NEWPORT BEACH, Calif. - By joining with a much bigger Catholic health system, a prominent Orange County hospital hopes to enhance patients' access to a host of services - except one.

Hoag Memorial Hospital Presbyterian, based in Newport Beach, started banning elective abortions this year after reaching an agreement to affiliate with St. Joseph Health, riling some doctors and women's advocates.

The controversy has fueled a feisty debate in local editorial pages and prompted a rally outside the hospital, making the Southern California suburbs the latest scene of a culture clash occurring across the country as Catholic and non-Catholic hospitals strike deals in a wave of mergers in the health-care industry.

Women's-health advocates say affiliations between non-Catholic and Catholic hospitals have squelched abortions in a number of locations, and full-blown mergers have also affected health services such as sterilization and contraception.

Hoag has a flagship 485-bed hospital with sweeping Pacific Ocean views and another hospital in nearby Irvine. It joined with Irvine-based St. Joseph Health, which has 14 acute-care hospitals in California and Texas, after winning state approval to form a regional health-care system called Covenant Health Network.

The economic downturn and the health-care overhaul have driven many nonprofit hospitals to form partnerships or merge entirely in recent years, and cultural conflicts related to religion, teaching style or other differences often need to be hashed out for the ventures to succeed, said Lisa Goldstein, associate managing director of the not-for-profit hospital ratings team at Moody's.

Dr. Richard Afable, Hoag's former president who now heads Covenant, said Hoag took a closer look at its abortion practices because it was joining with a Catholic health system where the procedure isn't allowed.

Afable said the hospital decided to cease performing elective abortions because it does so few of them anyway - only about 100 a year. He said that Hoag will continue to perform abortions when medically indicated.

Obstetrician Dr. Richard Agnew said he worries Hoag may start to weed out other services over time. He also said he doesn't feel his patients who choose abortion should be shuffled off to Planned Parenthood or a different hospital, noting most are women who wanted to get pregnant but are carrying a fetus with genetic abnormalities and need a hospital level of care.

Hospitals steeped in different faith traditions have had to contend with public concern over mergers and affiliations in states including Connecticut, Kentucky and Washington.

The debate has most often surfaced in mergers involving Catholic hospitals due to the church's directives on issues ranging from abortion and birth control to end-of-life decisions.