Findings and Barriers
Analysis of the SAIs shows that, given the way in which obligated entities systematize and disclose information, it is not possible to obtain comprehensive data on conscientious objection and induced abortion. The following findings and barriers are drawn from the responses provided by the obligated entities:
- In some states, such as Puebla, Article 10 bis of the General Health Law continues to be invoked to establish that health care personnel are not required to state the reason for their decision to be conscientious objectors and to argue that objection can only be invoked in cases where it does not pose a risk to the life of the users. In other words, they ignore the fact that the Supreme Court declared this article invalid, along with the prohibition on invoking conscientious objection in emergency medical procedures such as VTP.
- Despite the obligation to ensure that willing, trained, and available personnel are on hand at all times, some states (such as Hidalgo and Guanajuato) continue to rely on the obligation to refer service users to another medical unit when they are unable to perform the requested procedure. In other words, they continue to operate under a less rights- protective standard (NOM-046), instead of ensuring that their institutions have personnel available at all times to provide VTP, LTP, and abortion services on specific grounds, as required by the SCJN’s ruling in AU 54/2018.
- Some obligated entities confuse the terms LTP and VTP. When asked about the number of voluntary terminations of pregnancy due to sexual violence, some states—such as Hidalgo and Yucatán—reported the number of LTP procedures, even though in the latter abortion at the request of the woman or pregnant person has not been decriminalized.
- It is concerning that some states, such as Sonora, provided information that makes it possible to fully identify both conscientious objectors and willing, trained, and available personnel who provide induced abortion services—including full names, addresses, and hospital to which personnel belong—thereby violating their right to personal data protection.
- At the federal level, there is evidence of inadequate record-keeping regarding induced abortion procedures, as well as widespread lack of knowledge of the regulatory framework governing conscientious objection. This makes it difficult to assess whether health institutions are complying with their obligations in terms of access to induced abortion services. In the specific case of IMSS, it is alarming that the institution has not provided any induced abortion services and lacks information on both conscientious objectors and personnel willing, trained, and available to provide such services. Given that IMSS serves the largest share of the enrolled population (51%), it is urgent and necessary for the institution to guarantee access to comprehensive, safe, and high-quality health services to which service users are entitled, including induced abortion procedures.
- In the case of ISSSTE, it is noteworthy that five hospitals continue to report that all members of their health care personnel are conscientious objectors and do not perform abortion procedures under any circumstances. 1 The existence of institutional conscientious objection and the refusal of some hospitals to provide induced abortion services constitute serious human rights violations. These practices particularly affect the rights of women, pregnant people, and individuals who identify as part of sexual and gender diversity— groups that face discrimination and whose reproductive rights have historically been undermined by factors such as the ideological and religious convictions of those who refuse to provide appropriate health care services.
- On a positive note, Nayarit reported that, as part of its safe abortion program, it has a special budget allocation to provide VTP services in remote communities and, if necessary, to transfer users to a medical unit.
In its Abortion Care Guideline, the WHO establishes that conscientious objection creates greater barriers for populations in specific contexts—for example, in places where legislation on abortion has been recently amended and it is not yet entirely clear who may object and under what circumstances in the provision of abortion care. This can lead conscientious objector health care personnel to delay services or refuse to provide them altogether. Such situations are more likely to occur when the proportion of objecting health care personnel is higher and may result in service users being denied care, even in cases that constitute medical emergencies.
The WHO has also noted that when there is no regulation on conscientious objection—or when such regulation exists but is unclear—this can impose disproportionate workloads on willing, trained, and available health care personnel, particularly when the proportion of objecting personnel is higher. This situation, compounded by structural shortcomings in the national health system—such as insufficient funding and limited availability of medications and other supplies—hinders timely, high-quality access to abortion services.
When all health care personnel within an institution are conscientious objectors, it becomes necessary to question the quality of the health services provided and to examine how the state guarantees that such services are delivered with quality and without discrimination or revictimization. The Mexican state has an obligation to influence medical culture so that all service users are attended by personnel who are willing and trained to provide the services they request, including induced abortion procedures.
The information collected reveals the existence of significant obstacles to accessing induced abortion services and to complying with the regulatory framework governing conscientious objection, as well as deficient systematization of information by obligated entities. Moreover, in order to overcome the current limitations and move toward full, respectful access to induced abortion services, it is essential to promote a medical culture that prioritizes the health and rights of women and other pregnant people.
