More evidence has emerged suggesting women of color disproportionately face reproductive health-care restrictions in Catholic hospitals.

In the Chicago area, 38 percent of hospitals with labor and delivery units are Catholic facilities, where religious rules generally restrict abortion, tubal ligations, contraception, fertility treatments, and gender-affirming surgeries.

Women using Medicaid, particularly those who are Black or Latina, may be disproportionately funneled into Catholic facilities by their insurance plans, a new paper in the journal Contraception found. Of the seven Medicaid managed care plans available in Cook County in spring 2018, five had a greater concentration of Catholic hospitals in their network than the county as a whole. And 85 percent of Black and Latina women using Medicaid were enrolled in a plan that skewed Catholic, versus 75 percent of their white counterparts.

“If you go where your plan covers, overall women on Medicaid have a disproportionate number of choices that are Catholic, and women of color even more so than white women,” Debra Stulberg, an associate professor of family medicine at University of Chicago who co-authored the study, said.

Under Catholic rules, hospitals generally won’t end a pregnancy if the fetus has a heartbeat, unless the patient’s life is at risk. A doctor in Wisconsin told Rewire.News she had to wait for her patient to run a high fever before she could hasten her inevitable pregnancy loss in 2017.

“We’ve known of cases where people have been forced to carry unviable fetuses in their bodies; that’s a lifelong trauma,” Megan Jeyifo, executive director of the Chicago Abortion Fund, told Rewire.News. “So the idea that low-income people who are already [some] of our most vulnerable, are being treated at a higher rate at these hospitals is deeply concerning.”

The study confirmed that Catholic facilities restrict contraception on religious grounds, providing 93 percent fewer family planning services—a category that includes tubal ligations and Catholic-approved natural family planning—to Medicaid patients than non-religious hospitals. Stulberg said she was more surprised by the finding that non-Catholic Christian hospitals provided 45 percent fewer family planning services than non-religious ones, since she has found no explicit rules against contraception in the doctrines of these denominations.

Medicaid patients in Illinois can go outside of their insurance networks for family planning services, but patients may not realize that when seeking birth control. They might also choose a Catholic hospital that’s in-network to deliver their baby, and then be unable to get postpartum contraception or timely miscarriage care if they lose the pregnancy.

“If women are going home after their delivery without their desired contraceptive method, the risk of slipping through the cracks goes up,” Stulberg said.

Nationwide, 53 percent of births at Catholic hospitals are to women of color, versus 49 percent of births at non-Catholic hospitals, a study by Columbia Law School found last year. The report examined data from 33 states and Puerto Rico; in 19 of those states, including Illinois, women of color were more likely to give birth in Catholic hospitals than white women.

“We’re already under a maternal and infant mortality crisis in the Black community, and that is even further heightened under the risks that we’re put under by [Catholic] ethical and religious guidelines,” Laurie Bertram Roberts, co-founder and executive director of the Mississippi Reproductive Freedom Fund, told Rewire.News. She nearly died after a Catholic hospital sent her home twice while she was miscarrying more than two decades ago.

“We already tend not to be listened to by our providers, tend to have our pain discounted by our providers, tend to have our complaints dismissed by our providers, and tend to even have our humanity ignored by providers,” Bertram Roberts said. “To enter a hospital that sees us as less than human, or as equally human to an embryo or a fetus, further marginalizes us and dehumanizes us in a system where we’re already being marginalized and dehumanized.”

While Illinois is among a minority of states where Medicaid covers abortion, Jeyifo said she is concerned that Catholic hospitals—which sometimes ban providers from so much as referring for abortion care—may withhold information about this coverage from patients.

“If a person finds out they’re pregnant at a Catholic hospital and says, ‘What are my options?’, I don’t know that they would be told by their doctor or their nurse that they deserve and have access to abortion coverage by the state,” Jeyifo said.

Stulberg’s past research points to an information gap when it comes to Catholic health care more broadly. While one in six women say they rely on a Catholic hospital as their go-to place for reproductive health care, more than a third of them are unaware the facility is Catholic. Yet when women were asked about the importance of being informed about a hospital’s religious restrictions on care, nearly 81 percent said it was somewhat or very important to them.