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“JUST BECAUSE YOU’RE PREGNANT...” LIES, HALF TRUTHS, AND MANIPULATION AT CRISIS PREGNANCY CENTERS IN MASSACHUSETTS Table of Contents 1 Introduction 3 CPCs in Massachusetts 5 Inside a CPC 15 The Path to a CPC 18 The Finances of CPCs 19 Conclusion 21 Appendix I: Methodology 22 Appendix II: CPCs Investigated in MA 24 Endnotes “Just Because You’re Pregnant...” 1 Introduction Brochure, distributed by a MA CPC For years, we’ve heard the stories: A woman thinks she might be pregnant. Looking for counseling about her options and access to appropriate medical care, she stumbles across a “crisis pregnancy center” (CPC) that advertises free services. Once there, she’s shamed with anti-choice rhetoric, deceived by medical falsehoods, and delayed in getting health services by CPC staff and volunteers whose goal is to prevent her from considering abortion, regardless of her circumstances. At NARAL Pro-Choice Massachusetts, we believe that every woman deserves to make personal, private decisions about her pregnancy free of intimidation and coercion. Our mission is to protect and promote access to the full range of reproductive choices and health care options, including preventing unintended pregnancy, bearing healthy children, and choosing safe, legal, accessible abortion. Based on anecdotal evidence collected in the Commonwealth and research conducted nationally and in select other states, we were concerned that CPCs in Massachusetts might undermining women’s timely access to true options counseling and pregnancy-related care. To better understand their impact, NARAL Pro-Choice Massachusetts and the Pro-Choice Massachusetts Foundation decided to take a closer look at these CPCs. We embarked on an in-depth investigation of crisis pregnancy centers in the summer of 2010 after the Commonwealth began issuing “Choose Life” license plates, which created a new revenue source for these anti-choice facilities. Over the course of a year, staff, interns, and trained volunteers worked to identify and map CPCs, researched their advertising tactics and sources of funding, catalogued the information on all of their websites, and conducted “mystery client” calls and in-person visits to 24 of the 30 CPCs currently operating across Massachusetts. For more information on methodology, see Appendix I, p. 21. The upshot? These facilities undermine the health and well-being of women all across the Commonwealth. Their goal is to discourage women from considering abortion as a safe and appropriate option. Their tactics range from outright harmful to rather neglectful to simply biased. Their impact is to corrupt a pregnant woman’s decision-making process and delay her access to pregnancy-related care, whether she ultimately chooses abortion, adoption, or parenthood. 2 NARAL Pro-Choice Massachusetts Here’s what we found: 1 CPCs outnumber women’s health care providers three to one. And, location matters. There are 30 separate locations with active CPCs, compared with nine specialty women’s health providers who publicly advertise that they offer abortion care.1 Women in Western Massachusetts have access to six CPCs, Central Massachusetts has eight, and Southeast Massachusetts is home to six. In contrast, each of these regions has only one clinic providing abortion care. The ratio is somewhat better for women in the Northeast and Metro Boston, where women in each area can access three abortion providers compared to five CPCs. 2 CPCs design their online profiles and web-based advertising to mislead women seeking abortion care or nonbiased pregnancy options counseling. On 4 Many CPCs misstate data about miscarriage and pregnancy complications. Almost a third of the CPCs visited exaggerated miscarriage rates in an apparent effort to pressure our volunteers to get an ultrasound at the CPC or a related anti-choice facility, or to encourage them simply to delay making any decision about their pregnancies. Some went so far as to make the false claim that an ultrasound can predict if you’re going to miscarry. 5 CPCs prioritize their anti-choice agenda over a woman’s decision-making and health. More than half of our volunteers reported that they felt pressure not to terminate the pregnancy during an in-person visit. CPCs overwhelmingly denied referrals for abortion care, and some even failed to discuss other options such as adoption or provide resources for pre-natal care. Yellowpages.com and Superpages.com, CPCs in Massachusetts appeared in the top ten results for five out of six key search terms a woman facing an unintended pregnancy would likely use in the summer of 2010 and for three of the six in the spring of 2011. (The only thing that changed in between? NARAL Pro-Choice America conducted a nationwide campaign to challenge these online phonebooks to change their practices.) 3 CPCs misinform and deceive women about their health. Three out of five CPCs visited provided incorrect or misleading information, as did three out of five of the websites. The most common medical falsehoods included linking abortion to breast cancer or severe emotional or psychological problems, often described as being akin to post-traumatic stress disorder (PTSD). Almost a third of CPCs visited also severely overstated the likelihood that having an abortion would undermine a woman’s future fertility. Brochure, distributed by a MA CPC “Just Because You’re Pregnant...” 3 Crisis Pregnancy Centers in Massachusetts Today, there are an estimated 4,000 “crisis pregnancy centers” (CPCs) nationwide, a network of anti-choice facilities that dates back to the days before Roe v. Wade.2 Since the decriminalization of abortion, CPCs have grown in both number and scope, and they now serve as a central component of the anti-choice movement’s strategy to restrict and manipulate both the information women receive when they face an unplanned pregnancy and their access to the full range of reproductive health services. According to a comprehensive study conducted by the U.S. House of Representatives Committee on Government Reform, CPCs intentionally misinform and mislead women seeking options counseling, instead providing biased, coercive, or patently incorrect information about a woman’s health and pregnancy options, while often refusing to provide information or referrals for abortion and birth control services.3 Here in Massachusetts, there are currently 30 separate facilities across the Commonwealth where CPCs operate and advertise their services both online and in print. This makes CPCs three times as prevalent as the nine women’s health clinics specializing in reproductive health that currently advertise abortion care among their services.4 CPCs are located in every region of the state, including communities not served by known women’s health clinics. There are eight CPCs in Central Massachusetts, while Western and Southeast Massachusetts are each home to six CPCs; yet each of these three regions has only one women’s health facility providing abortion care. Women in the Northeast and Metro Boston have somewhat greater access to comprehensive care, with a choice of three women’s health clinics that provide abortion compared with the five CPCs in each of these two areas. CPC Locations in Massachusetts 4 NARAL Pro-Choice Massachusetts Of the national CPC organizations, CareNet opened the first CPC in Massachusetts in 1976,5 and Birthright International has since secured seven locations here. Perhaps most interesting, Massachusetts is home to several state-based CPC networks, including one with national significance (see Massachusetts as an Anti-Choice Breeding Ground). The largest