The right to abortion remains strongly protected in Massachusetts, but that doesn’t ensure equal access to care. Beyond cost barriers and patchwork insurance coverage, those seeking reproductive healthcare are more likely to encounter a crisis pregnancy center than a medical clinic.

These facilities, the majority of which do not staff medical professionals, operate with the primary mission of convincing pregnant people to carry to term. Their marketing campaigns specifically target vulnerable populations: low-income communities and college-aged students.

At the University of Massachusetts, the registered student organization UMass Students for Life works frequently in collaboration with these facilities. Within Western Massachusetts alone, there are six CPCs.

“As a provider, I have had patients who have come to me seeking care that’s been delayed because they mistakenly went to a crisis pregnancy center first. They were effectively sidelined and delayed in their care,” Dr. Steffanie Wright, licensed OBGYN and complex family planning fellow at Brigham and Women’s Hospital, said.

Crisis pregnancy centers are an arm of the anti-abortion movement that are not community health centers, even though they often advertise themselves as such. The Massachusetts Attorney General has released a consumer advisory warning of their uncredentialed status and deceptive narratives.

CPCs are one facet of a growing network of organizations, campaigns and donors lobbying against access to reproductive healthcare. While presenting as small community organizations, most are affiliated with larger players in the anti-abortion industry.

According to a report by coalition group the Alliance: State Advocates for Women’s Rights & Gender Equality, these partnerships “provide digital strategy, infrastructure, and marketing tactics to help CPCs intercept people searching online for abortion care, signal that they are trusted sources of health care and secure public funding.”

Two organizations alone, Heartbeat International and Care Net, operate or are affiliated with more than 3,700 of these centers globally.

CPCs outnumber medical clinics

There are thirty such centers identified throughout the state. A full list of CPCs is maintained through a project from the epidemiology and biostatistics department at the University of Georgia.

Six crisis pregnancy centers operate solely in Western Massachusetts. They have ambiguous titles such as Alternative Pregnancy Center in Greenfield, Pregnancy Support Services of Berkshire in Pittsfield, New Direction Women’s Center in Pittsfield and Springfield Pregnancy Care Center.

Their websites present cheerful, pastel infographics and often list free services such as pregnancy tests, ultrasounds and “options counseling” that may include abortion.

The majority of CPCs, despite presenting an intimate, welcoming front, “are exempt from regulatory, licensure and credentialing oversight…” which holds individuals accountable to ensure that patients get fair and appropriate healthcare services.

“The advice that you get from a physician, a qualified trained nurse or a medical professional, this is going to be the best science can offer you, but also the best in respect to your personhood that you can get,” Dr. George Corey, medical director of University Health Services at UMass, said.

A physician’s role is to meet a patient’s needs and support their decision “even if what you need is not what I can provide,” Corey said. “If you read the Hippocratic Oath, 2,500 years old, you’ll find that in there.”

No confidentiality standards 

CPCs are not associated with credentialed medical organizations, so the counseling that CPCs advertise has no requirement to be based on scientific evidence agreed upon by healthcare professionals, such as peer-reviewed randomized case studies. The AMA Journal of Ethics labeled CPCs’ behavior as, “An ethical violation that undermines women’s health.”

A person who receives services or counseling at a CPC is not protected by the HIPAA Privacy Act, which regulates the extent to which personal health information can be disclosed or used without the individual’s consent.

“It is incredibly well recognized that personal medical decisions are quite protected and private. Reproductive rights of women falls squarely within the confines of that,” Corey said.

The Privacy Practices of Worcester Women’s Clinic state that the medical care they provide is not regulated by the HIPAA Privacy Act and thus their privacy practices are “voluntarily undertaken.” The statement continues, “nothing in this notice should be construed as creating any contractual or legal rights on behalf of patients.”

Clearway Clinic in Springfield, which provides limited medical care, states in their privacy practices that none of their services are regulated by the HIPAA Privacy Act and thus are similarly “voluntarily undertaken.”

While CPCs encourage visitors to share sensitive personal health data, which can include their sexual history, menstrual cycle and family history, these centers are free to do whatever they want with that information.

Heartbeat International acknowledges that they collect data from their affiliate centers and user interactions on their website, hotline and chatbot. Initial reports by Privacy International indicate that sexual and reproductive data collected by corporations such as Heartbeat International is being exploited to reduce access to reproductive healthcare.

Heartbeat International’s privacy policy notes that they retain the right to share client information with vendors, consultants, third-party service providers and affiliates. They are ambiguous about the specific purpose of storing vast troves of personal health data.

Deceptive marketing strategies

With the location set to Amherst, a Google search for “abortion center near me” first loads sponsored advertisements for Clearway Clinic and Worcester Women’s Clinic, both of which are crisis pregnancy centers. When a person in the Amherst area searches for nearby pregnancy tests, anti-abortion center Problem Pregnancy is listed within the top five results.

Using the funding and marketing strategies disseminated by corporate partners Heartbeat International and Care Net, small-scale CPCs are able to weaponize search engine optimization to have their website’s promoted on platforms such as Google and Facebook.

The marketing campaigns are done to great success. In a recent study, the majority of participants were unable to correctly determine that a CPC was not a clinic.

States have slowly been taking steps to counteract deceptive marketing. Governor Maura Healey approved the state’s budget for fiscal year 2023, which included $1 million for a public awareness campaign on the dangers of CPCs.

Connecticut lawmakers passed a bill in 2021 which forbade CPCs from knowingly sharing deceptive reproductive health information. The law makes them potentially subject to “pay for and disseminate appropriate corrective advertising in the same form,” among other potential fines.

Inaccurate or incomplete medical information 

Despite rarely having medical personnel on staff, the majority of crisis pregnancy centers freely dispense medical advice.

