Women's Expectation of Receiving Reproductive Health Care at Catholic and Non‐Catholic Hospitals

Abstract

CONTEXT : Catholic hospitals operate under directives that prohibit the provision of contraceptives, sterilization and abortion. Little research has examined women ' s awareness of these institutions' policies, which aff ects their ability to make informed decisions about where to seek care. METHODS :In 2016, some 1,430 women aged 18-45 were recruited from a U.S. probability-based research panel for a survey about hospital care. Respondents were randomized to a hypothetical Catholic or nonreligious hospital group and asked about their expectations for receiving nine specifi c reproductive services. Multivariable logistic regression analyses were used to evaluate associations between participants' characteristics and their correctly identifying a hospital as Catholic, as well as between characteristics and expecting that birth control pills, tubal ligation or abortion for serious fetal indications would be provided there. RESULTS :Women randomized to the Catholic hospital group were less likely than those randomized to the nonreligious group to expect provision of birth control pills (77% vs. 86%), tubal ligation (70% vs. 78%) or abortion for serious fetal indications (42% vs. 54%). Income level was associated with correctly identifying the Catholic hospital: Compared with individuals with the lowest income, those in three of the four other income groups were more likely to identify the hospital as Catholic (odds ratios, 1.9-2.2). In comparison with women who misidentifi ed the Catholic hospital, those who identifi ed it as Catholic had lower expectations that the hospital would provide birth control pills (0.3), tubal ligation (0.5) or abortion (0.2). CONCLUSIONS : Many women do not realize the breadth of restrictions on reproductive health care at Catholic hospitals. Without institutional transparency, patient autonomy and health outcomes may be compromised.

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

“…This false documentation can lead to medical errors, and it forces providers to choose between professional integrity and patient care. Given the federal government's proposed policies to expand protections for conscientious objection, policymakers should prioritize efforts to protect the conscientious provision of reproductive care with as much vigor as they do conscientious refusals of care, to help clinicians avoid the ethically problematic practice of false documentation . Furthermore, these practices may stigmatize contraception and burden patients, especially underserved populations with social and financial constraints, thus delaying and negatively affecting patient care.…”

Anticipatory Counseling About Miscarriage Management in Catholic Hospitals: A Qualitative Exploration of Women's Preferences

“…14,15 Catholic hospitals do not adequately inform patients about restrictions on care, leaving many patients unaware of miscarriage management policies. 14,16,17 Moreover, Catholic hospitals are not required to disclose their religious affiliation or specific policies to patients, except in Washington state, which mandates that they provide their reproductive health and end-of-life care policies on their websites. 18 Policy restrictions and treatment options are often not disclosed even when a patient presents to a Catholic hospital during miscarriage.…”

“…8,19 In a national survey of women aged 18-45 from 2018, Wascher and colleagues found that more than a third of women who named a Catholic hospital as their primary hospital for reproductive care were unaware of its Catholic affiliation, 20 and Stulberg et al reported that most women were unaware of how religious policies impacted reproductive care. 16 Notably, the population of women seeking care in Catholic hospitals is demographically comparable to women nationally in terms of religion and religiosity, and most individuals do not choose a hospital based on its religious affiliation. 20,21 Furthermore, women expect to receive comprehensive reproductive health care services from both Catholic and secular institutions.…”

“…20,21 Furthermore, women expect to receive comprehensive reproductive health care services from both Catholic and secular institutions. 16,22 Indeed, 71% of women believe that a patient seeking care at a Catholic hospital for an inevitable pregnancy loss will be offered a dilation and curettage procedure; however, under the ERDs, this is true only if the fetus has died or the woman suffers life-threatening infection or blood loss. 3,23 Together, these studies suggest that there are significant gaps in patient education about hospital ownership and its implications for care, and yet the vast majority of patients say it is important to be informed about religious restrictions before deciding where to seek care.…”

How Should We Judge Whether and When Mission Statements Are Ethically Deployed?

“…When surveyed about their expectations for reproductive care at a Catholic hospital, 69% of women expected that they could receive birth control from an obstetrician/gynecologist (OBGYN), 63% that sterilization would be available, 44% that in vitro fertilization would be available, and 27% that abortion would be an option if the fetus had a serious health condition. 10 The directives that doctors in Catholic facilities must follow prohibit provision of all of these services, but many women did not anticipate denials of care.…”