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I. INTRODUCTION
Increasingly, public1 and privately-owned hospitals are merging with religious health care systems, which are often Catholic.2 Many hospitals experiencing financial troubles assert that merging with a religious health care system is the only way to stay in business.3 However, the nonfinancial cost for saving a hospital in this manner may be severe.4 Such mergers may reduce or eliminate women's health services in the affected communities,5 especially abortion, contraception, sterilization, infertility services, and emergency contraception for rape survivors.6 The women most affected by these cutbacks are low-income and minority women, particularly those living in rural areas, because these women have fewer health care options.7 This essay will provide a brief overview of the growing trend of these hospital mergers,8 the resulting loss of women's health services,9 and the various legal and grass-roots methods that activists have employed to preserve full access to women's health services.10
II. CATHOLIC INFLUENCE ON HEALTH CARE: FINANCIAL AND PROGRAMMATIC
A. Financial Influence: Driving Forces Behind Catholic Hospital Mergers
In the last ten years, the Catholic Church has become more influential in the health care industry, partly due to mergers with non-Catholic hospitals.11 Approximately 127 mergers between Catholic and non-Catholic medical institutions took place between 1990 and 1998.12 Ten of the twenty largest health care systems in 1999 were Catholic.13 The combined net patient revenues for these ten hospitals amounted to more than twenty-eight billion dollars in 1999.14
Many non-religious hospitals have merged with Catholic institutions in recent years, seeking much-needed financial support.15 Financial pressures in the health care industry can be so extreme that hospitals may feel forced to merge with more financially stable Catholic hospitals, sacrificing reproductive services in order to keep their doors open.16 Payments from managed-care providers and Medicare have fallen and many surgeries are now taking place on an outpatient basis, leaving hospital beds empty.17
B. The Impact of the Directives on Hospitals and Physicians
Upon affiliation with a Catholic institution, the non-religious hospital is often required to agree to abide by Catholic guidelines regarding the provision of health care services.18 These guidelines are derived from the Ethical and Religious Directives for Catholic Health Care Services that were approved by the National Conference of Catholic Bishops in November 1994.19 The Directives specifically ban contraception,...