Crisis pregnancy center

A crisis pregnancy center (CPC), sometimes called a pregnancy resource center (PRC),[1] is a type of nonprofit organization established to counsel pregnant women against having an abortion.[2][3][4] CPCs generally provide peer counseling related to abortion, pregnancy, and childbirth, and may also offer additional non-medical services such as financial assistance, child-rearing resources, and adoption referrals.[5][6][7] CPCs that qualify as medical clinics may also provide pregnancy testing, sonograms, and other services.[8] However, CPCs have also frequently been found to disseminate false medical information, usually about the supposed physical and mental health risks of abortion,[9][10][11] but sometimes also about the effectiveness of condoms and the prevention of sexually transmitted infections.[12]

CPCs are typically run by Christians who adhere to a strictly socially conservative viewpoint,[13] and they often operate in affiliation with one of three non-profit organizations: Care Net, Heartbeat International, and Birthright International. As of 2013, there were approximately 2,500 CPCs in the United States, as compared with 1,800 abortion clinics,[14] and Canada has several times as many CPCs as abortion clinics.[15][16] Hundreds more CPCs operate outside of the U.S. and Canada.[17] During the Presidency of George W. Bush (2001–2009) CPCs received tens of millions of dollars in federal grants.[18] As of 2015, more than half of the U.S. states helped to fund crisis pregnancy centers either directly and/or through the sale of Choose Life license plates.[19]

Legal and legislative action regarding CPCs has generally attempted to curb deceptive advertising,[20] targeting those that imply that they offer abortion services by requiring centers to disclose that they do not offer certain services or possess certain qualifications.[21] In 1993, the National Institute of Family and Life Advocates (NIFLA) was formed to provide legal advice to CPCs in the U.S.[2][22][23]

Origin
Protest against crisis pregnancy center in Chicago.

The Family Research Council describes the beginnings of the crisis pregnancy center movement in a 2009 report. In 1968, the first network of centers was established by Birthright, in Canada. Alternatives to Abortion, today known as Heartbeat International, was founded in 1971. Christian Action Council founded its first center in Baltimore, Maryland, in 1980. Christian Action Council eventually would become Care Net.[24] Others cite Robert Pearson as the founder of the first CPC. After abortion was legalized in Hawaii in 1967, he started a crisis pregnancy center in Honolulu to fight it.[25]

Activities

While CPCs often look like abortion clinics and are intentionally located near them,[4][26] most are not legally licensed as medical clinics and do not offer medical services.[8] However, CPCs often offer free pregnancy tests, often over-the-counter ones; additionally, there is a trend toward CPCs obtaining some form of medical certification, largely so that more CPCs may offer sonograms in an attempt to convince women to carry their pregnancies to term.[5][23][27][28] They may also provide screening for sexually transmitted infections, adoption referrals, religious counseling, financial assistance, prenatal services, child-rearing resources and other services.[5][6][7]

Peer counselors are typically covered by mandated reporting laws with regard to statutory rape, and they are encouraged to ask about the age of the woman and the biological father.[29] While some centers refer clients for contraception, most do not and the service may be limited to married women.[30][31] Others may offer Bible study sessions and peer counseling for women who have recently had abortions.[2]

CPCs have been criticized for misleading advertising, for the dissemination of inaccurate medical information, for religious proselytism, and for subjecting clients to graphic videos.[32][33] The British Pregnancy Advisory Service, an independent abortion-providing agency,[34] said that young women were particularly vulnerable to religiously-influenced anti-abortion "Crisis Pregnancy Centres", unregulated by the National Health Service, because many of the women knew less about the healthcare system or did not want to consult their family GP.[35]

Crisis pregnancy centers, along with hospitals and fire and police stations, are designated by state law in Louisiana as emergency care facilities where parents may surrender custody of newborn infants.[36]

Use of sonograms
Ultrasound scanner.

