Conscientious objection and abortion

The indicator was calculated based on seven questions posed to federal health institutions. Thus, the total possible score for each institution ranged from -14 to 14. As shown, some federal institutions, such as ISSSTE and the Secretariat of Health, responded to the questions by disaggregating the information by hospital unit. Furthermore, ISSSTE forwarded some questions to different hospital units, specifically those related to access to abortion on certain grounds (medical personnel available to perform induced abortions, number of abortions performed, and service users referred to other medical units due to a lack of trained and available personnel to carry out these procedures). In these cases, since the objective was to assess the transparency of the institution as a whole, the average of the scores obtained for each question was used. As a result, total scores were normalized on a scale from 0 to 10. The highest score corresponds to public health institutions that, through their responses, demonstrated that they maintain records of the required information and disclosed it in a complete manner. By contrast, institutions with the lowest scores showed, in most of their responses, that they did not have the information, did not maintain records of it, or provided it incorrectly.

In the case of local health institutions, the total number of questions posed to federal entities where abortion has been decriminalized and those where it has not was 10 and 7, respectively. Therefore, the range of possible scores varies: between -20 and 20 in decriminalized states and between -14 and 14 in states where abortion remains criminalized. Once the total scores for each federal entity were obtained, the information was standardized from 0 to 10, following the same methodology used for federal institutions.

The results for federal and local health institutions are presented below.

Overall, the question that received the most complete responses from both local and federal public health institutions was the one related to the total number of VTP procedures performed. Only four health institutions reported that they did not have records of the requested information or provided incorrect information (Hidalgo, Oaxaca, Sonora, and the Secretariat of Health). In the case of federal entities that have decriminalized abortion, the question that received the most complete responses was the one regarding the number of LTP procedures performed since decriminalization. By contrast, the question that received the poorest responses from local health institutions was the one related to the total number of VTP requests—only seven health institutions at the local and federal levels provided complete information.

After analyzing responses from state and federal health institutions, it was found that only Nuevo León, Baja California Sur, and IMSS scored 9 or higher on the transparency indicator. Nuevo León provided complete information for all questions, while Baja California Sur and IMSS each provided an incomplete response to only one question. Based on the information disclosed by IMSS, it is noteworthy that—contrary to what federal regulations require—this institution does not carry out induced abortion procedures. These scores are followed by Morelos, Chihuahua, and Michoacán, with scores equal to or higher than 8 and lower than 9.

Forty-seven percent of state and federal public health institutions scored equal to or higher than 6 and lower than 8; six of these institutions scored below 7. Of the sixteen federal entities within this score range, thirteen provided incorrect information regarding VTP requests. In most cases,  the error consisted of failing to distinguish between VTP requests and procedures actually performed, making it impossible to monitor refusals to provide this health service.

In turn, fourteen of the thirty-eight public health institutions to which SAIs were submitted scored below 6. Among these, the cases of Campeche, State of Mexico, Tlaxcala, Oaxaca, and Sinaloa stand out, as they obtained scores below 3. These low scores are largely explained by the fact that, because these entities do not have personnel willing, trained, and available to perform induced abortions, they do not maintain records of the personnel who carry out VTP procedures or of service users referred to other medical units.

It is important to recall that this indicator reflects only the extent to which obligated entities possess information and how they provide it, and that it does not allow for an assessment of how accessible induced abortion services are or how conscientious objection affects their availability. For example, IMSS received a favorable score on the indicator because it provided complete information for most questions; however, its responses indicate that induced abortion services are not being provided.

Improved data collection and systematization is urgently needed in order to determine whether conscientious objection constitutes a barrier to accessing induced abortion services. At the same time, strong transparency tools and higher standards for the information disclosed by health institutions are necessary, alongside effective enforcement of existing regulations to ensure comprehensive, non-discriminatory access to abortion services without revictimization. The transparency indicator developed by GIRE helps underscore the scale of the challenge and the need for more robust monitoring and accountability by obligated entities.