The right to abortion is not guaranteed in all public hospitals in the Community of Madrid. This is the main conclusion drawn from a tender by the El Escorial University Hospital to contract private external health centers to perform abortions on patients referred by the Madrid public health system. According to the contract of the Madrid Health Service (Sermas) with private centers, accessed by EL PAÍS, “in some public hospitals” in the region “it cannot be ensured” that voluntary terminations of pregnancy will be performed “among other reasons, due to the exercise of the right to conscientious objection by healthcare personnel,” states the document. The figures speak for themselves: in 2024 [the latest available figures], 18,149 voluntary terminations of pregnancy were performed in the Community of Madrid, according to the latest data provided by the Ministry of Health. Of these, 99.53% had to be performed in private centers, showing the residual role of public healthcare in this service.
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This aligns with the responses given by Isabel Díaz Ayuso’s government in recent months. On October 9, 2025, in the Madrid Assembly, the president rejected creating what she called a “blacklist” of objecting doctors and stated: “No one will be singled out for having an abortion, but neither for not having one. And no doctor will be singled out for performing an abortion or for not wanting to perform one.” In that same speech, directed at the parliamentary left, she added: “Does that seem little to you? Then go somewhere else to have an abortion.”
The acknowledgment by Sermas that some public hospitals cannot guarantee the practice of abortions also reopens the conflict over the registry of conscientious objectors provided for in the state law. As EL PAÍS reported, Ayuso’s government has paused its implementation while continuing to litigate against the Ministry of Health over this obligation. The Community refuses to create what it calls a “list of objectors,” but the central government maintains that the registry must serve to guarantee effective access to voluntary termination of pregnancy in public healthcare.
For its part, the Ministry of Health has assured this newspaper that “this service can be provided in any public hospital in the Community of Madrid. Just as Sermas guarantees the service, it also guarantees the absolute freedom and right of the doctor to object.”
The El Escorial file is not the first. On July 23, the Infanta Cristina University Hospital published a similar framework agreement on the contracting profile and in the BOCM to accredit clinics that would take on voluntary terminations of pregnancy referred from that center. But the procedure came to nothing: the file on the Community of Madrid’s Contracting Portal now appears as canceled and notes that on July 31 the withdrawal of the awarding procedure was published before it was resolved.
For Socialist deputy Lorena Morales, both cases highlight the absence of a common strategy by the Community of Madrid to organize this service. The parliamentarian argues that the Ministry of Health should tender a single framework agreement for the entire region rather than each hospital promoting its own contracts with private centers. “Ayuso’s obsession with ending women’s freedom to decide about their own bodies is turning the right to abortion into a Persian market in the Community of Madrid,” she says.
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For her part, Marta Carmona, Más Madrid deputy and Health spokesperson in the Assembly, demands explanations about the status of the registry of objectors provided for in the law and maintains that the Community still does not use the tools it has to organize this service within public healthcare. The parliamentarian accuses the regional government of resorting to conscientious objection to justify referring voluntary terminations of pregnancy to private centers.
The contract allowing clinics and external health centers to perform voluntary terminations of pregnancy on patients from the El Escorial University Hospital is a framework agreement, a public contracting formula that allows pre-selecting companies or centers that can provide a service during a set period and under conditions established by the Administration. In this case, the file was published on August 13, 2026, and the deadline for submitting offers ends on September 15.
It is promoted by the Madrid Health Service, the Community of Madrid body responsible for managing public healthcare in the region. Its objective is to accredit companies and health centers that will provide the voluntary termination of pregnancy service and set the conditions of contracts derived from that agreement for healthcare provided by the El Escorial University Hospital “in a subsidiary mode with respect to its own resources.” In practice, Madrid’s public healthcare seeks a network of external centers to which women can be referred when the hospital does not directly provide that service with its own means, which happens almost always.
The report first states that voluntary termination of pregnancy must be performed “as soon as possible,” both to comply with legal deadlines and to minimize risks. It then states that the Madrid Health Service cannot assume all the procedures included in the service portfolio. And, next, it introduces the central phrase of the file: “However, in some public hospitals in the Community of Madrid, its performance cannot be ensured, among other reasons, due to the exercise of the right to conscientious objection by healthcare personnel.”
The agreement covers both abortions at the woman’s request up to week 14 and those motivated by medical reasons in later pregnancies. “It is necessary to resort to contracting accredited external centers to guarantee effective access to VTP for all women entitled to public healthcare in the Community of Madrid.” The report adds that, “given the current impossibility of fully assuming these procedures,” it is proposed to contract the provision of this public service with private entities experienced in performing voluntary terminations of pregnancy.
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