Some CPCs conduct free sonograms as a way to dissuade women from abortion.[4][37][38] Proponents say that women who visit CPCs and see their embryos or fetuses through the use of ultrasound technology tend to decide against abortion, although there are no scientific studies which support this.[23][39]

Organizations such as Colorado-based Focus on the Family and the Southern Baptist Convention, the largest Protestant denomination in the United States, have worked to equip more CPCs with ultrasound machines.[40][41][42]

False medical information

CPCs have frequently been found to disseminate false medical information.[10][11][38] In some cases such information may be based on decades-old studies that have been discredited by more recent research.[13] In others, CPCs may falsely claim to be describing an existing scientific consensus.[11] CPCs' false information is usually about the supposed health risks of abortion, saying, for example, that abortion is much less safe for pregnant women than childbirth when the opposite is true.[9][13][28]

One common medical claim is the assertion of a link between abortion and breast cancer. Crisis pregnancy centers have told clients that their chances of getting breast cancer increase dramatically after abortion.[3][9][10][13][26][28][43][44][45][46][35] Major medical bodies (including the National Cancer Institute)[47] say that there is no link between abortion and breast cancer.[13][26][43]

Another assertion is that of a link between abortion and mental health problems. CPC counselors have warned clients of severely negative psychological consequences, including high rates of depression, "post-abortion syndrome", post-traumatic stress disorder, suicide, substance abuse, sexual and relationship dysfunction, propensity to child abuse, and other emotional problems.[4][9][13][26][46][48][49][50][35] Neither the American Psychiatric Association nor the American Psychological Association recognizes the existence of "post-abortion syndrome", and an American Psychological Association review of relevant studies found that "abortion is usually psychologically benign."[26] The Royal College of Obstetricians and Gynaecologists finds no evidence to support an increased likelihood of abuse.[50]

CPCs may also claim that surgical abortion is a dangerous procedure, with a high risk of perforation or infection and death.[4][13][45][48][49][51] In fact, the risk of complications requiring hospitalization after an abortion is approximately 2 in 1,000 in the US.[52] The alleged risk of perforation and infection is also part of the assertion that abortion negatively impacts future childbearing, by increasing the risk of infertility, miscarriages, complications, ectopic pregnancy, or fetal health problems.[9][13][46][48][49][50] These claims are not supported by medical data.[49][50]

CPCs have also been found to disseminate misinformation about birth control methods, in particular the idea that contraception and condoms do not work or have harmful effects.[13][26][51]

False information about pregnancy and the female body[49][51] or about fetal development[45] may also be provided, as may misinformation about the availability of abortion in early pregnancy[45][49][53] and the rate of postpartum depression among women who carry to term,[54] CPCs may also misinform women about their stage of pregnancy in order to prevent them from seeking an abortion until it is no longer legally possible.[55][56][57]

Care Net denounces "any form of deception in its corporate advertising or individual conversations with its clients", though they also say of their promotion of an abortion–breast cancer link that their "role is clearly to include this possible risk when [they] educate clients about all the risks of abortions."[28]

Religious affiliation

The overwhelming majority of CPCs in the U.S. are run by Christians according to a conservative Christian philosophy.[1][13][58][59] As of 2007, two Christian charities, Care Net and Heartbeat International, accounted for three quarters of CPCs in the United States.[17] Care Net, the largest CPC network in the United States, is explicitly evangelistic in nature, and says that its "ultimate aim...is to share the love and truth of Jesus Christ in both word and deed"[60] and that its "pregnancy centers are committed to sharing the love of Jesus Christ with every person who walks through their doors."[61] Heartbeat International, one of the largest CPC networks in the United States and also the largest CPC network in the world,[62] runs "Christian crisis-pregnancy centers"[63] and describes itself as a "Christian association of faith-based pregnancy resource centers" whose materials are "consistent with Biblical principles."[1] The National Institute of Family and Life Advocates (NIFLA), which works with CPCs on legal issues, "strongly believes that sharing the Gospel is an essential part of counseling women in pregnancy help medical clinics".[59] Some CPCs are run by the Catholic Church[3] or by other church groups.[5][64] Unaffiliated CPCs, or CPCs affiliated with other organizations, may provide a religious perspective in their counseling.[21][26][65][66]

In contrast to the overt Christian perspective of most CPC networks, Birthright International has a stated philosophy of non-evangelism.[67] A Jewish CPC organization, called In Shifra's Arms, also exists.[68]

