How to Spot a Crisis Pregnancy Center, and Why It Matters More Post-Roe

This article is part of POPSUGAR's project Roe, 50 Years Later, a collection of stories marking what would have been the 50th anniversary of Roe v. Wade. This moment comes more than six months after the Supreme Court struck down the constitutional right to an abortion in Dobbs v. Jackson Women's Health Organization, and these stories seek to mark the past, present, and future of abortion access in America.

Maleeha Aziz was 20 years old and new to the US the first time she walked into a crisis pregnancy center in Texas. She thought it was a medical clinic — somewhere she could get a cheap ultrasound before setting up an abortion appointment because, as a college student, she knew she didn't want to be a parent yet.

Aziz quickly realized the facility wasn't going to offer her the medical services she was seeking. "There was biblical imagery everywhere," she tells POPSUGAR. She spoke to employees in lab coats she assumed were doctors but later found out they had no professional medical credentials. She and her partner were told to watch a "graphic" video that seemed designed to persuade her not to get an abortion, even though Aziz hadn't mentioned she was considering it. The video was followed by a counseling session, where staff seemed determined to show her how dangerous abortion was, she says.

"I recognized that they weren't going to help me access an abortion pretty early on," Aziz says. "My partner and I . . . decided to play their game, get the sonogram, and get the hell out of there."

Nonprofit crisis pregnancy centers (CPCs) have been an arm of the antiabortion movement since 1967, when the first CPC opened in Hawaii, according to the Guttmacher Institute. There are now more than 2,500 CPCs in the US: they regularly rake in millions of dollars in government funding and seek to dissuade patients from obtaining abortions. And yet, these institutions often go under the radar. "In general, we find that knowledge and awareness about crisis pregnancy centers is extremely low," says Andrea Swartzendruber, MPH, PhD, a professor of epidemiology and biostatistics at the University of Georgia who has helped create a map of crisis pregnancy centers across the US.

Staying low-profile might be how CPCs prefer it. Multiple studies and investigative reports have shown that these facilities actively deceive and provide misinformation to their clients, but savvy marketing techniques and lack of public awareness mean unsuspecting patients continue walking through the door, often mistaking them for an abortion provider's office.

Since the Supreme Court overturned Roe v. Wade in June 2022, the impact of crisis pregnancy centers has only become more urgent. Now, abortion legality is a state-by-state decision, and two dozen states have banned or are likely to ban abortion soon. As legitimate abortion providers shut down, crisis pregnancy centers may increasingly become the only option for pregnant people looking for help. Often, that "help" does more harm than good, abortion-rights advocates say.

Eventually, Aziz went to Colorado to have a medication abortion, seeking financial help from a family member for travel expenses, because the center told her medication abortions were illegal in Texas. At the time, they weren't.

"I was very angry and still hold on to some of it," says Aziz, who's now a reproductive-justice advocate and deputy director of Texas Equal Access (TEA) Fund. "They straight-up lied to my face."

Crisis pregnancy centers are facilities that "seek to intercept people who have an unwanted pregnancy and may be seeking abortion, [in order] to talk them out of having that abortion," says Jonas Swartz, MD, MPH, an ob-gyn at Duke Health who has coauthored multiple studies on CPCs. The centers are typically religiously affiliated and run by volunteer staff.

While some centers will have a medically licensed professional on staff, he says, "they're not working under their licensed medical capacity." CPCs are unregulated and not subject to the same rules, procedures, and standards as medical clinics. They often spread misinformation, both about abortion and patients' own bodies and pregnancies, and do it under the guise of a medical facility and under little to no regulation, thanks in part to a 2018 Supreme Court ruling that said such centers could not be forced to inform patients about reproductive healthcare services, including abortion.

To bring people in the door, many CPCs will offer medical services like free ultrasounds and testing for sexually transmitted infections (STIs), as well as abortion or postabortion counseling services and essentials like maternity clothes, baby clothes, and diapers. The issue is that these medical services are not necessarily being provided in a legitimate medical setting or by professionals working in their trained medical capacity.

"I've cared for a bunch of patients who have gone to crisis pregnancy centers and don't realize that they're crisis pregnancy centers," Dr. Swartz says. "And the truth is that many times, I have encountered errors in the information that [patients] have been provided."

Take ultrasounds — the service that attracts many people, like Aziz, to a CPC. "Early-pregnancy ultrasound is one of the more complex skills in benign gynecology," Dr. Swartz says. "Having special training in that is important to be able to provide safe care for patients." He noted that there may be some skilled people providing ultrasounds in CPCs, "but I've certainly seen circumstances where the ultrasound was incorrect."

For example, patients might be told the wrong gestational age of the fetus. If the patient is considering an abortion, an incorrect gestational age could make them think they have more or less time to get an abortion than they actually do. Patients may also be told they're going to have a miscarriage when that's not the case — again, often in an attempt to sway them away from an abortion. CPC staff also often overemphasize the risks of abortion. During her visit, Aziz recalls, staff told her an abortion could lead to breast cancer and infertility, neither of which is true, studies show.

Crisis pregnancy centers, for their part, say they aim to aid pregnant people, and antiabortion advocates highlight the fact that the facilities provide resources. "Pregnancy-help organizations provide life-affirming care and confidential support to pregnant women at no cost," Andrea Trudden, vice president of communications and marketing for the large CPC organization Heartbeat International, tells POPSUGAR. She says services provided can include pregnancy tests, parenting classes, infant essentials like formula and diapers, and even housing.

