There’s just one abortion clinic left in North Dakota, and it’s in Fargo. But if you’re searching for a clinic around the state’s second-largest city, Google Maps won’t tell you about it.

Instead, searching Google Maps for “Where can I get an abortion in Bismarck, North Dakota?” will bring up results not only for a facility that doesn’t offer abortion but also for North Dakota Right to Life — an organization that lobbies to end abortion.

“That is very frustrating, and certainly I would love to be able to do something about that,” said Tammi Kromenaker, director of the Red River Women’s Clinic, North Dakota’s only abortion provider. “And a small clinic like ours doesn’t have the capacity to do it.”

In areas where abortion rights are under threat, confusing labels and a lack of policing by Google means misleading — and sometimes flat-out wrong — Google Maps results are common, a VICE News analysis found. Users who search Maps for abortion clinics will often be directed to centers that do not offer or refer patients for abortions, political groups that oppose abortion rights, and, in one case, a monument to “unborn” children.

A screenshot of Google Maps search results in Bismark, North Dakota.

Twenty-one states are considered “at risk” of banning abortion outright if Roe v. Wade were overturned, according to a report by the Center for Reproductive Rights. VICE News searched for abortion clinics in 55 of those states’ largest cities, using terms like “Where can I get an abortion in Boise, Idaho?”

In 21 cities, those searches returned results for facilities that do not appear to offer or refer for abortion and, in fact, frequently warn website visitors about the supposedly dire consequences of the procedure.

Results can vary across browsers, but Google Maps describes many of these places as “pregnancy care centers,” “women’s health centers,” or “women’s health clinics,” labels that make it difficult to discern what services the facilities actually offer. On their websites, they urge women to come in for a pregnancy test, an ultrasound, or counseling about their options. They supply information about adoption and parenting, and dive into graphic detail when describing the different types of abortion procedures and their risks.

Many also offer “abortion recovery” services for women who’ve already gone through the procedure. (While some people do regret having an abortion, one first-trimester abortion is no riskier to a woman’s mental health than carrying a pregnancy to term, a 2008 American Psychological Association task force found.) Some say their facilities are “faith-based.”

Any acknowledgement that a center does not support the procedure is frequently buried and in small type.

“We do not perform or refer for abortions,” the Hope Clinic for Women in Nashville, Tennessee, says on one page of its website. “We can answer further questions onsite.”

At least two centers tell users to contact them immediately if they want to “reverse” a medication abortion using the “abortion pill reversal.” There is no conclusive evidence that this pill works.

“There are situations in which it can be overt misrepresentation and the business knows what they’re doing.”

Businesses can choose from a list of pre-selected categories when describing themselves on Google Maps, such as “women's health clinic,” “pregnancy care center,” or “abortion clinic.” After a business creates or claims its listing, Google sends a physical postcard to its address for authentication.

Google knows that Maps struggles to differentiate facilities that offer abortions from those that don’t, spokesperson Paul Pennington told VICE News. Websites for both pro-abortion rights and anti-abortion organizations often use the same keywords, which can flummox Maps’ automated systems. That’s why Google deploys human analysts from its fraud and spam team to flag businesses that misrepresent themselves on Maps.

“There are situations in which it can be overt misrepresentation and the business knows what they’re doing. I mean, that’s the purpose of the business,” Pennington said. “If you are picking the right business category, if you are — again — being very clear in your website and you say, ‘We do not provide these services, etc.,’ that’s on us.”

But if Google tightens its automated controls too much in an effort to cut out centers that oppose abortion, it risks excluding real abortion providers, Pennington said. For Google, the question is, “What is that balance of having something that’s automated and scalable but also maintaining some level of manual labor that really has people kind of going in and reviewing this?”

“Abortion clinic” is supposed to be a protected category, so choosing that category requires a business to undergo additional certification to ensure it really offers the procedure. But Maps has occasionally mislabeled those facilities.

A screenshot of Google Maps results in Little Rock, Arkansas.

There’s just one clinic that performs surgical abortions in the state of Arkansas: Little Rock Family Planning Services in Little Rock. When searching “Where can I get an abortion in Little Rock, Arkansas?” Google Maps lists the clinic as a “family planning center.” That’s not necessarily wrong, given that the clinic does offer typical family planning services like STI tests, cancer screenings, and birth control. Abortion services are also sometimes considered family planning.

But if you’re searching Google Maps, the only so-called “abortion clinic” in town is Arkansas Right to Life, an anti-abortion organization that lobbies the state Legislature and supports anti-abortion political candidates. Needless to say, it does not offer abortions.

A person who answered the phone at Arkansas Right to Life told VICE News that the group was aware of the incorrect label and had asked Google to fix it in the past.

In a search for abortion clinics in Montgomery, Alabama — a state that recently passed a law to ban almost all abortions — Google Maps initially listed the COPE Pregnancy Center as an “abortion clinic.” The clinic does not provide or refer for abortions.

“That is absolutely insane. We would not do that and certainly didn’t do that, especially today — when it’s, when pregnancy centers have such a bad reputation anyway,” COPE Executive Director Lorie Mullins said of the inaccurate label, adding that she now plans to contact Google to correct it. “We really fight to be upfront and open about what we are and what we provide, and certainly would not lie.”

