As the U.S. focuses on Judge Amy Coney Barrett’s confirmation hearings, another story out this week may have flown under the radar. Michigan Sen. Gary Peters went public with a story about his first wife’s near-death experience from a miscarriage that sounded familiar to people who research Catholic hospitals. When his wife, Heidi, was four months pregnant in the 1980s, her water broke, meaning the fetus could not survive. The hospital sent her home twice to wait for a miscarriage. On the third day, as her health deteriorated, her doctor warned she could lose her uterus or die if she didn’t have an abortion soon. But the hospital’s policy banned abortion and its board denied the doctor’s request for an exception.
It wasn’t the first time that Debra Stulberg, chair of the family medicine department at the University of Chicago, had heard such a story.
“The experience that his wife went through is something that a lot of women around the country have gone through,” Stulberg told Truthout. “In interviewing OB-GYNs, it comes up regularly if they’ve worked in a Catholic hospital.”
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The report by journalist Laura Bassett did not say if the hospital that Peters went to was Catholic. But a growing number of hospitals nationwide that follow directives from the Catholic Church generally ban abortion in all but the most life-threatening circumstances. In the senator’s home state of Michigan in 2015, a Catholic hospital sent Tamesha Means home twice after her water broke at 18 weeks, and never told her that ending her pregnancy was an option. When Means returned a third time with an infection, the hospital prepared to send her home again, admitting her only when she began to deliver her fetus, according to the ACLU, which filed a lawsuit on her behalf. Another woman named Alison in Washington state told me how she almost died in 2013 after a Catholic hospital sent her home three times and then forced her to wait while an ethics board considered whether she could have a life-saving abortion.
Sen. Peters’s wife was rushed into an emergency abortion at another hospital because they were friends with an administrator there. “For people that aren’t friends with the hospital’s chief administrator or for people who simply live where there isn’t another hospital that will do the procedure, or another facility where there are providers, this could have had a very different outcome,” Stulberg said. “She could have lost her life; she certainly could have lost her potential for future fertility.” In Ireland, a woman named Savita Halappanavar died in 2012 after a hospital denied her request for an abortion while she was miscarrying.
Means and Alison share an experience that is becoming more common in states nationwide: The Catholic hospital is the only option in their community. A new report by Community Catalyst finds that there are now 52 hospitals operating under Catholic restrictions nationwide that are sole community hospitals, up from 46 in 2016 and 30 in 2013. “Sole community hospital” is a federal designation that applies when the nearest alternative is at least 35 miles away, or when the hospital is rural and meets certain other criteria.
“We’re losing rural hospitals left and right,” one of the report’s authors, Lois Uttley, told Truthout. “Among those that are still standing, we have an increasing number that are Catholic, and that means the people who live in that community and depend on the only hospital for care cannot get some of the services they might need in their hometown.”
The Catholic directives ban abortion, contraception, in vitro fertilization and sterilization, and have been cited to deny gender-affirming surgeries to transgender people. If people give birth by cesarean section in a Catholic hospital, they often can’t have their tubes tied at the same time — a common practice used to avoid the risks of a second surgery. Many of the states where Catholic health systems have proliferated have passed anti-choice laws and would ban abortion if Roe v. Wade is overturned. In South Dakota, where the pandemic has halted abortions at the only remaining clinic, 40 percent of acute-care beds and more than 40 percent of hospital births are in a Catholic hospital. In the midst of a pandemic, patients who are turned away because of religious restrictions, as the Peters were, face additional risks as a result.
“In [the Peters case] it sounds like they had to go at least three times and if this had happened during the COVID pandemic that would have been unnecessary risk of exposure by being in the health care facility repeatedly for a condition that could have been treated the first time they showed up,” Stulberg said.
Catholic health systems are not the only facilities that restrict reproductive health care on religious or political grounds. Public and Protestant-affiliated facilities may also have policies restricting abortion. But Catholic facilities are noteworthy in part because of how they have expanded, even as other hospitals have closed. The number of acute-care hospitals operating under Catholic restrictions grew by more than 28 percent over the past two decades, even as the number of non-Catholic facilities dropped by nearly 14 percent, the report found. During that same period, the number of public hospitals dropped by nearly 53 percent.
While it’s a common myth that Catholic hospitals serve more low-income patients, the report found Catholic hospitals do not serve a higher percentage of Medicaid patients or provide more charity care than other hospitals. Struggling public hospitals, which provide the most charity care, have in some cases partnered with religious health systems to survive. In Louisiana, for example, Natchitoches Regional Medical Center, a self-described government facility owned by a parish hospital district, is managed by CHRISTUS Health, one of the largest Catholic health systems. The management contract requires the facility, which is the only one serving the region, to abide by the Catholic restrictions and not provide abortions or tubal ligations.
Catholic hospitals have flourished financially in part because they are part of mega-systems like CHRISTUS that insulate even isolated, rural facilities from financial losses. The study found almost all Catholic hospitals — 98 percent — are part of a health system, versus 80 percent of non-Catholic hospitals. “As Catholic health systems expand and strengthen, we are witnessing a ‘snowball effect’ — these systems become more attractive business partners, setting them up for further growth with an ever-widening network of non-Catholic hospitals, urgent care centers, physician practices, ambulatory surgery centers and other health care providers,” the authors wrote.
The Catholic restrictions have extended into more and more facilities as Catholic health systems acquire secular hospitals, or as Catholic facilities are acquired by secular or for-profit systems that agree to keep the religious restrictions in place as a term of the merger or sale. In a striking trend highlighted in the report, the number of formerly Catholic-owned hospitals now owned by for-profit systems that are still following the Catholic directives increased from just four in 2001 to 49 in 2020. As more care shifts from acute-care hospitals into outpatient facilities, Catholic affiliations have cropped up in some unexpected places, like clinics or pharmacies inside businesses like Kroger and Walgreens. These relationships make it even harder to track down which facilities follow which of the Catholic rules — a task that was daunting even for Uttley and her colleagues.
“It was difficult enough for our team of professional researchers to determine whether a hospital was actually following religious restrictions or not, and so imagine how difficult it would be for an ordinary woman trying to find out if the hospital where she wants to give birth will allow her to have a postpartum tubal ligation,” Uttley said.
Indeed, a survey published in 2018 found that while one in six women in the United States named a Catholic facility as their go-to destination for reproductive health care, more than a third of them did not realize that their hospital was Catholic. But the researchers found in another study published in September that nearly all women think it is important to be informed of these rules. “I think any restrictions on the care that you can receive at those locations need to be plastered in 50 foot neon letters at the front door of the building,” one patient told the researchers, sharing how her doctor had prompted her to claim she had heavy periods in order to get around the religious ban on contraception.
Another interviewee was denied two postpartum sterilizations at the time of her C-sections and experienced two unintended pregnancies as a result. “I wish I would’ve gotten sterilization…. I probably wouldn’t have gotten pregnant two more times,” the woman said.
As the influence of Catholic hospitals has expanded, so has the legal cover for denying care to women and LGBTQ patients on religious grounds. While Catholic hospitals receive nearly $48 billion each year in public funding through Medicare and Medicaid, the Trump administration has sought to expand the ability of individuals and corporations to deny care. That’s a trend that experts say will accelerate if Amy Coney Barrett is confirmed to the Supreme Court.
“We’re frankly getting worried that a Trump-packed court will be even more sympathetic to claims from religiously affiliated health providers that they must be allowed to refuse to provide any services they find objectionable while still remaining eligible for billions in public funding,” Uttley said.