Frances Keet approaches a young woman outside an abortion clinic and shoves some pamphlets – “Pregnant? Confused? We can help” – into her hands.

“We offer help so you don’t have to go through with it,” Keet says.

When she learns the woman does not have an appointment but is thinking about it, she ushers her up a long narrow staircase and into a soft-lit room.

There is a comfortable couch. There is a coffee table. There are scale models of fetuses nestled into the womb.

This is the counselling room of Aid to Women, a registered charity set up next door to the Cabbagetown Women’s Clinic on Gerrard St. E. and Parliament St. in Toronto. Its website advertises counselling on unplanned pregnancy and information on abortion and its alternatives. The charity also gives away baby clothes, cribs and diapers.

Keet grabs a clipboard, settles into a padded wicker chair and begins the hard sell.

“I can’t make those decisions for you,” Keet says, but she has some troubling information to share. A woman who has an abortion, she says, puts herself at great risk of developing breast cancer. Terminating a pregnancy is far more dangerous than carrying a baby to term. And she might never be able to get pregnant again.

At one point she says the fetal parts, or “pieces of babies” are sold to medical research. “There was a big truck that was out there. I don’t know if you saw it: a big truck?” she asks, describing untruthfully how the parts are collected in a bin and picked up for sale.

She gives a terrifying description of the procedure itself. She shows pictures of an aborted fetus, limbs lying in a bloody mess. She plays with her lip as she watches the woman stare.

The point Keet drives home again and again is that a woman will, without a doubt, suffer severe emotional pain following an abortion because it is always – always —the wrong decision.

“You get hardened, because you know it’s a life and then that life is gone,” she says.

Aid to Women is one of many pro-life agencies across the continent called “crisis pregnancy centres,” which describe themselves as non-judgmental sources of support for women with unplanned pregnancies, but use misleading information to discourage them from choosing abortion.

These charitable organizations offer free pregnancy tests and counselling to women seeking accurate information about “all” of their options – abortion, adoption and parenting – without always readily disclosing their belief that terminating a pregnancy is the wrong choice.

The Star sent a reporter to eight of these centres in the Greater Toronto Area, posing as a woman six weeks pregnant who was leaning toward having an abortion but first wanted to learn more about the procedure and its risks.

The Star found volunteers and paid staff at the centres were giving out verbal and written information about the physical and psychological risks of terminating a pregnancy – including breast cancer, emotional trauma and infertility – that either lacked context or has been dismissed by medical experts.

The centres are run by compassionate and caring individuals who clearly believe strongly in the integrity of their mission. In the past couple of decades they have become an important part of the battle against abortion.

These are not the people who picket clinics, humiliate doctors or threaten violence. These are quiet servants and soldiers of God who make it their mission to save the unborn by changing the mindset of one woman at a time.

When the Star returned to confront Keet, counsellor and general manager at Aid to Women, she said she believes in what she is doing, even if some of the information she gives women is unclear.

“(Women) aren’t told the truth (at the abortion clinics) either, so not to say I’m lying, but there’s a lot of hidden truths everywhere and hidden stuff that people need to know,” Keet said. “We’ve seen so many women that said, ‘Oh my goodness, I wish I had been told the truth and if someone would have told me, I would have kept my baby.’”

Keet declined to address the specific allegations but emailed a link to an anti-abortion website that urges visitors to “stop the cover up” to explain why she said women who have an abortion increase their risk of breast cancer by 80 per cent.

Michael Connell, president of Aid to Women, could not be reached for comment.

Pro-choice groups and health care workers are concerned the organizations add to the stress of an already difficult situation.

“The greatest concern that we have . . . is that crisis pregnancy centres are offering misleading information to women who are faced with an unplanned pregnancy,” says Agathe Grametz-Kedzior, program manager at Ottawa-based reproductive rights group Canadians for Choice.

The charity operates a helpline that often takes calls from women who are distressed about information they have received from crisis pregnancy centres.

Victoria Scott is a registered nurse at the Bay Centre for Birth Control at Women’s College Hospital in Toronto, which provides abortion services. She says her job is to guide women through the risks in a realistic and reassuring way.

