Her Body, Their Conscience: Conscientious Objection and the Dangerous Reality of Abortion Access

There is a particular cruelty in telling a woman that she has a legal right to end her pregnancy while maintaining a healthcare system in which another person's conscience may stand between her and the exercise of that right. In Wales, that contradiction is no longer merely theoretical. As Laura Butler and Kate Morgan have reported, as seen on BBC, women are travelling from Wales to London to obtain surgical abortions because of inadequate provision at home, with clinicians raising concerns about the consequences of limited access. The existence of a statutory right to conscientious objection is therefore colliding with a much more fundamental question: what happens when the exercise of one person's conscience prevents another person from obtaining time-sensitive medical care?

For feminists, the answer cannot be to dismiss conscientious objection altogether. Healthcare professionals are entitled to moral convictions, and the law has long recognised that there are circumstances in which an individual should not be compelled personally to participate in a procedure to which they have a genuine conscientious objection. But the protection of the professional's conscience cannot become an unspoken qualification upon the woman's autonomy. The objection belongs to the clinician; the responsibility for ensuring access belongs to the healthcare system. What for the Jehovah's Witness doctor who refuses to perform blood transfusions? The Muslim doctor who denies a xenotransplantation (pig heart transplant in a human)? The Christian doctor declining to treat a homosexual patient? A doctor of any background or religion, who feels they cannot save the life of a patient, whom they know to be a murderer? These are situations in which the majority of us will be in agreement: it would be wrong for any doctor to refuse these, for this is the job they took on and the oath they took.

The distinction becomes particularly important because abortion is not ordinary healthcare in its relationship with time. A woman cannot postpone pregnancy while a health board searches for a clinician who is willing to provide an abortion. Delay has consequences. Gestational age advances, treatment options can change, travel can become necessary, and the physical and psychological burden upon the woman can increase. The legal framework in England and Wales generally permits abortion up to 23 weeks and six days, with abortions beyond 24 weeks permitted only in specified circumstances. A system that delays access therefore risks creating the very legal problem it subsequently uses to deny treatment: the woman who could have obtained a lawful abortion at an earlier stage may eventually find herself outside the ordinary legal limit.

That is not a hypothetical concern. It is one of the most disturbing consequences of abortion restrictions around the world, and there are cases in which the consequences of delayed or denied care have been catastrophic.

Izabela: when the law makes doctors wait

A similar tragedy occurred in Poland almost a decade later. Izabela Sajbor, known publicly as Izabela, was 30 years old and approximately 22 weeks pregnant when she was admitted to a hospital in Pszczyna in 2021 after her waters broke. Her foetus had a fatal abnormality, and her family alleged that doctors waited for the foetus to die rather than terminating the pregnancy. She subsequently developed septic shock and died.

The case became a national scandal in Poland and contributed to widespread protests against the country's increasingly restrictive abortion regime. In March 2026, an appellate court upheld and increased prison sentences imposed upon three doctors in connection with her death.

Again, precision matters. It would be wrong to suggest that the restrictive abortion law was the only factor in Sajbor's death; questions of medical negligence and clinical decision-making were also central to the criminal proceedings. But the legal environment plainly mattered. Doctors were operating within a system in which abortion had become extraordinarily restricted and in which the prospect of legal consequences could affect clinical decision-making.

This is the danger of abortion law when it is constructed around fear. The law may say that abortion is permissible where a woman's life or health is at risk, but if doctors are uncertain about when that threshold has been reached, the woman may be left waiting until the distinction between prevention and emergency treatment has collapsed.

A law intended to protect life can therefore produce the opposite result when it causes doctors to hesitate until the patient's condition becomes critical.

The woman who had to leave her country

Not every consequence of abortion denial ends in death. Sometimes the woman survives, but only after being forced to leave her country, pay privately and endure the psychological and practical consequences of being denied treatment at home.

This was the experience of the woman identified as M.L. v Poland before the European Court of Human Rights. M.L. was pregnant in 2020, and at approximately fourteen weeks the foetus was diagnosed with trisomy 21. She had a legal abortion scheduled at a Warsaw hospital, but following the Polish Constitutional Court's judgment removing foetal abnormality as a lawful ground for abortion, her appointment was cancelled. She ultimately travelled to the Netherlands, where she obtained the abortion privately the following day.

