What you don't know can hurt you: Patient and provider perspectives on postpartum contraceptive care in Illinois Catholic Hospitals

Wong, Zarina Jaffer; Thompson, Lee; Boulware, Angel; Chen, Jessica; Freedman, Lori; Stulberg, Debra; Hasselbacher, Lee

doi:10.1016/j.contraception.2021.10.004

Cited by 6 publications

(13 citation statements)

References 32 publications

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“…In a prior analysis, we described the consequences of Catholic hospital policies for postpartum patients, with a focus on how restrictions impeded access to contraceptive counselling and care. 14 Here, we report on themes that describe missed opportunities to ensure patients receive desired care and suggestions for novel approaches to prevent harmful consequences of denied care. In reporting our findings, we followed the Standards for Reporting Qualitative Research.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 27 we contacted who did not complete interviews, 17 did not respond despite three attempts, six declined and four were ineligible because they did not work with pregnant patients or in a Catholic hospital. 14 The influence of respondents' individual backgrounds was beyond the scope of the study, so we collected little information on religious practices or upbringing. Personal religious affiliations are provided solely to describe the sample characteristics.…”

Section: Recruitmentmentioning

confidence: 99%

“…14 In some settings where even counselling about contraception is prohibited, patients may not be aware that they could seek out these options at a later time. 14 In addition, contraceptive care is more difficult to access as the patient becomes more remote from delivery. 15,16 In most states, a woman's Medicaid eligibility based on pregnancy ends in the weeks following delivery.…”

Section: Introductionmentioning

confidence: 99%

“…A range of contraceptive methods are appropriate in the immediate and early postpartum period, but these are often restricted in Catholic hospitals. For instance, long‐acting reversible contraception methods and sterilisation could be provided onsite immediately following delivery but are rarely permitted in Catholic settings 14 . In some settings where even counselling about contraception is prohibited, patients may not be aware that they could seek out these options at a later time 14 .…”

Section: Introductionmentioning

confidence: 99%

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Missed opportunities in postpartum contraception: Bridging the gaps for patients who deliver at Catholic hospitals in Illinois

Boulware,

Wascher,

Wong

et al. 2024

Repro Female Child Health

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IntroductionCatholic hospitals' religious restrictions limit postpartum contraceptive care and reproductive counselling. This qualitative study explores opportunities for patients and providers to ensure access to desired postpartum contraception care.MethodsWe interviewed people who had obstetric experiences in Illinois Catholic hospitals: 21 patients and 23 providers, including clinicians, doulas, nurses, and maternal health home visitors. We transcribed interviews and coded transcripts then used a thematic content approach for analysis. To guide future interventions, we sought interviewees' perspectives on opportunities to improve postpartum contraceptive care for patients affected by these restrictions.ResultsPatients delivered in Catholic hospitals for varied reasons unrelated to religious affiliation and were generally unaware of limits on access to contraception. Some providers offered referrals or workarounds for some contraceptive methods. The majority of providers described the importance of initiating contraceptive counselling during the prenatal period, but few patients reported receiving comprehensive contraceptive counselling during this time. Patients who received contraceptive counselling often had these experiences with doulas and maternal health home visitors who were not affiliated with religious health centres.ConclusionContraceptive counselling in the prenatal period can be a particularly helpful tool for patients delivering in hospitals that limit access to postpartum contraception, particularly in Catholic hospitals. Prenatal counselling can support advance planning if a patient needs to transfer or seek care outside their preferred health system. Where counselling and referrals are prohibited by religious restrictions, doulas and other maternal health home visitors can bridge gaps and support patient decision‐making and navigation to receive postpartum contraceptive care.

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Section: Discussionmentioning

confidence: 99%

Section: Recruitmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Missed opportunities in postpartum contraception: Bridging the gaps for patients who deliver at Catholic hospitals in Illinois

Boulware,

Wascher,

Wong

et al. 2024

Repro Female Child Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…The Ethical and Religious Directives for Catholic Health Care Services prohibits contraceptive services except to treat serious conditions that have no alternative treatment, and the Church Amendment (enacted by Congress in 1973) allows Catholic hospitals to refuse services that conflict with their religious beliefs or moral convictions . Despite these restrictions, many women do not know whether their local hospitals are Catholic or whether contraceptive services are offered at Catholic hospitals …”

Section: Introductionmentioning

confidence: 99%

Catholic Hospital Affiliation and Postpartum Contraceptive Care and Subsequent Deliveries

Meille,

Monnet

2024

JAMA Intern Med

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ImportanceIn recent years, the number of Catholic hospitals has grown, raising concerns about access to contraception. The association between living in an area in which the closest hospital is Catholic and the probability of postpartum contraception and subsequent deliveries is unknown.ObjectiveTo assess whether living in an area in which the closest hospital was Catholic was associated with the probability of postpartum contraception and subsequent deliveries.Design, Setting, and ParticipantsThis cohort study used data from the Healthcare Cost and Utilization Project’s State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases for 11 states (California, Florida, Georgia, Missouri, Nebraska, Nevada, New York, South Carolina, Tennessee, Vermont, and Wisconsin). Female patients with a delivery from 2016 to 2019 who lived within 20 miles of a nonfederal acute care hospital were included, with patients followed up for 1 to 3 years. Coarsened exact matching was used to match patients based on the county-level percentage of the population affiliated with Catholic churches and urbanicity, and the zip code–level number of hospitals within 5 and 20 miles, median household income, and percentage of the population by race and ethnicity. Data were analyzed from April 2022 to November 2023.ExposuresResidence in a zip code in which the closest hospital was Catholic.Main Outcomes and MeasuresProbabilities of delivery at a Catholic hospital, surgical sterilization within 1 year of delivery, receipt of long-acting reversible contraception at delivery, and subsequent delivery within 3 years.ResultsThe sample consisted of 4 101 443 deliveries (1 301 792 after matching), with 14.5% of patients living in exposed zip codes (ie, where the closest hospital was Catholic). Living in exposed zip codes was associated with a 21.26–percentage point (pp) increase in the probability of delivery at a Catholic hospital (95% CI, 19.50 to 23.02 pp; 237.3% relative to the mean in unexposed zip codes; P &lt; .001). Additionally, comparing exposed vs unexposed zip codes, the probability of surgical sterilization at delivery decreased by 0.95 pp (95% CI, −1.14 to −0.76 pp; P &lt; .001) and the probability of sterilization in the year after discharge further decreased by 0.21 pp (95% CI, −0.29 to −0.13; P &lt; .001). Subsequent deliveries within 3 years increased 0.47 pp (95% CI, −0.03 to 0.97 pp; 2.3% relative to the mean in unexposed zip codes; P = .07).Conclusions and RelevanceThis cohort study finds that living in a zip code in which the closest hospital was Catholic was associated with a modest decrease in the probability of postpartum surgical sterilizations and a modest increase in the probability of subsequent deliveries.

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Catholic Patients and Reproductive Healthcare

Kaplan

2024

Cultural Responsiveness in Assisted Reproductive Technology

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What you don't know can hurt you: Patient and provider perspectives on postpartum contraceptive care in Illinois Catholic Hospitals

Cited by 6 publications

References 32 publications

Missed opportunities in postpartum contraception: Bridging the gaps for patients who deliver at Catholic hospitals in Illinois

Missed opportunities in postpartum contraception: Bridging the gaps for patients who deliver at Catholic hospitals in Illinois

Catholic Hospital Affiliation and Postpartum Contraceptive Care and Subsequent Deliveries

Catholic Patients and Reproductive Healthcare

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