencia; lo que los legitima a participar dichos procedimientos legales, asesorar a sus pacientes sobre esta opción, y derivarlas a los lugares donde estén disponibles los servicios. Es más, de la misma manera que los establecimientos de salud laicos deben reconocer el derecho a la objeción de conciencia de algunos proveedores, los establecimientos religiosos deben reconocer el derecho de los proveedores de abortos al compromiso moral de otorgar o disponer la prestación de abortos, y el derecho a la libertad de conciencia de las mujeres que reciben tales servicios.

El derecho humano de actuar legalmente y de acuerdo con su conciencia no es un monopolio de quienes se oponen al aborto. No obstante, en tanto derecho humano legalmente protegido, el derecho a la conciencia puede ser considerado principalmente como un derecho de los seres humanos del que podrían beneficiarse las instituciones corporativas, solo con carácter limitado. En este sentido, una persona puede alegar motivos de conciencia a la hora de participar o no participar en prácticas abortivas sin que por ello sea objeto de sanciones o discriminaciones fundamentadas en sus convicciones religiosas o filosóficas, siempre que informe y remita a las pacientes convenientemente.

El aborto en el derecho transnacional: casos y controversias es disponible en español    en inglés   y dos capítulos en portugués: Capítulo 2.    Capítulo 4
Descargar: Reseña del libro en Andamios, por Diego Garcia Ricci      
Introducción y Prólogo.
Índice con resúmenes de otros capítulos

Tabla de Casos/Jurisprudencia en línea con enlaces a muchas de las decisiones judiciales
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REPROHEALTHLAW:  Nuestras publicaciones en español o portugués.
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Italy: Widespread conscientious objection violates right to health and right to work in dignity

October 31, 2017

Many thanks to Tania Pagotto, a Ph.D candidate in comparative public law at Ca’ Foscari University of Venice in Italy.  She can be reached at:  tania{.}pagotto at unive.it.  We thank her for commenting on two recent decisions by the European Committee on Social Rights:

International Planned Parenthood European Network v. Italy (2014), Complaint No. 87/2012, decision published 10 March 2014 (European Committee on Social Rights, Strasbourg, France) Decision online[1]. 

Confederazione Generale Italiana del Lavoro (CGIL) v. Italy (2016), Complaint No. 91/2013 (European Committee on Social Rights, Strasbourg, France)  Decision online  [2]. 

These decisions addressed the issue of conscientious objection as an obstacle to lawful abortion in Italy, where interruption of pregnancy is regulated by Law no. 194 of 1978 [3].  The Act defines different conditions under which abortion is legal (i.e., where there is serious threat to the mother’s life, physical or mental health, or severe fetal malformation or anomaly).  The Act guarantees interruption of pregnancy as a public medical service.  However, it also provides healthcare professionals with the option to declare conscientious objection, which excuses them from involvement. In this medical field, Italian law encounters a strong conscientious objection movement, unevenly spread among different regions and hospitals.  Government statistics for 2014/15, published in 2016, show that about 70% of Italian doctors, 50% of anaesthetists, and 45% of other staff have declared conscientious objection. [4]

In International Planned Parenthood Federation – European Network (IPPF EN) v. Italy (2014),  the European Committee on Social Economic and Cultural Rights had found Italy in breach of certain provisions of the European Social Charter [5]:  the right to protection of health, both alone and in conjunction with the non-discrimination principle. The non-discrimination principle, in particular, requires the same legal treatment of individuals or groups, irrespective of their specific characteristics.  Italy could only guarantee the right to health for women who could afford to travel from hospital to hospital or from one region to another. Therefore, the Committee found a discrimination based on women’s economic and social capacities.

In a 2016 case, Confederazione Generale Italiana del Lavoro v. Italy, the same Committee confirmed the previous judgment, but went further.  It also found a violation of the right to work (paras 214-246), and the right to dignity in work (paras 282-298), because the state had failed to adequately address the burdensome workload on non-objecting doctors caused by the high percentage of objecting doctors in some areas of Italy.   Significantly, the complaint had been filed by one of Italy’s largest trade unions.  There was concrete evidence of the professional disadvantages for non-objecting medical professionals whose workload became dominated by the performance of abortions, restricting other career prospects.  This decision broke new ground in finding a violation of the right to work and the right to work in dignity of non-objecting providers.

After these two decisions against Italy, many voices are calling for an evolution of Law 194.   These two decisions suggest two legal directions.  On one hand, the territorial discrepancies regarding abortion services need to be taken into account.  The government must find adequate legal tools to distribute health services uniformly throughout the territory.  On the other hand, the supply of medical treatment concerning interruption of pregnancy by non-objecting medical personnel should not impair their right to work, nor their right to work in dignity.

