Attack on the Right to Choose

By Laura Gustafson*

A person’s right to choose has been under attack by state actions for some time, making headlines as the Supreme Court rules on bills restricting access to abortion. These bills can inflict great harm on people and attack the right to choose, but there is another very real threat that often goes unnoticed. Crisis pregnancy centers (CPCs), also referred to as pregnancy care centers, are facilities that mimic the style of medical clinics and claim to offer pregnancy resources, while their mission is to dissuade people from having abortions. These facilities mimic traditional abortion clinics while offering little to no actual medical care. When people are seen at CPCs, they are greeted with medical misinformation and emotional manipulation under the guise that these resources are helpful for people experiencing pregnancy. Not only do CPCs spread misinformation about the effects of abortion and use emotional language to try to convince people to keep their pregnancies, but according to some research, they also employ tactics such as promising procedures like ultrasounds, and not delivering or rescheduling to delaying access to abortion resources.

The Supreme Court in National Institute of Family and Life Advocates v. Becerra explicitly held that requiring CPCs to notify people of services including abortion, and disclosing when they are unlicensed, would violate the First Amendment. Based on that holding, CPCs are likely to continue creating procedures that mislead the people they claim to serve and creating a dangerous network of facilities that do not provide people with their options to choose, reinforcing a system of structural oppression for those most in need. CPCs are difficult to regulate because of the First Amendment but that does not mean change cannot be made on the state level. Because of this danger, greater transparency is needed, and states need to act now.

Crisis Pregnancy Centers Employ Misleading Marketing, Engage in Troubling Data Collection, and Result in Funding Disparities

1. Marketing Tactics Mislead and Harm Pregnant People

CPCs employ deceptive tactics to get potential patients through the door. They often are located nearby abortion clinics and use similar names and logos. Not only do they look like traditional clinics with a waiting room and people wearing white coats, they also invest in search engine optimization to reach those potentially seeking abortion care. Initial marketing tactics are not the only harmful aspect of CPCs. People are lured into thinking they will receive medical care and options during early pregnancy, but abortion is frequently not presented as an option even when it would be available, and volunteers misinform their patients about the risk or try to dissuade abortion. Often, even pregnant people who want to carry their pregnancy to term are not provided with adequate information about prenatal medical care.

CPCs accomplish their goal of reducing abortions not only through manipulating emotional conversations but also offering inadequate services and creating unnecessary delays. Ultrasounds are promised and then delayed, or presented as fulfilling an abortion requirement, forcing pregnant people to miss their window for an abortion and creating even more obstacles to care. For example, in Texas if people receive a sonogram at a CPC, it does not satisfy the state requirement for abortion services and will often cause enough delay that it forces pregnant people to seek abortion services out of state or carry a pregnancy to term. These deceptive tactics are harmful to people potentially in an actual crisis especially in an environment that already makes seeking an abortion very difficult.

2. Data Collection Concerning in Light of New Laws

Misinformation regarding pregnancy, especially in a time when traditional methods of seeking an abortion are being attacked can in itself be dangerous, but CPCs present additional areas of concern. First, they collect significant amounts of private health data from the people they see, and some they do not through online chats, even when people do not realize it is not a traditional clinic. As bills like SB 8 in Texas are introduced, where anyone can report a violation of the six-week abortion ban, there are growing concerns that CPCs could be used to gather information which in turn is used to report people. Erin Maye Quade, advocacy director at Gender Justice stated, “[b]ecause CPCs are a global network . . . they’re actually poised to become the surveillance mechanism to enforce these unconstitutional laws.” Additionally, because CPCs are not health providers, they are not required to meet the same HIPAA standards leaving sensitive, confidential medical information unprotected.

3. Funding Disparities Harm Marginalized Communities

In addition to privacy concerns, CPCs raise yet another concern. In 29 states, CPCs receive state funding. In many of these states, the uneven divide between CPCs and abortion clinics is far higher; in Minnesota there are eight abortion clinics and 90 CPCs. In Pennsylvania, abortion clinics cannot receive federal funding as a result of the federal Hyde Amendment or state funding per Pennsylvania law. However, funding from Temporary Assistance for Needy Families (TANF) is given to CPCs across the state. Texas also takes funds from TANF for CPCs, around $43.5 million over 15 years. This is a dangerous practice as these facilities provide medical misinformation, little to no actual medical care and “disproportionately [harm] Black and brown people who face structural inequities that make them more likely to live in poverty than white people.” These funds are supposed to help families with essential needs such as food and rent but when the funds are diverted to CPCs, these services are cut back. Ultimately, these funds meant to help people are getting diverted to CPCs that statistically target low-income individuals and people of color already at risk.

While CPCs do provide some resources, this aid is conditional. One small study showed that people did in fact get help with diapers, aid with Medicaid applications, clothes, and other parenting needs from CPCs. While this seems like a benefit to society, often this help is conditioned on meeting other expectations of the program such as watching videos or showing up to additional appointments which are often faith-based and time consuming. Again, these services are primarily used by those facing systemic oppression which reinforces a broken system forcing those in need to “earn” assistance with funds diverted from other social programs.

States Should Act to Protect Right to Choose

An organization called “The Alliance,” which is a coalition of state advocates for women’s rights and gender equality, reported on the impact of CPCs and included potential state-level policy ideas. These recommendations included passing laws that extend HIPAA protections to CPCs and addressing societal factors that drive people to CPCs. Extending HIPAA protections would likely alleviate some of the concern that CPCs will be used as enforcement mechanisms for alleged anti-abortion bill violations. From a privacy concern this would also protect people of all backgrounds who share their personal information while believing they are seeking medical care. The Alliance also suggests protecting public funding and not providing it for CPCs that are known to participate in deceptive tactics that target at-risk populations. Addressing other social factors would also allow for states to invest in programs that actually provide for people without strings attached and remove the burden that CPCs are trying to cover now.

Access to abortion is under threat through legislation but also from CPCs. CPCs far outnumber abortion clinics. They provide biased information and prey on people who suffer from systemic oppression. Even when providing some family resources, these resources are conditioned on conforming to their program. It is time for people to better understand the risk of these facilities on everyone’s right to choose and state legislatures need to act to protect the citizens of their states.

*Laura Gustafson, University of Minnesota Law School Class of 2023, JLI Vol. 40 Staff Member