Sparked by the U.S. Supreme Court’s 1973 decisions in Roe v. Wade and Doe v. Bolton that legalized abortion nationwide, federal and state governments have enacted laws that allow health care professionals and institutions to refuse to provide services related to reproductive health without facing legal, financial or professional consequences.

A patchwork of federal laws explicitly allows many health care professionals and institutions to refuse to provide care related to abortion and sterilization services. Collectively, these laws prevent government agencies from forcing the provision of services or “discriminating” against individuals and institutions that refuse to provide them; they also prevent institutions receiving certain federal funds from taking action against health care personnel because of their participation or nonparticipation in beliefs about abortion or sterilization. Separate federal laws and regulations, notably Title VII of the Civil Rights Act, prohibit employers from discriminating against personnel based on religion, including religiously based objections to performing specific job functions; an employer must reasonably accommodate an employee’s religious practices unless doing so would impose an undue hardship on the employer.

Almost every state has adopted similar policies related to abortion, and, in many instances, policies regarding sterilization or other contraceptive services; while some of the institutional policies are limited to private or religious health care institutions, others apply to all institutions providing health care. In addition to the rights granted by these specific policies, an individual health care professional’s actions may be legally protected by state statutes, similar to the federal Title VII law, prohibiting discrimination against employees based on their religious objections.  

In large part because of the introduction in the United States of emergency contraception in the late 1990s, the issue of religious and moral objections to providing care has expanded beyond doctors, nurses and hospitals to include pharmacists and pharmacies. Since that time, a few states have enacted laws that specifically allow pharmacists or pharmacies to refuse to provide health care because of religious or moral objections. Several other states have broadly worded refusal clause statutes that also might apply in these circumstances. In addition, many states that have policies requiring insurance plans to cover contraception if they cover other prescription drugs have included exemptions to those requirements for certain religious employers or insurers. (See Emergency Contraception and Insurance Coverage of Contraceptives for more details.)