Anne Nicol Gaylor Reproductive Rights Intern
Freedom From Religion Foundation
The right to sterilization — the decision to permanently prevent pregnancy — is threatened all over the country because of religiously affiliated hospitals and medical facilities.
Tubal ligation, colloquially referred to as “getting your tubes tied,” is a safe and effective procedure that permanently prevents pregnancy by closing or blocking the fallopian tubes. Tubal ligations are 99 percent effective and are extremely safe; Johns Hopkins Medicine reports that serious problems occur in less than 1 in 1,000 women.
Reproductive justice is defined as the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” This means that women’s reproductive health care demands comprehensive access to contraception, abortion, fertility options — and voluntary sterilization.
Before discussing the religious affront to voluntary sterilization, it is important to examine the historical context of sterilization. The United States has an oppressive history of forced sterilization. U.S. public policy claimed the right “to sterilize unwilling and unwitting people,” such as those deemed “feeble-minded,” poor, unwed and incarcerated. Additionally, Black women could be threatened with loss of government benefits should they refuse sterilization. Between 1929 and 1976, more than 7,000 people — largely poor, Black and disabled — were forcibly sterilized or coerced into sterilizations. In Puerto Rico, a commonwealth of the United States, one-third of all Puerto Rican mothers were sterilized between the 1930s and the 1970s, the highest sterilization rate in the world, in an effort to curb poverty and socioeconomic inequalities driven by colonial and capitalist policies. So frequent was the procedure that it was colloquially referred to as “La Operación”. The Catholic Church, interestingly, viewed sterilization as a one-time offense that could be forgiven in confession, whereas oral contraceptives was a regular offense that required a constant withholding of communion.
Compulsory sterilization denies women the right to make their own reproductive choices — and so does the denial of voluntary sterilization by religiously affiliated hospitals, particularly Catholic institutions.
Catholic hospitals abide by Ethical and Religious Directives, rules written by the U.S. Conference of Catholic Bishops. (It should be noted that women are prohibited from being Catholic bishops, as well as all leadership roles in Catholic institutions.) In the directive, as part of the section on “Issues in Care for the Beginning of Life,” reproductive health topics like fertility, abortion, contraception, and sterilization are addressed. Unsurprisingly, the Catholic Church and its health care facilities have rigid standards for reproductive health. For example, abortion is “never permitted,” and Catholic health institutions “may not promote or condone contraceptive practices.” For women who seek tubal ligations, the guidelines are similarly strict: “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.” That means that doctors, who have been educated in evidence-based medicine, are prevented from providing levels of care that are determined to be in the patient’s best interest.
As a result, women are prohibited from their human right to bodily autonomy. It is also important to mention that only 14 percent of U.S. Catholics agree with the Vatican’s position that abortion should be illegal in all cases and 98 percent of Catholics use contraception.
As Catholic hospitals continue to take up health care real estate, reproductive options for women dwindle, particularly for women of color and low-income women. According to researchers from the University of California-San Francisco, women of color and those in poverty are less likely to use contraception and more likely to have unintended pregnancies. When Catholic hospitals are the dominant health care facilities in their communities, these socioeconomic inequalities are compounded. For women delivering by C-section who choose sterilization as a permanent form of birth control, a physician can simply cut and cauterize the fallopian tubes while the abdomen is still open. But women with the bad luck to be delivering at a Catholic hospital are denied this right, and must undergo a second, unnecessary surgery, if they can even find a hospital in their area that will perform one, at great additional pain and expense.
The situation is much worse in Freedom From Religion Foundation’s home state. In Wisconsin, one-third of hospitals are Catholic — more than twice the national average. In fact, Catholic hospitals in Wisconsin grew by 13 percent, while the number of non-Catholic fell by the same percentage, between 2001 and 2018. Because Wisconsin is one of 15 states that does not require a Certificate of Need, a legal document before proposed acquisitions, expansions or creations of health care facilities are allowed, Catholic hospitals can expand with little oversight. They also receive billions of taxpayer dollars per year, with Medicaid and Medicare accounting for 45.7 percent of total revenues for Catholic-sponsored or -affiliated hospitals. In fact, Catholic hospitals in Wisconsin are so rampant that researchers from Columbia Law School determined that it is the only state in the country where Black women are more likely to deliver their babies in a Catholic institution than in a non-Catholic one.
Catholic hospitals are not forthcoming with their religious policies on health care, particularly reproductive care. For example, only 28 percent of hospitals listed in the Catholic Health Association’s directory described how their religious practices might influence patient care while 21 percent of hospitals did not explicitly disclose their Catholic identity. Additionally, only 24 percent of Catholic hospitals cited the Ethical and Religious Directives. Consequently, one-third of women who go to Catholic hospitals for reproductive care are unaware of limited health care options due to religion. Some Catholic hospitals prohibit their physicians from referring patients to locations where they can receive comprehensive reproductive care, including tubal ligation.
This means that women seeking tubal ligations are not able to make informed decisions about their reproductive health at Catholic hospitals. Professor Arthur Caplan, a bioethics researcher at the NYU School of Medicine, underscores the importance of informed consent that is disregarded in Catholic hospitals: “Patient autonomy absolutely requires being told of any limits, differences or variations from what a patient might expect to receive in terms of care in a secular hospital”.
In order to protect women’s full reproductive rights, including the right to choose a tubal ligation, it is imperative that Catholic hospitals disclose their religious health care limitations on their website, during patient registration, and throughout patient-provider conversations. Furthermore, Catholic hospitals should be required to refer patients to locations that can provide the reproductive health care that they seek. Lastly, states such as Wisconsin should require a Certificate of Need for health care facilities. Until these provisions are in place, women will never achieve reproductive justice.
Barbara Alvarez is from Madison, Wis., and attends the University of Wisconsin-Madison, working on a Ph.D. in library and information sciences with a minor in gender and women’s studies. Alvarez was a major winner in last year’s FFRF essay competition for graduate students, writing about the bible’s role in the abortion battle. She is FFRF’s first Anne Nicol Gaylor Reproductive Rights Intern, a program set up to memorialize FFRF’s principal founder, who was an early abortion rights activist and author of the book Abortion is a Blessing.