“I tell them that they statistically have a better chance of dying in a car accident between now and the time they have the abortion than to have one of the more serious complications result (from) having the abortion,” says Scott. “What risks do we take in our day-to-day lives and by choosing to . . . terminate the pregnancy, am I significantly changing that relative risk? And the answer is no.”

Crisis pregnancy centres are not new to Canada.

The oldest of the 17 found in the Greater Toronto Area has been registered as a charity since 1968 and they appear to have a well-established donor pool. The 14 registered charities that run those centres (excluding one set up at a church involved in many other activities) received a total of $546,851 in tax-receipted gifts in 2008.

But they have received far less attention than their 4,000-plus counterparts below the border, where many are state or federally funded and, in several jurisdictions, are the target of proposed truth-in-advertising legislation.

Here, neither Health Canada nor the Ontario health ministry have much to say about their existence. Neither government funds them. Neither government regulates them.

But they are prevalent and they outnumber abortion facilities.

Canadians for Choice, which tracks access to abortion services across the country, says that in 2008 there were 197 crisis pregnancy centres in Canada (83 of those in Ontario), compared to 151 abortion facilities (36 in Ontario). Many of them are affiliated with the umbrella organizations Canadian Association of Pregnancy Support Services (CAPSS), based in Red Deer, Alta., and Toronto-based Birthright International.

The Canadian Association of Pregnancy Support Services and its affiliates adhere firmly to Christianity and the pro-life position. Its website says that everyone involved must agree with statements of Christian faith and the sanctity of life. The association’s CEO Lola French declined numerous requests for a telephone interview and then was unavailable after receiving an emailed list of questions from the Star.

The Mississauga Life Centre, affiliated with CAPSS, is in the basement of a building in the trendy Port Credit area of Mississauga at Lakeshore Rd. E. and Hurontario St. The volunteers and staff are hip-looking, university-aged women who wear stylish casual clothing such as off-the-shoulder tops and chunky jewellery.

Director Eeleah Cummins sat down with a reporter for some gentle counselling.

The opportunity to counsel was something Cummins had prayed for, publicly. An anti-abortion website run by the Colorado-based conservative Christian organization Focus on the Family has a list of prayers from crisis pregnancy centres across North America, including one from Cummins that the Lord would place the desire in women to come in and discuss their options.

But during this session she just says it is her job to give out information about all three options “so you can go back and make an informed decision.”

Cummins reads from a booklet the Star found at other CAPSS affiliates. On the surface it appears to be a neutral, pro-choice approach to options counselling. A closer look reveals that the pamphlet presents abortion as an option fraught with peril, whereas both adoption and parenting are seen as largely positive choices with minimal risk.

“The most risky part of abortion is the emotional part,” says Cummins. She asks the reporter to read out a list of reactions reported by women who have had an abortion, including one called “anniversary grief”.

Loading... Loading... Loading... Loading... Loading... Loading...

“If someone had an abortion May 30, then every time May 30 came around, every year, they’d get depressed or they would maybe be promiscuous that month or they would drink heavy or they would just cry the whole month, and not understand why (they are) crying in May of every year. It doesn’t make sense, right? And if they’ve had an abortion, it’s linked back to that experience,” Cummins says.

Cummins says she knows a woman who found herself unable to vacuum her house because it brought flashbacks of an abortion, although she quickly acknowledges not every woman suffers a traumatic reaction to the procedure.

“But we can’t guarantee that you’re going to be that percentage or the other percentage, so the better you’re prepared for all of that, the better you’ll be,” she says.

Cummins originally agreed to a telephone interview, but insisted upon receiving questions in advance. After receiving the questions, Cummins reneged and emailed a statement noting the centre has a disclaimer on its website that says it does not “refer for or perform abortions” and that it is listed under the “Abortion Alternatives” category in the Yellow Pages.

The distinction between the “Abortion Alternatives” and “Abortion Services” categories is not obvious online, where both pro-life and pro-choice organizations appear under the general heading of “abortion”. Yellow Pages Group says it has received “no inquiries or complaints” about this.

“I would certainly never deceive anyone,” Ruth Gillespie, volunteer co-director of Birthright Mississauga says when asked whether she was concerned that a woman seeking unbiased information about abortion might wind up visiting her office by mistake.

Earlier, an undercover reporter had sat down with volunteer counsellor Liz Nixey at their office in the Dundas St. E. and Hurontario St. area of Mississauga to learn more about abortion and was told the organization preferred to promote life.

