How the spread of Catholic-owned health facilities can complicate access to reproductive care

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The 10 largest Catholic systems operate about 860 emergency care, 385 outpatient surgery centers and about 280 physician groups, according to the report.

Catholic facilities must follow ethical and religious guidelines that state they cannot provide abortion or sterilization services and cannot “promote or condone” contraceptives. The guidelines, approved by the United States Conference of Catholic Bishops, dictate how care is provided in Catholic institutions, which includes clinics, emergency care, and care provided by salaried physicians.

Religious restrictions are spreading rapidly outside of Catholic hospitals as they acquire doctor’s offices and ambulatory care facilities, said Lois Uttley, senior adviser at Community Catalyst, co-author of the 2020 Health Systems Growth Report. Catholic health.

The Catholic Health Association challenged Uttley’s study and questioned its accuracy when it was published in 2020. At the time, the CHA said one in seven beds were in Catholic hospitals , not one in six. The organization said at the time that it took issue with Community Catalyst’s methodology.

Yet the two largest Catholic health systems alone control a wide range of health services that cover much of the country.

As of March 31, Ascension says it has 40,000 providers “aligned” at 2,600 total care sites in 19 states, while CommonSpirit has 25,000 experienced physicians and clinicians in 21 states and 1,500 care sites.

Neither Ascension nor CommonSpirit responded to requests for comment.

Abortion should remain legal in half the country

Abortion laws by state

For patients, it is not always clear how care may be influenced by religious institutions. A 2019 JAMA report found that only 28% of Catholic hospitals disclosed how their religious affiliation may dictate care.

This lack of transparency can lead to dire health situations for pregnant women who present to Catholic hospitals with complications. There are reports of women who presented with miscarriage complications but were turned away due to religious guidelines from Catholic hospitals. If not treated in a timely manner, a miscarriage complication can become fatal for the pregnant person.

Although Catholic institutions cannot offer abortions, there are some exceptions. Still, it’s not always clear when Catholic hospitals can step in to save the mother’s life, and in those cases, facilities typically convene the hospital’s ethics committee to determine a course of action.

The United States Conference of Catholic Bishops has said there is a distinction between what it considers a “direct” abortion and a “legitimate” medical procedure.

In the 2010 guidelines, the conference explained that a medical procedure that “indirectly” terminates a pregnancy is permitted, such as in the case of a pregnant person who is diagnosed with uterine cancer. Removing the cancerous uterus “directly” resolves the medical problem and “indirectly” terminates a pregnancy, according to the United States Conference of Catholic Bishops.

However, if a pregnant person experiences organic complications due to the “extra burden of pregnancy”, an abortion is not allowed as it is considered a “direct” abortion.

The bishops released the advice after a Catholic hospital in Phoenix performed an abortion to save the life of a 27-year-old mother of four in 2009. Bishop of Phoenix Thomas Olmsted condemned the procedure even though the mother would have survived.

A nun, who was also a hospital administrator, authorized abortion and was excommunicated from the church for her actions, according to an earlier NPR report. The bishop also stripped the hospital of its Catholic affiliation, ABC News reported.

In some states where abortion remains legal, Catholic health care facilities have a strong presence and lawmakers should work to make transparency in those facilities a priority, said Marian Jarlenski, a professor at the College of Public Health at the University. ‘University of Pittsburgh. Jarlenski is co-author of a study on the market share of Catholic hospitals.

“I think a very clear policy response would be to say, ‘OK, any health care facility that receives public funds – Medicare, Medicaid – you should be required to state very clearly what services are and are not available,’ Jarlensky said.

In 10 states, more than 30% of acute care beds are in Catholic hospitals, including Colorado, Oregon and Washington. These are states that are committed to maintaining access to abortion.

In Illinois, Catholic facilities account for about 28% of hospital beds.

“The proliferation of religion-affiliated health care absolutely raises concerns about patient access to reproductive health care,” said Ameri Klafeta, director of women’s and reproductive rights at the American Civil Liberties Union. of Illinois.

“We also know that there are parts of the state where health care options can be very limited. So there may be parts of the state where, in practice, the only health care available — either by location or insurance limitations — might be a religious institution, Klafeta said.

The ACLU of Illinois filed a lawsuit in 2018 after a woman was denied long-acting, reversible birth control at a Catholic facility in Chicago.

The vast majority of abortions in the United States are performed in clinics, while only 5% of abortions are performed by hospitals, according to a 2017 abortion incidence analysis by the Guttmacher Institute.

Catholic institutions operating more urgent care clinics, physician groups and outpatient facilities are raising concerns about the complication of accessing contraceptives and Plan B, emergency contraception, commonly known as the morning after pill , which is used to prevent pregnancy.

“There may be areas in these states where that care is quite limited,” as hospitals tend to run outpatient facilities, emergency care, and run doctor’s offices in areas where they have hospitals. , said Uttley of Community Catalyst.

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