table, and a poster of Mary and Joseph. There are pictures of babies everywhere. Then there are three plastic “Stages of Life” models which show a baby’s development before birth. And on one wall, there’s a rainbow-colored rendering of overlapping fetuses.
The center is wedged between a travel agency and a parking lot on Whitney Avenue in Hamden, Conn. The window features a display of a teddy bear, a ceramic angel, and a bouquet of roses. A sign in the window advertises “practical support to the pregnant woman in crisis.” On Tues., Oct. 13, an elderly woman named Alfreda, who says she’s been volunteering at the center for “too many years to count,” welcomes me inside.
She hands me a pamphlet whose cover reads, “Are you pregnant? Scared?” It details a number of services Birthright can offer: free pregnancy tests, education on pregnancy, prenatal information, information about medical help and financial assistance, adoption referrals, maternity and baby clothes, and friendship.
Birthright of Greater New Haven is one of the 27 Crisis Pregnancy Centers in Connecticut. There are about 3,500 CPCs nationwide. The centers are non-profit, usually Christian organizations that counsel women who have unplanned pregnancies. Alfreda told me, “We provide love and care to all women who come to us. We help women recognize their options.” Abortion is notably absent from those options, though.
Birthright International states that one if its goals is to “attempt to effect, in every possible way, a decrease in the number of abortions by encouraging pregnant girls and women to have their babies.” When I asked her about abortion, Alfreda said that they don’t provide abortions or abortion referrals, because “we don’t believe in that.” While pro-life lawmakers try to restrict women’s access to abortions by squeezing funding from Planned Parenthood and passing legal limitations, CPCs engage in the war over women’s reproductive rights on a local, personal level.
Pro-choice activists are fighting back. They accuse CPCs of providing false medical information, using deceptive advertising, and emotionally manipulating women in crisis. This past June, NARAL Pro-Choice Connecticut, a non-profit advocacy organization, published a 32-page report that slammed the state’s CPCs for their tactics. And on Fri., Oct. 9, California Governor Jerry Brown signed the Reproductive FACT Act, the first legislation that regulates CPCs at the state level.
Both sides claim that they are working towards “choice” for women. The staff of CPCs say their goal is to provide as many options as they can to women facing unplanned pregnancies. They use the language of choice in their missions and advertising: “providing alternatives,” “options counseling,” “helping women decide.” One center inMiddletown, Conn. is named A Better Choice Women’s Center.
But Stacy Missari, board chair of NARAL Pro-Choice Connecticut, told me that the organizations hinder choice through their singular goal. “They’ve presented themselves as health centers giving unbiased information about pregnancy, but they have one agenda, which is to dissuade women from considering all their choices, including abortion. Their deception is in the hidden nature of their mission.”
***
I sit in the waiting area of Carolyn’s Place in Waterbury, Conn. on Fri., Oct. 16. One corner overflowed with children’s toys and books. I leaf through some informational leaflets from the front office. I pause on one whose cover reads, “This is NOT your only choice,” featuring a picture of woman holding up an open palm. On her hand in pen are the words, READ THIS. So I did.
It details the evils of abortion. Under the heading ABORTION HURTS (Physically. Mentally. Emotionally.) it lists uncited and unsubstantiated claims. It quotes a woman named Ann Marie saying, “Abortion changes you forever…it held me in bondage to feelings of regret, remorse, depression and despair. My soul became a slave to self-hatred and worthlessness.”
It goes on to claim that women who terminate pregnancies have suicide rates that are 10 times higher, anxiety, panic attacks, eating disorders, and a long list of psychological traumas. The pamphlet categorizes them as symptoms of “after-abortion trauma.” The American Psychological Society and the American Psychiatric Association have both issued statements debunking the myth that abortion is linked to mental health.
This misinformation has been widely documented by pro-choice groups. Missari sent me photographs of several others pamphlets from Connecticut CPCs. One, which she said came from Saint Gianna, the closest CPC to Yale’s campus, claimed, “Women who have abortions are twice as likely to die in the following two years.”
