Information for Health Care Personnel:
Regulatory Framework on Abortion
Last updated: April 30, 2026.
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Introduction
In recent years, the regulation of abortion in Mexico has shifted toward decriminalization and non-criminalization. For many years, the legal framework was limited to establishing a system of specific legal grounds; in other words, under both the Federal Criminal Code and the criminal codes of each federal entity, abortion was treated as a crime subject to exemptions from criminal liability or grounds for non-punishability. While this framework initially allowed for the expansion of access to abortion as a health service—at least in certain circumstances—it remains a restrictive model. By continuing to classify abortion as a crime, the law constrains the reproductive autonomy of women, trans men, non-binary people, and other people with the capacity to gestate.
In addition to criminal codes, there are currently a number of national and international standards that define abortion as a health service linked to human rights, public health, gender equality, and social justice.
However, some social actors—including sectors of health care personnel—remain unaware of this new paradigm. This lack of awareness can lead to confusion when these actors face abortion-related situations and, in some cases, may result in violations of service users’ right to health.
With the aim of providing legal certainty to health care personnel, the information presented here is grounded in a range of current legal standards and criteria in this field. The objective is for health care professionals across different specialties—as well as practitioners in psychology, nursing, social work, sociology, and other disciplines involved in addressing abortion-related situations—to be able to address questions they may have in this regard and to gain the understanding and legal knowledge necessary to act effectively within their respective areas of practice.
What Is Abortion?
Abortion is the termination of a pregnancy, either spontaneous (when it occurs without any intervention or procedure, also known as miscarriage) or induced (the intentional termination of an intrauterine pregnancy through a medical or surgical procedure). It is a procedure that forms part of the right to health of women and other people with the capacity to gestate.[1] The World Health Organization (WHO), in its Abortion Care Guideline (Guideline),[2] classifies comprehensive abortion care as an essential health service. The WHO further states that abortion care must be regulated in accordance with human rights standards and that states must guarantee its availability, accessibility, acceptability, and quality so that individuals are not forced to resort to unsafe abortions that endanger their lives, subject them to physical or mental suffering, or interfere with their ability to make decisions about their private lives.
More specifically, safe abortion is defined as the termination of a pregnancy carried out under conditions that do not endanger the health of the woman or pregnant person.[3] In Mexico, the Technical Guidelines for the Provision of Safe Abortion Care (Technical Guidelines)[4] incorporate international clinical standards, appropriate abortion methods for each stage of pregnancy, and specific obligations for health care personnel in the provision of this service. Their purpose is to establish a national network of services and ensure that care is delivered with the highest possible technical and human quality wherever it is provided. These Guidelines are of general applicability to all personnel within the national health system. For this reason, the procedures they set forth must be strictly followed.
The term legal termination of pregnancy (LTP; ILE in Spanish) refers to induced abortions carried out at the decision of a woman or pregnant person, under the protection of the applicable legal framework.[5] By contrast, voluntary termination of pregnancy (VTP; IVE in Spanish) is the term used in Mexican victims’ rights legislation in cases where access to abortion is granted on the grounds of sexual violence.
Abortion Should Not Be Associated with the Commission of a Crime
In Mexico, each federal entity defines, through its criminal code, the circumstances under which abortion is or is not penalized. This regulatory diversity generates a lack of total legal certainty regarding how abortion and its provision should be interpreted, which in turn generates confusion among health care personnel about their responsibilities. Moreover, certain obligations, although binding nationwide, are not always explicitly reflected in the criminal codes of the different entities.
The only circumstance in which abortion is not considered a crime in any federal entity in the country is when the pregnancy results from sexual violence, as established in section 6.4.2.7 of NOM-046-SSA2-2005, Family, Sexual, and Gender-Based Violence: Criteria for Prevention and Care (NOM 046).[6] This provision recognizes the right of victims of sexual violence to access VTP services.
The Technical Guidelines establish that the provision of safe abortion care is a public health priority and therefore does not depend on whether criminal codes explicitly provide for it. This derives from the constitutional obligation to protect the health and reproductive autonomy of girls, adolescents, women, and other people with the capacity to gestate. Accordingly, the Mexican state—through public health institutions and their personnel—is required to guarantee access to safe abortion under the terms and conditions established by the applicable legal framework, prioritizing the rule or interpretation that affords the greatest protection to those requesting the service.
This approach is reinforced by the WHO Guideline, which states that, insofar as voluntary abortion has not been fully recognized, grounds for non-punishability—i.e., the circumstances in which abortion is not sanctioned—must be formulated and applied in a manner consistent with international human rights law. In practice, this means that abortion care must be person-centered, non-judgmental, and non-directive, enabling individuals to make informed decisions about their own care with appropriate support.