CPC network, A Woman’s Concern, started in Dorchester (Boston) in 1993,6 and announced itself with an advertisement in the Yellow Pages that cost $28,000 at the time. Since then, it has been expanding its reach, now boasting five locations (Dorchester, Fall River, Hyannis, Revere, and a North Shore location under construction).7 Pregnancy Care Center, the second largest Massachusetts-only network, has four CPC facilities (in Amesbury, Haverhill, Lawrence, and Newburyport). An additional fourteen smaller CPCs operate in communities across the Commonwealth, with no apparent affiliation with any national or state umbrella organization. CPCs often locate near reproductive health facilities, and some follow these women’s health clinics from location to location. For more than half of the abortion providers in Massachusetts, a CPC is located nearby – within a ten-mile distance, or, if located in Boston, within a two-mile walking distance.8 Most notably, Problem Pregnancy of Worcester was originally located in the same building, on the same floor, and used the same acronym as the Planned Parenthood clinic. (Their “PP” logo was so similar to Planned Parenthood’s that a state court found them to be infringing on Planned Parenthood’s trademark, and Problem Pregnancy was forced to change its logo.9) Planned Parenthood has since moved from that building, but Problem Pregnancy followed, relocating directly across the street. Massachusetts as an Anti-Choice Breeding Ground While Massachusetts is often perceived to be a bastion of liberal politics, it has also served as a laboratory for antichoice strategies that have a national impact. For example, Massachusetts is home to the Gerard Health Foundation, a private charity based in Natick. With $1,295,000 in assets in 2009,45 Gerard – and its founder Raymond Ruddy – serves as a major funder of anti-choice initiatives on the more extreme end of the political spectrum. This includes long-standing, entrenched organizations such as Focus on the Family, whose founder, James Dobson, became one of the nation’s “most influential evangelical leader(s)” with strong ties to the Reagan and Bush Administrations,46 and new start-ups such as Lila Rose’s organization, Live Action,47 whose most recent claim to fame includes conducting an undercover “sting” at Planned Parenthood clinics and releasing doctored footage in an effort to discredit the organization.48 Furthermore, Gerard has given at least $900,000 to support A Woman’s Concern here in Massachusetts, “a Dorchester-based sponsor of abstinence-only sex education programs and antiabortion crisis pregnancy centers.”49 Since 2002, A Woman’s Concern has received millions in federal funds to support “Just Because You’re Pregnant...” 5 Inside a Crisis Pregnancy Center and distribute Healthy Futures, its abstinence-only-until-marriage programs, in Massachusetts and nationwide.50 The program, which has been taught in Greater Boston and Lowell schools,51 states that its mission is to “promote the critical message of sexual abstinence outside of a faithful, lifelong relationship.”52 Our investigation found that in Massachusetts – like in other states – CPCs often seek to undermine a woman’s ability to choose from the full range of health care options when facing the prospect of a pregnancy. Our volunteers found that CPCs utilize three main strategies to deter a woman from considering or seeking an abortion: Delay support and deny options and referrals for pregnancy-related care Spread medical falsehoods Sensationalize abortion and use anti-choice rhetoric to shame or pressure Raymond Ruddy A Woman’s Concern has also served as the launching pad for high-level anti-choice government officials, most notably Erik Kerouack, their former medical director, who was appointed by President Bush as Deputy Assistant Secretary of Population Affairs within the Department of Health and Human Services to lead the nation’s family-planning program – despite his avowedly anti-contraception views.53 Meanwhile, Gerard provided a soft landing for former Bush Administration official, Claude Allen, who served as a top domestic policy advisor to President Bush until his arrest for theft in an apparent phony refund scheme.54 Allen is currently a Vice President at the Foundation. Many of these tactics – particularly the medical misinformation and the sensationalized, extreme rhetoric – are echoed on the CPC websites and in materials women receive at their facilities. Our volunteers reported difficulties making appointments and, once they reached a CPC, they were often encouraged to schedule a follow-up “appointment” and/or to take their time making any decisions about what to do – tactics that would likely delay appropriate medical care related to a woman’s pregnancy. Our volunteers were given false and misleading information about pregnancy, the physical and mental health impact of abortion, and the effectiveness and appropriateness of using contraception. Yet only just under one-third (31%) of the unlicensed CPCs contacted – by phone or in person – disclosed that they were not medical facilities. In addition to bogus health claims, volunteers were subjected to biased information about abortion procedures and fetal development that, while not technically false, was sensationalized and presented out of context in an effort to reinforce the CPCs’ anti-choice agenda. 6 NARAL Pro-Choice Massachusetts Delaying Support & Denying Options While CPCs present themselves as a service to help pregnant women in need, many failed to answer their phones or respond to messages in a timely fashion. Overall, roughly one-third of the CPCs we attempted to contact failed to answer or were slow to respond, including seven that volunteers ultimately visited. When volunteers connected with the CPC, the intake person on the phone would often schedule an appointment for many days away, if not as long as a week later. This lack of responsiveness and tendency to delay stands in stark contrast to the traditional practices at women’s health providers. This delay tactic also wastes vital time during which a pregnant woman might otherwise be obtaining options counseling, securing a prenatal care visit, or scheduling an abortion – if not obtaining the care itself. Delaying prenatal care can have an adverse effect on both mother and child, with maternal mortality 3 to 4 times higher in women who receive no prenatal care and infant mortality 6 times higher.10 Further, while complications from surgical abortion are rare,11 they nonetheless increase as the pregnancy progresses, as does the cost of the procedure; abortions after the first trimester are also generally less accessible.12 “You don’t need money to raise a child, just time and love.” -CPC Counselor Both on the phone and in person, women often received incomplete and biased counseling and insufficient referrals – a practice not in keeping with standards of care for women may be pregnant. Of the CPCs contacted in person or through in-depth phone calls, more than one quarter (27%) offered no information on adoption, one-sixth (16%) offered no information – misleading or otherwise – on abortion, and one in 10 (10%) offered no counseling of any kind. The vast majority (83%) either refused outright to provide a referral for abortion services or made volunteers so uncomfortable that they felt they couldn’t ask for one. Yet 39% failed to disclose up front that they were a “pro-life” facility or that they would not provide such referrals. The advice some CPCs offered on pregnancy and parenting matters was also suspect. One volunteer was told, “you don’t need money to raise a child, just time and love.” Another volunteer who told the CPC that she had been drinking heavily throughout her pregnancy was informed that “new studies prove alcohol is not too harmful to a fetus.” Although light to moderate drinking in pregnancy is being considered safer, heavy drinking – more than one or two glasses once or twice a week – has consistently been shown to be damaging to a pregnancy.13 “Just Because You’re Pregnant...” 