Abstract
ObjectiveTo examine rural-urban differences in reproductive-aged Wisconsin women's expectations for contraceptive and abortion care at a hypothetical Catholic hospital. Study designBetween October 2019 and April 2020, we fielded a 2-stage, cross-sectional survey to Wisconsin women aged 18 to 45, oversampling rural census tracts and rural counties served by Catholic sole community hospitals. We presented a vignette about a hypothetical Catholic-named hospital; among participants perceiving it as Catholic, we conducted multivariable analyses predicting expectations for contraceptive services (birth control pills, Depo-Provera, intrauterine device or implant, tubal ligation) and abortion in the case of serious fetal indications. ResultsThe response rate was 37.6% for the screener and 83.4% for the survey (N = 675). Among respondents (N = 376) perceiving the hospital as Catholic, expecting the full range of contraceptive methods was more common among rural (70.9%) vs urban (46.7%) participants (adjusted odds ratio = 3.99, 95% confidence interval: 1.99–7.99). In adjusted models, odds of expecting each contraceptive method were at least 3 times greater among rural vs urban participants. About one-third expected provision of abortion for serious fetal indications, with no difference by rurality (p > 0.05). ConclusionsIn Wisconsin, rural women were more likely than urban women to expect a hypothetical Catholic hospital to provide the full range of contraceptive methods as well as each method individually. Disparities were especially large for tubal ligation and long-acting reversible contraceptives—methods that other studies suggest are least-likely to be available in Catholic healthcare settings—which may indicate a mismatch between patients’ expectations and service availability. ImplicationsMany reproductive-aged Wisconsin women—especially in rural areas—hold misperceptions about availability of reproductive care in Catholic hospitals. Policies mandating greater transparency in service restrictions and interventions enabling patients to make informed decisions about care may help connect patients to the care they need more quickly.
Highlights
Many rural communities in the US face widespread barriers to reproductive care [1,2,3,4,5]
Rural-urban differences were large for tubal ligation (80.2% vs 57.5%) and intrauterine devices (IUDs)/implant (81.2% vs 60.9%)
Models predicting expectation for all 4 contraceptive methods and abortion for serious fetal indications further adjusted for religion. In this state with a very high concentration of Catholic hospitals, we found that many Wisconsin women expected a hypothetical Catholic hospital to provide reproductive services that are prohibited by the directives
Summary
Many rural communities in the US face widespread barriers to reproductive care [1,2,3,4,5]. Rural women are less likely than urban women to have received any reproductive health services in the past year [7], likely reflecting geographic barriers in access to family planning services [1,2,3] Compounding these barriers is the expansion of Catholic healthcare systems, in which care delivery is governed by the Ethical and Religious Directives for Catholic Health Care Services [8]. The number of US Catholic sole community hospitals—the only feasible sources of care for their service areas—has increased 73% from 2013 to 2020 [4] These hospitals a largely in rural areas, where vast distances impede access to non-Catholic hospitals [4]
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