The WHO has recommended abandoning the use of criminal law altogether as a means of regulating abortion.[7]
Because abortion forms part of the right to health, it should not be regulated through criminal codes. Criminal regulation tends to sideline the objective of guaranteeing access through health laws and creates barriers both for women and pregnant people who seek abortion services and for health care personnel who provide them. Moreover, criminal law fails to address the structural factors that hinder access to abortion services, such as limited availability of medications, working conditions within the health system, or lack of willing, available, and adequately trained personnel.
One of the main arguments advanced by anti-rights groups that support the criminalization of abortion is that priority must be given to protecting life from the moment of conception and during pregnancy. However, the WHO has stated that gestational limits used to deny access to abortion lack a scientific basis. The Supreme Court of Justice of the Nation (SCJN) has issued significant rulings in this regard, which are outlined below.
In 2011, when the SCJN examined two actions of unconstitutionality[8] concerning provisions adopted in Baja California (Action of Unconstitutionality 11/2009) and San Luis Potosí (Action of Unconstitutionality 62/2009), it concluded that protecting life during pregnancy is compatible with the decriminalization of abortion at the request of a woman or pregnant person. A decade later, in 2021, the Court adopted a more rights-protective approach when it reviewed provisions on protection of life from the moment of conception in Sinaloa (Action of Unconstitutionality 106/2018 and its consolidated case 107/2018). By majority vote, it held that state legislatures lack authority to define when life begins and therefore may not confer legal personhood or grant general and absolute protection in a manner that restricts the rights of women and other pregnant people.
Provisions that protect life from the moment of conception do not justify denying services related to the reproductive health of women and other people with the capacity to gestate, nor may they be invoked to restrict access to abortion.
Following its ruling in the Sinaloa case, the SCJN ruled on three additional cases in the same manner: Nuevo León (Action of Unconstitutionality 41/2019 and its consolidated case 42/2019), Veracruz (Action of Unconstitutionality 85/2016), and Aguascalientes (Action of Unconstitutionality 72/2021 and its consolidated case 74/2021). In each instance, the Court declared unconstitutional the provisions of the respective stateFollowing its ruling in the Sinaloa case, the SCJN ruled on three additional cases in the same manner: Nuevo León (Action of Unconstitutionality 41/2019 and its consolidated case 42/2019), Veracruz (Action of Unconstitutionality 85/2016), and Aguascalientes (Action of Unconstitutionality 72/2021 and its consolidated case 74/2021). In each instance, the Court declared unconstitutional the provisions of the respective state constitutions that protected life from conception. The Court reiterated that such provisions are intended to restrict other fundamental rights—particularly those of women and people with the capacity to gestate—including the right to reproductive autonomy.
The SCJN reaffirmed this criterion on 20 April 2026 in deciding Amparo in Revision 426/2025. In its ruling, it declared the second paragraph of Article 16 of the Constitution of the State of Tamaulipas unconstitutional. The provision protected life “from the moment of fertilization […]”. The Court held that this wording unjustifiably restricted the rights of women and people with the capacity to gestate.
In 2021, the Court’s ruling in Action of Unconstitutionality 148/2017, concerning the Criminal Code of Coahuila, set an important national precedent by declaring unconstitutional the provisions that criminalized abortion without exception. The Court clarified that human rights are recognized from the moment a person is born alive, noting that neither the Constitution nor international treaties protect a right to life from the moment of conception. It further held that pregnancy may be protected only through the safeguarding of the rights of women and pregnant people. The Court also determined that criminal law is not an appropriate means to achieve this objective, as provisions that criminalize voluntary abortion without exception—without allowing any meaningful opportunity to exercise reproductive freedom, at least during an early stage of pregnancy—completely suppress the right to decide.
In that ruling, the SCJN struck down the provision of the Criminal Code of Coahuila that criminalized abortion without exception, as well as a portion of another article that penalized health care personnel who performed or assisted in abortions. Since then, no one in that state may be investigated or convicted for voluntarily terminating a pregnancy or assisting another person in doing so. The decision also established that no judge in the country may issue a conviction for the crime of abortion when it is carried out solely at the request of the woman or pregnant person during the first half of pregnancy. The ruling makes clear that criminalizing abortion without exception violates human rights and that these rights apply both to women and to people with the capacity to gestate.
As of April 2026, abortion has been decriminalized in the following federal entities: Mexico City (2007), Oaxaca (2019), Hidalgo (2021), Veracruz (2021), Coahuila (2021), Baja California (2021), Colima (2021), Sinaloa (2022), Guerrero (2022), Baja California Sur (2022), Quintana Roo (2022), Puebla (2024), Jalisco (2024), Michoacán (2024), Chiapas (2024), San Luis Potosí (2024), Zacatecas (2024), the State of Mexico (2024), Nayarit (2025), Chihuahua (2025), Campeche (2025), Yucatán (2025), Tabasco (2025), and Tlaxcala (2025).
