Note: If you or someone you know is seeking an abortion, we recommend researching ahead of time to ensure the clinic you visit is a medically licensed abortion provider, not a Crisis Pregnancy Center. Visit the National Abortion Federation website to find abortion providers in your area and read our article on “Finding a Reputable Abortion Clinic.”
When an unplanned pregnancy occurs, deciding to keep the baby, put it up for adoption, or have an abortion is a choice many individuals face. Some people decide that an abortion is their best option and begin the process of seeking a provider. Unfortunately, abortion care in the United States is not easily accessible to all individuals. As of 2017, 89% of U.S. counties did not have a clinic providing abortion services with 38% of women ages 15-33 living in these counties.1 While abortion is a legal procedure through viability of the fetus in the U.S., this procedure is not necessarily accessible to everyone.2 Additionally, it can be difficult to discern legitimate medical facilities from Crisis Pregnancy Centers (CPCs) which are anti-abortion organizations posing as comprehensive clinics for pregnant individuals. This article seeks to inform on the practices utilized by some CPCs to mislead the public, and to educate on how to distinguish legitimate abortion providers from CPCs.
Crisis Pregnancy Centers
CPCs are anti-abortion organizations that front as comprehensive reproductive health centers in order to attract clientele seeking abortions. CPCs use dishonest advertising, false information regarding health outcomes related to abortion, and other manipulative and coercive techniques to dissuade pregnant individuals from seeking an abortion.2 The impact on people’s lives resulting from CPC goals and strategies poses a threat to public health.3 This article serves to inform on the current practices of CPCs, assess the legality of their operations, and explore potentially effective interventions related to their legality and care.
Since 1967, when the first CPC was opened in Hawaii, these organizations have evolved from volunteers working out of basements and churches to the highly sophisticated national network that operates today.3 Over time, CPC techniques and practices have been refined to be increasingly deceptive and less transparent. The majority of CPCs have religious affiliations, and most are supported by one of the three major anti-abortion organizations in the United States: National Institute Family Life and Advocates (NIFLA), Care Net, and Heartbeat International.4 While legitimate abortion clinics are facing increasing restrictions and are decreasing in the number of operational clinics, the number of CPC locations is on the rise.5 As of 2018, the number of CPCs in the U.S. was approximately 3,500, while in 2017, the number of facilities providing abortion care was 1,857.1 As a result, there are many places across the country where CPCs are easier to access than reproductive health clinics.2Given the CPCs’ practice of spreading false health-related information, their presence in remote areas that have poor access to accurate health education poses a public health hazard.
Problematic Practices at CPCs
CPCs utilize a wide variety of practices that misinform and mislead pregnant individuals considering abortion. These practices include providing false information, false advertising, delay tactics, co-location strategies, scare tactics and manipulation. Each of these practices is explored in further detail below.
Many women who visit CPCs leave misinformed about mental and physical risks related to abortion. The most common myths spread by CPCs include mental health impact, breast cancer risk, infertility risk, miscarriage rates, and information regarding contraception and STI protection. For example, 87% of CPCs in Minnesota tell their visitors that abortion will lead to severe mental health problems, “post-abortion-syndrome,” or increased risk of suicide.2 Additionally, according to Lisa McIntire of NARAL, “85% of the CPCs investigated in California misled women to believe that abortion is both traumatizing and dangerous.”2 These claims are false and are not supported by mental health professionals. “Post-abortion syndrome” is not recognized by the DSM-5, the leading resource for mental health disorders among mental health professionals.6 Medically speaking, abortion is safer than a tonsillectomy and the primary emotion women report feeling after abortion is relief.2
CPCs make incorrect claims about cancer and infertility risks related to abortion. Their claims of increased risk have been entirely discredited, with the American Cancer Society and National Cancer Institute opposing the possibility of a link between breast cancer and abortion, and finding that abortion poses essentially no long-term risk of infertility.6,2 Lastly, many CPCs exaggerate the likelihood of miscarriage, as a way to convince pregnant individuals that abortions are unnecessary. According to The College of Obstetricians and Gynecologists, the likelihood of miscarriage is around 15%, though CPCs have been found to present women with rates as high as 50%.2 These practices of misinforming vulnerable individuals poses a threat to their health and infringes on their right to choose.