Thus, the Italian government must seek a new equilibrium between patients’ fundamental rights and interests and doctors’ freedom of conscience, as well as an equilibrium among doctors, the majority of whom declare conscientious objection, and the minority of whom provide abortion services.

———————————————————-

[1] International Planned Parenthood European Network v. Italy (2014), Complaint No. 87/2012,  10 March 2014 (European Committee on Social Rights, Strasbourg, France) Decision 2014

[2] Confederazione Generale Italiana del Lavoro (CGIL) v. Italy (2016), Complaint No. 91/2013, 11 April 2016 (European Committee on Social Rights, Strasbourg, France) Decision 2016

[3] Italian abortion law:  Gazzetta Ufficiale della Repubblica Italiana, Parte I, 2 May 1978, No. 140, pp. 3642-3646.    Law 194 in English    In Italian: Legge 194,

[4]  [Italian Ministry of Health,  Report of the Health Ministry on implementation of the Law concerning norms for the social protection of maternity and for the voluntary interruption of pregnancy]  Ministero della Salute, Relazione del Ministro della Salute sulla Attuazione della Legge Contenente norme per la tutela sociale della maternità e per l’interruzione volontaria di gravidanza  (Legge 194/78)  dati definitive 2014 e 2015 (Roma, 7 dicembre 2016), page 44ff.  Online in Italian

[5] European Social Charter is online here.

Related Resources:
Conscientious Objection: Articles and resources from the International Reproductive and Sexual Health Law Program – updated online here.

“The Right to Conscience,” by Bernard M. Dickens, in Abortion Law in Transnational Perspective: Cases and Controversies, ed. Rebecca J. Cook, Joanna N. Erdman and Bernard M. Dickens (University of Pennsylvania Press, 2014), 210-238  Abstract online
About the book_
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The REPROHEALTHLAW BLOG is managed by the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.  For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.


Spain: Health Service held accountable for objectors’ abortion delays and loss of uterus

October 31, 2017

Many thanks to Francisca Fernández Guillén, a feminist lawyer who specialises in sexual and reproductive health. She collaborated as an expert with the Women’s Health Observatory (part of the Spain’s Ministry of Health) on the development of the “Strategy for Assistance at Normal Childbirth in the National Health System”. She also gives training and talks for professionals on health legislation and bioethics and contributes articles and opinion pieces to journals and specialist presses, some of which can be read here.    We thank her for commenting on this enlightening case and decision:

Zurich Insurance PLC, Sucursal en España v. Doña Encarnacion y don César y Servicio Galego de Saude, Sentencia 00392/2017, Apelación 43/17 (High Court of Galicia at Coruña, Spain)  Decision online in Spanish

The Health Service of the autonomous region of Galicia in Spain was recently found guilty of intentionally concealing from a pregnant mother, the fact that her child was suffering from severe life-limiting anomalies that included “cri du chat” syndrome, a severe mental disability. The Health Service also obliged her to travel 600 km to receive an abortion in a private clinic that was insufficiently prepared to deal with her clinical condition. As a consequence, her child was born alive after seven months in the womb and died shortly afterwards, while the woman, only 32 years old, lost her uterus.

During the High Court proceedings, it emerged that her doctors had deliberately delayed the protocoled prenatal diagnostic testing. Once she had a proper diagnosis, following a consultation with a private geneticist, the gynaecologist in the regional health service then delayed authorization for an abortion, maintaining that it was necessary to carry out further diagnostic tests.  However, the expert witness called by the woman’s defence team made it clear that the tests on which the gynaecologist had insisted were primarily of interest to establishing cause of death and implications for future pregnancies, and were by no means urgent, especially in a case of advanced gestation that required immediate termination.

The High Court’s ruling made it clear that what had occurred was a “severe failure of the health system.” The president of the regional government, Albert Nuñez Feijoo, resolved not to appeal the initial decision of the county court and apologized for what had happened, attributing blame to the fact that a very high proportion of doctors in the region are “conscientious objectors” to medical abortions.  Nevertheless, the Health Service’s insurance company, hoping to reduce their compensation to the victim, appealed to the High Court of Galicia, which subsequently ratified the county court’s sentence, along with particularly harsh criticism of the Health Service’s actions.

During the court proceedings, it was put forth that the birth of child with such a severe illness is an insurmountable burden for the mother, her family and society.  As a lawyer, I am concerned that this woman’s experience is not an isolated case.  During the proceedings, I learned of a number of women who have had similar experiences with the Health Service.

