The 1996 Choice on Termination of Pregnancy Act of South Africa is hailed as one of the most exemplary liberal laws on abortion. However, one of the key challenges to the efficacy of the law is the refusal to perform or provide abortion care based on conscience grounds. The Act does not directly address conscientious objection. The consequences of such a gap serves as an obstacle to the efficacy of a liberal abortion law in practice. Where there are no clear laws or guidelines, the environment is conducive to health care providers acting within their ‘own’ interpretation of the law. The chapter examines the legal and ethical scope of conscientious objection in South Africa, especially as it relates to the essential conditions required to safeguard respect for women’s reproductive autonomy and human dignity when they seek abortion services.