With the end of Roe on so many of our minds, it might surprise those of us in liberal Seattle just how much abortion access in our state is under the control of the Catholic Church.

As Leah Rutman, policy counsel at the ACLU of Washington, put it, “Having the right to abortion does not mean you have access to it.”

Washington is just one of a handful of states in which more than 40% of hospital beds are controlled by Catholic doctrine. This shift became more acute with the 2021 merger of Virginia Mason and CHI Franciscan, creating Virginia Mason Franciscan Health, which operates 11 hospitals and 300 sites of care. With that merger, Virginia Mason said it would “not become Catholic,” according to reporting by The News Tribune, but it also would no longer provide “elective” abortions or participate in the state’s Death with Dignity process.

The new entity’s website now reads, “It is the policy of Virginia Mason Franciscan Health that all services rendered in our facilities shall be supportive of life. At no time may direct actions to terminate life be performed or permitted.”

This latest merger came nearly a decade after secular Swedish merged with Catholic Providence in 2013 and stopped providing most abortion care. Under pressure from reproductive health advocates in 2011 when the merger was being considered, Swedish partnered with Planned Parenthood to underwrite a clinic to provide abortion care near the hospital.

A spokesperson for Providence Swedish Puget Sound said in an email, “Elective abortions are not performed in Swedish facilities. However, Swedish does not deny emergency care. When a pregnant patient’s life is at risk, Swedish clinicians provide all necessary medical interventions, including pregnancy terminations, to protect and save the life of the patient.” 

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The spokesperson also said that while Swedish provides health care prohibited by the Catholic Church’s Ethical and Religious Directives for Catholic Health Care Services — such as birth control for the prevention of pregnancy, tubal ligations for the purposes of sterilization and in vitro fertilization to treat infertility — Providence does not. You can view the services hospitals provide at the Department of Health’s public database.

The emergency care provision aligns with the 2021 Protecting Pregnancy Act, which Gov. Jay Inslee signed to allow doctors practicing in Catholic-run hospitals to provide abortion care when a patient’s life is in jeopardy. 

Access to abortion care is dramatically uneven in Washington, with huge swaths of the state — particularly the rural and eastern counties — lacking any abortion clinics at all. 

Abortion is already illegal or heavily restricted in 11 states, with another 12 poised to do the same.

The Guttmacher Institute estimates that with Roe overturned, Washington will see a 385% increase in the number of people traveling here for abortion care, expected largely from Idaho and Montana to the east. 

With Catholic-controlled hospital systems representing a larger and larger portion of our health care providers, the small number of clinics offering care to the east side of the state, for example, could be inundated by patients from out of state.

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The ACLU’s Rutman said these types of hospital mergers have an effect on patient care. When these consolidations take place, she said, “We have around the state seen decreases in reproductive health care, end-of-life care, gender-affirming care access.”

But it does not have to be this way. Despite the strong words in support of abortion rights from Democratic elected state leaders, Rutman said, California and Oregon have done a much better job ensuring these mergers do not harm patient access to reproductive health care, offering a much more robust system of oversight. 

Rutman cited an example of a merger that affected both Washington and California, saying “You can see where California not only reviewed all the material, had public meetings across the state, comment periods to get input from individuals, and eventually approved the merger with caveats relating to maintaining reproductive health care … And in Washington state, none of this occurred. So it really demonstrates the significant need to ensure we have more oversight here.”

This past legislative session, the Keep Our Care Act was introduced, which would have required health systems to show how a merger would impact, among other things, “reproductive, gender-affirming, emergency, and end-of-life care.” It would have required the state attorney general to determine through a public process if the transaction would hurt access and affordability of care. It stalled, but could be reintroduced next year.

With so much fear and uncertainty around abortion care, it’s somewhat comforting to live in a state that protects a pregnant person’s right to choice, but it matters only if they have the ability to exercise that choice. Washington still has a long way to go to stand up to religious doctrines to fulfill that promise for everyone.