But according to Aziz, this form of help isn't enough — and comes with unacceptable caveats, like sitting through antiabortion videos or counseling. "Parents need tangible, ongoing support," she says, noting that TEA Fund is working on an initiative to host regular drives to hand out infant care kits to parents in need. "We want to be able to distribute them with no questions asked. No counseling, no nothing."

For Dr. Swartz, it comes down to wanting patients "to have autonomy to make decisions about what they want to do with their pregnancies." CPCs "undermine that by pursuing a specific agenda with patients," he says.

"Crisis pregnancy centers are not crisis pregnancy centers," Aziz adds. "They're antiabortion centers."

Despite their deceptive nature, crisis pregnancy centers have access to massive amounts of government funding. According to reporting by the Associated Press, nearly $89 million in state budget money was allocated for CPCs across about a dozen states in the 2022 fiscal year, representing an increase of about $72 million compared with annual funding a decade ago. In Texas alone, state lawmakers have allocated $100 million to programs offering abortion alternatives over the next two years. By comparison, government funding for abortion is limited by a patchwork of federal and state restrictions, including the Hyde Amendment, which has barred the use of federal Medicaid funds to pay for abortion except in cases of life endangerment, rape, or incest since 1977. (While states have the option to delegate their own funds to pay for abortion under Medicaid, currently only 16 states do so.)

"We're seeing record numbers of funding going towards CPCs," says Danielle Lambert, MPH, PhD, who developed the CPC Map with Dr. Swartzendruber. She points to state grant programs, redirected funds from the federal Temporary Assistance for Needy Families (TANF) program, and sales of "Choose Life" license plates as just a few public funding sources for these institutions.

The funding is one reason CPCs are so widespread and effective at bringing in new patients. Another factor? Their marketing campaigns, which typically try to mask their true goal of steering patients away from abortion.

Dr. Swartz led a study that asked participants to compare the websites of abortion providers and CPCs to determine which ones actually provided abortion care. Researchers found that abortion providers' websites made it very clear that they offered abortion; CPC websites, on the other hand, caused a lot of confusion. "People had difficulty figuring out from crisis pregnancy center websites whether or not they provided abortion," Dr. Swartz explains. "They have these intentionally vague websites, which mention abortion, may come up in a Google search for abortion, are maybe listed among the clinics if you look at a map online."

Adding to the confusion is the fact that CPCs often set up shop right next door or across the street from abortion providers, and when you walk in, "the centers really do mimic health facilities," Dr. Swartzendruber says. "It can be very difficult to tell the difference between what is a crisis pregnancy center and what is a health facility."

A lack of public knowledge about crisis pregnancy centers may also play into their success. According to Dr. Swartz's research, simply being aware of CPCs helped people discern whether or not they actually provided abortion services; if you know CPCs exist, you're more likely to recognize one when you see it. "But then again, you have to know that they exist," he says. (In the aforementioned study, which surveyed 1,044 people, about 60 percent of participants had prior knowledge of CPCs.)

The first crisis pregnancy center was founded as a response to a state law decriminalizing abortion. So what happens to them post-Roe, now that abortion is no longer a constitutionally protected right?

Short answer: we're not totally sure, but it's clear they're not going anywhere. According to data from Dr. Swartzendruber and Dr. Lambert's CPC Map, there was already a "heavy clustering of CPCs in the southern United States" before the high court's ruling, Dr. Lambert says.

"The states that are actively working to ban abortion or severely restrict abortion are the same states that are now actively working to increase funding for crisis pregnancy centers," Dr. Swartzendruber agrees, but she notes that we may also see more CPCs popping up in states where abortion is legal or protected. And in the past, she says, higher numbers of CPCs in a state has directly led to more state grant funding. "My own opinion would be that they will become more prominent wherever they are," she says.

And particularly in states where abortion has been completely banned or severely restricted, pregnant people may have to rely more on crisis pregnancy centers for reproductive healthcare. Patients "may have fewer options," Dr. Swartz says, "which could increase the influence of these places, which I find concerning based on the research on them and the misinformation they provide" — misinformation that could delay abortion care for patients who want it and shorten their window to legally obtain an abortion in a restricted state.

There are also concerns around the access crisis pregnancy centers have to patient information. CPCs aim to gather personal information from their clients, and there is growing concern that information could be used against those same clients. CPCs, especially those that aren't staffed by medical professionals, "are not bound by federal privacy laws, such as HIPAA, and therefore are not legally bound to protect their patients' information or confidentiality," according to the American College of Obstetricians and Gynecologists (ACOG). This raises serious concerns about what could happen to patient data that CPCs do have and what they might do with it, particularly in a time when data can be used to prosecute people getting an abortion.

Being able to differentiate between abortion providers and crisis pregnancy centers — and just knowing what CPCs are and what they're trying to do — is more important than ever in the post-Roe era. So how can you identify a crisis pregnancy center? Look for:

Dr. Swartzendruber also recommends using CPC Map and Abortion Finder as resources to determine whether a clinic is a CPC or an abortion provider.

Being aware of CPCs is important to at least help you know what kind of clinic you're going to — and where your tax dollars are going as well.

"If I had heard someone's story like mine at the time, I wouldn't have ended up [at the crisis pregnancy center]," Aziz says. "I wouldn't have ended up in Colorado to have my abortion." She shares her story as widely as she can, she says, to warn others and let them know that "there's a community . . . of people who've had abortions, but there's also a community of people who've been wronged by these centers. And I want them to come find me if they need support."Image Source: Getty / Cristian Borrego Sala and Photo Illustration: Aly Lim