I am no expert on this topic but it has sprung up in my life prominently over the past few years and especially this week and I figured I'd explore it.
The hospital that employs me is apart of a larger system of Catholic hospitals. The hospital was previously "secular" and it was suffering as many community hospitals are today. The merger occurred in the year that I started and I felt mostly positive about it. I wanted to work at this hospital, it had a great program and provided needed services to an underserved community. The clinic that I also worked in separated itself from the hospital so that they could continue to provide contraceptive services mostly unabated.
A brief profile of my average patient: young, African-American, female, poor, unemployed, poorly educated and often pregnant. We work hard at our clinic to aggressively educate and provide our patients with contraception. We know that delaying parenthood and pregnancy spacing makes a difference in the life of both the parent and the children. Not just economically and socially but in terms of the health of the child and the mother.
One of the hurdles I noticed initially was that as providers we could no longer give contraception immediately post-partum/delivery to our moms. In patients who we were sufficiently worried about in terms of clinic followup we would send DIRECTLY over to the clinic from the hospital on the same day of discharge to get long term birth control (usually Depo Provera). I've seen many a patient 8 weeks after deliver show up pregnant once again.
Of course our providers were no-longer able to provide tubal ligations at my hospital for permanent birth control. Initially we had partnerships with gynecologists who if desired, we sent directly to another hospital across the city on the day of discharge via cab for same day surgery. That partnership is no longer available and now our patients must wait for six weeks before they can obtain their desired tubal ligation.
While I know six weeks seems like a short amount of time, but in our patient population especially, sometimes it's about seizing the opportunity. Patient follow-up in clinic is pretty poor, now compound that with well baby visits, new baby sleep deprivation, traveling to a new distant hospital, to see a new doctor for an evaluation for a tubal ligation and then returning to the hospital for the actual procedure. The chance of follow through becomes even less with each factor.
This week in my clinic, I met a young mother of three seeking an IUD two months after her last delivery. This is not unusual but her medical history was. She got her care at another large local Catholic hospital and delivered there but she suffered a dangerous complication twice. She was advised by her primary provider that another pregnancy would put her life in danger. Her primary provider, because of the religious stance of her employer, cannot give this patient the necessary care. So she came to our clinic, we evaluated her, but we have to wait for her provider to send the necessary records so that we can perform the procedure. This disturbs me greatly because I believe in continuity of care. These rules interfere with the doctor-patient relationship and I believe potentially endanger women's lives.
One of our hospital's gynecologist, who got credentialed at another small community hospital in order to perform tubal ligations, pointed to his stack of charts with unscheduled tubals. "I have to do as many as I can in the next few months." Why? Because this hospital is being bought by another Catholic institution. One less provider able to take care of his patients to the best of his ability with the knowledge and skills he was taught. One more hospital in my community that will be using religion to decide what services women can be provided.
Please take some time to educate yourself further on this important issue regarding women's access to the full spectrum of health care:
Mergerwatch
Nurseweek
ACLU