Pregnant? Need Help? They Have an Agenda.
Their names sound benign, even comforting: Pregnancy Help Center. Options for Women. Clarity Clinic.
You might not notice them if you drove by.
But crisis pregnancy centers are frontline outposts in the war against abortion.
And there are more than 2,000 of them in the United States.
By Carly Thomsen, Carrie N. Baker and Zach Levitt
Carly Thomsen is an assistant professor at Middlebury College. Carrie N. Baker is a chaired professor at Smith College. Zach Levitt is a graphics editor for Opinion.
With the Supreme Court likely to overturn Roe v. Wade this year, the American anti-abortion movement is preparing for a near future in which abortion is more restricted, in more parts of the country, than at any time in the past 50 years.
Anti-abortion activists have spent decades fighting Roe while waiting for this moment, in part by establishing a national network of about 2,600 so-called crisis pregnancy centers, through which they try to deter women from getting abortions, often with deceptive practices — and, in some cases, using taxpayer dollars.
As the number of C.P.C.s has increased in the United States, the number of abortion facilities has dropped, from more than 2,700 in 1978 to about 785 today. As a result, C.P.C.s now outnumber abortion facilities three to one.
If the Supreme Court overturns Roe, at least 26 states are likely to ban abortion, reducing the number of abortion facilities nationwide to fewer than 600. In that scenario, C.P.C.s would outnumber abortion facilities more than four to one.
More than half of American women of reproductive age would live closer to a C.P.C. than to an abortion facility, according to our analysis.
Where C.P.C.s are closer
than abortion facilities
Where C.P.C.s are closer than abortion facilities
Wash.
Me.
Mont.
N.D.
Vt.
Minn.
Ore.
N.H.
N.Y.
Wis.
Mass.
Idaho
S.D.
Mich.
R.I.
Conn.
Wyo.
Pa.
Iowa
N.J.
Neb.
Ohio
Nev.
Md.
Del.
Ind.
Utah
Ill.
W.Va.
Calif.
Colo.
Va.
Kan.
Mo.
Ky.
N.C.
Tenn.
Okla.
ARK.
Ariz.
N.M.
S.C.
Ga.
ALA.
MISS.
TEXAS
LA.
Alaska
FLA.
Hawaii
Where C.P.C.s are closer than abortion facilities
Wash.
Mont.
Me.
N.D.
Vt.
Minn.
Ore.
N.H.
N.Y.
Idaho
S.D.
Wis.
Mass.
Mich.
R.I.
Conn.
Wyo.
Iowa
Pa.
Ohio
N.J.
Neb.
Ind.
Nev.
Md.
Calif.
Utah
W.Va.
Del.
Ill.
Colo.
Mo.
Va.
Kan.
Ky.
N.C.
Tenn.
Ariz.
ARK.
S.C.
Okla.
N.M.
MISS.
Ga.
ALA.
TEXAS
LA.
Alaska
FLA.
Hawaii
Where C.P.C.s are closer than abortion facilities
Wash.
Mont.
Me.
N.D.
Vt.
Minn.
Ore.
N.H.
N.Y.
Idaho
S.D.
Wis.
Mass.
Mich.
R.I.
Conn.
Wyo.
Iowa
Pa.
Ohio
N.J.
Neb.
Ind.
Nev.
Md.
Calif.
Utah
W.Va.
Del.
Ill.
Colo.
Mo.
Va.
Kan.
Ky.
N.C.
Tenn.
Ariz.
ARK.
S.C.
Okla.
N.M.
MISS.
Ga.
ALA.
TEXAS
LA.
Alaska
FLA.
Hawaii
Where C.P.C.s are closer than abortion facilities
Wash.
Mont.
Me.
N.D.
Vt.
Minn.
Ore.
N.H.
N.Y.
Mass.
Wis.
Idaho
S.D.
Conn.
R.I.
Mich.
Wyo.
Iowa
Pa.
N.J.
Neb.
Ohio
Nev.
Md.
Ill.
Ind.
Utah
Del.
W.Va.
Calif.
Colo.
Mo.
Va.
Kan.
Ky.
N.C.
Tenn.
Okla.
ARK.
Ariz.
N.M.
S.C.
Ga.
ALA.
MISS.
TEXAS
LA.
Alaska
FLA.
