U.S. Catholic bishops have vowed to fight the Obama administration's compromise on insurance coverage for contraception and sterilization, denouncing it as "coercive," "insulting," "unconstitutional," "belligerent," and "dangerous."
Yet there is evidence the sterilization services the bishops oppose have been provided by many Catholic hospitals across the country, including a few in the Philadelphia area.
Some evidence comes from news reports about bishops cracking down. In Texas in 2008, for example, two hospitals were ordered to stop doing the sterilization surgery, called tubal ligation. In Oregon in 2010, a hospital that refused to stop lost its Catholic status.
Last year, however, a more scientific look at sterilization practices was published as a doctoral dissertation at Baylor University by Sandra Hapenney, a Catholic in Waco, Texas.
Using standardized hospital discharge data, she found that between 2007 and 2009, more than 20,000 women who gave birth at Catholic hospitals in New Jersey and six other states then had their "tubes tied." Eighty-five hospitals - almost half of those providing obstetric services - were doing sterilizations to end fertility.
Among these were Our Lady of Lourdes Medical Center in Camden and Lourdes Medical Center of Burlington County in Willingboro, where Hapenney found that 282 women - 6 percent of those who gave birth - were sterilized in 2008 and 2009.
Catholic ecclesial and hospital authorities dismiss Hapenney's study as incorrect, although they won't discuss specifics.
For example, Bishop David M. O'Connell of the Trenton Diocese said in an e-mail that he had talked to hospital administrators and had "been assured that procedures at Lourdes Medical Center of Burlington County were in compliance."
A spokesman for Camden Bishop Joseph Galante first said the cleric would "look into the issue," then later deferred to Catholic Health East, the health system that operates both hospitals.
The system's spokeswoman e-mailed: "We previously reviewed the data in Hapenney's study and concluded at that time our facilities were in compliance."
Hapenney's analysis aside, the use of tubal ligation for contraception has for decades been a point of confusion and tension, if not dissension, among Catholic hospitals.
"I think the teaching is quite clear, but there was a debate, beginning in the early 1970s, about whether this [surgery] could be considered a therapeutic option," said John Brehany, executive director of the Catholic Medical Association, based in Bala Cynwyd. "Some people are [still] genuinely confused. They say, 'Well, this isn't a lady who wants sterilization because she's selfish; she's got a serious health condition' that would make another pregnancy risky.
"But the teaching says if the direct purpose is to sterilize, that's not acceptable," he said.
The latest contraceptive controversy stems from the 2010 health reform law, which requires insurance plans to fully cover preventive health care, including contraception and sterilization, beginning in August.
The rule exempted churches, and was similar to mandates that already exist in 28 states, including New Jersey but not Pennsylvania. Nonetheless, Catholic leaders and many others called it an attack on the constitutionally protected right to religious expression.
The Catholic Church teaches that artificial contraception is immoral because marital sex must be open to the possibility of procreation.
Stung by the outcry, Obama announced a compromise on Feb. 10. Religious-affiliated organizations such as colleges and churches would not have to pay for contraceptive coverage - but their insurers would. The companies also would have to inform women about the benefits.
Although questions remain to be answered - for example, what about self-insured religious organizations? - the accommodation has received wide support. Even the Catholic Health Association, which represents more than 600 Catholic medical facilities and which vehemently opposed the original mandate, said the new one "protects religious liberty and the conscience rights of Catholic institutions."
The bishops don't see it that way.
"No similarly aggressive attack on religious freedom in our country has occurred in recent memory," Archbishop Charles J. Chaput of the Archdiocese of Philadelphia, wrote in an opinion piece Feb. 12 in The Inquirer, referring to the compromise.
The U.S. Conference of Catholic Bishops, led by Cardinal Timothy Dolan of New York, said the revision represented "government coercion of religious people and groups to violate their most deeply held convictions."
The disparate views reflect a split between Catholics and their leaders, said Elizabeth Sepper, a Columbia University professor of health law who specializes in reproductive rights.
About 28 percent of American women have had their tubes tied, making it the single most common form of contraception, according to the Guttmacher Institute, a reproductive-health research center that supports abortion rights.
Surveys suggest Catholic women opt for it at the same rate as non-Catholic women.
Yet in 2001, the conference of bishops revised its Ethical and Religious Directives for Catholic Health Care Services, putting sterilization on a par with abortion as "intrinsically immoral."
The bishops specifically prohibited arrangements under which non-Catholic entities had provided tubal ligations at affiliated Catholic facilities.
That jeopardized the services at an estimated 40 Catholic facilities with such arrangements, according to Catholics for a Free Choice, which believes women should follow their conscience on matters of reproductive health.
Interestingly, Hapenney conducted her study to encourage adherence to Catholic doctrine, which she teaches at a Catholic high school. She has a theology degree from St. Mary's University, a public health degree from the University of Hawaii, and, as of last year, a doctorate in church-state studies from Baylor.
She fears that by deviating from that doctrine, Catholic hospitals are undermining the very argument the bishops are making: that health-care providers have a right to refuse to participate in practices they consider morally objectionable.
"My whole point," she said, "is keep up this diversity, and we'll jeopardize our conscience objections."