The European Court of Human Rights subsequently found that Poland had violated her Article 8 rights. The Court noted that she had been forced to travel abroad at considerable expense and away from her family support network, and that the interference had created a situation lacking proper safeguards against arbitrariness.

That case is particularly relevant to Wales because it exposes the fallacy in treating travel as an adequate substitute for local provision.

It is technically possible to say that M.L. ultimately obtained an abortion. It is also technically possible to say that a Welsh woman who travels to London ultimately obtains one. But that description deliberately removes the human reality from the equation.

M.L. had to leave her country because the healthcare system in which she was entitled to receive treatment would no longer provide it. Welsh women travelling to England may face a less extreme version of the same phenomenon: their legal entitlement exists, but the practical availability of care depends upon their ability to cross a border.

The European Court's judgment is instructive because it recognised that the problem was not solved merely because an alternative provider existed somewhere else. The forced journey, expense and separation from her support network were themselves relevant to the interference with her rights.

And then there is the legal danger

There is another consequence which deserves considerably more attention in Britain: when women cannot obtain abortions through the healthcare system, some may ultimately find themselves outside the legal framework altogether. Nicola Packer was prescribed mifepristone and misoprostol during the Covid-19 lockdown following a remote consultation under the temporary "pills by post" arrangements. She took the medication in November 2020 but was subsequently found to have been approximately 26 weeks pregnant. She was prosecuted under section 58 of the Offences Against the Person Act 1861 and accused of unlawfully administering medication to herself with intent to procure a miscarriage. In May 2025, a jury found her not guilty.

The circumstances were extraordinary and the facts of the case should not be distorted. Packer was not simply a woman who had been refused an abortion by a Welsh clinician and subsequently took medication. The prosecution concerned her taking abortion medication far beyond the gestational limit for home use, and the jury ultimately accepted her defence. Her case therefore cannot properly be presented as proof that conscientious objection directly caused an illegal abortion. When abortion falls outside the ordinary legal framework, the woman can move from being a patient to being a potential criminal suspect.Packer was arrested after attending hospital. She had experienced an extraordinarily traumatic event and subsequently found herself at the centre of a criminal investigation. Her acquittal does not erase what happened to her. Reporting of the case described her as being left "utterly traumatised" by the ordeal, while evidence indicated that she had initially been afraid to tell hospital staff that she had taken abortion medication because she feared what might happen as a result.

That fear is itself revealing. A woman seeking emergency medical care should not have to calculate whether telling her doctor the truth might result in police involvement. Yet that is precisely the danger created by retaining criminal offences around abortion.

The law does not merely determine whether a woman can obtain healthcare. It can determine whether, when something goes wrong, she feels safe enough to disclose what she has done.

What happens when the clock runs out?

This is why the question of access cannot be separated from the question of criminalisation.

Suppose a woman seeks an abortion at an early stage. She encounters delay. She is referred elsewhere. She waits for an appointment. She discovers that the local provider does not perform the procedure she requires. She is unable to travel immediately because she has children, no money, no transport or an abusive partner controlling her movements. By the time she reaches a provider, her gestation has advanced. The woman has not suddenly changed her mind. The system has changed the legal consequences of her decision.

At an earlier gestation, the same decision might have resulted in lawful medical treatment. At a later gestation, she may face a much narrower legal framework. If she is beyond the ordinary limit and does not fall within one of the statutory exceptions, the law can transform her from a woman seeking healthcare into someone potentially exposed to criminal investigation if she attempts to end the pregnancy herself. This is not an argument for suggesting that women routinely respond to delays by attempting illegal abortions. Nor should individual cases be stripped of their particular circumstances. It is an argument about risk. If the state creates barriers to lawful healthcare, it should not be surprised when some women are pushed towards less safe, less regulated or legally precarious alternatives. History has already demonstrated this.

The medical consequences of delay

The physical risks also deserve greater attention. Abortion is generally an extremely safe medical procedure, particularly when performed early and through established healthcare services. The danger lies not simply in the procedure itself but in what happens when access is delayed or when women are forced to navigate healthcare without adequate support.

