“My Hands Are Tied”: Abortion Restrictions and Providers’ Experiences in Religious and Nonreligious Health Care Systems

Lee A. Hasselbacher, University of Chicago Luciana E. Hebert, Washington State University, Seattle Yuan Liu, Mount Sinai Hospital Debra B. Stulberg, University of Chicago

First published online:

Abstract / Summary

Abortion is generally prohibited in Catholic hospitals, but less is known about abortion restrictions in other religiously affiliated health care facilities. As religiously affiliated health systems expand in the United States, it is important to understand how religious restrictions affect the practices of providers who treat pregnant patients.


From September 2016 to May 2018, in‐depth interviews were conducted with 31 key informants (clinical providers, ethicists, chaplains and health system administrators) with experience working in secular, Protestant or Catholic health care systems in Illinois. A thematic content approach was used to identify themes related to participants’ experiences with abortion policies, the role of ethics committees, the impact on patient care and conflicts with hospital policies.


Few limitations on abortion were reported in secular hospitals, while Catholic hospitals prohibited most abortions, and a Protestant‐affiliated system banned abortions deemed “elective.” Religiously affiliated hospitals allowed abortions in specific cases, if approved through an ethics consultation. Interpretation of system‐wide policies varied by hospital, with some indication that institutional discomfort with abortion influenced policy as much as religious teachings did. Providers constrained by religious restrictions referred or transferred patients desiring abortion, including for pregnancy complications, with those in Protestant hospitals having more latitude to directly refer such patients. As a result of religiously influenced policies, patients could encounter delays, financial obstacles, restrictions on treatment and stigmatization.


Patients seeking abortion or presenting with pregnancy complications at Catholic and Protestant hospitals may encounter more delays and fewer treatment options than they would at secular hospitals. More research is needed to better understand the implications for women's access to reproductive health care.

Author's Affiliations

Lee A. Hasselbacher is senior policy researcher, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, Chicago. Luciana E. Herbert is assistant research professor, Institute for Research and Education to Advance Community Health, Washington State University, Seattle. Yuan Liu is a psychiatry resident, Department of Psychiatry, Icahn School of Medicine, Mount Sinai Hospital, New York. Debra B. Stulberg is associate professor, Department of Family Medicine, University of Chicago.


The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.