In one instance, a woman gave birth to a boy who suffers from severe disability and cardiopathy, including Golenhar syndrome and Tetralogy of Fallot. His mother, abandoned by the boy’s father during the pregnancy, is an immigrant from South America who works as a domestic assistant and has insufficient economic or social resources to bring up a child with such severe disabilities. Unfortunately, she doesn’t wish to take the case to court for fear of repercussions, since her child must receive care from the same hospital for the duration of his life.

Despite reporting this and other known cases to the appropriate authorities in the health service, I have never received any response and, to this day, no effective measures have been put in place to ensure that religious ideology and a lack of ethical commitment, inappropriately called “conscientious objection”, don’t put the lives and health of women in danger.

Decision:
Zurich Insurance PLC, Sucursal en España v. Doña Encarnacion y don César y Servicio Galego de Saude, Sentencia 00392/2017, Apelación 43/17 (High Court of Galicia at Coruña, Spain)  Decision in Spanish 

News reports:
El Pais (English):  “The doctors’ right to object nearly cost me my life” Health system ordered to compensate woman who lost uterus after hospital refused to carry out abortion

(Spanish)  Eldiario.es The Galician government found guilty and must pay 270.000 € to women who lost her uterus  See also: The President of the autonomous region of Galicia apologizes
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The REPROHEALTHLAW BLOG is managed by the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.  For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.

 

 


REPROHEALTHLAW Updates — Sept 2017

September 29, 2017

SUBSCRIBE TO REPROHEALTHLAW: To receive these updates monthly by email, enter your address in upper right corner of this webpage, then check your email to confirm the subscription.

DEVELOPMENTS
[Chile] Abortion legalized in three cases: when the woman’s life is at risk, when the fetus will not survive the pregnancy, and in case of rape).  New law ruled constitutional by the Constitutional Court of Chile on August 28, 2017:  Decision in Spanish -295 pagesAccompanying documentsOther Submissions  Newspaper report in EnglishDecision summarized in English.

RESOURCES

[abortion] The Responsibility of Gynecologists and Obstetricians in providing safe abortion services within the limits of the law, by Anibal Faúndes,  International Journal of Gynecology and Obstetrics, 139.1 (Oct 2017): 1-3.  Wiley Online.

Abortion Law in Transnational Perspective: Cases and Controversies, ed. Rebecca J. Cook, Joanna N. Erdman and Bernard M. Dickens (University of Pennsylvania Press, 2014), now in paperback, 20% discount code PH70.  English edition from U Penn PressTable of Contents with chapter summaries.  Table of Cases
—El aborto en el derecho transnacional
, 2016
: Fondo de Cultura Económica
Libreria CIDE.    Índice con resúmenes de capítulos

[Africa]  Legal Grounds III: Reproductive and Sexual Rights in Sub-Saharan African Courts, published by Pretoria University Law Press (PULP) in 2017, 228 pages.   New Online edition with links to decisions.    Flyer with Table of Contents.    Download whole book

[Canada] After Morgentaler: The Politics of Abortion in Canada, by Rachael Johnstone, UBC press, 2017, 196 pages.  Based on this doctoral thesis in Political Science.   Purchase options.

“Conscientious Objection to Abortion and Accommodating Women’s Reproductive Health Rights: Reflections on a Decision of the Constitutional Court of Colombia from an African Regional Human Rights Perspective,” by Charles G Ngwena,  Journal of African Law 58.2 (October 2014) 183 – 209.  Abstract and article now online.      

[conscience] “The Conscience Wars in Historical and Philosophical Perspective: The Clash between Religious Absolutes and Democratic Pluralism,”  by Michel Rosenfeld, in  (Susanna Mancini & Michel Rosenfeld, eds.) The Conscience Wars: Rethinking the Balance between Religion, Identity, and Equality (Cambridge University Press 2018)   58 Pages online.

[stigma: abortion, sex work] “Perfectly Legal, but Still Bad: Lessons for Sex Work from the Decriminalization of Abortion,” by Jula Hughes, University of New Brunswick Law Journal 68 (2017): 232-252   Abstract and article at SSRN

NEWS
India: Supreme Court Allows Rape Survivor to Terminate Her 31-Week-Old Pregnancy, despite 20-week limit under Medical Termination of Pregnancy law, based on medical concerns re health of the mother, including trauma from rape.
Newspaper report.    Judgment forthcoming.

Northern Ireland:  Medical professionals will no longer face prosecution if they refer women to clinics in England and Wales for abortions  Newspaper report.