CPCs do not provide abortion services or refer their visitors to abortion providers elsewhere, but this is not readily apparent on their websites or from information given over the phone. These organization have been known to pay to have their sites associated with abortion-related searches on popular search engines. These tailored search results often direct people searching for abortion providers to CPC websites, or to 24-hour operating phone lines that direct the caller to the nearest CPC.7 The key words bought by CPCs create an illusion that they offer comprehensive care, including abortion, further misleading people into thinking that they can find the care they are looking for at one of these centers. According to NARAL, 79% of Google searches for “abortion clinic” led to advertisements funded by CPCs, though 75% of surveyed CPCs in New York City did not identify themselves as anti-abortive on their websites.7,2 People who are seeking safe and legal abortion care are getting redirected to CPC websites, where it is difficult to discern what services they provide and what their stance on abortion is.
After discovering these deceptive practices, the National Abortion Rights Action League (NARAL) collaborated with Google and Yahoo to update their “Truth in Advertising” policy.In the United States, federal law requires that advertisements be truthful and not misleading. As such, the Federal Trade Commission (FTC) upholds and maintains these standards.8 Based on extensive evidence of the CPCs’ false advertising collected and submitted by NARAL, Google cut CPC ads by ⅔, and both browsers greatly reduced the number of abortion-related key terms that led to the misleading ads.2
The use of delay tactics among CPCs is well documented and widespread.2 These strategies serve to stall women and prevent them from accessing real and accurate medical care during the time frame when it is most critical that they do so. First trimester abortionsare very safe from a medical perspective, however, risk of complication increases with gestational age, as does cost and difficulty finding providers. Providing incorrect information pertaining to the age of the fetus in addition to false information regarding legality of late term abortion misleads pregnant individuals understanding of the time frame they have to make a decision. As such, by the time individuals misinformed by CPCs may decide to choose an abortion, it may no longer be legal or safe to do so.
In lying about the gestational age of the fetus, CPCs restrict people’s right to access abortion, both financially and legally. Additionally, the methods CPCs employ to prevent individuals from accessing abortion can exacerbate existing socioeconomic, racial, and ethnic inequities.4
CPCs intentionally target people they think are vulnerable and could consider abortion, by placing advertisements in areas such as high school and college campuses and low-income neighborhoods.2 This strategic placement disproportionately impacts low-income people and people of color, thereby compounding the disadvantages experienced by these groups.
Additional examples of delay tactics include misinformation related to abortion access and timing. When an investigator posing as a pregnant woman visited a CPC in Maryland, one volunteer told her that abortion was legal through all nine months of pregnancy, indicating she had no rush to make a decision. This is inaccurate, as Roe v. Wade protects an individual’s right to abort only until viability of the fetus which, in the U.S., occurs approximately at week 24.9 Viability of the fetus refers to the ability of the fetus to survive outside the womb under normal conditions.9 However, many states posing restrictions prior to viability cut off prescribed by Roe v. Wade.2 Delay tactics employed by CPCs pose a serious health risk to their clients and can negatively affect their ability to access abortion.
Co-location strategies and confusing names are additional tactics utilized by CPCs across the country to confuse and attract those seeking an abortion provider.7 Some CPCs locate themselves immediately near a clinic that provides abortion services and choose a name similar to the clinic, in the hopes that an individual seeking an abortion will mistakenly come in to the CPC.7 For example, one CPC in Worcester, Massachusetts, named themselves Problem Pregnancy (PP) and was located within the same building as a Planned Parenthood (PP).2 When the Planned Parenthood moved location, Problem Pregnancy followed, and located directly across the street from the new location. This co-location strategy has proven to be effective, as many women seeking abortion come into the CPCs by mistake, thinking they are entering a comprehensive care clinic or abortion clinic.
