Crisis pregnancy center

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A crisis pregnancy center (CPC), sometimes called a pregnancy resource center (PRC),[1][2] is a type of non-profit organization established to counsel pregnant women against having an abortion.[1][3][4][5][6] 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.[7][8][9][10] CPCs that qualify as medical clinics may also provide pregnancy testing, sonograms, and other services; however, the vast majority are not licensed and provide no medical services.[1] CPCs have also been known to disseminate false medical information, usually about the supposed physical and mental health risks of abortion.[11][12]

CPCs are typically run by pro-life Christians according to a conservative Christian philosophy,[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 are roughly 2,500 CPCs in the United States, as compared with 1,800 abortion clinics.[14] Canada, as of 2003, had roughly 200 CPCs and about 25 abortion clinics.[15] Hundreds more operate outside of the U.S. and Canada.[16] At least 20 U.S. states provide funding for CPCs,[5] and from 2001 to 2005, 50 CPCs received $30 million in funding from the U.S. federal government.[1] By 2006, U.S. CPCs had received more than $60 million of federal funding, including some funding earmarked for abstinence-only programs.[17]

Legal and legislative action regarding CPCs has generally attempted to curb deceptive advertising,[18] targeting those that present themselves as abortion clinics or requiring centers to disclose that they do not offer certain services or possess certain qualifications.[19] In 1993, the National Institute of Family and Life Advocates (NIFLA) was formed to provide legal advice to CPCs in the U.S.[3][20][21]

History and activities

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.[22] 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.[23]

While CPCs often look like abortion clinics and are intentionally located near them,[5][24][25] the overwhelming majority are not legally licensed as medical clinics and do not offer medical services.[1] Most CPCs offer free pregnancy tests, often over-the-counter ones, and there is a movement towards obtaining medical clinic status, largely so that more CPCs may offer sonograms in an attempt to convince women to carry their pregnancies to term.[7][21][26] They may also provide screening for sexually transmitted infections, adoption referrals, religious counseling, financial assistance, prenatal services, child-rearing resources and other services.[7][8][9][10]

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.[27] While some centers refer clients for contraception, most do not and the service may be limited to married women.[28][29] Others may offer Bible study sessions and peer counseling for women who have recently had abortions.[3]

CPCs have been criticized for using heavy-handed methods such as graphic, detailed videos, religious proselytism, dissemination of inaccurate medical information[30][31] and the use of misleading advertising. Many are buying ultrasound machines, employing staff with medical training, and otherwise moving toward a "medical model" of serving women in the communities where they operate.[32] Paige Johnson, a spokeswoman for Chapel Hill based Planned Parenthood of Central North Carolina stated, "I don't discount the work that they do for women who know they want to keep their babies." And went on to say "But I don't think that government money should go to organizations that don't provide a full range of services."[32]

Use of sonograms

Ultrasound scanner.

About a quarter of CPCs conduct free sonograms as a way to persuade women not to abort.[1][5][33][34] It is frequently claimed that women who visit CPCs and see their embryos or fetuses through the use of ultrasound technology decide against abortion, although there are no scientific studies which support this.[21][35]

Colorado-based Focus on the Family had the goal of equipping 800 CPCs with ultrasound machines by 2010, through its "Option Ultrasound" program.[36][37] The Southern Baptist Convention—the largest Protestant denomination in the United States—has formed an Ethics & Religious Liberty Commission (ERLC), which works to equip more CPCs with ultrasound machines through a venture called the "Psalm 139 Project". ERLC President Richard Land wrote: "If wombs had windows, people would be much more reticent to abort babies because they would be forced to confront the evident humanity of the baby from very early gestation onward."[38]

Dallas-based Involved For Life reports that they have bought a mobile sonogram unit, Sonograms on Site, which is parked outside of abortion provider facilities so that they can discourage women from going into clinics for care.[39]

False medical information

Journalists, medical researchers, congressional investigators, prospective CPC clients, and pro-choice advocates have routinely found that CPCs disseminate false medical information.[12][34] In a few cases, such information may be based on decades-old studies that have been discredited by more recent research.[13] In others, CPCs claim an existing scientific consensus in favor of such information.[1] The information is usually about the supposed health risks of abortion; centers fail to mention that abortion is 11 to 12 times safer than childbirth.[13][32] Some centers even say that "terminating a pregnancy is far more dangerous than carrying a baby to term", although the opposite is the case.[11]

One common piece of medical misinformation is the assertion of a link between abortion and breast cancer.[1][4][11][12][13][24][32][40][41][42][43][44][45] One crisis pregnancy center counselor is reported to have told a client that "50 percent of women who have an abortion get breast cancer and 30 percent die within a year of the procedure";[43] others have claimed a 50% increase,[1]:8 an 80% increase,[1]:8,[11][42] a doubled increase,[1]:8[44] a quadrupled increase,[46] or said that a client with breast cancer in her family would certainly get cancer and die if she had an abortion.[42] Major medical bodies (including the National Cancer Institute[47]) say that there is no link between abortion and breast cancer.[13][24][40][41][42]

