美国国家公共电台 NPR--Getting contraception gets complicated for patients at Catholic hospitals

Getting contraception gets complicated for patients at Catholic hospitals

Transcript¹

Many hospitals and health care clinics in the U.S. are affiliated² with the Catholic Church, which means religious directives might limit the types of contraception they can offer.

STEVE INSKEEP, HOST:

This summer's abrupt³ changes in abortion⁴ laws are having a number of side effects, from the political to the personal. Abortion has become an issue in many of this year's election campaigns. And changing laws also raise the stakes for contraception. The effort to obtain it is complicated for many people served by Catholic institutions. Catholic health care serves people across this country, although many hospitals and clinics are subject to ethical⁵ and religious directives issued by the U.S. Conference of Catholic Bishops⁶. Hospitals will not perform tubal ligation or vasectomies. And some clinics will not fit IUDs or prescribe birth control pills to prevent pregnancy⁷. NPR's Maria Godoy has been looking at the implications of these restrictions⁸, and her story begins with a personal experience.

MARIA GODOY, BYLINE⁹: So when I, you know, was pregnant with my second child and I knew that was going to be my final child - and I was having a scheduled C-section. And my sister the last week before said, hey, you know, you - if you know you're done, why don't you get your tubes tied? And I said, oh, good idea. And I didn't have a chance to ask my doctor until I was actually on the operating table. And I said, while you're down there, would you mind tying my tubes? And he told me, I can't, actually, because this is a Catholic hospital, and they don't allow that here.

INSKEEP: I just want people to know, you grew up Catholic, but you still were a little bit surprised about what was and was not allowed in a Catholic hospital.

GODOY: Yeah, absolutely. And, you know, this kind of lack of awareness¹⁰ is pretty widespread, but turns out so is Catholic health care. It actually goes back to the early days of the country. Catholic sisters went around the U.S. setting up hospitals. And over time, those hospitals banded together to form health networks. And we actually see the impact today. You know, four of the 10 largest health care systems in the country are Catholic. In some counties, they dominate the market. In 52 communities, the only local hospital is Catholic.

INSKEEP: And it's not just hospitals?

GODOY: Right. So there's been a lot of consolidation¹¹ in the health care system just in general. And now you see Catholic health networks that have bought up doctors practices, urgent care clinics, surgery centers. These are now subject to Catholic religious directives, which, among other things, ban contraception for the sole purpose of preventing pregnancy. I actually talked to Debra Stulberg of the University of Chicago. She's done a lot of research on how these religious directives play out when it comes to reproductive health.

DEBRA STULBERG: You cannot promote or condone¹² contraception other than natural family planning for married couples under specific sort of church-sanctioned situations. That ban on contraception includes a ban on permanent contraception - so things like tubal ligation and vasectomy.

GODOY: And other forms of contraception as well - and this has the potential to impact a lot of people. One study, for example, found nearly 40% of women of reproductive age live in areas of the country where Catholic hospitals are big players or dominate the market.

INSKEEP: How strictly¹³ are the religious directives enforced in those institutions?

GODOY: The answer is it varies a lot. One thing Stulberg's research has found is many of the doctors who work at Catholic-owned or affiliated hospitals will often employ workarounds. So, for instance, while the directives ban contraception to prevent pregnancy, they do allow it for other medical uses. So you might find lots of prescriptions¹⁴ for hormonal¹⁵ birth control pills or IUDs that are written to control, quote-unquote, "heavy bleeding."

STULBERG: If a patient is interested in a hormonal IUD and the provider is prohibited from providing it for contraceptive purposes, if the patient says that they have very heavy periods and are interested in treatment for that, in many cases, the provider can provide it for that reason.

GODOY: So I heard this over and over again from the doctors I talked to. They wanted to help their patients prevent pregnancy. But they have to find another reason for providing birth control. One of them, Dr. Corinne McLeod, told me when she worked at a Catholic hospital in Albany, N.Y., several years ago, tubal ligation, which is a permanent form of birth control - it was prohibited. But doctors could remove a woman's fallopian tubes altogether if they said it was to reduce her risk of ovarian cancer.

CORINNE MCLEOD: And that was basically a wink¹⁶, wink, nudge, nudge. We're just doing it for - to reduce your risk for ovarian cancer, and it happens to also keep you from getting pregnant.

GODOY: So they couldn't tie a patient's tubes, but they could remove them altogether.

INSKEEP: In spite of these workarounds, are some options just not available to some women?

GODOY: Yeah. So people who study this say workarounds are less likely to be available for certain kinds of birth control. For example, it was rare to get one if you wanted a copper¹⁷ IUD, which is one of the most effective forms of long-acting, reversible contraception. Debra Stulberg has done surveys that find a lot of people don't realize their choices may be limited because they don't know their health provider is governed by these rules.

STULBERG: And of the people that had some kind of a reproductive health refusal, the majority - it wasn't until either they were there or afterwards that they, you know, found out that they couldn't get what they wanted.

INSKEEP: What should women do when they can't get what they want?

