How the Catholic Health System is Secretively Stamping Out Birth Control and Sacrificing Rural OB Care

As you drive across the great state of Illinois on Interstate 88, Dixon is one of the few towns outside Chicagoland whose hospital has OB services. It’s the only OB hospital in Lee County– that goes without saying. Next door, Ogle County has no maternity services.

But Dixon will probably not have OB services for much longer. Sure, all the usual factors contribute – rural hospitals suffer from declining population and low Medicaid payments for OB services. But the main reason maternity care in Dixon is on the brink is the Catholic Ethical Directives.

Yes, in these maternity deserts, where women already have to drive long distances to get care, where unplanned out-of-hospital births and maternal mortality and morbidity are already higher, Catholic health systems are actively driving previously happy Ob/Gyns out as they continue to acquire small hospitals and impose their draconian birth control restrictions.

And just like that, those maternity deserts get bigger and bigger.

Starting a new life as an Ob/Gyn in Dixon

Dr. Christine Doyle moved from suburban Chicago to Dixon, Illinois (pop. 15,274) in 2020 to escape her noncompete clause, after her previous practice was bought by private equity. Now she’s looking to escape the birth control restrictions being forced on her after her current practice was bought by a large Catholic system called OSF HealthCare. (I believe OSF stood for “Order of Saint Francis” once upon a time, but they are just called OSF now.)

Doyle says that when she first started working at the Katherine Shaw Bethea Hospital in Dixon, then not religiously affiliated, she thought she had found her “forever job.” She acknowledges it’s not easy working rural OB, but she loved it. “Between my patient population and my team from the bottom up, they’ve become friends and family since I’ve been here.”

However, like many rural hospitals, Katherine Shaw Bethea met with financial hardship. Earlier this year, hospital leadership announced the search for an affiliate to acquire the hospital. Several hospital systems submitted bids, and OSF’s was announced as the winner.

Life gets more and more complicated

Nervous about Catholic restrictions on the health care she would be allowed to provide her patients, Dr. Doyle sought out more information. Nobody seemed to want to give it to her.  She says, “I had to throw a tantrum to even speak with an Ob/Gyn employed by OSF.” She still isn’t exactly sure what the new restrictions are, but she believes she will never be able to perform a tubal ligation unless the patient is the carrier of an ovarian cancer mutation; she can never prescribe a copper IUD, Nexplanon, or progesterone only birth control pills under any circumstances; and she can prescribe combination birth control pills, Depo Provera, and hormonal IUDs, but not for contraception – only for an FDA approved non-contraceptive medical reason. Another OSF employee whom we shall call “Ms. X” as she wishes to remain anonymous, states bluntly that even when a pregnancy would threaten a woman’s life, contraception is strictly forbidden by OSF.  “Heart failure does not buy you contraception,” she says. “If mom’s life is in danger, can we tie their tubes? Like if she got pregnant again, it would be fatal? They said no.”

Rules about birth control are shrouded in secrecy.

Dr. Doyle is not the only one who had trouble finding out exactly what her future employer’s rules around birth control are. They are certainly not eager for the general public to know about them. Curious, I myself contacted the OSF Media Relations department to find out what their official policies were around birth control. They refused to tell me. Their representative simply replied, “We are a Catholic healthcare ministry and [sic] our commitment is to continue to abide by the Ethical and Religious Directives for Catholic Healthcare Services and the moral and ethical foundations upon which these stand.” Similarly, the OSF website does not specify that they do not provide contraception, one of the most foundational health care services for women – they simply state they follow the “Ethical and Religious Directives for Catholic Health Care Services” and provide a link to this 30-page document that is difficult for anyone not a theologian to decipher. If you simply want a yes-or-no answer, can I get a Nexplanon or not? You will be disappointed.

Dr. Doyle also learned that if she paid OSF about $400, she could purchase a “Limited Private Practice” (LPP) agreement that would allow her to prescribe her patients combined birth control pills for the purpose of preventing pregnancy. (To be clear, OSF would still be collecting the insurance payments for these visits. Dr. Doyle would not see any additional income.) Despite the secrecy to the greater world around OSF’s birth control policies, internal documents demonstrate an obsessive focus on denying women contraception. Ms. X confirms OSF dedicates a great deal of resources to police physicians closely when prescribing contraception, all to prevent even one prescription going through without the physician stating and documenting extensively that OSF does not approve of it, under the constant threat of physicians losing the LPP option.  OSF requires distribution of a fairly degrading handout (that states only married women should be having sex, states that contraception is frowned upon by OSF, and hilariously refers a women to her local diocese website for medical information on preventing pregnancy) that must be given to every woman receiving contraception. “I have been told that If anything falls through the cracks, the Sisters will take away the LPP completely… A lot of resources are being used to police contraception,” Ms. X states. Screenshots of these handouts are at the bottom of this article.

