It costs about a month’s salary for the average Mexican to deliver a baby at the hospital that looms, with a cross on top, over a busy street in the commercial hub of Monterrey. For an extra 10 percent per night, the equivalent of $133, patients can stay in hotel room-like “master suites.” In 2007, this hospital, Christus Muguerza Alta Especialidad (“High Specialty”), became the first in Mexico accredited by the prestigious Joint Commission International. Among its state-of-the-art offerings are intrauterine fetal surgery and a specialized treatment for oxygenating blood outside the body.

But there are some services this facility won’t offer—including intrauterine devices (IUDs), as Rewire.News discovered when we called its obstetrics division to ask about the availability of contraception.

“It’s a religious hospital,” a representative told us. “By policy, it’s not allowed.”

A company executive later confirmed to Rewire.News that the restrictions apply to a range of reproductive health services, including contraceptives, sterilization, and in vitro fertilization (IVF).

That’s not because contraceptives are restricted in Mexico, where 81 percent of the country is Catholic—in fact, they are available in pharmacies without a prescription, and getting an IUD inserted postpartum may be easier in Mexico than in the United States. But this hospital is part of Christus Health, a Catholic system based in Irving, Texas, that has grown to become Mexico’s third largest private health-care provider—and the only U.S.-based Catholic health system operating in Mexico. Christus describes itself as Mexico’s largest Catholic health-care system. In keeping with Catholic teachings, it restricts reproductive care.

Christus bought a majority stake in Mexico’s Catholic Hospital Muguerza in 2001 with an eye toward luring U.S. patients to Mexico, where health care is cheaper, although the company now says less than 3 percent of Christus Muguerza services are through medical tourism. Muguerza’s projected profit margin around the time of the purchase was better than that of most Christus facilities. The company’s expansion into Latin America “makes good business sense in the long term,” a Christus official wrote in 2016.

Rewire.News has reported extensively on the spread of Catholic hospitals in the United States, where they account for one in six acute-care beds. Christus Health, one of the ten largest U.S. Catholic health systems and the sole hospital for at least four U.S. communities, has taken this expansion international, becoming a leading health-care provider in three countries in Latin America. In total, more than 60 Christus hospitals and long-term care facilities and 350 outpatient centers sprawl across Texas, Arkansas, Louisiana, New Mexico, Iowa, and Georgia, as well as Mexico, Colombia, and Chile. Last year, Christus made headlines when it paid $12 million to settle claims it bilked a U.S. program that provided funds to hospitals to treat poor people. With control of more than $6 billion in assets and a CEO who makes more than $4 million a year, it is—like many Catholic hospitals—a nonprofit exempt from U.S. taxes.

Wherever it operates, Christus Health refuses to “perform, promote, or condone” abortion or sterilization, according to its ethics code. To interpret these rules, Christus Muguerza consults with Catholic bishops in the United States and Mexico, where it runs ten hospitals, four ambulatory surgery centers, and 14 outpatient medical centers, according to Alberto Sánchez, the regional operations director. Christus Muguerza also runs two nursing schools, four low-income clinics, and its own maternity home and adoption agency, Casa Cuna Conchita, which seeks to “protect life from its beginning,” and which Sánchez said allows adoptions only to heterosexual couples.

In Mexico, abortion is illegal except in Mexico City—where Christus has no health centers—but allowed in cases of rape and, in some states, a threat to the pregnant person’s life. In an interview at the company’s gleaming new surgery center in Irapuato, Sánchez said abortion cases where a patient’s life is in danger would go before ethics committees composed of lawyers, doctors, priests, and representatives of society. While the company’s ethics code does not mention IVF or contraception, Sánchez said these services are banned too.

But as with Catholic hospitals in the United States, in practice, it is more complicated. When Rewire.News called Christus Muguerza facilities to ask about contraception, some said they offered it. Company officials attributed the discrepancy to the fact that independent physicians who rent office space in Christus facilities may offer it in their private practices, although “we don’t recommend it,” Sánchez said. Sánchez also said Christus Muguerza sells contraceptives over the counter in pharmacies located inside its facilities because they can be used for medical purposes like regulating menstruation.

