Enter the glass doors at 222 West 14th Street in New York City, and the chaos of traffic horns and tire-screeches, jackhammers and concentrated humanity recedes into a hush. In the serene offices of Elizabeth Seton Childbearing Center, surfaces are awash in blue hues, the lighting is dim and the women at the desk are friendly and concerned. A receptionist is telling a nurse about a delivery the day before. The mother-to-be was getting a due-date manicure and facial and began having contractions during the appointment, the receptionist explained. "She said she wanted to look fabulous when she came in here to have the baby!"
At Elizabeth Seton, women are meant to feel fabulous, too. Oven mitts adorn the cold stirrups of the exam table. Clients are encouraged to labor wherever they like--each suite of birthing rooms contains a queen-size bed, a whirlpool bath and comfy chairs. Partners can assist the mothers or wait with family inches away in a room equipped with a kitchen where they can cook or have a party after the baby is born. Women giving birth have access to La Leche League (for breast-feeding support) and doulas (experienced mothers who assist new mothers), along with a midwife, a nurse and an acupuncturist. Other services include sibling preparation, infant massage and postpartum yoga. Gay mothers are welcome and make up a small percentage of Seton's clientele. In short, Seton is a feminist's dream.
Unless, that is, you need a tubal ligation after your childbirth, which is the best time to do the procedure. Or any sort of contraception, even family-planning counseling. Why? This birthing center, founded in 1996, receives funding from St. Vincent's, a Catholic hospital. And Catholic hospitals do not condone these services.
Elizabeth Seton--a midwifery clinic built on the principles espoused by Our Bodies, Ourselves and which claims to offer "full scope, well-woman gynecologic[al] services"--is not alone in its restrictive practices. Catholic HMOs, hospitals and affiliates, which together play an ever-larger role in healthcare delivery, are effectively eliminating virtually every health-related feminist victory of the past thirty years. The "Ethical and Religious Directives"--Catholic healthcare's seventy commandments, drafted by the Church's American Bishops--prohibit abortion, birth control, most vasectomies, tubal ligation and the morning-after pill even for rape victims. The result is a healthcare system that bypasses not just Roe v. Wade but Griswold v. Connecticut, the 1965 Supreme Court decision that allowed married couples to seek contraception.
Legislative tolerance of such restrictions is growing. The 1997 Balanced Budget Act applies the "conscience clause"--which originally meant that individuals would not have to perform procedures (such as abortions) to which they have moral objections--to the institution of managed care. As a result, health plans for federal employees may opt not to include reproductive care on religious or moral grounds. In South Dakota pharmacists are legally allowed to deny a woman a prescription if they have reason to believe it will be used to terminate a pregnancy.
Yet, to understand why midwifery clinics like Elizabeth Seton choose to play dumb when asked about birth control, one has to look beyond the antifeminist legislative climate to the changing face of our healthcare system. Hospitals fall into three categories: federal (such as Veterans Affairs hospitals), for-profit and nonprofit--including religious-affiliated and secular institutions. According to the records of the Catholic Health Association, 10 percent of nonfederal hospitals and 15 percent of nonfederal hospital beds are Catholic. And Catholic hospitals are the largest nonprofit healthcare provider. The Catholic Church currently owns five of the ten largest hospital corporations--amounting to more than 800 hospitals and healthcare systems and caring for more than 70 million patients.
Most significant, more and more hospitals are merging in an effort to cut costs, and when one of the two joining forces is Catholic, its practices frequently become the new standard. In the past few years, 40 percent of some 5,200 nonfederal hospitals have either merged or entered into an agreement to do so. Catholic hospital networks are expanding the most rapidly through mergers, with one survey observing a 12 percent growth rate among participating systems in 1997. According to a study by the nonprofit social justice group Catholics for a Free Choice, in the past eight years nearly one hundred mergers have occurred in which a non-Catholic hospital has aligned with a Catholic hospital. In half of those instances, reproductive health services have remained largely unchanged (that is, intact at the formerly non-Catholic facility, and still nonexistent at the formerly Catholic one), while in the other half such services have been either cut back or wiped out completely.
"This is stealth elimination," says Susan Berke Fogel, legal director of the California Women's Law Center, a nonprofit spearheading an aggressive campaign to bring attention to Catholic encroachment on reproductive freedom. She is most galled by the Catholic Church's assertion that because its hospitals are nonprofits rather than businesses, they are exempt from antidiscrimination law. A recent California Supreme Court decision ruled in favor of a Catholic hospital that was sued for not complying with fair employment laws. "Look, I don't argue with the importance of allowing hospitals to be nonprofits so that the communities will reap the benefits rather than shareholders," says Berke Fogel. "But that shouldn't be license to discriminate, either in the types of services they provide or in hiring based on race or gender."
Berke Fogel also points out that Catholic hospitals, far from being autonomous, are drawing much of their funding from federal sources such as Medicaid and Medicare. "The reality is that they are accumulating huge amounts of money that is exempt from taxation," she says. "We, the taxpayers, are subsidizing their expansion. Their revenues aren't required to go back into healthcare but can go into religious institutions. The public is simply not benefiting from these transactions." For example, the nuns who operate the Daughters of Charity, the largest owner of Catholic hospitals, commanded a pot of $2 billion in cash and investments as of March 1998. A reproductive health ideology that would work only for a celibate (or for the barefoot and pregnant) seems rather out of touch with women's needs. But low-income women disproportionately depend on Catholic hospital care, and as Catholic HMOs proliferate, they are serving a growing number of Medicaid patients--a "very frightening prospect for low-income women," says Berke Fogel.