Reproductive rights advocates and the ACLU worry that access to abortion, contraceptives, end-of-life care and LGBTQ services could end at Virginia Mason hospitals and clinics if a merger between the hospital and the Catholic health care provider CHI Franciscan is approved.

Seattle-based Virginia Mason is one of the largest providers of health care in Washington, with 12 hospitals and some 250 outlets across the state.

The proposed merger was announced on July 16, as executives from both medical systems signed a memorandum of understanding to explore combining their services. CHI Franciscan operates under the Catholic Church’s Ethical Religious Directives, which prohibits its hospitals from providing abortions, contraception, gender transition surgery and physician-assisted death, Modern Healthcare reported.

If a merger is approved, a spokesperson for Virginia Mason and CHI Franciscan said the combined health provider would “not cause CHI Franciscan to come out of compliance with the Ethical and Religious Directives.”

“As we work toward the definitive agreement, care will remain the same at Virginia Mason,” the spokesperson states in an email. “Should we reach a definitive agreement, some services related to reproductive health and physician-assisted death would no longer be provided at Virginia Mason.”

The spokesperson would not specify which procedures they would eliminate.

CHI Franciscan and Virginia Mason have partnered with each other in recent years to provide obstetric women’s health and radiation oncology care, a press release from Virginia Mason states. The merged health system would be led by a board seated by an equal number of members from each organization.

This is concerning for reproductive health advocates, and the ACLU of Washington, which released a joint statement opposing the merger.

Religious-based health care has grown dramatically in the state over the last decade.In 2010, one-quarter of hospital beds in Washington were provided by religious or affiliated health care systems. If the proposed merger goes through, more than half of the beds in the state would be owned by religious organizations.

“Having it become a religiously-affiliated health system, and denying this access to care, is really problematic,” said Leah Rutman, the ACLU of Washington’s health care counsel.

She specifically cited Yakima County, where the only hospital is owned by Virginia Mason.

There’s examples of similar reductions in services. Modern Healthcare reported that when Swedish Health Services partnered with Providence Health – a Catholic health care system – it stopped offering abortions services.

Kirsten Harris-Talley, interim director of NARAL Pro-Choice America, which advocates for reproductive freedom, said when mergers between secular and religious health care systems occur, services are typically cut.

She’s also concerned with what she called a lack of transparency about the merger, and questioned why it’s happening during a pandemic.

States like Alabama have generated national headlines recently as lawmakers attempt to restrict abortion. But even in states like Washington, with strong pro-choice legislation, if patients can’t reasonable access care, the effect is largely the same.

“A law is only as effective as someone’s ability to access (care),” Harris-Talley said.

There have been efforts to remedy this, she said, including the passage of HB 1608 during the 2020 Legislative session. The law prohibits health care providers from limiting information given to patients about their health status, treatments and the state’s death with dignity laws.

A work group is being formed to find ways to implement the law.

“I think this is absolutely the time when community and public voices need to be heard,” Rutman said.