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Catholic Health Care

Religious Freedom & Catholic Health Care

Over the last decade, there have been attempts to turn the meaning of religious freedom on its head. These attempts have occurred in the arena of health care, specifically over legislative efforts to counteract out-of-date regulatory policies and unethical and questionable religious restrictions on some services at Catholic and Catholic-controlled hospitals. Specifically, new laws have been introduced around the country to mandate contraceptive insurance coverage and emergency contraception provision in emergency rooms.

Opponents of reproductive choice in the institutional Catholic leadership have attempted to convince policy makers and the media that requiring them to comply with the law would violate their religious freedom.  In fact, the Catholic Health Association (CHA) has attempted to spin the debate in its favor, publishing a manual for its members that puts forward messages to this effect and ignores the profound violation of the consciences of women and couples by denying services.

The Scope of Catholic Health Care

Most Americans are unaware of the size of the Catholic health care system or the likelihood that a significant proportion of the population, Catholic or not, will seek treatment at a Catholic facility.  Catholic hospitals provide a substantial portion of care in the United States. In 2001, 31 percent of Americans received care in a Catholic facility.  The Catholic health care system controls more than 11 percent of the nation’s total community hospitals and more than 16 percent of the nation’s total community hospital beds.  Nearly 18 percent of all hospitals and 20 percent of all hospital beds in health systems are owned or controlled by the Catholic church.  Thus, the Catholic health care system has a significant medical responsibility to millions of Americans.

Catholic Restrictions on
Reproductive Health Care Services

Unfortunately, Catholic health care institutions do not provide women with all basic and essential reproductive health services.  Catholic health care in the US is regulated by the Ethical and Religious Directives for Catholic Health Care Services (the Directives), which were issued not by doctors, ethicists or regulatory authorities, but by the nation’s Catholic bishops. These directives forbid services that contradict church positions, namely, prohibiting reproductive health options such as:

  • abortion
  • contraceptive sterilization
  • in vitro fertilization and
  • prescribing or dispensing contraceptives and contraceptive devices such as IUDs and diaphragms, emergency contraception, and condoms. 

These restrictions are placed not only on Catholic hospitals, but also on Catholic HMOs, Catholic universities and social services agencies, such as Catholic Charities, which provides a significant amount of care to poor and lower income communities. 

These restrictions are contradictory to current regulatory and legal trends in reproductive health policy. Increasingly, advocates and policymakers are working to ensure that all health care facilities meet a standard of medical and ethical quality despite religious affiliation.  In this effort, they have met sharp resistance from two prominent Catholic institutions, the Catholic Health Association (CHA) and the Unites States Conference of Catholic Bishops (USCCB).  The CHA, a trade organization representing the nation’s Catholic health care institutions, has revenue of over $17 million annually.[1]  The USCCB, a pastoral assembly representing the hierarchy of the Catholic church in the US, boasts a budget of over $150 million[2] and devotes extensive financial and political resources to lobbying in support of restrictions on reproductive health services at Catholic health care facilities. 

The difficulty in establishing equal standards of care has been further hindered by an increase in the number of states with religious refusal clauses.  Currently, 27 states have exemptions from providing family planning services.[3]  As the CHA and the USCCB push to get additional provisions enacted, women’s access to reproductive health care is becoming increasingly curtailed.

The CHA and the USCCB aim to highlight the importance and commitment of Catholic services to the community, while at the same time downplaying the reproductive health needs of the people they serve.  At the core of their strategy is the creation of an ideological framework which would redefine the legal concept of religious freedom.  While working to deflect claims that granting exemptions to Catholic hospitals from following the law or regulations limits the religious freedom of consumers, the CHA and the USCCB seek to create the impression that they have a constitutional right to refuse to provide reproductive health services.  The problem with this argument is that a social service run by an agency affiliated with the Catholic church is not the same thing as the Catholic church.  The Catholic church is provided religious freedom by the US Constitution; its social services are subject to laws and regulations designed to protect consumers. 


1. “Financial Information: Management Discussion of Fiscal Year 2003 Financial Results,” Catholic Health Association website: http://chausa.org/finance/finance_discussion.asp, accessed September 1, 2004.
2. William C. Symonds, “The US Catholic Church, How it Works,” Business Week, April 15, 2002.
3. National Women’s Law Center, “Women’s Access to Care: A State-Level Analysis of Key Health Policies,” 2003, p.84.