In Aguascalientes, on August 30, 2023, the SCJN ruled on Amparo in Review 79/2023 and ordered the repeal of the crime of self-induced abortion. In December 2023, the state complied and decriminalized abortion up to 12.6 weeks of gestation. However, in August 2024, the state Congress voted to reduce the decriminalization period to six weeks.
In September 2023, the Supreme Court ruled that the Congress of the Union was required to repeal the provisions of the Federal Criminal Code that criminalized consensual abortion without exception, as they were unconstitutional (Amparo in Review 267/2023).[9] In turn, in 2024 and 2025, collegiate circuit courts in Jalisco, Nayarit, Zacatecas, and Durango ruled on amparos in review ordering the respective state legislatures to strike from their criminal codes the crimes of self-induced and consensual abortion. For its part, the SCJN ordered the Congress of Yucatán to repeal the provisions of its state’s criminal code that criminalized consensual abortion without exception. The same occurred in Morelos in 2024 and in Durango in 2025, by order of a federal district court; in both cases, compliance remains pending.
Furthermore, on January 23, 2025, the Official Gazette of the Federation (DOF, for its Spanish initials) published an agreement issued by the Director General of the Institute for Social Security and Services for State Workers (ISSSTE), guaranteeing the implementation of the procedure for Legal Termination of Pregnancy (hereinafter, the ISSSTE Agreement on LTP). ISSSTE is the third-largest public health institution in the country after IMSS and IMSS-Bienestar, based on the number of people it serves, and will now guarantee access to voluntary abortion for any rightful claimant who requests the service, regardless of their reasons for seeking it, in accordance with the regulations in force in each federal entity. The institution has also published a list of health care units authorized to provide this service.
Likewise, on March 17, 2026, IMSS issued the Technical Guidelines for Legal Abortion, launched a WhatsApp chatbot (55 4595 0448) to provide information and support, and added a filter to its facility directory to help users locate health units that provide legal abortion services.
On February 25, 2025, the SCJN resolved a case of conflicting precedents concerning safe abortion care. In doing so, it examined whether the Mexican state is responsible for guaranteeing abortion services as part of the right to health. After reviewing the matter, the Court held that these services are essential to the exercise of reproductive autonomy and must therefore be available to everyone without discrimination. In line with its prior ruling in Coahuila, the Court reaffirmed the obligation of state health authorities to implement, disseminate, and organize health services to guarantee access to voluntary abortion.
Regulating abortion as a health service, rather than from a criminal law perspective, helps prevent the criminalization of people who provide information on, assist with, or perform abortions, as well as those who experience miscarriages or decide to terminate a pregnancy.
The Court reaffirmed this criterion in deciding Action of Unconstitutionality 89/2024 concerning the Health Law of Tlaxcala. In its ruling, the Court held that the way healthcare services are delivered can itself constitute a barrier to accessing abortion. This decision confirms that guaranteeing access to abortion requires more than decriminalizing the procedure; it also requires reviewing healthcare regulations and the conditions under which abortion services are provided.
Cases in Which Abortion Is Permitted
The criminal codes of the 32 federal entities, as well as the Federal Criminal Code, contain provisions that allow abortion to be performed in specific circumstances. These circumstances are classified either as grounds excluding criminal liability or as grounds for non-punishability. The former refers to situations in which the crime of abortion is deemed not to have occurred, even though the act took place. In the latter, although the act is defined as a crime, its specific commission does not warrant the imposition of a penalty.[10]
These grounds include sexual violence, negligent or unintentional abortion, risk to life, serious fetal impairments, health-related grounds, denial by an authority, denial of information, and gynecological conditions, among others. In this regard, some of the grounds that most effectively facilitate access to abortion services and adequate support are outlined below.
A. When the pregnancy results from sexual violence
The General Law on Victims (LGV)[11] provides that victims of sexual violence have the right to abortion (Article 35) and that, when requesting the service on that basis, they must be presumed to be acting in good faith, i.e., without suspicion that they are lying (Article 4). It also establishes that pregnancy termination services in such cases, as well as in other circumstances permitted by law, must be treated as medical emergencies. Moreover, Official Mexican Standard NOM-046 provides that when the pregnancy results from rape, it is not necessary to file a criminal complaint in order to obtain an abortion. In these cases, it is sufficient to submit a written statement, made under oath, declaring that the pregnancy resulted from rape and that the person seeks to terminate it (Section 6.4.2.7).
