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Regulating Disclosure of Services and Sponsorship of Crisis Pregnancy Centers

Policy Date: 11/1/2011
Policy Number: 20113

Nearly half of all pregnancies in the United States are unintended,[1] and the women facing these pregnancies often deal with anxiety and fear when faced with the decision about whether to carry the pregnancy to term, to terminate the pregnancy, or to place a child up for adoption. Young and low-income women who have the highest rates of unintended pregnancy[2] have few options for unbiased and accurate medical advice regarding unintended pregnancies.[3] The need for comprehensive and medically accurate information regarding pregnancy should be made available to all women as early in the pregnancy as possible to ensure the most positive outcomes.[4]

Crisis Pregnancy Centers (CPCs) are largely religiously affiliated centers[5] whose primary purpose is to prevent women who are experiencing unintended pregnancy from seeking abortions by purporting to counsel women on their pregnancy options.[6] Women who contact and visit these centers have reportedly been presented with inaccurate information that is beyond the scope of the counselors’ training and is clouded with biased alternatives and suggestions.[7] While in theory the purpose of CPCs seems genuine, evidence suggests that the centers use deceptive tactics to advance hidden, anti-abortion agendas.

CPCs frequently target women who are young, members of minority groups, or financially disadvantaged,[8–9] and multiple investigations have found that CPCs often engage in techniques that are coercive, threatening, misleading, and aggressive toward these vulnerable groups.[10,11] Many CPCs have been found to distribute misleading, medically inaccurate, and false information regarding abortion risks, sexually transmitted infections, and contraceptive effectiveness.[12–13] Many CPCs also engage in false advertising by listing their organizations as “abortion services” and “clinic-medical”[14] when there are no trained medical personnel on staff, deception that has caused multiple attorney generals and state governments to seek legal action against these misleading advertising tactics.[15,16]
State and federal governments regularly appropriate public funds to support CPCs.[17] Federal, state, and local governments have a special responsibility to ensure that taxpayer resources are not used to mislead and misinform persons seeking constitutionally protected and legal health services. The American Public Health Association (APHA) supports safeguards to a woman’s right to reproductive choice[18,22] and opposes coercion in the family planning decisionmaking process.[22,23] Further, APHA states that “sexually active and/or pregnant adolescents need informed, professional counseling and health care regardless of whether they wish to prevent, continue, or terminate a pregnancy.”[24]

APHA supports the enforcement of laws that relate to misleading advertising of “so-called health products and services” and encourages the development of new legislation as well as public and professional efforts to minimize the promotion of misleading health products and services.[25] Regardless of an organization’s religious affiliation or moral beliefs, all “health products and services” should be held to a standard of medical accuracy.
All women deserve medically accurate and unbiased information when facing an unintended pregnancy, in order to ensure autonomy in decisionmaking and personal integrity.[26]