The website for Birthright International includes an exhaustive list of services for pregnant women but never explicitly states that it discourages abortion. That only becomes clear when one arrives in the office, where multicultural fetus models tucked into blankets line the top of a bookshelf against the wall and a basket filled with knitted baby socks sits on the coffee table in the counselling room.

Once asked about abortion, Nixey digs into a manila envelope for a blue pamphlet about “the facts of life,” opening it up and pointing to a picture of what a fetus looks like at six weeks gestation.

“I just want . . . the girl to know what is happening inside of her and what the stage of the baby is at,” Nixey said later when the Star revealed that she had been speaking to a reporter. But Gillespie later says this is generally against policy.

“You know, maybe when she looks back, she might say that she should have asked you first,” says Gillespie. “We’re all just human, you know?”

Reality check: Abortion risks — or myths?

Here are the three main risks that crisis pregnancy centres visited by the Star claim are associated with abortion. Medical experts have largely dismissed them as myths and exaggerations.

BREAST CANCER

What they said: Several centres suggested that a woman increases her risk of breast cancer by having an abortion. The counsellor at Aid to Women said the risk was as high as 80 per cent, whereas a counsellor at Mississauga Life Centre mentioned only a “possible link to breast cancer”.

Reality check: The U.S. National Cancer Institute convened a workshop of more than a hundred leading international experts in 2003 to review the existing studies and concluded that neither abortion nor miscarriage increases the risk of developing breast cancer. The Public Health Agency of Canada (according to spokeswoman Sylwia Gomes) and the Canadian Cancer Society both support this conclusion, and based on its own review, the Society of Obstetricians and Gynecologists of Canada recommends that women be reassured of the risk when they seek information about abortion from their doctors.

EMOTIONAL TRAUMA

What they said: Every centre visited by the Star said that abortion can cause negative psychological effects ranging from sadness and guilt to substance abuse and suicidal thoughts. Many of the staff and volunteers said they based this knowledge on working with clients through post-abortion support programs, which tend to be Bible-based and lead women toward asking for forgiveness for terminating a pregnancy. They list the emotional effects of abortion under the label of “Post Abortion Stress” or “Post Abortion Syndrome”, sometimes referred to simply as PAS.

Reality check: The American Psychiatric Association does not list either “Post Abortion Stress” or “Post Abortion Syndrome” in its Diagnostic and Statistical Manual of Mental Disorders, considered the authoritative index of mental illnesses. The association issued a statement in 2008 from then-president Dr. Nada Stotland noting the lack of evidence linking abortion to psychiatric illness.

“A woman may have many emotional reactions to an unwanted pregnancy and abortion – most commonly relief, but also sadness and a sense of loss. These feelings can coexist and, like feelings about any important life decision, they can vary over time,” said Stotland, adding that negative feelings are often associated with the circumstances that led the woman to choose abortion, and not the procedure itself.

FERTILITY PROBLEMS

What they said: Crisis pregnancy centres say abortion increases the risk of future miscarriages and premature births, which they attributed to complications from the surgical procedure such as perforation of the uterus, and could even cause infertility. Several counsellors told stories of women they had met who had chosen to terminate their pregnancies in the past and were now suffering because they were unable to bear children once they felt ready for motherhood.

Reality check: The Royal College of Obstetricians and Gynecologists in the United Kingdom includes a review of the literature in its guidelines for induced abortions and concludes there are no proven associations between terminating a pregnancy and subsequent infertility, but did note the procedure may be associated with a small increase in future preterm delivery or miscarriage, although the evidence is inconclusive.

If those problems are due to complications from the surgical procedure, then the relative risks are rare and influenced by factors such as gestational age and the experience and training level of the physician. Choice in Health Clinic in the Bloor St. W. and Keele St. area of Toronto, for example, informs clients that injury to the uterus happens less than once in every 1,000 abortions and major surgery to repair it, such as hysterectomy, happens approximately once for every 10,000 procedures. Their information sheet cites A Clinician’s Guide to Medical and Surgical Abortion (Churchill-Livingstone, 1999), considered an authoritative textbook for abortion providers and sexual health clinics.

Joanna Smith can be reached at (613) 237-4231 or jsmith@thestar.ca