October 1, 2012 — Summary of "The Public Health Risks of Crisis Pregnancy Centers," Rosen, Perspectives on Sexual and Reproductive Health, September 2012.
Crisis pregnancy centers -- which offer no-cost services to pregnant women but are not medical facilities -- "often provide inaccurate information that may delay or interfere with women's access to abortion and contraceptive services, improperly influence women's reproductive health decisions and potentially increase the number of unintended births," Joanne Rosen, an associate lecturer at Johns Hopkins School of Public Health, writes in a commentary.
The commentary describes how CPCs spread misinformation about abortion and contraception and how their practices jeopardize the health of women and their children. Rosen also reviews three responses that might be effective in addressing the deceptive practices.
There are an estimated 2,500 to 4,000 CPCs in the U.S., according to Rosen. The centers often are affiliated with national antiabortion-rights and evangelical groups, and their staff members typically do not have medical training or licenses. The centers offer no-cost pregnancy testing, and some also offer no-cost ultrasounds and testing for sexually transmitted infections; they do not offer services or referrals related to abortion or contraceptive services.
Women who visit CPCs are disproportionately young, low-income or not highly educated. Women in these groups all have high unintended pregnancy rates and might be drawn to CPCs because they offer no-cost services, according to Rosen.
Misinformation About Abortion Risks
CPCs disseminate a variety of claims about abortion that lack scientific validity, Rosen writes. For example, CPCs often tell women there is a link between abortion and breast cancer, even though the National Cancer Institute in 2003 examined all available data on the issue and found that no such link exists.
CPCs also tell women that abortion can lead to problems with future pregnancies, such as infertility, ectopic pregnancy, miscarriage and permanent uterine damage. Rosen notes that CPCs do not differentiate between the risks of first-trimester abortions -- which do not affect any of these factors -- and second-trimester abortions -- which can increase the risk of premature delivery or low birthweight.
In addition, CPCs often claim that abortion can cause mental health problems. Several studies have invalidated the notion that a "postabortion syndrome" exists or that abortion leads to long-term psychological damage, Rosen writes.
Misleading abortion information "is contrary to the legal and ethical standards of informed consent," which require "accurate and relevant information on the benefits, risks and costs of treatment," Rosen writes.
It also is important to note that unintended pregnancy and births are associated with numerous negative outcomes, Rosen continues. "Consequently, practices that potentially increase the number of unintended births" -- such as misleading women so they continue unwanted or unintended pregnancies -- "pose a public health risk," she writes.
Claims About Abortion Access
Some CPCs spread inaccurate information about the need for -- or availability of -- abortion, which "appears to be aimed at delaying or interfering with women's access to services," Rosen writes. For example, CPCs in Maryland and New York have advised women that abortion is legal throughout pregnancy, when, in fact, no state allows unrestricted access to abortion at all points during pregnancy. Websites of two CPCs in New York have suggested that some women might be at risk for miscarriages and, therefore, do not need to seek abortion care.
Abortion is safest and most accessible during the first trimester, Rosen writes. Young and socioeconomically disadvantaged women, who account for most visitors to CPCs, tend to confirm they are pregnant later, in comparison with older, more educated and higher-income women, she notes. Thus, women who seek care at CPCs rather than at abortion facilities likely are farther along in their pregnancies and "require immediate referral," Rosen states.
Misinformation About Contraception
Rosen writes that most CPCs do not provide information about contraception and STI prevention and that those that do mention contraception provide inaccurate information about the failure rates and risks. She notes that although most teenagers who visit CPCs are not pregnant, many are sexually active and would benefit from accurate information about contraception and STIs.
Rosen offers three potential approaches to addressing CPC practices. One approach is to pass laws requiring CPCs to disclose that they are non-medical facilities and do not provide abortion care or birth control. Rosen notes that a few municipalities have tried this approach, though most have been challenged in court.
Another possible response could be through the enforcement of state consumer protection laws that ban false advertising or deceptive practices by service providers. Public awareness campaigns also could be used to educate women about CPCs' deceptive practices, Rosen suggests.
CPCs' "entitlement to communicate and promote a prolife perspective is not in question," Rosen writes, adding, "However, when these centers disseminate inaccurate information to women seeking reproductive health care services, and blur the line between prolife advocacy group and health care provider, their practices ... jeopardize the health of women and their children, and a public health response is warranted."