As a follow-up to a 2012 study that found that half of all OB/GYNs working at Catholic hospitals had conflicts with their hospital over religiously based policies for patient care, Dr. Debra Stulberg of the University of Chicago, medical sociologist Lori Freedman of the University of California, San Francisco, and colleagues conducted in-depth interviews with a sub-sample of physicians to pinpoint the specific conflicts.

They weren’t surprised when doctors mentioned restrictions on abortion. There have been several high-profile cases where doctors clashed with Catholic hospital administrators over abortions for women who were experiencing catastrophic miscarriage or had a life-threatening health condition. But these cases are relatively rare. What was surprising, Freedman says, was how often doctors mentioned the denial of medically indicated sterilization. “What was striking was that it was the most common thing that bothered people in a daily way,” she says. “Doctors were really dying to talk about this because it’s kind of freaking them out.”

Catholic hospitals are prohibited from providing sterilization under the Ethical and Religious Directives for Catholic Health Care Services, which are issued by the U.S. Conference of Catholic Bishops and enforced by local bishops. But some Catholic hospitals quietly provided them if they were medically indicated, especially if a woman was already having a C-section and faced a health risk from another pregnancy.

In the early 2000s, however, the Vatican began insisting on stricter enforcement of the directives, which was right around the time the Catholic health system began growing due to a series of mergers—the number of Catholic hospitals increased 16 percent between 2001 and 2011. The study found several examples of tightening enforcement of the sterilization ban because of a more conservative bishop or new hospital management. “The bishop in [my city] was fairly liberal,” said one doctor who noted that his hospital used to perform tubal ligations for women who were at risk of gestational diabetes. “But then the bishop became much more conservative and the diocese became much more conservative and it’s absolutely never allowed.”

“Many doctors we spoke to had been given assurances when they were hired or when the hospital changed ownership that there would be ways of allowing tubal ligations if it was medically in the women’s best interest. That was not the case,” Stulberg says.

In early December, the ACLU filed a complaint with the Michigan Department of Licensing and Regulatory Affairs after Genesys Health System, a Catholic hospital in Grand Blanc, changed its policy to implement a total ban on tubals. The ACLU received a complaint from a woman identified as “Mrs. B” whose tubal was cancelled less than two weeks before her scheduled C-section. She had to forgo the procedure because her doctor only had admitting privileges at Genesys. The ACLU called the policy “contrary to the appropriate standard of care.”