The same discrepancy emerged when Rewire.News asked about tubal ligations. A representative at the Alta Especialidad hospital in Monterrey, for example, said patients can get a tubal ligation after a cesarean section if they meet certain medical criteria—a loophole that is not uncommon in U.S. Catholic hospitals.

Asked to clarify the discrepancies, the company said in a statement that “there are clinical situations and medical reasons that a physician in one of our facilities in the U.S. or Mexico would provide” tubal ligations or contraception. They cited a provision of the ethical directives issued by U.S. bishops that allows sterilization to address “a present and serious pathology.”

“In the same way, some contraceptive treatments may be prescribed to address other serious medical issues, such as a type of IUD, which has been approved by the FDA to help manage excessive menstrual bleeding,” the statement said.

Yet in a country where birth control is widely available, reproductive health activist Oriana López Uribe laughed at the idea of a multinational health-care company trying to restrict access for paying clients.

“Who’s going to go to a hospital that doesn’t provide contraceptives? Especially if they are going to charge you,” López Uribe said.

Her bemusement stems from the fact that Mexico, unlike the United States, has a robust publicly run health system that covers contraception. Today, most Mexicans can access their health care through one of three publicly administered programs that each have their own health-care facilities, depending on whether a patient is a private employee, public worker, or outside these work forces.

Over the past 15 years, the Mexican government has moved to bolster access to health care for the poor, earning praise on the international stage for enrolling more than 50 million people in publicly subsidized health insurance. While the country has made strides toward universal insurance coverage, its health outcomes remain unequal. Married women who lack health insurance, for example, have an unmet need for contraception that is almost double that of their insured counterparts. (Overall, 28.9 percent of single women have an unmet need for contraception, versus 11.5 percent of married women.) Meanwhile, poor people with diabetes live eight years less than their wealthy counterparts, a discrepancy that reflects a “chronic crisis” caused by underfunding, according to Dr. Rafael González, a professor at the National Autonomous University of Mexico’s School of Medicine.

At the same time, the private health-care sector, which accounts for about half of the country’s health-care spending, has seen a rise of major corporations. Hospitales Angeles is part of a sprawling corporation that includes the Camino Real hotel chain, a newspaper, and a TV channel. Mexican billionaire Carlos Slim, one of the world’s richest men, has moved into the the country’s health-care system with his company, Hospitales Star Médica. And then, of course, there is Christus.

Experts and advocates repeatedly told Rewire.News that private hospitals like Christus, which exist outside of the public system and where patients pay out of pocket or with private insurance, are only for the rich.

“The people who are going to go to these hospitals are people who have money, and who are accustomed to making their own decisions,” López Uribe said, expressing disbelief such patients would tolerate restrictions on birth control.

But more than a third of Mexicans covered by public programs still turn at times to private outpatient care. Even among Mexico’s lowest socioeconomic classes, about 18 percent of patients seek care from a private doctor as their point of first contact. Patients enrolled in publicly run programs may turn to the private sector to avoid what can be months-long wait times for certain services or because they believe—accurately or not—that they will get better care.

Dr. Noé Alfaro Alfaro, a professor at the University of Guadalajara, says there is a “hidden privatization” of health-care services in Mexico, including through government outsourcing of public services to private companies. Like other major companies, Christus Muguerza participates in these types of arrangements; in Chihuahua, for example, the company has a contract to provide care for state employees. On a broader level, Christus is trying to attract Mexicans enrolled in public programs with promotions, memberships, and high-end technology.

Sánchez said there are many Mexicans who “look for private health care that is cheap, affordable.” That’s why Christus is moving toward ambulatory care that allows it to “have very competitive prices,” he said.

Christus also runs four clinics for low-income patients in the cities of Monterrey, Chihuahua, and Saltillo. When Rewire.News called these clinics, two said they offered no contraception while the other two said they don’t insert contraceptive devices, but offered consults with gynecologists.

Reliance on private facilities like these that follow Catholic dictates can have a profound effect on patients’ lives.

