As the number of Catholic-affiliated hospitals grows in the United States, reproductive health will be increasingly threatened, a new report posits.

A joint effort of MergerWatch Project and the American Civil Liberties Union, the report, Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care, found that the number of Catholic non-profit hospitals in the Unites States grew from 329 to 381 between 2001 and 2011, an increase of 16 percent. Over the same period of time, the number of public hospitals fell from 843 to 581, a decrease of 31 percent.

The report noted that Catholic hospitals are governed by the Ethical and Religious Directives for Catholic Health Care Services, which prohibit a range of services including distribution of contraceptives, sterilizing operations, certain infertility treatments and abortion – even when a woman’s health is at risk.

In addition, the Directives frequently prohibit hospital staff from even providing patients with information about some health-care options if they would conflict with Catholic teachings. The Directives may also be used to override any end-of-life instructions in a patient’s living will, if those instructions are deemed to be in conflict with the Directives.

“With the rise of Catholic hospitals has come the increasing danger that women’s reproductive health care will be compromised by religious restrictions,” MergerWatch and the ACLU said.

The Los Angeles Times noted that the Directives do distinguish between “direct” abortion, which is never allowed, and “indirect” abortion, which may be permissible under certain circumstances. The problem is, women sometimes need a direct abortion to survive. Under the Directives, for example, if a pregnancy causes organ failure, doctors can’t give the woman an abortion even if the fetus is the source of the problem.

While the Catholic hierarchy may see this as something of a compromise, many Catholic hospital physicians have said the policy is bad for women. The Times pointed to a 2012 survey in which 52 percent of OB/GYNs who work in Catholic hospitals said the Directives conflict with sound medicine.

“For some physicians, their hospital’s prohibition on abortion initially seemed congruent with their own principles, but when applied to cases in which patients were already losing a desired pregnancy and/or the patient’s health was at risk, some physicians found the institutional restrictions on care to be unacceptable,” Lori Freedman and Debra Stulberg wrote in the American Journal of Bioethics.

The Directives are even facing increased legal scrutiny. The ACLU has taken the step of suing the U.S. Conference of Catholic Bishops for negligence after a pregnant woman in Michigan allegedly received inadequate care that led to unnecessary pain and suffering as result of Cath­olic doctrine.

The MergerWatch/ACLU report also made mention of the fact that some Catholic health organizations “often counter criticism of their reproductive health restrictions by emphasizing their mission of serving the poor and providing charity care.”

But Catholic hospitals actually perform less charitable care than their public counterparts, the survey found. In 2011, charity care made up 2.8 percent of Catholic non-profit hospitals’ total patient revenue, compared with 5.6 percent for public hospitals.

The report can be read online at MergerWatch’s website: mergerwatch. ­org.