It is OSF policy to not give these LPP agreements to nurse practitioners, who see many of the office’s low-risk patients, while her advanced training as a physician is needed for high-risk and surgical patients. At a meeting, she says, she was told that women should always be scheduled with her when they need contraception. “But that would be every annual and postpartum checkup. I am busy operating!”

It was a lot. “For a while I convinced myself that I can tolerate it,” she says, but she is actively job searching and says she will probably leave, because, “It’s absolutely against my principles to limit contraceptive care.”

A growing maternity desert

“I don’t think they can recruit to replace me, and I think it will result in the closure of our unit. It took them quite some time to recruit me, and we had someone leave two years ago, and we’ve been trying to recruit with no real interest,” Dr. Doyle says. As there is just one other Ob/Gyn physician at the hospital, they are already using locum tenens doctors to fill the gaps. “I don’t know why anyone would come to this location to practice with [birth control] restrictions,” she says. “It’s not for the faint of heart.”

If Katherine Shaw Bethea Hospital closes their Labor and Delivery, it won’t be the only one in the region. St. Margaret’s hospital in Peru, Illinois (44 miles from Dixon) shut down completely in January 2023, and patients were told to deliver in a town named Ottawa, in the next county over. St. Margaret’s has since been acquired by OSF and has resumed some services, but their birthing unit is still closed.

I wouldn’t blame Dr. Doyle for leaving. As doctors, in our training, we are taught to strive to provide patients with the best and most compassionate care possible, always learning new skills and information and trying to do our absolute best. And suddenly, she is faced with a new employer that is forcing her to provide third-rate care to her patients, forcing her to put their lives at risk on purpose via unwanted pregnancies, and degrade them by telling them that their perfectly reasonable desires to not be pregnant, or to control their pain or heavy bleeding from their periods with various widely available modern technologies, are sinful, immoral, and unethical.

So, in an area that is already a maternity desert, women few and literally far between options to deliver their babies safely as Catholic health care drives their doctors out.

They also have fewer options to NOT be pregnant, because Catholic health care treats contraception like a naughty, sinful afterthought. We already know that the patients of Dr. Doyle’s Ob/Gyn practice in Dixon will no longer have access to birth control. Moreover, even if there were another place to go to get birth control, OSF’s health insurance doesn’t cover it, so female employees of OSF are doubly screwed over. Finally, remember Ogle County, the maternity desert from earlier in this article, with no birthing services available? Well, at least women can get birth control from the family doctors in Ogle County… but only for the time being, because OSF acquired their practice, too. In fact, Dr. Doyle recently joined the Lee County Health Board. She says, “They’re very concerned, because they [Katherine Shaw Bethea Hospital] draw from three to four counties, and some of them have no access to birth control because OSF is buying up the practices.”

Interestingly, Dr. Doyle herself was raised in a Catholic family, and she reports that even her practicing family members are taken aback by the draconian restrictions imposed by OSF.

So over four counties in northern Illinois, OSF is eradicating access to birth control and sabotaging access to OB care, while being remarkably secretive about their practices. (One would think that if they were so proud of the ethics and morals behind their birth control bans, they would shout it from the rooftops.) And it’s not just Dixon. OSF continues to buy up small hospitals and shut down contraception throughout the state of Illinois. Next door, in Iowa, a similar Catholic system, MercyOne, is acquiring more and more hospitals and imposing similar restrictions on their doctors. Nationally, the number of hospitals owned by Catholic health systems is increasing.

Although Dr. Doyle will likely have to uproot and move her young family for the second time in five years, there is a shortage of Ob/Gyn physicians throughout the Midwest, and she is an excellent doctor who has her pick of options. Dr. Doyle will ultimately be fine.

If only the same could be said for the women of Dixon, Illinois.

Karla Solheim, MD, FACOG

Appendix I: Patient handouts that are required to be given and documented when a patient is prescribed contraception.

Appendix II: Patient handouts that are required to be given when a patient requests contraception or non Diocese approved fertility services such as insemination or IVF. As you can see, the verbiage is absolutely fuming that Illinois law requires them to provide information about where patients can go to get these services.

Appendix III: Response from OSF when basic concrete information about their rules about contraception was requested.