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The Powerful Constraints on Medical Care in Catholic Hospitals Across America
A woman with long dark hair and wearing a white doctor's coat stands in a hallway with arms by her side and looks at the camera.
Jennifer Chin, an OB-GYN at UW Medicine in Seattle, has treated patients turned away by Catholic hospitals. 鈥淲e had many instances where people would have to get in their car to drive to us while they were bleeding, or patients who had had their water bags broken for up to five days or even up to a week,鈥 Chin says. (Dan DeLong for 素人色情片Health News)

The Powerful Constraints on Medical Care in Catholic Hospitals Across America

Nurse midwife Beverly Maldonado recalls a pregnant woman arriving at Ascension Saint Agnes Hospital in Maryland after her water broke. It was weeks before the baby would have any chance of survival, and the patient鈥檚 wishes were clear, she recalled: 鈥淲hy am I staying pregnant then? What鈥檚 the point?鈥 the patient pleaded.

But the doctors couldn鈥檛 intervene, she said. The fetus still had a heartbeat and it was a Catholic hospital, subject to the 鈥 for Catholic Health Care Services鈥 that prohibit or limit procedures like abortion that the church deems 鈥渋mmoral鈥 or 鈥渋ntrinsically evil,鈥 according to its interpretation of the Bible.

鈥淚 remember asking the doctors. And they were like, 鈥榃ell, the baby still has a heartbeat. We can鈥檛 do anything,鈥欌 said Maldonado, now working as a nurse midwife in California, who asked them: “What do you mean we can鈥檛 do anything? This baby鈥檚 not going to survive.鈥

The woman was hospitalized for days before going into labor, Maldonado said, and the baby died.

Ascension declined to comment for this article.

The Catholic Church鈥檚 directives are often at odds with accepted medical standards, especially in areas of reproductive health, according to physicians and other medical practitioners.

The American College of Obstetricians and Gynecologists鈥 for managing pre-labor rupture of membranes, in which a patient鈥檚 water breaks before labor begins, state that women should be offered options, including ending the pregnancy.

Maldonado felt her patient made her wishes clear.

鈥淯nder the ideal medical practice, that patient should be helped to obtain an appropriate method of terminating the pregnancy,鈥 said Christian Pettker, a professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, who helped author the guidelines.

He said, 鈥淚t would be perfectly medically appropriate to do a termination of pregnancy before the cessation of cardiac activity, to avoid the health risks to the pregnant person.鈥

鈥淧atients are being turned away from necessary care,鈥 said Jennifer Chin, an OB-GYN at UW Medicine in Seattle, because of the 鈥渆mphasis on these ethical and religious directives.鈥

They can be a powerful constraint on the care that patients receive at Catholic hospitals, whether emergency treatment when a woman鈥檚 health is at risk, or access to birth control and abortions.

A close-up image of a woman standing outside in the woods and looking at the camera.
Michigan resident Kalaina Sullivan wanted to have surgery to permanently prevent pregnancy, but her doctor worked for the Catholic chain Trinity Health, the nation鈥檚 fourth-largest hospital system. Sullivan had to travel to North Ottawa Community Health System, an independent hospital near the shores of Lake Michigan, for the surgery.(Kristen Norman for 素人色情片Health News)

More and more women are running into barriers to obtaining care as Catholic health systems have aggressively acquired secular hospitals in much of the country. Four of the 10 largest U.S. hospital chains by number of beds are Catholic, according to federal data from the Agency for Healthcare Research and Quality. There are just over 600 Catholic general hospitals nationally and roughly 100 more managed by Catholic chains that place some religious limits on care, a 素人色情片Health News investigation reveals.

Maldonado鈥檚 experience in Maryland came just months before the Supreme Court鈥檚 ruling in 2022 to overturn Roe v. Wade, a decision that compounded the impact of Catholic health care restrictions. In its wake, roughly a third of states have banned or severely limited access to abortion, creating a one-two punch for women seeking to prevent pregnancy or to end one. Ironically, some states where Catholic hospitals dominate 鈥 such as Washington, Oregon, and Colorado 鈥 are now considered medical havens for women in nearby states that have banned abortion.

