title: Development of a Conceptual Model and Survey Instrument to Measure Conscientious Objection to Abortion Provision.
abstract: OBJECTIVE
  Conscientious objection to abortion, clinicians' refusal to perform legal abortions because of their religious or moral beliefs, has been the subject of increasing debate among bioethicists, policymakers, and public health advocates in recent years. Conscientious objection policies are intended to balance reproductive rights and clinicians' beliefs. However, in practice, clinician objection can act as a barrier to abortion access-impinging on reproductive rights, and increasing unsafe abortion and related morbidity and mortality. There is little information about conscientious objection from a medical or public health perspective. A quantitative instrument is needed to assess prevalence of conscientious objection and to provide insight on its practice. This paper describes the development of a survey instrument to measure conscientious objection to abortion provision.
  
  
  METHODS
  A literature review, and in-depth formative interviews with stakeholders in Colombia were used to develop a conceptual model of conscientious objection. This model led to the development of a survey, which was piloted, and then administered, in Ghana.
  
  
  RESULTS
  The model posits three domains of conscientious objection that form the basis for the survey instrument: 1) beliefs about abortion and conscientious objection; 2) actions related to conscientious objection and abortion; and 3) self-identification as a conscientious objector.
  
  
  CONCLUSIONS
  The instrument is intended to be used to assess prevalence among clinicians trained to provide abortions, and to gain insight on how conscientious objection is practiced in a variety of settings. Its results can inform more effective and appropriate strategies to regulate conscientious objection.
authors.affiliation: UC Berkeley-UCSF Joint Medical Program, School of Public Health, Berkeley, CA, United States of America.
authors.forename: Laura Florence
authors.initials: LF
authors.lastname: Harris
authors.affiliation: Global Doctors for Choice/Ghana, Bolgatanga, Upper East Region, Ghana.
authors.forename: John Koku
authors.initials: JK
authors.lastname: Awoonor-Williams
authors.affiliation: Ibis Reproductive Health, Oakland, CA, United States of America.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Gerdts
authors.affiliation: Global Doctors for Choice/Colombia, Bogota, Colombia.
authors.forename: Laura
authors.initials: L
authors.lastname: Gil Urbano
authors.affiliation: Global Doctors for Choice/Colombia, Bogota, Colombia.
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: González Vélez
authors.affiliation: UC Berkeley-UCSF Joint Medical Program, School of Public Health, Berkeley, CA, United States of America.
authors.forename: Jodi
authors.initials: J
authors.lastname: Halpern
authors.affiliation: UC Berkeley-UCSF Joint Medical Program, School of Public Health, Berkeley, CA, United States of America.|Bixby Center for Population Health and Sustainability, School of Public Health, University of California, Berkeley, CA, United States of America.
authors.forename: Ndola
authors.initials: N
authors.lastname: Prata
authors.affiliation: Global Doctors for Choice/Ghana, Bolgatanga, Upper East Region, Ghana.
authors.forename: Peter
authors.initials: P
authors.lastname: Baffoe
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D001291:Attitude of Health Personnel; D003105:Colombia; D003242:Conscience; D005869:Ghana; D006801:Humans; D008962:Models, Theoretical; D010820:Physicians / Q000523:psychology*; D016079:Refusal to Treat / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires