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The rapid growth of Catholic-affiliated hospitals in the U.S. could significantly reduce access to inpatient sterilization procedures, according to a new study that examines the rising influence of religion on reproductive health services.

The study, published by the National Bureau of Economic Research, estimates that Catholic hospitals reduce the per-bed annual rates of inpatient abortions by 30 percent, and tubal ligations, or sterilization, by 31 percent.


Those impacts are being magnified by rapid consolidation among hospitals nationwide, a trend that resulted in a 22 percent increase in Catholic-sponsored or Catholic-affiliated hospitals between 2001 and 2016. The study found that the restrictions on reproductive health services at those facilities translates to more than 9,500 fewer tubal ligations per year.

“This alone represents a substantial cost to women, who must subsequently rely on other, more inconvenient suboptimal forms of contraception,” the study concluded.

The finding comes amid increasing debate over the influence of Catholic doctrine on access to reproductive health services. The church’s restrictions have created flashpoints across the country, including a lawsuit filed by the American Civil Liberties Union on behalf of a Michigan woman who said she was repeatedly refused appropriate care — the surgical removal of a fetus — after experiencing a miscarriage at 18 weeks.


The United States Conference of Catholic Bishops, which enforces directives that prohibit sterilization, abortion, and contraceptive services at Catholic hospitals, did not respond to a request for comment.

The study found Catholic affiliation at hospitals did not result in a statistically significant increase in complications from miscarriages or sterilization procedures, nor did it affect the number of caesarean sections performed. The study also examined vasectomies, but turned up limited data on that procedure because it is typically performed on an outpatient basis.

Lack of access

The consolidation of Catholic hospitals has increased the likelihood of conflict over the church’s restrictions, because in many communities a Catholic hospital is the most convenient option, and sometimes it’s the only option.

By 2016, the study found, 14.5 percent of all U.S. acute care hospitals were Catholic, including 10 of the 25 largest health care systems in the country. In some states with fewer hospitals, Catholic providers are a dominant presence in the market. In five states (Alaska, Iowa, Washington, Wisconsin, and South Dakota), more than 40 percent of acute care beds were Catholic-owned or -affiliated in 2016.

The study found the Catholic affiliation consistently reduces the number of inpatient abortions and tubal ligations performed at hospitals. Abortions are more often provided as an outpatient procedure, so the effect on access is less pronounced. But the restrictions on tubal ligations could impair access, especially among populations that lack the time and resources to travel to another hospital to have the procedure performed.

“Most public health professionals believe that access to reproductive care, and in particular tubal ligations, is one of the many options for helping to reduce unwanted pregnancy in this country,” said Elaine Hill, a co-author of the study who is a professor of health economics at the University of Rochester School of Medicine and Dentistry. “Policies addressing the ways in which religious ownership of hospitals might impede access could be very beneficial to the population of women affected.”

Uneven effects

The Catholic restrictions on reproductive care impact racial groups unevenly, according to the study, which found that black and Hispanic women are disproportionately affected by the restrictions on tubal ligations.

The study used data from the American Hospital Association’s Annual Survey and the Healthcare Cost and Utilization Project to examine changes in ownership and estimate the impact of Catholic policies on the reproductive procedures performed by hospitals. The researchers reviewed data from six high-population states: Arizona, Florida, New Jersey, California, New York, and Washington.

The study noted that Catholic restrictions on reproductive care are not always followed, otherwise the reduction in abortions and sterilizations at these hospitals would be 100 percent, not 30 and 31 percent, respectively. A prior study found physicians intentionally violated Catholic care protocols when they believed the safety of the patient was being compromised.

  • I had a severe infection at 16 weeks pregnant and went into labor.A catholic hospital ER convinced me I was ok because the baby’s heart was still beating and they wanted NOTHING to do with the miscarriage. I miscarried at home and didn’t see the doctor for another 5 days. I should have died during the D&C because my body was so septic. My organs were failing and I lost 4/5 of my blood. They had to take my uterus out to save me.

    I can understand if they disagree with abortion. But please, tell women that abortion also means assisting in labor before 24 weeks. Tell her she can get help at another hospital. Don’t tell her she is ok and threaten her life just so she will go away. I lost my ability to be a mother and it is 100% due to catholic protocol. There is nothing good about these hospitals, they are absolutely evil.

  • I have no problem with people getting their tubes tied, burned, cut, or with people who choose different options. I do have a problem with people stating that because a group, organization, or religion exercise their right to make decisions on the services they are going to provide that they are labeled as horrible. Would you force another company, business, faith, and/or group of people to go against their beliefs or the tenets of their company, business, faith, and/or group? Would you force a company run by those of the Islamic faith to make their employees who willing cover their hair to leave it uncovered? Or perhaps force a Transgendered person to dress in the manner of their biological gender? As human beings we cannot force a group and/or entity to abandon their beliefs to suit our own, no matter how strongly we may feel it is wrong. It’s hypocritical.

    People know when they enter into Catholic run hospitals that there are procedures that the hospital will not engage in unless it presents a danger to the patient. Often, but not always, there is a secular/non-denominational/public hospital nearby or with the area. If not, then there are still alternative options.

  • I have always admired Stat’s journalism, so this is article is very disappointing.

    I assume the motivation for picking an flattering photo of a cleric in formal dress is obvious.

    And after reading the entire article, it’s clear that the influence is limited to tubal ligations, not the rather vague and scary-sounding “reproductive health care.”

    And then you cross-linked to an article about Samantha Bee describing her suggestion that a woman might die from miscarriage complications in a Catholic hospital, even as you later said that “The study found Catholic affiliation at hospitals did not result in a statistically significant increase in complications from miscarriages or sterilization procedures, nor did it affect the number of caesarean sections performed.”


  • This is also developing into a problem for Trans people, there have been several cases where literally moments before scheduled hysterectomies for gender disphoria, ftm trans women have been told their surgery is cancelled, since its “obviously ” actually being done as a sterilization, and patients asked to get up off the gurney and vacate the premises. As far as vasectomy, there was just an article in my local paper that access has dropped by 60% due to doctors signing with the local Catholic hospital here in Humboldt county.

    • I am opposed to “principled behavior” that imposes one’s peculiar alleged principles on others whether they like it or not, especially in matters of life and death such as health care. In the civilized world, deciding that it’s preferable to let a patient die because of the religious beliefs of their providers is extremely peculiar, and it cannot stand.

      Standing by a principle can be an overrated virtue. Not all principles are honorable. For example, Trump’s white supremacist supporters terrorize others, carrying torches, and they call it a matter of principle. Some people deny the humanity of gay people and they say it’s because of their principles. And some people put their beliefs about women’s reproductive health before those of the women seeking care. That’s principled? Not in my view. It’s doctrinaire, but not principled. People who think that they as health care providers have a duty to make health care decisions for others based on their own religious beliefs should find another line of work. That twisted idea of principle is intolerable.

      Resigning from a commission because the president is a pig is not an apt comparison. No one gets hurt. I anyone had asked me, I would have condemned their accepting positions on a Trump panel in the first place, and I applaud their resigning.

  • Tortured language here. Many Catholic hospitals provide maternity care. But your use of the term “reproductive health care” oddly excludes maternity care in favor of abortion and sterilization. Shouldn’t the latter services be correctly categorized under the rubric of “non-reproductive?”

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