Abstract
Objective
Tubal sterilization remains one of the most commonly requested contraceptive methods
in the United States. Catholic hospital policy prohibits all sterilizations, but this
ban is not uniformly enforced. We conducted this study to assess obstetrician–gynecologists'
beliefs and experiences with tubal ligation in Catholic hospitals.
Study design
We interviewed 31 obstetrician–gynecologists geographically dispersed throughout the
US who responded to a national survey and agreed to be contacted for a follow-up interview
or who were referred by colleagues from the survey sample. Twenty-seven had experienced
working in a Catholic hospital. Interviews were open ended and guided by a semistructured
instrument. Transcripts were thematically analyzed.
Results
Obstetrician–gynecologists disagreed with strict prohibition of sterilizations, especially
when denying a tubal ligation placed the patient at increased medical risk. Cesarean
delivery in Catholic hospitals raised frustration for obstetrician–gynecologists when
the hospital prohibited a simultaneous tubal ligation and, thus, sent the patient
for an unnecessary subsequent surgery. Obstetrician–gynecologists described some hospitals
allowing tubal ligations in limited circumstances, but these workarounds were vulnerable
to changes in enforcement. Some obstetrician–gynecologists reported that Catholic
policy posed greater barriers for low-income patients and those with insurance restrictions.
Conclusion
Obstetrician–gynecologists working in Catholic hospitals in this study did not share
the Church's beliefs on sterilization. Research to understand patients' experiences
and knowledge of their sterilization options is warranted in order to promote women's
autonomy and minimize risk of harm.
Implications statement
Tubal sterilization, even when medically indicated or in conjunction with cesarean
delivery, is severely restricted for women delivering in Catholic hospitals. For women
whose only access to hospital care is at a Catholic institution, religious policies
can prevent them from receiving a desired sterilization and place them at risk for
future undesired pregnancy.
Keywords
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Article info
Publication history
Published online: May 03, 2014
Accepted:
April 29,
2014
Received in revised form:
April 22,
2014
Received:
December 10,
2013
Footnotes
☆Funding Support: The Greenwall Foundation, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1K08 HD060663 to Dr. Stulberg) and the Society of Family Planning (career development grant to Dr. Freedman).
☆☆Disclosure: The authors have no conflicts of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
