Holy Owned

Zina Campos, 34, didn't intend to heed the biblical injunction to be fruitful and multiply. It just kind of happened. She was raised a Roman Catholic, but gave little thought to the Good Book when she had her first child at 17. Before long, though, she joined a gang and had fallen into the habit of having babies. She has eight kids and another due any day. "I didn't know a lot about birth control," Campos says. She has since studied her options and decided on a tubal ligation: a common procedure, usually performed after delivery, that permanently prevents pregnancy. "It has taken me since I was 17 to get off welfare and get a good job," says Campos, who has just left her public health counseling job in Gilroy, Calif., to prepare for the birth. "I love my children, but nine is way more than enough."

The hospital that serves her town of 40,000 apparently disagrees. Since October, not a single tubal ligation has been performed at the hospital--and Campos has been warned not to expect one. That is a dramatic change from last year, when more than 400 tubal ligations were performed at South Valley Hospital. In fact, nearly a fifth of all deliveries were immediately followed by the operation, which takes 15 min. and can often piggyback on the same epidural painkiller used during labor. So what changed? Well, South Valley became St. Louise Regional Health Center, and the hospital's new owner--Catholic Healthcare West--required the newly configured hospital to abide by the Ethical and Religious Directives for Catholic Health Care Services, a set of 70 regulations issued by Roman Catholic bishops in 1994.

In keeping with Vatican policy, the directives proscribe abortion and a host of reproductive services, including birth control, morning-after pills and sterilization. "We can't say we're opposed to abortion as a profound human evil and then go out and build an abortion clinic," says Father Michael Place, president of the Catholic Health Association, which represents more than 2,000 Catholic facilities in the U.S. "We can't be other than who we are."

So just who are these caregivers? Catholic health services have historically reached out to underserved communities, aggressively promoting immunization programs and sometimes even building low-income housing, considered fundamental to good health. Ten percent of the nation's 4,800 hospitals (not including long-term and specialty-care centers) are Catholic, according to the American Hospital Association. They enjoy a nonprofit tax status, a financial advantage that some critics feel is unfair in the highly competitive health-care market.

Eight of the nation's 13 largest health-care systems are Catholic, according to Catholics for a Free Choice, an advocacy group critical of the church's stance on reproductive issues. There were some 120 mergers between Catholic and non-Catholic institutions from 1994 to 1998, and CFFC estimates that reproductive health care was reduced or eliminated in half those cases.