7 Pregnancy Testing One of the most common services that a CPC offers is a free pregnancy test, which was offered at every one of the in-person visits and suggested during all of the in-depth phone calls. Without exception, the CPCs gave our volunteers pregnancy tests similar to those currently available over the counter at most grocery stores and drug stores. In one instance, a volunteer was given a generic brand, over-the-counter test that had been opened and was already expired. While over-the-counter tests are relatively accurate (up to 99% effective a week after a missed period), medical experts agree that a woman who suspects she is pregnant should visit a health care provider to confirm the results – whether positive or negative.14 By remaining vague in their advertising about the type of pregnancy tests available, CPCs may leave the impression that they provide the blood test that is more sensitive than what a woman can purchase on her own – thereby increasing the time it takes her to obtain appropriate care at a legitimate health care provider. The Miscarriage Myth By far the most troubling tactics were the insidious misuse of miscarriage rates and the lure of free ultrasounds, particularly given that a woman may be unfamiliar with the data and diagnostics related to pregnancy. In nearly every case, the volunteer reported being or was identified by the counselor as between 6 and 10 weeks pregnant. While the miscarriage rate after the 6th week of pregnancy is only 8%,15 more than one in four (27%) of the CPCs contacted gave misleadingly high miscarriage rates – for instance, making claims such as “most pregnancies are not viable” and “50% of pregnancies end in miscarriage.”16 Myth: “most pregnancies are not viable” Fact: Early in pregnancy, there is a 25% chance of miscarriage that drops to 8% after the 6th week.57 Our volunteers concluded that the CPCs used the incorrect miscarriage data to delay abortion decisions in two ways. First, in every instance when an incorrect miscarriage rate was mentioned, the CPC tried to convince our volunteer to schedule an ultrasound appointment days or weeks into the future. One volunteer reported that she heard that “the ultrasound can tell me if the pregnancy is viable, so it will help me decide what to do next.” Second, the CPCs seemed to suggest that planning on a miscarriage is an acceptable way to deal with an unintended pregnancy. Our volunteers were told, for example, “just because you are pregnant, doesn’t mean you’ll stay pregnant,” or that the “good news” about her positive pregnancy test is that the miscarriage rate is so high. Sometimes CPCs recommended that volunteers wait to make a decision until after the ultrasound, so they could avoid going through the “stress of an abortion” if they were going to miscarry anyway, which one CPC described as a “much easier way to lose a child.” The purpose of this misrepresentation seems clear: if a woman who is leaning toward abortion believes she has an unreasonably high chance that her pregnancy is not viable, she may delay seeking care in the largely vain hope that she will miscarry. Another consequence, however, is that she will delay necessary pre-natal care, causing adverse health consequences both for herself and for her child, should she decide to continue the pregnancy.17 8 NARAL Pro-Choice Massachusetts Spreading Medical Falsehoods Mental Health Myth: Abortion causes “post abortion syndrome” or post traumatic stress disorder. Fact: Although some women do experience sadness, grief, and feelings of loss after an abortion, there is no evidence to support the claim that mental health issues are caused by an abortion or that a woman is more likely to have mental health issues after an abortion than if she chooses to carry the pregnancy to term.58 Future Fertility The most common false claim CPCs made was that having an abortion causes many women severe psychological harm and future mental health problems, despite recent findings by the American Psychological Association to the contrary.18 More than half (55%) of the CPCs contacted told our volunteers that having an abortion would or could lead to negative mental health effects. These included statements that abortion would or could cause depression, PTSD, and “post-abortion regret,” or even lead to drug and alcohol abuse or promiscuity. As one volunteer was told, “Many women who choose abortion later have ‘what those soldiers have when they come home.’” When our volunteer asked “PTSD?”, the CPC volunteer responded, “Yeah that’s it.” Another volunteer described her experience as follows: “[The counselor] discussed ‘post-abortion syndrome’ and severe depression. She talked about women who are never able to get pregnant again and then every time they see a child on the street who would be the age of their child if they hadn’t had an abortion – they just can’t take it.” The website analysis elicited similar results, with more than half (54%) of the websites asserting that women who have had an abortion report emotional and/or psychological trauma or experience “post abortion stress” or PTSD-related problems. The pamphlets that CPCs distributed also focused on this alleged negative health effect of abortion, with half (50%) of the CPCs handing out one or more pamphlets that falsely describe the mental health risks of abortion. One third (33%) of CPCs informed our volunteers that abortion may cause infertility and/or ectopic pregnancy in the future. In fact, a video shown to one of our volunteers even claimed that “most women” are infertile after an abortion. Our volunteers were told that many women have trouble getting pregnant afterwards “because sometimes there is scar tissue that stops the egg from being able to implant,” and “to keep in mind that this could be your only child.” An even greater proportion (46%) of the CPC websites link abortion with a risk of future infertility, and more than a third (38%) gave incorrect information about ectopic pregnancy after an abortion. Nearly one in three (31%) of the websites stated that women are more likely to have a premature delivery in a future pregnancy if they have had an abortion. Half (50%) of the CPCs that were visited distributed one or more pamphlets that incorrectly linked abortion with risks to future pregnancies. Myth: Abortion causes future infertility or pregnancy complications. Fact: Abortion does not increase the risk of major pregancny complications during future pregnancies or deliveries.55 “Just Because You’re Pregnant...” 