A Google spokesperson told VICE News that both facilities have continually applied to be certified as “abortion clinics,” and that a Google employee must have mistakenly approved them. After VICE News flagged the miscategorizations to Google on Thursday, the company said it would fix them within 24 hours.

As of publication, Google Maps says COPE Pregnancy Center is a “pregnancy care center.” Arkansas Right to Life is still listed as an “abortion clinic,” but immediately running a second, identical search will pull up listings that describe it as a “research foundation.”

Google Maps has clearly gotten better at differentiating abortion clinics since February 2018, when Gizmodo published an investigation on the issue. At the time, if you stood in Jackson, Mississippi, and searched “Where can I get an abortion near me?” you’d get results for at least four facilities that don’t offer the procedure. The Jackson Women’s Health Organization, the last remaining abortion clinic in Mississippi, was only the second result.

Now, a similar search will lead you straight to the Jackson Women’s Health Organization. After that Gizmodo investigation, Pennington said, staffers zoomed in on the Jackson area to fix its Maps issues.

This online confusion can exacerbate real-life attacks on abortion, and vice versa. Anti-abortion centers are often located in states with stringent abortion restrictions, like requiring patients to wait up to 72 hours after an initial consultation or mandating that doctors give them counseling that, critics say, portrays abortion negatively. If a woman accidentally ends up at a crisis pregnancy center, she may still want an abortion — but she might struggle to find the time to make an appointment at a provider before her pregnancy is too far along.

In Chattanooga, Tennessee — a state with a 48-hour waiting period — the National Memorial for the Unborn pops up in a search for an abortion. It’s a monument to generations of “aborted and miscarried children,” according to its website.

A screenshot of the website for the National Memorial for the Unborn.

A dearth of clinics also makes Google Maps’ job harder, because it can struggle to accurately search remote places that have few options. When users search Google Maps, the engine wants to pull up businesses that are nearby. That gets tricky if there aren’t any, like in Bismarck, North Dakota.

“The closest abortion clinic to a lot of these places are like 300 miles away,” Pennington said. “And something that’s 300 miles away isn’t necessarily a local result.”

Plus, crisis pregnancy centers regularly set up shop next door to abortion clinics, with signage that co-opts “pro-choice” language, said Yvonne Morris, a web developer who has built sites for more than 200 abortion providers. Visitors can easily end up wondering which building actually offers the procedure.

“A lot of my web designs now include ‘Don’t go here, here’s images of [anti-abortion] clinics right next door,’” Morris told VICE News. “They’ll pull you in."

In Dallas, a search for an abortion will pull up multiple abortion clinics. It will also summon the “women’s health clinic” White Rose Women’s Center and the “pregnancy care center” Birth Choice — both of which are located within two blocks of a clinic. The website for the White Rose Women’s Center says life begins at fertilization and that the morning-after pill, Plan B, “results in the abortion of a conceived child.” Birth Choice’s website cautions men who get their partners pregnant, “Don’t run from your responsibilities. The more you try to avoid this situation, the harder things will get for the three of you. Now. And forever.”

A screenshot of Google Maps search results in Dallas.

Advocates on both sides of the abortion debate are now locked into something of a digital arms race. The pro-abortion rights Abortion Access Front runs an initiative called exposefakeclinics.com, which urges supporters to review anti-abortion centers and abortion providers on Google Maps, said Anna Bean, the nonprofit’s community engagement manager.

“We saw Google reviews as a tool to combat that misinformation,” she explained. “Write a completely accurate review: ‘As a consumer, I see that this place does not provide abortion services.’ As simple as that. So that when people then upvote that review — you know, give it that little thumbs-up — that rises to the top of the page.”

Abortion foes do the same thing to clinics, said Bean, who spends her free time trawling through Google results and writing negative reviews for anti-abortion centers. Exposefakeclinics.org — as opposed to .com — leads to a site that defends the centers. The site is run by Heartbeat International, a religious, anti-abortion organization affiliated with more than 2,500 pregnancy help locations, “maternity homes,” and adoption agencies.

Abortion rights activists have also long criticized Google for doing business with anti-abortion centers at all. Though the company removed deceptive ads for these groups as far back as 2014, it went even further in May: Under mounting criticism from Democratic lawmakers, Google announced that would-be advertisers are now required to certify whether they’re legitimate abortion providers. Today, when searching for the term “abortion,” ads carry a label clarifying whether the ad buyer actually performs the procedure.

Still, the Guardian recently found that anti-abortion clinics were able to advertise around similar search terms, like “pregnancy symptoms,” without tacking on that labeling. Alice Huling, counsel for the liberal government watchdog Campaign for Accountability, told the Guardian that these centers may be trying to pull in pregnant women searching for information about their options.

“They are trying to locate and populate those searches so that in a face-to-face discussion they can try to convince a woman to not have an abortion, including through ultrasounds or providing false information about or health and safety concerns,” she said.

Google denied that this finding constituted a loophole in its ads policy. In a statement to the Guardian, the company said the policy was designed to only target keywords related to getting an abortion. Google would not share those keywords with VICE News.

In any case, this policy does not affect Google Maps results. And that’s not enough for Bean.

"There's an influx of these clinics. They're more empowered than ever before by the Trump administration now,” Bean said. “Google needs to play a role in ensuring that people are getting factual information about the services in their community."

Correction: A previous version of the article misstated how many clinics there are in Arkansas. Little Rock Family Planning Services is the only clinic to offer both surgical and medication abortion in the state.