Now that the U.S. Supreme Court has ruled out the constitutional right to an abortion, access to birth control has taken on new urgency. By shifting the decision on abortion access to states, the fall of Roe v. Wade that it will be even more important for people to be able to prevent an unwanted or mistaken pregnancy.
Given the health risks of a rapid recurrent pregnancy, avoiding pregnancy is especially critical for those who have recently given birth. However, not all healthcare providers offer birth control to their patients.
Over the past two decades, the number of Catholic hospitals in the United States has increased dramatically. But it may come as a surprise to many people to learn that Catholic hospitals are not allowed to provide health care that is considered “intrinsically immoral” by their religious leaders.
The Catholic religion believes that life begins at conception and that sex should take place only for the purposes of reproduction. As a result, the American Conference of Catholic Bishops published ethical and religious prescriptions, last updated in 2018, banning Catholic hospitals from providing birth control, abortion, and infertility treatments. There are no exceptions, even if the care is necessary to protect a person’s life or health.
As a result, many people who want to have a birth control before leaving the hospital after giving birth may not receive it.
One of the most effective methods to prevent pregnancy is female sterilization, which is used by 18% of women in the US. This permanent method of birth control usually consists of tubal ligation, a surgical procedure in which the fallopian tubes are cut or sealed. Catholic hospitals are not allowed to perform this procedure.
However, many people are not even aware that they are choosing a Catholic hospital when deciding where to deliver. Others do not have an option, or may not realize that where they give birth can affect the reproductive treatment options available to them.
As a sexual and reproductive health epidemiologist, I have spent the past 20 years researching contraception and abortion in countries around the world, including the US. Much of my research involves studying differences in people’s use of birth control.
Avoiding a Catholic Hospital Can Be Difficult
As a result of hospital mergers and acquisitions, the number of Catholic acute care hospitals grew by 22% between 2001 and 2016. In general, about 17% of acute care hospital beds in the U.S. belong to Catholic hospitals.
Some people attend a Catholic hospital because they have limited choices. There are 46 Catholic hospitals in the U.S. that are the only providers of short-term acute hospital care in their geographic area, including in Santa Fe, New Mexico; Grand Junction, Colorado; and Bellingham, Washington. Others may be limited in where their health insurance will cover their care.
Some people are not even aware that they are attending a Catholic hospital. A 2018 national survey asked adult women of reproductive age where they go for their reproductive care; 16% mentioned a Catholic hospital. However, more than one-third of the women who called a Catholic hospital did not know that their hospital was Catholic. Furthermore, those who were wrong about their hospital’s Catholic status described themselves as “sure” or “very sure” about their wrong response.
In some cases, people may be unaware of their hospital’s status because the name does not sound religious. People may also not know that a Catholic network has bought their secular hospital and that their hospital is now obliged to follow its ethical and religious precepts. a 2017-2018 review of hospital websites found that 21% of Catholic hospitals did not explicitly disclose their Catholic status on their website.
Even if people know that their hospital is Catholic, they may not know that attending a Catholic hospital can limit the amount of care they can receive. A large survey among women found that most did not expect restrictions on care at Catholic hospitals, especially for services that are considered less taboo than abortion. Respondents did not realize that Catholic hospitals are limited in providing birth control, including female sterilization methods such as tube ligation.
The need for birth control after childbirth
The use of birth control after childbirth is critical because people’s fertility returns rapidly. Having at least 18 months of space between childbirth and a new pregnancy is important to protect the pregnant person and the baby’s health.
Short birth spacing increases the risks of adverse outcomes such as preeclampsia, premature birth and health problems for the newborn baby. Because of the health risks, the U.S. Department of Health and Human Services has recognized birth spacing as a high priority in the 2030 goals for healthy people.
For people who do not want more pregnancies, immediately after childbirth may be the most convenient time to have a tube ligation. For this reason, about half of all tubal ligaments are performed after delivery. About 6.2% of deliveries in the US are followed by a tubal ligation. Failure to receive a desired postpartum tubal ligation increases the risk of having a rapid recurrent pregnancy.
Birth control use after delivery at Catholic hospitals
Our team decided to investigate whether women who had recently given birth at a Catholic hospital were less likely to use birth control during the postpartum period compared to women who gave birth at a non-Catholic hospital.
Even though ethical and religious precepts say that Catholic hospitals may not provide birth control, it is plausible that some hospitals may not enforce the rules or that providers may find ways to circumvent them. Providers at Catholic hospitals, for example, can place an intrauterine device, or IUD, in a patient who desires one by justifying its use for non-contraceptive purposes. Or suppliers can perform an elective caesarean section to perform a tube ligation in secret.
My colleagues and I used survey data from the Pregnancy Risk Assessment Monitoring System of five states – Alaska, Illinois, Maine, Oregon and Wisconsin – over the period from 2015 to 2018. The Centers for Disease Control and Prevention and State Health Departments conduct annual surveys of women who have given birth in the past two to six months. We linked these survey data to birth certificates to know whether women were born at a Catholic or non-Catholic hospital.
Our study found that women born at a Catholic hospital at two to six months postpartum were about half as likely to undergo female sterilization as women born at another type of hospital. This difference remained statistically significant after we adjusted for women’s age, race or ethnicity, education, insurance status and parity.
Pregnancy poses health risks
Legal abortion is much safer than childbirth in the US. Because people are 14 times more likely to die from pregnancy than from a legal abortion, it is important that they avoid an unintended pregnancy.
These studies illustrate the need for people to have access to the birth control method of their choice – a choice that is all the more important now that people have lost their constitutional right to an abortion.