9 Breast Cancer One in five (20%) CPCs echoed the common anti-choice falsehood that abortion causes an increased risk of breast cancer. One explanation for this increased risk was that “the milk ducts start to form and then are cut off in their development so [they develop] cancer easier.” While CPCs stated an increased risk of anywhere from 20% to 50%, one CPC went so far as to tell our volunteer that “breast cancer had increased in [my] generation because of the pill and will increase for [yours] because of the pill and abortion. . . . Abortion increases your risk of breast cancer by 100%.” On their websites, CPCs perpetuate this breast cancer myth in greater numbers. Nearly half (46%) of the websites state that there is a 50% increased risk of developing breast cancer after one abortion. They distribute medically inaccurate pamphlets at a similar rate, with half (50%) of CPCs giving out one or more pamphlets that stated an increased risk of breast cancer. Brochure, distributed by a MA CPC Myth: “. . . Abortion increases your risk of breast cancer by 100%.” Fact: The scientfic community agrees that abortion does not increase a woman’s risk of breast cancer.56 10 NARAL Pro-Choice Massachusetts Contraception and Sexually Transmitted Infections CPCs’ medical misinformation is not limited to pregnancy and abortion, as demonstrated by the medically inaccurate information nearly one in three (30%) provided about contraceptives or sexually transmitted infections (STIs, also called STDs). One volunteer was told that she “must have wanted a baby to be using condoms as birth control.” Another CPC counselor claimed that our volunteer “had to have an STD test before abortion, otherwise D&C could cause [an untreated STD] to spread.” Although most websites steered clear of these topics, nearly one in six (15%) still made inaccurate statements about emergency contraception and, through various pamphlets, one in five CPCs (22%) gave misleading information about contraceptives or STIs. Additionally, one-third (33%) used materials promoting abstinence-only rather than a comprehesive approach to preventing pregnancy and disease. “. . .breast cancer had increased in [my] generation because of the pill and will increase for [yours] because of the pill and abortion. . .“ -CPC Counselor Brochure, distributed by a MA CPC Brochure, distributed by a MA CPC “Just Because You’re Pregnant...” 11 Sensationalizing Abortion Care and Shaming Women with Anti-Choice Rhetoric Abortion Procedures and Risks More than half (55%) of CPCs discussed during an in-person visit how abortions are performed, often using inaccurate, sensationalized, and/or unnecessarily graphic terms. One CPC said “they’ll have to open the cervix . . . with metal rods they put in a few days before” (false information italicized), continuing on to say that they “take the pieces of the baby out.” In another instance, a CPC described an abortion procedure by stating that the doctors would “deliver it part way, kill the baby, and then cut it into pieces and take it out.” A third volunteer reported that the CPC told her a medical abortion “was dangerous.” Nearly one in three (30%) CPCs discussed medical complications associated with abortions, frequently mischaracterizing the risks. Women were told that, if they had an abortion, the doctors could accidentally puncture their uterus or colon, they would experience hemorrhaging or heavy bleeding, the procedure could cause scarring or scar tissue or lead to infection, and/or that they could die. Nearly three in four (70%) CPCs handed out pamphlets that emphasized these risks, the most common being a brochure titled Before You Decide – which describes heavy bleeding, infection, incomplete abortion, sepsis, dangers of anesthesia, damage to the cervix, scarring of the uterine lining, perforation of the uterus, damage to the internal organs, and death as possible risks without indicating their relative likelihood. Brochure, distributed by a MA CPC “[The counselor] talked about women who are never able to get pregnant again and then every time they see a child on the street who would be the age of their child if they hadn’t had an abortion – they just can’t take it.” - Study Volunteer 12 NARAL Pro-Choice Massachusetts While these are all potential risks of abortion, CPCs present these complications to a woman considering abortion as though these rare outcomes are common occurrences. At one CPC, our volunteer was told only that she could die during an abortion. Stating this without noting, for instance, that only one in a million abortions before eight weeks results in death,19 may lead a woman to assume the risk is significantly greater than it actually is. That, in turn, undermines her ability to make an informed choice about her options. Emphasizing complications that occur in less than one percent of abortions – such as heavy bleeding, infection, or scarring that require hospitalization (occurring in only 0.3%)20 is similarly misleading. CPCs also failed to provide information – much less give equal weight – to the risks of continuing a pregnancy, including both the medical complications and the mental health impact, which are significantly higher than the risks of abortion.21 In fact, none of our volunteers reported being told about the process of giving birth, potential risks during pregnancy or childbirth, or the potential for post-partum depression (which occurs among 10% of women).22 Framing in Religious Terms Two out of three CPCs visited had a “religious influence,” according to volunteers. The counseling often incorporated a religious element – whether or not the volunteers indicated they had religious beliefs relevant to their decision-making. In those instances, CPCs stressed God’s influence in events, telling our volunteers that “God created [your] baby for a purpose,” “God wasn’t sleeping when this child was conceived,” and “God doesn’t approve of abortions.” In one case, a volunteer who identified as not being particularly religious was encouraged to take a bible, read it, and “accept the Lord into her life.” Brochure, distributed by a MA CPC “Just Because You’re Pregnant...” 13 Brochure, distributed by a MA CPC Nearly two-thirds (61%) of the CPCs discussed fetal development during the visit – of those, the vast majority (81%) provided misleading information. Fetal Development Another related tactic CPCs used was to mislead a woman about the degree of fetal development at her stage of pregnancy or to use terminology that equates a developing fetus to a child that is already born. Nearly two-thirds (61%) of the CPCs discussed fetal development during the visit – of those, the vast majority (81%) provided misleading information and nearly half (45%) relied on models or depictions that portray the fetus as a miniature fully-formed baby that is simply a larger size in each successive week. Furthermore, nearly three-quarters (72%) of the CPCs distributed pamphlets that sensationalized fetal development using skewed benchmarks and misleading graphics. Some were given dolls or other items to take home that represented the current size of their fetus. In many instances, CPCs presented technically accurate information, but they couched the discussion of fetal development in language that implied abortion would be inappropriate, wrong, or immoral. Lapel Pin, distributed by a MA CPC 14 NARAL Pro-Choice Massachusetts “I left so confused and feeling awful. I can’t stop thinking about how that would have been a terrible way to find out you’re pregnant.” - Study Volunteer Pressure One of the most troubling findings of our CPC investigation was hearing from more than half (60%) of our volunteers who received any “counseling” during an in-person visit that they felt pressure not to choose abortion. Many of our volunteers reported being disturbed by their visit, with one describing it as an “intense experience, nerve racking, emotional. [I] can’t imagine that being your only option, to go to one of these places.” Another said, “I left so confused and feeling awful. I can’t stop thinking about how that would have been a terrible way to find out you’re pregnant.” Attempts to sensationalize abortion care and shame women with antichoice rhetoric can take a troubling toll on women. Characterizing abortions as unsafe or dirty has been shown to have a stigmatizing effect on both women and the procedure, and frames women as victims.23 Personifying a fetus further allows the abortion to be equated with murder, turning the decision to terminate a pregnancy into a shameful choice.24 These anti-choice tactics cause a woman’s decisionmaking to be more difficult, and for particularly vulnerable groups of women, who are less likely to have the support they need to rise above the resulting shame, may create a barrier to choosing what is best for their own health and family circumstances.25 Brochure, distributed by a MA CPC “Just Because You’re Pregnant...” 