STEVE INSKEEP, HOST:
This summer's abrupt changes in abortion laws are having a number of side effects, from the political to the personal. Abortion has become an issue in many of this year's election campaigns. And changing laws also raise the stakes for contraception. The effort to obtain it is complicated for many people served by Catholic institutions. Catholic health care serves people across this country, although many hospitals and clinics are subject to ethical and religious directives issued by the U.S. Conference of Catholic Bishops. Hospitals will not perform tubal ligation or vasectomies. And some clinics will not fit IUDs or prescribe birth control pills to prevent pregnancy. NPR's Maria Godoy has been looking at the implications of these restrictions, and her story begins with a personal experience.
MARIA GODOY, BYLINE: So when I, you know, was pregnant with my second child and I knew that was going to be my final child - and I was having a scheduled C-section. And my sister the last week before said, hey, you know, you - if you know you're done, why don't you get your tubes tied? And I said, oh, good idea. And I didn't have a chance to ask my doctor until I was actually on the operating table. And I said, while you're down there, would you mind tying my tubes? And he told me, I can't, actually, because this is a Catholic hospital, and they don't allow that here.
INSKEEP: I just want people to know, you grew up Catholic, but you still were a little bit surprised about what was and was not allowed in a Catholic hospital.
GODOY: Yeah, absolutely. And, you know, this kind of lack of awareness is pretty widespread, but turns out so is Catholic health care. It actually goes back to the early days of the country. Catholic sisters went around the U.S. setting up hospitals. And over time, those hospitals banded together to form health networks. And we actually see the impact today. You know, four of the 10 largest health care systems in the country are Catholic. In some counties, they dominate the market. In 52 communities, the only local hospital is Catholic.
INSKEEP: And it's not just hospitals?
GODOY: Right. So there's been a lot of consolidation in the health care system just in general. And now you see Catholic health networks that have bought up doctors practices, urgent care clinics, surgery centers. These are now subject to Catholic religious directives, which, among other things, ban contraception for the sole purpose of preventing pregnancy. I actually talked to Debra Stulberg of the University of Chicago. She's done a lot of research on how these religious directives play out when it comes to reproductive health.
DEBRA STULBERG: You cannot promote or condone contraception other than natural family planning for married couples under specific sort of church-sanctioned situations. That ban on contraception includes a ban on permanent contraception - so things like tubal ligation and vasectomy.
GODOY: And other forms of contraception as well - and this has the potential to impact a lot of people. One study, for example, found nearly 40% of women of reproductive age live in areas of the country where Catholic hospitals are big players or dominate the market.
INSKEEP: How strictly are the religious directives enforced in those institutions?
GODOY: The answer is it varies a lot. One thing Stulberg's research has found is many of the doctors who work at Catholic-owned or affiliated hospitals will often employ workarounds. So, for instance, while the directives ban contraception to prevent pregnancy, they do allow it for other medical uses. So you might find lots of prescriptions for hormonal birth control pills or IUDs that are written to control, quote-unquote, "heavy bleeding."
STULBERG: If a patient is interested in a hormonal IUD and the provider is prohibited from providing it for contraceptive purposes, if the patient says that they have very heavy periods and are interested in treatment for that, in many cases, the provider can provide it for that reason.
GODOY: So I heard this over and over again from the doctors I talked to. They wanted to help their patients prevent pregnancy. But they have to find another reason for providing birth control. One of them, Dr. Corinne McLeod, told me when she worked at a Catholic hospital in Albany, N.Y., several years ago, tubal ligation, which is a permanent form of birth control - it was prohibited. But doctors could remove a woman's fallopian tubes altogether if they said it was to reduce her risk of ovarian cancer.
CORINNE MCLEOD: And that was basically a wink, wink, nudge, nudge. We're just doing it for - to reduce your risk for ovarian cancer, and it happens to also keep you from getting pregnant.
GODOY: So they couldn't tie a patient's tubes, but they could remove them altogether.
INSKEEP: In spite of these workarounds, are some options just not available to some women?
GODOY: Yeah. So people who study this say workarounds are less likely to be available for certain kinds of birth control. For example, it was rare to get one if you wanted a copper IUD, which is one of the most effective forms of long-acting, reversible contraception. Debra Stulberg has done surveys that find a lot of people don't realize their choices may be limited because they don't know their health provider is governed by these rules.
STULBERG: And of the people that had some kind of a reproductive health refusal, the majority - it wasn't until either they were there or afterwards that they, you know, found out that they couldn't get what they wanted.
INSKEEP: What should women do when they can't get what they want?
GODOY: It partly depends on their health insurance and whether or not the providers covered under the plan are subject to these religious directives. So ask questions when you are choosing health insurance. Check out the options and providers. And when you're booking an appointment for birth control and you know what type you want, ask ahead of time if that specific form is offered. But the fact is, for some people, depending on where they live or their insurance plan, there may just not be any other option.
STULBERG: In some cases, women truly have no other choices. This hospital or this system is the only provider in town.
GODOY: Low-income women on Medicaid, by law, are supposed to have access to at least some providers that offer contraception. But Stulberg's research has found that's not always the case either.
INSKEEP: What did the Catholic hospitals tell you about this?
GODOY: I reached out to the Catholic Health Association of the U.S. They couldn't make anyone available to talk, but they did send a statement acknowledging that Catholic health providers don't offer services for, quote, "the sole purpose of contraception." But they said they do offer services to address underlying medical conditions. They say Catholic hospitals have a long history of caring for women and children.
INSKEEP: NPR's Maria Godoy.
Thanks so much.
GODOY: My pleasure.
(SOUNDBITE OF MARK MCGUIRE'S "SILENT WEAPONS (THE ARCHITECTS OF MANIPULATION)") Transcript provided by NPR, Copyright NPR.