International news and resources for advocacy:  International Campaign for Women’s Right to Safe Abortion.

US-focused news, resources, and legal developments are available on Repro Rights Prof Blog.  View or subscribe.

JOBS
Links to employers in the field of Reproductive and Sexual Health Law are online here

______________
Compiled by the Coordinator of the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.


HR expert: Conscientious objection may not hinder lawful abortions

September 29, 2017

Many thanks to Christina Zampas, one of fifty international experts and policymakers who recently convened in Montevideo, Uruguay, to share findings on the legal status and harms of conscientious objection to lawful abortions.   The refusal to provide services on grounds of conscience hinders lawful abortion in countries with both liberal and restrictive laws.  The practice also stigmatizes basic reproductive health services and in some cases pushes women to carry risky or unintended pregnancies to term, or to seek illegal or unsafe alternatives, which may have dire consequences, including death.

United Nations and regional human rights bodies have recognized the harmful effects of conscientious objection on the health and human rights of women.  They have articulated state obligations under the rights to health, to privacy and to non-discrimination, to ensure that women can access reproductive health services that they are lawfully entitled to receive.  For decades, human rights bodies have recommended that to comply with human rights obligations, states should decriminalize abortion, liberalize restrictive laws and remove barriers that hinder access to safe abortion.[1] “[I]n cases where abortion procedures may lawfully be performed, all obstacles to obtaining them should be removed,” including the unregulated practice of refusing to provide services based on conscience. [2]

UN treaty bodies have expressed concern about the harmful impact of the exercise of conscientious objection and have repeatedly urged those states that permit the practice to adequately regulate it to ensure that it does not limit women’s access to abortion services. [3]  The UN Special Rapporteur on Health, for example, has recognized that “conscientious objection laws . . . make safe abortions and post-abortion care unavailable, especially to poor, displaced and young women. Such restrictive regimes, which are not replicated in other areas of sexual and reproductive health care, serve to reinforce the stigma that abortion is an objectionable practice.” [4]   He has also recommended that states “[e]nsure that conscientious objection exemptions are well-defined in scope and well-regulated in use and that referrals and alternative services are available” and urged states to ensure that conscientious objection cannot be invoked in emergency situations. [5]

Human rights bodies have called on states to prohibit the improper use of conscientious objection by medical professionals.  And while human rights law does not require states to allow conscientious refusals to abortion, these human rights bodies have noted that where states do allow for it, they must regulate it, to ensure that it does not deny or hinder women access to lawful abortion.  They have explicitly specified that the relevant regulatory framework must ensure an obligation on healthcare providers to refer women to alternative health providers [6] and must not allow institutional refusals of care. [7]   The CESCR Committee, which monitors state compliance with the International Covenant on Civil and Political Rights,  has specifically recommended that states should also ensure that “adequate number of health-care providers willing and able to provide such services should be available at all times in both public and private facilities and within reasonable geographical reach.” [8]

This first International Convening on Conscientious Objection and Abortion, held August 1-3, 2017 in Montevideo, Uruguay, was sponsored by Mujer y Salud Urugay (MYSU) and the International Women’s Health Coalition (IWHC).  Participants agreed to further legal, ethical, health, and policy objectives that can mitigate the damaging effects of conscientious objection and reduce the immense burden on women who seek a legal, professional service that must be rendered without prejudice.
About the International Convening on Conscientious Objection and Abortion
Report on the meeting, and its declarations in English and Spanish
Report by South African delegation.

Conscientious Objection – List of resources from members of the International Reproductive and Sexual Health Law Program are online here.

Conscientious Objection to Abortion and Accommodating Women’s Reproductive Health Rights: Reflections on a Decision of the Constitutional Court of Colombia from an African Regional Human Rights Perspective, by Charles G Ngwena,  Journal of African Law 58.2 (October 2014) 183 – 209  now online here.

Christina Zampas is a Reproductive and Sexual Health Law Fellow at the University of Toronto’s Faculty of Law.  Short bio

ENDNOTES:
[1]  See, e.g., Human Rights Committee, Concluding Observations: Jamaica, para. 14, U.N. Doc. CCPR/C/JAM/CO/3 (2011) (urging the state to “amend its abortion laws to help women avoid unwanted pregnancies and not to resort to illegal abortions that could put their lives at risk. The State party should take concrete measures in this regard, including a review of its laws in line with the Covenant.”); Human Rights Committee, Concluding Observations: Mali, para. 14, U.N. Doc. CCPR/CO/77/MLI (2003); Human Rights Committee, Concluding Observations: Djibouti, para. 9, U.N. Doc. CCPR/C/DJI/CO/1 (2013); Human Rights Committee, Concluding Observations: Ireland, para. 13, U.N. Doc. CCPR/C/IRL/CO/3 (2008). See also Human Rights Committee, General Comment No. 28: Article 3 (The Equality of Rights Between Men and Women), (68th Sess., 2000), para. 10, U.N. Doc. CCPR/C/21/Rev.1/Add.10 (2000).

