Eight of the largest health systems in America are now Catholic-owned. More and more won’t prescribe contraception.

Last year, Ascension Health system, a Catholic system, and the largest nonprofit health system in the country, attracted national attention when it reportedly told doctors at an Oklahoma hospital that they couldn’t prescribe birth control. Ascension quickly backed down, deciding that it would “tolerate,” but not “approve, condone or permit,” the prescription of contraception by physician employees.

Now it appears that the largest system in Illinois, Presence Health, is also prohibiting doctors from providing contraceptives. Presence was created by the merger of two smaller Catholic systems, Resurrection Health Care, which was the system that bought Angela’s doctor’s practice, and Provena Health. Today, Presence Health owns 11 hospitals and dozens of doctor’s offices.

These health systems are merging, and gobbling up doctors’ practices, because of incentives in the ACA for systems to coordinate care across the range of services that patients need, from doctor’s visits to in-patient hospital procedures, and because of health care economics, that make it prohibitively expensive for doctors to maintain solo practices.

Asked directly whether its doctors in Evanston and elsewhere in Illinois were prevented from providing contraception, Presence said in a statement, “We abide by the Ethical & Religious Directives, and there are certain services which we do not provide. It is our expectation that all physicians associated with Presence Saint Francis Hospital share with their patients the options that are available in accessing the care they seek.”

But telling women about their options isn’t a solution when they are denied access to contraception, says Chaiten. “Even if they tell you what your options are, you have to have a second appointment with another doctor to get birth control. This seems inconsistent with whole idea of OB/GYN practice.”

Not only do women have to face the inconvenience of making—and paying—for another doctor’s appointment to get one of the most basic gynecological services, but there’s also a bigger problem: “The more we stigmatize and silo reproductive health care, the more it seems like it’s OK to treat it as not basic health care,” says Chaiten.

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