Elina Anderson, who worked as an undercover investigator for NARAL’s report in North Carolina, visited 27 CPCs in 2011. She told me that the medical misinformation she received was startling. Most centers she visited claimed that abortions caused breast cancer, a claim that has been widely refuted by scientists and doctors, notably the American Cancer Society and the National Cancer Institute. Almost everyone she spoke with told her that abortions affect mental health, and also counseled her on “natural birth control methods” when she told them she was married but not trying to have children. “Condoms and birth control were never options,” Anderson said. “It was always pulling out, or the rhythm method, which are obviously ineffective.”
This sort of deception can be traced to the founder of the first CPC in the U.S., Robert Pearson. He was point-blank about his tactics. In 1967, Pearson, who was formerly a building contractor, opened the first center in Hawaii—six years before Roe v. Wade made abortion legal, but just after Hawaii decriminalized it. Pearson later moved to mainland U.S. to create a foundation to start more CPCs there. His manual, published in 1984 and titled How to Start and Operate your own Pro-Life Outreach Crisis Pregnancy Center, describes how CPCs should manipulate women out of terminating their pregnancies.
It instructs centers to seek listings in the Yellow Pages alongside abortion clinics so that women might confuse them. He encourages founders to have two names for their centers—one to attract women who are seeking abortions, and another to attract pro-life donors. His manual tells staff members never to counsel women in favor of contraception, and instructs them not to state that they are pro-life organizations over the phone. While most centers offer only drugstore-grade urine tests, Pearson wrote, “Tell her it’s a refined form of the old rabbit test. This usually satisfies them. At no time do you need to tell them what you’re doing.”
Pearson justified these lies by claiming that he was saving lives. In a 1994 speech, Pearson said, “Obviously, we’re fighting Satan… A killer, who in this case is the girl who wants to kill her baby, has no right to information that will help her kill her baby. Therefore, when she calls and says, ‘Do you do abortions?’ we do not tell her, ‘No, we don’t do abortions.’”
NARAL’s report on Connecticut’s CPCs—entitled, “The Right to Lie”—paints a portrait that aligns with Pearson’s tactics. Between February 2012 and June 2014, undercover investigators visited 21 of the 27 centers in Connecticut and pretended to be women concerned about unplanned pregnancies.
The statistics detail a deception of dramatic proportions. According to the report, one CPC volunteer told an investigator that birth control pills are W.H.O.-classified carcinogens, and that having a medical abortion is like “taking poison” because of its equivalence to a massive dose of birth control. Another told an investigator that she didn’t need to see a doctor during her pregnancy because pregnancy is “common sense,” and that she should just eat more fruits and vegetables.
The report claimed that 80 percent of CPCs incorrectly stated that abortion leads to breast cancer. Ninety percent claimed that abortion would lead to mental health problems. Ninety-five percent offered incorrect medical information about abortion. Seventy-five percent provided misleading information about birth control and emergency contraception.
The NARAL report in Connecticut does not point to specific CPCs, referring instead to “one CPC” or “a different CPC.” According to Missari, “the intent was not about wanting to attack a specific CPC, but to talk about them as a whole. They vary so greatly, but our original intent wasn’t to vilify one center, but to broadly address the deception of CPCs.” But the fact that the attacks on CPCs were semi-anonymous undermines the credibility of the report.
It’s unclear if most of the quotes came from one or two CPCs, or all 21 that investigators visited. I visited five Connecticut CPCs. I was never a patient, and so my ability to assess the medical information they provide was limited to what was publicly available. There was the pamphlet I picked up in Waterbury; and then there was “Before You Decide” from Care Net of South Eastern Connecticut in New London, a more honest approach to women’s health options.
