Health Care Personnel Who Provide VTP
The General Law on Victims (LGV, for its Spanish initials), enacted on January 9, 2013, establishes that access to voluntary termination of pregnancy (VTP) services must be guaranteed for victims of sexual violence and other acts that affect their physical or psychological integrity. It also provides that termination of pregnancy resulting from sexual violence constitutes a medical emergency service. Likewise, Official Standard NOM 046 recognizes that cases of sexual violence are medical emergencies requiring immediate care.
In November 2022, the National Center for Gender Equity and Reproductive Health issued the Technical Guidelines for the Provision of Safe Abortion Care in Mexico, which set forth the basic criteria for providing health services that ensure timely, effective, and comprehensive access to safe abortion for women and pregnant people. These guidelines reaffirm the provisions of the LGV and NOM 046, establishing that access to VTP is a right of victims of crimes related to sexual violence and that it is legally considered a medical emergency.
In accordance with the ruling in AU 54/2018, conscientious objection may not be invoked when the life of the user is at risk or in situations of medical emergency, such as cases involving termination of pregnancy resulting from sexual violence. The World Health Organization has also stated that conscientious objection must not be invoked in urgent or emergency situations, in order to guarantee respect for, protection of, and fulfillment of the human rights of people who seek an abortion.
Therefore, considering that abortion procedures provided on the grounds of sexual violence must be carried out by health care personnel regardless of whether they are conscientious objectors, GIRE requested information on the number of health care personnel who perform voluntary termination of pregnancy procedures in cases of sexual violence, disaggregating the information between conscientious objectors and personnel who are willing, trained, and available.
The expected response (both from health institutions at the state level and from federal institutions) was that all health care personnel perform VTP procedures, regardless of whether they are conscientious objectors, given that such cases constitute a medical emergency. Moreover, it was important for institutions to provide disaggregated information on the number of health care personnel who are willing, trained, and available, as well as the number of conscientious objectors, if any.
| Entity | Health Care Personnel Who Provide VTP | Conscientious Objector Personnel | Willing, Trained, and Available Personnel |
|---|---|---|---|
|
Aguascalientes
|
Incomplete response
|
Incomplete response
|
126 (2019)
|
|
Baja California
|
No information
|
No information
|
No information
|
|
Baja California Sur
|
Incomplete response
|
Incomplete response
|
16 (2022)
|
|
Campeche
|
No records
|
No records
|
No records
|
|
Chiapas
|
Incomplete response
|
Incomplete response
|
1 (2021)
|
|
Chihuahua
|
2 (2017-2018)
|
0
|
2 (2017-2018)
|
|
Mexico City* (Secretariat of Health)
|
70 (2016)
|
4 (2016-2021)
|
66 (2016)
|
|
Mexico City*(health services)
|
9 (2016-2017)
|
Incomplete response
|
Incomplete response
|
|
Coahuila* (Secretariat of Health)
|
33 (2016-2021)
|
No information
|
No information
|
|
Coahuila* (health services)
|
Incomplete response
|
No information
|
31 (2016-2020)
|
|
Colima
|
12 (2016)
|
4 (2018)
|
12 (2016)
|
|
Durango
|
Incomplete response
|
Incomplete response
|
1 (2020)
|
|
Guanajuato
|
No records
|
No records
|
No records
|
|
Guerrero
|
Incomplete response
|
Incomplete response
|
26 (2022)
|
|
Hidalgo
|
No records
|
No records
|
No records
|
|
Jalisco
|
Incomplete response
|
Incomplete response
|
Incomplete response
|
|
State of Mexico
|
No records
|
No records
|
No records
|
|
Michoacán
|
Incomplete response
|
No information
|
36 (2022)
|
|
Morelos
|
2179 (2020)
|
1817 (2020)
|
362 (2020)
|
|
Nayarit
|
1 (2016)
|
No records
|
No records
|
|
Nuevo León
|
516 (2022)
|
54 (2022)
|
462 (2022)
|
|
Oaxaca
|
No records
|
No records
|
No records
|
|
Puebla
|
No records
|
No records
|
No records
|
|
Querétaro
|
0 (2016-2020)
|
No records
|
No records
|
|
Quintana Roo
|
No records
|
No records
|
35 (2019)
|
|
San Luis Potosí
|
1579 (2016-2022)
|
2 (2016-2017)
|
1577 (2016-2018)
|
|
Sinaloa
|
No records
|
No records
|
No records
|
|
Sonora
|
Incomplete response
|
Incomplete response
|
93 (October 2022)
|
|
Tabasco
|
12 (2016-2022)
|
0
|
12 (2016-2022)
|
|
Tamaulipas
|
No records
|
No records
|
No records
|
|
Tlaxcala
|
No records
|
No records
|
No records
|
|
Veracruz
|
Conscientious objection does not apply to VTP
|
No records
|
No records
|
|
Yucatán
|
80 (2017)
|
55 (2017)
|
25 (2017)
|
|
Zacatecas
|
No records
|
No records
|
No records
|
Created by GIRE based on SAI data.
*Entity in which more than one obligated entity responded and data differ.
Findings
Due to the deficient responses provided by health institutions, it is difficult to determine whether
both conscientious objectors and willing, trained, and available health personnel perform VTP
procedures. Key findings include the following:
- Ten federal entities do not maintain records of health personnel who perform VTP procedures in their jurisdiction, making it impossible to determine whether there are sufficient personnel to assist service users who decide to terminate a pregnancy on the grounds of rape from the moment they submit their request.
- Nine federal entities provided information solely on the total number of willing, trained, and available personnel who perform VTP procedures. This makes it difficult to determine whether, in cases of medical emergency, conscientious objectors also perform the procedures upon request by the service user.
