With two more conservatives recently placed on the U.S. Supreme Court, Roe v. Wade is in great jeopardy of being overturned. And as that threat grows, crisis pregnancy centers — or as reproductive rights advocates call them, fake clinics — continue to proliferate.
The reproductive justice organization Reproaction released a data set on Friday that shows there are more than 2,600 fake clinics in the United States. In 2014, Guttmacher Institute estimated that there were only 788 of these fake clinics. According to Reproaction, these clinics are primarily clustered in major Southern and Midwestern cities, especially the upper Midwest.
These centers are not real medical facilities subject to the same accountability actual health centers are. Instead, they’re often evangelical organizations that focus on emphasizing traditional gender roles. Even the lure of free medical care — promising to many low-income women and gender minorities — is limited. These centers sometimes receive federal Temporary Assistance to Needy Families (TANF) funds and state funding, but don’t have any real accountability for how they spend the money.
Kimberly Kelly, director of gender studies and associate professor of sociology at Mississippi State University, said that when crisis pregnancy centers do offer services, it’s usually things like limited diagnostic ultrasounds or urine pregnancy tests that you could find at a drug store.
“It’s not a medical professional. They’re just providing an image of the fetus hoping that the woman will bond with it and that will prevent her from having an abortion, which you could consider emotional coercion,” Kelly said. “They’ll say if you come here, you can get a picture of your baby or if you have your baby they’ll actually help you.”
Erin Matson, co-director at Reproaction, said crisis pregnancy centers are “the core of the operating infrastructure of the anti-abortion movement in the U.S.”
These centers won’t go away, regardless of whether Roe gets overturned, Kelly told ThinkProgress. Even as states have passed dozens of abortion restrictions in the last 15 years, the number of these fake clinics has only steadily increased, she said. In states where abortion will still be legal after the overturning of Roe, centers would compete for influence on people’s abortion decisions.
“CPCs have long been present in restrictive regions, and there’s no reason that would stop if Roe is overturned,” she said. “Eight states have only one clinic, making access difficult or impossible, and there are still centers there.”
Kelly added that jobs at anti-choice organizations such as Care Net, Heartbeat International, and the National Institute for Family and Life Advocates, provide political power and social influence for many people, so the industry would not simply disappear, even if abortion were completely banned. They could argue that women who previously would have had abortions need their assistance.
Crisis pregnancy centers’ rise is all the more concerning given their public funding and the Supreme Court’s ruling in June that they don’t have to disclose that they aren’t medically licensed or that patients can receive low-cost family planning options elsewhere. Essentially, the court ruled that their misrepresentations and lies are protected free speech.
Fake clinics existed before the 1973 Roe v. Wade ruling, since the 1960s, Kelly said. From the mid-80s to late 90s, the anti-abortion movement was getting increasingly violent through Operation Rescue and Army of God.
“At the same time, crisis pregnancy centers were using very abusive and coercive tactics, telling women who wanted abortions that they are murdering their babies … CDCs were much more abusive and coercive then and they got into a lot of trouble for it,” Kelly said.
She said as NARAL and other groups sent people undercover posing as clients and anti-abortion activists were under heated criticism, women — who were the majority of volunteers but not the majority of leaders — took over fake clinics in the early 90s. There were only about 400 of these centers in the United States at that time. After standardization of these centers and more efforts to make centers look like actual medical facilities, “money started flowing back to the movement.”
Umbrella organizations for these centers, such as Care Net and Heartbeat International, have been successful at fueling their expansion across the country. These clinics are often very close to or across the street from abortion providers. Staff at an abortion clinic in Fayetteville, Arkansas told ThinkProgress in June that the crisis pregnancy center Loving Choices had a mobile unit at a gas station that was only a five-minute walk away.
“Mobile units are kind of new to the crisis pregnancy center movement. They tend to operate more on a shoestring-type budget. They are becoming more well funded,” Kelly said. “They locate them near women’s health centers and abortion providers to make it sound like they were the abortion provider, so the mobile clinic is just another step in what is the logical continuum.”
