Hospital Mergers and the Curtailment of Reproductive Health Services

Women's health care in the United States is at serious risk due to a declining number of reproductive health care providers. The most recent data indicate that 84% of U.S. counties have no abortion provider at all. While other reproductive health facilities are not as scarce, the violence directed at "women's health clinics," as well as other factors, has contributed to a shortage of services in general. In this context, the growing number of religiously controlled hospital mergers, joint ventures and affiliations is cause for alarm because it has curtailed reproductive services. These business relationships often require non-sectarian health care facilities to observe religious prohibitions against providing certain reproductive services. Although religiously controlled mergers may be motivated by economic considerations, and not necessarily the desire to curtail reproductive services, their impact on the availability of necessary health care is serious and far-reaching.

Religiously controlled hospitals comprise a significant percentage of all health care providers in the United States.

Many Americans depend on religiously controlled facilities for their health care. The Catholic health care system alone is the largest single private sector health care provider in the United States. It includes more than 600 hospitals, 200 health care centers, and 1,500 specialized care facilities, such as drug treatment centers. Catholic hospitals serve approximately 50 million patients a year.

Many religiously controlled hospitals do not provide basic reproductive health services.

Most religiously controlled hospitals do not provide services proscribed by their religious doctrine. For example, Catholic health care facilities, usually operated by religious orders, are subject to the control of the Roman Catholic Church. They are prohibited by church doctrine from providing a variety of basic reproductive health services: abortion, sterilization, contraceptive services and supplies, most forms of assisted reproduction, comprehensive AIDS prevention and condom distribution, and "morning-after" pills for rape victims (which prevent implantation of a fertilized egg). In 1971 the National Conference of Catholic Bishops' Committee on Doctrine codified these prohibitions as a set of incontrovertible rules in the Ethical and Religious Directives for Catholic Health Facilities. The Directives were updated in 1994, but the prohibitions remained. In recent years, American Bishops have been pushed to enforce doctrinal restrictions, and even hospitals that have disregarded some directives in the past have found or may find themselves subject to tighter control by the Bishops.

Patients are often not informed of policies that deny women reproductive health services.

Patients at religiously controlled hospitals often have no idea that they may be denied essential health services. Emergency patients or others who request prohibited procedures face serious physical and psychological risks. In one such case, a woman in Oregon went to a Catholic hospital to give birth and requested that she be sterilized after the delivery. Doctors did not perform the requested procedure, but failed to inform her that it had not been performed. Believing she had been sterilized, the woman later faced an unwanted pregnancy. 

Religiously controlled hospitals evade a legal obligation to provide essential reproductive health services.

In an attempt to justify their failure to provide services otherwise required by law, religiously controlled institutions often invoke statutory "conscience clauses" that allow entire institutions to claim religious or moral objections to offering specific services. The individual religious and conscientious choices of patients concerning their medical care are thus subordinated to the institutional "conscience" of hospitals. Federal, state, and local governments facilitate this denial of essential health care services by granting tax-exempt status to religiously controlled hospitals. 

Mergers with religiously controlled hospitals restrict women's access to reproductive health care services, even at non-sectarian institutions.

All patients, regardless of their religious affiliations, are profoundly affected by the refusal of religiously controlled hospitals to provide reproductive services. This is especially true in communities where a religiously controlled or religiously affiliated institution is the sole provider in the area. Low-income and minority women with few resources to obtain alternative medical care are the most vulnerable. For example, in 1992, 14 Catholic hospitals in the Chicago area denied 1,004 rape victims access to the morning-after pill. Of these 1,004 rape victims, 45% were low-income women seeking services in Catholic hospitals in poor and minority communities. The growth of religiously controlled health care systems in the last ten years has been extraordinary. Religiously affiliated networks now include everything from laboratory facilities to outpatient clinics, from insurance companies to individual doctors' practices. Indeed, for a growing number of Americans, religiously controlled systems are now the sole source of medical care.

Clinics that provide abortion services must be affiliated with hospitals.

Although 93% of abortions are performed in clinics or physicians' offices, hospitals have a vital role in maintaining women's access to this essential reproductive service. Abortion clinics are required by law in most states and by professional standards to be affiliated with local hospitals so that they can transfer a patient to a nearby full-service hospital for emergency care. Religiously controlled hospitals that refuse to provide clinics with this necessary back-up service effectively preclude them from performing abortions. In addition, hospitals must also provide abortions to women with critical needs. The 1% of all abortions performed as inpatient hospital procedures are cases involving serious complications, such as life-threatening conditions or fetuses with severe anomalies. In rural areas, where religiously controlled hospitals are often the primary or sole medical providers for families, their refusal to offer emergency services or perform medically complicated abortions is particularly problematic.

Mergers with religiously controlled hospitals have devastating economic consequences for women.

The scarcity of reproductive health services at religiously controlled hospitals not only poses health risks, but also has detrimental economic effects on women. Because these hospitals are forbidden from providing a wide variety of health services, women who need reproductive health services must find them elsewhere. The expenses associated with health care obviously increase when the cheapest and most convenient hospital will not provide needed reproductive services. For low-income women with no health insurance or those who receive Medicaid, these added costs could prevent them from obtaining the health care they need.

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