OB-GYNs encounter inconsistent protocols at Catholic hospitals when referring women to facilities for care that Catholic facilities refuse to provide, according to a forthcoming study in Perspectives on Sexual and Reproductive Health, Rewire reports (Knight Shine, Rewire, 8/3).
Background
Catholic hospitals operate under the Ethical and Religious Directives for Catholic Health Care Services, which ban Catholic facilities from performing abortion, sterilizations and certain other procedures.
According to a report released earlier this year, the number of hospitals in the United States that are Catholic-owned or affiliated increased by 22 percent over the past 15 years, posing problems for the provision of reproductive health care. The report found that in the United States, one out of every six hospital beds is located in a Catholic-owned or affiliated facility. Overall, 14.5 percent of short-term, acute-care hospitals comply with the directives.
The American Civil Liberties Union (ACLU) has filed several legal challenges against Catholic hospitals that have applied the religious directives when treating pregnant patients (Women's Health Policy Report, 5/6).
Study findings
For the study, researchers in 2011 and 2012 interviewed 27 OB-GYNs throughout the United States who had experience working at a Catholic hospital. The researchers looked at whether Catholic hospitals gave prompt referrals, provided necessary emergency treatment and offered comprehensive, medically accurate information.
OB-GYNs reported inconsistencies in hospitals' protocols for providing referrals for services Catholic facilities refuse to provide, as well as subsequent delays in care. For instance, the survey participants reported that some hospital administrators intentionally discouraged referrals, while others allowed or even encouraged referrals. According to the survey, some OB-GYNs felt compelled to keep their referrals secret.
Survey respondents also noted that a woman who sought abortion care often received less help with a referral than a patient who sought other services the hospital refused to provide. In one case, a secretary sought to block a referral for abortion care.
Some respondents reported that they felt as if the hospital "dumped" or "punted" abortion patients by requiring providers to offer referrals instead of providing abortion care. OB-GYNs also cited instances when referring a patient to an outside provider presented a risk to the patient's health.
Moreover, one OB-GYN noted that the hospital's prohibition on hormonal contraceptives made it "nearly impossible" to treat heavy vaginal bleeding. The OB-GYN stated, "Say you have…a 45-year-old who comes in (at three in the morning) with heavy bleeding and irregular periods. The most common approach to stopping her bleeding is to give her high-dose birth control pills for a short period of time. So, that became very difficult ... [be]cause [the hospital] didn't have them in stock."
In addition, some respondents cited the mixed messages they received when a prohibition on certain health care services undercut a Catholic hospital's financial interests. One OB-GYN noted that a Catholic hospital system circumvented a doctrinal ban on handling eggs and sperm for in-vitro fertilization by opening a fertility clinic offsite. "We had somewhere to send them anyway before -- it was just out of the system -- but now the system wants the business," the OB-GYN said.
Comments
Debra Stulberg, lead study author and an assistant professor of family medicine at the University of Chicago, said, "What doctors told us is sometimes for abortion … there was a sense of, 'You're on your own.'"
Stulberg added the disparities in referrals can delay treatment and promote abortion stigma, noting that bans on abortion care "tel[l] women that this care is not standard." She noted, "Imagining myself in those patient[s'] shoes, I might feel really abandoned by my doctor."
In response to the findings, the authors urged policymakers to mandate that Catholic hospitals with bans on certain health care services disclose those prohibitions to patients beforehand and provide comprehensive referral services. According to Rewire, the authors' recommendations align with the ethical guidelines of the American Congress of Obstetricians and Gynecologists.
Lori Freedman -- study co-author and an assistant professor in the department of Obstetrics, Gynecology and Reproductive Sciences at University of California-San Francisco -- said, " Having consistent procedures and help to access abortion will reduce the chance that the patient will be given the run around and have her care delayed." Noting that "[d]elays ... are not good for women," she added, "You really want women to find safe and compassionate providers as soon as possible" (Rewire, 8/3).
