By Carly Thomsen, Carrie N. Baker and Zach Levitt
Carly Thomsen is an assistant professor at Middlebury College. Carrie N. Baker is a chaired professor at Smith College. Zach Levitt is a graphics editor for Opinion.
With the Supreme Court likely to overturn Roe v. Wade this year, the American anti-abortion movement is preparing for a near future in which abortion is more restricted, in more parts of the country, than at any time in the past 50 years.
Anti-abortion activists have spent decades fighting Roe while waiting for this moment, in part by establishing a national network of about 2,600 so-called crisis pregnancy centers, through which they try to deter women from getting abortions, often with deceptive practices — and, in some cases, using taxpayer dollars.
As the number of C.P.C.s has increased in the United States, the number of abortion facilities has dropped, from more than 2,700 in 1978 to about 785 today. As a result, C.P.C.s now outnumber abortion facilities three to one.
If the Supreme Court overturns Roe, at least 26 states are likely to ban abortion, reducing the number of abortion facilities nationwide to fewer than 600. In that scenario, C.P.C.s would outnumber abortion facilities more than four to one.
More than half of American women of reproductive age would live closer to a C.P.C. than to an abortion facility, according to our analysis.
In 1967 a Christian carpenter in Hawaii named Robert Pearson opened his home as one of the first C.P.C.s in the country, as part of the backlash to expanding abortion access around the United States. By 1973, the year Roe v. Wade was decided, he reported that more than 120 women had visited his center. He later published a 93-page manual on how to start such a center. It was circulated widely among anti-abortion activists across the country.
The manual recommends that activists locate C.P.C.s near abortion facilities, choose neutral-sounding names and show women a slide show that includes misinformation about the health risks of abortion. It includes example scripts to help employees and volunteers deceive women about whether the C.P.C. performs abortions:
QUESTION:Do you do the abortions there?
ANSWER:Anything you need, we do here.
QUESTION:Can my friend be with me?
ANSWER:Your friend can stay with you the whole time you’re here.
QUESTION:I want an abortion. Will you help me?
ANSWER:We have many ways to help a woman and will gladly help you. Have you had a test? We will be glad to do one for you.
Many of the strategies that Pearson recommended are still used by C.P.C.s.
Once inside a C.P.C., women can be greeted by volunteers or staff members wearing lab coats or hospital scrubs who, despite their appearance, are usually not medical professionals. These representatives might try to frighten women by falsely claiming that abortions lead to breast cancer, mental health issues or infertility. They are also likely to suggest that abortion is much more dangerous than it is — in reality, women are almost 15 times as likely to die because of childbirth as from an abortion.
Today, C.P.C. volunteers increasingly use ultrasound machines in order to further appear as if they provide medical care. Women who’ve visited C.P.C.s have reported that volunteers underestimated how far along their pregnancies were. Other women say C.P.C. volunteers overstated natural miscarriage rates — so they might delay seeking an abortion and miss the window in which they are legally allowed to have one.
A 2014 study concluded that 80 percent of C.P.C.s included at least one false or misleading piece of medical information on their websites. Also, it appears that some C.P.C.s could share women’s private health information with national anti-abortion networks, something that could be especially concerning in states that criminalize abortion post-Roe.
Not all C.P.C.s engage in every tactic mentioned above, especially as the centers have come under greater scrutiny in recent years. And some C.P.C.s provide material resources to women, like diapers and baby clothes. These resources often are limited — not enough to care for a baby in the long term — and come with strings attached, like required attendance at parenting or Bible classes. A large share of women who visit C.P.C.s are not pregnant or undecided but are parents who in many cases have been failed by a society that does little to help poor mothers. The anti-abortion movement takes advantage of their economic vulnerability.
Many C.P.C.s in the United States are affiliated with one of four Christian organizations: Care Net, Heartbeat International, Birthright International and the National Institute of Family and Life Advocates.
For Camilla Allison, who was raised in an ultraconservative Protestant community in New Mexico, C.P.C.s were viewed as agents of the church. After she became pregnant at 22, she visited a Care Net center in Albuquerque to get an ultrasound. There a staff member took her to a back room and lectured her.
“It was almost like a Sunday school lesson, all of the fundamentalist dogma I grew up with. It brought up a lot of old shame in me,” Ms. Allison said. “It was all wrapped up in ‘Jesus died for your sins. You’ve already sinned, and if you kill your child, you’ll have lifelong trauma.’”
Cherisse Scott was given misinformation when she visited a Chicago C.P.C. in 2002 after seeing what appeared to be an advertisement for abortion in the Yellow Pages. She said that she was sent to another site for an ultrasound, where she was told that an abortion would perforate her uterus, leaving her infertile. In reality, major complications occur in less than one in 400 legal abortions.
Ms. Scott didn’t learn that she had been manipulated until years later. Today she runs SisterReach, a group that helps young people and women of color find accurate health care and sexual health education.
SisterReach is based in Tennessee, where we estimate that more than 99 percent of women will live closer to a C.P.C. than to an abortion facility if Roe v. Wade is overturned. (Tennessee has already passed a ban on abortion after six weeks of pregnancy; it would immediately go into effect post-Roe.) Ms. Scott said her work has taken on new urgency. As a result of not having access to birth control, emergency contraception or abortion care, “young people will not only become pregnant but might often have to make some decisions out of desperation,” she said.
For many women, these decisions will be shaped by the presence of C.P.C.s across the United States. The share of Black women and Latinas who live closer to a C.P.C. than to an abortion facility would nearly triple if Roe is overturned, according to our analysis.
Share of women of reproductive age living closer to a C.P.C than to an abortion facility
Shares of racial and ethnic groups closer to a C.P.C. than to an abortion facility today and if Roe is overturned
Black women are already 2.5 times as likely to die during childbirth as white women. If more Black women end up at C.P.C.s, they may experience more delays in obtaining professional prenatal care and encounter untrained volunteers who give them nondiagnostic ultrasounds that miss serious medical issues.
In at least a dozen states, C.P.C.s are funded in part by taxpayer money. This fiscal year, according to an Associated Press tally, a dozen states paid a total of at least $89 million to C.P.C.s, up from around $17 million a decade ago in about eight states. An analysis by Equity Forward found that some of this funding is diverted from the federal Temporary Assistance for Needy Families program, which helps low-income families pay for rent and food.
Unlike most programs that compete for government contracts, C.P.C.s are subject to almost no oversight, according to Amal Bass, an attorney at the Women’s Law Project. Investigations have alleged that C.P.C.s repeatedly misused and possibly skimmed public money and that some did not provide sufficient health services to warrant funding.
Despite the centers receiving taxpayer dollars, lawmakers have struggled to regulate C.P.C.s. Because the centers do not charge for their services, in recent years the Better Business Bureau and state attorneys general have mostly declined to go after C.P.C.s that misled women. And most C.P.C.s are not licensed medical facilities, so they are usually exempt from state and federal rules governing patient privacy and medical ethics.
Groups around the country are already working to limit the harms that C.P.C.s can have on their communities. In Connecticut, lawmakers recently banned deceptive advertising by C.P.C.s. As with previous attempts to regulate C.P.C.s, the law is being challenged in court.
Individuals who are concerned about C.P.C.s can take action, too, by asking their representatives or church leaders to stop funding C.P.C.s or by calling their school board to make sure that a C.P.C. is not teaching the sex education in their middle or high school. And of course, change can come by simply raising awareness in one’s community, including by talking to family and friends.