Crisis pregnancy center
A crisis pregnancy center (CPC), sometimes called a pregnancy resource center (PRC), is a non-profit organization established to counsel pregnant women against having an abortion. 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. 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. CPCs have been reported to disseminate false medical information, usually but not exclusively about the supposed health risks and mental health risks of abortion.
CPCs are typically run by pro-life Christians according to a conservative Christian philosophy, and they often operate in affiliation with one of three non-profit organizations: Care Net, Heartbeat International, and Birthright International. As of 2013[update], there are roughly 2,500 CPCs in the United States, as compared with 1,800 abortion clinics. Canada has roughly 200 CPCs and about 25 abortion clinics. Hundreds more operate outside of the U.S. and Canada. At least 20 U.S. states provide funding for CPCs, and from 2001 to 2005, 50 CPCs received $30 million in funding from the U.S. federal government. By 2006, U.S. CPCs had received more than $60 million dollars of federal funding, including some funding earmarked for abstinence-only programs.
Legal and legislative action regarding CPCs has generally attempted to curb deceptive advertising, targeting those that present themselves as abortion clinics or requiring centers to disclose that they do not offer certain services or possess certain qualifications. In 1993, the National Institute of Family and Life Advocates (NIFLA) was formed to provide legal advice to CPCs in the U.S.
History and activities
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. Others cite Robert Pearson as the founder of the CPC movement. After abortion was legalized in Hawaii in 1967, he started a crisis pregnancy center in Honolulu to fight it.
While CPCs often look like abortion clinics and are intentionally located near them, the overwhelming majority are not legally licensed as medical clinics and do not offer medical services. 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. They may also provide screening for sexually transmitted infections, adoption referrals, religious counseling, financial assistance, prenatal services, child-rearing resources and other services.
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. While some centers refer clients for contraception, most do not and the service may be limited to married women. Others may offer Bible study sessions and peer counseling for women who have recently had abortions.
CPCs have been criticized for using heavy-handed methods such as graphic, detailed videos, religious proselytism, dissemination of inaccurate medical information 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. 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."
Use of sonograms
About a quarter of CPCs conduct free sonograms as a way to persuade women not to abort. 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.
Colorado-based Focus on the Family had the goal of equipping 800 CPCs with ultrasound machines by 2010, through its "Option Ultrasound" program. 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."
False medical information
Journalists, medical researchers, congressional investigators, prospective CPC clients, and pro-choice advocates have routinely found that CPCs disseminate false medical information. In a few cases, such information may be based on decades-old studies that have been discredited by more recent research. In others, CPCs claim an existing scientific consensus in favor of such information. 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. Some centers even say that "terminating a pregnancy is far more dangerous than carrying a baby to term", although the opposite is the case.
One common piece of medical misinformation is the assertion of a link between abortion and breast cancer. 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"; others have claimed a 50% increase,:8 an 80% increase,:8, a doubled increase,:8 a quadrupled increase, or said that a client with breast cancer in her family would certainly get cancer and die if she had an abortion. Major medical bodies (including the National Cancer Institute) say that there is no link between abortion and breast cancer.
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. Figures included a 50% chance of long-term emotional problems or trauma, nine in ten women suffering "post-abortion syndrome", and a sevenfold increase in the suicide rate; one center said that anyone who had had an abortion was certain to experience mental health problems like those suffered by Vietnam veterans. 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."
CPCs may also claim that surgical abortion is a dangerous procedure, with a high risk of perforation or infection. 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; several reports mention that a CPC described or depicted a woman dying as a result of the procedure. However, fewer than 0.3% of women who have abortions experience complications that necessitate hospitalization.
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. One center claimed that there was a one in four chance of not being able to carry another pregnancy. These claims are not supported by medical data.
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. Some counselors said that "all condoms are defective and have slots and holes in them" or that they fail "something like 40 percent of the time." Other centers said that condoms were permeable to HIV or other diseases, or that hormonal contraceptives had abortifacient effects and did long-term harm to women's health, such as causing infertility and cancer, while one said that condoms caused cancer.
Other false information may concern the methodology of pregnancy tests, the advisability of STI testing on pregnant women, the comparative risk, availability, and advisability of abortion at different stages of pregnancy, descriptions of female anatomy, the rate of postpartum depression among women who carry to term, the progression of fetal development, fetal pain, the possibility of getting pregnant from rape, the progression of pregnancy, and the number of pregnancies that end in natural miscarriages.
Pro-choice organizations like Planned Parenthood, the National Abortion Federation, and Choice Ireland have criticized CPCs' dissemination of false medical information. 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."