GODOY: It partly depends on their health insurance and whether or not the providers covered under the plan are subject to these religious directives. So ask questions when you are choosing health insurance. Check out the options and providers. And when you're booking an appointment for birth control and you know what type you want, ask ahead of time if that specific form is offered. But the fact is, for some people, depending on where they live or their insurance plan, there may just not be any other option.

STULBERG: In some cases, women truly have no other choices. This hospital or this system is the only provider in town.

GODOY: Low-income women on Medicaid, by law, are supposed to have access to at least some providers that offer contraception. But Stulberg's research has found that's not always the case either.

INSKEEP: What did the Catholic hospitals tell you about this?

GODOY: I reached out to the Catholic Health Association of the U.S. They couldn't make anyone available to talk, but they did send a statement acknowledging that Catholic health providers don't offer services for, quote, "the sole purpose of contraception." But they said they do offer services to address underlying¹⁸ medical conditions. They say Catholic hospitals have a long history of caring for women and children.

INSKEEP: NPR's Maria Godoy.

Thanks so much.

GODOY: My pleasure.

(SOUNDBITE OF MARK MCGUIRE'S "SILENT WEAPONS (THE ARCHITECTS OF MANIPULATION)")

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 affiliated   

adj. 附属的, 有关连的

参考例句：

• The hospital is affiliated with the local university. 这家医院附属于当地大学。
• All affiliated members can vote. 所有隶属成员都有投票权。

3 abrupt   

adj.突然的，意外的；唐突的，鲁莽的

参考例句：

• The river takes an abrupt bend to the west.这河突然向西转弯。
• His abrupt reply hurt our feelings.他粗鲁的回答伤了我们的感情。

4 abortion   

n.流产，堕胎

参考例句：

• She had an abortion at the women's health clinic.她在妇女保健医院做了流产手术。
• A number of considerations have led her to have a wilful abortion.多种考虑使她执意堕胎。

5 ethical   

adj.伦理的，道德的，合乎道德的

参考例句：

• It is necessary to get the youth to have a high ethical concept.必须使青年具有高度的道德观念。
• It was a debate which aroused fervent ethical arguments.那是一场引发强烈的伦理道德争论的辩论。

6 bishops   

（基督教某些教派管辖大教区的）主教( bishop的名词复数 )； （国际象棋的）象

参考例句：

• Each player has two bishops at the start of the game. 棋赛开始时，每名棋手有两只象。
• "Only sheriffs and bishops and rich people and kings, and such like. “他劫富济贫，抢的都是郡长、主教、国王之类的富人。

7 pregnancy   

n.怀孕，怀孕期

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
• Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。

8 restrictions   

约束( restriction的名词复数 )； 管制； 制约因素； 带限制性的条件（或规则）

参考例句：

• I found the restrictions irksome. 我对那些限制感到很烦。
• a snaggle of restrictions 杂乱无章的种种限制

9 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

10 awareness   

n.意识，觉悟，懂事，明智

参考例句：

• There is a general awareness that smoking is harmful.人们普遍认识到吸烟有害健康。
• Environmental awareness has increased over the years.这些年来人们的环境意识增强了。

11 consolidation   

n.合并,巩固

参考例句：

• The denser population necessitates closer consolidation both for internal and external action. 住得日益稠密的居民，对内和对外都不得不更紧密地团结起来。 来自英汉非文学 - 家庭、私有制和国家的起源
• The state ensures the consolidation and growth of the state economy. 国家保障国营经济的巩固和发展。 来自汉英非文学 - 中国宪法

12 condone   

v.宽恕；原谅

参考例句：

• I cannot condone the use of violence.我不能宽恕使用暴力的行为。
• I will not condone a course of action that will lead us to war.我绝不允许任何导致战争的行为。

13 strictly   

adv.严厉地，严格地；严密地

参考例句：

• His doctor is dieting him strictly.他的医生严格规定他的饮食。
• The guests were seated strictly in order of precedence.客人严格按照地位高低就座。

14 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

15 hormonal   

adj.激素的

参考例句：

• Some viral diseases are more severe during pregnancy, probably tecause of hormonal changes. 有些病毒病在妊娠期间比较严重，可能是由于激素变化引起的。
• She underwent surgical intervention and a subsequent short period of hormonal therapy. 他接受外科手术及随后短暂荷尔蒙治疗。

16 wink   

n.眨眼，使眼色，瞬间；v.眨眼，使眼色，闪烁

参考例句：

• He tipped me the wink not to buy at that price.他眨眼暗示我按那个价格就不要买。
• The satellite disappeared in a wink.瞬息之间，那颗卫星就消失了。

17 copper   

n.铜；铜币；铜器；adj.铜(制)的；(紫)铜色的

参考例句：

• The students are asked to prove the purity of copper.要求学生们检验铜的纯度。
• Copper is a good medium for the conduction of heat and electricity.铜是热和电的良导体。

18 underlying   

adj.在下面的，含蓄的，潜在的

参考例句：

• The underlying theme of the novel is very serious.小说隐含的主题是十分严肃的。
• This word has its underlying meaning.这个单词有它潜在的含义。