MomDoc, the largest OB-GYN network in Arizona, restricts the ability of employees to refer or discuss abortion care with patients, Rewire reports.
Background
According to Rewire, MomDoc is a Mormon-founded organization launched in 1976 that opposes almost all abortion care based on religious beliefs. The organization provides care through 21 offices under multiple names, including Goodman & Partridge, MomDoc Midwives, MomDoc Women for Women and Mi Doctora.
The organization provides certain reproductive health care services, including contraception, and accepts Medicaid patients, which means it receives federal funding. The organization does not disclose its antiabortion-rights stance in promotional materials, Rewire reports.
'Gag order' on abortion care
Rewire interviewed former MomDoc employees -- including administrative staff, nurses and OB-GYNs -- and found that the organization places a "virtual gag order" on employees' ability to discuss abortion care. Abortion-rights supporters have voiced concern that this unofficial policy further exacerbates the difficulties women in Arizona face when trying to access abortion care. According to Rewire, the state has passed several abortion restrictions, including a mandatory delay law, laws targeting minors' ability to access care and biased counseling requirements.
In interviews with Rewire, former employees said MomDoc's policy affected hiring practices. One OB-GYN, who worked with the organization for five years, said, "They brought it up at the (job) interview ... They said they don't do abortions, don't talk about it, don't refer (patients)." Multiple people said job applicants who did not share MomDoc's antiabortion-rights stance were "screened out" of the application process.
Former staff said the unofficial gag order had varying effects on employees' actions, depending on their positions and individual supervisors. One former employee, who worked in surgery and referrals for MomDoc in 2011 and 2012, said, "I was told in my training that abortion was not something we did, it was not something we promoted, it was not something we referred (patients to)." Another former employee, who arranged patient appointments, said she was told not to provide abortion referrals and was warned that the organization recorded all conversations.
Separately, a nurse practitioner who used to work for the organization said while she was told in her interview not to discuss emergency contraception with patients, she "was never told that directly [she] couldn't refer patients to abortion providers." She added, "I had patients [who] did choose abortion, and I referred them."
According to Rewire, despite the policy, multiple former employees said once they were hired, they would discuss abortion care with patients. One said, "I talked about it, I know other doctors talked about it." The employee who worked as an appointment setter also said she would sometimes "sneak in" a referral to patients seeking abortion care.
Another OB-GYN who worked for MomDoc said she would disclose MomDoc's policy with patients. "I would always start off telling the patient, 'I'm not supposed to talk about [abortion care], but I will,'" she said, adding that she asked patients not to share the conversation with MomDoc.
Policy counters professional ethics
The policy counters guidance from the American Congress of Obstetricians and Gynecologists (ACOG), which recommends that health care providers who oppose abortion rights disclose their stance to patients before providing care and offer appropriate references to patients seeking abortion care.
Julie Kwatra, legislative chair of ACOG's Arizona chapter, said, "You need to give your patients all the options so they can make their own choice ... Not telling a patient information is in opposition to every rule of medicine."
Separately, Lori Freedman -- author of "Willing and Unable," a book exploring restrictions on physicians' ability to discuss and provide abortion care -- said MomDoc's policy violates professional standards on notifying and referring patients for care. "I think there's an ethical problem there -- this is information patients would want," she said.
The number of religiously affiliated organizations that restrict employees' speech regarding abortion care in the United States is unknown, Rewire reports. According to Rewire, the American Association of Pro-Life Obstetricians and Gynecologists said while it has not surveyed members about whether they provide patients seeking abortion care an appropriate reference, the organization maintains an overall opposition to abortion rights.
Situation spotlights 'conscience protection' laws
Rewire reports that MomDoc's unofficial gag order demonstrates the ramifications of "conscience protection" laws. Abortion-rights supporters have said such laws further stigmatize abortion care.
In 2012, Arizona lawmakers passed a law that allows a health care provider to object on religious grounds to providing certain services without losing his or her license. The state law follows the 1973 Church Amendment, a federal law that shields health care providers who object to providing abortion care at institutions that receive federal funding.
According to Rewire, interpretation of federal law is also at issue in a recent lawsuit filed on behalf of an OB-GYN who states that her employer tried to suppress her abortion-rights advocacy work. The OB-GYN's legal team contends that the Church Amendment also protects her rights to promote abortion rights in her professional capacity (Knight Shine, Rewire, 5/31).