素人色情片Health News analyzed state-level birth data to discover that more than half a million babies are born each year in the U.S. in Catholic-run hospitals, including those owned by CommonSpirit Health, Ascension, Trinity Health, and Providence St. Joseph Health. That鈥檚 16% of all hospital births each year, with rates in 10 states exceeding 30%. In Washington, half of all babies are born at such hospitals, the highest share in the country.

鈥淲e had many instances where people would have to get in their car to drive to us while they were bleeding, or patients who had had their water bags broken for up to five days or even up to a week,鈥 said Chin, who has treated patients turned away by Catholic hospitals.

Physicians who turned away patients like that 鈥渨ere going against evidence-based care and going against what they had been taught in medical school and residency,鈥 she said, 鈥渂ut felt that they had to provide a certain type of care 鈥 or lack of care 鈥 just because of the strength of the ethical and religious directives.鈥

Following religious mandates can be dangerous, Chin and other clinicians said.

A woman with long dark hair and wearing glasses, dark blue scrubs, and a white doctor's coat stands with her arms crossed and looks at the camera.
Chin was part of a larger effort by reproductive rights groups and medical organizations that pushed for a state law in Washington to protect physicians if they act against Catholic hospital restrictions. Washington enacted the bill in 2021.(Dan DeLong for 素人色情片Health News)

When a patient has chosen to end a pregnancy after the amniotic sac 鈥 or water 鈥 has broken, Pettker said, 鈥渁ny delay that might be added to a procedure that is inevitably going to happen places that person at risk of serious, life-threatening complications,鈥 including sepsis and organ infection.

Reporters analyzed American Hospital Association data as of August and used Catholic Health Association directories, news reports, government documents, and hospital websites and other materials to determine which hospitals are Catholic or part of Catholic systems, and gathered birth data from state health departments and hospital associations. They interviewed patients, medical providers, academic experts, advocacy organizations, and attorneys, and reviewed hundreds of pages of court and government records and health institutions to understand how the directives affect patient care.

Nationally, nearly 800,000 people have only Catholic or Catholic-affiliated birth hospitals within an hour鈥檚 drive, according to 素人色情片Health News鈥 analysis. For example, that鈥檚 true of 1 in 10 North Dakotans. In South Dakota, it鈥檚 1 in 20. When care is more than an hour away, academic researchers often define the area as a . Pregnant women who must drive farther to a delivery facility are at higher risk of harm to themselves or their fetus, .

Many Americans don鈥檛 have a choice 鈥 non-Catholic hospitals are too far to reach in an emergency or aren鈥檛 in their insurance networks. Ambulances may take patients to a Catholic facility without giving them a say. Women often don鈥檛 know that hospitals are affiliated with the Catholic Church or that they restrict reproductive care, .

And, in most of the country, state laws shield at least some hospitals from lawsuits for not performing procedures they object to on religious grounds, leaving little recourse for patients who were harmed because care was withheld. Thirty-five states prevent patients from suing hospitals for not providing abortions, including 25 states where abortion remains broadly legal. About half of those laws don鈥檛 include exceptions for emergencies, ectopic pregnancies, or miscarriages. Sixteen states prohibit lawsuits against hospitals for refusing to perform sterilization procedures.

鈥淚t鈥檚 hard for the ordinary citizen to understand, 鈥榃ell, what difference does it make if my hospital is bought by this other big health system, as long as it stays open? That鈥檚 all I care about,鈥欌 said Erin Fuse Brown, who is the director of the Center for Law, Health & Society at Georgia State University and an expert in health care consolidation. Catholic directives also ban medical aid in dying for terminally ill patients.

People 鈥渕ay not realize that they鈥檙e losing access to important services, like reproductive health [and] end-of-life care,鈥 she said.

鈥極ur Faith-Based Health Care Ministry鈥

After the Supreme Court ended the constitutional right to abortion in June 2022, Michigan resident Kalaina Sullivan wanted surgery to permanently prevent pregnancy.