Many CPCs require their staff to be Christian.[69] For example, as a condition of affiliation, Care Net and the Canadian Association of Pregnancy Support Services, the two largest CPC organizations in the United States and Canada respectively, require each employee and volunteer of a prospective affiliate to comply with a statement of faith.[9][30][70][71] CPCs unaffiliated with either of these may also require staff to be Christian.[31][71][72][73][74]

Religious activity is sometimes part of a CPC customer's experience. Care Net, which "is committed to presenting the gospel of our Lord to women with crisis pregnancies",[71] claims to have effected over 23,000 conversions or restatements of Christian faith.[61] NIFLA "strongly believes that sharing the Gospel is an essential part of counseling women in pregnancy help medical clinics".[59] Some visitors to CPCs report that employees subjected them to unwanted evangelizing.[26][51][75][76]

CPCs outside the United States are also frequently Christian. CareConfidential, the largest umbrella network for CPCs in the United Kingdom, runs "Christian-based pregnancy crisis centres"[77] and is a division of the Christian charity CARE.[78] The Canadian Association of Pregnancy Support Services, a similar network in Canada whose centers may also affiliate with Care Net or Heartbeat International, describes itself as a "Christian charity";[79] its affiliates "adhere firmly to Christianity."[9] The United States-based Human Life International runs "Catholic pregnancy centers" in Mexico[80] and also provides aid to the Centros de Ayuda para la Mujer, a network of CPCs in Latin America whose philosophy is "in conformity with the Magisterium of the Roman Catholic and Apostolic Church."[81] As in the United States, unaffiliated CPCs may also be run by church groups or are otherwise Christian.

Affiliation with the anti-abortion movement

Most crisis pregnancy centers are affiliated with several major anti-abortion organizations; these are Care Net, Heartbeat International, Birthright International, and National Institute of Family and Life Advocates (NIFLA).[22] A CPC may be affiliated with more than one network. US based Care Net and Heartbeat International are the world's two largest CPC networks with about 3,000 associated centers between them in the United States and abroad.[82][83] The largest UK organisations are CareConfidential and LIFE, while the largest Canadian one is the Canadian Association of Pregnancy Support Services (CAPSS). Human Life International, a Catholic group opposed to abortion, also runs CPCs outside the United States.

Advertising methods
Example of an advertisement for a CPC

CPCs have been criticized for deceptive advertising. Some falsely advertise abortion services, attracting clients who wish to have an abortion.[2][21][84][85] In the 1980s, investigative reporters from the Arizona Republic, the San Francisco Chronicle and CBS News, among others, filed stories about CPCs attracting women by offering free pregnancy tests but then presenting them with religious arguments and scare tactics against abortion.[86] CPCs may intentionally locate near, and look like, abortion clinics;[4][26] critics have also objected to CPCs' use of rhetoric and advertising language similar to those of abortion providers, such as "Plan Your Parenthood" or a directory listing under "abortion services" or "clinics". These, they say, may mislead pregnant women seeking abortion into contacting a CPC.[4][5][26][87] In particular, the advertising approach of the Pearson Foundation, which assists local groups establishing CPCs, has been criticized by some other anti-abortion groups, including Birthright International, another CPC operator.[51] The foundation recommends that a center seek out women who want abortions through "neutral" advertising, and refuse to answer questions that would reveal that they provide neither abortion services nor referrals to abortion services.[51] Pearson, identified by some as the founder of the first CPC, said that a woman "has no right to information" that will allow her to have an abortion.[75] In Ireland, where abortion is illegal except when pregnancy endangers the mother's life and women often travel to the United Kingdom to end their pregnancies, "rogue" CPCs, in contrast to government sponsored pregnancy centers, may falsely give the impression in their advertising that they refer women to Britain for abortions or otherwise provide information for women seeking to travel for abortion.[88][89]

In recent years, CPCs have also begun using the Internet as a means of advertising. Some use search engine optimization to get their websites closer to the top of search results[14] or bid against abortion providers to appear at the top of sponsored link sections on Google and Yahoo.[13] Heartbeat International, a Christian association that runs 1,800 crisis pregnancy centers, recommends that CPCs use two websites, one fundraising website that describes an anti-abortion mission to secure donors, and another website that purports to provide medical information to attract women seeking contraception, counseling, or abortion.[90]

Legality of advertising methods

Much legal and legislative action around CPCs has attempted to rein in deceptive advertising by CPCs seeking to give the impression that they provide abortions or other women's health services.

