What are Crisis Pregnancy Centers?

Anti-abortion crisis pregnancy centers (CPCs), also known as anti-abortion centers, fake clinics, or limited services pregnancy centers, are organizations that offer pregnancy-related “information,” “counseling,” and resources with an anti-abortion agenda. CPCs represent themselves as reproductive health care clinics, but they are rarely licensed to provide health care and do not offer accurate information or refer patients for abortion care, emergency contraception, or comprehensive prenatal care, and they do not make referrals to abortion providers.

Services vary from center to center, but most CPCs will offer free pregnancy testing, ultrasounds, and “pregnancy counseling,” which often includes dissemination of misinformation about abortion to dissuade the pregnant person, such as “abortion regret syndrome,” which has no psychological basis; “abortion pill reversal,” which is not medically recognized and potentially dangerous to patients; or the lie that abortions cause breast cancer. In addition, many CPCs offer pregnant people resources such as baby clothes, diapers, and other baby items, though they may only be available for people that participate in the CPC’s programming. They may also provide a pregnancy verification form, which pregnant people can use to enroll in prenatal care or apply for government assistance with medical care (e.g., Medicaid or the Special Supplemental Nutrition Program for Women, Infants, and Children).

Although CPCs brand themselves like health clinics, most CPCs are religiously affiliated non-profit organizations that are part of a well-connected and well-resourced religious network with a global mission to prevent abortions. The three largest organizations funding anti-abortion crisis pregnancy centers nationwide are Heartbeat International, Care Net, and the National Institute of Family and Life Advocates. Because of this nationwide coordinated effort, anti-abortion CPCs have a 5:1 funding advantage over organizations that provide abortion.

Why are CPCs Harmful?

Most anti-abortion crisis pregnancy centers are not licensed as medical clinics; there are only four CPCs in Massachusetts licensed by the Department of Public Health. The centers with medically trained staff are often comprised of medical doctors or registered nurses who volunteer their time and supervise volunteers remotely. Workers and volunteers at CPCs often give the impression of being medical providers by wearing white coats, talking to clients in a private area with an examination table, and collecting health information; however, they often have no medical training. These are intentionally deceptive tactics to make people think they are receiving legitimate health care. Many CPCs are also deliberately located near legitimate reproductive health centers and will purposefully use similar names or logos as abortion clinics to confuse pregnant people and lure them away from health centers that provide abortion care.

Visitors to CPCs are subjected to dangerous misinformation from staff, who routinely provide medically inaccurate and unsupported information regarding abortion. They may also inaccurately interpret the results of an ultrasound -- such as providing an incorrect gestational age or misdiagnosing a dangerous pregnancy as healthy -- which can mislead the pregnant person about what care they should seek to stay healthy or that they are eligible to receive. Recently, a woman sued Clearway Clinic, a Worcester-based CPC, for allegedly failing to diagnose her unviable ectopic pregnancy, which led to life-threatening complications and her needing to have an emergency surgery.

Because CPCs are not regulated medical facilities, they also have no HIPAA (Health Insurance Portability and Accountability Act) legal obligations to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. The personal information they collect, like contact details, sexual and reproductive history, test results, and ultrasound photos, through in-person interactions, telephone calls, and online chats -- are often sold or otherwise shared. Pregnant people who have visited a CPC may then be targeted by anti-abortion advertisements or included in data sold by national anti-abortion organizations, which have the potential to be used in criminal proceedings as states around the nation enact abortion travel bans.

In addition, the centers use deceptive advertising that will vaguely refer to the prenatal services they provide, suggesting that they offer a full scope of reproductive health services. They may also utilize search engine optimization and paid advertising to be in the top search results if a consumer searches for “pregnancy test,” “pregnancy,” or “abortion.” A report by the Center of Countering Digital Hate shows how Google profits from anti-abortion CPCs, who spent $10.2 million on search ads over 2021 and 2022. Another recent report by investigative journalists found that Facebook is collecting sensitive personal data about individuals seeking abortions from crisis pregnancy centers, which are then used by anti-abortion organizations to target and influence people online.

Where are Anti-Abortion CPCs in Massachusetts?

There are more than 30 anti-abortion crisis pregnancy centers in Massachusetts; in many parts of the state, CPCs outnumber health centers or hospitals that provide abortion. Nationally, CPCs outnumber abortion providers 3:1.  

Many CPCs are deliberately located near legitimate reproductive health clinics, often in lower income communities, and will use similar names or logos as abortion providers. They also utilize search engine optimization and paid advertising to appear in the top search results for “pregnancy test,” “pregnancy,” or “abortion.” These deceptive efforts, coupled with advertising of free pregnancy testing or "options counseling," are intended to lure pregnant people away from real reproductive health care providers and into CPCs. For example, a CPC called Problem Pregnancy has operated for years next door to Planned Parenthood’s health center in Worcester. More recently, a mobile CPC van run by Your Options Medical began operations on Cape Cod in the fall of 2023, a few months after Health Imperatives, a reproductive health care provider serving Cape Cod, Martha’s Vineyard, and Nantucket, began offering medication abortion services in the region.

