Abstract
Objective
Catholic Religious and Ethical Directives restrict access to contraception; yet offering
contraception during a delivery hospitalization facilitates birth spacing and is a
convenient option for patients during the postpartum period. We assessed patient and
provider experiences with hospital transparency around postpartum contraceptive care
in Illinois Catholic Hospitals.
Study Design
We interviewed 44 participants with experience in Illinois Catholic Hospitals: 21
patients, and 23 providers, including clinicians, nurses, doulas, and postpartum program
staff. We used an open-ended interview approach, with a semistructured guide focused
on postpartum contraceptive care. We conducted interviews by phone between November
2019 and June 2020. We audio-recorded interviews, transcribed them verbatim, and coded
transcripts in Dedoose. We developed narrative memos for each code, identifying themes
and subthemes. We organized these in a matrix for analysis and present here themes
regarding hospital transparency that emerged across interviews.
Results
Many patients knew they were delivering in a Catholic hospital; however, few were
aware that Catholic policies limited their health care options. Patients expressed
a desire for hospitals to be transparent, even “very vocal,” about religious restrictions
and described consequences of restrictions on patient care. Patients lacked information
to make contraceptive decisions, experienced limits on or delays in care, and some
lost continuity with trusted providers. Consequences for providers included moral
distress in trying to provide care using workarounds such as documenting false medical
diagnoses.
Conclusions
Religious restrictions on postpartum contraception restrict access, cause unnecessary
delays in care, and lead to misdiagnosis and marginalization of contraceptive care.
Restrictions also cause moral distress to providers who balance career repercussions
and professional integrity with patient needs.
Implications
To protect patient autonomy, especially during the vulnerable postpartum period, Catholic
hospitals should increase transparency regarding limitations on reproductive health
care. Insurers and policy-makers should guarantee that patients have the option to
receive care at hospitals without these limitations and facilitate public education
about what to expect at Catholic facilities.
Keywords
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Article info
Publication history
Published online: November 05, 2021
Accepted:
October 20,
2021
Received in revised form:
October 16,
2021
Received:
April 27,
2021
Footnotes
Declaration of Competing Interest: The authors declare no conflict of interest.
Funding: This study was supported by the Pritzker Community Health Initiative.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