This ground for pregnancy termination is not subject to criminal sanction in any federal entity. However, although access to abortion on this basis should not be conditioned on gestational age, some local provisions continue to establish time limits. This should not prevent access to VTP, as the SCJN has ruled on multiple cases concerning the right of victims of sexual violence to access abortion and has declared unconstitutional the provisions of criminal codes that impose such restrictions.[12]
In line with the LGV, the Court has established that abortion is a right of victims of sexual violence. It has also held that denying medical services for the termination of a pregnancy resulting from such violence constitutes a violation of human rights—specifically the right not to be subjected to cruel, inhuman, or degrading treatment.
The Court has also held that establishing a single, generalized time limit for terminating a pregnancy resulting from rape constitutes a form of violence against women and other pregnant people, as it undermines their dignity and affects their psychological health. Such restrictions are contrary to the rights to equality and non-discrimination, to a life free from violence, and to health. In this regard, in accordance with the LGV, the Court has established that requests for pregnancy termination from victims of sexual violence must be treated as urgent and addressed promptly and efficiently, so that the physical and psychological consequences of the violence are not prolonged over time.
B. When there is a risk to health
These grounds permit pregnancy termination when there is a risk to the health of the pregnant person and also encompass situations in which the pregnant person’s life is in danger, as such circumstances constitute an extreme risk to health. When abortion is permitted only in cases involving risk to life—without including risks to health—the right to health of women and pregnant people is violated, among other human rights.
In this regard, in 2019, the First Chamber of the SCJN held that abortion is a medical service provided for under the General Health Law (LGS) and that health services—both public and private—are required to provide it in cases involving risks to health (Amparo in Review 1388/2015). Among other considerations, the Court specified that the right to health encompasses not only physical aspects but also emotional and social dimensions. Because its normative scope includes pregnancy termination in situations of risk, abortion services on health grounds must be provided in all health institutions regulated by the LGS and its Regulations on the Provision of Medical Care Services.
In this sense, a risk to health means more than simple danger to the life of a pregnant person. Abortion must be available as a therapeutic measure in cases in which physical, mental, or social well-being may be compromised, since the human right to health includes these three dimensions of well-being. Taking them into account may prevent the risk from escalating into more serious harm.
Although determining whether a risk to health exists is a medical matter, the decision whether to assume that risk rests exclusively with each person, in the exercise of their rights to liberty, autonomy, and the free development of their personality.
When a pregnant person decides to terminate a pregnancy as a measure to protect their health, all health care personnel must respect that decision and refrain from interfering in any way. If a discrepancy exists between the medical assessment and the pregnant person’s own perception of their health, the latter must take precedence.[13]
Thus, in assessing the health risks posed by a pregnancy, scientific criteria must be considered alongside the particular subjective circumstances of each pregnant person. Only the person concerned can make an informed assessment of the degree of health impairment or risk they are willing to assume, and they must not be compelled to bear disproportionate burdens.
C. Denial of the provision of abortion services
The denial of services that only women or pregnant people require, such as abortion, as well as the imposition of barriers that restrict access to them, constitute acts of discrimination. In practice, even in federal entities where abortion has been decriminalized, access to this service is frequently denied without justified cause.
To eliminate the real barriers that hinder access, some state criminal codes establish an obligation to provide abortion services in cases where authorities have unjustifiably refused to perform the procedure, even though it is legally permitted. This is the case in Baja California Sur, Colima, Guerrero, and Michoacán, which incorporated these grounds following the decriminalization of abortion in 2021 (Colima), 2022 (Guerrero and Baja California Sur), and 2024 (Michoacán).
In this regard, the SCJN has held that denying access to abortion where it is legally permitted constitutes a violation of human rights, as forcing a person to continue a forced or unwanted pregnancy is comparable to subjecting them to cruel, inhuman, or degrading treatment (Action of Unconstitutionality 148/2017). It has further established that disrupting an individual’s life plan may cause harm to their health and even jeopardize their life (Amparo in Review 1388/2015).
Obligations of Health Care Personnel
a. Principles
The Technical Guidelines establish the standards applicable to the provision of abortion services. Accordingly, any service of this nature must comply with the following criteria:
Respect and protection
The exercise of the right to health must not be obstructed, whether directly or indirectly. In other words, services must not be denied or restricted, nor may requirements not provided for by law be imposed in order to refuse, hinder, or delay the provision of abortion services.
Timeliness of care
The necessary conditions in infrastructure, operations, human resources, and funding must be in place to provide abortion services. Furthermore, requests by users to access the service—and the relevant information in each case—must be promptly addressed.
