Growth of Catholic Hospitals May Limit Access to Reproductive Care As Roman Catholic leaders and government officials clash over the proper role of religion and reproductive health, shifts in health care economics are magnifying the tension. Financially stronger Catholic-sponsored medical centers are increasingly joining with smaller secular hospitals, in some cases limiting access to treatments like contraception, abortion and sterilization. In Seattle, Swedish Health Services has offered elective abortions for decades. But the hospital agreed to stop when it joined forces this month with Providence Health & Services, one of the nation's largest Catholic systems. In late December, Gov. Steve Beshear of Kentucky turned down a bid by Catholic Health Initiatives, another large system, to merge with a public hospital in Louisville, in part because of concern that some women would have less access to contraceptive services. And in Rockford, Ill., there is resistance to a plan by OSF HealthCare, run by the Sisters of the Third Order of St. Francis, to buy a hospital because of new restrictions that would require women to go elsewhere if they wanted a tubal ligation after a Caesarean section. About 20 such deals have been announced over the last three years, by one estimate, and experts expect more as stand-alone hospitals and smaller systems with no Catholic ties look to combine with larger and financially stronger institutions, in part because changes under the federal health care law are forcing all hospitals to become much more efficient. There is already considerable tension between Catholic-run medical institutions and the Obama administration over insurance coverage for contraception for employees. The cultural divide over reproductive health is playing out on the campaign trail as candidates debate hot-button issues like abortion and contraception. But while the growth of Catholic-run hospital networks is a testament to their long history and operational skill, local and state officials, doctors and advocates in many communities are concerned that some procedures that run counter to Catholic doctrine may no longer be available or will be much more limited. Some doctors fear they may not be able to do what's best for patients, forced to wait to treat a woman who is miscarrying, for example, or to send a rape victim elsewhere for an emergency contraceptive. The restrictions at any given hospital may not be clear. "Women simply don't know what they're getting," said Jill C. Morrison, senior counsel in health and reproductive rights at the National Women's Law Center. The confusion is likely to increase. "We are starting to see what was rare in the past," said Lisa Goldstein, who follows nonprofit hospitals for Moody's Investors Service and predicts more such partnerships. The institutions themselves are grappling with how to remain true to Catholic doctrine and serve a broader community. About one-sixth of all patients were admitted to a Catholic hospital in 2010. In many smaller communities, the only hospital within miles is Catholic. "That is a constant challenge," said Sister Carol Keehan, president of the Catholic Health Association of the United States, which represents the nation's roughly 600 Catholic hospitals. It's a challenge we take very seriously. Being a Catholic hospital means adhering to the church's religious directives about care, Sister Carol said, but she says hospitals also see their mission much more broadly, including caring for those who are less fortunate and treating patients with respect. At the Seton Healthcare Family in Texas, a unit of Ascension Health - the nation's largest Catholic system and largest nonprofit system - officials say partnerships with struggling community hospitals are integral to their mission. Seton's first partnership, in 1995, was to operate Brackenridge, a public hospital in Austin, because Seton was "not doing enough to care for the poor and vulnerable in central Texas," said Charles J. Barnett, an Ascension executive. In that case, Mr. Barnett says the system never agreed to provide services like elective abortions and sterilizations, and public officials and hospital administrators initially struggled to find a compromise. Although another system eventually offered sterilizations on a separate floor of the hospital, complete with a separate elevator, another hospital now provides those services. One large system, Catholic Healthcare West in San Francisco, announced in January that it was severing its formal ties to the church to better work with hospitals that did not share its faith. The system, renamed Dignity Health, operates 25 Catholic hospitals, which will remain Catholic, and 15 non-Catholic hospitals. While none of Dignity's hospitals will provide elective abortions or offer in vitro fertilization, the non-Catholic hospitals will not have to adhere to the church's religious directives. Dignity officials declined interview requests. Even as Catholic Healthcare West, however, the system was not without controversy. One of its Catholic hospitals performed what it considered a life-saving abortion in 2009, but the local bishop in Phoenix disagreed, and the nun who allowed the procedure was excommunicated. In many communities, like Rockford, the question is an intensely practical one: How will patients, particularly women, use services barred by the church? Because none of the city's three hospitals perform elective abortions, the debate has largely focused on whether a woman who has a C-section can have her tubes tied afterward.