- Two federal entities (Nayarit and Querétaro) did not disaggregate the information between conscientious objectors and willing, trained, and available personnel for VTP procedures; however, they did report the total number of health personnel who perform the procedure. This may indicate that these entities consider the performance of VTP an obligation, given that it constitutes a right of victims of sexual violence.
- In the case of Jalisco, the information provided on conscientious objectors and willing, trained, and available personnel includes health personnel specializing in anesthesiology, gynecology, and pediatrics as a single group. However, since conscientious objection may only be invoked by personnel directly involved in the procedure, the obligated entity’s response is incorrect, as not all the specialties listed are related to the performance of VTP procedures.
- Baja California does not have information on health personnel who perform VTP, nor does it provide specific data on conscientious objectors or on willing, trained, and available personnel to carry out this procedure. This makes it difficult to determine what type of personnel is providing VTP services to users.
- Although it is noteworthy that Veracruz is the only entity that explicitly recognizes that conscientious objection cannot be invoked in cases of VTP, it is not possible to determine whether its hospitals have personnel available at all times to perform the procedure, as the state does not provide the total number of health personnel who perform it, nor does it disaggregate the information between conscientious objectors and willing, trained, and available personnel.
- Only eight entities (Chihuahua, Mexico City, Colima, Morelos, Nuevo León, San Luis Potosí, Tabasco, and Yucatán) report the total number of health care personnel who perform VTP and distinguish between conscientious objectors and willing, trained, and available personnel who carry out this procedure.
- Overall, in 75% of federal entities, it is not possible to determine whether both conscientious objectors and willing, trained, and available personnel perform VTP procedures. This lack of information prevents assessment of whether conscientious objection is undermining the right to the highest attainable standard of health for service users by failing to ensure that all health personnel carry out medical emergency procedures, such as VTP.
| Obligated Entity | Health Care Personnel Who Perform VTP | Conscientious Objector Personnel | Willing, Trained, and Available Personnel | |
|---|---|---|---|---|
|
IMSS
|
No information
|
No information
|
No information
|
|
|
ISSSTE
|
Hospital Regional de Alta Especialidad Bicentenario de la Independencia, State of Mexico
|
16 (2022)
|
13 (2022)
|
3 (2022) |
|
Hospital Regional Centenario de la Revolución Mexicana, Emiliano Zapata, Morelos
|
No VTP procedures have been performed
|
All personnel are conscientious objectors
|
- | |
|
Dirección Normativa de Salud, Mexico City
|
No information
|
No information
|
No information
|
|
|
Hospital Regional General Ignacio Zaragoza, Mexico City
|
No VTP procedures
|
- | - | |
|
Hospital Regional Lic. Adolfo López Mateos, Mexico City
|
No personnel perform VTP procedures
|
No personnel perform VTP procedures
|
No personnel perform VTP procedures
|
|
|
Hospital Regional León, Guanajuato
|
No VTP procedures
|
15 (2016-2019)
|
0
|
|
|
Hospital Regional Dr. Manuel Cárdenas de la Vega, Sinaloa
|
69 (2016-2022)
|
63 (2016-2022)
|
6 (2016-2022)
|
|
|
Hospital Regional Mérida
|
19 (2016-2021)
|
16 (2016-2019)
|
3 (2016-2019)
|
|
|
Hospital Regional Morelia
|
No VTP procedures have been performed
|
All personnel are conscientious objectors
|
- | |
|
Hospital Regional Monterrey
|
No records
|
No records
|
No records
|
|
|
Hospital Regional 1.° de Octubre, Mexico City
|
No VTP requests have been submitted
|
No records
|
No records
|
|
|
Hospital Regional Presidente Benito Juárez, Oaxaca
|
No records
|
No records
|
No records
|
|
|
Hospital Regional Puebla
|
No VTP procedures have been performed
|
- | - | |
|
Hospital Regional B Veracruz
|
No records
|
No records
|
No records
|
|
|
Hospital Regional Dr. Valentín Gómez Farías, Jalisco
|
16 (2022)
|
14 (2022)
|
2 (2022)
|
|
|
PEMEX
|
No information
|
No information
|
No information
|
|
|
SEDENA
|
No information
|
No information
|
No information
|
|
|
SEMAR
|
No information
|
No information
|
No information
|
|
|
Secretariat of Health
|
No records
|
No records
|
No records
|
|
Created by GIRE based on SAI data.
Findings
There are clear obstacles at the federal level that prevent women and other people with the capacity to gestate from accessing VTP services, thereby violating their human rights. Some findings in this regard include:
- Federal authorities such as IMSS, SEDENA, and SEMAR do not have information on the personnel who carry out these procedures and therefore do not disaggregate the data between conscientious objectors and willing, trained, and available personnel. This is particularly concerning in the case of IMSS, which—according to data from the 2020 Population and Housing Census—accounts for 51% of the enrolled population. The Secretariat of Health also maintains no records of this information. This lack of data makes it impossible to determine whether abortion procedures on the grounds of sexual violence are performed by all health care personnel, regardless of whether they are conscientious objectors.
- In the case of ISSSTE, of the fifteen hospitals that responded to the request, only four did so adequately (by providing the number of personnel who perform VTP procedures and distinguishing between conscientious objectors and willing, trained, and available personnel).
- It is concerning that, of the fifteen ISSSTE-affiliated hospitals that provided a response, five stated that all their personnel are conscientious objectors or that no VTP procedures are performed. This suggests that conscientious objection is being treated as an institutional stance rather than as an individual decision of the health care personnel directly involved in VTP procedures.
When an institution declares itself a conscientious objector it violates human rights, as it constitutes a violation of the reproductive rights of victims of sexual violence, their right to access abortion, and their right not to be subjected to cruel, inhuman, and degrading treatment.
