How do catholic obstetrician-gynecologists reconcile their religious identity with the provision of reproductive health services? A qualitative study
Awarded 2018
Complex Family Planning Fellowship Research
Angela Marchin, MD
University of Colorado

Religious leaders of the Catholic Church have set forth guidelines for practicing medicine, which involve reproductive care restrictions that may conflict with professional desires or obligations. Using a qualitative investigation with semi-structured interviews, we explored how Catholic obstetrician-gynecologists integrate their religious values and professional obligations related to family planning services. We recruited US-based Catholic obstetrician-gynecologists through an online survey and invited a sample of them to participate in audio-recorded telephone interviews in 2018. Participants were obstetrician-gynecologists who self-identified as Catholic and reported providing reproductive health care as follows: (1) provide natural family planning only (“low” providers), (2) provide additional contraceptive methods (“moderate” providers), and (3) provide family planning services including abortion (“high” providers). Our purposive sampling selected for those with higher self-reported religiosity levels. During telephone interviews, we explored their integration of Catholic values and medical ethics as they relate to family planning service provision. Three coders analyzed responses using grounded theory.
Among the 34 Catholic obstetrician-gynecologists interviewed there were 10 low, 15 moderate, and 9 high providers from 19 states. We found that participants’ description of morality was consistent with Albert Bandura’s Social-Cognitive Theory of Moral Thought and Action. Within each group of providers, we found three themes that emerged and reflected their reconciliations between Catholic values and professional obligations. Across varying practice patterns, we categorized relevant themes as either autonomy, beneficence, nonmaleficence, or justice. Low providers primarily promoted natural approaches to avoid iatrogenic risks, reflecting nonmaleficence. Alternatively, moderate providers focused on nonmaleficence by offering contraception to prevent abortions. High providers primarily promoted patient autonomy by separating religious doctrine from medical practice. All had concerns for beneficence. In each group, one of the four medical ethical principles was underrepresented.
Catholic obstetrician/gynecologists establish their family planning care provision practices by emphasizing certain moral and/or ethical principles over others. Our findings highlight how physician morality in the realm of family planning service provision often involves certain religious and/or professional reconciliations. Understanding the dilemmas Catholic obstetrician-gynecologists face can guide professional development efforts and inform ongoing discussions about conscientious objection and provision.