Going unmentioned in LA’s new ordinance is how difficult it’s proven to regulate CPCs — Democratic lawmakers have been trying, and mostly failing, for years. Most recently, California’s 2015 Reproductive FACT Act required reproductive health care facilities to inform clients about the state’s programs that provide low-cost or free contraception and abortion, and forced unlicensed centers to post notices acknowledging that they were not licensed health care providers.

In 2018, after the law was challenged by an anti-abortion legal organization, the U.S. Supreme Court voted 5–4 to strike it down on the grounds that it violated the First Amendment.

For Christine Henneberg, a Bay Area OB-GYN and abortion provider — who says “a fair number” of her patients have interacted with a crisis pregnancy center by the time they land in her office — the continued lack of regulation is “absurd.”

“Working at medical facilities, we have so many regulations on everything we do,” says Henneberg. “But then these places that are not medical facilities — that are disguising themselves as medical facilities — are totally unregulated? It makes no sense.”

Absent meaningful regulation, some agencies have focused on education: In June of 2022, California Attorney General Rob Bonta issued a consumer alert about CPCs. And the state’s new hub for abortion resources, abortion.ca.gov, includes a section on how to spot the differences between clinics that offer abortion care and CPCs.

But to Henneberg, it’s unfair to put the onus of research on the consumer.

“When you send a patient to get their tonsils removed, the language is of informed consent: You tell them the risks, benefits and alternatives that you can offer them. That is the physician’s responsibility in an ethical sense, and it’s the law,” she says. “You don’t assume, oh, well, they can find out for themselves … it boggles my mind that anyone would think it’s the responsibility of the consumer seeking a legal service to figure this out on their own.”

‘Patients get confused’

Lynda Metz knew immediately that the building she’d entered wasn’t a health clinic. But it was 1995, she was 17, and the center had been the first thing listed when she looked up “pregnancy test” in the Yellow Pages. Pregnant and terrified in a strict Southern Baptist community north of Little Rock, Arkansas, she was happy to take whatever free services were closest to home.

“There was nothing clinical about it,” recalls Metz, who went on to have two children by the age of 20. “I peed on the stick, and then a woman pulled me into a room and took out her Bible … and kind of held me hostage for two hours. She showed me pictures of little plastic babies with arms and legs and said, ‘This is what your baby looks like now.’ There was nothing about how to [take care of myself]. Their focus was just baby, baby, baby.”

a young teen girl with brown hair in a school photo at left, and in a portrait with her infant son on the right
On the left, Lynda Metz in a photo from her sophomore year of high school, the year before she became pregnant. On the right, Metz a month before her 18th birthday, with her son Matthew. (Courtesy Lynda Metz)

Nearly three decades later, search engines have taken the place of the Yellow Pages — with arguably more complicated results. Last August, responding to mounting public pressure, both Yelp and Google Maps announced that their apps would begin labeling crisis pregnancy centers differently from health clinics that provide abortion care.

It would appear they’ve followed through, to a point: Up until July, a search for “abortion” on Google Maps returned at least two dozen CPCs across the Bay Area’s nine counties, including one in San Francisco, one in Oakland and several in the South Bay. Six months later, that’s no longer the case. However, a search for “pregnancy center” or “women’s clinic” still returns most of these centers. And paid advertisements for CPCs still regularly appear in Google’s search results without any disclaimers.

Carly Thomsen, assistant professor of gender and sexuality at Middlebury College in Vermont, thinks the algorithm update was a small, overdue step in the right direction — but she doesn’t expect it to put much of a dent in CPCs’ business model.

“I can see how people would think crisis pregnancy centers are using technology to transform their approach, but I actually don’t think that’s true. I think technology has allowed them to make their same strategies more sophisticated and more wide-reaching,” says Thomsen, who recently co-authored a deeply researched opinion piece on CPCs for The New York Times. “And that strategy is to use scare tactics and deception to make claims about what they will offer you in terms of support, even though they’re never held accountable for any of these things.”

a mural that says
The Alpha Pregnancy Center, a faith-based crisis pregnancy center, on Mission Street in the Excelsior neighborhood of San Francisco. After months of public pressure, Google Maps recently updated its algorithm so this center no longer appears when a user searches the word ‘abortion.’ (Beth LaBerge/KQED)

As a graduate student at UC Santa Barbara, Thomsen was part of a successful effort in 2010 to ban CPCs from advertising on campus. It’s still the only school, to her knowledge, with that restriction.

But perhaps the most insidious tactic, says Thomsen, remains simple geography: By design, religious groups open crisis pregnancy centers in close proximity to clinics that offer abortion care. In Thomsen’s research on these geographic relationships, she found that more than 99% of clinics that offer abortion care nationwide have a crisis pregnancy center located close by.

“Any place there’s an abortion clinic, there’s a crisis pregnancy center,” she says. “And that’s very intentional.”

In other words, say experts: Crisis pregnancy centers count on vulnerable people making mistakes.

