The following article was written by one of our 2022 MPH Interns, Abigail O'Keefe

“What is a crisis pregnancy center?” was a question that my professor posed in class during my senior year of college. I never had encountered the word before or had any knowledge of what these facilities were. This wasn’t just the case for me. My professor also asked for us to raise our hands if we had any idea of what these centers were, and only a couple of hands went up out of a sea of students. While my professor gave us a brief introduction of these centers, I remember quickly opening my computer after class and typing in “crisis pregnancy center” to get an in-depth answer to the question my professor had posed. These centers are extremely prolific in the United States¹. Given the large number of crisis pregnancy centers in the United States, however, I was shocked to learn that many of these centers are not actual medical facilities¹. Instead these centers attempt to impersonate facilities that provide a range of reproductive health care services - through advertisements, by establishing themselves close to healthcare facilities, and using language that medical professionals use, all with the express intention to divert individuals from having an abortion^1-3. While the tactics that these centers use can make it hard for anyone to discern between actual healthcare facilities and crisis pregnancy centers, many of the tactics these centers use are aimed at attracting young people ³. While abortion is still legal in North Carolina despite the recent overturning of Roe vs. Wade, crisis pregnancy centers present another obstacle to young people’s right to have an abortion in the state of North Carolina. 

Currently in North Carolina there are around 100 crisis pregnancy centers,⁴  which greatly outnumbers the 14 abortion clincs in the state⁵. While there is an overabundance of these centers across the state,  crisis pregnancy centers are more likely to be located near colleges and universities ^6,7.Specifically in North Carolina, over 75% of crisis pregnancy centers are within walking distance or a 10-15 minute drive from a college or university’s campus⁷. While the location of where these centers are may just appear to be a coincidence, this is a tactic that crisis pregnancy centers use to attract young people, especially students, to their clinics and talk them out of  having abortions. For example, two of the websites for crisis pregnancy centers located in Raleigh and Rocky Mount explicitly state that they want to attract students to their facilities in the area who may be considering abortion. Additionally, crisis pregnancy centers also attempt to attract college students by publishing their services in newspapers on college campuses⁸ and visiting college campuses⁹. Through establishing themselves near college campuses^6,7 and advertising themselves in these locations^8,9, crisis pregnancy centers are clearly trying to make their services known to the students in the area. 

Another tactic that crisis pregnancy centers use is having links on their websites that discuss abortion as well as having medical-sounding information about abortion on their websites, even though these sites do not refer to nor provide abortions¹⁰. Because these centers attempt to pose as real medical facilities^2,3, people are likely to be confused about what services are provided when looking at their websites, including if they are looking for abortion services¹¹. In North Carolina, over 75% of the websites for crisis pregnancy centers do not clearly state that they are  “not a medical facility”⁷, but 84% of crisis prengnancy center’s websites indicate that patients can receive guidance around abortion from the center¹⁰. To make it even more confusing, links and advertisements to crisis pregnancy centers are likely to be generated when abortion services are looked up on the internet^3,12. While this is an issue for anyone, young people are more likely to use the internet to find information on reproductive healthcare,^13,14 but are less likely to thoroughly look through all the results that appear when searching for the topic¹⁴. All of these tactics may place young people at a greater risk of being misled to crisis pregnancy centers because of uncertainty around what services they actually offer when looking at their websites. This would result in many young people being diverted away from medical facilities in the state that actually provide abortion services that they have a right to access and receive.

Another strategy that crisis pregnancy centers use to attract young people to their websites and facilities are through their free services^1,7,10. Many crisis pregnancy centers advertise on their websites that they provide free services to their clientele ^7,10. In North Carolina, most of the crisis pregnancy centers advertise that pregnancy tests and ultrasounds are some of the free services that they supply⁷, and the free services that these centers offer have been shown to be one of the main reasons why people end up going to these centers¹⁵. Young people are more likely to have a smaller weekly income¹⁶,  are more likely to be uninsured¹⁷, and are less likely to have access to a primary care doctor¹⁸ all compared to their older adults. Even though some young people may have insurance coverage through their parents or guardians, young people may not want to or may not be able to use that insurance for reproductive healthcare services because they do not want their parents or guardians to know about the services they are seeking out ^19,20. Understanding the constraints that young people can face when accessing health care, the freeness of the services that these centers offer may attract young people who want to keep their healthcare choices confidential, who may not have the resources to travel to receive reproductive healthcare services, who may not be able to pay for reproductive healthcare services, and who may not have any other choice for where to access reproductive health services.

