The Reality of Abortion in Spain and the Messages Circling It

Author: Erina Bazán López

August 28, 2026

HRRC holds that abortion is a fundamental human right and condemns the Community of Madrid's administrative obstruction of access. We advocate for robust public gynaecological services. We urge the Community of Madrid to support the right to abortion in its commitment to dignity and equitable care for all women who reside in the region.

Protest at the Asamblea de Madrid in 2012 [Image credit: Alex Luhrman/Flickr]

On March 9, 2026, the High Court of Justice of Madrid (TSJM) issued a decisive ruling ordering the regional government of Madrid to immediately initiate the administrative procedures to establish a registry of healthcare conscientious objectors to abortion. This decision came after a prolonged administrative standoff between the national Ministry of Health and the regional executive. The national reform of the abortion law, in force since 2023, requires every autonomous community in Spain to maintain a confidential register of healthcare professionals who decline to participate in voluntary pregnancy terminations. The objective of this tool is strictly organizational: to map the availability of willing staff in each public hospital and prevent instances where a 100% objection rate in a single facility leaves women entirely unable to access care in the public sector.

To coordinate this transition uniformly, the State's Interterritorial Health Council (Consejo Interterritorial del SNS) approved a State-wide protocol on December 16, 2024, setting the minimum criteria for implementing these regional registries. Crucially, this agreement was reached by total consensus, with the participation and affirmative vote of all autonomous communities, including the representative of the Community of Madrid.

However, as the months progressed, several right-wing regional governments failed to translate their signatures into operational registries. On October 14, 2025, the Ministry of Health, led by Mónica García, issued a formal warning to the autonomous communities of Asturias, Aragón, Illes Balears, and Madrid, demanding compliance within one month. When the deadline elapsed with no action from the capital, the Ministry initiated a process of litigation against Madrid on January 16, 2026.

Meanwhile, other autonomous communities continue to delay progress: Andalucía has kept its own registration process stuck in bureaucratic consultations since March 2025, and Castilla y León remains in a state of perpetual drafting, leaving gynaecological services in those territories in administrative stasis.

The ideological debate surrounding Spain's reproductive health policy has given rise to highly polarized claims, many of which diverge significantly from the material reality of the healthcare system.

Regional President Isabel Díaz Ayuso has repeatedly asserted that the registry is a "black list" designed to target, signal, and stigmatize doctors who exercise their right to conscientious objection. She argues that such registries violate fundamental constitutional rights, including freedom of conscience, religion, and privacy. But the TSJM explicitly rejected this framing, noting that a structured, confidential registry actually enhances the protection of physicians' rights. Under the current, uncoordinated system operated by the Community of Madrid, public hospital gynaecologists are forced to publicly declare their objection on each and every occasion they are requested to perform an intervention. The court established that a single, unified registry allows physicians to state their objection once, avoiding repetitive, public disclosures. Furthermore, access to the registry is restricted solely to health service planners and is never made public.

The regional Ministry of Health (Consejería de Sanidad) and regional spokespeople assert that abortion services are "fully guaranteed" within their territory, arguing that women face zero obstacles because the public system possesses "self-organizing capacity" to successfully manage care. Regional Health Counselor Fátima Matute even boasted in the regional Assembly that Madrid performing "one of every five abortions in Spain" is proof of excellent coverage. However, public gynaecological care is practically non-existent. In 2024, out of 18,149 abortions registered to women residing in Madrid, a staggering 99.53% were performed in private clinics. In 2025, out of 18,221 total abortions, only 92 occurred in public hospitals. Over the years 2023 and 2024, the Madrid government paid private clinics 8.77 million euros to perform 41,453 abortions, while only 134 were handled in public hospitals. The regional government admitted this systemic failure in writing on August 13, 2026, in a public tender for El Escorial Hospital, acknowledging that "in some public hospitals" the termination of pregnancy "cannot be assured, among other reasons, due to the exercise of the right to conscientious objection by healthcare personnel".

In July 2026, the regional Assembly approved the "Ley del concebido no nacido" (Unborn Child Law), allowing families to count a fetus as a family member for tax benefits and social aid. Ayuso defended the law under the banner of "defending life" under Article 15 of the Constitution, stating that "every life matters from the first breath". However, due to the presence of similar laws and concepts in extreme right-wing frameworks, feminist networks and legal analysts criticize the law as a wink to the far right by conceptually equating a fetus with born citizens to gradually desensitize the public and erode reproductive rights. The Spanish Constitutional Court has repeatedly established that the holder of the fundamental right to life under Article 15 of the Constitution is exclusively the person who has been born. While an unborn fetus (nasciturus) is an object of legal protection, it is not a holder of fundamental rights, and attempts to expand its legal status create a direct normative conflict with women's rights.

The disheartening statistics of access to abortion in the public health system that were finally publicized, coupled with the authority’ refusal to utilize the tools given to it by the nation’s laws, raise serious concerns about the Community of Madrid’s will to protect said right. It appears that these latest steps mirror steps in other places that led to a limiting or erasing of the right to abortion. This reflects an even worse light on the regional authority when its leader is posturing herself with statements like “Pues váyanse a otro lado a abortar” (Well, go somewhere else to get an abortion) when being questioned about her government dragging its feet in compiling the legally mandated registry passed by law to ensure the right to abortion to its constituents. 

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Glossary

• Affirmative - relating to a statement that shows agreement or says "yes"

• Autonomous community - territorial entities endowed with their own organization, a set of powers that represent the scope of their autonomy, and financial autonomy to exercise it.

• Bureaucratic - involving complicated rules and processes that make something slow and difficult.

• Compliance - the act of obeying a law or rule, especially one that controls a particular industry or type of work.

• Consensus - a generally accepted opinion or decision among a group of people.

• Conscientious objection - refusing to obey a particular order or rule or to do a particular type of work for moral or religious reasons.

• Consejería de Sanidad - has powers in the proposal, development, coordination and control of the execution of the policies of the Government of the Community of Madrid in the following matters: health insurance, health management and care, mental health, pharmaceutical care, health training and research, public health, food safety and drug addiction.

• Consejo Interterritorial del SNS -  the body for cooperation and communication between the health services of the autonomous communities and with the central government, ensuring the cohesion of the system and guaranteeing citizens' rights throughout the country. 

• Constituent - a voter (= person who can vote) in a particular area of the country

• Desensitize - to cause someone to experience something, usually an emotion or a pain, less strongly than before

• Fetus - a human being or animal as it is developing in the uterus before birth, after the organs have started to form

• Gynaecological - relating to gynaecology (= the area of medicine concerned with disorders and functions of women's reproductive organs)

• Intervention - involvement in a difficult situation in order to improve it or prevent it from getting worse, or an occasion when this is done

• Litigation - the process of taking a case to a court of law so that a judgment can be made.

• Nasciturus - refers to an unborn child, specifically one that has been conceived but has not yet been born. In legal contexts, this term is used to acknowledge the potential legal rights or interests of an individual who has not yet entered the world.

• Normative - relating to rules, or making people obey rules, especially rules of behaviour

• Perpetual - continuing for ever in the same way

• Stigmatize - to treat someone or something unfairly by disapproving of him, her, or it

• Termination - the act of ending something or the end of something.

• TSJM (Tribunal Superior de Justicia de Madrid) - the highest judicial body within the territorial scope of the autonomous community.