A wide shote of a woman standing outside in the woods and looking at the camera.
鈥淚 just don鈥檛 see why there鈥檚 any reason for me to have to follow the rules of their religion and have that be a part of what鈥檚 going on with my body,鈥 Sullivan says. (Kristen Norman for 素人色情片Health News)

Michigan voters in November enshrined the right to abortion under the state constitution, but the state鈥檚 concentration of Catholic hospitals means people like Sullivan sometimes still struggle to obtain reproductive health care.

Because her doctor worked for the Catholic chain Trinity Health, the nation鈥檚 fourth-largest hospital system, she had the surgery with a different doctor at North Ottawa Community Health System, an independent hospital near the shores of Lake Michigan.

Less than two months later, that, too, became a Catholic hospital, newly acquired by Trinity.

To mark the transition, Cory Mitchell, who at the time was the mission leader of Trinity Health Muskegon, stood before his new colleagues and offered a blessing.

鈥淭he work of your hands is what makes our faith-based health care ministry possible,鈥 he said, according to a video of the ceremony Trinity Health provided to 素人色情片Health News. 鈥淢ay these hands continue to bring compassion, compassion and healing, to all those they touch.鈥

Trinity Health declined to answer detailed questions about its merger with North Ottawa Community Health System and the ethical and religious directives. 鈥淥ur commitment to high-quality, compassionate care means informing our patients of all appropriate care options, and trusting and supporting our physicians to make difficult and medically necessary decisions in the best interest of their patients鈥 health and safety,鈥 spokesperson Jennifer Amundson said in an emailed statement. 鈥淗igh-quality, safe care is critical for the women in our communities and in cases where a non-critical service is not available at our facility, the physician will transfer care as appropriate.鈥

Leaders in Catholic-based health systems have hammered home the importance of the church鈥檚 directives, which are issued by the U.S. Conference of Catholic Bishops, all men, and were first drafted in 1948. The essential view on abortion is as it was in 1948. The last revision, in 2018, added several directives addressing Catholic health institution acquisitions or mergers with non-Catholic ones, including that 鈥渨hatever comes under control of the Catholic institution 鈥 whether by acquisition, governance, or management 鈥 must be operated in full accord with the moral teaching of the Catholic Church.鈥

鈥淲hile many of the faithful in the local church may not be aware of these requirements for Catholic health care, the local bishop certainly is,鈥 wrote Sister Doris Gottemoeller, a former board member of the Bon Secours Mercy Health system, in a 2023 . 鈥淚n fact, the bishop should be briefed on a regular basis about the hospital鈥檚 activities and strategies.鈥

Now, for care at a non-Catholic hospital, Sullivan would need to travel nearly 30 miles.

鈥淚 don鈥檛 see why there鈥檚 any reason for me to have to follow the rules of their religion and have that be a part of what鈥檚 going on with my body,鈥 she said.

Risks Come With Religion

Nathaniel Hibner, senior director of ethics at the Catholic Health Association, said the ethical and religious directives allow clinicians to provide medically necessary treatments in emergencies. In a pregnancy crisis when a person鈥檚 life is at risk, 鈥淚 do not believe that the ERDs should restrict the physician in acting in the way that they see medically indicated.鈥

鈥淐atholic health care is committed to the health of all women and mothers who enter into our facilities,鈥 Hibner said.

The directives permit care to cure 鈥渁 proportionately serious pathological condition of a pregnant woman鈥 even if it would 鈥渞esult in the death of the unborn child.鈥 Hibner demurred when asked who defines what that means and when such care is provided, saying, 鈥渇or the most part, the physician and the patients are the ones that are having a conversation and dialogue with what is supposed to be medically appropriate.鈥

It is common for practitioners at any hospital to consult an ethics board about difficult cases 鈥 such as whether a teenager with cancer can decline treatment. At Catholic hospitals, providers must ask a board for permission to perform procedures restricted by the religious directives, clinicians and researchers say. For example, could an abortion be performed if a pregnancy threatened the mother鈥檚 life?