CPCs try to appeal to vulnerable pregnant people who may have fewer resources or access to information about their health care options, such as young people, lower income people, and immigrants. Some CPCs employ multilingual internet sites and bilingual or even trilingual caseworkers to target non-English speakers; some strategically target college and high school students by providing directions from area colleges to their facilities and creating specific tabs on their websites dedicated to students.

Why are Crisis Pregnancy Centers Hard to Regulate?

Most CPCs are part of well-connected and well-resourced religious networks that can commit significant resources toward costly legal battles over attempts to regulate them. In fact, CPCs have a 5:1 funding advantage over organizations that provide abortion.

As a result of the deceptive tactics employed by CPCs, the American College of Obstetricians and Gynecologists has deemed CPCs’ activities “unethical.” But largely because of their designation as religious non-profit organizations that provide free services, they are incredibly hard to regulate. Most CPCs in Massachusetts are not licensed medical clinics, which allows them to be exempt from laws and regulations specific to medical practices. By offering “non-diagnostic” ultrasounds often performed by volunteers, CPCs are able to avoid oversight from medical licensing boards and circumvent state and federal requirements, including HIPAA. Unfortunately, policies aimed at increasing licensure and oversight requirements for CPCs can inadvertently impact legitimate reproductive health centers.

In an effort to address the growing dangers of CPCs, several states and municipalities have proposed or enacted legislation that aims to prevent CPCs from providing misinformation to pregnant people. For example, many states have attempted to prohibit CPCs from engaging in deceptive advertising practices or to require that CPCs accurately inform people receiving options counseling about abortion. However, these policies have been ruled unconstitutional by state courts for violating the First Amendment right to free speech. Similarly, legislative efforts to require CPCs to disclose if they are not medically licensed and to provide referrals or information about where patients can obtain abortion care have also not survived legal challenges. Courts in California and Colorado, among other states, have ruled that the First Amendment rights of free speech and freedom of religion have generally been found to protect CPCs from advertising restrictions or required disclosures. The First Amendment also protects CPCs from being compelled to share information they may be religiously opposed to.

Because CPCs offer free services, it is also difficult to invoke consumer protection laws against CPCs because free services typically aren’t legally considered trade and commerce.

How can we help people avoid dangerous CPCs?

Reporting Harm or Complaints about CPCs

• File a Civil Rights Complaint with the Massachusetts Attorney General’s Office detailing an individual’s experience at a CPC. Providers, community advocates, and other individuals can file a complaint on a person’s behalf. When completing the form, it is helpful to include as much information as possible on the individual’s interaction with the CPC. For example, information on how often the individual was seen by the CPC, the duration of the appointment(s), whether and/or how the CPCs followed up with the individual, and any other information that can help to contextualize an individual’s experience and relationship with the CPC.

• Providers can also work with patients to file Anti-Abortion Center complaint forms to report patient experiences.
• Reporting mistreatment: Any suspected abuse, neglect, mistreatment, and misappropriation of patient or resident property within the few CPCs that are licensed in Massachusetts can be reported to the Massachusetts Department of Public Health’s Division of Health Care Facility Licensing and Certification.
• Reporting licensed professionals: You can report licensed professionals working at CPCs to their respective professional licensing boards, so long as you have their full name and can confirm that someone is a medical doctor, nurse, or physician assistant online. Oftentimes, you can do so by searching their name online and noting whether they have an “M.D” or other indication along with their name. Even if they function as volunteers at the CPC, you can report them to their professional licensing boards.

Public Education and Community Solutions

Public education campaigns can be a highly effective tool to mitigate the harm of CPCs since the best way to ensure people get the health care they need is to inform them about their options with accurate, unbiased information. Importantly, educational campaigns are more effective when paired with providing resources pregnant people need, such as free pregnancy tests. CPCs offer such resources; in fact, data shows that 87% of CPC clients go there for access to free services.

Efforts may be state-led or hyper-local, and could include elements such as:

• Publicly listing where people may get free pregnancy resources, for example at local community health centers
• Provide public funding for free pregnancy tests and diaper banks
• Publicly listing abortion care providers
• Explaining common abortion misconceptions addressing the alarming and harmful trend of anti-abortion misinformation such as the "abortion pill reversal," "abortion regret syndrome," and that abortions cause infertility and breast cancer
• Informing how to spot the difference between a CPC and a legitimate health care provider
• Informing how CPCs can be harmful or deceptive
• Informing how data privacy, i.e. HIPAA, does not cover CPCs.

Reducing the harm of CPCs includes advocating to state and local policymakers to include funding for reproductive and maternal health care, resources, and public education in state and municipal budgets, or through a piece of legislation. For example, in March 2023, Massachusetts Governor Maura Healey approved the legislature’s supplemental budget that included $1 million for a public awareness campaign about CPCs.

Additionally, partnering with community health centers can help create another option for pregnant people other than a CPC. There are 52 community health centers in Massachusetts, many of which are in areas where CPCs operate. These community health centers offer pregnancy testing and other pregnancy-related services at little or no cost and do not deny care, regardless of a patient’s ability to pay. However, most people are unaware of these services, so engaging community health centers in developing an education campaign to advertise and inform about these services could be effective.