15 The Path to a Crisis Pregnancy Center CPCs in Massachusetts use a variety of misleading and ambiguous advertising tactics to draw women who believe they might be pregnant into their centers. One of the more traditional methods is Option Line, a “helpline” established in 2003 by two of the largest national CPC chains, CareNet and Heartbeat International. Option Line sponsors billboard campaigns advertising a toll-free number that employs 25 phone consultants who are available 24 hours a day to direct women to CPCs in their area.26 From 2003 to 2009, an estimated one million women had contacted Option Line, and the organization reports that its website receives more than 46,000 unique users each month.27 CPCs are also branching out into newer advertising tactics, spending thousands of dollars each month to purchase online search terms and online phone book listings28 to reach women who are increasingly turning to the Internet for health information and resources.29 Further, in marketing themselves, CPCs emphasize the availability of free pregnancy tests and ultrasounds in an effort to appeal to young women and low-income women who have lesser access to affordable care.30 Brochure, distributed by a MA CPC Myth: Abortion is dangerous. Fact: A complication serious enough that it requires hospitalization occurs in less than 0.3% of all abortion procedures59 and of procedures done in the first 13 weeks of pregnancy, 97% of women report no complications whatsoever.60 There is a 0.0006% risk of death in surgical abortions, caused generally by adverse reactions to anesthesia, embolism, infection, or uncontrollable bleeding.61 The risk of death in pregnancy and childbirth is ten times greater.62 16 NARAL Pro-Choice Massachusetts Traditional Advertising In the fall and winter of 2010, Option Line ran an advertising campaign in the Greater Boston area, including billboards in communities such as the lower-income neighborhoods of Roxbury and Mattapan. Advertisements also appeared on trains and bus shelters throughout the city’s public transportation system. Both featured a young woman with the tag line “Pregnant? Scared? Need Help?” and the number and website for Option Line. When a woman would call or visit the website, she was immediately referred to a CPC operating in her area. Example of an Option Line Billboard Online Advertising NARAL Pro-Choice Massachusetts surveyed the online versions of Yellow Pages and Super Pages, using six search terms a woman might use if she thought she might be pregnant and seeking information about her options, including abortion. Those terms were: “abortion services,” “abortion clinics,” “abortion providers,” “family planning centers,” “birth control information & services,” and “birth control.” In June of 2010, at least one CPC showed up in the top ten results in five of these six key search terms. When the same search was repeated in February of 2011, after NARAL Pro-Choice America’s campaign challenging Yellow Pages and Super Pages to change their practices, at least one CPC still appeared in the top ten results of three of the six key search terms. These findings are not an accident. The prominent positioning of CPCs in these searches is often due to “sponsored results,” which require an organization to create a profile and spend $63 to $182 dollars per month for a priority listing on yellowpages.com31 or $99 to $299 a month on superpages.com.32 These profiles allow organizations to list which services they provide and, in the case of CPCs, many of them include “abortion services” or “abortion referrals.” In our investigation, none of the CPCs that advertised those services provided either abortion services or abortion referrals when we visited them. “Just Because You’re Pregnant...” 17 Screen shot of a Yellow Pages online ad 18 NARAL Pro-Choice Massachusetts The Finances of Crisis Pregnancy Centers Most of the CPC activities in Massachusetts require little overhead and few expenses, so most of these facilities can set up shop with limited financial support. Even for the largest operations, the most significant operating expenses are compensation (if they have employees rather than being staffed entirely by volunteers) and occupancy (largely rent and related costs). Program expenses, including advertising, printing, and the cost of pregnancy tests, tend to be modest for all CPCs, except those large chains that are linked with national organizations. Thus, by renting small spaces or using donated space, and relying on volunteer hours, CPCs can thrive on very small annual revenues. There are three main sources of funding available to these anti-choice entities: federal and state grants, state-collected revenues, and private donations. Across the country, many CPCs receive federal funds from various government programs, many of them designed largely to support abstinence-only sexuality education.33 While the Commonwealth does not currently accept any federal funding for these purposes, at least one CPC chain – A Woman’s Concern – has historically received a direct federal grant to operate its abstinence-only-until-marriage education program.34 State governments also frequently fund CPCs directly, but although Massachusetts has not created a similar dedicated funding stream, in 2010, it became one of 23 states that now allow the sale of specialty “Choose Life” license plates35 designed as a conduit for funding local CPCs. From June 2010 through April 2011, the Registry of Motor Vehicles distributed approximately 2,000 plates, which raised roughly $80,00036 for Massachusetts Choose Life (MCL), an affiliate of the national Choose Life organization. MCL, which receives the proceeds from the license plates, has sole discretion in determining how those funds will be distributed and states that it provides the funds to “pregnancy crisis centers.” According to MCL’s website, the organization “will have a grant process whereby eligible organizations can apply for funds . . . [that] will ensure that the agencies are non-governmental, not-for-profit agencies not involved in abortion services in any way who offer free counseling and services to women with a crisis pregnancy.”37 Their website features a list of 46 of these “pregnancy care organizations,” but have not yet disclosed which – if any – have received the state-collected funding or how much MCL has given them.38 (Our investigation focused on the 30 CPC organizations still open and actively operating in Massachusetts, most of which appeared on MCL’s list.) While the license plate program is still in its infancy, more established programs in other states have already raised millions to support CPCs.39 CPCs in Massachusetts appear to rely heavily on individual donations, including funds raised through events. A small number appear also to receive support from foundations known to fund a broad range of anti-choice activities and organizations (see Massachusetts as an Anti-Choice Breeding Ground p. 4-5) and religious organizations and their affiliates. Perhaps as a result of these operational and funding parameters, CPCs in Massachusetts range greatly in size and scope. The largest, A Woman’s Concern – which claims to have six facilities around the state – reported revenues of $1.3 million in 2009 (down from an apparent high of $2 million in 2007).40 The other multi-center entity, Pregnancy Care Center, reported just over $368,000 in revenues,41 and the stand-alone facility – Friends of the Unborn – also reported revenues close to that figure ($351,000) that same year.42 An additional four anti-choice facilities investigated had budgets clustered between $80,000-$180,000,43 while three others reported revenues of less than $25,000 in 2008.44 Fourteen do not appear to have filed recently with the Internal Revenue Service, likely because their budgets are so small. “Just Because You’re Pregnant...” 