***
Care Net feels like a doctor’s office when you walk in, and it is. It’s the only medically licensed CPC in Connecticut. There’s a sparse waiting room and a window for check-in. Picture ID is required. The baby clothes and religious iconography are notably absent from the waiting area,
as are informational leaflets. As a licensed outpatient clinic, their function is also more advanced. Rather than the self-administered urine tests that the other CPCs use, nurses administer medical-grade tests and ultrasounds. The medical staff recently received Department of Health training to become a certified HIV testing center.
The director, Lisa Maloney, shows me “Before You Decide,” the publication put out by Care Net that staff members show women during their decision-making process. “We’re here to help women make informed choices,” Maloney says. “There are essentially three options for a pregnant woman: abortion, adoption, and parenting. We give equal time to all three choices.”
I ask Maloney what counseling they provide on abortion, and she flips to a page that lists abortion risks. “If you go to the Planned Parenthood website, you’ll see the same risks. All of the information here is cited. It’s from the Center for Disease Control and the Guttmacher Institute,” Maloney says. “We’re using their information.” The risks listed do match up with the ones on Planned Parenthood’s website—allergic reaction, blood clots in the uterus, failure to end pregnancy, infection, injury to the uterus, and bleeding. The only difference is in the framing. While Planned Parenthood devotes only a bulleted list to potential risks, “Before You Decide” devotes a paragraph to each.
Anticipating my next question, she says, “I know one of the things pregnancy resource centers get hit for is saying that abortion causes breast cancer. You’ll notice that’s not in here.”
Maloney strongly denies that Care Net in New London uses deceptive advertising or medical misinformation. “We get lumped in with a lot of scary stuff,” Maloney says. “But we’re a licensed outpatient clinic. We provide women with an honest assessment of their options.”
Medical licenses for CPCs—or the lack thereof—are currently a hot topic. California’s Reproductive FACT Act, which has been in effect for 20 days, requires unlicensed centers that provide pregnancy-related services to disclose that they are not licensed providers. It also forces licensed health clinics to state that California has public programs that provide free or low-cost access to comprehensive family planning services, prenatal care, and abortion.
Two clinics have sued California Attorney General Kamala Harris over the FACT Act. Their claim is that the posted notices violate first amendment rights and that the law unconstitutionally requires centers “to speak messages that they have not chosen, with which they do not agree, and that detract, and distract from, the messages they have chosen to speak.” Similar laws were struck down in Baltimore and New York City for violations of first amendment rights, but one was upheld in San Francisco. This is the first statewide legislation that regulates CPCs.
When the legislative session begins in January, NARAL will push for similar legislation in Connecticut, Missari said. She named Connecticut Senator Richard Blumenthal as an ally in this push—he came out strongly against CPCs after NARAL published the report. She argues that because no clinics are licensed family planning providers—even Care Net is licensed only as an outpatient clinic—the lack of clarity can be harmful to women.
“If I were someone who didn’t study this, I would reasonably assume that if this is a place where I can go and get a pregnancy test, they would also do all the other things that a comprehensive family planning clinic would do—information about possible complications, preexisting conditions, prenatal information,” Missari said. “This is not going to happen at any of these clinics, even the more medicalized ones.” Based on the services most CPCs offer, Missari is right.
And the consequences can be serious, she continued. “So it’s very dangerous, actually. Women who are early in their pregnancy don’t know that they’re supposed be doing certain things because these centers don’t tell them.”
A representative from Senator Blumenthal’s office said that he is not currently working on legislation related to CPCs, but he acknowledges the urgency of the issue. “Crisis pregnancy centers that pose as a source of reliable medical advice—especially in vulnerable situations—are a threat to women here in Connecticut and across the country,” Senator Blumenthal wrote in an email. “Women need and deserve access to honest, professional medical advice and care.”
Although only a small number of the country’s CPCs have medical licenses, others are moving in this direction. The National Institute for Family and Life Advocates is hosting their “medical and legal summit” on Nov. 13-14 in Fredericksburg, VA. The panels seek to provide medical information to directors and staff of CPCs. Their mission states that one of their goals is “to provide legal resources that enable PRCs [another term for CPCs] to convert to medical clinic status.”