Equality and equity
Access to the service must be guaranteed to all users on equal terms, ensuring the effective enjoyment of their right to health. To prevent barriers to care, the necessary material conditions must be established to enable provision of service. The confidentiality and privacy of service users must also be safeguarded, including the protection of their personal data and their decision to undergo the process with or without the support of a trusted person.
Non-discrimination
Services must be accessible and available to all users without any form of discrimination. Under this principle, the refusal to provide reproductive health services when legal requirements are met constitutes a discriminatory act.
Safety
The safety of the user must take precedence over any other consideration. Appropriate facilities, the necessary equipment, and adequately trained providers must be available.
Respectful and dignified care
Care must be provided without stigmatization and with full respect for the service user’s dignity and lived experience. Health care personnel have an ethical duty to guarantee the right to health and the exercise of users’ reproductive rights.
b. Confidentiality and professional secrecy
In the context of abortion, confidentiality is directly linked to the criminalization of women and pregnant people for having abortions. It is therefore essential to bear in mind that the duty of confidentiality is a right of all users of health services (Article 77, section X of LGS) and is regulated by Official Mexican Standard NOM-004-SSA3-2012, Medical Records. This standard recognizes that users are the holders of the data related to their personal identity and medical condition. Such information is confidential and, under the standard, reinforces and consolidates the ethical principle of professional secrecy.
NOM-004 specifies that health care personnel may disclose such personal data to third parties only upon a written request from the user, their guardian or legal representative, or medical personnel duly authorized by them (Section 5.5.1). It further provides that, in health care facilities, the information contained in a medical record must be handled with discretion and confidentiality by all staff (Section 5.7). This obligation is reinforced by Article 36 of the Law on Professions, which establishes that all professionals are required to maintain confidentiality regarding matters entrusted to them by their clients, except in cases where disclosure is required by applicable law.
The General Law on the Protection of Personal Data Held by Obligated Entities defines sensitive personal data as data relating to a person’s most intimate sphere, or data whose improper use may give rise to discrimination or entail a serious risk to the individual—for example, information concerning racial or ethnic origin, present or future health status, genetic information, and sexual orientation (Article 3, section X). The processing of sensitive personal data requires the express written consent of the data subject (except in the cases set forth in Article 22). In the case of data concerning children and adolescents, the best interests of the child must prevail (Articles 7 and 21).
With respect to abortion, the Technical Guidelines specifically state that any condition suggesting prior abortion-related procedures must be documented in the medical record, which is confidential in nature, and that health care personnel are not obligated to report cases in which they suspect that an induced abortion has occurred, as the applicable regulations protect both service providers and users by safeguarding medical professional secrecy (Technical Guidelines, pp. 46 and 55). Likewise, the new ISSSTE Agreement onLTP provides that both personal data and the information supplied by users in the context of an LTP must be protected and safeguarded under the principle of confidentiality (Article 8, section VI).
It is mandatory to protect users’ information and to guarantee their access to timely health services. The possibility that the confidentiality of such information may be breached can deter individuals from seeking appropriate treatment and medical care—for example, in cases of incomplete abortion or sexual violence—which may in turn compromise their health and well-being (Technical Guidelines, p. 45).
The legal question of whether health care personnel should report a suspected crime or uphold their duty of confidentiality toward the user is resolved by reference to domestic law and international human rights treaties that protect the rights to life, health, personal integrity, and privacy, among others that must be effectively guaranteed.[14]
Such situations have been examined by various international human rights courts. In one such case, the Inter-American Court of Human Rights (I/A Court H. R.) held that all health care personnel must adopt protocols with clear criteria to ensure the confidentiality of the information to which they have access by virtue of their profession. The I/A Court H. R. further stated that access to health services must not be contingent on whether or not users are alleged to have committed a crime, nor used as a means of compelling them to cooperate in criminal proceedings. In these circumstances, health care personnel must refrain from questioning service users for the purpose of obtaining confessions or reporting them to the authorities.[15]
The I/A Court H. R. also established that, in cases of obstetric emergencies, disclosing medical information may restrict access to adequate care; therefore, the duty to maintain professional secrecy must take precedence. In such a case, based on these considerations, the I/A Court H. R. concluded that the complaint filed by the treating physician constituted a violation of the rights to privacy and to health.[16] This ruling underscores the importance of complying with the duty of confidentiality and upholding professional secrecy, as doing so may determine whether a person is able to access the medical care necessary to protect their health.
c. Three stages of safe abortion care
El Lineamiento Técnico establece tres momentos en la atención del aborto seguro, a saber: la consejería, el consentimiento informado y el manejo clínico.
