People seeking help with a pregnancy decision may see ads for a free pregnancy test and ultrasound and believe they are visiting a medical clinic, where all of their options will be explored. Instead, they will soon discover that they are visiting a center with no licensed medical providers that is designed to convince them not to seek an abortion.1
There are more than 2,500 crisis pregnancy centers (CPCs) in the United States, compared with fewer than 1,000 abortion clinics in 2020, when researchers conducted the study.1
“Those are essentially clinics that operate to prevent or dissuade people from pursuing an abortion as an option in their pregnancies,” says Christina Frasik, MD, lead study author and a former Albany (NY) Medical College student currently in OB/GYN residency. “Most of the research done on these have been in much more conservative states; for example, Ohio, Louisiana, and South Carolina. We wanted to see how they are functioning in the state of New York, which has more accessible reproductive healthcare and an easier access to abortion.”
Even CPCs located in places like New York City, where laws require them to disclose that they are not medical facilities, few will voluntarily offer that admission, Frasik and colleagues found.
Reproductive health providers may not have heard anything or much about these places, says Rachel Flink-Bochacki, MD, MPH, study co-author and associate professor and chief of family planning in the department of obstetrics and gynecology at Albany Medical Center.
When providers hear a patient visited a CPC, they might believe the center gave accurate medical information. “We assume everyone else is following the same rules of helping patients get the care they want and that everyone has the integrity to follow the rules,” Flink-Bochacki says. “The idea that there are people out there masquerading as healthcare clinics and people are lying to patients is shocking to us.”
The CPCs enticed women by promising free medical care and using inflammatory rhetoric. Frasik, Flink-Bochacki, and colleagues found that 76% of CPCs that were called in a mystery client study made inaccurate or inflammatory statements about pregnancy or abortion. Only 14% spontaneously disclosed they did not offer medical services.
“I think a lot of healthcare professionals are not aware of this,” Flink-Bochacki says. “I have people who come up to me every week and say, ‘Did you know there are crisis pregnancy centers?’”
Researchers wanted to find out what kind of information CPCs were giving out over the phone. The centers’ signs and ads suggest they offer free medical services, such as ultrasounds, says Claire Jordan, MD, study co-author and an attending OB/GYN and former resident in the department of obstetrics and gynecology at Albany Medical Center.
“Abortion is never something most of them are willing to refer to or speak about,” Jordan says.
CPCs may offer people vitamins, encourage them to take parenting and birth classes, or even offer them baby supplies. A small percentage offered testing for sexually transmitted infections.1
When asked about abortion as an option, the lay counselors at these centers often exaggerate abortion procedure risks and describe procedure inaccurately. “Based on the phone calls, we didn’t get much information about abortion being available or true facts about it,” Jordan adds.
While medical providers are learning and practicing shared decision-making with patients, these crisis centers often provide information coercively. They might tell a woman that her best option is to continue the pregnancy and give the baby up for adoption.
“And there are comments: ‘You don’t have to kill the baby,’ and ‘You can still do everything in your life, and nothing else will be changed,’” Jordan says. “They’ll give you a personal experience with abortion and how it ruined them.”
Investigators could not find the credentials of the people who answered phones at CPCs, but none of the facilities were licensed medical facilities. Historically, the people who answer the phone are not medically trained, Flink-Bochacki says.
The lack of medical credentials can pose even graver risks to patients in the post-Roe era. Women in many states face law enforcement investigations, arrests, and jail time for actions they have taken during pregnancy. If a woman visits a CPC, thinking her privacy is protected through HIPAA but the center is not a medical provider, then they may give information to law enforcement, letting them know she was considering an abortion.
“Licensed medical facilities are bound by the privacy rule and have to follow HIPAA and keep our patients’ information private,” Flink-Bochacki explains. “The federal government has resoundingly said that not only are you not obligated to report patients to the police for suspected abortion-related activities, but you should not report them because of the privacy rule and the ethical treatment of patients.”
Non-licensed state clinics like CPCs are not bound by those rules. “They’re not bound by medical ethics,” Flink-Bochacki says. “They mislead patients and try to coerce and guilt-trip them into doing what counselors want them to do, so there’s nothing legally that would prevent them from sharing that information with law enforcement.”
Even when researchers were calling the centers as part of the study, they anticipated the possibility of privacy breaches. “We issued [callers] phone numbers not connected to their own personal numbers to distance themselves from data collection and from crisis pregnancy centers having any of their personal information,” Frasik explains.
For these reasons, reproductive health providers could inform patients about CPCs and how they should be cautious before calling a center they found in an online search or how to call and ask questions to find out whether the center is a licensed medical facility.
“Ask straight up, ‘Are you a licensed medical facility, and do you have credentialed medical doctors, nurse practitioners, or physician assistants, practicing under ACOG [American Academy of Obstetricians and Gynecologists] regulations?’” Jordan suggests. “Some of the pregnancy centers say they have a doctor who oversees everything, and the most we could see is they have a board that oversees it, and a physician is on that board. But none of them had a doctor providing medical information.”
Reproductive health providers also can give patients information about databases with accurate information about where to access full reproductive healthcare, including abortion care. For instance, two such sites are abortionfinder.org and IneedanA.com.Those databases include facilities that provide a spectrum of contraceptive, abortion, and reproductive care. They also quality-check the information they list, Flink-Bochacki says.
“Regardless of what type of physician you are, or what subspecialty you specialize in, you can help your patients navigate the healthcare system, which is inherently confusing. That’s how patients end up at crisis pregnancy centers,” Frasik says. “You can make a difference by knowing where patients can access comprehensive and legitimate care within your own community, and you can refer your patients to the best care for them.”
REFERENCE
- Frasik C, Jordan C, McLeod C, Flink-Bochacki R. A mystery client study of crisis pregnancy centers practices in New York State. Contraception 2022 Aug 31;S0010-7824(22)00224-4.
People seeking help with a pregnancy decision may see ads for a free pregnancy test and ultrasound and believe they are visiting a medical clinic, where all of their options will be explored. Instead, they will soon discover that they are visiting a center with no licensed medical providers that is designed to convince them not to seek an abortion.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content