Scare Tactics and Manipulation
CPCs use powerful language to describe abortion as a fearful or shameful act, and even use scare tactics to convince individuals against seeking an abortion. Some examples of these scare tactics include: forcing the individual to pray in a chapel before further discussing the possibility of abortion; showing them graphic images such as a fetus in a trash bin; and using inaccurate and emotionally manipulative language such as “murder” or “killing.”7,2 In New York City, 73% of CPC staff referred to the fetus as a “baby” or “unborn child,” and another CPC staffer referred to the local abortion provider as “a butcher.”2 Using harsh language and pressuring the individual is a way to manipulate them into rethinking abortion as a suitable option.
Fronting as Medical Operations: A Public Health Hazard
Many CPCs offer free ultrasounds, pregnancy tests, and STI/STD testing. However, a majority of CPCs are neither medically licensed nor staffed with medical personnel – thereby putting clients’ health at risk when they pose as a medical operation. A medical license is not required to purchase an ultrasound machine, a loophole CPCs discovered and have adopted into the mainstream services provided. Offering free ultrasounds provides competition with legitimate reproductive health care clinics which would usually charge a nominal fee for a sonogram, and the presence of ultrasound machines portrays the CPCs as legitimate medical operations. Though they can perform the ultrasound, the lack of licensure means that CPCs cannot guarantee that the information they provide regarding the state of the pregnancy is medically accurate.2
The pregnancy tests provided by CPCs are the same ones found in drugstores, and therefore are not as reliable as tests conducted in a licensed medical facility.2 Additionally, CPC staff are advised via their training manual not to handle the pregnancy test so as to avoid any legal responsibility for the service. CPCs regularly provide STD/STI testing; however, it is well documented that they provide clients with biased and inaccurate information which poses additional threats to future health decisions.2 They mislead clients by either misrepresenting risk rates or inventing them altogether.2 Although free services provided by CPCs may initially seem appealing, they lack legitimacy and have the potential to cause more harm due to the misrepresentation of health information.
The lack of licensure means that CPCs staff and the organizations themselves are not bound by the Health Insurance Portability and Privacy Act (commonly referred to as HIPPA), a confidentiality agreement protecting the privacy of patient information present in medical settings.4,10 This poses a serious confidentiality risk to the people who are seen at CPCs, because CPCs have no legal obligation to keep their clients’ personal information confidential. This is problematic because CPCs could legally publicize client information without their consent and expose private health information, potentially placing individuals who had sought abortive care at CPCs at risk.
Federal and State Support for CPCs
Crisis pregnancy centers are both legal and supported by state and federal governments in numerous ways. Given that CPCs are predominantly backed by religious organizations, federal and state endorsement of their mission has been challenged by some reproductive health activists as “amounting to establishment of religion,” questioning whether this involvement demonstrates a breach of the separation of church and state.11 When searching for resources in state directories, many states do not provide information regarding legitimate abortion providers.6 On the other hand, 11 states directly fund CPCs, 20 states directly refer people to CPCs, and 1 state (South Dakota) has a law requiring people seeking an abortion to visit a CPC first.2 An extreme example of government support was exemplified when Texas diverted 18 million dollars of funds intended for preventative women’s health and family planning services to the Alternatives for Abortion services (synonymous term for CPC).2 Government funding and legal support for CPCs legitimizes the practices of these centers, and makes the government complicit in their harmful effects on vulnerable people.