Many centers will offer “abortion consultations” for pregnant persons, during which a staff member may perform an ultrasound.

Clearway Clinic advises that, “you should not seek an abortion until you have a confirmation from an ultrasound that the pregnancy is viable.” This contradicts the ACOG clinical practice bulletin that found, “for patients with regular menstrual cycles, a certain last menstrual period within the prior 56 days, and no signs, symptoms, or risk factors for ectopic pregnancy, a clinical examination or ultrasound examination is not necessary before medication abortion.”

Clearway Clinic’s FAQ justifies their advice because, “many women can avoid having to decide what to do with their unintended pregnancy, because about 1 in 5 of all pregnancies end naturally. Pregnancies that end naturally are not viable, and result in what are called miscarriages. Who wants to go through the pain, cost and risk of an abortion if it’s not necessary?”

Clearway Clinic is just one example of how CPCs promote inaccurate information about the “side effects” and “risk factors” of abortion. The American Psychological Association has conclusively determined that depression, suicidal ideation and eating disorders are not side-effects of abortion. Many anti-abortion centers, however, promote “postabortion syndrome” which they posit as a form of PTSD that requires counseling and healing retreats.

In a response to a question about the qualifications of the “trained staff members” that provide abortion recovery services, Wilcox wrote via email that they “do not provide mental health services.”

Clearway’s website advertises pregnancy tests that “are lab-quality, high-sensitivity urine tests with instant results.” This language suggests a higher efficacy than at-home pregnancy tests, but doctor-administered urine pregnancy tests have the same accuracy and no benefit in comparison to drug-store urine tests.

Some CPCs even go as far to suggest inaccurate physical effects of having an abortion. Problem Pregnancy lists infertility, premature births with future pregnancies and even death as risks of surgical abortion. In contrast, the professional medical community at large has determined this to be a safe and low-risk procedure.

“It is possible to very safely offer medical abortion in a facility such as [UHS], by people who are trained and experienced in doing so, with high safety [and] high effectiveness at medical termination,” Corey said.

The Pioneer Valley is not immune to this crisis 

UMass Students for Life is an advocacy council RSO at UMass. For fiscal year 2023, they were allocated $4,709.61 by the Student Government Association.

They are self-described as, “​​using education, activism and compassion to defend human life.” The RSO frequently advertises volunteer days at Bethlehem House in Easthampton, a pregnancy center funded by the Catholic Diocese of Springfield.

They are a chapter of Students for Life of America, a national anti-abortion organization specializing in student-centered advocacy groups.

Articles titled “Why abortion is never an option” and “abortion risks” claim that pregnant people who undergo an abortion are more at risk of substance abuse, breast cancer and future miscarriages, all of which has been routinely denied by the medical community. According to the American College of Obstetricians and Gynecologists, abortion does not increase the chances of breast cancer or infertility. They also suggest the feasibility of an abortion pill reversal, an unfounded medical treatment gaining popularity among anti-abortion groups.

UMass Students for Life did not respond to requests for comment.

The value of a medical professional in medical care

It unbalances the patient-provider dynamic when options that are safe and viable are not given equal consideration. Crisis pregnancy centers present abortion as an option, but they would always prefer another alternative. “In medical ethics … you’re allowed to have that personal belief but to impose it on others is not helpful,” Corey noted.

On the donor page of New Direction Women’s Center, their mission statement includes a passage on sexual integrity which reads, “we declare as unacceptable all sexual activity not in agreement with the Bible, including but not limited to premarital sex, adultery, and homosexuality. We believe in the Biblical concept of marriage between one man and one woman.” This exists in sharp contrast with their client site’s promise that, “clients will always receive open and honest answers,” or “clients are treated with kindness, compassion and in a caring manner.”

“Patient autonomy is always the goal. The basis of patient autonomy is honesty, transparency, and truth. And the only way that a person can be fully autonomous and make the best decisions for themselves is if they’re equipped with all of the information they need in order to make that decision for themselves,” Wright said. “No one else knows yourself or your body any better than you do. I think of us, as providers, in the same way … we are there to help patients make medical decisions, but not to make it for them.”

“The woman alone gets to decide”

Women’s healthcare has a long legacy of holistic and nonconventional approaches to medicine and wellbeing. Complications arise when those not beholden to stringent professional standards of medicine, such as the HIPAA Privacy Act, take liberties to dispense health advice and direct the flow of resources at their own discretion and due to their own personal beliefs. It unbalances the patient-provider dynamic when options that are safe and viable are not given equal consideration.

“[It] is really hard, as a physician, to see patients come to you so delayed and sometimes after consequences and complications. For them to reach you [after visiting a CPC] it’s frustrating, but it’s also devastating, right? Because these are people’s lives that are being manipulated,” Wright said. “I don’t know what the right answer is for providers, but [we can] continue to follow medical science and continue to follow the evidence and provide the best care that we can and help patients when they need it.”

Nationwide, legal decisions are increasingly being made which reject long standing medical advice and narrow the accessibility of reproductive health services. The Supreme Court’s June 2022 decision, Dobbs v. Jackson Women’s Health Organization, overturned the precedent set by Roe v. Wade, leaving regulations around abortion procedures up to the states. In Texas, a federal district judge suspended the Food and Drug Administration’s approval of mifepristone, the first pill used in medication abortion.

This past summer, University Health Services began preparing to offer medication abortion pills, in compliance with a state law passed in July 2022. The legislation requires all state university health services to provide medicated abortion pill services by November 2023.

“It is an ethical stance in accordance with medical practice that the woman alone gets to decide,” Corey said. “[This] is endorsed by most physicians, by all UHS physicians, by the University. Reproductive choices are women’s, including college women.”

Grace Fiori can be reached at [email protected] and followed on Twitter @grace_fiori.