[2]  Human Rights Committee, Concluding Observations: Argentina, para. 14, U.N. Doc. CCPR/CO/70/ARG (2000); see also CESCR, Concluding Observations: Argentina, para. 22, U.N. Doc. E/C.12/ARG/CO/3 (2011); Poland, para. 28, U.N. Doc. E/C.12/POL/CO/5 (2009); CEDAW, Concluding Observations: India, para. 41, U.N. Doc. CEDAW/C/IND/CO/3 (2007); Poland, para. 25, U.N. Doc. CEDAW/C/POL/CO/6 (2007).

[3]  ESCR Committee, Concluding Observations: Poland, para. 28, U.N. Doc. E/C.12/POL/CO/5 (2009); CEDAW Committee, Concluding Observations: Poland, para. 25, U.N. Doc. CEDAW/C/POL/CO/6 (2007); Slovakia, para. 29, U.N. Doc. CEDAW/C/SVK/CO/4 (2008); Human Rights Committee, Concluding Observations: Poland, para. 12, U.N. Doc. CCPR/C/POL/CO/6 (2010).

[4] Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Interim rep. of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, transmitted by Note of the Secretary-General, para. 24, U.N. Doc. A/66/254 (Aug. 3, 2011), para. 24.

[5] Id. Para 65(m), and Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover – Mission to Poland, U.N. Doc. A/HRC/14/20/Add.3 (2010). paras. 50, and 85(k).  See also: CESCR Gen. Comment 22 in note 8 below.

[6]  See, e.g., CEDAW, General Recommendation No. 24: Article 12 of the Convention (Women and Health), para. 11, U.N. Doc. A/54/38/Rev.1, chap. I (“It is discriminatory for a State party to refuse to legally provide for the performance of certain reproductive health services for women. For instance, if health service providers refuse to perform such services based on conscientious objection, measures should be introduced to ensure that women are referred to alternative health providers.”); CESCR, Gen. Comment No. 22, paras. 14, 43; HRC, Concluding Observations,: Italy, U.N. Doc. HRC/C/ITA/CO/6, paras 16-17 (2017); CEDAWConcluding Observations: Croatia, para. 31, U.N. Doc. CEDAW/C/HRV/CO/4-5 (2015) (urging the State party to “ensure that the exercise of conscientious objection does not impede women’s effective access to reproductive health-care services, especially abortion and post-abortion care and contraceptives”); Hungary, paras. 30-31, U.N. Doc. CEDAW/C/HUN/CO/7-8 (2013) (urging the State party to “[e]stablish an adequate regulatory framework and a mechanism for monitoring of the practice of conscientious objection by health professionals and ensure that conscientious objection is accompanied by information to women about existing alternatives and that it remains a personal decision rather than an institutionalized practice”); CESCR, Concluding Observations: Poland, para. 28, U.N. Doc. E/C.12/POL/CO/5 (2009) (“The Committee is particularly concerned that women resort to clandestine, and often unsafe, abortion because of the refusal of physicians and clinics to perform legal operations on the basis of conscientious objection…. The Committee calls on the State party to take all effective measures to ensure that women enjoy their right to sexual and reproductive health, including by enforcing the legislation on abortion and implementing a mechanism of timely and systematic referral in the event of conscientious objection.”).

[7]  See, e.g., CEDAW, Concluding Observations: Hungary, para. 31(d), U.N. Doc. CEDAW/C/HUN/CO/7-8 (2013); CRC, Concluding Observations: Slovakia, paras. 41(f), U.N. Doc. CRC/C/SVK/CO/3-5 (2016).

[8] UN CESCR, Gen. Comment No. 22, paras. 14, 43 (“Unavailability of goods and services due to ideologically based policies or practices, such as the refusal to provide services based on conscience, must not be a barrier to accessing services. An adequate number of health-care providers willing and able to provide such services should be available at all times in both public and private facilities and within reasonable geographical reach. … Where health-care providers are allowed to invoke conscientious objection, States must appropriately regulate this practice to ensure that it does not inhibit anyone’s access to sexual and reproductive health care, including by requiring referrals to an accessible provider capable of and willing to provide the services being sought, and that it does not inhibit the performance of services in urgent or emergency situations”).

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