While it may seem that there is no harm in crisis pregnancy centers wanting to reach and provide services to young people, it is important to highlight that these centers are largely unlicensed and unregulated^1-3. This allows for many of these centers to spread inaccurate information about abortions in their attempts to deter patients from having them^1-3,21. In North Carolina, false information about abortions is disseminated by numerous crisis pregnancy centers through the people who work in the centers as well as through their websites^7,22.  Considering that young people are targeted by these centers and the fact that young people in North Carolina make up a large portion of the people who have abortions each year²³,  young people are at risk of receiving false information and misleading guidance about abortions that may prevent them from making a fully informed decision about their reproductive health^1-3,21. Even if young people are aware of the misinformation and agenda of these centers, they may not have any other option for receiving health care services, and the fact that crisis pregnancy centers are mostly unregulated^1-3 leaves young people at risk of potentially receiving harmful advice for their health.

While it is a known fact that crisis pregnancy centers spread misinformation about abortion and  that they are not regulated, licensed medical facilities, the North Carolina General Assembly has provided these centers close to $19 milion in the state’s budget for 2021- 2023²⁴.  Understanding how these centers have the potential to affect the reproductive choices of young people, it is extremely important that we advocate for the North Carolina General Assembly to direct their attention and funding to policies, programs, and services that have been proven to support the reproductive freedom of young people. Some of these actions are expanding Medicaid so that more young people are able to access reproductive health services, ensuring that all young people have access to medically accurate and comprehensive sex education,  and protecting access to abortion services in the state. With directing attention to these actions that will support the reproductive health of young people, taking these steps will start to ensure that every young person has the right to make and seek out the reproductive health choices that they desire without any interference or misguidance. 

