“Am I Going to Be in Trouble for What I'm Doing?”: Providing Contraceptive Care in Religious Health Care Systems

Abstract

CONTEXT: Catholic systems control a growing share of health care in the United States. Because patients seeking contraceptives in Catholic facilities face doctrinal restrictions that may affect access to and quality of care, it is important to understand whether and how providers work within and around institutional policies regarding contraception. METHODS:In 2016-2018, in-depth interviews were conducted in Illinois with 28 key informants-including providers (obstetrician-gynecologists, other physicians, nurse-midwives) and nonclinical professionals (ethicists, administrators, chaplains)-who had experience in secular, Protestant or Catholic health care systems. Interviews addressed multiple aspects of reproductive care and hospital and system policy. A thematic content approach was used to identify themes related to participants' experiences with and perspectives on contraceptive care. RESULTS: While respondents working in secular and Protestant systems reported few limitations on contraceptive care, those working in Catholic systems reported multiple barriers. Providers who had worked in Catholic systems described variable institutional policies and enforcement practices, ranging from verbal admonishments to lease agreements prohibiting contraceptive provision in secular clinics on church-owned land. Despite these restrictions, patients'needs motivated many providers to utilize work-arounds; some providers reported having been pressured or directly instructed to document false diagnoses in patients' medical records. Interviewees described how these obstacles burdened patients, especially those with social and financial constraints, and resulted in delayed or lower quality care. CONCLUSIONS: Providers working in Catholic hospitals are limited in their ability to serve women of reproductive age. Work-arounds intended to circumvent restrictions may inadvertently stigmatize contraception and negatively affect patient care.

Prevalence and experiences of Wisconsin women turned away from Catholic settings without receiving reproductive care

“…Using a random sample of Wisconsin reproductive-aged women, we found that 2% of respondents had ever been turned away from a Catholic hospital or clinic, with this proportion increasing to 8.1%, or one-in-twelve respondents, in rural counties served by Catholic sole community hospitals. The relatively low prevalence of being turned away in the total sample might reflect providers' use of workarounds [2,3] or patients' ability to access services elsewhere. However, the fact that the figure is significantly higher in rural areas with high Catholic healthcare system concentration suggests that patients residing in such areas may be at a distinct disadvantage in accessing the full range of reproductive care.…”

“…Further, in some rural areas, a Catholic hospital is the sole community hospital, a federal designation indicating the next-nearest hospital is too distant for community members to access [1]. Care delivery and referrals vary across providers and institutions [2][3][4][5], and many systems lack transparency about Catholic status and restrictions [4,6].…”

How Can the Experiences of Black Women Living With HIV Inform Equitable and Respectful Reproductive Health Care Delivery?

“…3,4 More specifically, a variety of cultural and historical factors, such as religious and moral belief systems and political ideologies, can manifest in health care systems' policies and patient treatment for reproductive health. 5,6 Thus, individual reproductive decision-making power is subject to external social influences, including health care practitioner biases.…”

Expectations about availability of contraception and abortion at a hypothetical Catholic hospital: Rural-urban disparities among Wisconsin women

“…Although most women want to know about service restrictions [9] , this information is often not clear to patients [10] . If patients expect contraceptive and abortion care at Catholic hospitals, they may present there only to be turned away and may experience subsequent delays and potential harm [11][12][13][14][15] . Catholic restrictions have led to delays in patients obtaining services [15] , which may directly result in unintended pregnancy [16] .…”

“…If patients expect contraceptive and abortion care at Catholic hospitals, they may present there only to be turned away and may experience subsequent delays and potential harm [11][12][13][14][15] . Catholic restrictions have led to delays in patients obtaining services [15] , which may directly result in unintended pregnancy [16] . For patients seeking to end their pregnancies, long wait times may render services completely inaccessible.…”