In the wake of the Supreme Court’s overturning of landmark abortion case Roe v. Wade, anti-abortion pregnancy centers have come under increased scrutiny. Termed crisis pregnancy centers (CPCs), they often mimic medical nomenclature, outfit employees in lab coats and provide medical advice, though critics argue most of these centers employ few, if any, medical professionals. Some people who go to a CPC say they didn’t even realize they weren’t in an abortion clinic.
In the past week, heightened fear over lack of CPC privacy regulations and their use of clients’ data has renewed criticism, drawing the attention of members of the U.S. Senate. While CPCs are agents of a national debate, their presence is most felt in the communities they are drawn to—CPCs tend to pop up in low-income communities, near college campuses, or in locations close to abortion clinics, often outnumbering abortion clinics themselves.
In 2017, there were only 16 abortion clinics operating in Virginia. In 2018, the state had 51 CPCs. There are eight of these centers currently located in Williamsburg and Hampton Roads, and only four abortion clinics in the same area, with at least one CPC located within 6 miles of each abortion clinic. While Williamsburg does not have an abortion clinic, it does have a CPC—Hope Pregnancy Center, operated by the Williamsburg House of Mercy and located directly behind the College of William and Mary’s Alumni House.
Pregnancy centers are no new phenomenon and have existed in the Hampton Roads area since the early 1980s—many are operated by religious organizations and they attempt to dissuade pregnant individuals from recieving an abortion. Often, their websites use seemingly neutral language on the issue, claiming they are a space to “process all your options” by offering free “options consultations.” But according to Dr. Amy Bryant, MD, an assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine, CPCs never consider abortion an option.
“What might not be immediately apparent to someone seeking help at a CPC is that these centers take a distinct anti-abortion approach to pregnancy in that unintended or ‘crisis’ pregnancies have two viable options, adoption or parenting,” Bryant wrote in the AMA Journal of Ethics.
While they do sometimes provide material support, such as diapers, formula or baby clothes, CPCs offer few necessary medical services—usually just pregnancy and STI testing and occasionally non-diagnostic ultrasounds. In a statement, a spokesperson for the Hope Pregnancy Center said their goal is to provide material and emotional support during and after pregnancy, linking their services with others the House of Mercy provides, like rapid rehousing and career development.
“If someone calls wanting an abortion, we quickly explain that we do not provide that service,” the spokesperson wrote to The Flat Hat. “Sometimes people come in to talk and later call to say they have changed their minds and have decided to have an abortion. It is always a deeply emotional experience. We tell them if they find they are experiencing grief or emotional turmoil afterward, they can come back to see us, and we can assist with licensed professional counseling. Having an abortion does not preclude women from receiving our food, shelter, clothing, diaper, or financial support.”
President of the College’s chapter of Vox: Planned Parenthood Generation Action Becca Gaylin ’23 said college students are particularly susceptible to CPC messaging.
“Especially students who would possibly be experiencing this and would need this type of health care—the fact that the closest, most available option is going to sort of shame them into thinking a certain way or making them try to, you know, change their minds about what they want with their own bodies and lives is upsetting,” Gaylin said. “So I think that students need to be aware of that so that they can avoid it and know that there are other options and that that's not the only place that they have to go to.”
Few of the services offered by CPCs are necessary prerequisites for obtaining an abortion in Virginia. Many CPCs encourage women to receive an ultrasound and counseling prior to an abortion appointment, which critics argue can cause pregnant individuals to wait longer and risk missing the window of availability for a legal abortion.
A blog post by Alcove Health Women’s Clinic in Newport News—which previously used the name of its affiliate national organization Care Net—suggests a person confirm their pregnancy, receive an ultrasound, get tested for STIs and consult a registered nurse for an “abortion consultation” before they should receive an abortion. In Virginia, it is not required to recieve an ultrasound, STI testing or a consultation before an abortion and there is no waiting period required. Alcove did not respond to The Flat Hat’s requests for comment.
