A Research Gap in Crisis Pregnancy Center Patient Outcomes

This summer, Ohio more than doubled its annual funding for crisis pregnancy centers (CPCs). In California, two bills that would have limited their reach stalled in the state legislature. The recent uptick in state and federal funding for CPCs has had me questioning what the mental and physical health implications are for those who use them.

While the outcomes associated with unwanted pregnancy are well documented in literature, there is a research gap on the impacts of seeking care at a CPC on a patient’s health. This article covers what is already known about CPCs and why researchers should examine this further.

What are CPCs?
CPCs are nonprofit organizations that provide anti-choice pregnancy counseling and prenatal services. The majority of centers are affiliated with the largest pro-life organizations in the United States: Heartbeat International, Care Net, and The National Institute of Family and Life Advocates.

CPCs describe themselves as faith-based and community-based nonprofits that provide personalized and life-affirming services to empower women to welcome their children into the world. Their goal is to improve maternal health outcomes and to promote well-being of women and families.

While some centers have obtained licenses to offer medical services (e.g., ultrasounds, testing for sexually transmitted infections), 84% do not have a physician on staff and a quarter of centers do not have a registered nurse. But these unlicensed centers, run by volunteers, give out free pregnancy tests, offer parenting classes, and provide material assistance such as maternity clothing, diapers and more.

Many CPCs mislead patients into thinking they offer comprehensive reproductive health services, including contraception, abortion care, and/or abortion referrals. Many lie about what they offer in their advertisements; some even dress their staff in scrubs or alter the office environment to mimic a doctor’s office.

The ultimate goal of these tactics is to delay access to time sensitive services, such as abortion, with the hope that patients will ultimately carry their pregnancies to term. As such, CPCs are often located near abortion clinics, to steer pregnant folks away from neighboring services.

How prevalent are CPCs?
There are over 2,500 CPCs nationwide, which is triple the number of abortion clinics. That figure is continually growing, based on a live directory created by a research team at the University of Georgia School of Public Health.

The Associated Press reported that there has also been a significant increase in annual investment nationwide for CPCs in the last decade, from $17 million/year in 2013 up to $89 million/year in 2023.

Who do CPCs serve?
CPCs disproportionately serve pregnant women who are young, low income, and have limited education. These women are often drawn in by the free health services advertised on billboards, public transportation, and high school bulletin boards.

What is known on the impact of CPCs care on patient health?
There have only been a few qualitative accounts detailing patient experience at CPCs.

One study found that women often felt like “bad people” for considering an abortion. The women further explained that once their interest in pursuing an abortion was disclosed, CPC staff changed their behavior toward them and began devaluing them.

Another report shared that women felt traumatized by the deception they experienced at CPCs. For example, some were distressed after counselors warned them of a fake “post-abortion syndrome” that can cause suicidal thoughts and depression.

Similarly, a short documentary by Vice News revealed hidden camera footage of patient distress when CPCs counselors shared false information about abortions causing long-term psychological damage and infertility.

Although there is minimal research quantifying their impact, one study found that nearly 30% of respondents who considered abortion were significantly less likely to have an abortion after visiting a center compared to those who had not visited one.

How do CPCs impact public health?
According to the Society for Adolescent Health and Medicine and the North American Society for Pediatric and Adolescent Gynecology, CPCs pose risks to vulnerable women by not adhering to medical and ethical practice standards (e.g., informed consent, patient autonomy).

While these centers are not bound to these principles since they’re not medical practices, their influence may play a role in the number of unintended births and second-trimester abortions that arise.

Consequences of unintended births include pregnant folks being more likely to avoid prenatal care, use tobacco and alcohol during pregnancy, deliver pre-term, avoid breast feeding, suffer from postpartum depression and deliver infants with low birth weight and negative mental health outcomes.

What’s more, second-trimester abortions are more expensive, harder to access, and come with higher mortality and post-surgery complication rates for the parent.

What should we do about it?
Since most CPCs are not medical clinics and do not charge for their services, they are not regulated and are exempt from laws that apply to commercial enterprises. Protected by the First Amendment as well, CPCs have been successfully winning most legal challenges.

However, some states (e.g., Connecticut, Illinois) now have laws to hold CPCs accountable and maximize protections against fraud. Cities around the nation are working to pass similar local ordinances requiring transparency on what services CPCs do and do not offer.

This clarification is crucial for patients when choosing reproductive care and a vital next step until more research is gathered on the suspected health impacts of receiving care at a CPC.

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