That dynamic is especially evident in places like Napa, where anti-abortion activists work blatantly to direct people away from Planned Parenthood and toward the Napa Women’s Center.

“Patients get confused,” says Gloria Martinez, senior director of operations for Planned Parenthood Northern California, of the situation at those two facilities. “Especially if it’s their first time with us or visiting that location, and there’s this person out there in scrubs and this person is telling them, ‘Oh, come over here instead.’”

While a so-called buffer zone is supposed to render the clinic’s entrance off-limits to protesters, Martinez says local law enforcement seems hesitant to enforce it due to fears “that the opposition will take action against them” with lawsuits that claim the buffer violates their First Amendment rights.

The presence of protesters is one major reason this Napa location of Planned Parenthood is scheduled to close in 2023 after more than 20 years. It will reopen in a new, larger facility elsewhere in Napa — staff are hesitant to say exactly where, lest anti-abortion activists begin planning protests there as well — in the hopes of a better patient experience.

As for the current patient experience, it’s difficult to quantify exactly how many people who intend to visit Planned Parenthood end up at the crisis pregnancy center next door. But there are indicators. During the twice-yearly campaigns by 40 Days for Life — in which anti-abortion protesters are present in larger numbers for, yes, 40 days — Martinez says the no-show rate for appointments at that Planned Parenthood doubles: It normally hovers at around 19%, but during campaigns, the number “skyrockets to 40, sometimes 50%.”

The hand of an older white woman holds a pamphlet describing inaccurate side effects of abortions
40 Days for Life volunteer Teresa Conemac holds pamphlets she distributes outside Planned Parenthood in Napa. (Beth LaBerge/KQED)

“It’s just another barrier [for patients], when there are already so many barriers,” says Martinez. “So many of our patients are low-income, or maybe they’re facing a language barrier or a transportation barrier.

“And then this is another layer that they have to face: harassment. Harassment when seeking health care.”

Targeting communities of color

Even if a person mistakenly visits a CPC, then eventually finds their way to a clinic that offers abortion care, it’s difficult to overstate the trauma that such an experience can inflict, says Susy Chávez Herrera, communications director for California Latinas for Reproductive Justice in Los Angeles (CLRJ).

“It can be really intense, and it can really hurt a person’s well-being,” says Chávez Herrera. “Whether physically, by delaying a procedure that might be needed for medical reasons, or mentally, because of the toll it takes on folks who are seeking a medical service and met with this series of misinformation.”

That may be especially true considering the already vulnerable communities targeted by CPCs, according to advocates: immigrants, first-generation Americans, Black and Latinx people, young people and people from lower-income families living in rural areas.

pamphlets in English and Spanish on a shelf show a Black woman and a Latina woman who are pregnant. The pamphlet is titled
Pamphlets available at the Alpha Pregnancy Center in San Francisco. The APC, unlike the majority of crisis pregnancy centers, has a medical license. (Emma Silvers/KQED)

“We know they target the Latinx community,” says Chávez Herrera. “Just driving down the street here in LA, you see billboards from these groups, with this misinformation, in neighborhoods that we know have largely Latinx communities. And we know these anti-abortion clinics set up shop in our communities.”

A study by The Alliance, a consortium of law organizations and policy groups studying reproductive justice, found that some CPCs try to appeal to Black communities (PDF) — which already face disproportionate maternal mortality rates — by “blackwashing” their websites or pamphlets, prominently featuring images of Black women.

In the Latinx community, advocates say CPCs prey on fears undocumented immigrants might have about visiting a government-funded health clinic, wary that it could lead to deportation; others note that CPCs make a point of advertising on Spanish-language radio.

a screenshot of a spanish language website of a crisis pregnancy center called real options medical clinics, featuring a woman in scrubs talking to another woman, a patient
A screenshot from the website of Obria Medical Clinics, a network of crisis pregnancy centers that operates five facilities in the Bay Area, funded partially by federal grants it received under the Trump administration. Obria clinics also advertise that they accept Medi-Cal, which means their clinics receive reimbursements from the taxpayer-funded state program.

Care Net, one of the two biggest national networks of CPCs, has had a programming arm explicitly devoted to outreach in Black and Latinx communities since 2003, according to a study in the International Journal of Women’s Health. Initially dubbed the “Urban Initiative,” tactics include advertising on Black Entertainment Television (BET) and “drawing comparisons between abortion and slavery.”

“There’s no question that they target communities of color,” says Thomsen. “So we also need to be talking about crisis pregnancy centers as something that is impeding racial justice.”

a Black woman is seen on a website for the Alpha Pregnancy Center, a Christian anti-abortion center
A screenshot from the website of the Alpha Pregnancy Center, a crisis pregnancy center in San Francisco.

One small step in the right direction, according to abortion rights advocates, is Assembly Bill 2586, which was signed by Gov. Gavin Newsom in September as a means of addressing “the reproductive and sexual health inequities that Black, Indigenous and other communities of color face” by issuing grants to community-based organizations that focus on culturally relevant care.

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