Several medical ethicists with whom I spoke raised questions about the ethics of the medically licensed centers. Benjamin Doolittle, a doctor and a pastor who heads Yale’s program for Medicine, Spirituality, and Religion, said that while there is no need for pro-life doctors to perform abortions, they are ethically obligated to provide a referral. “If I as a provider were categorically against abortion and the patient felt that they needed an abortion, I would refer the patient to someone who would give them an abortion,” he said.
Back at Care Net, Maloney shows me a form that women sign when they come into the Care Net facility. At the bottom, in bold, it reads: “Care Net does not offer annual exams, birth control, mid-life services, abortion services or referrals, mammograms or breast screenings, in-vitro fertilization services, pre or post natal care, treatment of infertility, or treatment of reproductive tract infections.”
Perhaps their bias runs too deep. Susan Yolen, Vice president of public policy and advocacy for Planned Parenthood of Southern New England, wrote in an email, “We have never pushed to require these organizations to become licensed because it legitimizes them inappropriately.” Licensure could make them eligible for government funds as community health centers under Title X. Currently, no CPCs receive government funding in Connecticut, though 11 states fund them directly through “abstinence education” grants.
Even if licensed centers provide correct information, and are upfront about their ideological bias, the issue of that bias remains. A center that has a moral opposition to abortion is unlikely to provide women with an unaffected assessment of abortion as an option.
***
The most nebulous—but perhaps the most serious—charge against CPCs is that they emotionally manipulate women in crisis. This emotional manipulation can include using graphic descriptions of abortion, videos of the procedure, and testimonials about emotional regret from women who’ve had abortions. The presence of baby clothes, toys, and pictures can be construed as manipulation of a subtler form.
Anderson, the researcher in North Carolina, said she was surprised by the negative emotional impact of the experience. “At first I was pretty blasé about it. I just thought, okay, I’m going undercover and it’ll be kind of fun, in a way,” she said. “For a little while it was, and then it really gets to you. I didn’t realize how dogmatic these folks would be and how angry they would be. I started having nightmares about it, and I was doing this as a student and a researcher.”
She described one clinic where a woman made her watch a graphic video about abortion, and then pulled out a machete and told her that this was the tool they used for abortions.
I found no machetes, but I did encounter the verbal equivalent in the pamphlet from Carolyn’s Place.
Some quotes: “In [vacuum aspiration abortions]…the baby is torn to pieces as he or she is pulled through the hose.”
“I don’t think a woman is ever prepared for the effect abortion has on a family. I couldn’t even look at my living children after I chose to abort their sibling.”
Under the headline, RAPE & INCEST (Abortion Isn’t The Answer): “I was raped and got pregnant. Nobody told me abortion would hurt more emotionally than the rape. —Maya”
But when I go see Therese Richie at Hope Pregnancy Center in Cheshire, Conn., it’s hard to square these tactics with her warmth. Hope Pregnancy Center is located next to Christ Community Church (with which it was formerly affiliated) and the Cheshire Public Library. The center is in a white wooden building. Outside, there’s a sign advertising free pregnancy tests.
Therese is a blonde mother of four wearing a bright blue sweater, a long blue and white skirt, and dangly earrings. She reminds me of a fourth-grade teacher: sunny, vivacious, and engaged. She was hired as director only a year ago, though the center has a big sign outside advertising 30 years of service in the community. “Every day here is eye-opening and heart-opening for me,” she says. “Every story is different. What I do is listen. That’s the most important thing I do in this job.”
She tells me that this is not a place of judgment. “The door here is always open, to anyone,” she said. “A woman will walk in and ask what we do here, and then a few minutes later she’ll be telling me that she had an abortion 15 years ago and she hasn’t stopped thinking about it.”
Therese is expressive, concerned, when she talks about the women she works with. “I don’t think that any woman’s first thought when she finds out she’s pregnant is, ‘I want to have an abortion,’” she said, shaking her head. “I think it’s, ‘I’m scared. I need help.’” She says she wants to provide that help.
