A new study has revealed just how little patients understand about how Catholic hospitals restrict health care.

At least 1 in 6 acute-care beds nationwide follow, to some degree, Catholic rules that ban sterilization, abortion, in vitro fertilization, and all contraception except for natural family planning. But many patients still expect to receive these services in Catholic institutions, according to a study published Wednesday in Perspectives on Sexual and Reproductive Health. This lack of information can put their health—and sometimes their lives—at risk.

First, researchers measured whether participants recognized a hospital as Catholic based on a religious name. Asked about a hypothetical hospital named “Saint John’s,” only 46 percent said they thought of it as Catholic. Women with annual household incomes of less than $25,000 a year were less likely to identify Saint John’s as Catholic than those with higher incomes.

Next, researchers measured what reproductive services these patients expected Saint John’s to offer. Even those who identified the hospital as Catholic didn’t realize how that might restrict care: 69 percent expected OB-GYNs at the hospital to prescribe birth control; 63 percent expected them to offer tubal ligations; and 44 percent expected them to offer IVF.

Among all respondents—including those who didn’t identify Saint John’s as Catholic—the results were even more striking. Seventy-seven percent thought OB-GYNs there would prescribe birth control; 70 percent thought they would offer tubal ligations; and 52 percent thought they would offer in vitro.

“This study tells us that nationwide, women do not have the information they need to make educated decisions about where to seek care,” Debra Stulberg, an associate professor of family medicine at University of Chicago who co-authored the study, said in an email to Rewire.News. “Many show up to a hospital expecting the doctor to provide them with the healthcare services appropriate for their own personal situation, when in fact, the religious doctrine of the church sponsoring the hospital doesn’t allow these services to be provided.”

In a study last year based on the same cohort of participants, 37 percent didn’t realize the Catholic hospital they relied on for reproductive health care was Catholic. Here, again, lower income women were less likely to realize that their go-to hospital was Catholic; 90 percent of women with incomes over $100,000 correctly identified their hospital as Catholic, compared to 49 percent of those who made under $25,000 a year.

A lack of transparency from Catholic hospitals may be to blame for this pervasive information gap. Researchers in another study reviewed 646 Catholic hospital websites and found only 28 percent noted how the facility’s religious affiliation affected care.

The knowledge gap can be life-threatening for patients who lose pregnancies. Because of the ban on abortion, Catholic facilities have sent miscarrying patients home or forced them to wait until they sickened before ending their pregnancies. But in the latest study, even among those who identified Saint John’s as Catholic, 71 percent thought the facility would offer a dilation and curettage (D and C) for miscarriage management; 44 percent thought it would offer an abortion for a life-threatening pregnancy; 27 percent thought it would offer an abortion for a serious fetal indication; and 12 percent thought it would offer one for a patient’s personal reasons. (While policies vary, Catholic hospitals often end pregnancies if they deem a patient’s life to be at sufficient risk.)

The study did find some difference in expectations about Catholic versus secular hospitals. Researchers divided the 1,430 survey participants into two randomized groups: One was asked about a secular-sounding facility called Metropolitan Hospital and the other about Saint John’s. Women in the Saint John’s group were less likely than those in the secular group to expect the facility to provide birth control pills (77 percent vs. 86 percent), tubal ligations (70 percent vs. 78 percent), or abortion for serious fetal indications (42 percent vs. 54 percent).

Notably, the researchers found that women of color were less likely than white women to expect to receive birth control pills and tubal ligations at Catholic facilities. Nationwide, women of color are more likely to give birth in a Catholic hospital where care is restricted on religious grounds. In some states that difference is stark: In New Jersey, women of color represent 80 percent of births at Catholic hospitals, even though they make up only half of all women of reproductive age.

“The racial and ethnic differences observed in our study may result from women of color having more experience with Catholic hospitals,” the researchers wrote. “Given existing evidence of racial discrimination in U.S. health care, it is possible that attendance at Catholic facilities further compounds the health care disparities that women of color face.”