Counseling consists of an exchange of information, analysis, and deliberation aimed at strengthening individuals’ autonomy to make free, informed, and conscious decisions regarding their sexual and reproductive health. It must be centered on the individual circumstances of users and take into account their physical and emotional condition, as well as the context in which they request services, fostering a safe and trusting environment. Counseling comprises four elements: emotional support and empathetic listening; privacy and confidentiality; relevant information about care before, during, and after the procedure; and respect for the person’s decision.
To provide appropriate emotional support through empathetic listening, it is necessary to build positive relationships with users grounded in communication, understanding, and respect. The interview setting must ensure both privacy and visual confidentiality, preventing the conversation from being seen or overheard in order to foster safety and trust. Throughout the entire process—before, during, and after the procedure—it is essential to provide clear and relevant information about the available options and the procedures involved in care (including methods of administration, duration, pain management, expected symptoms, warning signs, and services available in case of emergency) so that users can make free and informed decisions. Finally, whatever decision is made must be respected, ensuring that it has been reached without any form of coercion.
Informed consent is closely linked to counseling and constitutes a process designed to ensure that individuals retain full control over their decisions, recognizing their autonomy and enabling them to assume an active role in exercising their right to health.[17] It is the process by which a health professional communicates to a user the risks, benefits, and alternatives of a specific action, treatment, or service, and it is formalized through a document in which the user voluntarily agrees to undergo a medical procedure. [18]
To that end, as previously established, health care personnel must provide counseling and address any questions before requesting the user’s signature (and must remain available to do so afterward). The information must be presented in a format and setting that facilitate understanding. Users have the right to accept or refuse the procedures proposed by medical personnel.[19]
For consent to be valid and fully informed, it must be given in advance, freely, and voluntarily, i.e., only after the user has received accurate and complete information about all available methods, risks, benefits, and the effectiveness of the proposed procedure, and has made a decision autonomously and without any form of pressure. The user’s signature must not be used as a condition for accessing other services or obtaining benefits, and consent must be free from coercion, threats, misinformation, or discrimination.[20]
If any of these elements is missing, the consent provided—even if documented in writing and signed—will not be considered duly informed. Informed consent is both a right of users and an ethical and legal obligation for health care personnel.[21]
In accordance with the Technical Guidelines, during the first trimester of pregnancy, abortion may be safely self-managed. In the second trimester, the Guidelines recommend that care be provided within a health facility under the supervision of available and trained personnel.
Up to fourteen weeks of gestation, abortion may be performed using medication or by uterine aspiration. After this period, the Technical Guidelines recommend dilation and evacuation in a supervised clinical setting. The Guidelines further state that instrumental uterine curettage is an obsolete method that not only entails greater health risks and complications for the user, but is also more costly for the health system, as it requires a surgical setting and specialized anesthesia management. In this regard, it emphasizes that the use of this method is unjustified and should be avoided.[22]
d. Specific obligations in cases of induced abortion and sexual violence
The provision of abortion care requires specific measures to ensure that it is safe, high- quality, and responsive to the needs of women and pregnant people, taking into account their health status and any circumstances of vulnerability. The following directives must therefore be observed:
- Provide safe, high-quality abortion care
- Adhere to the principles of respect and protection; timeliness; confidentiality, equality, and equity; non discrimination; safety; and respectful and dignified care.
- Comply with counseling requirements.
- Fulfill the requirements of informed consent.
- In the case of girls and adolescents, ensure that counseling in the area of reproductive health identifies their specific needs and addresses potential questions in a friendly, clear, understandable, and impartial manner. Adolescents may be accompanied by their parents, guardians, or legal representatives, or may choose to forgo such accompaniment; this decision must be documented in writing and respected.[23]
- Do not impose disproportionate waiting periods between the request for the service and its provision (Recommendation 6 of the WHO Abortion Care Guideline).
- Perform an abortion when the life of the woman or pregnant person is at risk (Recommendation 2(b)(ii) of the WHO Abortion Care Guideline).
- In cases of inevitable abortion, provide immediate care as an obstetric emergency and do not impose gestational age limits.
- Assess cases in which the physical, mental, or social well-being of users is compromised and act accordingly to prevent the risk from escalating into more serious harm (Amparo in Review 1388/2015).
- Provide users with all necessary information regarding potential health risks so that, in accordance with informed consent, they may decide what level of harm or risk they are willing to assume (Amparo in Review 1388/2015).
- Do not require users to assume disproportionate burdens in relation to potential health risks (Amparo in Review 1388/2015).
- In assessing the risks a pregnancy may entail, recognize that the right to the highest attainable standard of health implies that standards of well-being vary from person to person and are linked to autonomy; accordingly, such standards must be defined by users themselves, as it is they who require the service (Amparo in Review 1388/2015).