She gives me a tour of the center, and we linger in the back room where there are baby clothes, bassinets, cribs, car-seats, mobiles. She lingers over particularly cute items, holding up a purple onesie. “And look at this—it’s a diaper-wipe heater,” she says, pointing. “Sometimes we get really nice stuff, too.” All of what Hope has on hand is donated. Women earn items through the “Earn While You Learn” program—they take parenting classes through the center, and earn one baby buck each time. With the baby bucks, they can purchase items of varying degrees of expense.
At the end of our interview, Therese asks if I’m life-affirming. I tell her that I’m not, that I think abortion is a morally complicated issue but that I think it should be woman’s choice. She nods. “When a woman comes in here, I always see the woman first. Not her baby, but the woman,” she said. On the way out she hands me a bottle of water for the road, and a gold pin shaped like little feet. It’s mounted on a piece of paper that reads, “The exact size and shape of a 10-week unborn baby’s feet.”
I wonder, driving back to Yale, how I would feel if I had been pregnant and come to Hope Pregnancy Center. Comforted, maybe. Confused, definitely. My insight into what women feel when they visit these centers is limited—I have only the NARAL investigators’ perspectives, several lawsuits filed against the centers, and patient evaluations from Care Net.
When I visited, Maloney showed me a number of client exit questionnaires from women who had had ultrasounds. Overwhelmingly—with two exceptions in the roughly 30 that I saw—patients said they were very satisfied with their care. They felt that the ultrasound technician was sensitive to their values. Towards the end of the form, the patients are asked whether the ultrasound helped them in their decision about their pregnancy. Some checked, “no” and wrote that they’d already decided. But most checked yes. Next to this box, one woman wrote, “I decided to keep it!”
On Care Net’s national website, a large banner claims, “469,089 Lives Saved.”
***
Crisis pregnancy centers operate at a number of crossroads—at the intersections between science and religion, loving advice and manipulation, and the various avenues of a woman’s choice about her unplanned pregnancy. In the minds of many who work at the centers, they also operate at the crossroads between life and death for an unborn child.
While legislation can help regulate CPCs, there is no clear solution for the deeper issue, the stark divide about conceptions of when life begins. Abortion is the most divisive social issue in the U.S. today. A Gallup poll in May 2015 showed that 50 percent of Americans identified as pro-choice, and 44 percent as pro-life.
I do not pretend to be outside of this divided sphere. At Christmas one year, my parents gave me $100 to give to a charity of my choice, and I chose Planned Parenthood. In visiting CPCs, I expected to encounter deception and scare tactics that I associate with the pro-life movement.
But the division is, I think, more complicated: “choice” and “life” are not diametric opposites. They may even be misnomers. It is possible to be pro-choice and believe that life begins at conception. But is it possible for a pro-life counseling center to really provide a woman with comprehensive choices?
I left my visits feeling like CPCs do offer possibilities to women, especially women who are not seeking abortions. There is no doubt in my mind that women have come to Hope Pregnancy Center and found Therese Richie to be an invaluable guide through a difficult time.
But still, the entrenched ideology of CPCs limits and manipulates choice. Sometimes this happens in obvious, dramatic ways: medically inaccurate information, deceptive advertising tactics, the wielding of a machete. But I also encountered more subtle interferences: the refusal to refer to abortion providers, the presence of baby shoes in a waiting area, a pin that is “the size of an unborn baby’s feet at 10 weeks.” These subtle manipulations were sometimes hard separate from my own emotional responses.
One morning, as I left Saint Gianna center, I even had my own crisis of faith. I texted my friend, “Remind me why I don’t think abortion is wrong?” She reminded me and I reminded myself. My own moral position aside, I have always been committed to a woman’s right to make her own judgment. My confidence wasn’t shaken for long, but it was telling. Even I’m not impervious to the tactics CPCs use to influence women’s choices.