The later an abortion occurs, the more complex the clinical circumstances can become. More importantly, delaying care can leave women continuing pregnancies that they have already decided they cannot or do not wish to continue. For some women, that means continuing a pregnancy with serious medical implications; for others, it means enduring worsening mental health, domestic abuse, financial instability or other circumstances that formed part of their original decision. The point is not that every delayed abortion produces a medical catastrophe. It is that the state should not design a system in which catastrophe becomes the price of waiting.

Conscientious objection and the burden placed on women

This returns us to conscientious objection. The right protected by section 4 of the Abortion Act is personal. It is designed to prevent an individual from being compelled to participate in treatment against their conscience. It should not become a mechanism through which the healthcare system itself becomes unable to provide that treatment.

The woman should not be expected to carry the consequences of somebody else's objection. If a doctor objects, another doctor should be immediately available. If a hospital has a high proportion of objectors, the health board should ensure adequate alternative provision. If Wales does not have sufficient providers, the answer cannot simply be that Welsh women can travel to England. And if a woman is delayed until she reaches a point at which the ordinary legal framework no longer permits the abortion she originally sought, the state cannot wash its hands of the consequences by saying that the legal limit has now been reached.The moral burden of conscientious objection must fall upon the system capable of accommodating it.

It should never fall upon the woman whose pregnancy is advancing, whose healthcare is being neglected, while everybody else debates their personal principles.

The feminist question is ultimately one of power

Abortion law has always been about more than abortion. It is about who is permitted to make decisions about women's reproductive capacity.

For centuries, women were told that pregnancy was their biological destiny and that the consequences of reproduction were simply something they had to endure. The development of modern reproductive rights represented a rejection of that premise. Women were entitled to determine whether and when they would have children because without that capacity, formal equality between men and women was always going to be incomplete. That is why it is insufficient to ask whether abortion is "legal". The better question is: who has the power to make the right real?

If the answer is the doctor, the hospital, the health board, the availability of a clinic, the woman's ability to pay for travel, or ultimately the gestational clock, then the woman's autonomy remains conditional. The cases of Izabela Sajbor demonstrate the potentially lethal consequences of delay and legal uncertainty. M.L. demonstrates the psychological and financial consequences of forcing a woman to leave her country to obtain healthcare that she had already been entitled to receive. Nicola Packer demonstrates the frightening legal consequences that can arise when a woman ends up outside the ordinary legal framework and finds herself treated not as a patient but as a potential offender.mThese women are not interchangeable symbols. Their circumstances were different, their legal systems were different and the failures involved were different. But together they demonstrate something that should be impossible to ignore: when abortion access fails, the consequences do not fall upon the abstract concept of "the healthcare system". They fall upon women.

Sometimes the consequence is inconvenience. Sometimes it is debt, travel and isolation. Sometimes it is a later and more complicated procedure. Sometimes it is profound psychological trauma. Sometimes, as the cases of Savita and Izabela demonstrate, the consequences can be fatal. And sometimes there is a further indignity: a woman who was unable to obtain the healthcare she needed may find herself exposed to the criminal law for attempting to resolve the situation herself.

That is why Wales should not be discussing conscientious objection as though it were simply a question of protecting doctors' beliefs. The question is what price women are being asked to pay for those beliefs. A doctor may have a conscience. A woman has one too. The difference is that the doctor can exercise theirs by stepping away from the pregnancy; the woman cannot. The state therefore has a responsibility to ensure that conscientious objection remains exactly that: an individual's refusal to participate, not an institution's refusal to provide. Otherwise, the right to abortion becomes a peculiar legal fiction. It exists in statute, but its exercise depends upon geography, resources, gestation and the willingness of another person to participate. And when those conditions fail, it is not the doctor who carries the pregnancy. It is not the health board that gives birth, it is not the state that assumes the physical, psychological and financial consequences. It is the woman.

That is why abortion access is not merely a question of healthcare provision. It is a question of women's liberty, equality and bodily autonomy. And when a healthcare system allows another person's conscience to determine whether a woman can exercise those rights, the question feminists should be asking is not whether the doctor's conscience has been protected.

It is whether the woman's has.