Gaylin also emphasized that for students at the College, similar services like STI testing and pregnancy tests are offered for free at the student health center, and emergency contraception pills (Plan B) is subsidized to $5. Gaylin said Vox has attempted to make students aware of these services, and of the presence of Hope Pregnancy Center near campus, via social media. She said they also have a confidential reproductive health assistance form that the club views as an alternative to CPCs for students seeking to know their options.
Opponents say CPCs tend to give incorrect, incomplete or intentionally skewed medical advice to their clients in consultations and on their websites. Hope Pregnancy Center in Williamsburg states on its website that several forms of emergency contraception (also known as “the morning after pill”), including ella and Plan B cause abortions. This information is incorrect, as emergency contraception pills do not cause abortions and they cannot end a pregnancy. Alcove also has a page on its website advertising abortion pill reversal, a procedure that does not meet clinical standards according to the American College of Obstetricians and Gynecologists.
Many pregnancy centers also imply that abortion can be painful, dangerous and ill-advised. Abortion is a safe procedure—according to CDC data from 2013-2018, abortions caused 0.4 deaths per 100,000 abortions while pregnancy caused 17.4 deaths per 100,000 pregnancies. Furthermore, unsafe abortions in locations without access to safe procedures cause increased deaths around the world.
While some CPCs employ medically licensed professionals—such as the Keim Centers, which employs a registered nurse as its Director of Medical Services—most are not certified medical clinics with the ability to diagnose conditions. For example, a CPC might give someone a pregnancy test, Bryant said in a phone call, but they do not have the ability to diagnose a pregnancy.
“A nurse, you know, somebody with a medical background can volunteer to do anything they want,” Bryant said. “It doesn't make them the appropriate person to give that care or give a license to that facility to be able to make diagnoses.”
Furthermore, most of the client-facing positions, including those employees or volunteers giving medical and counseling advice, require no medical qualifications.
In a set of job postings at the Keim Centers—a group of CPCs in the Hampton Roads area—the role of a “Patient Advocate” is described as meeting with clients and offering “education and information” on pregnancy. The only qualifications for the role are that the applicant be at least 21 years old and agree with the center’s statement of faith. On the other hand, the full-time Director of Marketing must possess a bachelor’s degree and at least two years of work experience.
CPCs are also able to evade laws on minimum staffing and health information privacy that generally apply to certified medical clinics. Bryant warned that in a post-Roe world, who knows about a pregnancy becomes a matter of legal concern.
“I fear it is a big theoretical worry because, if you think about it, in the absence of Roe, where many states are criminalizing abortion, one of these centers could know that someone's pregnant and bring somebody in,” Bryant said. “I mean, it's theoretical but they no longer have this backstop of Roe where that would not be okay.”
Last week, a group of seven U.S. senators agreed, penning a letter to CPC umbrella organization Heartbeat International urging it to provide information on the types of data its CPCs collect and how it is used.
“While your organization and many of its affiliate CPCs claim to adhere to HIPAA to protect patients’ health information, it does not disclose how it is using the data it collects, whether it is keeping personal information secure, and whether it intends to do so in the future,” the letter states. “Heartbeat International promotes websites that have inaccurate claims, including that CPCs ‘use intake forms as a type of confidentiality agreement, which grants the woman confidentiality protections like she would receive under HIPAA. In other words, they ‘resemble’ HIPAA forms because they act like HIPAA forms.’ But these forms do not offer the same protections as HIPAA.”
CPCs often posit that abortion is a for-profit insudstry aimed at scamming pregnant individuals and that they are a better financial alternative. On its website, the Keim Centers says it does not perform or refer abortions, linking the practice to financial gain for those who do.
“They talk about abortion as something like an ‘abortion industrial complex’ and this idea that people are just trying to make money off of you,” Bryant said.
Evidence suggests these financial claims are not well-based. Planned Parenthood, the largest provider of abortions in the country, is a non-profit organization that is prohibited from using federal funds for abortion services. Furthermore, there is no evidence that abortion providers gain financially from offering the service.
