Original Research Article| Volume 107, P62-67, March 2022

What you don't know can hurt you: Patient and provider perspectives on postpartum contraceptive care in Illinois Catholic Hospitals



      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.


      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.


      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.


      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.


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        • Solomon T
        • Uttley L
        • HasBrouck P
        • Jung Y.
        Bigger and bigger: the growth of Catholic health systems.
        Community Catalyst. 2020;
      1. United States Conference of Catholic Bishops. Ethical and Religious Directives for Catholic Health Care Services 2018 [Available from:

        • Liu Y
        • Hebert LE
        • Hasselbacher LA
        • Stulberg DB.
        “Am I going to be in trouble for what I’m doing?”: providing contraceptive care in religious health care systems.
        Perspect Sex Reprod Health. 2019; 51: 193-199
        • Hasselbacher LA
        • Hebert LE
        • Liu Y
        • Stulberg DB.
        “My hands are tied”: abortion restrictions and providers’ experiences in religious and nonreligious health care systems.
        Perspect Sex Reprod Health. 2020; 52: 107-115
        • Stulberg DB
        • Hoffman Y
        • Dahlquist IH
        • Freedman LR.
        Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns’ experiences.
        Contraception. 2014; 90: 422-428
        • Judge C
        • Wolgemuth T
        • Hamm M
        • Borrero S.
        “Without bodily autonomy we are not free”: exploring women’s concerns about future access to contraception following the 2016 US presidential election.
        Contraception. 2017; 96: 370-377
        • Brito M
        • Ferriani R
        • Quintana S
        • Yazlle M
        • Silva de Sá M
        • Vieira C
        Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study.
        Contraception. 2009; 80: 519-526
        • White K
        • Teal S
        • Potter J.
        Contraception after delivery and short interpregnancy intervals among women in the United States.
        Obstet Gynecol. 2015; 125: 1471-1477
        • Schummers L
        • Hutcheon J
        • Hernandez-Diaz S
        • Williams P
        • Hacker M
        • VanderWeele T
        • et al.
        Association of short interpregnancy interval with pregnancy outcomes according to maternal age.
        JAMA Intern Med. 2018; 178: 1661-1670
        • Zhu B
        • Rolfs R
        • Nangle B
        • Horan J.
        Effect of the interval between pregnancies on perinatal outcomes.
        N Engl J Med. 1999; 340: 589-594
        • American College of Obstetrics and Gynecologists
        Interpregnancy care. Obstetric Care Consensus No. 8.
        Obstet Gynecol. 2019; 133: e51-e72
        • American College of Obstetrics and Gynecologists
        Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670.
        Obstet Gynecol. 2016; 128: e32-e37
        • Soliman A
        • Dalton V
        • Moniz M.
        Understanding patient preferences about immediate postpartum long-acting reversible contraception: a qualitative study.
        Obstet Gynecol. 2017; 129: 64S
        • Polis C
        • Schaffer K
        • Harrison T.
        Accessibility of emergency contraception in California’s Catholic hospitals.
        Womens Health Issues. 2005; 15: 174-178
        • Thorne N
        • Soderborg T
        • Glover J
        • Hoffecker L
        • Guiahi M.
        Reproductive health care in Catholic facilities: a scoping review.
        Obstet Gynecol. 2019; 133: 105-115
        • Takahashi J
        • Cher A
        • Sheeder J
        Disclosure of religious identity and health care practices on Catholic hospital websites.
        JAMA. 2019; 321: 1103-1104
        • Guiahi M
        • Sheeder J
        • Teal S.
        Are women aware of religious restrictions on reproductive health at Catholic hospitals? A survey of women’s expectations and preferences for family planning care.
        Contraception. 2014; 90: 429-434
        • Wascher JM
        • Hebert LE
        • Freedman LR
        • Stulberg DB.
        Do women know whether their hospital is Catholic? Results from a national survey.
        Contraception. 2018; 98: 498-503
        • Stulberg D
        • Jackson R
        • Freedman L
        Referrals for services prohibited in Catholic health care facilities.
        Perspect Sex Reprod Health. 2016; 48: 111-117
        • Guiahi M
        • McNulty M
        • Garbe G
        • Edwards S
        • Kenton K.
        Changing depot medroxyprogesterone acetate access at a faith-based institution.
        Contraception. 2011; 84: 280-284
        • Stulberg D
        • McHugh A
        • Hasselbacher L.
        Obstetric and postpartum care in Illinois Catholic hospitals: impact and implications for patients with Medicaid insurance.
        The University of Chicago, Chicago2020
        • Morse JM.
        “Perfectly healthy, but dead”: the myth of inter-rater reliability.
        Qual Health Res. 1997; 7: 445-447
        • Braun V
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Nowell LS
        • Norris JM
        • White DE
        • Moules NJ.
        Thematic analysis: striving to meet the trustworthiness criteria.
        Int J Qual Methods. 2017; 16: 1-13
        • Freedman L
        • Hebert L
        • Battistelli M
        • Stulberg D.
        Religious hospital policies on reproductive care: what do patients want to know?.
        Am J Obstet Gynecol. 2018; 218: 251.E1-251.E9
        • Stulberg D
        • Guiahi M
        • Hebert L
        • Freedman L
        Women’s expectation of receiving reproductive health care at Catholic and non-Catholic hospitals.
        Perspect Sex Reprod Health. 2019; 51: 135-142
        • Wascher J
        • Stulberg D
        • Freedman L.
        Restrictions on reproductive care at Catholic hospitals: a qualitative study of patient experiences and perspectives.
        AJOB Empir Bioeth. 2020; 11: 257-267
        • Freedman LR
        • Landy U
        • Steinauer J.
        When there’s a heartbeat: miscarriage management in Catholic-owned hospitals.
        Am J Public Health. 2008; 98: 1774-1778
        • Guiahi M
        • Helbin P
        • Teal S
        • Stulberg D
        • Sheeder J.
        Patient views on religious institutional health care.
        JAMA Netw Open. 2019; 2: e1917008
        • Wingo EE
        • Wascher JM
        • Stulberg DB
        • Freedman LR.
        Anticipatory counseling about miscarriage management in Catholic hospitals: a qualitative exploration of women’s preferences.
        Perspect Sex Reprod Health. 2020; 52: 171-179
        • Stulberg D
        • Dude A
        • Dahlquist I
        • Curlin F.
        Obstetrician-gynecologists, religious institutions, and conflicts regarding patient-care policies.
        Am J Obstet Gynecol. 2012; 207: 73.E1-73.E5
        • Jameton A.
        Nursing practice: the ethical issues.
        Prentice-Hall, Englewood Cliffs, NJ1984: 331
        • Pauly B
        • Varcoe C
        • Storch J.
        Framing the issues: moral distress in health care.
        HEC Forum. 2012; 24: 1-11
        • Younjae O
        • Chris G.
        Moral distress experienced by nurses: a quantitative literature review.
        Nurs Ethics. 2015; 22: 15-31
        • Guiahi M.
        Religious refusals to long-acting reversible contraceptives in Catholic settings: a call for evidence.
        Am J Obstet Gynecol. 2020; 222: S869.e1-S869.e5
        • Brown BP
        • Hasselbacher L
        • Chor J.
        Whose choice? Developing a unifying ethical framework for conscience laws in health care.
        Obstet Gynecol. 2016; 128: 391-395
      2. 775 ILCS 55/Reproductive Health Act. 2021 [Available from:].