A woman sits on a wooden bench on a beach and looks off-camera to her left.
Sullivan has seen firsthand the growth of Catholic hospitals in western Michigan. She would now have to travel nearly 30 miles for care at a non-Catholic hospital. (Kristen Norman for 素人色情片Health News)

How and when an ethics consultation occurs depends on the hospital, Hibner said. 鈥淭hat ethics consultation can be initiated by anyone involved in the direct care of that situation 鈥 the patient, the surrogate of that patient, the physician, the nurse, the social worker all have the ability to request a consultation,鈥 he said. When asked whether a consultation with an ethics board can occur without a request, he said 鈥渟ometimes it could.鈥

How strictly directives are followed can depend on the hospital and the views of the local bishop.

鈥淚f the hospital has made a difficult decision about a critical pregnancy or an end-of-life care situation, the bishop should be the first to know about it,鈥 Gottemoeller wrote.

In an interview, Gottemoeller said that even when pregnancy termination decisions are made on sound ethical grounds, not informing the bishop puts him in a bad position and hurts the church. 鈥淚f there鈥檚 a possibility of it being misunderstood, or misinterpreted, or criticized,鈥 Gottemoeller said, the bishop should understand what happened and why 鈥渂efore the newspapers call him and ask him for an opinion.鈥

鈥淎nd if he has to say, 鈥榃ell, I think you made a mistake,鈥 well, all right,鈥 she said. 鈥淏ut don鈥檛 let him be blindsided. I mean, we鈥檙e one church and the bishop has pastoral concern over everything in his diocese.鈥

Katherine Parker Bryden, a nurse midwife in Iowa who works for MercyOne, said she regularly tells pregnant patients that the hospital cannot perform tubal sterilization surgery, to prevent future pregnancies, or refer patients to other hospitals that do. MercyOne is one of the largest health systems in Iowa. Nearly half of general hospitals in the state are Catholic or Catholic-affiliated 鈥 the highest share among all states.

The National Catholic Bioethics Center, an ethics authority for Catholic health institutions, that referrals for care that go against church teaching would be 鈥渋mmoral.鈥

鈥淎s providers, you鈥檙e put in this kind of moral dilemma,鈥 Parker Bryden said. 鈥淎m I serving my patients or am I serving the archbishop and the pope?鈥

In response to questions, MercyOne spokesperson Eve Lederhouse said in an email that its providers 鈥渙ffer care and services that are consistent with the guidelines of a Catholic health system.鈥

Maria Rodriguez, an OB-GYN professor at Oregon Health & Science University, said that as a resident in the early 2000s at a Catholic hospital she was able to secure permission 鈥 what she calls a 鈥減ope note鈥 鈥 to sterilize some patients with conditions such as gestational diabetes.

Annie Iriye, a retired OB-GYN in Washington state, said that more than a decade ago she sought permission to administer medication to hasten labor for a patient experiencing a second-trimester miscarriage at a Catholic hospital. She said she was told no because the fetus had a heartbeat. The patient took 10 hours to deliver 鈥 time that would have been cut by half, Iriye said, had she been able to follow her own medical training and expertise. During that time, she said, the patient developed an infection.

Iriye and Chin were part of an effort by reproductive rights groups and medical organizations that pushed for a state law to protect physicians if they act against Catholic hospital restrictions. The bill, , was opposed by the Washington State Hospital Association, whose membership includes multiple large Catholic health systems.

State lawmakers in Oregon in 2021 enacted legislation that if they would reduce access to the types of care constrained by Catholic directives. The hospital lobby has . Washington state lawmakers last year, which the hospital association opposes.

Hibner said Catholic hospitals are committed to instituting systemic changes that improve maternal and child health, including access to primary, prenatal, and postpartum care. 鈥淭hose are the things that I think rural communities really need support and advocacy for,鈥 he said.

Maldonado, the nurse midwife, still thinks of her patient who was forced to stay pregnant with a baby who could not survive. 鈥淭o feel like she was going to have to fight to have an abortion of a baby that she wanted?鈥 Maldonado said. 鈥淚t was just horrible.鈥

素人色情片Health News data editor Holly K. Hacker contributed to this report.