References

1. Polcyn C, Swiezy S, Genn L, et al. Truth and Transparency in Crisis Pregnancy Centers. Womens Health Rep (New Rochelle). 2020;1(1):224-226. Published 2020 Jul 27. doi:10.1089/whr.2020.0057
2. Borrero S, Frietsche S, Dehlendorf C. Crisis Pregnancy Centers: Faith Centers Operating in Bad Faith. J Gen Intern Med. 2019;34(1):144-145. doi:10.1007/s11606-018-4703-4 
3. Society for Adolescent Health and Medicine and the North American Society for Pediatric and Adolescent Gynecology. Crisis Pregnancy Centers in the U.S.: Lack of Adherence to Medical and Ethical Practice Standards: A Joint Position Statement of the Society for Adolescent Health and Medicine and the North American Society for Pediatric and Adolescent Gynecology. J Adolesc Health. 2019;65(6):821-824. doi:10.1016/j.jadohealth.2019.08.008 
4. Crisis Pregnancy Center Map. Identify CPCs. Crisis Pregnancy Center Map. Accessed June 24, 2022. Crisis Pregnancy Center Map & Finder - CPC Map
5. Guttmacher Institute. State Facts About Abortion: North Carolina. Guttmacher Institute. Accessed June 9, 2022. State Facts About Abortion: North Carolina | Guttmacher Institute
6. Swartzendruber A, Mercaldo R, Newton-Levinson A, Rathbun S. Targeting Young People: A State-Wide Analysis Describing Location of Crisis Pregnancy Centers throughout Georgia and Around High Schools and Colleges/Universities. J Adolesc Health. 2018;62(2):S67-S68. doi:10.1016/j.jadohealth.2017.11.137
7. NARAL PRO-CHOICE NORTH CAROLINA FOUNDATION. The Landscape of CPCs: North Carolina’s Crisis Pregnancy Centers. 2017. Accessed June 24, 2022. Website version 10.17 The Landscape of CPCs- North Carolina's Crisis Pregnancy Centers (1).pdf (prochoicenc.org)
8. Holtzman B. Have Crisis Pregnancy Centers Finally Met Their Match: California's Reproductive FACT Act. Northwestern Journal of Law and Social Policy. 2017;12(3):78-110. 
9. Park J. STUDENTS LEAD CHARGE TO BAN CRISIS PREGNANCY CENTER FROM CAMPUS. University Wire. Published October 25, 2018. Accessed July 10, 2022 https://go.exlibris.link/Zq1YtsHL. 
10. Bryant AG, Narasimhan S, Bryant-Comstock K, Levi EE. Crisis pregnancy center websites: Information, misinformation and disinformation. Contraception. 2014;90(6):601-605. doi:10.1016/j.contraception.2014.07.003
11. Swartz JJ, Rowe C, Truong T, Bryant AG, Morse JE, Stuart GS. Comparing Website Identification for Crisis Pregnancy Centers and Abortion Clinics. Womens Health Issues. 2021;31(5):432-439. doi:10.1016/j.whi.2021.06.001
12. Center for Countering Digital Hate. GOOGLE DIRECTS USERS TO ANTI-ABORTION ‘FAKE CLINICS’. Center for Countering Digital Hate. Published June 9, 2022. Accessed June 27, 2022. Google Directs Users to Anti-Abortion 'Fake Clinics' — Center for Countering Digital Hate | CCDH (counterhate.com)
13. Bryant-Comstock K, Bryant AG, Narasimhan S, Levi EE. Information about Sexual Health on Crisis Pregnancy Center Web Sites: Accurate for Adolescents?. J Pediatr Adolesc Gynecol. 2016;29(1):22-25. doi:10.1016/j.jpag.2015.05.008  
14. Buhi ER, Daley EM, Fuhrmann HJ, Smith SA. An observational study of how young people search for online sexual health information. J Am Coll Health. 2009;58(2):101-111. doi:10.1080/07448480903221236
15. Kimport K. Pregnant Women's Reasons for and Experiences of Visiting Antiabortion Pregnancy Resource Centers. Perspect Sex Reprod Health. 2020;52(1):49-56. doi:10.1363/psrh.12131
16. U.S. Bureau of Labor Statistics. Table 3. Median usual weekly earnings of full-time wage and salary workers by age, race, Hispanic or Latino ethnicity, and sex, first quarter 2022 averages, not seasonally adjusted. United States Department of Labor. Updated April 15, 2022. Accessed June 15, 2022. Table 3. Median usual weekly earnings of full-time wage and salary workers by age, race, Hispanic or Latino ethnicity, and sex, first quarter 2022 averages, not seasonally adjusted - 2022 Q01 Results (bls.gov)
17. Riley B. Profiling North Carolina’s Uninsured: How Expanding Medicaid Can Make a Difference. North Carolina Justice Center. Published January 29, 2019. Accessed June 16, 2022. HAP-Report_How-Expanding-Medicaid-Can-Make-a-Difference.pdf (ncjustice.org)
18. Boodman SG. Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model. Kaiser Health News. October 9, 2018. Accessed July 10, 2022. Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model | Kaiser Health News (khn.org)
19. Copen CE, Dittus PJ, Leichliter JS. Confidentiality Concerns and Sexual and Reproductive Health Care Among Adolescents and Young Adults Aged 15-25. NCHS Data Brief. 2016;(266):1-8.
20. Fuentes L, Ingerick M, Jones R, Lindberg L. Adolescents' and Young Adults' Reports of Barriers to Confidential Health Care and Receipt of Contraceptive Services. J Adolesc Health. 2018;62(1):36-43. doi:10.1016/j.jadohealth.2017.10.011 
21. Bryant AG, Swartz JJ. Why Crisis Pregnancy Centers Are Legal but Unethical. AMA J Ethics. 2018;20(1):269-277. Published 2018 Mar 1. doi:10.1001/journalofethics.2018.20.3.pfor1-1803 
22. Bryant AG, Levi EE. Abortion misinformation from crisis pregnancy centers in North Carolina. Contraception. 2012;86(6):752-756. doi:10.1016/j.contraception.2012.06.001
23. Kortsmit K, Mandel MG, Reeves JA, et al. Abortion Surveillance - United States, 2019. MMWR Surveill Summ. 2021;70(9):1-29. Published 2021 Nov 26. doi:10.15585/mmwr.ss7009a1
24. Khachaturyan S. NC lawmakers increase funds for harmful ”crisis pregnancy centers”. NC Budget and Tax Center. July 5, 2022. Accessed July 10, 2022. NC Budget & Tax Center