Another is the assertion of a link between abortion and mental health problems. CPC counselors are reported to have conveyed various supposed psychological consequences of abortion, 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.[1][5][11][13][24][41][42][45][46][48][49][50] Figures included a 50% chance of long-term emotional problems[41] or trauma,[1] nine in ten women suffering "post-abortion syndrome",[1] and a sevenfold increase in the suicide rate;[1] one center said that anyone who had had an abortion was certain to experience mental health problems like those suffered by Vietnam veterans.[1] 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."[1][24][41][42]

CPCs may also claim that surgical abortion is a dangerous procedure, with a high risk of perforation or infection.[5][13][41][42][44][46][48][50] One CPC counselor is reported to have told an undercover investigator that a patient was left needing a colostomy bag after her bowel was perforated;[46] several reports mention that a CPC described or depicted a woman dying as a result of the procedure.[42][44][51] However, fewer than 0.3% of women who have abortions experience complications that necessitate hospitalization.[41]

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.[1][11][13][41][42][45][46][48][49][50] One center claimed that there was a one in four chance of not being able to carry another pregnancy.[50] These claims are not supported by medical data.[1][41][50]

Besides false information about health risks of abortion, 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][23][24][41][42][46][51] Some counselors said that "all condoms are defective and have slots and holes in them"[13] or that they fail "something like 40 percent of the time."[24] Other centers said that condoms were permeable to HIV or other diseases,[23] or that hormonal contraceptives had abortifacient effects and did long-term harm to women's health, such as causing infertility,[41][42] while one said that condoms caused cancer.[46](registration required) Some CPCs refuse to counsel on birth control.[39]

Other false information may concern the methodology of pregnancy tests,[51] the advisability of STI testing on pregnant women,[42] the comparative risk, availability, and advisability of abortion at different stages of pregnancy,[44][46][50][52] descriptions of female anatomy,[50] the rate of postpartum depression among women who carry to term,[1] the progression of fetal development,[44][46] fetal pain,[44] the possibility of getting pregnant from rape,[46] the progression of pregnancy,[23][46] and the number of pregnancies that end in natural miscarriages.[23]

In 2006, Congressman Henry Waxman (D-CA) led an investigation of taxpayer-funded CPCs and found that they provided "false and misleading information about the health risks of an abortion" to "vulnerable teenagers".[1]

Pro-choice organizations like Planned Parenthood, the National Abortion Federation, and Choice Ireland have criticized CPCs' dissemination of false medical information.[4][52][53] 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."[32]

Religious affiliation

The overwhelming majority of CPCs in the U.S. are run by pro-life Christians according to a conservative Christian philosophy.[2][13][54][55] As of 2007, two Christian charities, Care Net and Heartbeat International, accounted for three quarters of CPCs in the United States.[16] 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"[56] and that its "pregnancy centers are committed to sharing the love of Jesus Christ with every person who walks through their doors."[57] Heartbeat International, one of the largest CPC networks in the United States and also the largest CPC network in the world,[58] runs "Christian crisis-pregnancy centers"[59] and describes itself as a "Christian association of faith-based pregnancy resource centers" whose materials are "consistent with Biblical principles."[2] NIFLA "strongly believes that sharing the Gospel is an essential part of counseling women in pregnancy help medical clinics".[55] Some CPCs are run by the Catholic Church[4] or by other church groups.[7][60] Unaffiliated CPCs, or CPCs affiliated with other organizations, may provide a religious perspective in their counseling.[19][24][61][62]

In contrast to overt Christian perspective of most CPC networks, Birthright International has a stated philosophy of non-evangelism.[63] A Jewish CPC, called "In Shifra's Arms", also exists.[64]

Many CPCs require their staff to be Christian.[65] 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.[11][28][66][67] CPCs unaffiliated with either of these may also require staff to be Christian.[29][67][68][69][70]

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",[67] claims to have effected over 23,000 conversions or restatements of Christian faith.[57] NIFLA "strongly believes that sharing the Gospel is an essential part of counseling women in pregnancy help medical clinics".[55] Some visitors to CPCs report that employees subjected them to unwanted evangelizing.[23][24][51][71]

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"[72] and is a division of the Christian charity CARE.[73] 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";[74] its affiliates "adhere firmly to Christianity."[11] The United States-based Human Life International runs "Catholic pregnancy centers" in Mexico[75] 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."[76] As in the United States, unaffiliated CPCs may also be run by church groups or otherwise Christian.

