A letter to the editor from ASPIRE, a regional pro-choice reproductive health non-governmental organization registered in Dominica and five other Caribbean nations, has exposed a striking disconnect between the private beliefs of Dominican health professionals and the public silence of their industry associations regarding abortion law reform. Over four years of national surveys on abortion and abortion policy, and two years of mounting a constitutional challenge to the island’s existing restrictive abortion legislation, ASPIRE reports that not a single major professional health association has released any public statement on the contentious issue. Even the Dominica Bar Association has remained entirely silent on the matter, leaving the advocacy group deeply disappointed by the inaction of the country’s civil society institutions.
Internal survey data collected by ASPIRE tells a far different story than the empty public record. Among responding health professionals, 77% agree that abortion is fundamentally a medical issue that requires active participation from healthcare industry groups in national policy dialogue. An even larger share—84%—support the position that their professional associations should investigate the clear connection between Dominica’s current criminal abortion laws and the prevalence of unsafe, unregulated abortion procedures across the country. Most strikingly, 86% of surveyed health professionals believe that their industry associations carry a formal professional duty to advance equitable access to fair healthcare across the national system.
ASPIRE’s leadership argues that the massive gap between these privately held, widely held views and the complete public silence of organized professional bodies can be traced to two core factors: deep-rooted social taboos surrounding discussions of sex and abortion in Dominica, and an unresolved conflict between evangelical Christian religious beliefs held by association leadership and their formal professional obligations. Over multiple formal requests to host discussions of ASPIRE’s research with members of the medical association, nurses’ association, pharmaceutical association, and social workers’ association, only the Dominica Nurses’ Association has agreed multiple times to open its space to the group’s findings. Crucially, ASPIRE emphasizes that these requests did not demand groups publicly endorse pro-choice positions—they only asked for a space to share peer-reviewed research findings with practicing professionals, a core tenet of scientific engagement.
The organization charges that the conservative evangelical religious views of association leadership have overridden both their professional duties and the expressed interests of rank-and-file members. This conflict, ASPIRE argues, is not just unethical and unprofessional—it poses a direct danger to patient health, as it places the religious dogma of institutional leaders above the right of patients to receive evidence-based healthcare. The group acknowledges that individual health professionals retain the right to personal conscientious objection to providing abortion care, but notes that with more than 80% of surveyed members supporting open dialogue and professional investigation of the issue, individual objection cannot explain the complete institutional shutdown on the topic. Instead, ASPIRE frames the silence as active sabotage of reform by association leadership.
To illustrate the standard of ethical leadership that ASPIRE says is missing in Dominica, the letter points to the precedent set by former U.S. Surgeon General Dr. C. Everett Koop. A devout evangelical Presbyterian with personal anti-abortion beliefs, Koop was asked by President George H.W. Bush to develop an anti-abortion national policy aligned with his personal views. Despite his personal convictions, Koop refused to act without rigorous, independent scientific evidence to support policy changes, even when his refusal cost him his position. In doing so, Koop upheld both his personal faith and his professional obligations, refusing to let personal religion override scientific and professional duty. That model of leadership, ASPIRE argues, is nowhere to be found in Dominica’s current debate.
Closing the letter, ASPIRE condemned the current state of institutional inaction as disgraceful, calling it a misuse of religious faith to suppress scientific progress and equitable access to reproductive healthcare for Dominican women. ASPIRE’s core mission centers on advancing research and open dialogue with civil society and governments across the Caribbean to expand fairness and justice in reproductive health, framing its work as aligned with pro-motherhood and pro-family values alongside support for reproductive choice.