19 Conclusion NARAL Pro-Choice Massachusetts and the Pro-Choice Massachusetts Foundation believe that a woman facing an unintended pregnancy has a right to accurate, unbiased, and comprehensive information about the full range of her reproductive health options. When facing the prospect of pregnancy, a woman deserves to receive information that is based on medical fact, not anti-choice ideology masking as options counseling. Moreover, because continuing a pregnancy has significant impact on a woman’s health and life, she should not be delayed or deterred from obtaining true options counseling and appropriate medical care. Unfortunately, our research shows the opposite to be true at crisis pregnancy centers (CPCs) in the Commonwealth. By delaying women’s decisions, misinforming them about the risks, and shaming women’s choices, the vast majority of these facilities in Massachusetts deny women access to the timely, appropriate counseling and medical services they need and deserve, including both abortion and pre-natal care. We encourage policymakers, public health officials, social service agencies, health care providers, community organizations, and concerned citizens to use this report to familiarize themselves and their colleagues with CPCs’ deceptive practices. We recognize that there may be many opportunities to work together to counter the harmful effect CPCs may have on the health and well-being of women in the Commonwealth. Chief among them is to do more to educate the public about their reproductive health, pregnancy options, and the resources that can aid them in preventing or terminating a pregnancy, carrying a pregnancy to term, or parenting a healthy child. W h e n f a c i ng the prospect of p re g n a n c y, a woman deser ves to re c e i ve i n fo r m ation that is based on m e d i c a l f a c t , n ot anti-choice ideolog y m a s k i n g a s options counseling.. “Just Because You’re Pregnant...” 21 APPENDIX Appendix I: Methodology The list of organizations identified on the Massachusetts Choose Life website and several web-based searches for pregnancy-related organizations served as the basis to determine the number and location of CPCs currently operating in Massachusetts. For the purposes of this research, a facility was deemed to be a CPC if it was a center or clinic which (1) purports to provide education and counseling services and pregnancy-related services such as pregnancy tests and ultrasounds, (2) provides misleading, incomplete, or proven-to-be-false information related to sexuality, abortion, abortion-related risks, and birth control, and (3) will not perform abortions or provide abortion referrals. Those facilities still in operation were then mapped against the locations of clinics and private practices specializing in reproductive health care – including abortion care – who publicly advertise their services. Online Yellow Pages and Super Pages were surveyed twice -- in the summer of 2010 and again in winter of 2010/11 – using six key search terms women seeking pregnancy or family planning options would likely use to find providers. Those terms were: “abortion services,” “abortion clinics,” “abortion providers,” “family planning centers,” “birth control information & services,” and “birth control.” In the summer of 2010, a trained volunteer catalogued and conducted a content analysis of all of the information provided on the websites of 27 of the 30 active CPCs in the Commonwealth (13 websites in total); we revisited the sites again in the fall of 2010 and winter of 2010/11. A volunteer with specialized finance background reviewed federal tax returns (IRS-990s), where publicly available through Guidestar.org, and used other online sources – including CPCs own websites – to determine the revenues and sources of funding in the winter of 2010/11. Finally, in the spring of 2011, trained volunteers made direct contact with 24 of the 30 active CPCs through 20 in-person visits (typically in pairs) and 15 in-depth phone conversations, cataloguing what they were told, how they were treated, and which resources they were provided. 22 NARAL Pro-Choice Massachusetts Appendix II: CPCs Investigated in Massachusetts Name Address Phone Website A Woman’s Concern 103 Broadway Revere, MA 02151 1855 Dorchester Ave. Dorchester, MA 02124 (866) 435-7292 (781) 284-8747 (866) 435-7292 (617) 825-0838 www.awomansconcern.org 484 Highland Ave. Fall River, MA 02720 48 Camp St. #6 Hyannis, MA 02601 466 Main St. PO Box 344 Greenfield, MA 01302 (866) 435-7292 (508) 646-2665 www.awomansconcern.org (866) 435-7292 (508) 790-3076 www.awomansconcern.org (413) 774-6010 www.alternativespregnancycenter. org A Woman’s Concern A Woman’s Concern A Woman’s Concern Alternatives Pregnancy Center www.awomansconcern.org Birthright International 79A Main St. (508) 620-0657 Framingham, MA 01702 www.birthright.org Birthright International 233 N. Pleasant St. Amherst, MA 01002 (413) 549-1906 www.birthright.org Birthright International 320 Gifford St. Falmouth, MA 02540 (508) 457-0680 www.birthright.org Birthright International 277 Main St. (508) 481-2055 Marlborough, MA 01752 www.birthright.org Birthright International 78 Broadway Taunton, MA 02780 (508) 822-2921 www.birthright.org Birthright International 398 County St. (508) 996-6744 New Bedford, MA 02740 www.birthright.org Care Net 326 Nichols Rd. #13 Fitchburg, MA 01420 (978) 342-4244 www.carenetfitchburg.net 1-800-395-HELP Compassion Pregnancy Center 70 Highland St. Worcester, MA 01609 (508) 438-0144 Daybreak 101 Tremont St. #514 Boston, MA 02108 2 High St. Clinton, MA 01510 (617) 742-9170 www.daybreakinc.org 1-888-9-OPTION (978) 365-9817 www.firstconcern.net (888) 657-1773 First Concern www.compassionpregnancycenter. org “Just Because You’re Pregnant...” 