Advertising methods

Example of alleged deceptive advertising for a CPC

CPCs have been criticized for deceptive advertising. Some falsely advertise that they offer abortion services, attracting clients who wish to have an abortion.[3][19][49][77] In the 1980s, investigative reporters from the Arizona Republic, the San Francisco Chronicle and CBS News, among others, filed stories about CPCs luring women by offering free pregnancy tests but then scaring them with religious arguments.[78] Observers have also pointed out that they use rhetoric and advertising language similar to those of abortion providers—for example, "Plan Your Parenthood" or a directory listing under "abortion services" or "clinics"—and object to the use of such techniques which they say may mislead pregnant women seeking abortion into contacting a CPC.[5][7][24][41] Some crisis pregnancy centers advertise in a manner called deceptive by "the Texas Attorney General, the North Dakota Supreme Court, the Federal Centers for Disease Control, the National Organization for Women, Planned Parenthood[,] the New York Metropolitan Religious Coalition for Abortion Rights",[51] "NARAL Pro Choice America, Planned Parenthood Federation of America[,] the National Abortion Federation, as well as the American Civil Liberties Union".[79] In particular, the advertising approach of the Pearson Foundation, which assists local groups establishing CPCs, has been criticized by some other pro-life 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] 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, CPCs may give the impression in their advertising that they can refer women for abortions in British cities or otherwise provide information for women seeking to travel for abortion.[80][81]

Planned Parenthood charges that CPC administrators portray their businesses as "medical facilities", when they do not have professional licensing from local or state health departments, and are staffed primarily with volunteers rather than medical professionals.[82] "They are integrating increasing numbers of medical services in what they do, offering free pregnancy tests and low-cost testing for sexually transmitted diseases and sonographs", says Gloria Feldt. "[But] if they are going to practice medicine—and as they add these tests they are practicing medicine—they either need to practice it legitimately or cut out the charade."[7]

In their advertisements, some CPCs may describe themselves as offering "abortion alternatives", or with another term that indicates that they do not assist clients in obtaining an abortion. However, Robert 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.[23]

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]

Legality

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[19][77][83] or obliged to affirmatively tell clients that they did not do so.[19][32] In some instances, CPCs were prohibited from using names similar to nearby medical clinics that provided abortions,[83] from providing pregnancy tests,[19][32] or from advertising pregnancy tests as "free" if they were conditional upon hearing a presentation or counseling.[32] 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.[83]

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.[84][85][86] 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 that they do not offer medical services under the direction of a licensed health provider.[87] 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.[88][89][90] 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.[91] 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.[92][93]

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."[79][94] Maloney and her colleagues have re-introduced the bill in several Congresses,[43][95][96][97][98] most recently in May 2013, in the 113th Congress.[99]

In 2002, after an investigation and subpoenas of a number of New York State CPCs alleged to be engaged in deceptive business practices,[100] 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.[101]

Safe haven

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.[102]

Government funding

As of July, 2006, 50 American CPCs had received federal funding.[1] 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.[17]

Florida Choose Life tag

In 2006, 20 U.S. states subsidized crisis pregnancy centers.[5] These included Florida, Louisiana, Minnesota, Missouri, Nebraska, North Dakota, Pennsylvania and Texas.[4] Efforts are led by anti-abortion Republicans.[103] Some CPCs in Canada have received funding from provincial governments.[104] In 29 U.S. states,[105] 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.[106] In July 2013, the governor of Rhode Island vetoed a bill for the license plates stating "It is my belief that state participation in the transmission of funds to this organization would violate the separation of church and state, one of the fundamental principles upon which our state was founded."[107]

Mandatory consultation

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.[108] 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."[109] 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.[110]

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.[111]

Affiliation

Most crisis pregnancy centers are affiliated with several major pro-life organizations that fund CPCs; these are Care Net, Heartbeat International, Birthright International, and National Institute of Family and Life Advocates (NIFLA).[20] Care Net is the largest network of CPCs in North America, with 1,100 centers advising over 350,000 women annually.[1] Heartbeat International, a U.S.-based group which affiliates with CPCs both in the United States and abroad, is associated with 1,800 centers.[112] Some CPCs are affiliated with multiple organizations at once, so the sum does not reflect the total.[28] The largest UK organisations are CareConfidential and LifeUK, while the largest Canadian one is the Canadian Association of Pregnancy Support Services (CAPSS). Human Life International, a Roman Catholic group that opposes abortion, also runs CPCs outside the United States.

Ireland: confusion with government sponsored centers

In Ireland, centers also exist that attempt to persuade women not to have an abortion. These have been reported to "use manipulation and alarmist information",[80][113] including false medical information,[45][46] and been called "rogue agencies."[44][80][114] There are three main agencies of this nature, with branches, but they often change their name or advertise under different names.[46]

The government's Crisis Pregnancy Programme (formerly Crisis Pregnancy Agency) funds crisis pregnancy initiatives and is in turn reimbursed by the Health Service Executive;[115] however, crisis pregnancy counseling grants, provided through a campaign called "Positive Options", are only awarded to centers that offer non-directive and medically accurate counseling that discusses all possible options, including traveling abroad for abortion.[80] Government sponsored centers' 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."[115] A survey by the CPP found that 4 in 46 women surveyed encountered a "rogue agency" when seeking counseling.[116] 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 centers that do not provide information on abortion.[81][117]

See also

References

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