The overwhelming majority of CPCs in the U.S. are run by pro-life Christians according to a conservative Christian philosophy. As of 2007, two Christian charities, Care Net and Heartbeat International, accounted for three quarters of CPCs in the United States. 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" and that its "pregnancy centers are committed to sharing the love of Jesus Christ with every person who walks through their doors." Heartbeat International, one of the largest CPC networks in the United States and also the largest CPC network in the world, runs "Christian crisis-pregnancy centers" and describes itself as a "Christian association of faith-based pregnancy resource centers" whose materials are "consistent with Biblical principles." NIFLA "strongly believes that sharing the Gospel is an essential part of counseling women in pregnancy help medical clinics". Some CPCs are run by the Catholic Church or by other church groups. Unaffiliated CPCs, or CPCs affiliated with other organizations, may provide a religious perspective in their counseling.
Many CPCs require their staff to be Christian. 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. CPCs unaffiliated with either of these may also require staff to be Christian.
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", claims to have effected over 23,000 conversions or restatements of Christian faith. NIFLA "strongly believes that sharing the Gospel is an essential part of counseling women in pregnancy help medical clinics". Some visitors to CPCs report that employees subjected them to unwanted evangelizing.
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" and is a division of the Christian charity CARE. 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"; its affiliates "adhere firmly to Christianity." The United States-based Human Life International runs "Catholic pregnancy centers" in Mexico 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." As in the United States, unaffiliated CPCs may also be run by church groups or otherwise Christian.
CPCs have been criticized for deceptive advertising. Some falsely advertise that they offer abortion services, attracting clients who wish to have an abortion. 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. 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. 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", "NARAL Pro Choice America, Planned Parenthood Federation of America[,] the National Abortion Federation, as well as the American Civil Liberties Union". 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. 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.
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. "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."
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 CPC movement, said that a woman "has no right to information" that will allow her to have an abortion.
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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.
Legal and legislative action
Legal and legislative action in response to CPCs has typically focused on their advertising practices, and has usually resulted in the CPCs in question being obliged to make clear statements about the services they offer.
In 1986, a lawsuit by the Fargo Women's Health Organization, a medical clinic that performed abortions, led to the North Dakota Supreme Court judging that the Fargo Women's Help Clinic, a CPC, had engaged in "false and deceptive advertising" by advertising that they provided abortions. The Help Clinic argued that, because it received no money from its clients and its statements were in support of a position rather than for commercial gain, they were exempt from regulations on commercial speech, but the court ruled that the CPC's advertisements were "placed in a commercial context and...directed at the providing of services rather than toward an exchange of ideas" and thus were not exempt. The court upheld a preliminary injunction forbidding the Help Clinic from advertising that they provided abortions, and from using a confusing name that might "falsely lull people...into thinking that they are, in fact, the Women's Health Organization or the Fargo Women's Health organization, Inc."
Also in 1986, the Problem Pregnancy Center in Fort Worth, Texas was sued by the Texas Attorney General's office after reports from women who had telephoned the agency, which was listed under "abortion information", and found that it was a "right-to-life outfit." A jury found that the center had violated the Texas Deceptive Trade Practices Act and required it to pay $39,000 in fines, in addition to a larger sum in lawyers' fees.
In 1994, the Center for Unplanned Pregnancy, a San Diego CPC, was legally determined to have engaged in false advertisement. This resulted in it being court-ordered to tell every client that it did not provide abortions or abortion referrals and that its counseling was "from a Biblical anti-abortion perspective", and to stop advertising under "clinics", "abortion service providers", "birth control information" or "pregnancy options counseling" in the telephone directory. The court also disallowed the center from providing pregnancy tests. Three other CPCs involved in the case—Escondido Pregnancy Services, Poway Pregnancy Counseling Center and San Diego Counseling Center—settled out of court and agreed to change their advertising practices, while the last, San Diego Pregnancy Services, had earlier closed when faced with accusations of coercion in its adoption practices.
Other CPCs in New York and California have been enjoined from providing pregnancy tests without a license, while a CPC in California was forbidden to advertise pregnancy tests as "free" if they are conditional upon hearing a presentation or counseling.
In January 2002, then-New York Attorney General Eliot Spitzer launched an investigation into alleged deceptive business practices of 24 crisis pregnancy centers across the State and issued subpoenas to 11 of them. Spitzer's investigation was criticized by some as politically motivated harassment on behalf of political allies like NARAL Pro-Choice America. In February 2002, a number of the targeted crisis pregnancy centers filed motions in New York State court against the Attorney General's office, seeking to quash the subpoenas. Later that same month, Spitzer withdrew all the subpoenas. However, the Attorney General's office also 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.
In 2006, Congressman Henry Waxman (D-CA) led an investigation of taxpayer-funded CPCs and found that they provided "false and misleading information" on an alleged link between abortion and breast cancer, on the alleged effects of abortion on fertility, and on the alleged mental health effects of abortion.