In cases of pregnancy resulting from any form of sexual violence, health care personnel in all federal entities are required to guarantee the right to access abortion. In addition to the obligations outlined in the previous section, specific actions must be taken in light of the particular needs of victims, as follows:
- Provide immediate care to girls, women, and other pregnant people, without imposing conditions for admission (LGV and NOM-046, Sections 6.4.2.7 and 6.7.2.9) and without revictimizing them (ISSSTE Agreement on LTP, Article 8, section VII).
- Ensure that medical care includes the promotion and protection of physical and mental health and seeks the fullest possible restoration of health through treatment, rehabilitation, or referral to specialized services (NOM-046, Section 5.2).
- Provide counseling, follow-up, guidance, and accompaniment (NOM-046, Sections 4.5 and 6.4.2.6).
- Guarantee access to care at any time, regardless of gestational age (NOM-046, Section 6.7.2.9; SCJN precedents; and Recommendation 2(b)(ii) of the WHO Abortion Care Guideline).
- Guarantee access to emergency contraception and voluntary termination of pregnancy (LGV, Article 35; NOM-046, Sections 6.4.2.3 and 6.7.2.9).
- Ensure periodic examinations and specialized treatment for as long as necessary to achieve full recovery (LGV, Article 35).
- Ensure follow-up care in cases of possible sexually transmitted infections and human immunodeficiency virus (LGV, Article 35).
- Provide the service without conditioning it on the filing of a criminal complaint or authorization from any authority (including public prosecutor’s office, an ethics committee, or any other body) (Technical Guidelines, p. 24; SCJN precedents; and Recommendations 2(b)(v) and 7 of the WHO Abortion Care Guideline).
- Provide the service without verifying or requiring proof that the pregnancy resulted from sexual violence; it is sufficient to receive a statement made under oath declaring that the pregnancy resulted from this type of violence (NOM 046, Section 6.4.2.7).
- Provide care to girls aged 12 and older without conditioning it on the presence or authorization of a parent or guardian (Recommendation 7 of the WHO Abortion Care Guideline; NOM-046, Section 6.4.2.7; Technical Guidelines, p. 35).[24]
- Inform the victim that she has the right to report the acts of violence and to seek assistance from the Executive Commission for Victim Assistance (CEAV, for its Spanish initials), from state-level victim assistance commissions, and from available support centers (NOM-046, Section 6.6.1). This must be done in full respect of her autonomy and without exerting any pressure to file a complaint.
- Notify the public prosecutor’s office of the existence of rape, sexual violence, and/or sexual abuse, but not of the abortion. It should be clarified that the purpose of this type of notification is to report violence suffered by the user and does not constitute a report of the abortion itself; therefore, it must not condition the provision of care (Technical Guidelines, pp. 24 and 35). This obligation applies throughout the national health system.
- Refrain from implementing mechanisms or internal policies that prevent victims of sexual violence who request it from accessing pregnancy termination (SCJN precedents).
- Provide care in a safe and trusting environment, free from judgment or prejudice, ensuring respect, privacy, and confidentiality (NOM 046, Section 6.2.1.2).
Conscientious Objection and Abortion
Conscientious objection refers to the freedom of individuals to act in accordance with their beliefs, ideas and convictions. It is grounded in the right to freedom of conscience and religion established in Article 24 of the Constitution. Therefore, on an exceptional basis, individuals may refuse to comply with a legal obligation on the grounds of personal, moral, or religious convictions. In the health sector, this manifests as the individual position adopted by health care personnel when they are required to directly perform a specific medical procedure.
The WHO has recommended that states regulate conscientious objection in order to safeguard comprehensive access to abortion services. It emphasizes, however, that conscientious objection must not be invoked in urgent situations or medical emergencies, nor may it be used to deny or delay access to abortion services. According to the WHO, when conscientious objection is not regulated in a manner that respects, protects, and fulfills the rights of those seeking abortion, its exercise cannot be justified. From this perspective, priority must be given to adherence to international clinical best practices and to the protection of those requesting the service; therefore, the exercise of conscientious objection by health care personnel must not constitute an obstacle to access to safe abortion.
In line with this approach, the LGV provides that access to VTP must be guaranteed for victims of sexual violence and other acts affecting their physical or psychological integrity, and that pregnancy termination resulting from sexual violence is to be treated as a medical emergency. In addition, NOM-046 establishes the obligation of public health institutions to ensure the availability of personnel who are willing, trained, and able to provide health services—including abortion—to victims of sexual violence. This standard further specifies that, where an institution is unable at a given time to provide abortion services in a timely and adequate manner or lacks the necessary personnel, it must refer users to another institution capable of providing such care.
In this regard, the SCJN has held that, in order to promote, protect, and restore the health of women and other pregnant people in all its dimensions, abortion must be regarded as a health service. It has further determined that the Mexican state has the obligation to guarantee effective access to this service.
