Crisis pregnancy centers take advantage of state ultrasound requirements to get patients in the door despite not offering abortion care. (Image: Ultrasound operator via Shutterstock; Edited: JR/TO)

Over the past few years, crisis pregnancy centers (CPCs) – storefronts masquerading as reproductive health clinics – have been dragged out of the shadows where they had operated largely unnoticed by the general public. The awareness created by documentaries like 12th and Delaware and investigations by national and state chapters of NARAL Pro-Choice America have led to a wave of proposed legislation designed to curtail their deceitful tactics.

The potential regulations forcing CPCs to be upfront about their services and intentions are a bright spot in the current slate of state-level bills concerning reproductive health. With 332 abortion restrictions floating through legislatures just in the first quarter of 2015, this new trend is welcome and necessary. Because the bills regarding regulation of CPCs wouldn’t explicitly expand abortion access, they are both an easier sell for middle-of-the-road elected officials and mundane enough to slide under the radar of anti-choice politicians and candidates seeking to court “pro-life” votes.

CPCs’ Insidious Tactics

The majority of the United States’ 3,500 or so CPCs were founded and are funded by anti-choice religious organizations. While the American Medical Association declares, “The patient’s right to self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice,” CPC employees regularly pose as medical professionals while lying to clients about their options and gestational age, and forcing them to watch anti-abortion propaganda.

There are roughly twice the number of CPCs as abortion providers in the United States, and they are allowed to advertise falsely, purposely create websites with URLs that mimic full-scale health clinics, and lie to patients during appointments. This creates a climate where thousands are unwittingly injured annually, both emotionally and physically.

“It’s unconscionable that CPC workers think it’s OK to mislead and lie to women about their health care,” National Abortion Federation (NAF) president and CEO Vicki Saporta told Truthout. “Many CPCs are affiliated with religious groups and it’s unconscionable that they would condone lying to women.”

Beyond simply coercive language and a refusal to refer patients to doctors who perform abortion, NARAL’s extensive national investigation has found that CPCs engage in a host of tactics and borderline illegal activities including (but not limited to):

Evasive answers on the phone – using state ultrasound requirements to get patients in the door despite not offering abortion care;

Confusing names and locations, including names that are similar to the legitimate clinics in their vicinity;

Intimidation – telling patients they have “the devil inside” them;

Anti-choice propaganda – showing patients grotesque, inaccurate photos and consequences that aren’t scientifically supported, like an increased likelihood for breast cancer;

Misinformation – giving those seeking abortion false promises of miscarriage and lying about gestational age.

Proving their practices are against the law can be tough – even though they are illegal – because there’s so little regulation currently, especially if a particular CPC isn’t registered with a medical license. If your business doesn’t have a license that puts it under the purview of a particular agency that does inspections, no one is coming to see what you’re up to. When a group of businesses are privately funded and have purposely vague services listed on foundational documents, there’s no obvious board, agency or individual to routinely inspect and oversee a group of them. Unless a CPC has ultrasound equipment, they can pose as simply a counseling or referral office or church/faith-based storefront – none of which, as anti-choicers know, automatically fall under the purview of any regulatory agency.

Far from overseeing or regulating CPCs, some states even funnel public money to them. The use of “pro-life” license plates to fund CPCs is a tactic that often escapes scrutiny because it doesn’t seem like that much money and most people just think of it as a vanity plate design. Illinois and Michigan have introduced “pro-life” license plate bills this year, so clearly the push to expand that practice is ongoing. The Michigan bill explicitly allows for CPCs to apply for and receive money from a new Choose Life Michigan Fund, while the Illinois bill states that no group “involved in or associated with any abortion-related activities or counseling” may benefit from that state’s Choose Life Fund. How diligent the vetting process would be remains to be seen and anti-choice groups have been masking their activities and motivations for decades.

Illinois and Michigan aren’t outliers; the prevalence of CPCs and their ability to remain either supported or unnoticed by legislators is not a conservative-area phenomenon. Overwhelmingly liberal California, for example, has seen CPCs flourish in recent years. A Los Angeles Times investigation found 160 CPCs in the state and, according to NARAL Pro-Choice California, there are more than 200 following an explosion in recent years.

What Does Regulation Do?

To address the public health crisis created by the CPC tactics, California has followed Arizona and Missouri as well as San Francisco – its city ordinance regulating CPC advertising was just upheld – in bringing regulation legislation to the floor. As if to illustrate the necessity of proactive legislation on this and other reproductive health issues, Missouri has introduced a conflicting bill prohibiting CPC regulation as well.

These bills require everything from disclosure that CPCs do not provide abortion care and/or contraception to reining in deceptive advertising and allowing for inspections by government agencies. The legislation with the best chance of passing and potentially serving as a model for other states is also the most comprehensive: California’s Reproductive Freedom, Accountability, Comprehensive Care and Transparency Act (FACT Act).

“The FACT Act would require facilities without medical licenses that advertise and provide pregnancy testing and care to post a notice saying they have neither a license nor licensed providers on staff,” Saporta said. “This bill is an important first step toward ensuring women have access to medically accurate information and aren’t misled by CPCs.”

The law would also force CPCs to offer resources on abortion care – a bold provision. Bill co-sponsor Assembly member David Chiu explained in a press release why he was moved to introduce such unapologetic, comprehensive legislation: “We have a responsibility as lawmakers to make sure that the information given to women who are making their own healthcare decisions is accurate and timely.”

Pro-choice faith group the Religious Coalition for Reproductive Choice (RCRC) agrees that decisions belong to the patients, condemning both the tactics and the motivation of CPCs.

“Shame enacts barriers to health services. Shame disempowers doctors from giving accurate information. Shame bullies women out of making the parenting decisions best for them and their families,” RCRC president and CEO Rev. Harry Knox told Truthout. “Our communities need more access to health care and education, not less. We are called, as people of faith, to put shame behind us and ensure that every woman can find support, compassion and accurate information.”

Anti-choice groups who claim their opposition to abortion is based on religion have called the FACT Act a “bully bill” as though their religious freedom and free speech are infringed upon by being held accountable for their lies. Knox refutes these groups’ motivation, and the foundation their opposition is supposedly based on.

“Every tradition has a different definition of when life begins. This is a matter of faith, not a matter of science. Medical professionals should provide scientific information and should leave the religious questions to the clergy, and even then, only when a woman decides to seek them out,” he said. “Women have abortions for many different reasons. God trusts and empowers us to make the best decisions for our families and ourselves.”

Long-Term Reproductive Justice Goals

Trusting people and their families to make the best decisions for themselves is at the core of legislation regulating CPCs. Patients should be entrusted with the agency to determine the outcomes of their immediate circumstances and, therefore, their lives.

“CPCs do a great disservice to women and we need to limit their ability to mislead and deceive,” Saporta said. “Proactive legislation like this is important.”

Knox expressed a similar sentiment and related it back to the long-term goals of the reproductive justice movement.

“Decisions about reproductive health and whether and under what circumstances to become a parent are among the most sacred decisions we make. Anti-choice politicians have sought to incrementally deny us that sacrosanct decision,” he said. “Those of us seeking to advance reproductive justice cannot be content with merely slowing down their progress. We must confidently claim our voice and boldly proclaim our vision for a just society. We are building a society where each of us has a safe and sacred space to make these important health and life decisions. That means those of us seeking an abortion must receive accurate information from our doctors.”