Reproductive Health in Religious Hospitals
About 75% of religious hospitals are Catholic. Catholic facilities adhere to the Ethical and Religious Directives for Catholic Healthcare Services which prohibit abortion, contraception (including tubal-ligation), infertility treatment and more. Catholic hospitals treat 1 out of 9 acute care patients in the United States. With the growth of Catholic health care networks, important questions emerge about the dynamics between institutions, providers, and patients. Little is known about how these religious policies affect patient care. At ANSIRH, we work to understand these complex issues from both the provider and patient perspectives:
Institutional Influence and Provider Experiences
While doing research on obstetrics and gynecology abortion training and practice, our physician subjects explained that miscarriages are managed differently in Catholic hospitals when the fetal heartbeat is still detectable, because treatment is equated with abortion. Some physicians expressed frustration when their ethics committee would not approve uterine evacuation in these cases, even when miscarriage was inevitable. Doctors reported transporting their patients to non-Catholic facilities or waiting for the patient to become infected and sick, at which point the ethics committee would approve the intervention. These findings were published in American Journal of Public Health in October 2008 and motivated us to further investigate the impact of Catholic health care on patients.
To further this work, our team collaborated with Dr. Debra Stulberg and her team at the University of Chicago to conduct a new qualitative study about Catholic hospital obstetrician-gynecologists’ beliefs and practices around sexual and reproductive health care, specifically inquiring about hospital or practice-related factors that influence how they care for their patients. While the patient-doctor relationship has received much attention, little is known about an often-hidden third party in this relationship: the hospital or practice that employs or credentials the physician. Thus, the study looks at the bedside bioethics of religiously affiliated health care institutions and their employees. We have published findings about obstetric complication management and tubal sterilization and more findings are forthcoming.
Patient Experiences in Catholic Hospitals
In our past studies, physicians have reported that they feel their hands are often tied by religious hospital policies that restrict care. However, there is an enormous gap in knowledge about the experiences of patients who receive (or attempt to receive) reproductive and Ob/Gyn care in Catholic health care settings. This qualitative, interview-basted study seeks to understand patient experiences with pregnancy-related care—including pregnancy loss, miscarriage, abortion care, sterilization, contraception—and/or refusals to provide any of that care due to facility compliance with Catholic doctrine.