{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:57:44Z","timestamp":1788303464775,"version":"build-2803163510"},"reference-count":20,"publisher":"Guttmacher Institute","issue":"3","license":[{"start":{"date-parts":[[2016,7,28]],"date-time":"2016-07-28T00:00:00Z","timestamp":1469664000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001146","name":"Greenwall Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001146","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000008","name":"David and Lucile Packard Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Perspect Sexual Reproductive"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec><jats:title>CONTEXT<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Twenty\u2010seven obstetrician\u2010gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011\u20132012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral\u2010related themes were identified in interview transcripts using qualitative analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Obstetrician\u2010gynecologists 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\u2010income patients or those with urgent medical conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Some Catholic hospitals make it difficult for obstetrician\u2010gynecologists to provide referrals for comprehensive reproductive services.<\/jats:p><\/jats:sec>","DOI":"10.1363\/48e10216","type":"journal-article","created":{"date-parts":[[2016,7,28]],"date-time":"2016-07-28T17:02:46Z","timestamp":1469725366000},"page":"111-117","source":"Crossref","is-referenced-by-count":35,"title":["Referrals for Services Prohibited In Catholic Health Care Facilities"],"prefix":"10.1363","volume":"48","author":[{"given":"Debra B.","family":"Stulberg","sequence":"first","affiliation":[{"name":"Department of Family Medicine University of Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori R.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"259","published-online":{"date-parts":[[2016,7,28]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"UttleyL KhaikinCandHasbrouckP Growth of Catholic Hospitals and Health Systems: 2016 Update of the Miscarriage of Medicine Report New York: MergerWatch 2016 http:\/\/static1.1.sqspcdn.com\/static\/f\/816571\/27061007\/1465224862580\/MW_Update\u20102016\u2010MiscarrOfMedicine\u2010report.pdf?token=7BXxQRTEBazfRtuaaRz1iTUeicE%3D."},{"key":"e_1_2_7_3_1","unstructured":"Department of Health and Human Services Centers for Medicare and Medicaid Services Acute Care Hospital Inpatient Prospective Payment System Baltimore: Department of Health and Human Services 2016 https:\/\/www.cms.gov\/Outreach\u2010and\u2010Education\/Medicare\u2010Learning\u2010Network\u2010MLN\/MLNProducts\/Downloads\/AcutePaymtSysfctsht.pdf."},{"key":"e_1_2_7_4_1","volume-title":"Ethical and Religious Directives for Catholic Health Care Services","author":"United States Conference of Catholic Bishops","year":"2009"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000291561.48203.27"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.5840\/ncbq201212254"},{"issue":"6","key":"e_1_2_7_7_1","first-page":"43","article-title":"Catholic health care and sterilization","volume":"83","author":"O'Rourke K","year":"2002","journal-title":"Health Progress"},{"issue":"1","key":"e_1_2_7_8_1","first-page":"52","article-title":"Conscience, cooperation and full disclosure","volume":"87","author":"Panicola MR","year":"2006","journal-title":"Health Progress"},{"issue":"6","key":"e_1_2_7_9_1","first-page":"49","article-title":"Institutional cooperation: the ERDs","volume":"83","author":"Cataldo PJ","year":"2002","journal-title":"Health Progress"},{"issue":"3","key":"e_1_2_7_10_1","first-page":"23","article-title":"The principle of cooperation","volume":"76","author":"Keenan JF","year":"1995","journal-title":"Health Progress"},{"key":"e_1_2_7_11_1","unstructured":"National Catholic Bioethics Center Transfer of care vs. referral: a crucial moral distinction 2015 http:\/\/www.ncbcenter.org\/resources\/news\/transfer\u2010care\u2010vs\u2010referral\u2010crucial\u2010moral\u2010distinction\/."},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.04.023"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2014.04.015"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1363\/4304111"},{"issue":"4","key":"e_1_2_7_15_1","first-page":"1","article-title":"Conflicts in care for obstetric complications in Catholic hospitals","volume":"4","author":"Freedman LR","year":"2013","journal-title":"American Journal of Bioethics Primary Research"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-010-1329-6"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2011-100176"},{"key":"e_1_2_7_18_1","unstructured":"FrenchV A sense of obligation: opinions on abortion referral among clinicians in Nebraska paper presented at the annual meeting of the American Public Health Association Chicago Oct. 31\u2013Nov. 5 2015."},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2014.10.007"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.06.007"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.12.017"}],"container-title":["Perspectives on Sexual and Reproductive 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