23 Friends of the Unborn Heartbeat Pregnancy Help Center PO Box 692246 (617) 786-7903 Quincy, MA 02269 (888) 761-8538 113 Winn St. (781) 229-7887 Burlington, MA 01803 Liferight of North Adams 57 Main St, # 208 (413) 664-4106 North Adams, MA 01247 www.pccnortheast.org Pregnancy Care Center 496 Main St. Haverhill, MA 01830 (978) 373-5700 1-866-254-4440 www.pccnortheast.org Pregnancy Care Center 140 Main St. Amesbury, MA 01913 (978) 388-7960 1-866-254-4440 www.pccnortheast.org Pregnancy Care Center 11 Hale St. (978) 914-0036 Newburyport, MA 01950 www.pccnortheast.org Pregnancy Care Center 124 Ames St. Lawrence, MA 01841 (978) 686-5124 www.pccnortheast.org Pregnancy Care Center 704 Sumner Ave. Springfield, MA 01108 (413) 732-2006 Pregnancy Help Brighton Marine Health Center (617) 782-5151; 77 Warren St. #251 (888) 771-3914 Brighton, MA 02135 www.pregnancyhelpboston.org Pregnancy Help 5 Wilson St. Natick, MA 01760 2 Park Ave. Stoughton, MA 02072 www.pregnancyhelpboston.org Pregnancy Services (508) 651-0753 www.friendsoftheunborn.org www.pregnancyma.com (781) 344-5900 Pregnancy Support Services 74 North St. Pittsfield, MA 01201 (413) 443-7351 Problem Pregnancy of North Quabbin 105 Main St. Athol, MA 01331 (978) 249-4300 www.problempregnancy.org Problem Pregnancy of Worcester, Inc. 495 Pleasant St. Worcester, MA 01609 (888) 310-7217 www.problempregnancy.org Your Life Matters Pregnancy Health Center 176 Main St. Southbridge, MA 01550 (508) 764-6404; (888) 764-6404 www.ylmphc.org 24 NARAL Pro-Choice Massachusetts Endnotes 1 For the purposes of this report, the term “clinic” encompasses licensed clinics and private physician practices specializing in reproductive health services, including abortion care, in Massachusetts. According to separate research conducted by NARAL Pro-Choice Massachusetts and the Pro-Choice Massachusetts Foundation, in the summer of 2011, there were 11 such facilities operating in the Commonwealth, only 9 of whom make it known to the general public that the scope of their services includes abortion care. For more information, see NARAL Pro-Choice Massachusetts, Access to Abortion Care in Massachusetts, October, 2011, available at: http://www.prochoicemass.org/media/2011abortion.shtml 2 Lin V and Dailard C, “Crisis Pregnancy Centers Seek To Increase Political Clout, Secure Government Subsidy,” Guttmacher Report on Public Policy, 2 (2002). 3 In 2006, the United States House of Representatives Committee on Government Reform conducted a study that investigated CPCs that received any form of federal funding under the Bush Administration and reached three major conclusions: 1) the Centers provided misinformation about the link between abortion and breast cancer 2) the Centers provided misinformation about future fertility and abortion and 3) the Centers provided misinformation on the mental health effects of abortion. Over the telephone, women were informed that an abortion “could destroy [their] chances of ever having children again” and that they may experience a “downward spiral where they lose friends and family members.” The websites of these CPCs espoused statistics for similar inaccurate claims – stating that most women experienced a 50% or greater risk of breast cancer following abortion or that 2-5% of women are left sterile after the procedure. The report notes that President Bush supported this spread of false information when his Administration edited the National Cancer Institute website to suggest that the link between breast cancer and abortion was an unresolved scientific question. (Rep. Henry A. Waxman, False and Misleading Health Information Provided by Federally Funded Pregnancy Resource Centers, United States House of Representatives Committee on Government Reform -- Minority Staff Special Investigations Division (July, 2006), available at: http://www.chsourcebook.com/articles/waxman2.pdf.) 4 See note 1 (above). NARAL Pro-Choice Massachusetts, Access to Abortion Care in Massachusetts, October, 2011, available at: http://www.prochoicemass.org/media/2011abortion.shtml 5 Friends of Care Net Fitchburg, History of Care Net Fitchburg, http://www.friendsofcarenetfitchburg.org/history.html (last accessed August 2011.) 6 A Woman’s Concern, Our History, http://www.friendsofawomansconcern.org/aboutus/ourhistory/tabid/659/Default. aspx (last accessed August 2011.) 7 Id. 8 Sophie Lyons, Crisis Pregnancy Centers in Massachusetts: Ethics of False and Misleading Information, NARAL Pro-Choice Massachusetts (2010). 9 Planned Parenthood Federation of America v. Problem Pregnancy of Worcester, Inc., 398 Mass. 480, (1986). 10 The American College of Obstetricians and Gynecologists, Healthy Women 2008, Special Edition April 27-May 3 is Cover the Uninsured Week, April 2008, available at http://www.acog.org/acog_districts/dist_notice.cfm?recno=1&bulletin=2612. 11 Dudley S and Kruse B, “Facts: Safety of Abortion,” National Abortion Federation, December 2006, available at http:// www.prochoice.org/about_abortion/facts/safety_of_abortion.html. 12 Bitler M and Zavodny M, The effect of abortion restrictions on the timing of abortions, Journal of Health Economics, 2001, 20(6):1011–1032. 13 BBC News, Mothers-to-be ‘can drink alcohol’, Oct 11, 2007, http://news.bbc.co.uk/2/hi/health/7039249.stm 14 Mayo Clinic staff, “Home Pregnancy Tests: Can you trust the results?” October 30, 2010, MayoClinic.com available at http://www.mayoclinic.com/health/home-pregnancy-tests/PR00100. 15 Wang , et.al., Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study, 79 Fertility and Sterility 577–84 (2003). 16 This last statement is a prime example of the ways in which CPCs will take accepted medical facts and mischaracterize and distort them. In this case, 50% is not a miscarriage rate, but rather the proportion of fertilized eggs lost before or during implantation (typically within two weeks of fertilization, so early in the pregnancy that the woman may not even know fertilization occurred). Center for Reproductive Health , “Contraception: How it Works,” University of California/San Francisco Medical Center, available at http://coe.ucsf.edu/ivf/conception.html#imp (last accessed October 2011). 17 The American College of Obstetricians and Gynecologists, Healthy Women 2008, Special Edition April 27-May 3 is Cover the Uninsured Week, April 2008, available at http://www.acog.org/acog_districts/dist_notice.cfm?recno=1&bulletin=2612 “Just Because You’re Pregnant...” 25 18 In 2008, the APA Task Force on Mental Health and Abortion evaluated all of the empirical, peer-reviewed studies on this subject since 1989. They concluded that while “it is clear that some women do experience sadness, grief, and feelings of loss following termination of a pregnancy, and some experience clinically significant disorders, including depression and anxiety . . . the TFMHA reviewed no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.” The Task Force further noted that perceptions of stigma, secrecy, and lack of social support for the abortion; prior mental health problems and low self esteem; and the degree to which a woman was invested in her pregnancy are “predictive of more negative psychological responses following first-trimester abortion.” APA Task Force on Mental Health and Abortion, Report of the APA Task Force on Mental Health and Abortion, 2008, http://www.apa.org/pi/women/programs/abortion/index.aspx 19 Guttmacher Institute, Facts on Induced Abortion in the United States, January 2011, http://www.guttmacher.org/pubs/ fb_induced_abortion.html. 20 Id. 21 Henshaw SK, “Unintended pregnancy and abortion: a public health perspective”, in: Paul M et al., eds., A Clinician’s Guide to Medical and Surgical Abortion, New York: Churchill Livingstone, 1999, pp. 11–22. 22 The American College of Obstetricians and Gynecologists, “Postpartum Depression”, January 2009, http://www.acog. org/publications/patient_education/bp091.cfm 23 Norris, et. al., “Abortion Stigma: A Reconceptualization of Constituents, Causes, and Consequences”, Women’s Health Issues. 2011 May-Jun;21(3 Suppl):S49-54, available at: http://www.guttmacher.org/pubs/journals/Abortion-Stigma.pdf 24 Id. 25 Id. 26 Option Line, About Option Line, http://www.optionline.org/about/(last accessed August 2011.) 27 Id. 28 Entsminger K, Building a Successful Internet Advertising Campaign for Your Pregnancy Center 2006, available at: http://www. care-net.org/publications/cot/internetadvertising.pdf. 29 Fox S and Fallows D, Internet Health Resources, Pew Internet and American Life Project, July 16, 2003, http://www. pewinternet.org/~/media//Files/Reports/2003/PIP_Health_Report_July_2003.pdf.pdf. 30 The Truth About Crisis Pregnancy Centers, NARAL Pro-Choice America Foundation, January 2010, available at http:// www.prochoiceamerica.org/media/fact-sheets/abortion-cpcs.pdf 31 AT&T Advertising Solutions, Internet Solutions/Internet Listings, http://adsolutions.att.com/advertising/internetlistings (last accessed August 2011.) 