Ibis surveyed staff at Catholic and non-Catholic hospitals across the United States to investigate the accessibility of emergency contraception (EC) at hospital emergency departments. Using a “mystery client” approach, we telephoned staff at all US Catholic hospitals and at 17% of non-Catholic hospitals. Staff at 42% of non-Catholic hospitals and 55% of Catholic hospitals said they do not dispense EC, even in cases of sexual assault. More respondents at Catholic hospitals (23%) reported that they provide EC only to victims of sexual assault compared to staff at non-Catholic hospitals (17%). Among staff who said their hospital does not provide EC under any circumstance, only about half gave callers a valid referral, and most referrals were ineffective. To improve women’s access to EC, hospitals can develop and communicate written policies that support provision of EC and encourage health care providers who observe religious or ethical guidelines to provide effective referrals for women seeking EC.