July 26, 2012 — Summary of "Abortion Misinformation From Crisis Pregnancy Centers in North Carolina," Bryant/Levi, Contraception, July 9, 2012.
In North Carolina, crisis pregnancy centers -- which offer no-cost services to pregnant women but are not medical facilities -- outnumber comprehensive women's health clinics that offer abortion care four to one. While women's health clinics are inspected by the state Department of Health and Human Services and are required to meet various health and safety standards, CPCs are not subject to the same provisions, despite that some promote themselves as women's health clinics and give the impression through online ads that they offer abortion services.
Amy Bryant and Erika Levi of the University of North Carolina-Chapel Hill's Department of Obstetrics and Gynecology performed a secondary data analysis of an investigative survey of the state's CPCs by a not-for-profit reproductive rights organization. They also reviewed information available online to assess the accuracy of medical information provided by CPCs in North Carolina.
The original data were collected from March 1 to June 30, 2011, by researchers posing, either on the phone or in-person, as pregnant women in need of a pregnancy test. Of the 122 CPCs in North Carolina, researchers were successful in contacting 32 by telephone, including 19 that also were visited in-person.
At each center, researchers told CPC volunteers that their period was very late and that they feared they were pregnant. They said that the pregnancy was unintended and requested information on available options, including abortion. Each researcher documented the information she received about abortion, adoption, breast cancer, contraception, and HIV and other sexually transmitted infections. The researchers also noted the services and referrals provided by the center and accepted all written materials given to them during in-person visits. The authors then analyzed the information for content and medical accuracy. Misleading information on abortion, pregnancy and contraception was entered into a database. The authors also reviewed the CPCs' websites for content and accuracy.
Of the 32 CPCs contacted, 19 centers (59%) said that they do not provide or refer for abortion care, but 14 centers (44%) said they "provide counseling on abortion and its risks." Seventeen CPCs (53%) provided at least one misleading or inaccurate medical statement to researchers. Abstinence was promoted at 13 of the 32 CPCs, and three said they did not refer for contraception.
Of the CPCs visited in person, three mentioned a link between abortion and breast cancer, five stated a link between abortion and mental health disorders, five said abortion was associated with "post-abortion stress," and four said that abortion could cause infertility. Five centers told visitors that "condoms are ineffective," while three said other forms of birth control often fail. Over the phone, staff at three clinics told callers that pregnancy carries a substantial risk of miscarriage and that "there is plenty of time" to make a decision, despite not knowing details of the pregnancy. Four centers contacted by phone also informed callers of a link between abortion and mental health disorders, and three mentioned "post-abortion stress."
Of the 36 websites evaluated by the authors, 31 centers (86%) provided false or misleading information. Inaccurate information included a link between abortion and breast cancer on four sites, a link to preterm birth on 15 sites, and a link to infertility on seven sites. Twelve of the sites contained information on condoms, including 11 that said condoms were ineffective. In addition, 19 sites linked abortion to poor mental health, 26 cited a link to "post-abortion stress" and 11 contained a list of mental health issues allegedly associated with abortion.
The results are "worrisome" because "many states recommend or require that women receive information about abortion from these centers, and several states fund CPCs through license plates and other programs," the authors wrote. The CPCs in the study "grossly overstated the risk of abortion," despite medical evidence that refutes a link between abortion and breast cancer, infertility, and mental health disorders.
The authors also noted that at three CPCs, staff who knew no details of women's pregnancies told them that they had "plenty of time" or faced a 25% to 30% chance of miscarriage. Although the overall rate of early pregnancy loss is about 32%, after 8 weeks of pregnancy, the percentage drops to as low as 2%. "Without an accurate estimation of the gestational age, delay in seeking care may lead to abortion at a later gestational age or cause women to present too late to care to receive an abortion," the authors wrote.
Given that many CPCs "purport to explain medical risks to patients," they "should be held responsible for providing accurate information," the authors wrote. "Women choosing abortion should be allowed to make a truly informed decision based on the most medically accurate evidence available," they added, concluding, "Unregulated, ideologically driven CPCs should not be allowed to mislead women with inaccurate medical information."
Debra Ness, publisher & president, National Partnership
Andrea Friedman, associate editor & director of reproductive health programs, National Partnership
Marya Torrez, associate editor & senior reproductive health policy counsel, National Partnership
Melissa Safford, associate editor & policy advocate for reproductive health, National Partnership
Perry Sacks, assistant editor & health program associate, National Partnership
Cindy Romero, assistant editor & communications assistant, National Partnership
Justyn Ware, editor
Amanda Wolfe, editor-in-chief
Heather Drost, Hanna Jaquith, Marcelle Maginnis, Ashley Marchand and Michelle Stuckey, staff writers
Tucker Ball, director of new media, National Partnership