Sonia Gutiérrez Leon, now in her mid-50s, lives in Guadalajara: the capital of the western coastal state of Jalisco, one of Mexico’s most conservative states. After she got married, she planned to have no more than two children, so that she could keep working and pursue her plans to study and travel. So when she was pregnant with her second son in her late 20s, she asked her doctor to tie her tubes. She delivered in a private Catholic hospital paid for by her employer, a major bank. But the doctor refused to perform the tubal ligation, saying Gutiérrez Leon was too young. When she insisted, he said she might divorce and want to start another family. But Gutiérrez Leon was adamant: Even if she got divorced, she didn’t want more kids.

“And finally he told me: It’s because it’s a Catholic hospital, and we can’t operate on you,” Gutiérrez Leon recalled in an interview with Rewire.News.

“I was angry, because even though I was Catholic at that time, I didn’t think he should be able to make the decision about something that I wanted.”

By the time she got pregnant again, Gutiérrez Leon had left her job to care for her two young children. Hoping to avoid what she thought would be poor treatment in the public hospitals, she chose a less expensive private facility that also turned out to be Catholic. A doctor again refused to perform a tubal ligation.

Her husband kept promising he would have a vasectomy, but he never did. Before long, she was pregnant for a fourth time. This time she found a non-Catholic hospital, but by then she and her husband were struggling financially; she forewent an epidural to save money and couldn’t afford a tubal ligation. After her fourth son was born, she broke off her sexual relationship with her husband. She was too terrified of getting pregnant again.

“I look at my sisters, who had no more than two kids, and they could travel, they had more chance to advance,” she said. “And I didn’t. With four kids, no. I couldn’t.”

The hospitals at which Gutiérrez Leon sought care weren’t operated by Christus, but they shared the company’s religious tenets. In the decades since her experience, Catholic hospitals have maintained a presence across Mexico—including Christus, which has expanded rapidly. One of its newer facilities is an ambulatory surgery center in the industrial city of Irapuato, set in a commercial area near an upscale bowling bar and a luxury housing complex. On a tour of the facility, Christus representatives proudly displayed its offerings: the area’s most modern ultrasound equipment and endoscopy processes, the state’s only plasma autoclave for sterilizing instruments, the city’s most advanced blood analysis machine.

But this facility won’t provide sterilization procedures or IVF, Sánchez said. Nor will it perform abortions, even in cases of rape, a circumstance under which it is legal across Mexico. Asked how Christus Muguerza handles this legal right to abortion for rape victims, Sánchez said, “We prefer to avoid it.”

A Christus communications official interjected: “They refer the cases, no?”

Sánchez clarified that if a rape victim came to their facility, they would attend to them before referring them elsewhere. But he said they do not provide a crucial piece of this attention: emergency contraception.

In addition to greater investment in the public health sector, supporters of incoming President Andrés Manuel López Obrador are hoping for a liberalization of Mexico’s harsh anti-abortion laws. While López Obrador himself raised concerns by building an alliance with a conservative, evangelical party, his chosen interior minister, Olga Sánchez Cordero, has called for decriminalizing abortion in the first trimester. In late October, two legislators from López Obrador’s MORENA party introduced legislation aimed at legalizing abortion nationwide. These moves come amid a rising tide of protests across Latin America demanding the legalization of abortion and an end to religious attitudes that have kept women from living full lives.

On September 28, Sonia Gutiérrez Leon, now a political activist who supported López Obrador’s campaign, was among hundreds of people who marched through Guadalajara as part of the so-called Green Wave of abortion rights protests that began in Argentina. Gutiérrez Leon sees Catholic hospitals as part of the oppressive religious dogma that this movement is up against. So she was discouraged to hear about U.S.-based Christus expanding in Mexico.

“I think these companies can bring us other, more positive things, like technology and invention and other things that can come out of their development, and not these religious dogmas,” she said. She went on to tick off a list of U.S. exports she would appreciate: culture, American football, ballet teachers. Anything but more Catholic dogma. “If Mexico has anything, it’s churches,” she said.

Paloma Robles, Lorenza Torres, and Jade Ramírez contributed to this report, which was supported by the International Women’s Media Foundation as part of the Adelante Latin America Reporting Initiative. 

Tell us your story. Have religious restrictions affected your ability to access health care? Email [email protected].