The Vatican has clarified its opposition to hysterectomies, saying it’s OK to remove a uterus that is “no longer suitable for procreation.”

If “medical experts have reached the certainty” that any future pregnancy would end in a “spontaneous abortion” before viability, then the patient can have a hysterectomy, because it won’t have the (immoral) effect of sterilizing them, the Vatican said late last week.

The Catholic Church opposes reproductive health care that interferes with procreation—including abortion, tubal ligations, vasectomies, and most contraception. In the United States, directives issued by the U.S. Conference of Catholic Bishops govern one in six acute-care hospital beds; in some states the number is closer to half. In at least 46 regions nationwide, a Catholic hospital is the only accessible option.

A spokesperson for the group that represents U.S. Catholic hospitals said Tuesday the Vatican’s ruling is unlikely to change patient care.

“These are the same principles that Catholic hospitals have been operating under so this really doesn’t change anything,” Brian Reardon of the Catholic Health Association told Rewire.News.

Under the directives followed by these hospitals, sterilizing procedures are allowed “when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.” In 2016, a Catholic hospital in California cancelled transgender man Evan Minton’s hysterectomy because it didn’t consider his gender dysphoria a legitimate reason for the surgery. Minton sued his hospital, as did Jionni Conforti, a trans man who was denied a hysterectomy at a Catholic hospital in New Jersey in 2015.

In 1993, apparently using the word “mother” to refer to anyone who could become pregnant, the Vatican said hysterectomies are allowed if they address an “immediate serious threat to the life or health of the mother,” but not to prevent a future pregnancy that would pose a “danger to the mother.”

There’s almost no data about what happens when patients are denied care in Catholic facilities. But when Rewire.News shared the Vatican’s update on Twitter, people responded with an outpouring of stories:

I’ve had 9 (NINE) failed pregnancies, between ectopic and miscarriages, cysts on my ovaries, endometriosis, a fibroid, and they still won’t do a god damned thing because, “I am of child bearing age”. So ridiculous.

— Unlikable_SKI13 (@FeministAnnie) January 7, 2019

The hospital where both my sons were born is Catholic. I elected to have my tubes removed and had to wait 6 weeks to be cleared, another 30 days after I signed the paperwork and still had to go to a different hospital for the procedure. So much time and energy wasted.

— 🏳️‍🌈SourPatch Sally✨ (@snide_sally) January 7, 2019

https://twitter.com/ElephiPelephi/status/1082307806894702593

https://twitter.com/ElephiPelephi/status/1082308152488529921

https://twitter.com/Gravelark/status/1082305197240651777

Some people noted that in their communities, the Catholic hospital is the only option.

I live in a small Nebraska town and our hospital is Catholic-owned. Even if there is a medical need for a hysterectomy, a woman has to travel out of town to get it done. And men can forget about a vasectomy. That’s completely elective and will not be performed here.

— Brandi is a fine girl (@Brandi_NE) January 7, 2019

https://twitter.com/defendsthepeeps/status/1082411696491098113

As the reach of Catholic health systems has expanded, this is becoming the reality for more and more patients.

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