January 6, 2015 — Ob-gyns working at Catholic hospitals are concerned that the institutions' ban on tubal ligation violates the accepted standard of care and presents a "risk of harm" to women, according to a study that surveyed providers across the country, The Atlantic reports.
For the study, a follow up to a 2012 study evaluating ob-gyns' conflicts with Catholic hospitals over patients' care, researchers from the University of Chicago, University of California-San Francisco and colleagues conducted in-depth interviews with a subset of physicians who participated in the original research.
The participants worked at Catholic hospitals, which are governed by the U.S. Conference of Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services. The directives, which are enforced by local bishops, ban Catholic facilities from performing sterilizations, abortions and certain other procedures.
Sterilization is the second-most-common birth control method in the U.S. Ob-gyns often perform tubal ligations in conjunction with cesarean sections so women do not have to have a second surgery for the sterilization. A sterilization procedure is performed at the end of about one in 10 U.S. childbirths, according to The Atlantic. Women of color and those without a college education are more likely than other groups to use sterilization as their birth control method.
In the past, some Catholic hospitals provided sterilizations if they were medically indicated, such as when a woman was undergoing a C-section and another pregnancy would present a health risk, The Atlantic reports.
However, around the early 2000s, the Vatican sought stricter enforcement of the directives. Since then, the number of Catholic hospitals in the U.S. has grown, in part because of mergers with secular facilities. The number of Catholic hospitals increased by 16% from 2001 to 2011, according to The Atlantic.
In the 2012 study, about half of ob-gyns at Catholic hospitals reported conflicts with religiously based policies relating to patient care.
In the follow up, the researchers expected the doctors to mention conflicts over abortion, but they were surprised by how often they also mentioned denials of medically indicated sterilization as the source of conflicts, co-author Lori Freedman, a medical sociologist at the University of California-San Francisco, said.
This type of denial "was the most common thing that bothered people in a daily way," she said, adding, "Doctors were really dying to talk about this because it's kind of freaking them out."
Further, study co-author Debra Stulberg of the University of Chicago said, "Many doctors we spoke to had been given assurances when they were hired or when the hospital changed ownership that there would be ways of allowing tubal ligations if it was medically in the women’s best interest. That was not the case."
The Catholic Hospital Association, which represents the more than 600 Catholic hospitals in the U.S., declined to comment on the study but has said in the past that requiring hospitals to provide sterilization would conflict with "the fundamental values of Catholic healthcare" (Miller, The Atlantic, 1/2).