Last week, students returning to campus at Oberlin College in Ohio were shocked: A local media outlet reported that student health services on campus will severely limit who can get prescriptions for contraception. They will only be given to treat health problems – not for the purpose of preventing pregnancy – and emergency contraception will only be available to victims of sexual assault.
It turns out that the college has outsourced its student health services to a Catholic health agency — and like other Catholic health institutions, the college follows religious directives banning contraception to prevent pregnancy. It also prohibits gender affirmation sponsorship.
“I would describe the student’s reaction as outrage,” says Remsen Welch, a fourth-year student at Oberlin University and co-director of the student-run sexual information center on campus. “A lot of people in my circles were sending [the news story] About like, what’s going on? “
Although the college quickly came up with a new plan to offer reproductive health services to students on campus, the incident in Oberlin shows the broad scope of Catholic health care in the United States, and how the rules these institutions follow can limit access to the means Contraception.
Now that many states – including Ohio – have adopted restrictions or outright bans on abortion, this has also increased the risks of accessing contraceptives.
Religious restrictions affect many healthcare settings
Issued by the American Council of Catholic Bishops, the ethical and religious directives guiding Catholic health care systems “prohibit a wide range of reproductive care,” including birth control pills, IUDs, tubal ligation, and vasectomy, it says Dr. Debra Stolberga professor of family medicine at the University of Chicago who has researched how these directives perform in health care.
Catholic hospitals have long been a mainstay of health care in America. These days, the guidance applies to a wide range of places where people seek reproductive health care — including urgent care centers, doctor’s offices and outpatient surgery centers that have been purchased or merged with Catholic health systems.
They can also apply when Catholic health agencies are appointed to run health care services for other institutions, which is what happened in Oberlin.
Four of the country’s 10 largest healthcare systems are Catholic, according to A Report 2020. In some countries, they dominate the market. In 52 communities, the report found that only the Catholic Hospital was within a 45-minute drive.
“After all this consolidation, that’s where it explodes, as we have about 40% of women of childbearing age who live in areas with a high or dominant market share of Catholic hospitals,” he says. Marian Garlinsky, A health policy researcher at the University of Pittsburgh, who Data checked in 2020.
“not transparent at all”
Patients often say they do not realize that these restrictions may affect the care they receive Louis Oatley Senior advisor to the Community Catalyst group for health advocacy. They may not realize that the hospital or doctor’s office has Catholic ties. For example, Common Spirit Health is one of the largest health systems in the country, and it’s Catholic, but you wouldn’t know it from its name. Oatley says Catholic health institutions usually do not publish these policies.
“They’re not open and transparent about it at all,” Otley says. “We believe it is fair for the patient to be forewarned about what they may or may not be able to obtain at a local doctor’s office, urgent care center or hospital.”
in campus flyer Published Tuesday, Oberlin’s president, Carmen Toile Ambar, said Oberlin only recently learned that these restrictions would be imposed by Bon Secours, a major Catholic health system whose branch is designated to manage college health services. Tell Bon Secours to the local Telegram Chronicle They will only provide prescription birth control for medical reasons – an exception allowed under religious guidelines.
Samuel Corum/Bloomberg via Getty Images
When solutions are all you have
In practice, many physicians who work for Catholic-owned or affiliated healthcare providers routinely rely on “medical condition” exceptions as a way to get around religious restrictions on contraception, Stulberg’s research found.
For example, a hormonal IUD can be used to control heavy menstrual bleeding, so doctors will often say they provide an IUD to treat this condition, even if the real goal is to prevent pregnancy.
Or doctors who aren’t allowed to perform a tubal ligation may remove the tubes completely instead – they’ll just say it reduces the patient’s risk of ovarian cancer. Dr. Corinne MacLeodMD, an obstetrician-gynecologist at Albany Medical Center, says these types of solutions were very common when she worked at a Catholic hospital in Albany, New York.
“It was basically a wink, a wink, a prick, a prick,” MacLeod says, adding, “Everyone knew what was going on. That was how they got around [restrictions]She says, “One of the problems with relying on such loopholes is that if the ultra-Orthodox in institutions take advantage of them, they may crack down.
In other cases, solutions may include setting up a separately managed and funded ward within a Catholic hospital or health clinic to provide a full range of reproductive health services.
This is basically what happened in Oberlin: The The college is partnering with a local family planning clinic To provide these services on campus three days a week, she said she would provide students with transportation to the clinic on other days. But the Catholic health care provider will continue to provide other health services on campus.
Tiffany Yuen, a fourth-year student at Oberlin University who runs the Sexual Information Center with Wales, said the solution was “a start. But it’s not enough.” In the past, about 40% of visits to a student health center were related to sexual health, according to Amy Holmes, a certified nurse midwife who worked as a women’s health specialist in Oberlin for many years until Bon Secours took over.
“In some cases, women really don’t have other options”
Research suggests that even with alternative solutions, Catholic guidelines can limit women’s contraceptive choices. for example, I found one study While it was very easy for patients to book a hormonal birth control appointment at Catholic Hospital-owned clinics, it was rare to get one if you wanted to use the copper IUD, one of the most effective forms of long-acting, reversible contraception.
I personally faced these limitations eight years ago, when I had my second child. When I asked my doctor to do a tubal ligation as soon as I was on the birthing table, he told me he couldn’t do the procedure because we were in a Catholic hospital. A recent study suggests this experience is common: it found that women who give birth in a Catholic hospital are half as likely To have or remove a tubal ligation Like those who give birth in another type of hospital.
Stulberg has conducted surveys that find that many people don’t realize their options will be limited because they don’t know their healthcare provider is subject to these rules. “It is people who have a kind of Reproductive health rejectionThey, the majority, didn’t find out that they couldn’t get what they wanted until they got there or after that.”
In some cases, patients may simply be able to go to another health care provider to get the contraception they need – but not always. “In some cases, women really don’t have other options,” Stolberg says. “This hospital or this system is the only provider in town.”
It says a patient’s options may also be restricted depending on their health insurance and whether covered providers are subject to religious guidelines.
Many experts said these restrictions can often affect low-income patients disproportionately. Dr. Karishma Dara, a family medicine physician in Seattle, says that when she worked as a resident at a Catholic hospital in Washington, D.C., which served many low-income people, patients who showed up for IUD appointments were told they had to go to a different, non-Catholic clinic to have the devices inserted.
“Anytime you have to add another step to getting care or contraception, it’s another point where an unwanted pregnancy can occur,” says Dara.
In fact, Catholic directives can limit access to contraceptives long after a health care facility has ceased to be Catholic, she says. Elizabeth Siber, an expert in religious freedom and health law at the University of Texas at Austin. “There are a lot of examples where a Catholic health system bought a hospital, kept it for a few years, and then sold the hospital,” she says. “But the purchase agreement then obligates the next owner to continue with Catholic religious restrictions.”
Reproductive rights advocates would like to see laws that require hospital systems to be more transparent about what health services they provide and what they don’t. New York lawmakers introduced such a law.
“You know, I’m not against Catholic healthcare, but I do think patients need to know what kind of services are available to them,” Garlinsky says.