APHA—
• Encourages state and local governments to require CPCs to disclose that (1) the center is not a medical facility or medical clinic, (2) the center does not perform or provide referrals for abortion, and (3) the center does not prescribe or provide referrals for Food and Drug Administration (FDA)-approved contraception;
• Urges federal, state, and local governments to support only programs that provide medically accurate and unbiased information to women facing unintended pregnancies;
• Encourages federal, state, and local governments to enforce existing consumer protections and other laws when those laws prohibit the kind of deceptive practices engaged in by many CPCs;
• Urges public health researchers to study CPCs and their activities and publish this research in order to fill the need for research on these centers and provide support for evidence-based policy; and
• Urges public health professionals to educate themselves about the potential dangers of CPCs and to advocate for regulation, public education, and the cessation of public funding for those facilities.
References
. Santelli J, Rochat R, Hatfield-Timajchy K, et al. The measurement and meaning of unintended pregnancy. Perspect Sex Reprod Health. 2003;35(2):94–101.
2. Forest JD. Epidemiology of unintended pregnancy and contraceptive use. Am J Obstet Gynecol. 1994;170(5 pt 2):1485–1489.
3. Cook CA, Selig KL, Wedge BJ, Gohn-Baube EA. Access barriers and the use of pre-natal care by low-income, inner-city women. Social Work. 1999;44(2):129–139.
4. Cohen S. Abortion and mental health: myths and realities. 2006. Available at: http://www.guttmacher.org/pubs/gpr/09/3/gpr090308.html. Accessed July 5, 2010.
5. Care Net. Statement of principle. November 2004. Available at: https://www.care-net.org/public/file_server.php?id=49&xcf=NDk=. Accessed June 3, 2010.
6. Focus on the Family. Excellence of care: standards of care for providing sonograms and other medical services in a pregnancy medical clinic. 2009. Available at: http://www.heartlink.org/pdf/standardsofcare.pdf. Accessed June 28, 2010.
7. NARAL Pro-Choice Maryland Fund. (2008). Maryland Crisis Pregnancy Center Investigations: The Truth Revealed.
8. Care Net. Care Net initiatives. 2010. Available at: https://www.care-net.org/ourwork/program.php?id=1. Accessed June 20, 2010.
9. Heartbeat International. Urban initaitive. 2010. Available at: http://www.heartbeatinternational.org/our-initiatives/urban-initiativ. Accessed June 20, 2010.
10. National Abortion Federation. Crisis Pregnancy Centers: an affront to choice. 2006. Available at: http://www.prochoice.org/pubs_research/publications/downloads/public_policy/cpc_report.pdf. Accessed June 3, 2010.
11. Boes v Deschu, 768 SW 2d 205, 206.
12. NARAL Pro-Choice Maryland Fund. Maryland Crisis Pregnancy Center Investigations: The Truth Revealed. 2008.
13. NARAL Pro-Choice Maryland Fund. Maryland Crisis Pregnancy Center Investigations: The Truth Revealed. 2008.
14. NARAL Pro-Choice Virginia Foundation. Crisis Pregnancy Centers Revealed. 2010.
15. United States House of Representatives. False and Misleading Health Information Provided by Federally Funded Pregnancy Resource Centers. 2006.
16. National Abortion Federation. Crisis pregnancy centers: an affront to choice. 2006. Available at: http://www.prochoice.org/pubs_research/publications/downloads/public_policy/cpc_report.pdf. Accessed June 3, 2010.
17. Mother & Unborn Baby Care of North Texas Inc v State, 749 SW 2d 533 (Tex App-Fort Worth, March 30, 1988).
18. Lin V, Dailard C. Crisis pregnancy centers seek to increase political clout, secure government subsidy. 2003. Available at: http://www.guttmacher.org/pubs/tgr/05/2/gr050204.htm. Accessed June 18, 2010.
19. Stipulation of Settlement. Choice Inc of Texas v Graham, Case 2:04-cv-01581-SRD-KWR. Available at: http://reproductiverights.org/sites/crr.civicactions.net/files/documents/[88]%20Stipulation%20of%20Settlement.pdf. Accessed January 31, 2010.
20. The Adolescent Family Life Act (1981) Pub L 97-35, 95 Stat. 578, 42 USC 300z et seq.; Guttmacher Institute, “Choose Life” License Plates, State Policies in Brief. Available at: http://www.guttmacher.org/statecenter/spibs/spib_CLLP.pdf. Accessed February 14, 2012.
21. APHA Policy Statement 89-01: Safeguarding the Right to Abortion as a Reproductive Choice. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1180. (Available only to APHA members.) Accessed January 31, 2010.
22. American Public Health Association. APHA Policy Statement 200314: Support for Sexual and Reproductive Health and Rights in the United States and Abroad. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1251. Accessed January 31, 2010.
23. American Public Health Association. APHA Policy Statement 200122: Opposition to Coercion in Family Planning Decision Making. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=261. Accessed January 31, 2010.
24. American Public Health Association. APHA Policy Statement 9001: Adolescent Access to Comprehensive, Confidential Reproductive Health Care. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1212. Accessed January 11, 2012.
25. American Public Health Association. APHA Policy Statement 6005: Misleading Advertising of Health Products and Services. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=444. Accessed January 11, 2012.
26. American Public Health Association. APHA Policy Statement 9814: Preservation of Reproductive Health Care in Hospital Mergers and Affiliations With Religious Health. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=166. Accessed January 11, 2012.