Appealing to financial anxieties, trust and privacy, CPCs often have blogs or ‘resource’ pages that use keywords that might appear more frequently in search engine results. Alcove Health, for example, authored a blog post that specifically references the College and targets students’ financial concerns, stating that Alcove should be a “first call” for anyone with an unplanned pregnancy in Williamsburg. The post also implies that students will not be billed for insurance (CPCs are not considered a healthcare provider by most insurance companies) and that Alcove is a cheaper alternative to real healthcare providers.
“Oh, and we don’t accept insurance payments either,” Alcove’s blog post says. “This means there are no insurance bills mailed to your home – which may be especially important for you if you’re a student at the College of William and Mary. We know your privacy is important to you – and it’s important to us, too. After all, how can you rest when you’re worried about your privacy?”
Bryant said CPCs deliberately place themselves near campuses and that their messaging often targets those most likely to receive an abortion, demographically, women ages 20-24.
Anti-abortion activists argue that search engines like Google have purposely limited CPCs’ outreach as a political statement. Gaylin contended the opposite—that CPCs intentionally attempt to game search engines to be the top result.
“I think when people are seeking that type of care, and just reproductive health care in general, the first thing you're going to do is Google it,” Gaylin said. “And the thing with crisis pregnancy centers is that, I don't know how, but they always make sure that they're the first result that comes up. So if you Googled 'abortion in Williamsburg, Virginia,' a bunch of these pregnancy centers come up and they do everything except abortions, basically.”
These misleading rhetorical tactics are common among CPCs, according to Bryant.
“CPCs have really positioned themselves as this alternative to abortion and somehow as being appropriate options counseling, when in fact, they have a very clear purpose and agenda,” Bryant said.
Despite a tendency in many centers to offer limited or misleading medical advice, CPCs are legal and protected under the first amendment.
A 2018 U.S. Supreme Court ruling decided that the first amendment protects CPCs from being required to provide information on abortion or options to end a pregnancy. They also do not have to disclose whether they have licensed medical professionals on staff. The case was litigated by the Fredericksburg, VA based organization, the National Institute of Family and Life Advocates, which has also pushed for the introduction of ultrasounds in CPCs.
CPCs are not isolated non-profits—they are often connected to well-endowed national organizations. NIFLA is known to provide legal and financial support to CPCs in the state and across the country. A NIFLA Facebook post mentioned the Keim Centers while commending pro-life pregnancy centers in Virginia. Care Net, another Virginia-based Christian organization, also acts as an umbrella organization and affiliates with local CPCs, such as Alcove.
Reporting by the Associated Press suggests that at least 13 states directly fund CPCs, often through “abortion alternative” state legislature. Thirty four states, including Virginia, have a program through the Department for Motor Vehicles that allows people to buy a “choose life” license plate, with a portion of the money directly funding CPCs. A 2015 supreme court decision in Walker v. Texas Division, Sons of Confederate Veterans held that license plates are government speech and gave states the right to approve or deny certain license plate designs.
“As a revenue-sharing plate, after the sale of the first 1,000 qualifying plates, $15.00 of the $25.00 fee is transferred to Heartbeat International, Inc., for distribution to tax exempt pregnancy centers in Virginia that provide services to pregnant women and women who suspect that they may be pregnant,” the DMV website says.
Since the license plates were issued in Virginia in 2009, a reported $750,000+ has been raised for CPCs, according to the Richmond Coalition for Life. Virginia is one of four states that offers a similar “pro-choice” license plate option since 2010, with the money donated to Planned Parenthood but unable to be used for abortion care.
“I really think people should be aware that state legislatures around the country are supporting these and that they're not providing patient-centered care,” Bryant said. “They're not providing care that's necessarily in the best interest of the patients, rather, it's to further a political agenda. And that's not good medical care and they shouldn't be legitimized or supported.”