Conscientious objection must not prevent or constitute an obstacle to the exercise of the right to health, including access to abortion services (Amparo in Review 1388/2015).
It should be clarified that conscientious objection is not absolute; it may not be invoked in any circumstance or under any modality.[25] For its regulation and exercise to be valid, it must be subject to certain limits: it must be exercised on an individual basis; it must arise from a genuine conflict of conscience within a constitutional and democratic framework; and it must respect the human rights of others.
Furthermore, the SCJN has established that both public and private health institutions must at all times ensure the availability of personnel who are willing, trained, and able to perform the procedures requested by users, and that they may not simply refer users to another medical unit. This interpretation expands upon the provision set forth in NOM-046. In this regard, Article 23 of the ISSSTE Agreement on LTP provides that the Institute’s medical units must ensure the availability of a sufficient number of non- objecting health care personnel to guarantee the provision of voluntary abortion services.
Conscientious objection must never restrict or violate the human rights of others and therefore may not be invoked by health care personnel to obstruct access to services such as abortion.
In order to protect the rights of women (and other people with the capacity to gestate) recognized in the Constitution and in the country’s health laws—namely, care that is timely, of high quality, and free from discrimination—the Mexican state is obligated to guarantee the following:
- Ensure that sufficient, available, and adequately trained personnel are present at all times to guarantee the right to health.
- Limit the invocation of conscientious objection to personnel directly involved in the procedure, who must invoke their objection within a reasonable timeframe for it to be considered valid.
- Recognize that conscientious objection is not valid when the life of the user is at risk, in cases of medical emergency (such as pregnancy termination resulting from sexual violence), or when it poses a risk to health or may prolong the user’s suffering.
- Ensure that the exercise of conscientious objection does not hinder or delay the provision of services.
- Prohibit the invocation of conscientious objection on discriminatory grounds, such as sexual orientation, race, ethnicity, etc.
Necessary Conditions for the Provision of Safe Abortion
In order for health care personnel to fulfill their obligations regarding abortion, and given that they provide a health service, certain institutional and state-level conditions must be in place to ensure that health care personnel are able to perform their duties appropriately.
For example, personnel who provide care to users in situations of sexual violence must receive ongoing training, periodic updates, and awareness-raising on the subject (NOM-046, Section 6.7.1, and Article 9 of the ISSSTE Agreement on LTP), as well as adequate institutional support to deliver competent care (WHO Abortion Care Guideline, p. 19).
In addition, health care personnel must be able to carry out their responsibilities without suffering discrimination for their ethical and professional decision to provide counseling and safe abortion care (Technical Guidelines, p. 39). It must be ensured that neither authorities nor private actors harass those who provide pregnancy termination services. As established by the Inter-American Commission on Human Rights in its Second Report on the Situation of Human Rights Defenders in the Americas (2011),[26] the state must adopt all necessary measures to prevent health care personnel from being subjected to investigations or judicial proceedings for carrying out this work.
As the WHO has stated in its Guideline, legal provisions that criminalize health professionals for providing these services must be eliminated. In this regard, the SCJN has held in various precedents—and as a result of the decriminalization of abortion at the federal level—that health care personnel have the right not to be prosecuted or sanctioned for performing or assisting in the performance of an abortion. Given that they provide a health service, punishing those who facilitate an abortion with the consent of a woman or pregnant person is unconstitutional (as is sanctioning the woman or pregnant person herself) (Amparo in Review 267/2023). The Court has further established that disqualifying health care personnel from practicing their profession on these grounds has a discriminatory effect on those who provide pregnancy termination services. Thus, the decriminalization of abortion also entails that health care personnel must not be stigmatized, prosecuted, or otherwise criminalized for providing this service.
On 20 April 2026, the SCJN ruled on Contradiction of Criteria 125/2025, concerning the effects of amparo rulings in abortion cases. The Court held that guaranteeing access to abortion services may require institutional measures aimed at removing structural barriers, including actions related to infrastructure, the provision of healthcare services, and the dissemination of information.
Closing Remarks
As members of the health sector, you play a crucial role in reducing the number of unsafe abortions and in ensuring that those who seek these services receive comprehensive, high- quality, and non-discriminatory care. This is essential to guaranteeing the rights to health and reproductive freedom of women and pregnant people.
We hope that, regardless of the federal entity in which you are located, this material clarifies any uncertainties regarding the applicable legal framework and provides practical guidance on how to fulfill your obligations and contribute to the promotion and protection of the reproductive autonomy of women and people with the capacity to gestate. In doing so, you can make a meaningful contribution to ensuring these populations effective access to the health services to which they are entitled, including abortion.
