No Strings Attached: How Catholic Institutions Prospered at the Expense of the Administrative State and Patient Autonomy.

Catholic hospitals and health systems have proliferated and succeeded in American healthcare; they now operate four of the largest health systems and serve nearly one in six hospital patients. Like other religious entities that Wuest and Last write about in this issue, in their article Church Against State, they have benefited by and supported the long reach of conservative efforts to undermine the administrative state.

Beyond : Employer's responsibilities and opportunities to improve network access to reproductive healthcare for employees.

The majority of United States (US) women age 15-49 have employer-sponsored health insurance, but these insurance plans fall short if employees cannot find providers who meet reproductive health needs. Employers could and should do more to facilitate and advocate for their employees through the insurance plans they sponsor. We conducted interviews with 14 key informants to understand how large United States employers see their role in health insurance benefits, especially when it comes to reproductive health care access and restrictions in religious health systems.

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

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.

"Going through it together": Being accompanied by loved ones during birth and abortion.

We sought to understand the meaning people who have given birth and have had an abortion ascribe to being accompanied by partners, family members and friends during these reproductive experiences. Incorporating this knowledge into clinical practice may contribute to improving the quality of these services, especially in abortion care, in which loved ones are often excluded. The study took place in Northern California in 2014.

Reproductive healthcare denials among a privately insured population.

This study aimed to quantify and examine reproductive healthcare denials experienced by individuals receiving employer-sponsored health insurance. We conducted a national cross-sectional survey using probability and non-probability-based panels from December 2019-January 2020. Eligible respondents were adults employed by any Standard and Poor's 500 company, who received employer-sponsored health insurance.

Expectations about availability of contraception and abortion at a hypothetical Catholic hospital: Rural-urban disparities among Wisconsin women.

Objective: To examine rural-urban differences in reproductive-aged Wisconsin women's expectations for contraceptive and abortion care at a hypothetical Catholic hospital.

Study Design: Between October 2019 and April 2020, we fielded a 2-stage, cross-sectional survey to Wisconsin women aged 18 to 45, oversampling rural census tracts and rural counties served by Catholic sole community hospitals. We presented a vignette about a hypothetical Catholic-named hospital; among participants perceiving it as Catholic, we conducted multivariable analyses predicting expectations for contraceptive services (birth control pills, Depo-Provera, intrauterine device or implant, tubal ligation) and abortion in the case of serious fetal indications.

Prevalence and experiences of Wisconsin women turned away from Catholic settings without receiving reproductive care.

Objective: To estimate prevalence of being turned away from a Catholic healthcare setting without receiving desired reproductive care among Wisconsin women and to document firsthand accounts of these experiences.

Study Design: Between October 2019 and April 2020, we fielded a two-stage survey to Wisconsin women aged 18-45, oversampling rural census tracts and rural counties served by Catholic sole community hospitals. We present prevalence of ever being turned away from a Catholic hospital or clinic without receiving desired contraceptive or fertility care and document accounts of referrals, perceived barriers, and wait times to acquire services elsewhere.

Denial of tubal ligation in religious hospitals: Consumer attitudes when insurance limits hospital choice.

Objectives: Postpartum tubal ligation provides demonstrated benefits to women, but access to this procedure is threatened by restrictions at Catholic healthcare institutions. We aimed to understand how insured employees assign responsibility for postpartum sterilization denial and how it impacts their view of the quality of care provided.

Study Design: We conducted a nationally representative, cross-sectional survey of employees at Standard and Poor's (S&P) 500 companies utilizing a dual panel drawn from Amerispeak, a probability-based research panel, and a non-probability panel.

Interprofessional Abortion Opposition: A National Survey and Qualitative Interviews with Abortion Training Program Directors at U.S. Teaching Hospitals.

Context: Hospital policies and culture affect abortion provision. The prevalence and nature of colleague opposition to abortion and how this opposition limits abortion care in U.S.

Choosing a hospital for obstetric, gynecologic, or reproductive healthcare: what matters most to patients?

Background: Despite millions of U.S. women receiving obstetric/gynecologic or reproductive care in a hospital each year, little is known about which factors matter most to women in choosing a hospital for this care.

Chilean Medical and Midwifery Faculty's Views on Conscientious Objection for Abortion Services.

Context: In 2017, Chile reformed its abortion law to allow the procedure under limited circumstances. Exploring the views of Chilean medical and midwifery faculty regarding abortion and the use of conscientious objection (CO) at the time of reform can inform how these topics are being taught to the country's future health care providers.

Methods: Between March and September 2017, 30 medical and midwifery school faculty from universities in Santiago, Chile were interviewed; 20 of the faculty taught at secular universities and 10 taught at religiously affiliated universities.

The Fine Line Between Informing and Coercing: Community Health Center Clinicians' Approaches to Counseling Young People About IUDs.

Context: While community health centers (CHCs) are meeting increased demand for contraceptives, little is known about contraceptive counseling in these settings. Understanding how clinicians counsel about IUDs in CHCs, including whether they address or disregard young people's preferences and concerns during counseling, could improve contraceptive care.