The summary of the report states:
The individuals who contact federally funded pregnancy resource centers are often vulnerable teenagers, who are susceptible to being misled and need medically accurate information to help them make a fully informed decision. The vast majority of pregnancy resource centers contacted for this report, however, provided false or misleading information about the health risks of an abortion. This may advance the mission of the pregnancy resource centers, which are typically pro-life organizations dedicated to preventing abortion, but it is an inappropriate public health practice.
Proposed "Stop Deceptive Advertising for Women's Services Act"
On March 30, 2006, Rep. Carolyn Maloney (D-NY) and eleven co-sponsors 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." Maloney re-introduced the bill in 2007 in the Democratic-controlled 110th Congress, and was joined by Senator Bob Menendez (D-NJ) in reintroducing it in July 2010 in the Democratic-led 111th Congress, but in no case did it progress out of committee.
State and local ordinances
Disclosure and Signage Laws
Most efforts by municipalities to mandate that CPCs provide certain information or post signage have been found to run afoul of the United States Constitution when challenged in the federal courts.
A local law requiring Baltimore crisis pregnancy centers to display signs stating that they do not offer or refer clients for abortion or birth control was declared unconstitutional by the federal court in Maryland in January 2011. The court held that "it is for the provider — not the government — to decide when and how to discuss abortion and birth-control method." The City of Baltimore has appealed the decision to the federal Court of Appeals.
The Montgomery County ordinance, which required CPCs to post signs stating that they do not employ licensed medical professionals and that the county health department advises seeking a licensed health care provider, was enjoined in part by the federal court in Maryland in March 2011. Chief U.S. District Judge Deborah K. Chasanow held that the provision of the law requiring CPC's to state the county health department's position amounts to compelled speech likely violative of the First Amendment.
New York City's effort to regulate the information provided by CPCs was enjoined by the federal court in Manhattan in July 2011. The New York law would have required all pregnancy counseling centers to disclose whether they provide abortion, birth control, or prenatal care. In enjoining enforcement of the law, Judge William H. Pauley III called it "offensive to free speech principles." The City has filed an appeal.
Some campaigns to pass disclosure laws have been supported by NARAL Pro-Choice America, a pro-choice political organization, which cites the ways in which "the centers mislead women." The organization took credit for the passage of the Austin law.
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. 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."
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). Care Net is the largest network of CPCs in North America, with 1,100 centers advising over 350,000 women annually. Heartbeat International, a U.S.-based group which affiliates with CPCs both in the United States and abroad, is associated with over 1,000 centers. Some CPCs are affiliated with multiple organizations at once, so the sum does not reflect the total. 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.
Some CPCs in Canada have received funding from provincial governments.
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", including false medical information, and been called "rogue agencies." Because abortion is illegal in Ireland except when pregnancy endangers the mother's life and women often travel to the United Kingdom to end their pregnancies, these centers may also 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. There are three main agencies of this nature, with branches, but they often change their name or advertise under different names.
The government's Crisis Pregnancy Programme (formerly Crisis Pregnancy Agency) funds crisis pregnancy initiatives and is in turn reimbursed by the Health Service Executive; 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. Legitimate 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." A survey by the CPP found that 4 in 46 women surveyed encountered a "rogue agency" when seeking counseling. The Department of Health does not regulate the rogue agencies.
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In 2005 Florida launched the Florida Pregnancy Support Services Program with $4 million. The funding paid for a toll-free hotline which provides information for non-abortion options and funding for CPCs. Governor Charlie Crist vetoed a funding cut in 2009 saying, "I appreciate the effort and support that chairman Dean Cannon and so many other House leaders put forth in making sure that innocent human life was protected in Florida."
In 24 U.S. states, 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.
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- A Passion to Serve: A Vision for Life – Pregnancy Resource Center Service Report 2009, the status of the CPC movement by a coalition CPCs and pro-life organizations
- Crisis Pregnancy Centers, National Abortion Federation
- The Truth about Crisis Pregnancy Centers, NARAL Pro-Choice America
- Crisis Pregnancy Centers Seek To Increase Political Clout, Secure Government Subsidy, Guttmacher Institute
- RH Reality Check on CPCs
- States React to Crisis Pregnancy Centers, Washington Post, May 9, 2007
- Pregnancy Centers Found to Give False Information on Abortion, Washington Post, July 18, 2006
- Some Abortion Foes Forgo Politics for Quiet Talk, New York Times, January 16, 2006
- Church Groups Turn to Sonogram to Turn Women From Abortions, New York Times, February 2, 2005
- Congressional Inquiry Examines Reports of Bogus Abortion Clinics, New York Times, September 21, 1991