title: Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns' experiences.
abstract: OBJECTIVE
  Tubal sterilization remains one of the most commonly requested contraceptive methods in the United States. Catholic hospital policy prohibits all sterilizations, but this ban is not uniformly enforced. We conducted this study to assess obstetrician-gynecologists' beliefs and experiences with tubal ligation in Catholic hospitals.
  
  
  METHODS
  We interviewed 31 obstetrician-gynecologists geographically dispersed throughout the US who responded to a national survey and agreed to be contacted for a follow-up interview or who were referred by colleagues from the survey sample. Twenty-seven had experienced working in a Catholic hospital. Interviews were open ended and guided by a semistructured instrument. Transcripts were thematically analyzed.
  
  
  RESULTS
  Obstetrician-gynecologists disagreed with strict prohibition of sterilizations, especially when denying a tubal ligation placed the patient at increased medical risk. Cesarean delivery in Catholic hospitals raised frustration for obstetrician-gynecologists when the hospital prohibited a simultaneous tubal ligation and, thus, sent the patient for an unnecessary subsequent surgery. Obstetrician-gynecologists described some hospitals allowing tubal ligations in limited circumstances, but these workarounds were vulnerable to changes in enforcement. Some obstetrician-gynecologists reported that Catholic policy posed greater barriers for low-income patients and those with insurance restrictions.
  
  
  CONCLUSIONS
  Obstetrician-gynecologists working in Catholic hospitals in this study did not share the Church's beliefs on sterilization. Research to understand patients' experiences and knowledge of their sterilization options is warranted in order to promote women's autonomy and minimize risk of harm.
  
  
  CONCLUSIONS
  Tubal sterilization, even when medically indicated or in conjunction with cesarean delivery, is severely restricted for women delivering in Catholic hospitals. For women whose only access to hospital care is at a Catholic institution, religious policies can prevent them from receiving a desired sterilization and place them at risk for future undesired pregnancy.
authors.affiliation: Department of Family Medicine, University of Chicago, Chicago, IL; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL; Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL. Electronic address: stulberg@uchicago.edu.
authors.forename: Debra B
authors.initials: DB
authors.lastname: Stulberg
authors.affiliation: Department of Family Medicine, University of Chicago, Chicago, IL.
authors.forename: Yael
authors.initials: Y
authors.lastname: Hoffman
authors.affiliation: Department of Family Medicine, University of Chicago, Chicago, IL.
authors.forename: Irma Hasham
authors.initials: IH
authors.lastname: Dahlquist
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
authors.forename: Lori R
authors.initials: LR
authors.lastname: Freedman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002410:Catholicism; D002585:Cesarean Section; D005260:Female; D006176:Gynecology; D016519:Hospitals, Religious / Q000458:organization & administration*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D016134:Organizational Policy; D036301:Qualitative Research; D012068:Religion and Medicine; D013246:Sterilization, Tubal / Q000191:economics; D014481:United States; D016387:Women's Health
keywords: Gynecology; Obstetrics; Qualitative research; Religious hospitals; Sterilization