32 Supermedia, Business Listings, Compare Prices, http://www.supermedia.com/business-listings/compare-businesslisting-options (last accessed August 2011.) 33 Lin V and Dailard C, “Crisis Pregnancy Centers Seek To Increase Political Clout, Secure Government Subsidy,” Guttmacher Report on Public Policy, 2 (2002). 34 A Woman’s Concern, Our History, http://www.friendsofawomansconcern.org/aboutus/ourhistory/tabid/659/Default. aspx (last accessed August 2011.) 35 Guttmacher Institute, “‘Choose Life’ License Plates,” State Policies in Brief, August 1, 2011, http://www.guttmacher.org/ statecenter/spibs/spib_CLLP.pdf 36 Massachusetts Choose Life, Homepage, http://www.machoose-life.org/ (last accessed August 2011.) 37 Massachusetts Choose Life, Frequently Asked Questions, http://www.machoose-life.org/cl_faqs.htm (last accessed August 2011.) 38 Massachusetts Choose Life, Pregnancy Care Organizations, http://www.machoose-life.org/cl_pregnancycare.htm (last accessed August 2011.) 39 Choose Life It Matters!, Newsletter, available at: http://www.choose-life.org/newsletter.php (last accessed August 2011.) 40 A Woman’s Concern Inc., Form 990, Internal Revenue Service, available at http://www2.guidestar.org/organizations/223196616/a-womans-concern.aspx 41 Pregnancy Care Center of the Merrimack Valley Inc, Form 990, Internal Revenue Service, available at http://www2. guidestar.org/organizations/22-2630861/pregnancy-care-center-merrimack-valley.aspx 42 Friends of the Unborn, Inc., Form 990, Internal Revenue Services, available at http://www2.guidestar.org/ organizations/04-2932613/friends-unborn-incorporated.aspx 26 NARAL Pro-Choice Massachusetts 43 Care Net Pregnancy Resource Center Of North Central Massachusetts Inc., Form 990, Internal Revenue Service, available at http://www2.guidestar.org/organizations/04-2597799/care-net-pregnancy-resource-center-north-centralmassachusetts.aspx. Daybreak Inc., Form 990, Internal Revenue Service, available at http://www2.guidestar.org/ organizations/22-2474290/daybreak.asp. First Concern Pregnancy Resource Center Inc., Form 990, Internal Revenue Service, available at http://www2.guidestar.org/organizations/04-3091048/first-concern-pregnancy-resource-center.aspx. Compassion Pregnancy Center of Worcester Inc., Form 990, Internal Revenue Service, available at http://www2.guidestar. org/organizations/04-3532986/compassion-pregnancy-center-worcester.aspx. 44 Alternatives A Crisis Pregnancy Center, Form 990, Internal Revenue Services, available at http://www2.guidestar.org/ organizations/01-2930736/alternatives-a-crisis-pregnancy-center.aspx, Heartbeat Crisis Pregnancy Center, Form 990, Internal Revenue Services, available at http://www2.guidestar.org/organizations/04-3220314/heartbeat-crisis-pregnancycenter.aspx , and Liferight of North Adams Inc., Form 990, Internal Revenue Services, available at http://www2.guidestar. org/organizations/04-2622657/liferight-north-adams.aspx 45 Gerard Health Foundation LLC, Form 990, Internal Revenue Service, available at http://www2.guidestar.org/ organizations/04-3580039/gerard-health-foundation-llc.aspx 46 See, e.g., Michael Crowley, “The Right’s New Kingmaker,” Nov. 12, 2004, Slate.com http://www.slate.com/id/2109621/ and Focus on the Family, “About Us: Our Founder,” http://www.focusonthefamily.com/about_us/james-dobson.aspx (last accessed August 2011.) 47 Life Prizes, “2008 Life Prizes Awards Ceremony Speeches,” http://www.lifeprizes.org/life-prizes-ceremony.asp (“Life Prizes is an initiative of the Gerard Health Foundation,” http://www.lifeprizes.org/about-life-prizes.asp). (Last accessed August 2011.) 48 Anemona Hartocollis, “Latest Hidden Video by Abortion Foes Shows Bronx Clinic of Planned Parenthood,” New York Times, Feb. 8, 2011. 49 Irene Sege, “Conservative causes get Bay State patron,” Boston Globe, Oct. 31, 2008. 50 Healthy Futures, “Media Advisory: $1.5M Grant Award by the U.S. Department of Health and Human Services to Healthy Futures to Expand Sexual Health Education,” January 28, 2004, available at: http://www.healthy-futures. org/docs/$1.5M%20Grant%20Award%20by%20the%20U.S.%20Department%20of%20Health%20and%20Human%20 Services%20to%20Healthy%20Futures%20to%20Expand%20Sexual%20Health%20Education.pdf (hereinafter “Healthy Futures Media Advisory”). 51 Healthy Futures, “News Release: Healthy Futures Program Teaches Abstinence in Boston-Area Schools,” Jan. 28, 2004, available at http://www.healthy-futures.org/docs/Healthy%20Futures%20Program%20Teaches%20Abstinence%20in%20 Boston-Area%20Schools.pdf 52 See Healthy Futures Media Advisory, Jan. 28, 2004. 53 Schaffer A, “The Family Un-Planner,” Slate.com, Nov. 21, 2006, http://www.slate.com/id/2154249/. 54 Fletcher M and Partlow J, “Arrest of Ex-Bush Aide Shocks Associates,” Washington Post, March 12, 2006, http://www. washingtonpost.com/wp-dyn/content/article/2006/03/11/AR2006031101358.html. 55 Hogue C et al., The Effects of Induced Abortion on Subsequent Reproduction, 4 Epidemiological Reviews 66, 67, 88-9 (1982). 56 National Cancer Institute, Abortion, Miscarriage, and Breast Cancer Risk, Apr 2003 at http://www.cancer.gov/ cancertopics/factsheet/Risk/abortion-miscarriage 57 Wang , et.al., Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study, 79 Fertility and Sterility 577–84 (2003). 58 The American Psychological Association, Task Force on Mental Health and Abortion, Report of the APA Task Force on Mental Health and Abortion, 2008, http://www.apa.org/pi/women/programs/abortion/index.aspx 59 Guttmacher Institute, Facts on Induced Abortion in the United States, January 2011, http://www.guttmacher.org/pubs/ fb_induced_abortion.html. 60 National Abortion Federation, Abortion Fact: Safety of Abortion, http://www.prochoice.org/about_abortion/facts/ safety_of_abortion.html (last accessed August 2011.) 61 Id. 62 Id. “Just Because You’re Pregnant...” 27 Acknowledgements “Just Because You’re Pregnant...”: Lies, Half Truths, and Manipulation at Crisis Preganncy Centers in Massachusetts was authored by staff at NARAL Pro-Choice Massachusetts and the Pro-Choice Massachusetts Foundation with help from our interns Sophie Lyons and Jennifer Robertson. The report was designed by Brita Lund. We would like to thank NARAL Pro-Choice Virginia for their help in setting up our study, and NARAL Pro-Choice America for supporting our work. Special thanks to the GAIN Access Committee, Emily Polak, and Charles Glovsky for their invaluable contributions. This report would not have been possible without the help of all of our amazing volunteers who conducted and contributed to the undercover investigation of CPCs. We are incredibly grateful for all of your work, enthusiasm, and dedication to women’s access to reproductive health. Contact Us For more information about the report please contact: Rose MacKenzie Director of Policy & Community Engagement NARAL Pro-Choice Massachusetts 15 Court Square, Suite 900 Boston, MA 02108-2524 Phone: 617-556-8800 x18 Fax: 617-338-2532 Email: [email protected] For more information about NARAL Pro-Choice Massachusetts please visit our website at www.prochoicemass.org. NARAL Pro-Choice Massachusetts Mission To develop and sustain a grassroots constituency that uses the political process to guarantee every woman the right to make personal decisions regarding the full range of reproductive choices, including preventing unintended pregnancy, bearing healthy children, and choosing safe, legal, and accessible abortion.