“I don’t know how else to put it, except that people lied all the time.”

That’s how a medical provider described the culture in a Catholic-run health-care system, where religious rules ban most contraceptive methods.

“You would say birth control pills were [prescribed] because [a patient] had irregular periods, when her periods were fine,” the provider told the authors of an article published December 4 in Perspectives on Sexual and Reproductive Health. “She’d be using it for contraception, but you couldn’t prescribe [the pill] for that reason.”

Catholic health systems, which have expanded to control at least one in six acute-care beds and many outpatient offices nationwide, generally follow rules that also ban abortion, sterilization and some gender-affirming procedures. The report focused on the issue of contraception, and found that while Protestant-affiliated health systems did not restrict access to the service, Catholic systems did.

Providers in Catholic facilities have long found creative ways to get around the rules and provide needed care, often by documenting a medical diagnosis of heavy periods, severe cramps or acne. “The providers wanted to be able to offer their patients the contraception […]