By Hannah Recht

素人色情片Health News identified areas of the country where patients have only Catholic hospital options nearby. The 鈥淓thical and Religious Directives for Catholic Health Care Services鈥 鈥 which are issued by the U.S. Conference of Catholic Bishops, all men 鈥 dictate how patients receive reproductive care at Catholic health facilities. In our analysis, we focused on hospitals where babies are born.

We constructed a national database of hospital locations, identified which ones are Catholic or Catholic-affiliated, found how many babies are born at each, and calculated how many people live near those hospitals.

Hospital Universe

We identified hospitals in the 50 states and the District of Columbia using the from August 2023. We removed hospitals that had closed or were listed more than once, added hospitals that were not included, and corrected inaccurate or out-of-date information about ownership, primary service type, and location. We excluded federal hospitals, such as military and Indian Health Service facilities, because they are not open to everyone.

Catholic Affiliation

To identify Catholic hospitals, we used the . We also counted as Catholic a handful of hospitals that are not part of this voluntary membership group but explicitly follow the Ethical and Religious Directives, according to their mission statements, websites, or promotional materials.

We also tracked Catholic-affiliated hospitals: those that are owned or managed by a Catholic health system, such as CommonSpirit Health or Trinity Health, and are influenced by the religious directives but do not necessarily adhere to them in full. To identify Catholic-affiliated hospitals, we consulted health system and hospital websites, government documents, and news reports.

We combined both Catholic and Catholic-affiliated hospitals for analysis, in line with about the influence of Catholic directives on health care.


To determine the share of births that occur at Catholic or Catholic-affiliated hospitals, we gathered the latest annual number of births by hospital from state health departments. Where recent data was not publicly available, we submitted records requests for the most recent complete year available.

The resulting data covered births in 2022 for nine states and D.C., births in 2021 for 23 states, births in 2020 for nine states, and births in 2019 for one state. We used data from the 2021 American Hospital Association survey, the latest available at the time of analysis, for the eight remaining states that did not provide birth data in response to our requests. A small number of hospitals have recently opened or closed labor and delivery units. The vast majority of the rest record about the same number of births each year. This means that the results would not be substantially different if data from 2023 were available.

We used this data to calculate the number of babies born in Catholic and Catholic-affiliated hospitals, as well as non-Catholic hospitals by state and nationally.

We used hospitals鈥 Catholic status as of August 2023 in this analysis. In 10 cases where the hospital had already closed, we used Catholic status at the time of the closure.

Because our analysis focuses on hospital care, we excluded births that occurred in non-hospital settings, such as homes and stand-alone birth centers, as well as federal hospitals.

Several states suppressed data from hospitals with fewer than 10 births due to privacy restrictions. Because those numbers were so low, this suppression had a negligible effect on state-level totals.

Drive-Time Analysis

We obtained hospitals鈥 geographic coordinates based on addresses in the AHA dataset using geocoder. For addresses that could not be automatically geocoded with a high degree of certainty, we verified coordinates manually using hospital websites and Google Maps.

We calculated the areas within 30, 60, and 90 minutes of travel time from each birth hospital that was open in August 2023 using tools from HERE. We included only hospitals that had 10 or more births as a proxy for hospitals that have labor and delivery units, or where births regularly occur.

The analysis focused on the areas with hospitals within an hour鈥檚 drive. Researchers often define hospital deserts as places where one would have to drive an hour or more for hospital care. (For example: [1] 鈥,鈥 [2] 鈥,鈥 [3] 鈥,鈥 [4] 鈥.鈥)

We combined the drive-time areas to see which areas of the United States have only Catholic or Catholic-affiliated birth hospitals nearby, both Catholic and non-Catholic, non-Catholic only, or none. We then joined these areas to the 2021 census block group shapefile from and removed water bodies using the to calculate the percentage of each census block group that falls within each hospital access category. We calculated the number of people in each area using the 2021 鈥淎merican Community Survey鈥 block group population totals. For example, if half of a block group鈥檚 land area had access to only Catholic or Catholic-affiliated hospitals, then half of the population was counted in that category.