title: Referrals for Services Prohibited In Catholic Health Care Facilities.
abstract: Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored.
  
  
  
  Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011-2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis.
  
  
  
  Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions.
  
  
  
  Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services.
authors.affiliation: Department of Family Medicine, University of Chicago. stulberg@uchicago.edu.
authors.forename: Debra B
authors.initials: DB
authors.lastname: Stulberg
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Jackson
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco.
authors.forename: Lori R
authors.initials: LR
authors.lastname: Freedman
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D002410:Catholicism; D003267:Contraception; D004991:Ethics, Institutional; D005260:Female; D006176:Gynecology; D016519:Hospitals, Religious / Q000941:ethics* / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D016134:Organizational Policy; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation; D027724:Reproductive Techniques, Assisted; D013245:Sterilization, Reproductive