Madrid Court Orders Abortion Objector Registry Amid Spain’s Reproductive Rights Debate
Abortion has once again become a major political and legal issue in Spain, after a court ruling ordered the regional government of Madrid to create a registry of doctors who refuse to perform abortions on moral or religious grounds.
The decision by the High Court of Justice of Madrid directs authorities in the Spanish capital to “immediately” begin compiling a list of healthcare professionals who invoke conscientious objection to avoid participating in abortion procedures.
The ruling follows a legal dispute between the national health ministry and the conservative-led regional administration of Madrid. According to Spanish media outlet El Salto, the lawsuit was filed after the regional government failed to comply with a national law requiring all autonomous communities to create such registries.
Why Spain introduced the registry
Under Spanish law, abortion is legal during the first 14 weeks of pregnancy. However, medical professionals retain the right to refuse involvement in the procedure under what is known as conscientious objection.
In 2023, the Spanish government strengthened legislation on sexual and reproductive health, requiring all regional governments to establish confidential lists of doctors who refuse to perform abortions. The goal was to reduce barriers women face when seeking abortion services.
The registry is not accessible to the public or patients. Instead, it allows hospitals and healthcare centers to plan staffing and ensure that qualified professionals are available to carry out the procedure when requested.
Officials say the measure aims to guarantee equal access to abortion services across all regions of Spain.
Madrid’s political resistance
However, the initiative has faced resistance in some regions, particularly Madrid.
The president of the Community of Madrid, Isabel Díaz Ayuso, previously criticized the plan, arguing it could create what she described as a “blacklist of doctors.”
She also suggested that women seeking abortions could travel to other locations if necessary — comments that sparked criticism from reproductive rights advocates and opposition politicians.
While three regions initially failed to implement the registry — Aragón, the Balearic Islands, and Madrid — the first two have since agreed to comply with the national law. Madrid remains the only region that has refused, leading to the court case.
Private clinics perform most abortions
Despite abortion being legal nationwide, access remains uneven. The total number of doctors who invoke conscientious objection in Spain is not publicly known.
However, data suggests that more than 80 percent of abortions are performed in private clinics rather than public hospitals. In Madrid, that number rises to approximately 99 percent.
Health experts say the high reliance on private facilities is partly linked to the large number of doctors who decline to perform the procedure in public healthcare settings.
A broader European issue
Spain is not alone in facing challenges related to conscientious objection.
Across Europe, many countries allow healthcare workers to refuse involvement in abortions for moral or religious reasons. Only a few countries — including Sweden, Finland, and Bulgaria — do not permit such exemptions.
In Italy, for example, up to 90 percent of doctors in some regions refuse to perform abortions, making access extremely difficult for women in certain areas.
Similarly, reports suggest that more than half of doctors in Croatia invoke conscientious objection.
Combined with strict abortion bans in countries such as Malta and Poland, these practices continue to shape access to reproductive healthcare across the European continent.
Recently, more than 1.2 million European citizens called on the European Commission to support women who cannot access abortion services in their own countries. In response, the commission said member states could use funds from the European Social Fund Plus to help provide abortion services for those not covered by national healthcare systems.
The debate over conscientious objection and reproductive rights is likely to remain a contentious issue in Spain and across Europe in the coming years.