Legality of CPC Operations
Since their beginning, CPCs have faced legal pushback. In 2018 the U.S. Supreme Court struck down a California law, the Reproductive FACT Act. This act required unlicensed clinics to disclose that they are not legitimate state-run medical operations and required licensed clinics to provide women with state health care information. In other cases of disclosure requirements, such as calorie counts on food labels, the courts have been supportive.12 In the case of National Institute of Family & Life Advocates v Becerra, regarding female bodily autonomy and the right to accurate health care information, efforts to require clinics to disclose their lack of licensure were struck down on the basis of violating First Amendment free speech rights of clinics.12 While this ruling means CPCs are still able to disseminate false and potentially harmful information, some activist groups propose alternative methods to achieve what the FACT Act intended to.
Exploring Effective Measures to Increase CPC Accountability
Public health officials may be in the best position to supply the statistical, hard evidence that proves the culpability of CPCs in spreading misinformation and leading harmful practices, which in turn could be used as evidence against CPCs in a legal setting.12 Additional suggestions intended to reduce and hopefully end the harmful effects of CPCs include: increasing access to full care clinics, repealing state and federal funding of CPCs, implementing fines on businesses that use false advertising and deceptive business practices, and providing monetary compensation through legal cases to women who are negatively impacted by their experiences in these centers.13 Lastly, public education can serve to increase public awareness of reproductive health, rights, and resources.3
Access to accurate and comprehensive health information regarding one’s own body is an inherent right. The misinformation, emotional manipulation, and deceptive practices utilized by CPCs in order to drive pregnant individuals away from choosing or accessing abortion pose a serious moral issue as well as a public health threat. Researching the reputability of clinics prior to scheduling an appointment or visiting a provider is one-way individuals can ensure they do not mistakenly go to a CPC while seeking abortive care.
- Jones, Rachel, et al. “Abortion Incidence and Service Availability in the United States, 2017.” Guttmacher Institute, 4 Feb. 2020.
- McIntire, Lisa. “CRISIS PREGNANCY CENTERS LIE: The Insidious Threat to Reproductive Freedom.” NARAL, 2015.
- Rosen, Joanne D. “The Public Health Risks of Crisis Pregnancy Centers.” Perspectives on Sexual and Reproductive Health,vol. 44, no. 3, 2012, pp. 201-205. ProQuest.
- Bryant, Amy G., and Jonas J. Swartz. “Why Crisis Pregnancy Centers are Legal but Unethical.” AMA Journal of Ethics, vol. 20, no. 1, 2018, pp. 269-277. ProQuest.
- Borrero, Sonya, Susan Frietsche, and Christine Dehlendorf. “Crisis Pregnancy Centers: Faith Centers Operating in Bad Faith.” Journal of General Internal Medicine, vol. 34, no. 1, 2019, pp. 144-145. ProQuest.
- Bryant, Amy G., et al. “Crisis Pregnancy Center Websites: Information, Misinformation and Disinformation.” Contraception, vol. 90, no. 6, 2014, pp. 601-605. ProQuest.
- NARAL. “The Truth about Crisis Pregnancy Centers.” National Abortion Rights Action League, 1 Jan. 2017.
- “Truth In Advertising.” Federal Trade Commission, 7 May 2020.
- GH;, Breborowicz. “Limits of Fetal Viability and Its Enhancement.” Early Pregnancy (Online), U.S. National Library of Medicine.
- “Summary of the HIPAA Privacy Rule.” HHS.gov, US Department of Health and Human Services, 26 July 2013.
- “’Choose Life’ License Plates.” Guttmacher Institute, 1 Apr. 2020.
- Pomeranz, Jennifer L. “Abortion Disclosure Laws and the First Amendment: The Broader Public Health Implications of the Supreme Court’s Becerra Decision.” American Journal of Public Health, vol. 109, no. 3, 2019, pp. 412-418. ProQuest.
- Malcolm, Hayley E. “PREGNANCY CENTERS AND THE LIMITS OF MANDATED DISCLOSURE.” Columbia Law Review, vol. 119, no. 4, 2019, pp. 1133-1167. ProQuest.