I’ve always had a contentious relationship with contraception. When I started taking the pill at 18 years old, I could feel something in my body shifting, perhaps irrevocably. My breasts grew two sizes, making exercise uncomfortable and inviting commentary from the opposite sex that made me feel unsafe. My posture worsened as I tried to hide the alien entities, and my moods felt out of control and unpredictable. After eight years on the pill, I was in a stable, monogamous relationship—about to get married, in fact—and ready to see what life might be like without a hormonal contraceptive.
I was nervous and excited about the consult for my first intrauterine device (IUD) at MedStar Georgetown University Hospital. After a brief conversation, Dr. Case (a pseudonym) asked me to get off the exam table and follow her to her office for a “chat.” But in her office, when the door was safely shut, my excitement slowly started to fade. “Well, first things first, this is a Catholic hospital,” she said in a mock whisper.
“Oh,” I said, not hiding my surprise. She explained that Georgetown University Hospital does not prescribe birth control for the sole purpose of preventing pregnancy. “Do you have heavy cramping?” she asked. “Because we could prescribe hormonal birth control for heavy cramping.”
“No, I don’t have heavy cramping,” I said, wondering how on earth I had ended up in this situation. A month earlier, I had set up an appointment at MedStar Health for a physical. After two years of living abroad, I had a lot of questions about some symptoms I found troubling; hair loss and fatigue I thought could be linked to a thyroid problem. “Most young, menstruating women are a little anemic,” the doctor responded when I told him about my symptoms. Perhaps I should have left right then. But my main aim was a referral to a gynecologist so that I could get Paragard, a copper IUD. He seemed delighted in my decision, even saying he wanted to learn how to put in IUDs himself, and wrote me a referral to the woman I was now chatting with at Georgetown University Hospital.
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Dr. Case went on to explain that when she took this gig, she knew it would mean she wouldn’t be able to help young women in all the ways she wanted to. But there was a workaround. She ripped a piece of paper in half and wrote a phone number on it in blue pen. “Call this number,” she said, passing me the paper in a way I can only describe as illicit.
I was confused by the process, and the implications of what it meant to be a woman asking for reproductive health services at a Catholic hospital, and Dr. Case could tell. She gave me detailed instructions about how to connect with a provider who could give me the contraception I sought.
Afterward, looking at the ring on my finger, she said, “Tell me about your fiancé.” I gave her the spiel: We’d been together for seven years, on and off, and we were getting married in the winter.
“And why do you want an IUD?” she asked.
“We’re hoping to start trying for kids in five to six years, so the timing would be perfect for me,” I said.
She gasped. “Well, that makes me sad!”
“Excuse me?” I said, wondering if I’d heard correctly.
“You’ve been with this man for seven years; you’re the perfect age to have children. It makes me so sad.”
In my shock, I told her the first thing I could think of: the truth.
“We recently decided not to get a cat, because if the cat got sick, we don’t think we could cover possible medical bills.”
I wasn’t trying to be funny. The silence in the room took on a palpable form.
She looked at my chart, trying to ease the tension. “Well, you could still safely start conceiving until you’re 32,” she said with a shrug. Though my head was spinning, it wasn’t lost on me that she was passing judgment rather than stating fact. While fertility rates do begin to decline after age 35 for most people, many women over 40 have successfully conceived.
On my way out of the labyrinthian building, I scrunched up the unofficial paper in my hand. The ripped edges felt sharp against my skin. In the Uber ride home, after paying transportation to and from my apartment to a world-class hospital and forking over a $50 copay for unsolicited advice about my vagina, I cried.
When I told the story to my fiancé, he was indignant. Friends couldn’t believe it. Some wouldn’t believe it. “Doctors don’t say that,” some said. “Is that even legal?” asked others.
At first, I blamed myself. Clearly, I hadn’t done my homework. ‘There must be clear verbiage on the website,” I thought. After a frustrating hour-long search, here’s a summary of what I found:
- Georgetown University Hospital was ranked #1 Hospital in the Washington Region by U.S. News & World Report for three years in a row, including 2018-2019.
- Georgetown University Hospital was founded in the Jesuit principle of cura personalis—caring for the whole person—and it’s stated mission is “to provide physical and spiritual comfort to our patients and families.”
- Georgetown University Hospital puts the patient first: “We strive to deliver the best to every patient every day. The patient is the first priority in everything we do.”
- Georgetown University Hospital values respect: “We treat each individual, those we serve and those with whom we work, with the highest professionalism and dignity.”
- Georgetown University Hospital values professionalism: “We project a professional image at all times and demonstrate expertise in our professional practice.”
- Georgetown University Hospital believes that patients have rights and responsibilities: “You have the right to respectful and considerate care and to be free from neglect, exploitation, abuse, or harassment. You have the right to receive treatment without discrimination as to age, race, ethnicity, color, religion, culture, language, physical or mental disability, sex, sexual preference or orientation, national origin, disability, gender identity or expression or socio-economic status.”
Here’s what I did not find: Any language that stipulates Georgetown University Hospital adheres to religious directives issued by the United States Conference of Catholic Bishops governing Catholic health services and will prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments, and abortion care.
But it does adhere to religious directives. And it does prohibit a range of reproductive health services, including the insertion of the IUD that I sought. Changes to the site since I first checked now reflect that fact. (I also confirmed in a phone call to the hospital this week that it only prescribes contraception for medical purposes—such as constant bleeding, long periods—and not if someone seeks birth control solely because they don’t want to get pregnant.)
Even so, why, when I asked my doctor for a referral to a gynecologist so that I could get Paragard, a form of contraception that exclusively prevents unwanted pregnancy, did he send me to a Catholic hospital? And why aren’t patients given more information about what it means for a hospital to follow religious directives?
The answer to that question may no longer be as important as I once thought. On May 2, the Trump administration issued a final “conscience rule” granting protection to health-care professionals who refuse to provide care that violates their religious beliefs. The future seems clear: Already vulnerable groups—women and members of the LGBTQ community, especially in underserved and rural areas where access to family planning and reproductive services is already a systemic issue—will be most affected. But this will affect all of us.
A co-worker recently asked me where she should go to get an IUD, and I told her to steer clear of Georgetown University Hospital. But where can I tell her to go now? Where is safe?
Months later, during a pregnancy scare, I decided to get the copper IUD for emergency contraception. But also because I still wanted it. Despite the shaming experience at the No. 1 hospital in the nation’s capital, I still knew my own mind. We found an abortion clinic, carafem, that took my insurance, didn’t require referrals, and offered same-day insertion.
In the midwife’s comfortable office, my story came out slowly, then all at once. She made no effort to hide her disgust. “Friends told me I should share this, but I was really, really ashamed,” I told her. She called my fiancé into the room and told both of us that no matter how long it took me to muster the courage to tell this story, I should. Because no woman needs a reason to not want to have a child right now. Or ever.
Unfortunately, this safe, supportive environment for women who know their own minds may soon be only a comforting memory. In February, the Trump administration released the text of its rule barring any clinic that provides or refers patients for abortions, clinics like carafem, from federal family planning funds under Title X. A federal judge did issue a nationwide injunction in April, preventing the rule from taking effect, but President Trump is only ramping up his anti-contraception and anti-abortion rhetoric.
Reproductive health-care clinics like carafem and Planned Parenthood are often the only option for low-income people across the country. If the Trump administration gets its way, be prepared for an outpouring of stories that bear a resemblance to this one, but don’t wrap up so neatly.