Matson said fake clinics tend to focus on places where there isn’t a robust reproductive health system, which means they’re often in rural areas and neighborhoods where there are many women of color.
“They just give them the wrong information to keep them there.”
Leslie McGorman, deputy policy director at NARAL Pro-Choice America said these centers have started to pursue things like abortion reversal, the unscientific concept that patients can take progesterone to reverse their medication abortions.
“There was no regulatory structure they have to operate within and there’s no medicalization, so they were able to avoid state laws that focused on abortion providers or even medical providers,” McGorman said. “That’s why they like to hide behind the whole counseling component. But what has happened over the last five or 10 years is that they have moved to a more medicalized appearance.”
Centers will tell people that although there isn’t a physician on staff, they do have a physician who is the head of board of directors and oversees medical operations, for example, to lend some legitimacy to the centers, McGorman explained.
Matson said that another tactic some fake clinic staff participate in is putting on vests to make them look like clinic escorts and handing out snacks. Some providers won’t do the procedure if patients ate within a certain time window. She said she saw this at Germantown Reproductive Health Services in Maryland, which has since been bought by an anti-abortion group, Maryland Coalition for Life.
Dr. Stephanie Ho, a physician at the Planned Parenthood Fayetteville Health Center in Fayetteville, Arkansas confirmed that these centers sometimes tell people their pregnancies are further along than they are to prevent them from seeking abortions. Matson said she has seen misinformation from fake clinic staff that goes in all directions.
“Women who have gone in and are not pregnant, the crisis pregnancy center will say they are or the reverse — they know they’re pregnant and they say they aren’t. They just give them the wrong information to keep them there,” Matson said.
On top of the misinformation and misrepresentations, these centers don’t have staff that are trained to spot abuse or are mandatory reporters of abuse. And in some cases, crisis pregnancy center staff themselves can participate in coercive and abusive behaviors themselves, experts and physicians tell ThinkProgress.
For example, Kelly recalls when she sat in a fake clinic for her fieldwork and saw a woman she calls Josephina come into the center with two men. The woman didn’t speak English and was shown a video about abortion regret in Spanish. One of the clinic staff, who she refers to as Karina, found out that she had six children in Mexico and that she and her husband came to the United States to work construction and send money back home. Karina, who was dealing with fertility issues, told the woman that if she continued her pregnancy she would adopt her child. She also told the woman that her abortion was illegal. Josephina came out crying and yelling at the two men — she thought she was in an abortion clinic — and left. Karina then told the entire room of five or six people what happened in the private room.
“It was incredibly coercive and inappropriate,” Kelly said.
Then the women at the center criticized Josephina’s life choices, such as leaving her children in Mexico.
“These are white upper middle class women. They just didn’t get it. The clients they are talking to, they’re ethnically diverse and they’re lower down on the economic ladder and in tough situations. These women have set themselves up as the rightful intervenors in their pregnancy decisions and don’t actually understand anything they are going through, which can lead, whether they want it to or not, to abusive and coercive tactics.”
Dr. Ho said that one of her patients told her that her family forced her to go to a Loving Choices center.
“They wanted her to ‘reverse’ the abortion that she had,” Dr. Ho said. “There was a lady in there questioning her, berating her with questions, telling her fake information and that you’re going to regret this. You’re going to commit suicide because of this. You’re going to get breast cancer. All of the myths they tell women. When the patient was still resistant to that information, as well as taking the progesterone regimen they recommend, they brought in another woman and they berated her together and actually kept her from leaving.”
Dr. Ho said the patient took the medicine in front of them and said she needed to use the restroom, where she then spit it out.
“Essentially it was her perceived only way out of that, was to take it. They were blocking her way,” she said. “They’re not timid in admitting they don’t want women to choose abortion but what they are not forthcoming about is the measures they take from reproductive coercion to threatening women and giving them false information.”
McGorman said that although every state has anti-coercion requirements for abortion providers, the same accountability doesn’t exist for these fake clinics.
“Because they operate in the margins, they don’t have that same requirement so essentially there isn’t anything to stop them from coercing women or outright lying to them,” she said.
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