EXECUTIVE SUMMARY

The Society for Adolescent Health and Medicine and the North American Society for Pediatric and Adolescent Gynecology have issued a joint position paper detailing how crisis pregnancy centers pose serious health risks for adolescents.

According to the position paper, such centers fail to consistently follow medical and ethical practice standards, which could lead to negative health outcomes.

Also known as pregnancy resource centers or pregnancy care clinics, such facilities are nonprofit organizations with a primary aim of preventing women from obtaining an abortion. Many also oppose contraception. More than 2,500 crisis pregnancy centers currently are operating in the United States.


The Society for Adolescent Health and Medicine (SAHM) and the North American Society for Pediatric and Adolescent Gynecology (NASPAG) have issued a joint position paper detailing how crisis pregnancy centers, or CPCs, pose serious health risks for adolescents.1 According to the position paper, such centers fail to consistently follow medical and ethical practice standards, which could lead to negative health outcomes.

Also known as pregnancy resource centers or pregnancy care clinics, such facilities are nonprofit organizations with a primary aim of preventing women from obtaining an abortion. Many also oppose contraception. More than 2,500 crisis pregnancy centers are currently operating in the United States.

“Crisis pregnancy centers attempt to prevent use of reproductive healthcare services, particularly abortion and contraception, often without revealing their true intentions,” said Andrea Swartzendruber, PhD, MPH, the lead author of the position paper and an assistant professor of epidemiology and biostatistics at the University of Georgia College of Public Health. “The lack of transparency, use of inaccurate health information, and failure to provide evidence-based services could harm young people and their health.”2

Swartzendruber leads the Crisis Pregnancy Center Map Project, which aims to provide location information about all crisis pregnancy centers operating in the United States. Most centers are affiliated with national religious organizations that oppose abortion and create policies against promoting and providing contraception. Some centers only offer pregnancy tests and pregnancy-related information or counseling, while others provide limited medical services, such as obstetric ultrasounds to confirm a pregnancy.

“It can be difficult to distinguish between CPCs and healthcare clinics that provide safe, comprehensive care, especially online,” said Maria Trent, MD, MPH, pediatrician and adolescent medicine specialist at Johns Hopkins University Schools of Medicine, Nursing, and Public Health, and president of SAHM. “Health professionals should help young people recognize CPCs and the limitations of CPC services, and facilitate access to quality, unbiased sources of information, care, and resources.”

A 2016 survey of sexual health information presented on crisis pregnancy centers websites revealed that the websites provided inaccurate and misleading information about condoms, sexually transmitted infections (STI), and methods to prevent STI transmission. Such information could be harmful to teens, who might be unable to discern the quality of sexual health information presented, researchers concluded.3

“Government-funded health programs have a responsibility to protect and promote health and provide accurate information,” said Eduardo Lara-Torre, MD, vice chair of obstetrics and gynecology at Virginia Tech Carilion School of Medicine, and NASPAG president. “Because CPCs prioritize their own beliefs over the needs and rights of clients and prevailing medical guidelines, their practices and services clearly do not align with a public health approach.”

Centers Gain Momentum

According to analysis provided by the Guttmacher Institute, more states are passing legislation bolstering crisis pregnancy centers’ positions as healthcare providers. For example, Arkansas Gov. Asa Hutchinson signed a measure in April 2019 that permits, but does not require, the state Department of Health to establish a crisis pregnancy support program. If implemented, the program would promote childbirth and parenting as an alternative to abortion, as well as operate a hotline for social, medical, and charitable services referrals. The law took effect in July.

In June 2019, the Michigan House of Representatives passed a budget bill that would allocate nearly $8.5 million for family planning services, but would prevent funding from going to any entity that provides abortions, or counsels or refers for an abortion.

According to information from the Charlotte Lozier Institute, a research group that opposes abortion, most CPCs provide non-healthcare services such as counseling and baby supplies.4 While an estimated 70% of centers provide ultrasounds, about 25% offer STI testing, and 5% provide prenatal care.

Some CPCs are taking a new approach. Eight independent, Texas-based pregnancy centers merged in 2019 to form a chain called The Source. The nonprofit organization will offer a full array of medical services, including STI testing, first-trimester prenatal care, and contraception choices, at centers in Houston, Dallas, San Antonio, and Austin. The centers will offer such methods as pills, contraceptive injections, and intrauterine devices.4 This practice differs sharply from other pregnancy centers, which refuse to discuss or offer contraception due to the belief that it encourages sex outside marriage.

With Planned Parenthood declining to apply for Title X funding due to current administration rules that ban participating clinics from referring patients for nonemergency abortions and requiring financial separation from facilities that provide abortions, The Source clinic administrators say they will file for such funding in 2020. Another group of nonprofit crisis pregnancy organizations, the Obria Group, is now expanding beyond the West Coast, operating 30 clinics in five states. The group is adding medical services to allow it to bill insurers and qualify for government funds.

Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine, has expressed concerns about CPCs and “problem pregnancy centers.”

“First and foremost is my concern is that those phrases suggest that there is counseling, and counseling is not really the objective; the objective is to talk people out of considering an abortion if they are pregnant,” says Hatcher. “Secondly, there is minimal counseling beyond the goal of reducing the likelihood of a woman seeking an abortion, and moreover, there is minimal counseling about how to proceed to have a healthy pregnancy if a woman does want to continue her pregnancy.”

While the eight Texas-based centers are a desirable step in the right direction, as they offer pills, injections, intrauterine devices, and presumably other contraceptives, their failure to offer abortion when that is the immediate need of many women seeking counseling about a possible pregnancy is “extremely undesirable,” says Hatcher, as it may delay such women from receiving information about where to obtain an abortion as early as possible.

REFERENCES

  1. Society for Adolescent Health and Medicine. Crisis pregnancy centers in the United States: 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 Pediatr Adolesc Gynecol 2019 Oct 28. pii: S1083-3188(19)30335-3. doi: 10.1016/j.jpag.2019.10.008. [Epub ahead of print].
  2. Society for Adolescent Health and Medicine. Medical groups serving youth warn that crisis pregnancy centers pose serious health risks. Available at: https://bit.ly/33YirLv.
  3. Bryant-Comstock K, Bryant AG, Narasimhan S, et al. Information about sexual health on crisis pregnancy center web sites: Accurate for adolescents? J Pediatr Adolesc Gynecol 2016;29:22-25.
  4. Bailey SP. A new chain of Christian pregnancy centers will provide a controversial service: Contraception. The Washington Post. Nov. 7, 2019. Available at: https://wapo.st/34YoUG0.