Lawsuits against a number of CPCs have determined that they engaged in false advertising and required them to change their methods, or led to settlements where they agreed to do so. CPCs that advertised that they provided abortion services were forbidden from doing so[21][84][91] or obliged to affirmatively tell clients that they did not do so.[21][28] In some instances, CPCs were prohibited from using names similar to nearby medical clinics that provided abortions,[91] from providing pregnancy tests,[21][28] or from advertising pregnancy tests as "free" if they were conditional upon hearing a presentation or counseling.[28] In one of these cases, the CPC argued that they did not receive money from clients and were therefore not subject to regulations on commercial speech, but the court ruled that they were not exempt because they aimed to provide services rather than exchange ideas.[91]

Several ordinances requiring CPCs to post signs disclosing that they do not provide abortions, birth control, referrals for either, and sometimes other medical services have been enjoined, with courts finding that such "compelled speech" violates the centers' rights.[92][93][94] In December 2009, Baltimore, Maryland was the first local government to introduce and pass a CPC ordinance—Ordinance 09-252, "Limited Service Pregnancy Centers—Disclaimers". [25]Austin, Texas amended its law requiring centers to disclose that they do not offer abortion or birth control services to instead require them to disclose whether they do offer medical services under the direction of a licensed health care provider.[95] A bill in Oregon would require its CPCs, currently unregulated, to disclose whether or not they provide these services, and bar them from releasing health information collected from clients without the clients' consent.[96][97][98] In San Francisco, rather than compelling any speech, the city ordinance is framed as a false advertising law which allows courts to fine CPCs up to $500 every time they falsely imply in an advertisement that they offer abortion services.[99] The law's constitutionality was upheld in federal court, with a judge dismissing a lawsuit from a CPC that had been identified by the city attorney as advertising deceptively.[100][101]

California's 2015 "Reproductive FACT Act" requires CPCs without medical licenses to post signs saying that they are not licensed medical facilities and have no medical professionals providing or supervising services; CPCs must also let clients know about the state's public programs for reproductive health care.[102][103] The law has been challenged in National Institute of Family and Life Advocates v. Becerra, argued at the Supreme Court on March 20, 2018, and the Court will decide whether or not the disclosures required by the California Reproductive FACT Act violate the free speech clause of the First Amendment.[104]

On March 30, 2006, Rep. Carolyn Maloney (D-NY) and eleven co-sponsors first introduced a bill called the "Stop Deceptive Advertising for Women's Services Act", which would have required the Federal Trade Commission to "promulgate rules prohibiting...persons from advertising with the intent to deceptively create the impression that such persons provide abortion services" and "enforce violations of such rules as unfair methods of competition and unfair or deceptive acts or practices."[105][106] Maloney and her colleagues have re-introduced the bill in several Congresses,[44][107] most recently in May 2013, in the 113th Congress.[108]

In July 2006, Representative Henry Waxman and his team from the Special Investigation Division published "False and Misleading Health Information Provided by Federally Funded Pregnancy Resource Centers", which analyzes the scientific accuracy of the information provided by a Bush Administration priority: federally funded “pregnancy resource centers.” Since 2001, pregnancy resource centers have received over $30 million in federal funding. Most of this money has come from federal programs for abstinence-only education. Additional funding has been distributed as “capacity-building” grants to 25 pregnancy resource centers in 15 states as part of the new $150million Compassion Capital Fund. For this report, female investigators telephoned the 25 pregnancy resource centers that have received grants from the Compassion Capital Fund, requesting information and advice regarding an unintended pregnancy. During the investigation, 20 of the 23centers (87%) provided false or misleading information about the health effects of abortion.[109]