Methods: As part of a training program, 20 clinicians from 11 San Francisco Bay Area CHC sites who counsel young people about contraception were interviewed by telephone in 2015 regarding their IUD counseling approaches.

Anticipatory Counseling About Miscarriage Management in Catholic Hospitals: A Qualitative Exploration of Women's Preferences.

Context: Catholic hospitals represent a large and growing segment of U.S. health care.

Restrictions on Reproductive Care at Catholic Hospitals: A Qualitative Study of Patient Experiences and Perspectives.

Background: Previous studies have shown that many women who would seek care at Catholic hospitals are unaware of the hospital's religious affiliation. Furthermore, women often do not realize that these institutions operate according to religious beliefs that restrict access to certain reproductive services. Our study aimed to gain patient perspectives on experiences seeking reproductive care at religiously affiliated institutions.

Abortion Policies in U.S. Teaching Hospitals: Formal and Informal Parameters Beyond the Law.

Objective: To evaluate the prevalence and features of policies regulating abortion in U.S. teaching hospitals.

Exploring young women's reasons for adopting intrauterine or oral emergency contraception in the United States: a qualitative study.

Background: The recent focus on increasing access to long-acting reversible contraceptive methods has often overlooked the diverse reasons why women may choose less effective methods even when significant access barriers have been removed. While the copper intrauterine device (IUD) is considered an acceptable alternative to emergency contraception pills (ECPs), it is unclear to what extent low rates of provision and use are due to patient preferences versus structural access barriers. This study explores factors that influence patients' choice between ECPs and the copper IUD as EC, including prior experiences with contraception and attitudes toward EC methods, in settings where both options are available at no cost.

Women's Expectation of Receiving Reproductive Health Care at Catholic and Non-Catholic Hospitals.

Context: Catholic hospitals operate under directives that prohibit the provision of contraceptives, sterilization and abortion. Little research has examined women's awareness of these institutions' policies, which affects their ability to make informed decisions about where to seek care.

Methods: In 2016, some 1,430 women aged 18-45 were recruited from a U.

Do women know whether their hospital is Catholic? Results from a national survey.

Objectives: Catholic healthcare limits access to common reproductive care. We assessed what percentage of US women seeking care at Catholic hospitals are aware of their hospital's religious affiliation and identified variables associated with correct identification.

Study Design: We conducted a national survey of women ages 18-45 (response rate 50%).

"Birth Control can Easily Take a Back Seat": Challenges Providing IUDs in Community Health Care Settings.

Objective: To assess community health centers' (CHCs) capacity to offer streamlined intrauterine devices (IUDs) services.

Methods: Prior to implementing a contraceptive training project, we surveyed health care staff (N=97) from 11 CHC sites that offer IUDs onsite. Twenty interviews with clinicians explored more deeply their challenges offering IUDs in the CHC setting.

Expanding the Abortion Provider Workforce: A Qualitative Study of Organizations Implementing a New California Policy.

Context: Access to abortion care in the United States varies according to multiple factors, including location, state regulation and provider availability. In 2013, California enacted a law that authorized nurse practitioners (NPs), certified nurse-midwives (CNMs) and physician assistants (PAs) to provide first-trimester aspiration abortions; little is known about organizations' experiences in implementing this policy change.

Methods: Beginning 10 and 24 months after implementation of the new law, semistructured interviews were conducted with 20 administrators whose five organizations trained and employed NPs, CNMs and PAs as providers of aspiration abortions.

Religious hospital policies on reproductive care: what do patients want to know?

Background: Religious hospitals are a large and growing part of the American healthcare system. Patients who receive obstetric and other reproductive care in religious hospitals may face religiously-based restrictions on the treatment their doctor can provide. Little is known about patients' knowledge or preferences regarding religiously restricted reproductive healthcare.

A good abortion experience: A qualitative exploration of women's needs and preferences in clinical care.

What do women ending their pregnancies want and need to have a good clinical abortion experience? Since birth experiences are better studied, birth stories are more readily shared and many women who have had an abortion have also given birth, we sought to compare women's needs and preferences in abortion to those in birth. We conducted semi-structured intensive interviews with women who had both experiences in the United States and analyzed their intrapartum and abortion care narratives using grounded theory, identifying needs and preferences in abortion that were distinct from birth. Based on interviews with twenty women, three themes emerged: to be affirmed as moral decision-makers, to be able to determine their degree of awareness during the abortion, and to have care provided in a discreet manner to avoid being judged by others for having an abortion.

"She's on her own": a thematic analysis of clinicians' comments on abortion referral.

Objective: The objective was to understand the motivations around and practices of abortion referral among women's health providers.

Methods: We analyzed the written comments from a survey of Nebraska physicians and advanced-practice clinicians in family medicine and obstetrics-gynecology about their referral practices and opinions for a woman seeking an abortion. We analyzed clinician's responses to open-ended questions on abortion referral thematically.