Hawaii
Where C.P.C.s are closer
than abortion facilities
Where C.P.C.s are closer than abortion facilities
Fargo
Billings
Boise
Sioux Falls
Detroit
Salt Lake City
Indianapolis
Omaha
Nashville
Phoenix
Atlanta
Dallas
Charleston
Jackson
Houston
Miami
Where C.P.C.s are closer than abortion facilities
Fargo
Billings
Boise
Sioux Falls
Milwaukee
Detroit
Omaha
Salt Lake City
Des Moines
Columbus
Indianapolis
Charleston
Louisville
Nashville
Oklahoma City
Atlanta
Little Rock
Birmingham
Phoenix
Charleston
Dallas
Jackson
Tallahassee
Houston
Orlando
New Orleans
San Antonio
Miami
Where C.P.C.s are closer than abortion facilities
Wash.
Mont.
Me.
N.D.
Fargo
Billings
Vt.
Minn.
Ore.
Boise
N.H.
N.Y.
Idaho
S.D.
Wis.
Mass.
Mich.
Sioux Falls
R.I.
Milwaukee
Conn.
Detroit
Wyo.
Iowa
Pa.
Ohio
Omaha
N.J.
Neb.
Salt Lake City
Des Moines
Ind.
Columbus
Nev.
Md.
Calif.
Utah
W.Va.
Del.
Indianapolis
Charleston
Ill.
Colo.
Mo.
Va.
Kan.
Louisville
Ky.
N.C.
Nashville
Tenn.
Oklahoma City
Ariz.
ARK.
S.C.
Okla.
Atlanta
N.M.
Little Rock
Birmingham
Phoenix
MISS.
Charleston
Ga.
Dallas
Jackson
ALA.
TEXAS
Tallahassee
LA.
Houston
Orlando
New Orleans
Alaska
San Antonio
FLA.
Miami
Hawaii
Where C.P.C.s are closer than abortion facilities
Fargo
Billings
Boise
Sioux Falls
Milwaukee
Detroit
Cleveland
Salt Lake City
Indianapolis
Omaha
Louisville
Oklahoma City
Nashville
Atlanta
Phoenix
Charleston
Dallas
Jackson
Tallahassee
Houston
New Orleans
San Antonio
Miami
Over 16 million women of reproductive age in the United States currently live closer to a C.P.C. than to an abortion facility.
In a post-Roe America, that number would increase by 18 million, to 34 million.
In 1967 a Christian carpenter in Hawaii named Robert Pearson opened his home as one of the first C.P.C.s in the country, as part of the backlash to expanding abortion access around the United States. By 1973, the year Roe v. Wade was decided, he reported that more than 120 women had visited his center. He later published a 93-page manual on how to start such a center. It was circulated widely among anti-abortion activists across the country.
The manual recommends that activists locate C.P.C.s near abortion facilities, choose neutral-sounding names and show women a slide show that includes misinformation about the health risks of abortion. It includes example scripts to help employees and volunteers deceive women about whether the C.P.C. performs abortions:
Many of the strategies that Pearson recommended are still used by C.P.C.s.
Once inside a C.P.C., women can be greeted by volunteers or staff members wearing lab coats or hospital scrubs who, despite their appearance, are usually not medical professionals. These representatives might try to frighten women by falsely claiming that abortions lead to breast cancer, mental health issues or infertility. They are also likely to suggest that abortion is much more dangerous than it is — in reality, women are almost 15 times as likely to die because of childbirth as from an abortion.
Today, C.P.C. volunteers increasingly use ultrasound machines in order to further appear as if they provide medical care. Women who’ve visited C.P.C.s have reported that volunteers underestimated how far along their pregnancies were. Other women say C.P.C. volunteers overstated natural miscarriage rates — so they might delay seeking an abortion and miss the window in which they are legally allowed to have one.
A 2014 study concluded that 80 percent of C.P.C.s included at least one false or misleading piece of medical information on their websites. Also, it appears that some C.P.C.s could share women’s private health information with national anti-abortion networks, something that could be especially concerning in states that criminalize abortion post-Roe.
Not all C.P.C.s engage in every tactic mentioned above, especially as the centers have come under greater scrutiny in recent years. And some C.P.C.s provide material resources to women, like diapers and baby clothes. These resources often are limited — not enough to care for a baby in the long term — and come with strings attached, like required attendance at parenting or Bible classes. A large share of women who visit C.P.C.s are not pregnant or undecided but are parents who in many cases have been failed by a society that does little to help poor mothers. The anti-abortion movement takes advantage of their economic vulnerability.
Many C.P.C.s in the United States are affiliated with one of four Christian organizations: Care Net, Heartbeat International, Birthright International and the National Institute of Family and Life Advocates.
For Camilla Allison, who was raised in an ultraconservative Protestant community in New Mexico, C.P.C.s were viewed as agents of the church. After she became pregnant at 22, she visited a Care Net center in Albuquerque to get an ultrasound. There a staff member took her to a back room and lectured her.