In 2002, after an investigation and subpoenas of a number of New York State CPCs alleged to be engaged in deceptive business practices,[110] then-New York Attorney General Eliot Spitzer's office worked out an agreement with one of the CPCs in question, intended to be used as a model, which sets out practices including informing clients that the center does not provide abortion or birth control, that it is not a licensed medical facility, and that the pregnancy tests it provides are over-the-counter.[111]

In the United Kingdom, the Advertising Standards Authority mandated in 2013 that the Central London Women's Centre must stop using "misleading" and "irresponsible" advertisements implying that it offered abortion services.[35]

Government support

As of July, 2006, 50 American CPCs had received federal funding.[54] Between 2001 and 2006, over $60 million in federal funds were given to crisis pregnancy centers, much of it coming from funding for abstinence-only programs provided under the conservative George W. Bush administration.[18]

Florida Choose Life tag

In 2006, 20 U.S. states subsidized crisis pregnancy centers.[4] These included Florida, Louisiana, Minnesota, Missouri, Nebraska, North Dakota, Pennsylvania, and Texas.[3] Efforts are led by anti-abortion Republicans.[112] Some CPCs in Canada have received funding from provincial governments.[113] In 29 U.S. states,[114] individuals can support CPCs by purchasing Choose Life license plates. Motorists in these states can request these plates and pay an extra fee, a portion of which is used by the state to fund adoption support organizations and crisis pregnancy centers.[115] In July 2013, then governor of Rhode Island Lincoln Chafee vetoed a bill for the license plates saying that in his opinion it violated the separation of church and state.[116]

Under the Trump administration, CPCs were encouraged to apply for title X funding which is intended to go to organisations offering family planning services. However, most struggled to qualify because offering hormonal birth control, which many CPCs oppose, is a requirement to receive the grants. One CPC organisation, The Obria Group, was awarded millions in grants in 2019 after promising to provide those services in some clinics, despite not currently offering them.[117][118][119]

Mandatory use of CPCs

South Dakota enacted a law in 2011 which would have required consultation at a crisis pregnancy center as a precondition to obtaining an abortion. The law, which was to take effect in July 2011, also would have established a 3-day waiting period, the longest in the country.[120] In June 2011, Judge Karen Schreier issued a preliminary injunction blocking the law from going into effect, writing that the provisions "constitute a substantial obstacle to a woman's decision to obtain an abortion because they force a woman against her will to disclose her decision to undergo an abortion to a pregnancy help center employee before she can undergo an abortion."[121] Although the law remains enjoined, the state later enacted another law which excluded weekends and holidays from the 72-hour waiting period mandated for a person seeking an abortion, potentially extending the wait for the procedure to 6 days, so that only days when CPCs were already open would count as part of the period.[122]

In some cases, judges responsible for granting judicial bypasses to minors have required them to go to a CPC for counseling before having an abortion.[123]

Confusion with government-supported centers in Ireland

In Ireland, centres not affiliated with the government exist that attempt to persuade women not to have an abortion. These have been reported to "use manipulation and alarmist information",[88][124] including false medical information,[46] and have been called "rogue agencies".[45][88][125]

The government's Crisis Pregnancy Programme (formerly Crisis Pregnancy Agency) funds crisis pregnancy initiatives and is in turn reimbursed by the Health Service Executive;[126] however, crisis pregnancy counseling grants, provided through a campaign called "Positive Options", are only awarded to centres that offer non-directive and medically accurate counselling that discusses all possible options, including travelling abroad for abortion.[88] Government sponsored centres' efforts to reduce the number of women who opt for abortion consist primarily of the provision of "services and supports which make other options more attractive."[126] A survey by the CPP found that 4 in 46 women surveyed encountered a "rogue agency" when seeking counseling.[127] The Department of Health does not regulate the anti-abortion agencies, since the 1995 Abortion Information Act, which establishes that Irish women have a right to know about abortion services abroad and which regulates providers of information, does not apply to centres that do not provide information on abortion.[89][128]

The term "crisis pregnancy" is used by abortion-rights agencies, like the Irish Family Planning Association.[129]

See also

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