Imagine for a moment that a cancer patient in desperate need of treatment selects a local “crisis cancer center” that — unbeknown to them — is run by an organization opposed to conventional medical treatment. It therefore doesn’t provide best-practice cancer treatment, nor employ physicians or medical personnel. The patient has no idea that this facility — advertised as a cancer treatment center — doesn’t provide actual medical treatment. They’re given tests to determine how far their cancer has progressed, yet the tests are not administered by medical professionals, and they’re neither diagnostic nor accurate. The patient is told they have Stage 2 cancer when they actually have Stage 4. This misinformation delays their medical treatment, decreasing chances of survival.
Now imagine that this devastating scenario is actually happening in this country — not with cancer care but with reproductive health care. “Crisis pregnancy centers,” first opened in 1967, have proliferated across the country during the last 50 years and vastly outnumber health care facilities and providers that offer abortion care. At least 29 states fund crisis pregnancy centers with taxpayer money, including through the diversion of federal Temporary Assistance for Needy Families funds.
But the biggest problem is what crisis pregnancy centers are legally allowed to do. Because they are not medical facilities and don’t charge a fee, and neither the federal government nor the states have altered the policy choice to allow these facilities to remain unregulated, the centers’ practices are governed as protected speech. And they definitely do involve speech. They were designed around an information-based abortion deterrence strategy, an effective and inexpensive discouragement tactic compared with coercive approaches. In the case of crisis pregnancy centers, however, the manner in which the information is delivered is specifically designed to deceive pregnant people, making the approach both coercive and expensive for their targets.
Here is a common scenario: A young woman in a state with a 10-week abortion ban who believes she is eight weeks pregnant and wants an abortion calls a crisis pregnancy center after seeing advertisements all over town that suggest it is a legitimate medical facility. The staffer does not tell her they don’t provide abortions but encourages her to come in to their “clinic.” Once there, another staffer without medical training performs an abdominal ultrasound to “date” the pregnancy, tells her she is 12 weeks pregnant and that it’s too late to have an abortion, offers her diapers and sends her home. But at eight weeks gestation, an external abdominal ultrasound cannot detect and accurately measure the size of an embryo — only an internal transvaginal ultrasound can — a fact that crisis pregnancy center employees, who are actually anti-abortion activists, know but don’t reveal. The provision of this misinformation is just one of many different deceptive practices that crisis pregnancy centers routinely engage in to steer pregnant patients away from having an abortion.
From a policy perspective, the speech that anti-abortion “crisis” pregnancy centers engage in actually creates crisis pregnancies by misdating pregnancies, lying to patients about their options (including that medication abortions can be reversed, which is medically false), misrepresenting the safety of abortions and delaying the best-practice medical care that patients deserve.
Staff at abortion clinics, in contrast, are legally required to tell patients all their options, including adoption and childbirth, and ensure that abortion is the patient’s own choice by asking if they are being forced or coerced into having one.
The deceptive and coercive practices of crisis pregnancy centers have not gone unchallenged. Several state attorneys general and a 2006 U.S. House of Representatives committee have investigated them for fraud. In recent weeks, crisis pregnancy centers have been scrutinized for collecting data protected by the federal law restricting release of medical information, which crisis pregnancy centers don’t have to adhere to because they’re not medical facilities. That these centers collect sensitive medical information and aren’t held accountable for how they use it or who they give it to is a serious privacy concern.
The policy choice to allow crisis pregnancy centers to remain unregulated raises important questions about patients’ lack of access to quality health care, beginning with free pregnancy tests, accurate pregnancy-related diagnostic tests, prenatal care, social services, treatment for complex conditions such as diabetes and cancer that can be exacerbated by pregnancy, postpartum care (including mental health care), and newborn and infant care. Some of these centers attract women who simply can’t get a free pregnancy test and free diapers anywhere else. Why are we allowing fraudulent, deceptive pregnancy centers to fill in these gaps in care instead of demanding access to quality medical care for everyone?
Crisis pregnancy centers’ tactics also raise the critical question of why patients seeking reproductive health care — yet not other forms of health care, such as cancer treatment — are routinely being served by organizations that falsely and duplicitously represent themselves as offering medical services when they do not. The fact that crisis pregnancy centers, as research shows, target “disproportionally young, poorly educated or poor” girls and women illuminates how these centers’ practices are discriminatory.
If crisis pregnancy centers represent themselves as providing medical services, they should be regulated as medical clinics. If crisis pregnancy centers are allowed to operate as nonmedical entities with free speech rights, then they must make clear upfront and in their advertising that the information and services they provide are opinion-based and not medical-based. Crisis pregnancy centers shouldn’t be allowed to engage in bait-and-switch tactics that run the pregnancy clock to delay abortion care until it is too late for patients to legally obtain one, thereby risking their physical and mental health and well-being.
To be clear, the choice not to regulate is still a policy choice. It represents the tacit permission of legislators to maintain the status quo in the face of evidence of public harm. Elected representatives can and should make different policy choices.
Tamara Kay is a professor of global affairs and sociology, Anna Calasanti is a postdoctoral researcher, and Susan Ostermann is an assistant professor of global affairs and political science at the University of Notre Dame. The authors’ opinions are their own and do not necessarily reflect those of the university.
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