“It was almost like a Sunday school lesson, all of the fundamentalist dogma I grew up with. It brought up a lot of old shame in me,” Ms. Allison said. “It was all wrapped up in ‘Jesus died for your sins. You’ve already sinned, and if you kill your child, you’ll have lifelong trauma.’”
Cherisse Scott was given misinformation when she visited a Chicago C.P.C. in 2002 after seeing what appeared to be an advertisement for abortion in the Yellow Pages. She said that she was sent to another site for an ultrasound, where she was told that an abortion would perforate her uterus, leaving her infertile. In reality, major complications occur in less than one in 400 legal abortions.
Ms. Scott didn’t learn that she had been manipulated until years later. Today she runs SisterReach, a group that helps young people and women of color find accurate health care and sexual health education.
SisterReach is based in Tennessee, where we estimate that more than 99 percent of women will live closer to a C.P.C. than to an abortion facility if Roe v. Wade is overturned. (Tennessee has already passed a ban on abortion after six weeks of pregnancy; it would immediately go into effect post-Roe.) Ms. Scott said her work has taken on new urgency. As a result of not having access to birth control, emergency contraception or abortion care, “young people will not only become pregnant but might often have to make some decisions out of desperation,” she said.
For many women, these decisions will be shaped by the presence of C.P.C.s across the United States. The share of Black women and Latinas who live closer to a C.P.C. than to an abortion facility would nearly triple if Roe is overturned, according to our analysis.
Share of women of reproductive age living closer to a C.P.C than to an abortion facility
If Roe is
overturned
Currently
19%
58%
Black
46
16
Hispanic/Latina
34
60
White
40
63
Native American
8
29
Asian
0
25
50
75%
Currently
If Roe is overturned
19%
58%
Black
16
46
Hispanic/Latina
34
60
White
40
63
Native American
8
29
Asian
0
25
50
75%
Black women are already 2.5 times as likely to die during childbirth as white women. If more Black women end up at C.P.C.s, they may experience more delays in obtaining professional prenatal care and encounter untrained volunteers who give them nondiagnostic ultrasounds that miss serious medical issues.
In at least a dozen states, C.P.C.s are funded in part by taxpayer money. This fiscal year, according to an Associated Press tally, a dozen states paid a total of at least $89 million to C.P.C.s, up from around $17 million a decade ago in about eight states. An analysis by Equity Forward found that some of this funding is diverted from the federal Temporary Assistance for Needy Families program, which helps low-income families pay for rent and food.
Unlike most programs that compete for government contracts, C.P.C.s are subject to almost no oversight, according to Amal Bass, an attorney at the Women’s Law Project. Investigations have alleged that C.P.C.s repeatedly misused and possibly skimmed public money and that some did not provide sufficient health services to warrant funding.
Despite the centers receiving taxpayer dollars, lawmakers have struggled to regulate C.P.C.s. Because the centers do not charge for their services, in recent years the Better Business Bureau and state attorneys general have mostly declined to go after C.P.C.s that misled women. And most C.P.C.s are not licensed medical facilities, so they are usually exempt from state and federal rules governing patient privacy and medical ethics.
Groups around the country are already working to limit the harms that C.P.C.s can have on their communities. In Connecticut, lawmakers recently banned deceptive advertising by C.P.C.s. As with previous attempts to regulate C.P.C.s, the law is being challenged in court.
Individuals who are concerned about C.P.C.s can take action, too, by asking their representatives or church leaders to stop funding C.P.C.s or by calling their school board to make sure that a C.P.C. is not teaching the sex education in their middle or high school. And of course, change can come by simply raising awareness in one’s community, including by talking to family and friends.
Methodology
Sources for driving time analysis: Caitlin Myers at Middlebury College (abortion facility locations, March 2022); Reproaction (crisis pregnancy center locations, 2020); American Community Survey demographic data, aggregated by IPUMS at the University of Minnesota (collected between 2015 and 2019); Guttmacher Institute (states certain or likely to ban abortion if Roe v. Wade is overturned).
Driving times were calculated for the geographic center of every census tract using HERE at four time intervals: 30, 60, 90 and 120 minutes. Crisis pregnancy center locations do not include those labeled as mobile units. The Hispanic or Latina category includes people of any race. All other categories, except white, include people who identify as Hispanic or Latina. Data does not include multiracial individuals. The Asian category includes people who identify as Pacific Islander or Native Hawaiian. The Native American category includes people who identify as Native Alaskan. Women of reproductive age category includes women 15 to 44 years old.
The first four images of C.P.C.s are by Annie Mulligan for The New York Times. The remaining C.P.C. images are from Google. C.P.C.s were determined to be open and at the given address based on the Reproaction database, web presence and available street view imagery.